COVID-19

WHAT ARE THE INTERNATIONAL TRAVEL REQUIREMENTS FOR AUSTRALIANS GOING OVERSEAS?

The Australian Department of Home Affairs website provides details for travellers entering or leaving Australia. All details are provided on the department's website. Read more 

Smartraveller now has four travel advice levels with regards to health and safety overseas:

• Level 1: Exercise normal safety precautions
• Level 2: Exercise a high degree of caution
• Level 3: Reconsider your need to travel
• Level 4: Do not travel

Further details can be found at:

• Australian Govt. Dept of Health and Ageing: COVID-19 and travel
• Australian Govt. Dept of Home Affairs: Travel for vaccinated Australians and permanent residents
• Australian Govt. Dept of Health: International travel and COVID-19
• IATA COVID-19 Travel Regulations Map (provides information on COVID-19 vaccination requirements for countries worldwide)
• US CDC COVID-19 International Travel Recommendations by Destination

WHAT are SARS-CoV-2 AND COVID-19?

COVID-19 is a disease caused by a novel coronavirus, SARS-CoV-2, that was first reported in December 2019 in the city of Wuhan, central China.

Coronaviruses are a large group of viruses which affect both mammals and birds, and they cause different diseases depending on the species infected. Human coronaviruses usually cause a mild, common cold-like illness which passes in a few days.

As part of the replication process of viruses, errors or mutations occur which can be minor, but they may also prove to be an advantage to the virus. This may be evident through increased transmissibility, virulence or, in the case of SARS-CoV-2, ability to jump species (a spill-over event). There is relatively recent history of this with two previous extensive outbreaks of coronavirus infections of animal origin spreading to humans - SARS (in 2002-3) and MERS (from 2012 and continuing).  

The virus can spread from person to person through:

• Contact with an infectious person through aerosols which are expelled through talking, shouting or singing, particularly in indoor setting with inadequate ventilation (including in the 48 hours before symptoms, if any, appear).
• Contact with droplets from an infected person’s saliva (cough, kiss) or discharge from the nose (sneeze).
• Touching objects or surfaces (like doorknobs or tables) that have droplets from an infected person, and then touching your mouth or face – this is a much less common mode of transmission.

WHAT ARE THE SYMPTOMS?

COVID-19’s incubation period, the time between exposure to the virus and symptoms appearing, ranges from 1 to 14 days, but most people will develop symptoms within 5 to 6 days of exposure. Full details for testing and isolating close contacts and positive cases are in the COVID-19 Test and Isolate National Protocols.

In a systematic review and meta-analysis of 95 studies it is estimated around 40.5% percent of infections are asymptomatic. You can access the article here: Asymptomatic positive test review

COVID-19 can range from an asymptomatic or mild illness to pneumonia, with symptoms that can include:

• fever, fatigue
• respiratory symptoms, including cough, sore throat, shortness of breath, chest pain, runny or blocked nose
• headache
• muscle and/or joint pains
• nausea, diarrhoea, vomiting
• loss or altered sense of smell &/or taste
• loss of appetite

COVID -19 can progress to a severe illness with acute respiratory distress syndrome (ARDS), multi-organ system failure, septic shock, and death. Such severe cases require assisted ventilation and ICU management.

WHERE IS IT FOUND?

We remain in a COVID-19 pandemic (declared by WHO on March 11, 2020). As such, COVID-19 virus is currently a risk world-wide.

REDUCING THE RISK OF TRANSMISSION

When you are well

• Have your COVID-19 vaccinations.
• Wear a mask in indoor or high risk settings, physical distancing 1.5 metres away from others wherever possible and follow local public health guidelines.
• Wash your hands often with soap and water or use alcohol-based hand sanitisers.
• Avoid touching your eyes, nose and mouth.
• Clean and disinfect surfaces you use often such as bench tops, desks and doorknobs (these last 3 points will help prevent other infections such as colds and influenza).

When you are sick

It is important that you stay at home if you feel unwell and continue to use good hygiene practice.  If you have cold or flu-like symptoms, even if they are mild, you should get tested for COVID-19 and follow public health recommendations). Rapid antigen testing kits are best used in the event of a potential exposure when you don't have symptoms – if a positive result is obtained, contact your doctor and obtain a PCR test for confirmation of the infection. If the rapid test is negative and you go on to develop symptoms, get a PCR test done. Isolation until a negative result is received will help to protect others. While PCR tests are free under Medicare, rapid antigen kits are not covered for all people (limited number provided to concession card holders) and so must be purchased by the individual.

HOW IS COVID-19 TREATED?

Most people with COVID-19 disease will experience a mild to moderate respiratory illness and recover without requiring any specialist treatment. Rest, fluids and analgesia are generally the mainstays of treatment, however new therapies have, and continue, to be developed and the management of the disease will depend on the symptoms displayed. In cases of severe COVID-19 and for people at risk of complications, hospitalisation with supportive and antiviral or monoclonal antibody treatments may be required. Many treatments are currently being studied by the TGA.

WHAT IS COVID-19 VACCINATION?

The Australian Government’s COVID-19 free vaccination program for citizens, residents and most visa holders began in February 2021. The vaccines being used in Australia are effective and aimed at stopping the spread of the disease and reducing COVID-19 virus-related harm, preventing serious illness and loss of life, as much as possible. They are inactivated vaccines (not live) which are based on a harmless, non-replicating part of the virus to provoke an immune response in our bodies which will be remembered if we are ever exposed to the virus in the future.

VACCINE SCHEDULES

The Australian Technical Advisory Group on Immunisation (ATAGI) advised that 3 of the earlier COVID-19 vaccines – Vaxzevria, Comirnaty and Spikevax - and now also the protein vaccine Nuvaxovid can be administered to adults aged 18 years and older. Vaccines and doses for children aged 5 years to 17 years (also adults and immunocompromised individuals) are listed in a comprehensive table of recommended COVID-19 doses and vaccines published by ATAGI on Jan 19, 2023. Read more. Update: As of May 30, 2023, ATAGI 'advises that for people aged 12 years or older, a bivalent COVID-19 vaccine is now preferred over original (ancestral) vaccines for primary vaccination' - more details in link.

Higher risk groups: 

The advice from ATAGI, the Australian Technical Advisory Group on Immunisation, is that 'the timely receipt of a booster dose is particularly important for:

• people with risk factors for severe disease (including those aged ≥60 years, those with underlying medical conditions, those in aged/disability care and Aboriginal and Torres Strait Islander peoples); and
• people with increased risk of exposure to SARS-CoV-2. This may include those in an outbreak area, or those with a high risk of occupational exposure.' 

ATAGI added to its recommendations for severely immunocompromised individuals aged 5 years and above:

'Immunocompromised individuals who have received 3 primary doses of a COVID-19 vaccine are also recommended to have a booster dose in line with the timing for the general population, i.e., currently a 4-month interval from their primary course, and when capacity permits, 3 months. Read more 

Individuals are not considered to be fully protected until 7-14 days after their booster dose of the COVID-19 vaccines.

ATAGI announced the recommendations on the use of a fourth dose of COVID 19 vaccines for individuals who are severely immunocompromised. Severely immunocompromised individuals need four doses of vaccine to elicit a more robust and durable immune response. From April 2022, ATAGI  recommended that certain groups can access a 'additional winter booster dose' -

• Adults aged 65 years and older
• Residents of aged care or disability care facilities
• People aged 16 years and older with severe immunocompromise (as defined in the  ATAGI statement on the use of a 3rd primary dose of COVID-19 vaccine in individuals who are severely immunocompromised)
• Aboriginal and Torres Strait Islander people aged 50 years and older.

On July 8, 2022, ATAGI recommended a winter dose of COVID-19 booster for adults aged 50 to 64 years, while also stating those aged 30 to 49 years can also now receive a winter booster dose. More information can be found at ATAGI updated recommendations for a winter dose of COVID-19 vaccine. Read more 

On Feb 8, 2023, the Australian health department outlined ATAGI’s recommendations for a booster COVID-19 vaccine dose and the rationale behind the decision. Read more. 

An ATAGI update on Sept 1, 2023 recommended 'that all adults aged ≥ 75 years should receive an additional 2023 COVID-19 vaccine dose if 6 months have passed since their last dose', while others (see details in link) 'should consider an additional 2023 COVID-19 vaccine dose if 6 months have passed since their last dose, after discussion with their healthcare provider'. The updated table on ATAGI recommended COVID-19 vaccine doses.

Studies will continue into the duration of protection offered by the vaccines and the likely impact emerging virus variants will have on this.

PREGNANCY & BREASTFEEDING

COVID-19 infection during pregnancy has been found to present a higher risk to both the mother (for hospitalisation, ICU admission, requiring ventilation) and the baby (premature birth, stillbirth, care in neonatal unit). Vaccination is the best way to reduce these risks and global surveillance data from large numbers of pregnant women have not identified any significant safety concerns with mRNA COVID-19 vaccines given at any stage of pregnancy. Furthermore, there is also evidence of antibody in cord blood and breastmilk, which may offer protection to infants through passive immunity.

ATAGI recommends that pregnant women are routinely offered either of the mRNA vaccines at any stage of pregnancy, so, if you are planning pregnancy, are pregnant or breastfeeding you can receive either of these COVID-19 vaccines at any time. You do not need to stop breastfeeding before or after vaccination.

Vaccination does not affect fertility and getting vaccinated before conceiving means you will have some immunity against COVID-19 throughout your pregnancy.

The federal health department has published 'COVID-19 vaccination – Shared decision making guide for women who are pregnant, breastfeeding or planning pregnancy'. Read more

POSSIBLE SIDE EFFECTS

As with any vaccine, some temporary side effects may occur after receiving a COVID-19 vaccine.

Common side effects with either vaccine may include:

• injection site pain or tenderness
• tiredness
• headache
• muscle pain
• fever and chills
• joint pain

Uncommon side effects may include:

• redness or swelling at the injection site
• swelling or tenderness in the armpit
• nausea/vomiting
• enlarged lymph nodes
• insomnia

Most side effects are mild and temporary, going away within 1-2 days. As with any medicine or vaccine, there may be rare and/or unknown side effects.

Rare side effects that may occur:

Severe allergic reaction – Anaphylaxis: is a very rare occurrence with all vaccines.

- VAXZEVRIA (AstraZeneca)

Thrombosis with thrombocytopenia syndrome (TTS)

Vaxzevria has been associated with a rare side effect (4-6 cases per million doses) called Thrombosis with thrombocytopenia syndrome (TTS), also known as Vaccine-induced prothrombotic immune thrombocytopenia (VIPIT), which appears to be more frequently reported following the first dose. This thrombotic syndrome differs from common venous thrombo-embolic disease in that it is immune- mediated, rather than associated with the commonly known risk factors for thrombosis. It tends to occur in unusual sites resulting in cerebral venous sinus thrombosis and splanchnic vein thrombosis, both of which carry significant morbidity and mortality. TTS following Vaxzevria vaccination has occurred mostly in younger vaccine recipients (under 60 years of age).

- COMIRNATY (Pfizer)

Temporary one sided facial drooping (Bell’s Palsy), may affect up to 1 in 1,000 people.

- COMIRNATY (Pfizer) & SPIKEVAX (Moderna)

Myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the sac surrounding the heart) are very rare side effects which have more commonly been observed following the second dose of a mRNA vaccine and particularly in males aged under 30 years. Symptoms may include chest pain, pressure or discomfort in the chest, irregular/skipped heartbeats or ‘fluttering’, fainting, shortness of breath and pain when breathing. Most cases have mild symptoms and recover well and longer term follow up is continuing, however prompt medical attention should be sought if any of these symptoms present 1 - 5 days post-mRNA vaccination.

For individuals with a history of recent (i.e., within the last 3 months) myocarditis or pericarditis, acute rheumatic fever or acute rheumatic heart disease or acute decompensated heart failure, ATAGI’s advice is to consult with a GP, specialist immunisation service or cardiologist when planning vaccination. The Group has also recommended ‘People who have had confirmed myocarditis attributed to a dose of Comirnaty or Spikevax should defer further doses of an mRNA COVID-19 vaccine and if they are > 18 years can consider Vaxzevria on a case-by-case basis, after they have recovered from their symptoms’.

‘COVID-19 vaccination – Guidance on Myocarditis and Pericarditis after mRNA COVID-19 vaccines’ is available online from the federal Dept of Health website.

 

References:

Australian Government Department of Health, COVID-19 vaccines – Is it true? https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/is-it-true

NCIRS, COVID-19 Vaccines, Frequently asked questions: https://www.ncirs.org.au/covid-19/covid-19-vaccines-frequently-asked-questions

Australian Government Department of Health: https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines

Therapeutic Goods Administration, COVID-19 vaccines: https://www.tga.gov.au/covid-19-vaccines

RACGP: Australian study determines true asymptomatic COVID rate:   https://www1.racgp.org.au/newsgp/clinical/australian-study-determines-true-asymptomatic-covi

Health Direct: Symptoms of COVID-19 and how the virus spreads | healthdirect

Australian government, Dept. of Health. Pregnancy, breastfeeding and COVID-19 vaccines:  https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/who-can-get-vaccinated/pregnant-women     

Melbourne Vaccine Education Centre, Thrombosis with thrombocytopenia syndrome: https://mvec.mcri.edu.au/references/thrombosis-with-thrombocytopenia-syndrome/

TGA approves booster doses of the Pfizer COVID-19 vaccine, COMIRNATY: https://www.tga.gov.au/media-release/tga-approves-booster-doses-pfizer-covid-19-vaccine-comirnaty 

World Health Organisation: https://www.who.int/health-topics/coronavirus#tab=tab_1

European Medicines Agency: https://www.ema.europa.eu/en/news/ema-recommends-nuvaxovid-authorisation-eu 

ATAGI Statement on the Omicron variant and the timing of COVID-19 booster vaccination: https://www.health.gov.au/news/atagi-statement-on-the-omicron-variant-and-the-timing-of-covid-19-booster-vaccination 

ATAGI statement on recommendations on a 2022 winter booster dose of COVID-19 vaccine: https://www.health.gov.au/news/atagi-statement-on-recommendations-on-a-winter-booster-dose-of-covid-19-vaccine 

ATAGI advice on the preferential use of bivalent COVID-19 vaccines for primary vaccination of people aged 12 years or older: https://www.health.gov.au/news/atagi-advice-on-the-preferential-use-of-bivalent-covid-19-vaccines-for-primary-vaccination-of-people-aged-12-years-or-older  

ATAGI recommendations from the Australian Technical Advisory Group on Immunisation (ATAGI) regarding an additional COVID-19 dose for highest risk people in 2023 (Sept 1, 2023) https://www.health.gov.au/news/atagi-update-on-the-covid-19-vaccination-program 

Vaxzevria vaccine 

Comirnaty vaccine 

Spikevax vaccine

Nuvaxovid vaccine 

 

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