‘One person’s freedom is another person’s going to hospital’

Public health experts have expressed concern about NSW’s road map to reopening its economy, which they say appears to have been driven by industry rather than consideration of the state’s stretched hospital system.

On Thursday, Premier Gladys Berejiklian announced that fully vaccinated people in NSW would be able to visit gyms, pubs and households – subject to capacity limits – once the state reaches 70 per cent full vaccination. Larger gatherings, in stadiums and theatres, will also be permitted subject to capacity limits for the double-dosed.

Premier Gladys Berejiklian announced a suite of restrictions would ease once NSW hit 70 per cent full vaccination.Credit: James Brickwood

Grattan Institute health economist and former health bureaucrat Stephen Duckett said, even though the plan was subject to the significant caveat that local areas could be placed under tighter restrictions if cases rise, “one person’s freedom is another person’s going to hospital”.

“This plan was developed by business for business. They said right up front ‘the Deputy Premier has worked with industry to develop this road map,’” he said.

“It is an extremely risky strategy which guarantees an increase in the number of cases and the number of hospitalisations. The question is how NSW Health will cope in this environment.”

Asked if she was comfortable with the scale of the reopening, Chief Health Officer Kerry Chant stressed that public health responses would still be in place for local outbreaks.

“I think the road map gives certainty to businesses about what it looks like,” she said. “I think the Premier has been very clear that this is all contingent on us getting case numbers down.”

There were 1175 COVID-19 cases in NSW’s hospitals on Thursday, with 202 people in intensive care. The NSW government’s Agency for Clinical Innovation reports only 26 per cent of cases now receive a phone interview from contact tracers within 24 hours of testing positive.

Modelling released by the Burnet Institute on Monday showed that NSW Health was expected to be caring for more than 3400 hospital patients, including non-COVID patients, by the end of October.

Professor Margaret Hellard, deputy director of the institute, said the projections were based on the current outbreak restrictions being in place and that they were “continuing to do work with NSW Health”.

Professor Alexandra Martiniuk, an epidemiologist at the University of Sydney, said she believed the measures were prioritising industry above public health, expressing surprise that some restrictions – such as allowing for large seated gatherings – would ease, even for the double-dosed.

“I don’t think we’ve got enough data to say whether a person who is double-vaccinated could lead to a super-spreader event,” she said.

With 30 per cent of people at this time, definitionally, not yet vaccinated, Professor Martiniuk said reopening to the extent planned was “inequitable and too early”.

“Even though there are freedoms for some, others – including the elderly, immunocompromised and those yet unable to access a vaccine – will be placed in their own personal lockdown if contact with the virus is increasingly likely,” she said.

Associate Professor Holly Seale, a vaccine communications researcher at UNSW, doubted the promise of greater freedom once double-dosed would be “the nudge that will help everybody” come forward for a shot.

“Those people who maybe were sitting and waiting, they may be the people who now feel a little bit more urgency to get vaccinated,” she said.

Dr Seale said the way some restrictions operated – such as allowing household visits only if all adults in a household are vaccinated – could result in tensions that are not productive to encouraging those not yet vaccinated to change their mind.

“Within households there may be a split between who is vaccinated and who is not, and navigating those conversations is difficult at the best of times,” she said.

Then there is the issue of access, either due to appointment availability or difficulty in making a booking or accessing a clinic.

“Talking about ‘enjoying the removal of restrictions’ [at press conferences] isn’t fair because some LGAs that are on their journey to be immunised haven’t had that access,” Dr Seale said. “Different communities are going to be at different stages.”

In a paper published by the Sax Institute this week, Deakin University chair of epidemiology Professor Catherine Bennett said restrictions on large gatherings would be one of the infection control protocols likely to remain in place the longest in Australia’s COVID-19 response.

“The 70 per cent target was about when we can do small things – the 70 per cent modelling we all know about [from the Doherty Report used by national cabinet] isn’t the same as this setting,” Professor Bennett said in response to NSW’s announcement.

Although she believed the state did eventually need to stop focusing on daily cases, Professor Bennett said NSW’s current numbers were likely too high to do that, although the reproductive rate of the virus was on the decline.

“The reality is that 70 per cent is better than 68 but not as good as 72,” said ANU infectious diseases physician Professor Peter Collignon, acknowledging the need to balance restrictions against mental wellbeing.

“The main time respiratory viruses transmit is in winter and early spring, so the risk will be lower when this plan comes into force,” he added.

Professor Collignon stressed that the NSW plan was not a UK-style Freedom Day.

“This is a gradual process. And allowing people to do things they want to do in a less risky way – be that with a four-square metre rule or by having people meet outside – is going to help to reduce the risk of transmission.”

On Thursday night the NSW Department of Education said Broderick Gillawarna School, Dundas Public School, Enfield Public School, Holroyd School, Rooty Hill Public School and Yagoona Public School would be closed on Friday, 10 September, until further notice, for cleaning and contact tracing.

“All staff and students are asked to self-isolate and follow the NSW Health advice and protocols,” it said.

with Lucy Carroll

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