Good tracing holds the key to Christmas cheer
" ...We saw good reason for confidence. The states and territories have boosted investments and readiness, and their handling of the pandemic is effective. What they need to know is that their neighbours are similarly prepared."
Dr Finkel published an editorial in the Herald Sun newspaper on Saturday 14 November 2020.
The full editorial is available below.
As we made a flying visit to each state and territory last month, we were struck by how similar it felt to international travel.
Most jurisdictions had what felt like immigration and customs. We had to apply for exemptions, a bit like getting a visa. At borders we faced defence, police and civilian officials, and questions about our health and recent travel.
Of course, we knew there would be border processes. That was the reason for the trip, after I was asked by National Cabinet to chair a panel to review testing and tracing systems to determine preparedness for reopening.
The reception we received was invariably enthusiastic and helpful — typically Australian. But to experience the border processes first-hand crystallised how much they are at odds with normally unfettered travel within Australia.
It brought home to our panel that open domestic borders and an active economy will depend on whether the states and territories, and the public more widely, have confidence in the procedures for testing, tracing and outbreak management in each jurisdiction.
We saw good reason for confidence. The states and territories have boosted investments and readiness, and their handling of the pandemic is effective.
What they need to know is that their neighbours are similarly prepared.
To this end, our report outlines optimal characteristics that the states and territories can use to evaluate their own testing, tracing and outbreak management systems. This includes transparency measures such as the daily and weekly publication of simple-to-understand performance metrics.
We recommended a shorter turnaround for notifying close contacts that they must quarantine. The national target has been 48 hours from a confirmed test result to notifying close contacts.
Going forward, the 48 hour clock should start from the time a swab is taken, not from the reporting of a confirmed test result.
Among other key metrics, we recommended no more than 24 hours from when a test swab is taken to reporting the result to the patient, a short enough time that people will not be discouraged from taking a test.
In the medium term, Australia needs a system for case and contact tracing across domestic borders. For this purpose, we recommended the development of a digital exchange, using data such as contact details from airline passenger lists, government databases, diagnostic test information and contact tracing databases.
To protect privacy, it would only exchange information relevant to contact tracing, such as phone numbers, addresses and test results, and no data would be stored in the exchange itself.
The experience of Victoria has been salutary. The fast acceleration of case numbers in July put the nation on alert.
The success in bringing numbers down from a daily peak of approximately 700 in early August to zero by the end of October gave the nation heart.
Victoria has now invested in improving all aspects of its public health management.
It has transitioned from manual and paper systems for testing, pathology and interviews to a system that is well on its way to being digital end to end.
The need for as much digitisation and automation as possible across the states and territories is one of the recommendations in our report. Technologies such as smartphone apps and web portals should be used for managing home quarantine and for contact tracing.
We suggest the jurisdictions adopt attendance apps for venues that are as simple as “click and enter”, with only an email or phone number shared. The ACT has developed an app of this kind.
Our blueprint has other measures for optimal management of the pandemic, including well-trained permanent public health workforces in each jurisdiction and access to surge workforces from interstate and the commonwealth, and regular stress testing.
We are in a good place in Australia partly because of our collegiate governance, the cooperation of the public, the commitment of all jurisdictions and the willingness to listen to health experts.
However, we emphasise in our report that any system for testing and tracing is only as good as its weakest link and no jurisdiction can afford to let down its guard.
We also stress that while testing, tracing and outbreak management systems must be prepared, it is more important to avoid transmission in the first place.
Complacency is dangerous. In the absence of a vaccine or effective therapeutic, the frontline is physical distancing, personal hygiene, mask wearing where appropriate, attendance limits on public gatherings, extra protections for vulnerable communities and quarantine of high-risk international arrivals.
With these measures, backed by strong systems for testing, contact tracing and outbreak management, we believe Australia’s economy can open up by Christmas without a significant risk of new waves of disease and without the need for the domestic border closures that have been a feature of our winter months.
Dr Alan Finkel chaired a panel on testing tracing and outbreak management, with members Tarun Weeramanthri, President of the Public Health Association of Australia, and Leigh Jasper, cofounder of Aconex.