Australia is already embarking on its living with Covid-19 plan. What can we learn from other countries that has not yet been widely discussed in Australia?
The UAE, Canada and Hong Kong offer unique insights for Australia in terms of Covid-19 at this phase of the pandemic.
The UAE has the highest proportion of population vaccinated in the world (even surpassing Portugal). It experienced a moderate level of infection with Covid so is more like Australia in terms of “natural immunity” versus Portugal, the UK or the US, which have had devastating waves of disease.
Hong Kong is also an experience worth watching, as they learned lessons from the original Sars in 2003 and continue to aim for Covid zero.
Canada has a higher proportion of its total population vaccinated than Australia, but some provinces have similar vaccination rates to states in Australia.
Re-open gradually with indoor masks, vaccine passports, capacity restrictions and attention to ventilation
Australia has 53% of its total population double dose vaccinated. NSW leads the way with 78% of its population aged over 16 double vaccinated and 91% having received a single dose. As a proportion of the total 8.2 million population, that is 65% double dose and 73% single dose vaccinated. But vaccination is not all that is needed against Covid-19.
There is no singular list of factors that are currently required to live “well” with Covid-19. We can observe patterns from other countries and learn from these.
Countries doing “well” with Covid-19 currently are mostly high-income countries; they procured sufficient and early supply of multiple vaccines; have a public which is trusting of government; experience clear messaging and transparency from government; have good quality digital databases (eg for healthcare utilisation and planning, contact tracing, vaccination); combine high testing rates with contact tracing along with quarantine/isolation of Covid cases and contacts.
Countries living “well” with Covid-19 have greater equity across society (socioeconomic, education, access to care, access to vaccines).
Those countries doing “well” have implemented phased re-opening in conjunction with high vaccination of the total population including teens (or moderate vaccination levels with prior significant Covid-19 infections in the country).
They have re-opened gradually with indoor mask wearing including in schools, vaccine passports, indoor capacity restrictions and attention to ventilation of indoor venues.
Countries that loosen restrictions too quickly and/or with insufficient vaccination coverage (and/or natural immunity) have needed to return to strict restrictions.
The UAE had fewer people infected with Covid-19 than Portugal, so it is more Covid-19 naive, immunity wise, and thus more similar to Australia and may make a better comparison than Portugal.
The UAE had a similar experience to many countries through 2020 – building field hospitals and providing drive-through PCR testing, tracking wastewater for viral fragments to understand community spread, and needing social distancing restrictions to slow spread.
Currently, the UAE is the most vaccinated country in the world (86% double dose, 96% single dose), surpassing even Portugal’s 85% and 87% respectively. In August the UAE gave emergency approval for the Sinopharm vaccine to be provided to children three years and older.
The strong vaccination response has been attributed to the UAE government campaign called “Together We Recover”, as well as religious leaders sharing that vaccines were allowable under Islam. 71% of UAE residents said they feel well informed about Covid-19 vaccines.
The UAE has taken a unified national approach to the Covid response across the seven emirates, has a Covidsafe equivalent contact tracing app (Al Hosn), is vaccinating teens and providing boosters to high-risk individuals at three months after their second dose and six months later for all others.
Unvaccinated people have their movement and access to some places restricted, like in Australia. The UAE currently has a 7-day average of 245 Covid-19 cases. As in Australia, the majority of those hospitalised with Covid in UAE are not vaccinated – for similar reasons (uncertainty over which vaccine to take, hesitancy over vaccines in general, hesitancy over Covid-19 vaccines).
The UAE is building a Covid-19 vaccine manufacturing factory and businesses are giving discounts to people who have been vaccinated (eg free coffee or hotel stays).
Hong Kong is interesting for different reasons. Hong Kong experienced the brunt of the original Sars back in 2003 (when 1,755 Sars cases and 298 deaths occurred). There were three waves of the original Sars epidemic for HK, and they’ve had three waves thus far with Covid-19.
A publication following the original Sars in 2003 in HK said that: “The epidemic produced not only health but also social, economic and humanitarian problems. The epidemic, however, created a strong sense of unity among all sectors of the population in the fight against the disease.”
As of Sept 1, 2021 HK remains dedicated to a Covid zero approach, with strong public support – potentially assisted by the government Anti-Epidemic Fund supporting residents through restrictions.
Their Covid Zero approach has halted discussions with Singapore regarding previous plans for a travel bubble. HK has about four cases a day spending three weeks in hotel quarantine. Data on every case is publicly available, including naming where each case was infected.
HK plans to re-assess its restrictions on 27 Oct but, for now, masks are mandatory inside and out, QR codes assist with contact tracing, venues have capacity restrictions and there is restricted travel between regions.
Half of HK residents have downloaded the Leave Home Safe contact tracing app (28% of Australians downloaded the Covidsafe app).
Interestingly, instead of two dose vaccination being a requirement for entry into indoor venues as in Australia, in HK there is a requirement for only 2/3 of customers to have received at least the first dose of a Covid-19 vaccine.
Schools in HK with a 70% vaccination rate for teachers and students can attend face-to-face classes. In HK 62% of the total population has received two doses of a Covid-19 vaccine, in comparison to Australia’s 53%.
HK vaccination coverage is similar to Australia’s in younger age groups but surprisingly vaccination coverage in the elderly is poor in HK, with only about 25% of those older than 70 years of age double vaccinated.
Like Australia, HK’s legislation on the public health state of emergency has been extended to March 2022.
Canada is akin to Australia as provinces (like the states) have control over their health systems and public health policies – leading to vast differences nationally.
Alberta’s Covid response stands out as worth learning about. It has a population of 4.5 million (about half of NSW’s 8.2 million). Alberta is experiencing a terrible time currently with Covid-19. It has 65% of its population double dosed with a vaccine (NSW is also 65%), yet removed all public health restrictions in July 2021 when 70% of its total population had one dose of a vaccine.
The people of Alberta have suffered due to a lack of government transparency, initially failing to share its own predictive modelling with the public. Instead the premier promised Albertans their “best summer ever”, which now has been called the “last summer ever” for many.
Today it has been said that Alberta’s healthcare system has “collapsed”. Even with surge capacity in terms of beds, there are insufficient staff. Ten per cent of schools in Alberta have Covid-19 outbreaks. Yet the province continues with few public health measures.
Of particular note is Alberta’s dismal testing rate and policy regarding Covid- positive people. The province conducts about 16,000 Covid tests each day and has a 10.3% test positivity rate. This has important implications for its ability to contact trace and therefore the ability to reduce transmission and limit future case numbers.
Even those who test positive to Covid-19 do not need to isolate in Alberta.
Compare this to NSW, which is regularly doing more than 80,000 tests a day and a 0.4% test positivity rate, along with clear rules regarding isolation when Covid-positive or a contact, and public health measures like masks and other restrictions.
In this phase of the pandemic, in order to reduce the healthcare burden and deaths (and ultimately improve economic situations), countries should vaccinate their populations, stick to the science and transparent reporting, while keeping some public health measures like masks, distancing, cohorting, ventilation, vaccine passports, contact tracing and isolation of positive individuals.
Now, and for future pandemics, countries need to build resilient healthcare systems (including digital systems), protect health workers, support science and fight misinformation, invest in vaccination from development to implementation, focus on equity, and think in terms of one globe, one health.