The OzSage report: 10 key points from his critique of Australia’s Covid response | Health

OzSage, an independent Australian advisory group of experts in epidemiology, health and economics, has responded to rising Covid-19 cases in New South Wales and other states with a condemnatory critique of both the federal and NSW state governments’ strategies to protect the population from disease.

Below are the main points of their critique, edited for space. The full report can be found here.

1. Removal of restrictions in NSW

OzSage remains deeply concerned about Covid-19 in NSW, which is already affecting the whole of Australia. The decision to remove restrictions, just as Omicron rose sharply, has cost us dearly. We now have over 12,000 cases a day in NSW, a test system that can not keep up with demand, and a health system so strained that citizens are told they may not be able to access health care.

The workforce will continue to escalate and affect more and more people. It includes supply chains, logistics and all parts of civil society. All models to date required good test capacity and adequate contact tracking. Without these, case numbers will blow further out. At present, there is no publicly available modeling that supports a national plan based on public health principles that will protect our hospital systems from collapse.

2. Test disaster

Testing in NSW fails, with many people rejected after waiting in queues for hours, and many test centers closed. Regional and remote areas have even less capacity.

There are unacceptable delays in sending test results. Worse, there have been> 1,000 infected people who were mistakenly sent a negative test result, and this problem has not been resolved in a transparent manner.

Instead of investing in expanded testing capacity, the government’s response is to restrict access to testing by changing the definition of close contacts and allowing PCR testing to only family contacts, health care workers, and a few other groups. This will reduce our monitoring capacity for new variants and give false low case numbers.

Rapid lack of antigen testing

There is a serious shortage of RATs nationwide. This means that even people who can afford them and could ease the pressure on the labs simply cannot buy a RAT kit.

RATs are useful for screening for asymptomatic cases, but may not serve as the backbone of the public health testing and monitoring system. The results are not reported to the government, so people who test themselves and self-administer their Covid-19 will not be counted in official case figures.

There is unknown reliability of individual RAT marks with the Omicron variant. We are concerned about the repeated messages that only symptomatic individuals should receive [PCR] tested when 40-45% of transmissions are asymptomatic, and even in people who develop symptoms, the peak of infectivity is for two days before symptoms begin.

The false assurance about the message will result in more cases of viral transmission which would otherwise have been prevented.

4. Change to definition of ‘close contact’

The proposed change to the definition of close contact is to reduce testing and resources and is not based on sound public health principles.

Definitions of close contact must be based on risk. Risk is related to the amount of exposure to virus-filled aerosols. Risk is not limited to arbitrary four-hour time frames within 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.

The introduction of a narrower definition of close contact, when the test positivity rate is currently 13% in NSW, will hardly improve the burden on the health system and will instead boost the outbreak. Limiting the amount of testing reduces the pressure on the testing and tracking system in the short term, but will exacerbate the burden on the healthcare system because it will result in transmission chains that might otherwise have been stopped.

In the long run, these rapid adjustments for resource reasons and better optics will be detrimental.

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5. Case numbers matter

The rhetoric that case numbers “do not matter” is wrong – especially with the Omicron variant. The daily number of cases is now 10 times higher than during the delta wave and may be 100 times higher in January. Although the hospitalization rates are lower with Omicron compared to Delta, halving the hospitalization rates with a 10- or 100-fold increase in cases will still result in a high burden on the healthcare system. This is likely to overwhelm the health care system, with regional services at particular risk.

The trajectory of observed data suggests that hospitalization and ICU occupancy are on a steeply increasing trend and are expected to exceed previous peaks fairly quickly. In other words, optimistic assumptions about the effect of the Omicron variant on hospitalizations are unrealistic.

6. Omicron cannot be described as mild

Preliminary data suggest that compared to the Delta variant, Omicron infections are 40-45% less likely to result in hospitalization.

This means that the Omicron variant is at least as virulent as the original strain of Sars-CoV-2, with much greater vaccine release and cannot be described as mild.

In the US, we are seeing rapid increases in hospitalizations in children. As the virus moves into vulnerable populations such as elderly Australians, people with disabilities and Aboriginal and Torres Strait Islander people, we can see an increase in hospitalizations and deaths, as has been observed in countries like Denmark, which is a week or two ahead of Australia in the Omicron climb.

7. The effects of long Covid

We still know nothing about the occurrence of long Covid in connection with the Omicron variant. Lang Covid could impose huge financial and human costs on the Australian healthcare system for years. New research from the United States shows that the virus remains in the brain, heart, kidneys and many other organs long after the first disease, so disease prevention can now prevent long-term chronic diseases.

8. Lack of access to health care and deaths in the home

Our healthcare system, which stretched before Covid-19, has had its capacity eroded by staff layoffs and a blowout of waiting lists.

NSW recognizes the congestion of the hospital system and is already warning society against expecting access to hospital treatment. One week ago, NSW Health advised people under the age of 50 to take care of themselves at home without access to Hospital in The Home. This week, they have revised the age limit for everyone under 65. This is the ultimate ‘personal responsibility’ – where citizens are left without access to health care and to arrange their own Covid care, as well as make their own contact tracking while ill with Covid-19.

The consequence of this policy is that people may die at home when their lives could have been saved by proper timely health care. Without the safety net of regular contact from medical services, the unintended consequences are likely to be multiple ambulance calls and presentations in the emergency room.

We remain deeply concerned that people with preventable and treatable Covid-19 complications may die at home in NSW, even without access to Hospital in The Home support.

9. Lack of urgency on boosters

Two doses of vaccine provide minimal protection against Omicron and decrease rapidly against Delta. While the changes to the Atagi guidelines to advance the timing of boosters from “at least three months” after 31 January are welcome, the lack of urgent delivery of boosters will allow both Delta and Omicron to spread. In Victoria, state-administered vaccines have dropped dramatically despite the need for swift action. During the holiday season, when people travel and mix more, there is a need to increase the messages and the delivery of boosters to control the transmission of Covid-19.

10. ‘Let it rip’ strategy will be fatal to some

The ‘let it tear’ strategy and the defeatist narrative that ‘we all get it’ ignore the harsh living reality of the vulnerable in our society. Despite three doses of vaccine, some cancer patients and other immunosuppressed humans have significantly reduced protection against Omicron. Similarly, people with concomitant health conditions (estimated to be 50% of the adult population) have an increased risk of disease. The effects of a fragmented test system and a disrupted health system will be felt most by our older, lower socio-economic groups, First Nations people, people with disabilities and regional populations.

We must keep public health measures in place to protect these populations and ensure that no one is left behind. A fatalistic approach will be fatal to some people. OzSage is deeply concerned that children who are unvaccinated are completely unprotected. Already a 10-year-old has died in NSW. Children’s admissions are on the rise in both the UK and the US. The lack of making schools and childcare centers safe from aerosol transfer of Covid-19 needs to be addressed immediately, as we have already outlined.

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