The latest isolation rules for critical workers strike the right balance. But that’s not the end of the story
Thousands of additional essential workers will be allowed to return to work rather than having to self-isolate for seven days, under new rules agreed by the national cabinet.
High-risk close contacts — those who live with someone who has COVID-19 — must take a negative rapid antigen test on day one, show no symptoms, and follow certain rules.
These include wearing a mask at work, carrying out rapid antigen tests every other day until day six and monitoring symptoms for 14 days. They can only leave quarantine to get to and from work.
Any worker in these categories who develops symptoms will be required to leave work immediately. Anyone who tests positive will also be required to self-isolate.
The move is designed to stem staffing shortages and maintain essential services in the face of high COVID infection rates and growing numbers of lone workers.
Food logistics workers and healthcare staff already had different self-isolation requirements than most others. However, the new rules also apply to first aiders, teachers and childcare staff, among others.
This is a commensurate risk management response at this stage of the pandemic, when so many of us are being vaccinated and receiving booster shots.
However, we need to watch closely how the changes influence the number of cases in these critical workplaces.
This is how we can increase or decrease future public health measures in response to changing conditions, including any future variations.
What are the benefits?
The Treasury estimates that existing isolation arrangements could see 10% of workers, including those in critical industries, out of the workforce. If schools closed and parents had to stay home to care for children, he estimates an additional 5% would be off work.
This latest announcement therefore aims to strike the optimal balance between freeing up our industry and education sector as much as possible to return to work and maintaining a ceiling on the risk of infection.
This balance has changed over time. We now know that Omicron generally causes less severe disease in most people than previous variants, and the risk is further reduced because many of us are vaccinated and given booster shots.
Teachers have been added to the list of workers who can return to work under these new rules. This should give us more confidence when planning the reopening of schools after the summer holidays.
Ensuring schools stay open, with teachers to staff them, is not only essential, but also a matter of equity – we know that school closures disproportionately affect disadvantaged students.
Allowing other essential workers to return to work while balancing risk is also a matter of fairness. This latest decision means that people who have been disproportionately affected by the pandemic so far – including young workers, casual workers, people from lower socio-economic groups – can return to work and not lose revenue.
What are the risks ? How do we manage them?
Yes, we need to manage the risk of more infections at work. But we are far from having zero fund risk as it stands.
The virus is already present in many workplaces. And only a fraction of infections involve people who would meet the definition of close household contact; they could have caught the virus at the pub or from socializing.
We also know from experience that people often wait two to three days after developing symptoms to get tested and wait even longer for a result. So by the time they know their status, they may have been infected for a week or more, with their housemates likely already infected and unknowingly taking the virus to work.
The latest changes also rely on rapid antigen testing to clear people to work, which comes with its own risks. Home-use rapid antigen tests may miss some infections, especially early in the infection. In other words, some infectious people will test negative, risking returning to work while being able to transmit the virus to others unknowingly.
That’s why the latest changes call for rapid antigen testing every other day. This makes it less likely that you will repeatedly miss an actual infection. Repeated testing also means you can detect those who incubate the virus longer before becoming infectious.
There is some evidence that the reliability of rapid antigen testing may increase later in the traditional isolation period, which is more likely to overlap with the period when a contact knows they should quarantine or test work if they is asymptomatic.
Workplaces and workers still need to minimize the risk of onward transmission for these identified at-risk groups of workers. For example, there will be different rules for wearing personal protective equipment, and returning workers will still be entitled to breaks, but they will not be allowed to sit with other people.
After all, it is in the interests of industries to manage this well to keep enough employees healthy and working.
So what we have with these latest changes is a marginal increase in risk that relies on testing, symptom monitoring, and safe work practices.
What should happen next?
I would like to see some additional measures in place to monitor these changes. These will tell us if we should increase or decrease public health measures for this current wave and for future variants.
The number of infections should be monitored by occupation to look for signs of spikes in particular occupational groups. The number of cases is not the best measure because testing patterns change in the community and over time, but it would still detect large changes in infection patterns, especially in critical parameters that require now testing.
After the peak of the current wave passes, we should sample personnel from key industries to see how many are infected and monitor this over time (called surveillance). Ideally, we look at infection rates before and after changing public health measures to measure the impact. This then allows us to design and manage quarantine and testing rules with greater precision in the future.
We could target high-risk workplaces like butcher shops. These could be the canary in the mine. If case rates are OK there, they’re probably OK everywhere.
We also need to change the way we test
We should move more widely from PCR testing to surveillance testing as Australia learns to live with the virus. This is an approach that South Africa is taking.
If monitoring doesn’t suggest the numbers are rising and there’s no change in hospital patterns, then it’s business as usual. So rather than slamming the brakes with the kinds of strict public health measures we’ve seen in the past, we’re tapping the brakes lightly or simply decelerating. We do this when we see a change in infection patterns or new variants – minimum parameters with the greatest potential for disease control.
It’s no longer about blanket lockdowns, but we have to be careful to avoid the phantom lockdowns we’re seeing right now. We must also invest in the assessments we need to more accurately manage the risk of transmission in the workplace and in educational institutions in the future.
Professor Catherine Bennett is the chair of epidemiology at Deakin University. This piece first appeared on The Conversation.