National Cabinet COVID close contact definition changes questioned preference for RAT over PCR test pushed

COVID-19 test and insulation rules across much of Australia has undergone a major overhaul with the aim of reducing the pressure on overwhelming test clinics and companies struggling with staff forced to quarantine.

Business executives have welcomed the “gear shift” – which began at midnight in NSW, Victoria, Queensland, South Australia and ACT – but some medical experts have warned that they could further spur the spread of the violent Omicron variant with serious consequences for hospitals.

The headline changes from Thursday’s national cabinet meeting were a significant reduction in isolation periods, a new, standardized definition of “close contact” and a reduced reliance on PCR tests in favor of faster, cheaper fast antigen tests.

Prime Minister Scott Morrison during a press conference at Parliament House in Canberra on Thursday, December 30, 2021. (Alex Ellinghausen)

Close contacts are now “those who normally live with or have resided in the same household for more than four hours as a matter of their period of infection”.

Quarantine is also no longer required for random contacts, who now only need to be isolated if they develop symptoms and test positive for a rapid antigen test, which then needs to be confirmed by a PCR. Both changes are expected to reduce the number of people to be isolated.

Individuals who have tested positive for COVID-19 with a PCR test can now be released from isolation after seven days – but only if they return a negative PCR or rapid antigen test (RAT) on the sixth day of their quarantine.

If their day six test is positive, the person’s isolation period begins again, the Prime Minister’s office confirmed to 9News on Thursday night.

The extra quarantine period means they are not allowed to stop isolating until after at least 12 days, which can result in longer quarantine for some in NSW and Victoria, where the current duration is 10 days.

A COVID-19 Antigen Rapid Test Kit
Rapid tests will be available at state test clinics (Flavio Brancaleone)

Australians warned of expecting more cases

Prime Minister Scott Morrison said the decisions made by the National Cabinet were a “gear shift” and a “reset” after two years of the pandemic.

While admitting that the new rules would result in an increase in cases, Mr Morrison said the changes were “practical” compared to Omicron’s “game changer”.

“We see that the severity of this disease, the effect, especially on those who are hospitalized, in the most extreme disease situations, remains relatively constant, and it is an experience we also see in other countries,” he said.

“However, there is the higher number of cases that we see and we will continue to see. That is the nature of Omicron. It replicates itself very, very quickly.

“That means we have to change who is a close contact, how they are isolated and how their tests are managed.”

President of the Australian Medical Association  Omar Khorshid has called for a tighter closure in Sydney.
President of the Australian Medical Association Omar Khorshid warned that more cases would be missed. (Alex Ellinghausen)

Business and medical experts shared

Business groups welcomed the change, but medical experts have expressed concern that the changes will allow the Omicron variant to spread even faster and put more pressure on hospitals.

“We will miss so many more cases with this new, narrower definition of close contact,” said Dr. Korshid in a statement.

“Anyone who catches Omicron in a restaurant or pub, for example, and who is asymptomatic does not know that they are infected and can transmit the virus to more vulnerable people.

“The change will help maintain test capacity and should limit the number of health workers fired, but it will come at the expense of speeding up the outbreak.

“It appears that the National Cabinet is prepared to bet that a massive Omicron outbreak will not cause a large number of hospitalizations.”

University of New South Wales Professor of Epidemiology Mary-Louise McLaws reiterated concerns about missing cases.

The overhaul has been billed as an ointment for companies struggling with a large number of employees isolating themselves after coming into contact with a COVID-19 patient.

The Executive Director of the Business Council of Australia, Jess Wilson, welcomed the changes, saying the National Cabinet had “the right to focus on managing risk and letting people get on with their lives”.

“This will help limit the economic damage and uncertainty created by the omicron variant, giving companies and society clarity on who to isolate and under what circumstances people should be tested,” she said in a statement.

“This move will also help ensure that supply chains work, shelves are in stock, and companies can keep their doors open by taking a risk-based approach to managing close contacts.”

OzSAGE, an independent group of experts who have consistently argued for a more cautious approach to reopening, said the changes were based on reducing the demand for testing rather than “sound public health principles”.

“Risk is related to the amount of exposure to virus-filled aerosols. The risk is not limited to arbitrary four-hour time frames in households.

“Settings like nightclubs and restaurants have been places with super-scatter events, and if people exposed to these settings can not get a PCR test, the spread will accelerate.”

Experts with experience across public health, epidemiology, economics and other fields said it was wrong to argue that case numbers “do not matter”.

“Even if hospitalization rates are lower with Omicron compared to Delta, halving hospitalization rates with a 10- or 100-fold increase in cases will still translate into a high burden on the healthcare system,” OzSAGE said.

“This is likely to overwhelm the health care system, with regional services at particular risk.”

The National Cabinet has sought to reserve PCR testing to close symptomatic cases and individuals tested positive on a RAT. (Office of the Prime Minister)

Tap to use RATs over PCR tests

Currently, although the number of COVID-19 patients in hospitals has increased, it is much lower than for Delta peaks, and it has been the test clinics overwhelmed by demand.

The National Cabinet has tried to limit PCR testing to close symptomatic cases and individuals tested positive on a RAT.

“We need to protect our PCR test for where it’s best for the money,” said Chief Medical Officer Paul Kelly.

“Over the last week, we have seen an increase in this positivity rate, from about one percent, which is what we have seen throughout the pandemic, to almost five percent and even higher in some states.

“It demonstrates to me that there is, we do not reach the people we need to get to in terms of PCR testing, therefore the risk-based approach to who we want to get to PCR testing.”

Tasmania will introduce the new definition of close contact from 1 January, while the Northern Territory and Western Australia will confirm in a few days, “how they will move to these new definitions”.

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