NSW scraps home quarantine for returnees. What are the risks, and what does this mean for the rest of Australia?

New South Wales Premier Dominic Perrottet has announced that from November 1, quarantine will no longer be required for international arrivals who are fully vaccinated against COVID-19.

The federal government, which makes decisions about international borders, is supporting the plan to a point. Tourism will not reopen, with only Australian citizens, residents and their families eligible to return in the initial stages^[1]. Victoria also announced it was opening borders to fully vaccinated people coming from NSW^[2] without the need for quarantine, and then announced it was lifting lockdown restrictions.

The federal government had previously announced^[3] it was reopening international borders over the coming months for vaccinated returnees, who could quarantine at home for seven days. But the NSW decision scraps quarantine altogether for vaccinated travellers.

So what are the risks and benefits, and what might Australia look like over the coming months?

Read more: Australia's international borders to reopen from November. It's one big step towards living with COVID^[4]

Is this as scary as it sounds?

There are reasons for concern, but there are also some protections in place.

This rule will only apply to those who are fully vaccinated, with a vaccine approved by Australia’s drug regulator, the Therapeutic Goods Administration (TGA).

The most recent research shows full vaccination is 65%-90% effective^[5] depending on the vaccine at protecting against symptomatic infection. And those who have had both doses are less likely to pass the virus on.

For those who aren’t vaccinated, caps will remain in place. Only 210 non-vaccinated people will be allowed to enter NSW from overseas each week. Quarantine requirements will also remain in place for unvaccinated people^[6].

Returning travellers will also require proof of a negative COVID-19 test within 72 hours of their departure flight. This significantly decreases the risk of people travelling to Australia with COVID-19, but doesn’t eliminate the risk.

Data from hotel quarantine in NSW this year has shown between 0.2% and 1.4% of people in hotel quarantine have returned a positive test^[7]. However, the risk of individual infection will likely differ depending on where people are travelling from.

Reasons for concern

While more than 80%^[8] of the NSW population over 16 years is fully vaccinated, this isn’t distributed equally.

Some regional areas have vaccination coverage of less than 60%^[9] in those aged over 16 years. This creates greater risk for people living in these communities as international travel resumes.

Importantly, Australians aged less than 12 years are still not eligible for vaccination, meaning no one in this age group is currently vaccinated.

What’s more, if case numbers do rise in response to the relaxation of international travel rules, this may increase the pressure on the NSW health-care system. Previous media reports have suggested the system is under strain already^[10].

Relaxation of international quarantine may also increase the risk of introducing new COVID-19 variants into the population, which would increase the risk of large outbreaks^[11].

There is some good news, too

The announcement will mean many Australians who remain stranded overseas will now be able to return home.

This is significant given the current situation is resulting in serious mental and economic impacts for those stranded^[12].

What do we still need to know?

There are a number of key details missing from the premier’s announcement last Friday, the most important of which is: how will people be monitored when they return to Australia and what testing will be required?

It also remains unclear how this will affect families travelling with unvaccinated children aged less then 12, who aren’t eligible for vaccination.

And while it won’t change the outcome, providing more information on any health advice this decision was based on may help to boost public confidence.

What does this mean for other states and territories?

This will likely further divide the individual state and territory COVID-19 responses in Australia.

NSW has a high vaccination rate, which again provides some protection for the population when reopening. But this isn’t the case for all other states and territories. Queensland and the Northern Territory are reporting two-dose vaccination coverage of less than 60%^[13] in those aged 16 years and over.

In the short term, the NSW announcement will likely have impacts for states and territories with lower vaccination rates or those taking a more cautious approach. The details are still not clear, but it’s unlikely those coming into NSW from overseas will be able to travel freely across Australia. This may also impact states opening up to residents of other states with different procedures in place, like NSW and Victoria.

However, as vaccination rates increase and the rest of the country announces their strategies to open up, the country should end up on more even footing over time.

The home quarantine trials currently underway in some Australian states remain important.

International travellers not fully vaccinated will still be required to quarantine, which has significant mental health impacts^[14].

Trials of home quarantine to decrease the economic and mental burden of hotel quarantine remain vital to the pandemic response.

It’s also unlikely all states and territories in Australia will follow the lead of NSW, which means quarantine will still be required for overseas travellers coming into other states for the foreseeable future.

How COVID-19 spreads in NSW and Victoria over the coming months will also be important. The effects of eliminating quarantine on the spread of disease will provide valuable information for other states to better inform their strategies moving forward.

Overall, we don’t know definitively what the implications of this announcement will be as there are many unknowns. This is a constantly evolving situation that will need to be monitored closely over time.

Even the experts don’t appear to agree as to whether this is the best way forward, but no matter what decisions are made, transparency and clear messaging are key for public health.

Going forward, let’s try to remember the good news that many stranded Aussies will now be able to return home.

And for us as individuals and a community, increasing our vaccination rates remains critical to better protect us all from the spread of COVID-19.

References

1. ^{^} eligible to return in the initial stages (www.abc.net.au)
2. ^{^} opening borders to fully vaccinated people coming from NSW (www.abc.net.au)
3. ^{^} previously announced (theconversation.com)
4. ^{^} Australia's international borders to reopen from November. It's one big step towards living with COVID (theconversation.com)
5. ^{^} 65%-90% effective (assets.publishing.service.gov.uk)
6. ^{^} remain in place for unvaccinated people (www.sbs.com.au)
7. ^{^} between 0.2% and 1.4% of people in hotel quarantine have returned a positive test (www.health.nsw.gov.au)
8. ^{^} more than 80% (twitter.com)
9. ^{^} less than 60% (www.health.gov.au)
10. ^{^} system is under strain already (www.abc.net.au)
11. ^{^} increase the risk of large outbreaks (www.mja.com.au)
12. ^{^} serious mental and economic impacts for those stranded (www.theguardian.com)
13. ^{^} less than 60% (www.health.gov.au)
14. ^{^} significant mental health impacts (www.mja.com.au)