COVID-19 Test, Trace, Isolate, Quarantine (TTIQ) National Protocols
OMICRON has rapidly changed the Australian coronavirus landscape and I read somewhere that we are now the world leaders in rate of change of incidence of COVID-19…not a particularly good thing to be a world leader in.
It was a bit over a month ago that it was a hardly known “variant of interest from South Africa” and now official figures are over 50,000 cases in Victoria. The real figure, however, due to lack of RAT kits (and recording of positive RAT results…see below) and clogged up swabbing PCR queues, is likely 5-10 times that or even more. For the first time, everyone seems to know someone who either has it or is a close contact and is self-isolating. Businesses have been massively hit with staff shortages and supplies of some common foods are starting to run short.
Omicron does seem to cause less severe disease than the last variant, delta, although it is important to remember that there has been limited time to assess this properly. In South Africa preliminary figures show that it is 80% less likely to lead to hospitalisation than previous variants. But it is greatly more infectious…hugely more infectious!…and that is why the hospital numbers (which surely are of more interest than the daily numbers) continue to rise and why NSW is preparing for a tripling of their hospital admissions by next month.
Keeping up with current guidelines and directives is hard when things change so much from one week to another. And there is a lot of mis-information circulating again. So let us confine discussion here to what we do know about RATs, Boosters, and what we can do/are doing locally.
There has been much talk about Rapid Antigen Tests (RATs).
What are they? In essence, a RAT involves either a saliva or nose swab, performed at home (does not need any health practitioner involvement) which will deliver a result within 15-30 minutes.
Rapid antigen tests are very accurate when used by people with symptoms or people who have come into contact with COVID-19. It is now mandatory that if you do have a positive RAT, that you report it. (Ring 1300651150 or go to www.coronavirus.vic.gov.au/rapid-antigen-tests#report-a-positive-result-on-a-rapidantigen- test.)
This will enable more accurate following of the pandemic and help the macro-management by the Health Departments, State and Federally. If you have symptoms or are a close contact and have a positive RAT you do not require a nose/throat PCR test. If you do not have symptoms and are not a contact and you test positive then it is recommended you get a PCR to confirm the result.
All this can be quite confusing and there is an up-to-date (6/1) chart reproduced from health.gov.au (enter ‘COVID-19 Test and Isolate National Protocols’) following this article which, although initially looking a bit busy, is easy to follow and answers many questions.
We are told that within the next 2 weeks RATs will be made available free of charge to certain groups. Ten free RATs will be available every 3 months to Pensioners, Health Care card holders, Vet Affairs card holders, Low Income and Commonwealth Senior card holders. But please do not ask for them yet! They are in massive demand and no one has yet seen the promised supply avalanche! (And watch this space as we are likely to follow what is happening overseas where in many countries, they are free for everyone.)
Booster shots are in full swing as a result of the rampant Omicron. The 5-month gap has been shortened to 4 months and will be 3 months ‘as soon as practical’ (ATAGI).
Why Boosters and do they work?
There is a lot we know and a lot we are still learning. For instance:
‘A recent pre-print study from the UK suggested that protective effectiveness against symptomatic COVID-19 due to the Omicron strain was not observable after 2 doses of the AstraZeneca vaccine and was only approximately 35% at about 4 to 6 months (from 15 weeks onwards) after 2 doses of the Pfizer vaccine’ (health.gov.au).
That’s a pretty stark statement (although it goes on to say that ‘protection against severe disease is generally higher than against symptomatic infection’).
The good news is that ‘strong evidence suggests that booster doses of COVID-19 vaccines may enhance protection against symptomatic disease due to the Omicron variant and that the protective effectiveness against symptomatic disease was estimated at about 70–75% after receiving a Pfizer booster dose’ for both people who previously had AstraZeneca or Pfizer initial vaccination courses (health.gov.au again).
ATAGI expects that booster vaccination alone will not be sufficient to avert a surge due to Omicron. However, maximising booster coverage by expanding eligibility and encouraging high uptake, in combination with enhanced public health and social measures, may prevent a large surge in case numbers, hospitalisations and deaths.
At Foster Medical Centre we have started the children 5-11 vaccinations since Monday 10/1. Ring the clinic for an appointment. We have re-instigated the Saturday booster sessions and last Saturday did 312 vaccines which took the total our clinic has given to 13,408 vaccines! We will be running the Saturday clinics for at least the next month or so….book in, they are filling fast.
Recently we have had to restrict both vaccines and Respiratory clinic testing to only our own patients as demand far out strips supply, both in vaccines but also in personnel…we have lost staff from COVID-related issues like every other business. It was very disturbing that a few of our staff have been abused by some elements of the public who were dissatisfied with being turned away. This is obviously never OK and cannot be condoned. Hopefully with the return of many of the visitors to our area things will settle to a new COVID-normal. Again.
We are also looking after many more COVID-positive patients who are well enough (as the vast majority are) to remain at home, so far almost exclusively virtually.
A few thoughts to finish with.
It is worth remembering that transmission in the home is the most likely form of transmission. Being prepared for the time (which is an ever-increasing possibility) when someone in your household either gets COVID or is a contact and needs isolating is sensible.
(We recommend abc.net.au: “Omicron has arrived, here’s how to prepare for a COVID-19 case in the home”.)
And, public health measures work. See Priscilla’s article and the graph which shows the numbers skyrocketing when these were relaxed. You can protect yourself by wearing a well-fitting mask, by avoiding excessive crowds, by hand hygiene and by getting vaccinated.
Our wish was for a New Year free of COVID and related issues.
Maybe next year?
Dr Phil Worboys