Unfortunately the business of opening international travel has been marred by the politics of the definition of ‘hotspots’.
PM Scott Morrison has announced that an agreement has been reached at National Cabinet and with New Zealand that New Zealanders can enter New South Wales and the Northern Territory without quarantine from 16 October, provided they have not come from an area designated as a Covid hotspot by the Australian Government. This announcement was made via media release from the PM and five other Commonwealth ministers.
It should be noted the New Zealand is not reciprocating. Said NZ persons upon returning to NZ would have to quarantine.
It’s more than curious that Tasmania on the same day announced that it plans to open up the low risk states which:
- include South Australia, Western Australia, the Northern Territory, Queensland, the ACT and possibly NSW.
I want to be clear, that if at any time the situation changes in these states and the advice is that the risk is too high – then I won’t hesitate to change this decision.
We will review the situation in New South Wales over the next week and border restrictions will remain in place for the foreseeable future with Victoria until we are satisfied that the risk has reduced to a lower level.
Also noteworthy is this from the PM’s statement:
There are currently no COVID-19 hotspots in New Zealand. The last locally acquired case with an unidentified epidemiological source occurred on 21 August 2020. We are working closely with New Zealand authorities to ensure we are notified promptly of any outbreaks there.
So the Kiwis have achieved what Gladys Berejiklian has long said was impossible. Curiously, our aim, according to Morrison (see statement of 4 September 2020), confirmed in the statement of 18 September 2020, is no community transmission.
Now international participation by states is being made conditional on acceptance of the Commonwealth definition of ‘hotspots’, when, as I will show below, the agreed arrangement between our nation’s health officers was that identification of hotspots would be a separate matter from decisions on state border control, which were considered a state prerogative.
One of the problems here is that National Cabinet is just a forum, but is treated by the Commonwealth as a cabinet subcommittee, hence there are no publicly accessible minutes. If decisions are made that affect state law, the the states would have to change their laws under their normal parliamentary processes.
At the beginning of September there was a lot of grief and public spats about the positions being taken by Queensland and Western Australia. See:
- Vanessa Brown – Annastacia Palaszczuk defends Queensland’s hard border and slams her ‘relentless’ critics
- Vanessa Brown – Queensland border spat gets ugly
- Katharine Murphy – Scott Morrison seeks state backing on ‘hotspot’ definition in effort to have Covid border closures scrapped
- Phillip Coorey – Hotspot plans in chaos as states feud
I don’t want to rehash this part of the story, except to say that the Chief Medical Officer in Queensland was making the calls, not the Premier. There is an assumption that Annastacia Palaszczuk was acting in her own political interests. Looking at what happened one would be forgiven for coming to the conclusion that her troops were conspiring to sink her politically. In practice Queensland handled the border issue badly in terms of medical and work access and brilliantly in terms of facilitating sporting teams.
Dr Jeanette Young, the Chief Health Officer, was always clear. She wanted to see zero community transmission for 28 days in New South Wales. I take this to mean cases with an unidentified epidemiological source, or mystery cases.
After the National Cabinet meeting of 4 September Morrison said:
- The Commonwealth, New South Wales, Victoria, Queensland, South Australia, Tasmania, the Northern Territory and the Australian Capital Territory agreed in-principle to develop a new plan for Australia to reopen by Christmas, including the use of the hotspot concept for travel between jurisdictions.
The hotspot concept was:
- The Commonwealth trigger for consideration of a COVID-19 hotspot in a metropolitan area is the rolling 3 day average (average over 3 days) is 10 locally acquired cases per day. This equates to over 30 cases in 3 consecutive days.
- The Commonwealth trigger for consideration of a COVID-19 hotspot in a rural or regional area is the rolling 3 day average (average over 3 days) is 3 locally acquired cases per day. This equates to 9 cases over 3 consecutive days.
Internationally I understand a hotspot to refer usually to a local government area. If so that is quite a lot of virus if no community transmission is your aim. Moreover, I’ve never seen a three-day average being used anywhere at all when discussing virus suppression.
Samantha Maiden’s article (I rate her as a journalist) Coronavirus Australia: Magic ‘hotspot’ numbers to reopen borders revealed provides more information, including from the discussion document:
“In metropolitan areas, triggers are not specifically limited geographically as 10 cases per day across six suburbs may be more indicative of community transmission than 10 cases per day within one local government area (LGA) because of a specific cluster,” the document states.
Not sure what that means, but Morrison specifically said this:
- The Commonwealth will work with seven states and territories to refine the definition of COVID-19 hotspots. Officials have been asked to continue the development of the final definition and protocols for its application. (Emphasis added)
At that stage Morrison seemed to be relaxed about WA going its own way.
From media reports I also thought Queensland remained recalcitrant, so in researching this post was astonished to find an article of 16 September by Lydia Lynch in the brisbane times – Australia’s chief health officers back Queensland border trigger:
- Australia’s state and territory chief health officers have backed Queensland’s strict trigger for reversing hotspot declarations, which stop people from those areas travelling to the state without a special exemption.
In a letter sent to some state premiers and chief ministers, seen by Brisbane Times, the nation’s health panel has outlined its draft definition for a COVID-19 hotspot ahead of the national cabinet meeting on Friday.
The Australian Health Protection Principal Committee, a panel made up of all state and territory chief health officers and chaired by the national Chief Medical Officer, will have the power to declare hotspots.
The panel has set out three proposed definitions for COVID-free, controlled and community transmission zones.
A COVID-free zone would be an “area that has no locally acquired cases that pose a risk to the community in the previous 28 days”.
A controlled zone is an area with locally acquired cases in the previous 28 days, but where authorities have been able to trace how someone contracted the virus.
A community transmission zone, known as a hotspot, will be determined by the AHPPC rather than individual states.
“It is an area where the disease is spreading in the community and cases are acquired locally but the source of infection for a proportion of cases in the previous 28 days is not clear.”
The committee made it clear that its declaration of a hotspot would not “trigger or preclude specific actions for state and territories to take”.
Hallelujah, all the medicos agree!
On the same day, Thursday 16 September, an article appeared by Dana McCauley and Kate Aubusson in the SMH and presumably The Age – New hotspot definition aims to carve a path for border opening acknowledging input from Lydia Lynch, who is from the same stable of newspapers. One point of note:
- A COVID-community transmission zone – akin to a hotspot- would be defined as an area where the virus was spreading, cases were locally acquired from an unknown source and “a proportion” of locally acquired cases had no known source in the previous 28 days.
“The risk of exportation of disease by individuals in this zone who travel to other areas is high,” the draft statement said.
In other words, beyond clusters or hotspots it acknowledges possible transmission paths.
Then there was also this:
- Mr Morrison said on Thursday morning he was “not expecting a lot of progress” on the issue by Friday, saying the Commonwealth hot spot definition drawn up by the federal health department was “a sensible definition.”
The Commonwealth defines a hotspot as more than 30 locally acquired cases over three consecutive days in metropolitan areas, a figure that would mean Queensland’s border would open to NSW.
“If other states want to have more extreme definitions than that, that’s up to them,” the Prime Minister told Nine’s Today show.
Andrew Ellinghausen’s photo shows Morrison is not for turning:
He will have none of these silly ideas that let Queensland off the hook. This was about the time Morrison and his deputy Michael McCormack started bullying states about increasing the quota of Australians returning overseas.
So the National Cabinet meeting was held on Friday 17. In Morrison’s statement of 18 September 2020 there is simply no mention of hotspots. Almost certainly hotspots were discussed*. Morrison is the only one who talks about what happens in National Cabinet. He said nothing about it to us, that’s all we know.
In the statement about opening to New Zealand Morrison says the Australian Government defined hotspot has been “announced already” and:
- Any state or territory that imposes travel restrictions consistent with the Australian Government-defined hotspot, as advised by the acting Chief Medical Officer, Professor Paul Kelly, will be able to participate in the Safe Travel Zone.
Except that I can’t find the statement or an announcement based on a national decision, not in Morrison’s media statements, nor the Australian Health Protection Principal Committee (AHPPC) site. However, there is indeed a hotspot statement on the Commonwealth Health Department site – Listing areas of COVID-19 local transmission as hotspots for the purpose of provision of Commonwealth support from the Acting Chief Medical Officer, Professor Paul Kelly on 4 September. The purpose was:
- identifying an area requiring Commonwealth support such as such as deployment from the National Medical Stockpile, deployment of medical teams and additional support funding.
That was the one that was going to be used as a basis for discussion with the states. It acknowledges that the states would have a very different approach to hotspots, including “where there is an individual case where the extent of community transmission is not fully understood.”
When a single case is in a facility conducive to spread, for example, a hospital, aged care home, jail, abattoir or the Crossroads Hotel it is a different matter than an isolate in the suburbs. So numerical definitions are indicative, but no more than that.
Phillip Coorey did cite a federal source as saying the AHPPC had been politicised.
What we have is a hotspot statement that is fit for purpose for distributing Commonwealth assistance now being used as a condition relating to border control, where it is not fit for purpose.
My initial motivation in writing this post was to share a couple of articles, first one written by Professor Sharon Lewin of the Doherty Institute and Scientia Professor John Kaldor of the Kirby Institute – Hotspot plan can make us one country again published in the AFR on 20 September, also available here.
On the one hand they point to:
Harvard University produces a colour-coded risk-assessment map for domestic travellers, giving daily case counts of COVID-19 down to the level of counties (analogous to our local government areas): red for no-go zones/hotspots, progressing to “good to go”/green – which represents one case per 100,000 population. To put this in perspective, that “safe” green figure is double the rate of infection in Melbourne.
They contrast this with Hong Kong and Singapore who use a much more fine-grained approach that goes down to the level of a residential building as a hotspot. They say we need something in between.
Other points they make include that we can only tell that the virus is there if we test. This is no longer true, as we now seem to have extensive sewerage testing. A few days ago Queensland authorities nominated four places showing virus, all accounted for by people returning from overseas.
I’ve lost the link, but this image from the Doherty Institute shows Victorian virus clusters linked by genetics and contact tracing from January 25 to April 29:
In a big city, (Melbourne has over 4.9 million people) the virus spreads easily. When Queensland experienced an outbreak at the Brisbane Youth Detention Centre at Wacol, near Ipswich just west of Brisbane, the virus spread quickly to a training centre and to Ipswich Hospital. Then positive tests came from Paradise Waters on the Gold Coast, Toowoomba and Russell Island in Moreton Bay via workers who were travelling more than hour each way to work.
Restrictions included use of masks by aged care centre workers, and the denial of visitors. Because Toowoomba is a provincial centre, providing services to the west, authorities tried to ring-fence the virus by extending restrictions to the Western Downs shire, where there had been no cases. My sister is in an aged care facility in Miles, near the western edge of that area. Then I heard that one of the staff at the Miles facility comes 359km on a weekly basis from Jimboomba, south of Brisbane, and quite close to Lowood where those two young women brought the virus from Melbourne.
Virus suppression is better managed by people who understand local factors transmission paths rather than someone in Canberra declaring hotspots.
Finally, Nathan Grills and Antony Blakely address the issue of opening to the world in How to reopen Australia’s international borders in the AFR. They point out that there is a difference between an ‘elimination’ strategy and an ‘aggressive suppression’ strategy. The latter accepts more risk, and will loosen restrictions earlier, relying more on contact tracing and testing to mop up cases.
Australia is an outward facing country, where two large industries, tourism and tertiary education depend on the large-scale entry of people. They could have added fruit and vegetable harvesting.
It is simply not possible to quarantine 125,000 students.
Cutting to the chase, an aggressive suppression strategy is likely more tolerant of international arrivals without strict quarantine – especially if they are coming from countries with low community transmission, and the risk of virus importation can be mitigated.
They suggest our country needs a plan along the lines of the following, put forward for discussion purposes:
Countries could be divided into three zones depending on the average new infections over the preceding month:
Red zone (US, India, UK): Daily cases over 20 per million. Current quarantine or, subject to risk modelling, a pre-departure negative test, negative rapid test on arrival, health declaration, 10 days’ enforced quarantine with negative test on day 10, masks after quarantine, immediate testing if symptoms.
Orange zone (Japan, Singapore): Active cases between two and 20 per million. Inward travel allowed with a pre-departure negative test, negative test on arrival, health declaration, seven days’ home or self-isolation, negative test on day seven, masks, testing if symptoms.
Green zone (Taiwan, China, NZ): Daily cases less than two per million. Negative test on arrival, health declaration, advise caution, masks for 14 days, testing if symptoms.
This makes sense for states or territories aiming for daily cases of fewer than one per million (or about five to 10 cases a day in Victoria), as these measures ensure in-bound travellers have a similar infection risk when they mix in the community.
And any residual risk is dealt with through surveillance and contact tracing, as it is for Australian residents.
Emerging rapid tests, and the use of phone apps to verify self-isolation will help.
The question is whether our current leadership is interested in formulating a plan in discussion with, and acceptable to the state health authorities, who have to do the testing and contact tracing work.
The Labor government in Queensland has extended the official health emergency to the end of the year. It appears that the powers currently used by the Chief Health Officer depend on the declaration of a health emergency, which would be normally declared on advice from the Chief Health Officer. Queensland is about to enter caretaker mode ahead of an election on 31 October, which Labor has about a snowflakes chance in Hades of winning in my opinion. LNP leader Deb Frecklington will receive the keys of office with virus suppression in good shape.
The Queensland criterion of two incubation periods of no mystery community transmission seems to me an appropriate aim and key performance indicator if you are serious in your aim of aggressive suppression and no community transmission. The Lowood outbreak came after I think 18 community virus free days. We are approaching that again now, and life feels not so bad in the sunshine state. It really feels good to get the joint cleaned up.
If Queensland can do it (along with the smaller states) then Victoria and NSW should be able to manage it also. NSW are now in their 10th day without community transmission.
However, to reboot industries requiring overseas travel we will need more flexible arrangements involving more risk.
* Update 19 October 2020: Later, when NSW Health Minister, Brad Hazzard, took to public radio to accuse Queensland of basing policy on politics, Palaszczhuk responded that the proposal on hotspots and borders agreed to by the health officers in early September was not taken to National Cabinet at the meeting of 18 September. So the hotspot definition now claimed by Federal politicians as a national standard was, as far and I can see, never considered by National Cabinet.