18 March 2020

100+ indoor gatherings banned; school closures debated

Communicable Disease Policy Public Health Travel

The federal government has introduced its toughest measures yet to contain the spread of COVID-19, banning all non-essential indoor gatherings of more than 100 people and advising Australians not to travel abroad.

The ban on gatherings of more than 500 people will remain in place for outdoor gatherings, Prime Minister Scott Morrison announced this morning.

Supermarkets, retail stores, shopping centres, parliaments, office buildings, factories and construction sites could remain open for business as these were considered essential. The ban would also not affect airports, public transport, medical and health service facilities, emergency service facilities, disability or aged care facilities, correctional facilities, courts or tribunals.

And despite the tight restrictions on indoor gatherings, schools will remain open until further notice despite mounting pressure from medical groups and others to close them.

The federal government has also put in place an indefinite and unprecedented level-four travel ban for the world. As of this morning, the travel advice for all Australians wanting to go overseas was “Do Not Travel”.

People who had returned from overseas – or had been in contact with a confirmed case of COVID-19 – in the past 14 days would not be permitted to visit aged care facilities, Mr Morrison said.

This ban would also extend to people with a fever or acute respiratory infection and people who had not been vaccinated against influenza after the 1st of May, he said.

The federal government had instructed aged care facilities to limit visits to a short duration with a maximum of two visitors at one time per day.

Aged care facilities could use their discretion to determine how to manage family meetings for patients in end of life care, Mr Morrison said.

“Visits should be conducted in a resident’s room, outdoors or in a specific area designated by the facility, rather than communal areas where the risk of transmission to other residents is greater,” he said.

“This is a once-in-a-100-year-type event,” Mr Morrison said. “We haven’t seen this sort of thing in Australia since the end of the First World War.”

 The debate around school closures

Meanwhile, pressure has been mounting on the federal government to also close schools, but the measure is controversial.

A letter sent to health minister Greg Hunt over the weekend signed by 2,476 doctors called for the immediate closure of schools, cultural and religious places, gyms and leisure centres, pubs, bars, theatres, cinemas and concert halls for three to four weeks.

“[COVID-19] is already picking up speed,” said Perth GP Dr Hemant Garg, who wrote the letter. “And if we wait until the end of the week on this, then we’ve got another doubling of cases.”

Federal health minister Greg Hunt said this morning that the chief medical officer Professor Brendan Murphy had not ruled out school closures in the future.

However, Professor Murphy was being cautious because children were less likely to contract COVID-19 and the disease had a lower impact than it did on older people, said Mr Hunt.

Mass school closures would impact emergency service workers and health workers who would need to look after their children at home, he said. Young people would be more likely to come in contact with grandparents if they were not in school, said Mr Hunt.

These statements mirrored those made by Brett Sutton, the chief health officer director for the Victorian state government.

Associate Professor James Wood, an applied mathematician at UNSW who has been helping the federal government with COVID-19 disease modelling, said that school closures would reduce COVID-19 spread by around 15%.

“I’ve no specific problem with school closure as a measure,” he told The Medical Republic.

“I expect of itself that it will reduce transmission by say ~15%, whereas it looks like we need to be more at around a 60-70% reduction (and sustain it for perhaps months at a time) to have really beneficial effects in stopping transmission.

“If we’re going to do other economically disruptive things like close workplaces, bars, clubs, churches, cinemas etc then closing schools makes perfect sense alongside them.”

Professor Wood said the “conversation is shifting” around school closures, with a report published 16 March by Imperial College London that considered the measure for the US and UK.

The main drawback to closing schools was that healthcare workers might be unable to attend work because they had to look after their children, the report said.

Associate Professor Rachel Wilson, an education researcher at The University of Sydney, told The Medical Republic that Australia could consider “skeleton” schools, where only children who cannot be cared for at home attend, and all students complete online coursework.

There was some research to back up school closures before the rate of transmission became exponential, she said, pointing to three studies on influenza pandemics (1,2, and 3).

Professor John Hall, the president of the Rural Doctors Association of Australia, supports the closure of schools, and the cancelling of all gatherings, as soon as possible.

“Anything that we can do to minimise the spread of COVID-19 is going to flatten the curve,” he said. “It’s going to reduce the peak or the surge in demand on our hospital systems.”

COVID-19 was incredibly infectious and, which only 1-2% of Australians would become seriously ill from the disease, that was enough to overload hospitals, he said.

“And we know that in other countries where they haven’t put in these measures around social distancing, cancelling large gatherings, minimising essential travel and, and really hyper vigilant hand washing, they had a massive spike in numbers.

“It’s overwhelmed their hospital system and they’ve had to turn people away from intensive care. And if people can’t get into an intensive care, they die. So, there’ll be people with non-COVID-19 related illnesses like car accidents and heart attacks that can’t get an ICU bed if our system is overwhelmed.”

However, school closures remain a controversial measure.

The AMA told ABC News, it did not believe the actions proposed in the letter were necessary yet.

“[Chief medical officer] Professor Brendan Murphy … will provide advice on these matters at the appropriate time, based on the best available medical evidence,” the AMA said.

Allen Cheng, a professor of infectious diseases epidemiology at Monash University in Melbourne, told The Medical Republic that school closures should not occur right now.

“No, we shouldn’t close schools at the moment (other than short term closures for contact tracing and cleaning),” he said.

“As far as I’m aware, there haven’t been any large-scale school outbreaks (in contrast to the many large outbreaks related to gatherings of adults e.g. conferences, religious gatherings, large family gatherings).

“Children under-represented in reported case numbers and potential for infected children to transmit is uncertain.”

 

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