ABSTRACT
Since the emergence of SARS-CoV-2 in 2019 through to mid-2021, much of the Australian population lived in a COVID-19 free environment. This followed the broadly successful implementation of a strong suppression strategy, including international border closures. With the availability of COVID-19 vaccines in early 2021, the national government sought to transition from a state of minimal incidence and strong suppression activities to one of high vaccine coverage and reduced restrictions but with still-manageable transmission. This transition is articulated in the national "re-opening" plan released in July 2021. Here we report on the dynamic modelling study that directly informed policies within the national re-opening plan including the identification of priority age groups for vaccination, target vaccine coverage thresholds and the anticipated requirements for continued public health measures -- assuming circulation of the Delta SARS-CoV-2 variant. Our findings demonstrated that adult vaccine coverage needed to be at least 70% to minimise public health and clinical impacts following the establishment of community transmission. They also supported the need for continued application of test-trace-isolate-quarantine and social measures during the vaccine roll-out phase and beyond.
ABSTRACT
BackgroundSince its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE) and testing approaches to prevent these events is unclear, especially in light of ongoing limitations in access to both. MethodsUsing stochastic simulations with an SEIR model we quantified and compared the impacts of PPE use, patient and HCWs testing, and cohorting. FindingsIn the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection, and that creation of smaller patient/HCW subcohorts can provide additional resilience to outbreak development. InterpretationThese findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing, and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions. FundingNational Institute of General Medical Sciences, National Institutes of Health. Research in contextO_ST_ABSEvidence beforeC_ST_ABSPreserving healthcare from outbreaks of respiratory viruses is a longstanding concern, brought into sharp relief by the covid-19 pandemic. Early case series and numerous anecdotal reports suggest that health care workers (HCWs) and patients receiving treatment for conditions other than SARS-CoV-2 infection are at elevated risk of becoming infected, and the consequences of infections in long term care facilities are well known. In addition, the early stages of the pandemic have been marked by shortages of personal protective equipment (PPE) and diagnostic testing, but the most effective strategies for their use given the specific characteristics of SARS-CoV-2 transmission are unclear. Value addedOur research plainly shows the importance of presymptomatic transmission. Given reasonable estimates of this, random testing of currently asymptomatic staff and patients once a week is not able to prevent large outbreaks. We show that PPE is, as expected, the most effective intervention and moreover even suboptimal PPE use is highly beneficial. To further limit transmission, we show the benefit of sub-cohorting into smaller groups of HCWs and patients. When the force of infection in the community is low, this can entirely prevent the establishment of infection in a large fraction of healthcare. ImplicationsPPE should be used throughout healthcare, on the assumption that any patient or HCWs is potentially infected. Further work should determine the most effective means of PPE for the non-COVID cohort. If PPE resources are limited, whether in general or due to a second surge, we recommend subcohorting to limit the impact of introductions from the community.
