Experts from Singapore, Canada, the UK and the US give Australia 'living with COVID' advice – ABC News

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Across the world, many countries are well ahead of Australia in regards to loosening COVID restrictions, with some "open" for more than six months. 
Yet Australia is in the midst of a state-by-state pandemic. 
NSW, which has 91 per cent of the population over 16 fully vaccinated, lifted its first restrictions five weeks ago and has recorded seven-day average COVID case numbers of just above 200.
Victoria, which has 86.6 per cent fully vaccinated, loosened its restrictions in late October and has seen a gradual decrease in case numbers since. 
Yet Western Australia, with no current cases, is not expected to open up until late January or early February The Northern Territory has extended the lockdown for greater Katherine and is predicted to open just weeks before
Queensland and Tasmania open up next month and South Australia will open its border next week. 
Although the low case numbers in NSW have surprised many experts, most believe a spike in case numbers, at some point, is inevitable.
Others suggest another wave of COVID-19 infections in Australia could be around the corner.
We've put together this simple guide to what each state requires for people entering.
So, what is going on in countries well ahead of Australia? And what can we learn?
We asked leading experts in four countries — Canada, Singapore, the US and the UK — about "living with COVID".
This is what they said.  
In the UK, daily case numbers are hovering around the 40,000 mark, with weekly deaths now averaging over 1,000.   
Boris Johnson's government has faced criticism for its COVID approach since its so-called ''freedom day" in July, which included the scrapping of mask mandates and the end of most restrictions. 
About 68 per cent of the total population is double-vaccinated, ranking it 18th out of the 38 OECD countries.
Australia is 14th on the list, with 70 per cent of the total population fully vaccinated. 
Deepti Gurdasani, epidemiologist and public health researcher at the Queen Mary University of London, said four months after its freedom day, the "hindsight hasn't been different from the foresight" in the UK. 
"It was a huge mistake for us to come out of lockdown at the 66 per cent vaccine rate," she told the ABC. 
"And we've seen what's happened since." 
Professor Gurdasani said for Australia, she recommended the vaccination of children and teenagers as soon as possible.  
"Lots of transmission happens in schools, and we're seeing this right now in the UK." 
Experts say there are things to learn from England, where there has been a large increase in children being kept home due to COVID-19. 
According to epidemiologist John Edmonds from the London School of Hygiene & Tropical Medicine, the removal of mask mandates and not vaccinating teenagers before they returned to school were the main "mistakes" the UK made.   
"And I think that we should have adopted a more aggressive testing approach — using lateral flow device testing — for those returning to work and for contacts of cases," Professor Edmonds said.     
"And I'd encourage Australia to take those approaches and encourage working from home as much as possible." 
Some states in the US have had loosened restrictions for more than six months.
COVID cases are sitting at a 7-day moving average of 83,000, with an average of 1,100 deaths a day across the country. 
About 69 per cent of the country's population aged over 12 is fully vaccinated, with a booster program now being rolled out across the country.  
According to Harvard University's Bill Hanage, the US  — like Australia — is going through a state-by-state pandemic, but in a very different way. 
"Poorly vaccinated places have struggled," the professor of evolution and epidemiology of infectious disease said.  
"Those regions that determinedly put the pandemic in the rear-view mirror saw a lot of deaths.
"[For example] a third of all Florida’s pandemic deaths happened since May 2021."
Stanford University professor of medicine and health economist Jay Bhattacharya, who has been critical of blunt lockdowns, said the "biggest tragedy" had been the failure to protect the elderly, who had died "in enormous numbers" across the country. 
He said lockdowns led many people to skip essential health services, including cancer screening, elective surgeries, and many other important health priorities. This has also happened in Australia.
As the US enters winter, Professor Bhattacharya said the health sector was "stretched" but not "overwhelmed" — yet.
"I do worry that there may be nurse shortages in places that enforce a vaccine mandate at work," he said.
"Some have opted to leave the labour force rather than be coerced into vaccination.
"If health care demand increases this winter, while the medical labour force shrinks, some healthcare systems may become overwhelmed."
Professor Hanage's advice for Australia was simple: "Don't think vaccines will make the virus disappear," he said.
"You will likely have a good summer because of fresh immunity and seasonal factors.
"Next winter it will likely return and the most at risk will be, once more, older and otherwise vulnerable people.
"You have other 'light lift tools' in the locker besides lockdowns, like masks and rapid testing. Be prepared to use them if necessary."
Canada has had 1.76 million cases of COVID and 29,376 deaths. Over the past seven days, it is averaging 2,373 cases and 24 deaths a day. 
About 76 per cent of the entire population is fully vaccinated, making it the ninth most-vaccinated country in the OECD, behind Spain, South Korea, Iceland, Chile and Portugal.
Canada opened its international border in September, with restriction levels varying depending on the province. 
Colin Furness, an infection control epidemiologist based at the University of Toronto, said Canada — like Australia — had no "one narrative for COVID", with public health organised and run by its large provinces. 
However, he said the one factor he wished all governments would introduce was "mass use of rapid tests". 
"They’re not diagnostic tools, but they are absolutely brilliant screening tools," Professor Furness said.
"The province of Nova Scotia [in the country's south-east] hands them out like condoms, with encouragement to self-test before going out on a Friday night."
Professor Anne Gatignol, a professor of immunology at the Lady Davis Institute for Medical Research in Montreal, said the "sanitary pass" — known in Australia as the vaccine certificate — had worked well in Canada. 
"[In Montreal] when we go to a restaurant we enter only if we have the sanitary pass, we enter and leave with a mask and we remove it only for eating," Professor Gatignol said. 
"Tables are separated with plexiglass and gathering is for a maximum of 10 from three different households."
She agreed with Professor Furness on the introduction of rapid self-tests, which she said should be available in pharmacies.
"[Overall my advice to Australia would be to] open everything gradually and monitor the cases very closely to avoid clusters to expand," she said.
"Make rapid tests easily available. Be ready to re-install stronger restrictions if necessary and inform the population about it."
Singapore is going through its most challenging period of the pandemic.
With one of the highest vaccination rates in the world, the tiny island nation had planned for a phased reopening once 80 per cent of the eligible population were fully dosed.
But over the past two months, it has faced its steepest curve of infections and deaths of the pandemic so far, with daily case numbers rising to a seven-day average of about 2,700 and 13 deaths a day. 
Many Australians are rightly looking forward to a carefree summer. However, experts warn Singapore's current COVID-19 surge may be a prime example for Australia.
Professor Yik-Ying Teo, Dean of the Saw Swee Hock School of Public Health at the National University of Singapore, said despite the number tracking lower in Victoria and NSW, Australian states "must prepare" for a rise in infection numbers.
"And with the surge in infections, there will be an increase in the demand for hospital resources," he said. 
"And I'd encourage [the Australian government] to communicate to the public that vaccinations alone will not be sufficient.
"Natural infections will be needed to complement the protection from the vaccines, which means there will be an increase in the number of infections [and] of people who will be hospitalised."
Professor Tikki Pang, a microbiologist and former WHO director of research policy for infectious disease clusters, said there needed to be a continued focus on hospitalisations and deaths in Australia — not case numbers.
He said Australia needed to "continue to be prepared". 
"Continue monitoring and surveillance, especially for the appearance of variants," said Professor Pang, now based at the National University of Singapore.
"Maintain and enforce proven public health measures and targeted testing [and] keep an eye on the availability of new treatments."
See our full coverage of coronavirus
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