“Australia will be ready for takeoff very soon” Prime Minister Scott Morrison said today as he announced restrictions on international travel would be lifted sometime next month.
Returning Australian citizens and permanent residents will be able to quarantine at home for seven days if fully vaccinated with a TGA-approved vaccine.
Recognized vaccines include vaccines already approved for use in Australia by Pfizer, AstraZeneca, Moderna, and Johnson & Johnson/Jensen, as well as Sinovac and Covishield (Covishield is AstraZeneca’s vaccine made in India).
Unless Australia moves beyond Phase C of the national plan, unvaccinated returnees will be required to enter managed hotel quarantine for 14 days.
People who cannot be vaccinated, including young children and those with medical exemptions, will be counted as being vaccinated for travel.
The arrival limit for fully vaccinated returnees will also be abolished.
Today’s announcement is a major step towards allowing vaccinated Australians to return home soon, as we move towards a future that somewhat resembles pre-Covid life.
Is seven days enough?
Home quarantine trials in South Australia and New South Wales will answer this question.
Officials will test the returnees and inform the proportion of people who are COVID positive, as well as decide on when they test positive. Once we open it will be continuously monitored and can be adjusted if it exceeds the allowable number of passengers who test positive between day seven and 14.
Currently, NSW data tells us that less than half of those returning to hotel quarantine are testing positive. NSW surveillance reports from 21 August show that only 4% of those positive cases were fully vaccinated.
The low percentage of those who return positive will matter less anyway as Australia progressively moves towards “living with COVID” with a background rate of the virus in the community.
We know that people who are fully vaccinated can still become infected, but at much lower rates. There is also growing evidence that their infectious period is shorter than that of uninfected people, so the virus is less likely to be passed on to them. Importantly, all TGA-recognized vaccines for international arrivals now have a better than 70% reduction in the risk of serious infections requiring hospitalization.
How will we ensure that people stay at home?
South Australia is currently testing an app that uses geo-tagged facial recognition software to ensure people stay home during quarantine.
If this app is successful then it could be rolled out across Australia.
It may also include support for other aspects of compliance, such as signs to test, a checklist of symptoms and other ways to check in with the return.
Random investigation by police or ADF personnel has proven home quarantine and high level of compliance in isolation. Something similar can be brought up at some point if there are compliance concerns.
Read more: Home quarantine is extremely low-risk for vaccinated travelers, and will not harm their mental health
One thing that is more difficult to keep track of is whether other people come into the home of the person who has to isolate. The risk of transmission to the visitor is much greater if the returnee has ventured in. But it is the same risk we currently have with isolating close contacts locally.
Ultimately the system will need to rely, in part, on trust. We know that Australians are generally very obedient, and many will be desperate to travel again and be reunited with family and friends. The facility to keep travel open will likely have to comply with the requirements of the majority.
This system will be sufficiently secure – and that is all we need to move forward.
What about other members of the household?
One question yet to be answered is whether everyone else in the house will have to home-quarantine the returned traveller.
There is a risk to the family as well, with the risk of the vaccinated being completely vaccinated being very small. Members of their household may also need to be quarantined if they test positive on their testing days. Rapid antigen tests can be useful in these cases for early detection of infection.
Another question is, will we still have offshore screening, requiring a negative test before departure for Australia?
As we collect data and manage changing risks, the finer details will emerge and will likely change over time. We’ll probably start conservatively and then slowly open things up more and more as we learn which components of risk mitigation are proportional.
Which states will go first?
International travel to states and territories will open gradually as soon as they reach 80% Complete vaccination of over 16. So we don’t have to wait till all the jurisdictions reach the individual limit.
Based on vaccination uptake rates, ACT and NSW will probably be the first to open, followed by Victoria.
Tasmania is still on track well but other states are lagging. Queensland and Western Australia will likely be the last countries to open their borders.
This is roughly in line with the national plan, but is coming perhaps a month or two earlier than would have been possible in June. Immunization rates, particularly in NSW, Victoria and the ACT, have been driven by significant COVID outbreaks. States are also assessing the distribution of vaccine coverage to ensure that no part of the community is left behind by the time of inauguration.
What about travel bubbles?
The prime minister also flagged possible bubble arrangements with countries such as New Zealand, where there would be no quarantine requirements. The list of such countries is likely to change over time, depending on the circulating forms and the risk profile of the country.
We are probably moving in the direction that eventually there is no need for quarantine for the returnees, only testing. For now, it is clear that we are moving towards a system that manages risks rather than operating with zero risk tolerance.
Will the contacts be able to cope?
As fully vaccinated people contribute less to transmission and are at lower risk of severe COVID-19 symptoms, all states and territories will progressively move to risk settings that minimize contact tracing. We have used extensive contact tracing, widening the epidemiological net to ensure that not a single contact is missed of a case that has contracted the virus.
The probability of someone being positive decreases the more accidental exposure. Once you don’t have to worry about missing just one case, we can narrow the trap and find the people most at risk.
Read more: WorkSafe’s hotel quarantine violation penalty is a warning to other employers to keep workers safe from COVID
We may reach a stage where even close contacts will have to undergo just one test without quarantining.
This change brings with it some risk of cases for the community, but we are likely to continue even when the level of cases in the community is low. The low rate of introduction across international borders will not materially add to this. It is about managing risk and being more selective about identifying who is at risk in a highly vaccinated population.
What about new variants from overseas?
Watching what types are circulating will be a priority and some limit rules may need to be changed if new risks are identified. For example, stricter arrangements for people coming from “high-risk” areas, where a particularly worrisome form has emerged.
The system can be adapted to changing risks. There may be more transmissible variants that emerge, but we may also start using next-generation COVID vaccines that are a better fit for the variant and the precautions can be reduced.
Being highly vaccinated allows Australia to move away from the ultra-conservative ways we have had to manage the pandemic before, and allows us to start reopening the world.