2020 has been an unpredictable year for me, as it has for most people. In Canberra, the year started with weeks of smoke after the horrendous bushfire season. Then the threat of a novel coronavirus arose. My work prior to my DVA appointment in February 2019 was at the Department of Health, managing communicable disease threats and health emergencies, so I knew how busy that team must be with these two events.
Then in early February, the Commonwealth Chief Medical Officer asked DVA’s Secretary Liz Cosson to allow me to return to Health to assist in the response to COVID-19, and that’s where I stayed for the next five months as one of the Commonwealth Deputy Chief Medical Officers. This experience, while involving a lot of hard work and very long hours, has been a highlight of my medical career.
While this was a novel coronavirus, the approach to managing a respiratory disease threat was one that Health had worked on over many years. Following the 2009 H1N1 influenza pandemic, plans to tackle a respiratory pandemic were reviewed and rewritten. These were evidence-based and included advice on which measures were most effective in controlling the spread of disease. This included mathematical modelling that looked at different scenarios and the effect of different interventions, such as where to target antivirals and immunisation to achieve the optimal effect as well as the use of personal protective equipment (PPE) under different models of care. These plans were developed with input from the states and territories, which developed corresponding pandemic plans.
While this planning had been focused on an influenza pandemic, there were many features of the plan that could be applied to other communicable diseases. Over the years since 2009, the principles and practices in the plans were tested with other disease outbreaks including the Middle East Respiratory Syndrome (MERS), the Ebola virus epidemic in West Africa and then the Zika virus epidemic.
In early February, the modellers adapted the influenza models to the evidence emerging about the novel coronavirus and were able to conduct scenario modelling that showed the potential effects of such a disease. We then provided this information and advice to the Government, which immediately took steps to reduce transmission of COVID-19 in Australia. Though we were as prepared as we could be to deal with a pandemic of a new disease, the number of unknown facts about COVID-19 soon highlighted the enormity of the task Australia was facing.
The public health tools to tackle a respiratory virus epidemic and pandemic include identifying and testing, contact tracing and isolation, travel restrictions, social distancing, immunisation and antiviral treatments. Unfortunately, immunisation and antivirals were not available for COVID-19, so it was important to implement the other public health measures effectively in order to control this disease.
This was where the planning over all those years with health authorities from the Commonwealth and the states and territories was so important. Not only did we have the plans in place but, just as importantly, we had formed strong relationships between the federal and jurisdictional health authorities that meant working together on a common problem was not new. Australians should be proud of how well the jurisdictional health teams have united to tackle this pandemic.
Many of the challenges related to the sheer size and duration of the response. The health emergency policy sections of all health departments swelled rapidly. Communications and liaison officers were vital to keeping the public as well as the rest of government informed. Offers of assistance from all over the country were received and many public servants and Defence Force personnel were seconded to assist.
Unfortunately, the Chinese city of Wuhan is a major PPE manufacturing centre. So at the same time as the rest of the world realised they needed more PPE supplies, this important manufacturing centre was affected. A Department of Health team worked tirelessly to source PPE supplies for the national stockpile and distribute them to where they were most needed.
With the experience of Wuhan and then the grim news coming from Italy and then the UK, the focus shifted to intensive care unit (ICU) capabilities, including access to ventilators, trained staff and beds and making sure our health system was as ready as possible. Ventilators were sourced and training delivered for nurses to care for patients in ICU.
Pathology testing was critical to identifying all the cases. Australian pathologists quickly developed COVID-19 tests and shared this knowledge with the world. Testing consumables were the next items to come under supply pressure and both private sector and governments sourced a range of test kits and platforms to allow Australia to test at one of the highest rates in the world.
As the numbers of cases climbed, more public health measures were put in place. Social distancing, including movement restrictions and keeping 1.5 metres from other people, hand hygiene and respiratory hygiene were emphasised and then enforced through public health legislation. Australians responded magnificently and in response the case numbers fell. Soon the new cases being reported were largely among travellers in quarantine. I’m sure everyone breathed a collective sigh of relief and were pleased to know that we had avoided the terrible health outcomes seen in some European countries and by then unfolding in New York.
However, this is a novel coronavirus and we are still learning about how it affects individuals and spreads in the community. As I write, Victoria is experiencing a resurgence of cases and reapplying all the measures and lessons learned over the last few months. It is harder the second time around to experience social and movement restrictions but the important lessons we learned need to be reapplied. With every individual contributing to control of the virus we can control the spread of COVID-19. You can do this by:
- staying home if you are unwell
- getting tested if you have symptoms
- isolating if you are a contact
- social distancing
- applying hand and respiratory hygiene
- complying with health and government advice and directions.
We must change our behaviours and learn to live with this virus because, while researchers all around the world are focused on developing a vaccine, this is still some time in the future.
The national response to this pandemic is still ongoing but the Australian response and the ability of our health care sector to respond has been heartening. There is still a long way to go but you can be assured the foundations for the pandemic response are strong.