A statement from the Australian Health Protection Principal Committee (AHPPC) on winter season preparedness.

On 23 March 2022, the AHPPC met to reflect on the pandemic response to date, define objectives, discuss and endorse actions to be implemented at all levels of government. Discussions and actions aim to ensure all health outcomes are optimised in the context of living with COVID-19, with a particular focus on maintaining strong delivery of services including health and social services, and supporting business continuity while protecting those most at risk of severe illness.

 

As Australia enters the final phase (Phase D) of the National Plan and is living with COVID-19, the 2022 winter season may present challenges to health systems, healthcare providers, aged care and disability care residents, communities and to the economy arising from the likely co-circulation of COVID-19 and influenza. Increasing predominance of the Omicron BA.2 variant of concern, resurgence of Omicron BA.1 or emergence of a new variant are all possible.

 

These challenges are likely to be offset by increasing population level immunity from vaccination and natural infection and the availability of treatments, which will likely mitigate against high hospital demand, although COVID-19 and influenza-related absenteeism in the health system will likely be significant. Addressing these challenges is a shared responsibility between individuals, businesses and government


TColdhese challenges require the least restrictive public health and social measures to:

  • support the health system to function while avoiding resorting to activation of surge plans where possible (e.g. cancelling non-urgent elective surgery);
  • support populations at risk of severe illness, such as older people, those with chronic disease and people who are immunosuppressed;
  • maintain social and business continuity, specifically to ensure the delivery of essential goods and services, if disruptions occur; and
  • continue to ensure health equity by supporting those people in our community with higher risk of disease transmission and where access to health care may be reduced, such as with Aboriginal and Torres Strait Islander people and those in culturally and linguistically diverse communities

Australian Health Protection Principal Committee

The Australian Health Protection Principal Committee is the peak decision-making committee for public health emergency management and disease control in the Commonwealth of Australia. It is chaired by the Chief Medical Officer of the Australian Government and comprises the chief health officers of the states and territories.

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Reasonable and proportionate steps to manage risk should be taken by Commonwealth, state and territory governments to mitigate the impact of COVID-19 and influenza, by continuing to manage disease in the community while normal social and economic activity resumes. Providing specific supportive measures for those at higher risk of severe illness remains a priority.

 

Residents of aged care and disability facilities are among the most vulnerable to severe outcomes of COVID-19 and influenza. Residential aged care settings are high-risk transmission settings for respiratory viruses, so specific measures to support residential aged care facilities (RACFs) are required.

 

It is the view of AHPPC that, businesses and individuals also have an important role to play in winter preparation and response, by following guidance on preventive measures and planning for potential disruptions. People with acute respiratory symptoms are recommended to stay home until symptoms have resolved, regardless of their diagnosis or whether they have been tested. Clear and consistent communication is critical to ensure the community understands the shared responsibility for protective health behaviours between individuals, businesses, and governments.

 

Current context

AHPPC notes the increase in COVID-19 cases observed in recent weeks (see Table 1 below). This increase is due to a number of factors, including the emergence of the more transmissible Omicron BA.2 sub-lineage, relaxation of public health and social measures, waning of population level protection from vaccines and previous COVID-19 infection, and slowing booster and primary vaccination course for 5-12 year old uptake. These trends are aligned with the experience reported internationally. We also note forecasting which suggests this current wave will peak around mid-April in many jurisdictions.

Table 1: COVID-19 cases and clinical status as reported to the Commonwealth on 23 March 2022, compared with 11 March 2022

 23 March 202211 March 2022DifferenceChange %

Cases*

61,689

34,863

26,826

↑76.95%

Hospitalisations

2,104

1,689

415

↑24.57%

ICU Patients

95

101

-6

↓5.94%

Ventilated Patients

26

38

-12

↓31.58%

Lives Lost#

26

28

-2

↓7.14%

  • *Please note, cases reported may be based on date of reporting, which may not reflect date of diagnosis or date of death.
  • #Lives lost are representative of the date the death is reported, not necessarily the date of death, and deaths generally follow some weeks after infection.

AHPPC notes the demands for the hospital system in managing the multiple challenges of the existing COVID-19 case load, the usual care of acute medical and surgical activities, the backlog of elective surgery and health issues due to delayed health care, along with the greater burden on staff due to enhanced infection prevention and control measures.

 

AHPPC notes the outcome of National Cabinet on 11 March 2022 and supports phased changes to implement more targeted testing and removal of routine quarantine requirements for all close contacts.

 

AHPPC recommends that, given the current need to maintain some transmission reduction strategies, the appropriate time for any changes will be in the weeks following the anticipated peak of the current BA.2 variant of concern surge. Making changes, including changes to quarantine settings, that will result in increased transmission in the community at a time when cases are already increasing or are at their peak, may result in further disruption to the health system. The resulting escalation in case numbers is likely to increase, rather than decrease, any disruptions to broader societal functioning.

 

Vaccination

AHPPC recommends maximising COVID-19 and influenza vaccination uptake and coverage as an important step in providing protection against both severe illness and infection, including through the co-administration of COVID-19 and influenza vaccines, where possible. In addition, whilst not a target group for COVID-19 vaccine, the provision of influenza vaccination for the 6 month to 5 year age group needs particular attention after two years of minimal influenza transmission in Australia.

 

AHPPC notes the importance of increasing coverage for the third (booster) dose in adults, and subject to ATAGI advice, in the under 16 age group, and achieving high coverage of the additional winter booster dose for COVID-19 vaccination in eligible cohorts, as advised by ATAGI, in a timely way.

 

AHPPC notes that there are a range of methods, including improving access and enhanced monitoring and reporting, that are likely to be successful in increasing influenza vaccination coverage among health care, aged care and disability workers, without the need to mandate influenza vaccination (which are not considered justifiable in many jurisdictions).

 

AHPPC recommends that vaccination against influenza continues to be strongly encouraged for the broader community through existing mechanisms, including general practices and pharmacies, and should not be delayed just so that it can be co-administered with the COVID-19 vaccine.

Testing and treatment

AHPPC recommends the continued focus of public health policy on prevention of severe illness and targeting high-risk populations for testing and treatment for COVID-19 and influenza.

 

AHPPC recommends all people with compatible symptoms continue to be tested for COVID-19 through appropriate access to Rapid Antigen Tests (RAT) and Polymerase Chain Reaction (PCR) until the impact of the current BA.2 wave on the health system has reduced. A transition should then occur to focus on PCR testing of symptomatic people at risk of severe disease, symptomatic people who live with or care for people at risk of severe disease, household contacts of people with COVID-19 who are at risk of severe illness and any others who would benefit from early diagnosis and treatment. Symptomatic people otherwise not at risk of severe illness disease are strongly recommended to isolate until symptoms resolve and have a RAT for COVID-19.

 

AHPPC notes the importance of maintaining testing capacity that allows for targeted, timely access to testing and treatment for those at increased risk of severe illness, those in high-risk settings and those who would benefit from early treatment.

 

AHPPC notes the need to consider alternative approaches to surveillance of COVID-19 for the purposes of monitoring and responding to the pandemic, including detecting new variants and tracking emerging variants, as the testing strategy shifts towards a focus on high-risk individuals for clinical management. Anticipating changing caseloads will remain essential for health sector and societal adaptation to ensure system functions are maintained.

 

AHPPC recommends state and territory, private and public testing arrangements, support the targeted testing of multiple respiratory pathogens simultaneously (e.g. multiplex nucleic acid amplification), where clinically indicated. The prevalence of influenza in the community will inform decisions on the appropriate timeframe for this to commence.

 

AHPPC recommends treatment access for high-risk individuals is supported through the primary care setting, following an agreed treatment pathway. Other pathways to treatment such as respiratory clinics, hospital in the home (or similar) and Emergency Department virtual triage should be considered where barriers to access exist, to ensure equitable and timely treatment for those at risk of severe illness arising from COVID-19 or influenza infection.

Quarantine of close contacts

AHPPC notes that scenarios and projections from some jurisdictions suggest that removing quarantine at this time may lead to higher caseloads and a reduced capacity for the health system to provide some acute and elective services.

 

AHPPC notes that numerous countries[1] have recently relaxed quarantine and isolation arrangements. Many of these countries are experiencing significant societal and health system disruption arising from increased rates of infection.

 

AHPPC notes that there have been numerous guidance materials developed and adjustments to close contact settings made since the emergence of the Omicron variant with a view to mitigating societal disruptions while also protecting the most vulnerable in our community. These guidelines include (but are not limited to):

  • Updated CDNA National Guidelines for Public Health Units (22 March 2022) which state that people with prior history of COVID-19 infection are not required to isolate for a period of 12 weeks post infection.
  • AHPPC Statement - Mandating booster vaccination for disability support workers (16 March 2022)
  • Updated CDNA National Guidance for remote Aboriginal and Torres Strait Islander communities for COVID-19 (16 February 2022)
  • AHPPC interim guidance - Permissions and Restrictions for Workers in Health Care Settings (10 January 2022)
  • AHPPC Statement - Mandating booster vaccination for residential aged care workers (15 February 2022)
  • Updated CDNA National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Aged Care Facilities (15 February 2022)
  • AHPPC interim guidance on permissions and restrictions for workers in food and grocery supply (10 January 2022)
  • AHPPC statement on testing, tracing, isolating and quarantining in high-levels of COVID-19 community transmission (30 December 2021) that states:
    • Contacts exposed in non-household settings (e.g. workplaces, social and educational settings) no longer required to quarantine except in exceptional circumstances;
    • Recommendation to standardise isolation requirement for cases and household contacts of cases to 7 days; and
    • Changed management of contacts, with a focus on quarantine of household or household-like contacts.

AHPPC recommends a nationally consistent, risk-based transition to the removal of the requirement for close contacts of COVID-19 cases to quarantine:

  • where quarantine is required, 7 days remains appropriate at this time; and
  • following the peak impact of the BA.2 wave, quarantine will be replaced by other measures, which may include:
    • requirements for frequent rapid antigen testing;
    • wearing of masks when leaving the house;
    • work from home, where this is feasible;
    • limiting access of close contacts to high-risk settings; and
    • monitoring of symptoms (and isolating if symptomatic).

Residential Aged and Disability Care Facilities

AHPPC notes that all parties – Commonwealth, states/territories and residential aged care providers – have responsibilities in managing COVID-19 and influenza outbreaks in RACFs.

 

AHPPC agrees that COVID-19 and influenza outbreaks in RACFs will continue to be managed in the least restrictive way, in line with agreed nationally consistent guidance.

 

AHPPC notes that monitoring of influenza cases in RACFs (as in the broader community) relies on reporting nationally through established mechanisms.

 

AHPPC notes the Commonwealth is prepositioning oseltamivir in RACFs for use in influenza outbreaks and supports facilities, in collaboration with states and territories, having a plan for risk assessment, prescribing and administration in the event of an outbreak.

 

AHPPC notes that it is a requirement that the aged care workforce receive a third (booster) dose of an approved COVID-19 vaccine.  All residents are also strongly recommended to receive an influenza vaccination, as this is of most importance to personal protection, and arrangements must be in place to ensure this is made available. Aged care and disability care workers are strongly encouraged to be vaccinated against influenza, including through free vaccination clinics facilitated by residential aged care providers. It is further strongly recommended visitors receive an influenza vaccine.

Engagement and Communications

AHPPC recognises the importance of consistent messaging and communication strategies for the prevention, diagnosis and treatment of COVID-19 and influenza across all jurisdictions and population cohorts.

 

AHPPC recommends public communications should reinforce business and individual responsibility for prevention of, preparedness for and response to viral respiratory illness in winter 2022.

 

AHPPC recommends that primary care and other healthcare providers continue to support their patients to ensure that all health conditions are diagnosed and managed as early as possible in the course of illness.

 

AHPPC notes that even mild COVID-19 may impact on other health conditions and that a holistic approach to clinical care is required.  Additionally, AHPPC notes that there is a need for consumers and primary care providers to ensure that any deferred health care (including preventive care such as screening and vaccination) is progressed and provided.

 

[1] For example Germany has reported record high case numbers of between 250,000-300,000 per day over the past week, compared to approximately 50,000 cases reported on 15 January 2022.