Australia needs a more consistent and sensible approach to Covid-19 border decisions | Coronavirus

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Border closures to date have been inconsistent across states and territories. An event in one state will result in different national travel rules for residents depending on where they need to travel to, and different states also respond to equivalent events quite differently.

For example, Victoria has put the entire state into lockdown with the most recent Holiday Inn hotel quarantine breach, whereas Western Australia and Queensland focused on the more immediate urban areas where potential exposures occurred.

Federation should create a collaborative framework for assessing and managing risks consistently, but it is failing us.

The first step in considering border closures is the trigger – a credible risk of wider community transmission that warrants management of people movement at scale, possibly including border closure. The justification for closures is to protect one jurisdiction from community transmission in another. Given the disruption and costs of closures, this has to be carefully assessed and evaluated against what can be achieved through more targeted measures that address local transmission risk.

Every outbreak scenario is different and there is a myriad of factors that influence the potential for community transmission; how quickly the cases have been identified, how complex their contact networks are, and so on. This decision would benefit from the expert input available through the Australian Health Protection Principal Committee (AHPPC) which brings together all chief health officers from the states and territories along with other health experts. A joint decision on the level of risk of wider spread could then lead to a designation of a specific area or region as a red or amber zone based on an assessment of the transmission risk beyond the region.

A number of states have introduced a permit system, or equivalent, for border crossings. These allow states and territories to manage who can enter and to identify who is within their jurisdiction who has been in areas during exposure periods that correspond with a changed risk status since their entry permit was issued. This can be critical information that allows people to be contacted and alerted that their personal risk level has changed given new case information that relates to an area where they have been. Travellers or returnees can then be notified that they need to test and quarantine as appropriate to their risk status and monitored to ensure they do so.

All states could institute the permit system to screen would-be travellers and allocate (or not) permits according to their exposure risk as defined under nationally agreed zonings; red (no permit given unless extenuating circumstances), amber (test and isolate till a negative result) and green (no travel restrictions). It would be a more efficient spend of resource if states and territories were to rely on the state with the red zone to introduce travel restrictions for the designated red areas while they focus on following up people in their own jurisdiction that might have returned from the red zone in recent days. People travelling from an amber zone can be tracked to ensure they comply with testing and quarantine requirements. Random border checks would be required to ensure compliance, but it would be less onerous than full border closures

There seem to be a number of elements at play that are preventing a more coordinated approach. Differences in risk tolerance between states, differences in confidence in their own public health responses, and suspicion about the quality of public health responses across states. We have to move beyond this, and we should be in a position to do so as national standards continue to be refined, and as all states meet the benchmarks.

Border closures often represent the proverbial closing of the stable door after the horse has bolted. Permits allow us to manage the movement of people who have potentially been exposed, and to act on managing risks we only learn about retrospectively in an effective and efficient way.

Lifting border closures has been a rather painful and often drawn out process to date. The less clear or more subjective the trigger to initiate closures, the harder it is to determine when circumstances have changed sufficiently to justify reopening. If the AHPPC deem the zone designation can be downgraded, then that would initiate a consistent response across states and territories to once again allow permits to be issued, with test or quarantine requirements as may still be appropriate.

There is no magic number of cases or even secondary community cases that can be set as a threshold. We have learned how differently community transmission can play out, and now have new variants to factor in as well. But that does not mean we cannot have national consensus on risk that then flows through to predictable travel restrictions, and also relaxing of rules as risk declines. We must be prepared for outbreaks to appear in any state on an ongoing basis, alas. Addressing the issue of risk recognition, designation and response in a nationally consist way is one area of pain that we could manage better.

Hafta Ichi
Source: The Guardian
Keyword: Australia needs a more consistent and sensible approach to Covid-19 border decisions | Coronavirus

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