COVID restrictions are easing but the pandemic is not over; here's how services can manage this new phase

Last week the NSW Government announced that from 7 March, masks are no longer required indoors in education and care settings. Advice to services sent from the NSW Department of Education on 23 February stated that the decision around masks is now placed on individual services:

“NSW Health continues to recommend the wearing of masks indoors when you cannot socially distance, and this will now be a decision for services and educators to determine.
 
Your staff and visitors in ECE services should continue to be supported to wear a mask should they choose to do so.”

As for QR codes, they are no longer required and not even recommended.

With restrictions easing, the priority for keeping children and educators safe remains.

Omicron may be past its peak, but the pandemic is not yet over

As of 27 February, there were an average of 23,082 cases reported each day over the preceding week^₁. This represents a significant drop when compared with an average 70,708 cases as was the situation on 11 January².

While many services may welcome the autonomy to decide what is appropriate, others are concerned. In our Omicron in Preschools Pulse Check survey which closed late last week, many respondents expressed dismay at the relaxation of rules. One respondent wrote:

We need to keep the current level of restrictions in services as children are not vaccinated and many staff have not as yet caught covid or have health issues making them more vulnerable.

Another wrote:

I strongly believe we should be continuing with surveillance RATs for a while longer as well as mask wearing, particularly indoors. I appreciate the department providing the RATs. Omicron is raging through all the local schools and every day we have a few children identified as close contacts or they test positive for COVID while isolating. We have also had a couple of staff isolate as a close contact or while having COVID. I am very concerned about the rules being relaxed and don’t think the government is considering the staff and children who will end up with COVID. The majority of our staff team feel the same. The government keeps going on about how mild it is and we just have to get used to it but many people still get very sick and are hospitalised. It is so contagious. We still need to have some restrictions to protect the vulnerable and those with immune deficiencies etc. The government is only thinking about the economy, not children, staff and families.

Experts at OzSAGE, a multi-disciplinary network of independent Australian experts from a broad range of sectors relevant to the well-being of the Australian population during the pandemic, strongly advised against removing all restrictions in a recent press relase³.

Ozsage notes that more deaths from Omicron occurred in one month (January) than the entire two previous years of the pandemic. In their video press release, available on their website, the panel notes that there were about 20,000 COVID-19 cases in NSW schools and 10,000 in Victorian schools during the week 14-18 February.

OzSAGE experts believes that vaccination alone is not enough.

The panel recommends:

Retaining masks indoors and high quality respirators (N95/P2/KF94/FFP2 masks);
Initiating widespread education on the importance of higher quality masks and how to wear them;
Providing free RATs;
Expanding PCR testing capacity followed by Tracing, Isolation and Quarantine and expand surveillance for emerging variants;
Retaining QR Codes;
Mandating and regulating indoor environments to ensure adequate ventilation – especially schools and early learning; and
Planning logistics to vaccinate children aged 6 months to 5 years and increase 3rd dose vaccination rate.

(Source: Media Release: OzSAGE recommends against removing all preventive measures against COVID-19)

Why is OzSAGE so concerned about the relaxation of rules?

OzSAGE refer to new research⁴ showing that about 37 per cent of people had long-term effects after a month of having COVID-19 including serious neurological side-effects as well as double the risk of heart failure, blood clots and stroke a year after infection. Significantly, they note a research finding that the risk of developing or acquiring long COVID is associated with the amount of viral load you’ve been exposed to. In other words, if a person breathes in a large amount of air containing viral particles, they are more likely to develop long COVID than someone who only breathed in a small amount due to having most of their air filtered by a respirator.

OzSAGE state that not enough is known yet about vaccine waning and when/if to do the fourth dose, and note that the efficacy of the 3rd dose starts to wane at 3 months.

However, the expert panel does say that COVID-19 is epidemic, meaning it comes in waves and that we will continue to see this as a pattern. Surging reinfections are occurring overseas and will occur here.

All of that being said, OzSAGE believe we can live comfortably and safely with COVID-19 if we continue preventive measures like masks, vaccination, testing and surveillance.

With the end of Government directions regarding masks and ventilation, what should services do?

Consider vulnerable people in your service, be precautionary and beware of misleading comparisons in the media

While many of our direct experiences with COVID-19 may have seemed relatively benign, as the research referred to above shows, COVID-19 remains a serious disease. In its 8 February press release, OzSAGE castigated what they saw as potentially misleading comparisons with other causes of death. They noted that in the month of January alone, 1,532 people died from COVID-19. This number was much higher than 2020 monthly causes of death. The ‘runner-up’ for causes of death was heart disease, causing on average 1,382 deaths per month. OzSAGE produce a more robust comparison of COVID-19 deaths against influenza and road traffic in their article, which we reproduce below:

Chart via OzSage press release

COVID-19 is even more serious for those people with an underlying health condition. As OzSAGE notes, over half the NSW population has a chronic disease of some kind, and one in five people in NSW have a disability. NSW also has the largest Aboriginal population in Australia. For these communities and groups, removal of COVID-19 prevention measures and high levels of transmission is more likely to be fatal or cause severe complications.

With children being too young to receive a COVID-19 vaccination, the 0-4s are the largest group of unvaccinated people who regularly congregate. COVID-19 is more mild in children than it is in adults, but there is still much which is unknown about the long-term effects of COVID-19 in children.

Combined, these factors mean it is appropriate that educators do all they can to be cautious in their approach to maximise the safety of children, educators working at the service and vulnerable family members connected to the service.

Get better masks

OzSAGE notes that given the very high transmissibility of Omicron, high quality face coverings that provide filtration are critically important. They recommend that N95/P2/KF94/FFP2 face coverings are the most appropriate⁵. Unlike respirators where air is only breathed in through the mask material filtering the air, surgical masks do not seal around the face, so unfiltered air is breathed in via the gaps around the mask. Respirators, when sealed to the face, are designed to filter out these small particles containing virus. 

This is particularly pertinent when considering research that shows that the amount of virus a person is exposed to correlates with the likelihood of later developing long COVID⁶.

Consider maintaining masks indoors and at pick up and drop off and use/update service policies to enforce

Services may wish to adopt a policy whereby educators continue to wear masks indoors. Education and care services can also, if they wish, adopt a policy requiring families to wear a mask at drop-off and pick-up. If the Approved Provider decides to adopt such policies, it will be important to:

communicate the relevant service policy and rationale to educators and families;
provide educators with the words to remind families to wear masks and what to say if they encounter refusal;
have masks on hand for families who may forget to bring a mask;

remind educators of your complaints process if some families are refusing to wear a mask;
remind families who believe that the policy is inappropriate of your complaints policy and process so that they may make a complaint if they wish.

Ensure you have appropriate ventilation

CELA wrote an extended piece about the importance of ventilation last year – in case you missed it, read it here.

The advice shared in the article is still relevant, and good ventilation will remain vital. The Victorian Government has offered early education and care services access to funding to ensure ventilation is adequate to minimise transmission and CELA has called on the NSW Government to offer similar support to services in NSW.

Maintain a safe workplace

OzSAGE is deeply concerned about NSW Parliamentary lower house decision that workers cannot have access to workers compensation for COVID-19 unless they can prove it was contracted at work⁷. This measure would reduce the onus on employers to provide a safe workplace.

As OzSAGE writes in its 21 February Media Release:

This will mean teachers and health workers have to go to work with no recourse if they get seriously ill or disabled from COVID-19 caught at work, while simultaneously facing high levels of infection because of removal of preventive measures to reduce SARS-COV-2 transmission.

While all of this works its way through parliament, given that children are too young to be vaccinated, and given the early education and care workforce is already experiencing significant professional fatigue, it is a no-brainer that responsible Approved Providers should ensure their staff feel safe while at work. This should include providing adequate ventilation, regular and thorough cleaning, and mask wearing as much as possible.

What we are advocating for

Last week CELA wrote to Minister Mitchell requesting that consideration be given to enable education and care services to access grants to help off-set the cost of purchasing air purifiers, CO2 monitors, modifications to learning spaces and additional RATs – similar to the $4,500 grants which the Victorian Government has made available.