NSW’s COVID reopening plan is risky, and signals an end to a national approach - Grattan Institute

NSW’s “Roadmap to Freedom” announced on September 9 is a risky gamble. If NSW pulls it off – and returns substantial freedoms to the vaccinated without a spike in hospitalisations that its system cannot handle – then Victoria and the ACT can follow suit. But if the gamble fails, the costs will be enormous: many more deaths, further widespread lockdowns, and increased risks to other states.

Attempting this high-wire act is consistent with NSW’s Covid approach to date, trying to pull off win-win situations where health impacts are managed, but restrictions remain minimally burdensome. NSW has successes pre-delta, but this approach has proven unsuccessful in managing the delta variant. NSW initially locked down too little and too late, discovering that against delta its contact tracing system and restrictions were insufficient to push cases into decline. And now it risks coming out too early.

NSW’s plan for reopening helps provide certainty to the community and business, and may encourage more people to get vaccinated, but it is risky, does not provide assurances that hospitals will cope, will be difficult to enforce, may unfairly discriminate against areas with low vaccine supply, and appears to signal an end to a national approach for reopening. NSW should change its plan and aim for a higher rate of vaccination before it takes its leap to “freedom”.

NSW’s plan is risky

NSW’s plan to substantially ease restrictions for fully vaccinated people once 70 per cent of adults are vaccinated is an experiment that has not been modelled, and is reported to go against the advice of the NSW chief health officer, who recommended waiting until 85 per cent of adults are vaccinated.

But we can confidently predict that Covid will continue to spread – and spread faster than it has been spreading – when this step is taken. Seventy per cent adult vaccination translates to about 56 per cent total population vaccination. Double-dose vaccination does not fully prevent infection or transmission, so delta will still continue to spread in NSW. While eased restrictions on gatherings, hospitality, retail, and events are all caveated with density limits and requirements for attendees to be fully vaccinated, it is unclear how big the risk of further uncontrolled spread and further hospitalisations will be at a time when NSW hospitals are already under significant strain and the premier herself has admitted that this has not yet reached its peak under lockdown settings.

The Doherty Institute modelling that informed the national plan did not model a scenario where the starting point had thousands of cases already in the community, vaccinated people would be exempt from lockdown restrictions, and the testing, tracing, isolation and quarantine system was not coping. It simply modelled what the likelihood of lockdowns would be with 70 per cent adult vaccination, baseline restrictions, and “optimal” or “partially effective” test, trace and isolate capabilities.

Despite proposing to take a significant step into the unknown when Doherty’s modelling suggests bad outcomes – in terms of deaths and high levels of hospitalisations – are still possible, NSW has not provided guarantees that it has the capacity and infrastructure to do tracing effectively with a much higher case load, especially when vaccinated people (and likely some unvaccinated people) will have many more contacts per day.

While the NSW plan does provide some caution by stating that targeted restriction may be needed “to deal with outbreaks“, this is difficult to do in cities because essential workers need to travel outside their areas.

NSW’s plan does not provide assurances that hospitals will cope

NSW’s health system is already under huge pressure, including in rural areas, and this will probably increase when Covid is allowed to spread more rapidly in the community while many people remain unvaccinated. Burnett Institute modelling of the current NSW outbreak under lockdown suggests that hospital admissions will peak in mid to late October, but NSW’s plan was never factored into this model. And just recently, national cabinet said that “further work [was] underway to understand the surge capacity available should it be required in the transition to Phase B and Phase C under the national plan”, suggesting that NSW made its decision before this was fully understood.

In our Grattan Institute Race to 80 report, we advocated for 95 per cent vaccination of people over 70, a critical contributor to keeping the number of hospital admissions and deaths down. Currently, just 52 per cent of people over 60 and 64 per cent of people over 70 in NSW are fully vaccinated.

NSW’s plan will be difficult to enforce

Giving vaccinated people freedoms in the first stage of easing restrictions is a good way to drive up vaccination rates, and could shift about 20 per cent of people who are unsure or unwilling to get vaccinated, but it needs to be carefully planned and implemented.

A lockdown is, by definition, no longer a lockdown when 70 per cent of adults are exempt. It won’t be difficult for unvaccinated people to bypass the restrictions, in situations where enforcement depends on social policing, such as for household gatherings, which are known to be higher risk.

And non-compliance is likely to be higher among “vaccine refusers”. The risk of transmission from non-compliance needs to be factored into the plan and modelling for easing restrictions, but it is not clear this has been the case.

NSW’s plan may unfairly discriminate against areas with low vaccine supply

Some communities in NSW, particularly rural communities, are struggling to get vaccines. These communities now face a double whammy. They are at higher risk of infection outbreaks because of their low vaccination rate, and opening up before these communities have had a chance to be fully vaccinated unfairly discriminate against them.

NSW’s plan signals an end to a national approach

NSW’s plan to reopen at 70 per cent double-dose adult vaccination is not consistent with the national plan, agreed by national cabinet on July 31 2021. That plan clearly states that:

“Phases [are] triggered in a jurisdiction when the average vaccination rates across the nation have reached the threshold and that rate is achieved in a jurisdiction expressed as a percentage of the eligible population (16+).” (emphasis added)

Contrary to the national plan, NSW is signalling a move that in fact amounts to skipping Phase B of the plan and enacting something approximating Phase C (which was to be tied to 80 per cent of the adult population) without the rest of the nation having reached either threshold. This further fractures federalism. The national plan is being abandoned in favour of a “go it alone” approach, knowing that it is not alone and increased infections in NSW will inevitably spill over into other states.

And with more vaccines being allocated to NSW to date, these states with lower vaccination coverage are vulnerable.

To better protect its residents and health system, and the residents and health systems of other states, NSW should not open up until it reaches a higher vaccination rate. This would mean waiting only another two weeks under current projections to get to 80 per cent adult coverage, or four weeks to get to 90 per cent adult coverage. And it should consider children in its coverage targets, as children 12 and above are now eligible for vaccination.

In the meantime, NSW should boost vaccination rates in vulnerable groups, commission modelling of its plan, ensure its health system can cope, ramp up its tracing capabilities, and ensure equitable access to vaccines across the state.

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