Work colleagues of confirmed cases, not just people who live together, may be classed as close contacts if a significant transmission event occurs, according to expert health advice cited by Scott Morrison to overhaul Covid-19 rules in Australia.
Newly published advice from the Australian Health Protection Principal Committee also went beyond health factors to justify the “pragmatic” changes to testing and isolation rules. It said it was a response to fast-increasing case numbers and “the living with Covid policy approach”.
The expert advisory panel – which brings together all state and territory chief health officers and is chaired by Australia’s chief medical officer, Prof Paul Kelly – said the changes would support “public health sustainability, social cohesion and economic recovery”.
The AHPPC warned that previous testing rules were “placing considerable pressure on available laboratory resources”. On Friday New South Wales reported a record high 21,151 confirmed Covid cases, while Victoria reported 5,919, Queensland 3,118 and South Australia 2,093.
The prime minister called for a “reset” to Australia’s pandemic response, describing the more infectious Omicron variant as a “game changer”.
He said after a national cabinet meeting on Thursday that most states and territories would adopt a newly agreed definition of a close contact – with relatively Covid-free Western Australia a notable exception.
But South Australia announced it would stick with a broader definition of close contacts.
Morrison had said a close contact “is a household contact or household-like of a confirmed case only” – except in exceptional circumstances.
“A household contact is someone who lives with a case or has spent more than four hours with them in a house, accommodation or care facility setting,” Morrison told reporters.
However, the AHPPC statement appears to be more nuanced and does not mention the four-hour timeframe.
The advisory group said in its statement: “Household or household-like contacts are the key group who should be required to quarantine as these individuals are the most likely to develop disease.
“In addition, where a significant transmission event has been documented, those who were at this site or venue may be determined to be close contacts,” it added.
“This may include worksites. Worksites and businesses are strongly encouraged to have business continuity plans in place to ensure workplace health and safety is achieved and outbreaks can be contained as quickly as possible.”
The AHPPC said there was “still risk of transmission based on the nature of exposure for other contacts (such as in social, educational or workplace settings) who have had less extensive exposure to a case than household-like contacts”.
“This group will not be required to quarantine, except in exceptional circumstances, and may be required to undertake other behaviours to decrease their risk of transmission to others,” it said.
Morrison told reporters that the change to close contact definitions “and the complete abolition of the casual contact notion” would have a positive impact on staff shortages, particularly in the health system.
But the AHPPC statement said other contacts who had potentially been exposed to a case but who were at lower risk of infection should monitor for symptoms and have a rapid antigen or PCR test if these occur.
“All contacts should wear a mask when outside home, monitor symptoms and avoid visiting high-risk settings for 14 days following exposure to reduce their risk of transmission to others.”
The AHPPC also warned that for the effective control of outbreaks, “different management approaches will be needed for contacts in closed, high-transmission settings, particularly when there are a large number of individuals at risk of developing severe disease”.
This would include outbreaks in residential aged care facilities and remote Aboriginal and Torres Strait Islander communities.
The South Australian premier, Steven Marshall, said his state would continue to define close contacts as not merely “household and household-like contacts and intimate partners”.
The definition would also cover “those who have been in a setting where there has been significant transmission of Covid-19 (and there has been greater than 15 minutes face-to-face contact)”.
The SA announcement was interpreted as a departure from the nationally agreed definition. But it does not appear to clash with the AHPPC advice published overnight.
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Marshall told reporters on Friday he did not believe national cabinet had agreed on the four-hour cutoff.
He said people needed to be aware “that you can still catch this disease if you’re not living with somebody, or in an intimate relationship” – and should monitor for symptoms.
“That’s just a fact and people need to be aware of the risks associated with Omicron.”
Dr Chris Moy, the vice-president of the Australian Medical Association, said on Friday the national cabinet announcement was a “party trick” that meant fewer potentially infectious people would be identified as a close contact.
What would have been better is to maintain the definition, and to adjust quarantine and testing requirements utilising more RATs to determine who is infectious………BTW where are the RATs and where can I get one?
— AMA VICE PRESIDENT (@ama_vice) December 30, 2021
Moy said on Twitter the move “defies the reality of who will actually become infectious, and unknowingly accelerate the propagation of Covid through the community”.
But Prof Peter Collignon, an infectious diseases physician at the Australian National University, said the changes were a “reasonable” response to the current situation.
“We don’t need zero Covid rules – what we need is practical rules that get the vast majority of people who are high risk [and] keep them away from others, but not expect that we’ll have zero risk,” Collignon told the Seven Network.
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“This disease is actually in the society, it’s going to be here for years to come. We need to adapt the rules so that we don’t, in fact, lose huge amounts of the workforce for little extra benefit.”
Kelly said Omicron was “very transmissible” and there was “no doubt” case numbers would continue to rise. But he said data from South Africa – which had “the longest and most extensive experience” of the new variant – indicated a 73% decrease in severity of disease compared with Delta.
