Almost 40,000 Australians are trapped abroad because of the Covid-19 epidemic. Many have been trying to return for more than a year. Many in countries with raging epidemics, such as India and Brazil are in real danger of personal infection. Many new viral ‘variants’ are more infectious and can cause serious disease in younger populations than was the case with the first generation of SARS-2-Cov.
Certainly the Federal government must prioritise the protection of the resident population from COVID-19. However its moral obligation to protect all Australians demands that it constantly seeks innovative strategies to get our fellow Australians home in a way that doe not threaten our national Covid security. It’s heartbreaking to think of the financial and emotional toll being experienced by so many of our fellow Australians.
The major limiting factor with our current situation is the lack of sufficient hotel based capacity for the quarantining required for a two weeks stay by all returning home. Apart from capacity issues, we know that human error and the fact that the hotels used are not ‘fit for purpose’ in terms of the ventilation requirements to contain aerosolised virus, has been responsible for all recent escapes of virus into our communities. However if we had thousands more hotel rooms we could manage these deficiencies with our contact tracing capacity and get trapped Australians home. But we don’t have these rooms.
This reality has fuelled the debate about the need to immediately start building adequately designed facilities for safe quarantining. We have such a facility in the Northern Territory and Victoria has announced it will build one. This will be expensive but will certainly be supported by the clinical/scientific community.
We are years away from containing the global Covid epidemic and all indications are that we should be preparing now for COVID-25. We have had increasingly damaging Corona virus outbreaks ( 2003, 2011, 2019) and we must prepare for more even as we struggle to contain the current epidemic.
The same forward thinking sees States building and maintaining desalination plants for the droughts ahead, despite the costs. ($21 million per year for the NSW plant).There is much more that we need to do in terms of preparation for foreseeable future battles with microbes but that is a discussion for another time.
The above strategy will not help with our current crisis for trapped Australians. Can recent scientific studies of SARS- 2 and vaccines help?
The challenge is to find a way to bring Australians home and allow them to self-isolate at home, rather than in a hotel, without putting resident Australians at risk from so doing.
Imagine that Mr and Mrs Smith, trapped in New Delhi for the last few months, desperate to get home and scared that they may get infected in a country with neither hospital beds nor oxygen are available, get a message on their phone from the Australian High Commission in New Delhi with whom they are registered.
The message says that they can return to Australia in three weeks under certain conditions. If they have not been vaccinated they are to come to the Commission at a given time for a Covid test. If negative, as anticipated, they will be given a first dose of the AstraZeneca vaccine. They will be booked on a flight home three weeks later. Until then they are to be diligent about the continuation of all public health measures that would best protect them from infection.
They will be tested the day before the flight which they would not be able to take in the extraordinarily unlikely circumstance that this Covid test was positive. On arriving in Australia they would be require to wear a mask on arrival and would be tested yet again. If negative, as would almost certainly be the case, they would be allowed to exit the airport via a ‘red zone’ and go to their home for two weeks of self isolation. The chance that individuals subjected to this protocol would pose any threat to the resident community is virtually nil.
Let’s look at the logistics and the data to support this approach. Standard nasal swab testing for SARS (PCR) can detect infection before symptoms develop, indeed in many cases infection is not associated with any symptoms creating the well known “silent spreader” phenomenon. As it can take a few days after infection for the PCR test to be positive it is possible, though highly unlikely, that Mr and Mrs Smith’s first negative test could be a false negative hence the need to retest later in the safe return protocol.
Three weeks after one dose of the AstraZenica vaccine 76% of recipients are fully protected and that immunity lasts three months after which the standard protocol calls for a booster dose. Importantly, the one dose provides almost 100% protection from serious COVID related illness. I am sure the very small risk associated with the AZ vaccine would pale into insignificance for Australians desperate to get home.
So as Mr and Mrs Smith prepare to come home they are protected. However none of the COVID vaccines reliably produce sterilising immunity. It is possible to be fully protected but still have virus in secretions that one might “shed” as aerosolised particles.
Vaccination certainly reduces the incidence of shedding but to protect people the Smiths may come in contact with on the way home and those that they will meet after returning, the second negative PCR is required. If that is negative, as would be the case in the vast majority of those enrolled in the return program, we can have every confidence that the Smiths pose no threat to the Australian community.
Two weeks of self isolation in these circumstances, while not shown to be essential from scientific studies, would provide government and community with maximum confidence in the protocol. I am confident we could safely return 3000 Australians a month with this protocol.
Compare this approach to the one proposed by our Federal government which says not only can you not come home, but if you do so you could spend 5 years jail and be fined $66,000.
I realise the logistics are difficult but achievable. We are dealing with a huge crisis that demands an unprecedented commitment to a major logistic challenge.
It requires our diplomatic agencies abroad to sign onto the program. It requires stranded Australians to be registered with these agencies. We would supply AZ vaccine to these embassies, consulates, high commissions etc. We have a surplus of AZ vaccine here at the moment and we are making millions of doses a month for use here (sluggish) and to countries we will help vaccinate their communities. The AZ vaccine is easy to handle and can be stored in a regular refrigerator.
How would we get the vaccines to our agencies? DHL, Fed Express, and even the Air Force could help. I remember flying from Sydney to Melbourne in the bosom of a huge Hercules aircraft during the commercial airline strike in the 80’s. Logistics experts need to be major partners of this initiative.
Who would give the injections, arrange the PCR tests and make the flight bookings? I could explore options here but I am certain these are not overly difficult issues. I would envisage a “Bring them Home” coordination centre here funded by the Federal Government and charged with oversight management of the project.
As for the tragic and urgent Indian crisis, I am aware that our High Commission in New Delhi has branches in all the major Indian cities. It is a long time ago, but when I regularly visited India as part of the Australian effort to help that country with its AIDS epidemic, the Delhi High Commission was well staffed with officials willing to help.
Most Australians who are desperate to come home are not in India but the protocol outlined could be applied globally. We need to work out the payment protocol for flights home though I am confident Australians would be comfortable with government assistance being available.
Some countries are bringing their citizens home and supplementing the requirement for self-isolation with electronic devices that monitor compliance. Hong Kong and some other jurisdictions have people wearing tracker wrist watches. Poland has the self isolated needing to take selfies at random to times to show their location. Some countries are exploring the use of ankle bracelets! Such tactics would be unacceptable (and unnecessary) here, though we do have fines for those who breach Covid regulations. Many countries have accepted the imperative moral responsibility for getting stranded citizens home. We must do the same.