It may not be possible to bring all Australians with COVID home from India. But we can do better than we are now


Catherine Bennett, Deakin UniversityA 47-year-old Sydney man has died in India after contracting COVID-19.

This news comes amid anger after the first repatriation flight from India following the controversial travel ban arrived in Darwin half empty on Saturday. Some 40 passengers tested positive for COVID-19 meaning neither they, nor their close contacts, were allowed to travel.

There’s no suggestion the Sydney man was due to board that flight, or any subsequent repatriation flight. But his case puts a spotlight on the current situation in India, where countless Australians are imploring the government to bring them home from a country in deep COVID crisis.

I would argue we can, and should, bring home at least some COVID-positive Australians — particularly those at highest risk of needing hospital-level care.

Weighing up the risks

Since Saturday’s repatriation flight, there’s also been controversy over the reliability of the tests which deemed so many passengers ineligible to travel. It’s critical the Australian government irons this out to ensure pre-flight testing is as accurate as possible.

Although, even if all passengers do test negative before flying, we still can’t guarantee a flight out of India, or any country, will have no positive cases on board. There’s a blind spot in testing between the time a person is exposed and when testing will reveal the infection. This gap could be up to ten days, but for most would be two to three days.

We know even with pre-flight screening requirements up to 1% of passengers are positive by the time they arrive in Australia.

At least if we know certain passengers are COVID positive at the time of boarding, we can manage the risk of transmission in transit.




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Flying COVID-positive Australians home safely

Despite our best efforts, we can’t rule out the risk of transmission if there are COVID-positive travellers on a flight.

However, transmission on planes appears to have been relatively infrequent. Recent reports of high positive rates on arrival and in quarantine may signal high rates of pre-flight exposure and transmission in transit — it’s hard to assess to what degree on-board transmission is a factor.

Although we know being in an enclosed space with someone with COVID-19 for a long time is high risk, the air in the cabin is filtered and turned over very regularly and therefore protects against viral spread. This could be why transmission on flights is not as common as we might expect.

That said, if we do knowingly put COVID-positive people on a flight with other passengers and crew, it would be important to take extra precautions.

A woman sleeping on a plane, wearing headphones and a face mask.
In the age of COVID, there’s always some level of risk associated with taking a flight.
Shutterstock

All crew on repatriation flights should be vaccinated regardless. To minimise the risk further, all crew dealing directly with COVID-positive passengers should be wearing full personal protective equipment (PPE).

COVID-positive passengers should be seated in a separate section of the plane to those who have tested COVID negative. An analysis of possible on-board transmission during a flight from London to Hanoi demonstrated most infection risk was restricted to the business class section, with attack rates dropping when people were two or more seats apart.

Commissioning large planes with more space to spread passengers out and group them according to risk would help in this regard.

It’s already a requirement that everyone on board must wear a mask unless eating or drinking. Of course, none of this eliminates the risk completely, just as negative tests might still allow someone incubating the virus on board.

It would also be important to consider end-to-end safety including using separate buses from the airport for COVID-positive patients.




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Another option would be dedicated flights for COVID-positive passengers.

Either way, it’s essential to have medical staff on board to provide care for travellers, if needed, and oversee infection control.

Accommodating COVID-positive returned travellers in quarantine

At present, Howard Springs, the Darwin quarantine facility housing returned Australians from India, is aiming to keep the number of COVID-positive residents at 50 or below.

Over time, COVID cases are increasingly likely to be asymptomatic or have mild disease if more people are vaccinated, and therefore shouldn’t need high levels of medical care. If most can stay in normal quarantine accommodation, maybe this could see the number of positive cases Howard Springs can accommodate increased.

If there’s a sound reason for this cap to remain as is, we should still use this capacity to enable evacuation of known cases at high risk of needing hospital care in India.

Sticking to a cap of 50 would likely mean we couldn’t accommodate every COVID-positive Australian who wanted to return home. But we could prioritise those at greatest risk of serious COVID disease, such as older people and those with underlying illnesses. Medical professionals would be on the ground to decide who qualifies as the highest priority.

We need to shift our mindset

Would we feel we had balanced the risks well if our thorough off-shore screening were to result in only a few positive cases in Howard Springs this month, while some people left in India were to die as a result of the virus and inadequate hospital care?

We pat ourselves on the back for what we achieved in containing the first wave by moving hard and fast, and rightly so. But as we’ve learnt more about the virus, we have become more determined to simply keep it out rather than use our knowledge and increased public health response capacity to control it.

We are now vulnerable and are resorting to inhumane steps to protect ourselves. Given the devastating situation in India, I believe it’s time to step back and weight up the true costs of the “zero tolerance” strategy underpinning our approach to repatriation.




Read more:
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The Conversation


Catherine Bennett, Chair in Epidemiology, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Should we vaccinate all returned travellers in hotel quarantine? It’s no magic fix but it could reduce risks


Catherine Bennett, Deakin UniversityThis week, a returned traveller who was quarantining in South Australia seems to have been infected with the virus during his stay, before testing positive once returning to Melbourne. It’s the latest in a long line of hotel quarantine leaks in Australia.

And in this week’s federal budget, the government has committed to welcoming back over 17,000 Australians stranded overseas over the next year, which will likely place more pressure on our hotel quarantine system.

In light of the seemingly continued spillover of hotel quarantine infections into the community, one researcher raised an intriguing possibility online: should we vaccinate all arrivals on day one of their stay in hotel quarantine?

There may be reasonably high vaccination rates among our arrivals already. But, if not, it’s definitely something worth thinking about.

In my view, overseas travellers should be considered equivalent to frontline workers, as they traverse the routes into Australia and cross through border quarantine. Therefore, they could be included in phase 1a of the vaccine rollout alongside these frontline workers.

It’s complex and there’s a lot to take into account, and vaccinating all arrivals won’t be the magic fix to our hotel quarantine troubles. But it might take the edge off some of the transmission risks.

You only have to prevent one case, which could have otherwise led to community spread and lockdown, for such a scheme to pay for itself many times over.

Here’s how it could work.

Vaccinating all arrivals could reduce infection risk

There are a number of potential ways this strategy could reduce infection risk, by:

  • preventing severe illness in people already infected
  • reducing the chance returnees will pass the virus on if they are infected, or become infected
  • protecting them from infection should they be exposed to the virus while in quarantine.

A Public Health England study found that a case who has had a single dose of either the Pfizer or AstraZeneca vaccine is up to 50% less likely to pass the virus on to their close household contacts.

However, when the researchers looked more closely at the timing, they found the full 40-50% reduction in transmission risk only occurred when the case received their first dose five or six weeks before becoming infected. In fact Pfizer didn’t reduce the transmission risk cases posed to others unless the first dose was given at least 14 days before the case became infected. In other words, giving returned travellers a dose of Pfizer while in quarantine might be too late to protect others.




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In saying that, the same study shows AstraZeneca’s vaccine does appear to at least partly reduce the transmission potential of cases even when the dose is given on the same day that person was infected.

In those who’ve received the AstraZeneca vaccine on day zero of their infection, the chance of them transmitting the virus to their close contacts over the ten days or so they’re infectious was on average roughly 20% lower than positive cases who weren’t vaccinated.

Getting the AstraZeneca vaccine when exposed to the virus, or soon after, might therefore marginally protect the wider population if, for example, a traveller contracts the virus late in quarantine and it isn’t picked up in day 12 testing and is released from quarantine.

Both Pfizer and AstraZeneca do provide partial protection from infection within 12 days of the first dose. While this is too late for those already infected, it might still provide some protection from infection for those exposed to the virus in the later stages of their stay in quarantine.

Both vaccines also appear to reduce the risk of subsequently dying from COVID-19 with an 80% reduction in deaths reported in the UK. Some in this study were infected within seven days of their first vaccine dose, but we do not know how this effectiveness against deaths changes with time since vaccination from this report.

Nevertheless, there might be some additional value in offering vaccines to both slightly reduce transmission rates and mitigate against serious illness and death in people who do become infected.

One challenge is that AstraZeneca has more to offer in reducing transmission risk in the first critical two weeks after receiving the first jab, but Australia currently doesn’t advise it for people under 50. Pfizer is in limited supply and our vaccine rollout phase 1a and 1b recipients haven’t all been fully vaccinated yet. The relative risks and benefits of reallocating some of our vaccine supply and delivery must be carefully thought through.

Many of those arriving in Australia will likely have opted for vaccination before travel, if available to them, even if just to increase their chances of testing negative and being allowed to board their flights home. Many are arriving from countries that began their vaccination programs months before Australia.

How many returnees are already vaccinated?

The number of positive cases in hotel quarantine has grown month on month, from 160 in February to 469 in April.

New South Wales provides the most detailed information on returned travellers. Its latest surveillance report on about 21,000 returnees shows 180, or 0.8%, tested positive to COVID-19. About 75% of these positive cases tested positive by day two, suggesting they were exposed before arriving in Australia or in transit.




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The report does include information on how many arrivals have been vaccinated since March 1. Of the 302 positive cases reported to the start of May, 20 had been vaccinated, with six fully vaccinated (two doses at least two weeks prior) and 14 partially vaccinated. Although, those considered “fully vaccinated” might not have been two weeks post-vaccine at the time they actually contracted the virus.

We haven’t been provided the overall vaccination rates for returnees across Australian hotel quarantine, so we can’t yet work out what percentage of arrivals are vaccinated. But if this is quite low, it strengthens the argument for offering vaccines to travellers on arrival.The Conversation

Catherine Bennett, Chair in Epidemiology, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

All Boeing 737 MAX flights grounded – and travellers could feel it in the hip pocket


Chrystal Zhang, Swinburne University of Technology

With investigations under way into two crashes of Boeing’s 737 MAX 8 aircraft, the US manufacturer has caved to pressure and grounded the entire global fleet totalling 371 planes. That includes both model 8 and 9 versions of the aircraft.

The company issued a statement saying this occurred:

… out of an abundance of caution and in order to reassure the flying public of the aircraft’s safety.




Read more:
Flights suspended and vital questions remain after second Boeing 737 MAX 8 crash within five months


But the impact on passengers and air travel could last for months as airlines try to reschedule flights and seek other aircraft to meet demands. While things are still evolving, what should you anticipate as a traveller?

Everybody down

US President Donald Trump’s order on Wednesday prompted the Federal Aviation Authority to ground all 737 MAX aircraft flying in and out of the US.

While it is legitimate for a government to issue regulatory orders to intervene in an airline’s operation due to safety or security concerns, it is unprecedented that such a large number of countries are taking action.

At least 45 International Civil Aviation Organisation member states had already either ordered their airlines to ground 737 MAX aircraft, or suspended entry of such planes into enter their airspaces.

Countries affected include China, Indonesia, Germany, UK, France, the Netherlands, Singapore, Australia, New Zealand, Canada and now the US.

While investigations into the two crashes could last for months or even years before any conclusion is drawn, the length of suspension is also unknown at this stage.

Yet holiday seasons such as Easter and school vacations are approaching, and many of us will no doubt be looking to fly away for a break.

Expect disruption

Airlines face disruption almost every day: airline operation is a complex system. Disruption can be caused by unforeseeable weather conditions, unexpected technical or mechanical issues of an aircraft, or associated safety hazards or security concerns.

Airlines therefore have strategies in place to manage or at least mitigate the effect of the disruption and reduce any potential delays. This could include but is not limited to:

  • changing or swapping an aircraft type

  • combining two or three flights into one operation

  • arranging alternative flights for travellers

  • moving travellers to other airlines if their tickets have been issued.

With only 371 Boeing 737 MAX family jets in operation, this is a small percentage of the total of more than 6,000 of the previous model and gives airlines the ability to use other jets in their fleet as a replacement.

A snapshot of Boeing 737 models in flight at 7:52am UTC Thursday (6:52pm AEDT) shows 1,500 aircraft. Not a 737 MAX in sight.
Courtesy of Flightradar24.com

But the current suspension will present significant challenges for some airlines.

Subject to their fleet size, the scope of their network, and other resources and capacity available, big airlines with multiple types of aircraft in their fleet are more capable of managing such disruption.

For example, Air China, China Eastern, China Southern, American Airlines and Southwest will have more resources to arrange for travellers to fly to their destinations.

In contrast, low-cost or regional carriers will be limited in their capacity to manage the disruption.

For instance, SilkAir and Fiji Airways have six and two Boeing 737 MAX aircraft in their respective fleets. Grounding the model means that both carriers will lose 16% of their total capacity.

Fares could go up

While airlines are making every effort to minimise the disruption, all these arrangements come at a cost.

Airlines might have difficulties in sourcing capacity to replace the aircraft, resulting in inevitable delays or cancellations. And delays and cancellations also result in additional cost to airlines operation.

Travellers could soon see an increase in airfares. The rising fuel cost and shortage of pilots have already put global airlines under pressure to manage operational costs.

Impact on Boeing

Boeing and Airbus are a duopoly, said to dominate 99% of the global large aircraft orders, which make up more than 90% of the total aircraft market.

Over the past few decades, Boeing has weathered problems before and maintained an exceptional reputation for its reliable and efficient aircraft design, manufacturing and service.

In 2018 , Boeing received US$60 billion for 806 aircraft deliveries, comparing to Airbus’s US$54 billion for 800 aircraft deliveries.

Of all the aircraft sales, the Boeing 737 MAX series – designed to replace the current 737 family – was becoming one of the most popular airliners, despite being only introduced to the market in May 2017.

But the two recent crashes have raised concerns about reliability of the 737 MAX 8 autopilot system, the Manoeuvring Characteristics Augmentation System.

Some pilots have complained about a lack of training for the MAX 8. Others have complained of problems.

The aircraft represents a significant change from its predecessor models, including new engines, new avionics and different aerodynamic characteristics.

Potential risks

The risk for Boeing now is the potential consequences flowing from any investigation into the aircraft crashes. These could include:

  • complete or partial cancellation of orders placed by global airlines yet to be delivered

  • litigation by the affected airlines and the victims of the ill-fated aircraft, seeking damages caused by any product defect (if proof of any defect could be established)

  • new opportunities for its rivals to promote their aircraft; this could allow, for example, China’s state-owned aircraft manufacturer, COMAC, to make new waves in the industry.

Regardless, Boeing could face enormous financial losses and devastating economic consequences.

Boeing’s shares dropped after the Ethiopian Airlines crash on Sunday, but have started to recover.

While Boeing surely carries enough insurance coverage for losses, it is inevitable the damage to its brand is more far-reaching in the medium to long term. This will affect the confidence of aircraft operators and the general public.

Even if any technical defects discovered are quick to fix, a damaged brand tends to require more time and much more significant efforts to recover.

Is it safe?

Of course there is a question everyone wants answered: is it safe to fly?

The answer is definitely. Statistically speaking, flying on a commercial passenger airliner is the safest mode of transportation.

A recent study of US census data puts the odds of dying as a plane passenger at 1 in 188,364. That compares with odds of 1 in 4,047 for a cyclist, 1 in 1,117 for drowning and 1 in 103 for a car crash.

Globally, 2017 was the safest year in aviation history with no passenger jet crashes recorded.

The most advanced technology used in aircraft design and manufacturing, and in air traffic control management, and the comprehensive, efficient pilot training and management are aimed at a safe flight.

So the decision of Boeing to suspend flights of its 737 MAX aircraft is welcomed, for now. But, pending the findings of the investigations, the questions as to how long the suspension will be in effect and how Boeing will address the issue remain unanswered.The Conversation

Chrystal Zhang, Senior Lecturer in Aviation, Swinburne University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.