Richardson: The anxiety of SA’s COVID Christmas

Learning to live with COVID has made for an unusually anxious Christmas week, writes Tom Richardson.

Dec 20, 2021, updated Dec 20, 2021
Chief Public Health Officer Nicola Spurrier on Friday, flanked by Police Commissioner Grant Stevens. Photo: Tony Lewis / InDaily

Chief Public Health Officer Nicola Spurrier on Friday, flanked by Police Commissioner Grant Stevens. Photo: Tony Lewis / InDaily

In a radio interview this morning, Police Commissioner and state emergency coordinator Grant Stevens made a couple of telling, if obvious, admissions.

The first was a concession that the state’s TTIQ [Test, Trace, Isolate and Quarantine] model had necessarily evolved due to a combination of limited resourcing and growing COVID caseloads – something he said was all part of the plan.

“It was always expected as our case numbers grow that the number of staff that are available to do contact tracing will have a limited capacity to investigate every possible contact from positive cases, and this is part of the planning for the introduction of COVID into South Australia – they shift in terms of how they manage that contact tracing process so… as much as it would be ideal to make contact with every possible close contact of a positive case, the reality is that with positive cases in the double digits every day that’s just not going to happen to the same extent.”

Which leads to the second admission, prompted by ABC Radio interviewer Spence Denny, who suggested it wouldn’t be long until the daily double digits become triple figures.

“That’s probably the likely scenario, but it’s one that was forecast,” said Stevens.

Was it though?

It’s worth revisiting the modelling done by the University of Adelaide (or the Doherty Institute, as the Government keeps calling them) that was used to sell the state’s November 23 border reopening plan.

This is, after all, to date the only specific SA modelling currently publicly available.

The specific scenario to which the SA Government committed allowed for an 80 per cent vaccination coverage in adults, maintaining existing activity restrictions – and, significantly, maintaining current “optimal” TTIQ settings.

Under this scenario, an outbreak was defined as SA “averaging more than 100 cases per day over any three- day period”.

We’re not there yet – the past three days have seen growing case numbers of 64, 73 and 80 respectively, each a new daily record for the state.

The modelling estimated the chance of an outbreak, thus defined, to be 27 per cent.

“Note the importance of attempting to maintain Optimal TTIQ in conjunction with these policy settings, with the chance of an outbreak estimated to increase to 68 per cent if Partial TTIQ was used only,” the document stated.

And yet, we already know now that, as Stevens said, “the number of staff that are available to do contact tracing will have a limited capacity to investigate every possible contact from positive cases”.

And, as with all modelling, the assumptions would only hold as long as the inputs remained consistent.

The Government, for example, took a fairly loose interpretation of the 80 per cent double vaccination benchmark before reopening the state’s borders.

SA was still short of that milestone when border controls were relaxed on November 23 – though we hit the 80 per cent mark sometime in the same weekend, around the 27th.

Interestingly, we may be taking a similarly loose approach to the next vaccination milestone, with a raft of ongoing restrictions – though not mask-wearing requirements or quarantine rules – set to be relaxed from December 28, when the Government says 90 per cent of the population will be fully vaxxed.

However, as of yesterday’s SA Health COVID update, 86.1 per cent of South Australians over 12 were double-dosed.

With just eight days until the next milestone date, it seems improbable the 90 per cent mark will be reached before the accompanying restrictions are relaxed.

Under the October modelling, an “outbreak” scenario of 100+ cases a day for three days – something Stevens now concedes is almost inevitable – “is estimated to be manageable with respect to hospital capacity”, with peak ward occupancy to reach a median of 36 and an “extremely small chance of demand exceeding 200 ward beds”.

As of yesterday, there were just four cases in hospital, with Stevens today reminding people “that the whole purpose of encouraging the community to be vaccinated was to ensure that we could safely manage COVID within our community and minimise the stress on the hospital system”.

“So that’s what we’re really watching quite closely, just how our hospital system is going at the moment – and at the moment things are looking pretty good,” he said.

So while he “fully expects the numbers of positive COVID cases to grow in the community”, Stevens says hospitalisations and ICU admissions have become “the key information for us”.

Indeed, he implied the number of new cases beyond that was almost redundant – despite the fact SA Health provides them in a daily update.

“I understand the level of community interest about positive cases… there is a high level of interest, it is being reported by the media, but I do think we’ll get to a point where the number of active cases is almost irrelevant,” he said.

Surely, however, this is relatively empty rhetoric.

The modelled hospital admissions are a function of the number of new cases – so you cannot, logically, regard soaring caseloads as irrelevant.

In reality, though, a different and competing anxiety has crept in as a symptom of the escalating caseloads.

When the modelling was released and the November 23 reopening date was flagged, the magnitude of the public impact was barely countenanced.

In fact, it was sold as a positive that the then-mandated 14-day quarantine period for close contacts of COVID cases would be halved for people who were fully vaccinated.

This selling point was underpinned by the Government’s newly devised matrix of how COVID ‘contacts’ were defined.

In it, a close contact was deemed someone “who has had at least 15 minutes face to face contact with a COVID-19 case and there is reasonable risk of transmission”.

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“This will include household contacts, extensive social interaction with a case or being present at a high risk setting,” the matrix read.

An image from there Government’s contact matrix released in October.

But it appears to be that latter point that is being bluntly enforced, with numerous dining and entertainment sites being designated as close contact locations in recent days.

As such, the mood in SA one week before Christmas has become one of anxiety that a simple meal or drink with friends could see you bundled into isolation for the next seven days.

This is a real and pervading mindset.

On the weekend, a mate of mine opted not to use his ticket for the Adelaide Oval Test, as he was due to visit family interstate this week and didn’t want to jeopardise the reunion.

I’m aware of others who made the same decision, and it was one I strongly considered myself.

In effect, we are imposing isolation on ourselves before it gets thrust upon us.

And it stands to reason that the higher the case numbers climb, the higher the chance that your next social event will see you pinged with an SA Health missive limiting you to quarters for seven days, or more.

Still, the anxiety may ease once Christmas is passed – unless the COVID caseloads continue to escalate.

The fact that the Government’s inputs have changed may make the published data less reliable in any case, but we have not yet seen how the impact of Omicron may affect the assumptions upon which our reopening was predicated.

Indeed, it’s not even clear if the Government has.

“I don’t think we know enough about Omicron yet,” chief public health officer Nicola Spurrier told ABC Radio this morning when asked whether SA would follow NSW in easing mask mandates.

“That was certainly what was shown in that [original] modelling, that it would be important to keep masks.

“This is a very dynamic situation… things keep changing, and I know it’s a lot of uncertainly and that makes people feel very anxious.”

She said various new inputs, including the emerging case numbers and transmission rates, would be plugged into the existing models in coming days “to try and do some forecasting”

“I’m looking forward to having some more information about that this week and it means that we can tweak our public health response,” she said.

Stevens notes that even with a plan for December 28, “the Omicron variant adds a level of uncertainty”

“We are still waiting for hard evidence in relation to the true nature of the Omicron variant, but we’re not seeing startling consequences from people who are contracting the Omicron variant in New South Wales, Victoria or even overseas,” he said.

“It is clearly more transmissible but we’re not seeing people being hospitalised in large numbers as a result of the new variant.

“So, if we take an optimistic view on that, we should be okay.”

Nonetheless, it would be prescient to await the data of how an expected influx of Omicron cases would likely impact the hospitalisation rates on which we have predicated our entire COVID plan.

That reopening plan, we were told, should not be considered SA’s so-called “Freedom Day”.

And it’s increasingly clear why not.

Tom Richardson is a senior reporter at InDaily.

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