Health authorities have suggested people be able to conduct their own tests at coronavirus clinics, removing doctors and nurses from the equation.
The new pandemic intelligence plan, just released, says patients at GP or respiratory clinics could be given their own swab and instructions. The method "may be more acceptable to people" and would reduce demand on personal protective equipment, since health staff would not conduct the test.
"It is a reliable method of testing with adequate sensitivity, and any potential reduction of performance in terms of increased false-negatives (when compared to clinician-collected samples) is outweighed by the increase in testing capacity and reduction of demand on PPE," the plan from the country's chief health and medical officers says.
The plan shows caution among the advisory group as governments begin to ease restrictions.
It says sharing indoor spaces presents a significant risk compared with outdoors, and suggests governments ease outdoor restrictions first. Despite this, the national cabinet decided on Friday to allow indoor gatherings to resume and restaurants to reopen, while limiting numbers to 10 and leaving final decisions on timing to each jurisdiction.
If indoor trading was allowed, the plan urges consideration of extra rules such as ventilation and regular disinfection.
It also points to a new "stringency index" developed by Oxford University, which rates countries with a full lockdown such as New Zealand at 100, Italy and France at 95, and Australia at 71 alongside Britain in stringency measures. The health group said all of the countries now considering rolling back restrictions have a harder lockdown - and so a higher "stringency" score - than Australia.
This reinforces [the Australian Health Protection Principal Committee]'s position that Australia should not be too hasty to relax the most effective of measures that have been implemented," it warns.
The plan also rejects calls for widespread testing of people without symptoms.
"Even with very high levels of testing, cases in the population would be missed, and the estimates of prevalence would still have a comparatively wide range of uncertainty around them," it says.
"Further, at low prevalence of disease, the proportion of positive tests that are false-positives increases. Although intuitively attractive, ongoing active surveillance of asymptomatic people across the whole population is not supported."
Instead, the preference was to test specific groups or occupations. It sets out four groups, in order of priority:
- Everyone with a fever or acute respiratory illness, with only 30 per cent of people in that group being tested currently.
- People with less typical symptoms who were at a high-risk, such as healthcare workers and aged care workers.
- Contacts of cases, including those without symptoms.
- Vulnerable populations when a single case is found.
In this last category, it says when a case is found in a residential care or health setting all residents and staff should be tested, including those without symptoms. All contacts should be tested in remote indigenous communities, and workers in critical infrastructure should also be tested when a single case is identified. It doesn't give detail for this last category.
On top of that, it says questions about the extent of community transmission could be addressed through limited surveys in three tranches - first, elective surgery patients; second, aged care workers; and third, health care workers.
"Community anxiety can be allayed by conducting representative surveys," it says. "When well considered, such surveys can also provide information about community transmission."
Australia would also do antibody testing , and wastewater sampling could be used as an early alert in hospitals and aged care centres.
Restrictions could be eased when case numbers were stable over four weeks.
"Disease surveillance that indicates increasing numbers of cases without a known source of transmission or cases without an overseas link, would indicate the need for widespread tightening of restrictions."
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