Community Services Industry Communique (COVID-19 Recovery) — Responses to Questions [19-01-22]

Community Services Industry Communique (COVID—19 Recovery) — Public Health Responses to Questions

19 January 2022 COVID-19 Modelling/Expectations: 1. What is the current Public Health approach and messaging on COVID-19? The Premier said on Thursday (20/1) we will “get through this transition phase in the coming weeks and months, we will get to a point where this is no longer a pandemic…” and treat COVID-19 like the flu. Is there an indication of when this point will be and when we will see the current wave peak and recede?

The Kirby modelling commissioned by the State Government in 2021 prior to borders opening suggested a slower rate of infection with a peak in March-April 2022. This seems to have happened quicker than the Kirby modelling predicted. There has been a recent dip in case numbers, but we will need to wait to see whether this is a trend or not.

Omicron changed the ball game. All the preparation prior to 15 December was for Delta, with all indications suggesting that our highly vaccinated population would see us well prepared. Omicron has been a different virus. It is more transmissible, resulting in infection rates and case numbers rising much faster than anticipated.

This has required rapid changes to Public Health response, particularly relating to communicating and managing isolation and cases. This has resulted in a shift from community-wide trace and track to a greater focus on managing outbreaks, particularly those in high-risk settings and/or with vulnerable populations.

The current wave of cases and transmission appears to be greatest in 20-40 year old age group. We need to consider what it will look like to have higher rates of COVID in the community for older people, and for other people at greater risk of severe ill health or death due to COVID-19. In light of this, Public Health is working in partnership with targeted sectors, including the aged, disability, and child care sectors in particular.

There are many questions we don’t have comprehensive answers to, but we are learning as we go, and learning from other states and territories.

Outbreak Management and Business Continuity:

Contact Points for Advice: 2. Many organisations operate outside of regular business hours and may need clarification or advice on Public Health requirements quickly in order to ensure service delivery can continue.

• Is there a direct and timely liaison point with Public Health and the COVID-19 Operations Centre that is specific to service delivery for community service organisations?

• Is advice available outside of regular business hours?

Public Health have medical and nursing staff who are tasked with specific focus in certain sectors/industries, however it is unlikely that there would be consistent access to these individuals outside of regular business hours. The main point of access is through the Public Health Hotline — 1800 671 738. The hotline maintains an out of hours contact option with a Clinical Nursing Consultant on call until at least 9pm.

Public Health acknowledges this means there remains a gap from at least 9pm-8am.

The Department of Health are in the process of setting up a dedicated outbreak response team and will take on board the feedback of this group and investigate the scope for another line of communication. For now, however, the Public Health Hotline remains the best option.

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Check-in/Contact Tracing: 3. Is the Check-in TAS app playing any role in case suppression? If not, why is it still mandatory?

We can understand why people are confused about the need to continue with the check-in, as we are not following up contacts in the same way we were. However, there are a few ways in which the app is still useful both for individuals and for contact tracing. The app: - Provides an individual record of locations visited throughout the day — not always easy to remember - Is a useful tool for showing vaccination status - Is still used by Public Health in the case of a significant transmission event, at a large event or a particular site with a large number of related cases.

We can still use the app to message individuals and follow up with them to provide advice, suggest monitoring for symptoms and testing.

The Premier has recently announced that the use of the Check-in TAS app is currently being reviewed by Public Health. Further updates on the outcome of this review will be announced in the coming weeks and published on the Coronavirus website.

4. What are the case reporting requirements for services with clients/staff who test positive?

There are a couple of different levels. For example, many organisations may be required to report cases to their regulatory bodies, such as those in the aged care sector. Organisations should check and be aware of their regulatory requirements.

Employers also have obligations to notify WorkSafe Tasmania when it is confirmed that a person has contracted COVID-19 through carrying out work and: • The person dies; or • The person is required to have treatment as an in-patient in a hospital; or • The reason the person contracted COVID-19 is reliably attributable to carrying out work that involves providing treatment or care to a person; or involves contact with human blood or body substances. In this case, the carrying out of work must be a significant contributing factor to the infection being contracted.

From a State Department of Health perspective, there is no Public Health direction mandating reporting by organisations. The direction require an individual to notify Public Health of a positive test and follow Public Health directions given. We encourage everyone who has a positive RAT to register that online.

Public Health welcomes and encourages organisations to report when there are cases in the workplace. It is useful, as it will help Public Health to provide advice and support for organisations to manage the case. We do have methods of trying to monitor whether we are receiving notifications from the same place/type of environment on a regular basis, but not as efficient as your organisations notifying us.

Testing Processes and Procedures: 5. What is the current status of Rapid Antigen Test (RAT) supplies in Tasmania, and what is the outlook for the next 8 weeks?

The Department of Health continues to have a healthy supply of Rapid Antigen Tests (RATs). These RATs are being provided to people who are symptomatic, close contacts, and to critical workers. Additionally, the Department of Health is supporting the Department of Education with RAT supply for the upcoming return to school.

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We are anticipating that commercial supply will continue to stabilise in the coming weeks — we do have people contacting us now advising they have a supply, so hopefully they will be available more broadly soon. Courier service announced last Thursday for those who can’t get to a test, or have someone pick up a test for them.

6. Can organisations who are providing services to vulnerable clients be granted a supply of RATs for this purpose or access RATS from distribution hubs on behalf of individuals? If so, what is this process?

Arrangements can be made for individuals to pick up RATs from state distribution centres on behalf of others.

Individuals should request a RAT Kit through the online form or by calling the Public Health Hotline. If completing the online form, individuals requiring the test should enter their own name on the form, but enter the mobile number of the person collecting the kit on their behalf.

The community services supply of RATs being provided is intended primarily for use by the workforce to ensure they can continue to deliver services to Tasmanians — and should be used to ensure compliance with your COVID-19 Safety Plans. However, if there’s clear need, and testing cannot be arranged through the regular channels, organisations are not prevented from providing these RATs to clients.

7. What guidance is there on the use of RATs to ensure most accurate results?

Guidance is available on the Coronavirus website here: coronavirus.tas.gov.au/keeping-yourself-safe/testing-for-covid-19/types-of-covid-19-tests#Taking-a-rapidantigen-test There are different RATs available, so it is very important that people closely follow the manufacturer’s instructions.

8. Does Public Health have any guidance on how community service organisations should utilise RATs to ensure the wellbeing of their staff and continuity of services for clients? a. What is good practice? For example, is it best to test immediately on potential exposure and then test every day or to test periodically, on day three and six?

At this stage, Public Health does not recommend routine testing or screening for staff in community services.

Organisations should consider using RATs when: • Individuals present with symptoms (even very minor), and are unable to access a test through the regular channels, • You know you are going to see a particularly vulnerable client, or working in a particularly vulnerable setting: or • When there has been a significant exposure risk which may not rise to the threshold of ‘close contact’ (i.e. four hours in close quarters) While advice has changed and it is no longer required for a positive RAT be followed up by PCR, if in doubt, you can still book a PCR. That is still the gold standard. Pressure on PCR testing has been reduced. The advice is that if people have any doubt, get a test.

Individuals with symptoms or who are close contacts are able to access RATs and PCR test by calling the Public Health Hotline on 1800 671 738. They can register for a RAT via the online request form. There are also options available to courier RATs to those who can’t get to a testing or distribution centre, or have someone pick one up for them.

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Quarantine/Isolation and Close Contacts: 9. Can you provide any clarification of current close contact isolation requirements? a. Can workers continue to look after a COVID positive client/participant with appropriate PPE without becoming a close contact who is required to isolate?

When preparing for Delta, we were using tools to assess risk due to exposure, comparing vaccination, PPE use, etc. Some of that goes to having more nuanced definitions of close contacts in particular settings. Attempt to define for the hospital settings, but other settings are different. Our team is trying to answer these questions in light of Omicron.

As a general guide, if you have PPE (appropriate mask and eyewear), and the COVID-19 positive person is also wearing a mask, then you would not automatically be a close contact. The key is to minimise interaction, with anyone who is a positive case isolating and avoiding others as much as possible. b. What do the recent national cabinet changes mean, are the furlough arrangements likely to extend to our industry in the near future? What about for those in high-risk settings?

Exemptions under the framework for critical industries were initially considered and applied because of supply chain issues (food and groceries) but have become relevant for many other sectors and industries. The Tasmanian Government is continuing to consider other industries for inclusion in the framework. The list of identified critical sectors is available here.

Current arrangement for those who are eligible requires an organisation to register individual workers for exemption via an online form. Applying for RATs for critical workers is also done through these forms.

Further information about the framework, the requirements for organisations and workers, and the exemption registration forms are available here.

10. What is the current Public Health advice for organisations providing services to clients/patients who are not vaccinated, or not fully vaccinated? a. Is there a right for individual staff to refuse to provide services?

The only Public Health directions in place which are not directed at workforce are those requiring vaccination for entry in pubs, bars, nightclubs and major events, for travel, and access to residential aged care facilities.

There are sectors where service providers have been advised that they cannot refuse service on the basis of vaccination. The NDIS has provided this advice to providers.

Other services have put in place their own requirements for their workers and/or clients to be vaccinated.

Organisations considering requiring vaccination as a condition of service/entry or employment should seek legal advice, or contact: • Tasmanian Chamber of Commerce and Industry (TCCI) business advice hotline on 1300 559 112, • WorkSafe Tasmania on 1300 366 322; or • Fair Work Ombudsman.

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PPE and other Supplies: 11. Some experts are suggesting that cloth and surgical masks are essentially ineffective against omicron. What is the Public Health advice on standards and usage? a. If a minimum standard mask is required (e.g. N95, P2), will government ensure an adequate supply and equitable distribution?

The medical advice suggests that unless they are fit tested/fit checked, N95 and P2 masks provide little advantage over a surgical mask. As such, it is unlikely there will be a requirement through Public Health directions to move to N95/P2 masks.

The Department of State Growth maintains a supply register to ensure organisations are able to access necessary PPE and other supplies.

12. One-off grant funding for PPE and other COVID-19 supplies is welcome, however if organisations are expected to use it on an ongoing basis, rather than in an emergency period, will these costs be covered in contracts moving forward?

This is a longer-term question. Organisations should have this conversation with their funding bodies as they negotiate contracts moving forward.

Outbreak Approach in Shelters, etc.: 13. It appears we need a clear, consistent approach/strategy for an outbreak in a shelter for homeless people or other temporary accommodation. Does this exist or is the government working towards this?

It is difficult to have a blanket approach, because much depends on the physical setup of the service and its environment. Some are able to isolate clients in separate part of facility and manage this well on their own.

However, if there was a situation with individuals in shared rooms, for example, a different risk assessment would need to be done and the management approach would likely be different. Providers are encouraged to engage with Public Health to provide advice or guidance based on the specific setup of a facility and circumstances of exposure.

Public Health advised that they would take this issue back and the question whether an alternative approach might be worth investigating.

Vaccines: 14. What is the advice on current two-dose vaccine mandates extending to boosters? It appears to be imminent for residential, in home and community aged care. a. Is ‘fully vaccinated’ likely mean three doses in the near future, so should organisations should start collecting evidence now?

Tasmania is closely following the Commonwealth advice on this. ATAGI has as yet provided no official advice in relation to requiring a booster dose in order to be considered fully vaccinated.

We acknowledge that if it were to change overnight, this would automatically mean many workers would be noncompliant with Public Health directions requiring vaccination of certain workers. It would not be done in a rush, and Public Health would ensure that any deadlines to comply with the new requirements would allow ample opportunity for workers to receive their third dose and provide the necessary information to their employer.

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15. Is there data collected and available on the proportion of children (under 12 and under five) that make up the COVID-19 caseloads?

Since 15 December 2021, the proportion of cases were: • 0-4: 4% • 5-9: 4% • 10-19: 13% The largest proportion currently is in the 20-29 age group (31%). Rates are currently rising in all age groups.

16. Given the wide spread of the virus and an imminent return to school, what is being done to protect those unable to be fully vaccinated (including children, immunocompromised, those with other medical exemptions)? And those who work with them?

The government released a plan for schools and early childhood education and care on 20 January 2022. The plan details guidelines and support for COVID-19 safety, including vaccination of staff and children, provision of face masks and RATs, improved ventilation, more outdoor learning, and maintaining physical distancing, good hygiene practices and frequent cleaning.

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