Plan for rapid test results as Sutton’s Omicron health advice is revealed

Plan for rapid test results as Sutton’s Omicron health advice is revealed

December 31, 2021

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Victorians who test positive to COVID-19 on a rapid test will be able to share their result with the government and be included in official figures, as people forgo PCR testing due to unpalatable waiting times and site closures.

The Age has confirmed existing government IT infrastructure that allows people to create unique codes to store their PCR test results online is likely to be used to allow people to upload their rapid test results, as use of at-home tests overtakes the PCR system.

Chief Health Officer Brett Sutton’s first report under the state’s new pandemic laws has been released.Credit:Paul Jeffers

Detail of the testing overhaul was confirmed following the release of a report under the state’s new pandemic laws showing that Chief Health Officer Brett Sutton urged the Andrews government to close dance floors, implement density caps in hospitality, require people attending major events to have a negative rapid tested before entry and restrict access to hospitals and aged care homes.

Professor Sutton also requested that his public health team gain control over the public health management of events with more than 5000 people, rather than the current threshold of 30,000.

He said his advice, dated December 23, was designed to avoid a worst-case scenario of more than 25,000 cases per day in Victoria, as modelled by the Burnet Institute.

“[They] are the most important measures in the short term, to reduce the probability that more restrictive measures will be required to manage Omicron morbidity,” Professor Sutton’s recommendations to Health Minister Martin Foley state, along with an acknowledgement the new rules could dent confidence in the administration of public health.

Of the additional health measures recommended by Professor Sutton to halt the spread of Omicron, only the introduction of an indoor mask mandate was accepted by Mr Foley, who argued further changes to the rules might diminish the government’s social licence to manage the pandemic and “likely contribute to community fatigue and distress”. Under the state’s new pandemic legislation, the health minister makes decisions on public health measures after considering their impact on society more broadly.

The document outlining Professor Sutton’s advice, required to be published under the state’s new pandemic laws, revealed Burnet Institute modelling projections of more than 25,000 cases a day in a worst-case scenario for Victoria. The unpublished modelling shows this outcome could occur if Omicron turned out to be highly infectious, vaccines did little to stop the variant’s spread and if public health interventions were not taken or enacted early enough.

“While it is plausible that these projections might not come to pass, and it is appropriate not to overreact, it is equally plausible that they might come to pass, and it would be reckless to ignore them entirely,” Professor Sutton’s advice states.

In Victoria, cases have been surging dramatically in those aged in their 20s and 30s, and many respected epidemiologists have been calling for the closure of nightclubs, considering them too big a spreading risk.

Doctor and infectious diseases epidemiologist Paul Van Buynder said: “We are all really worried about case numbers four or five days after New Year’s Eve.”

“When you see some of these nightclubs that look like one giant mosh pit with everybody with their arms in the air … yelling at the top of their voices, they’re just total transmission sites.”

More than 32,000 COVID-19 infections were reported in Australia on Friday, with the highly infectious Omicron variant driving record daily cases across all states bar Western Australia. More than 1200 COVID-19 patients are in hospital in NSW and Victoria, an increase of about 60 per cent in a week.

Epidemiologists and public health officials say the actual number of COVID-19 cases in the community is likely to be significantly higher than reported because some returning positive rapid tests are bypassing swamped state testing sites. More than a dozen Victorian sites were closed on Friday because of snaking queues or extreme heat.

Victoria’s COVID-19 response commander, Jeroen Weimar, confirmed on Friday that officials were exploring ways to allow the public to upload the result of their rapid antigen tests. “We’re working on some options at the moment. We’ll make some announcements in the coming days,” he said.

Rapid tests are much cheaper but also less sensitive than PCR tests, meaning they occasionally produce false negatives. Those approved for use in Australia must identify at least 80 per cent of PCR-confirmed cases, and the rate of error diminishes significantly if at-home tests are completed over consecutive days, according to University of Melbourne epidemiologist Professor Tony Blakely.

“So the marginal gain of going and confirming that result with a PCR is minimal,” he said.

In the UK, the public is encouraged to report the result of their rapid tests to the National Health Service no matter the result, using a QR code or ID number printed on the test.

NSW Chief Health Officer Kerry Chant said there were no plans to introduce a reporting system for rapid antigen tests in her state.

A month ago, the positivity rate from PCR testing was 2 per cent in Victoria and just 0.3 per cent in NSW. On Friday it was close to 9 per cent in Victoria and more than 14 per cent in NSW from 66,774 and 148,410 tests conducted respectively.

Professor Allen Cheng believes most Australians will be exposed to COVID-19 at some point.Credit:Nicole Reed

Epidemiologist Allen Cheng, who has been a key government adviser throughout the pandemic, said the high positivity rate from the PCR testing was an indicator there was a “reasonable amount” of COVID-19 cases in the community going undetected.

Asked if it was inevitable that most Australians would get COVID-19, Professor Cheng said he believed most would be exposed to the highly infectious virus.

“Whether we’ll actually get COVID depends on vaccinations and all the other things that we do,” he said.

“If you look at places like the UK and the US where there’s been a lot of infection, the proportion that have antibodies would suggest infection was probably well over 50 per cent in some places.”

In an attempt to ease the pressure on the PCR testing system, significant changes were made to testing requirements this week, with a decision of national cabinet meaning the public will no longer need to get a PCR test if they are exposed to COVID-19 at places such as cafes, schools and supermarkets.

While Omicron is now thought to be significantly milder than previous strains, and the majority of seriously ill people are unvaccinated, there are still concerns the sheer number of active cases will put severe strain on hospitals through sick patients. Large numbers of staff being forced into isolation could also prove challenging.

Professor Paul Van Buynder, who works with Ambulance Victoria on COVID-19 case management, said he was hoping and praying that emerging evidence suggesting people with Omicron were up to 70 per cent less likely to be hospitalised compared with Delta turned out to be true for Australia.

Due to a lag between people testing positive and falling ill, he said, the biggest impact of the tens of thousands of cases reported on Friday was still a week or two away, and health services were now looking at compromises that could be made to ensure staff were available to look after the ill.

He said even though the Omicron variant seemed like it was milder than Delta, the fact remained that case numbers in Victoria were now almost 10 times higher than the 2020 COVID-19 second wave.

“We may still have strain on our system, just through pure numbers, if you’re 70 per cent less likely to end up in hospital but there are 20 times as many of you,” the public health physician said.

“The key message for everyone remains the booster dose … Two doses is insufficient after four or five months to protect you against Omicron.”

Professor Van Buynder said it was not possible to control the variant through quarantine and instead the focus needed to switch to sensible public health measures such as masks, ventilation and restrictions on some gatherings.

The number of people hospitalised with COVID-19 in NSW has increased from around 150 early in December to more than 800 and is now inching close to the peak of the Delta wave, where over 1200 people with COVID-19 were admitted.

Numbers in intensive care have remained much flatter to date and are now at 69, an increase from 53 a week ago.

In Victoria, where COVID-19 cases were higher ahead of the Omicron wave, hospitalisations have increased from just below 300 in early December to 428.

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