rapid antigen testing

NSW’s “Let it rip” strategy will condemn many people to death – especially among the vulnerable – and has placed an enormous strain on an already exhausted health system, says the independent expert group OzSAGE.

OzSAGE is a multi-disciplinary group of infectious disease and public health experts, engineers, architects, economists and social scientists. Here is a summary of their critique of Australia’s COVID response:

Removal of restrictions in NSW has cost dearly

OzSAGE remains deeply concerned about COVID-19 in NSW, which is already affecting all of Australia. The decision to remove restrictions just as Omicron surged has cost us dearly.

All models to date assumed good testing capacity and adequate contact tracing. Without these, case numbers will blow out further. At this point in time there is no publicly available modelling to support a national plan that is based on public health principles, which will protect our hospital systems from collapse.

Testing disaster

Testing in NSW is failing, with many people turned away after waiting in queues for hours and many testing centres shut. Regional and remote areas have even less capacity.

There are unacceptable delays in testing results being sent. Rather than investing in expanded testing capacity, the response of government is to restrict access to testing by changing the definition of close contacts and requiring PCR tests only for family contacts, health workers and a few other groups. This will reduce our surveillance capacity for new variants and give falsely low case numbers.

“Disturbed” by false reassurances in messaging

There is a severe shortage of RATs nationwide. This means that even people who can afford them and could thus relieve the pressure on the laboratories, simply cannot buy a RAT kit.

RATs are useful for screening of asymptomatic cases, but cannot serve as the backbone of the public health test-and-control system.

We are disturbed by the repeated messaging that only symptomatic people should get (PCR) tested, when 40 to 45 per cent of transmissions are asymptomatic, and even in people who develop symptoms, the peak of infectiousness is in the two days before symptoms begin.

The false reassurance of the messaging will result in more cases of viral transmission that otherwise would have been prevented.

Changes to a definition of ‘close contact’ are not based on sound public health principles

Close contact definitions need to be based on risk. Risk is related to the amount of exposure to virus-laden aerosols. Risk is not limited to arbitrary four-hour time frames within households.

Settings like nightclubs and restaurants have been sites of superspreading events, and if people exposed in these settings cannot get a PCR test, spread will accelerate.

Introducing a narrower close contact definition when the test positivity rate is currently 13 per cent in NSW, is unlikely to improve the burden on the health care system and will instead fuel the outbreak.

Limiting the amount of testing reduces pressure on the test-and-trace system in the short term, but will worsen the health system burden because it will result in chains of transmission that could otherwise have been stopped.

Over the long term, these quick-fix adjustments for resource reasons and better optics will be detrimental.

Case numbers matter – it’s simple maths

The rhetoric that case matters “do not matter” is incorrect – particularly in the face of the Omicron variant.

Even if hospitalisation rates are lower with Omicron compared to Delta, a halving of hospitalisation rates with a 10-fold or 100-fold increase in cases will still translate to a high burden on the health system. This is likely to overwhelm the health system, with regional services at particular risk.

The trajectory of observed data suggest that hospitalisation and ICU occupancy are on a steeply rising trend and anticipated to exceed earlier peaks quite soon. In other words, optimistic assumptions about the impact of the Omicron variant on hospital admissions are unrealistic.

Omicron cannot be described as mild

Preliminary data suggest that compared to the Delta variant, Omicron infections are 40 to 45 per cent less likely to result in hospitalisation.

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

Lack of access to health care and deaths at home

Our health system, stretched before COVID-19, has had its capacity eroded by staff resignations and a blowout in waiting lists.

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

‘Let it rip’ kills

The “let it rip” strategy and defeatist narrative that “we are all going to get it” ignores the stark lived reality of the vulnerable of our society. Despite three doses of vaccine, some patients with cancer and other immunosuppressed people have substantially reduced protection against Omicron.

Similarly, people with co-existing health conditions (estimated to be 50 per cent of the adult population) are at increased risk of illness. The impacts of a fragmented testing system and disrupted health system will be felt most by our elderly, lower socio-economic groups, First Nations people, people with disability and regional populations.