This level of disease and transmission is unprecedented in our modern time, and while we can learn some lessons from history, today’s COVID-19 situation is very fluid.
Various influenza viruses have occurred over time. Spanish flu hit Europe and America in about 1918 and reached Australia in January 1919. The H1N1 pandemic was the most recent widespread and serious pandemic until now. By November 2009, there had been over 37,000 confirmed cases of the H1N1 disease and 191 deaths reported in Australia.
Our current problem, COVID-19, is more infectious than the flu. Current estimates are that each person with COVID-19 can transmit it to about 2.5 people. Whereas the SARS mortality rate was about 10%, the death rate of COVID-19 – and this is early stages – appears less than 1%. While somewhat comforting, this is also a double-edged sword because it means more people with mild illness potentially may be going about their daily lives while infecting others.
We’re facing a new virus that causes a serious and acute lung infection with no known treatment, no vaccine to prevent it, and a reasonable rate of infection in a nonimmune population. Even in milder cases, people may take weeks to recover, and, more important for those who are vulnerable, the disease can be life-threatening. Patients must be treated with sophisticated healthcare for a long period of time. The virus is already in the community and spreading, and it’s going to cause a big imposition on Australia’s health services.
How Australia Is Responding
The Australian health sector’s emergency response plan for COVID-19 is based on an influenza pandemic and has been adapted for this novel coronavirus. The first feature is the use of existing hospitals and intensive care units (ICUs), since we understand how to source and manage them. Another feature is evidence-based decision-making, to look to experts and analyze all the overseas data. In Australia, because we’re behind in terms of an impact, we can learn from what’s occurring overseas.
The next part of the plan is strong linkages with emergency response arrangements. This allows finances to be released and stockpiles like masks to be used and released while also allowing other emergency plans to be activated. The country needs to collect national surveillance data. While it might seem unnecessary now, post-pandemic analysis will show important trends, such as which groups might have been more susceptible, so we can help ourselves in the future. For example, when all the data was crunched for swine flu, it was clear that the people who had the worst outcomes were pregnant women, Aboriginal people, and the morbidly obese. As a result, the free flu vaccine is now available for pregnant women and Aboriginal people.
The final part of the plan is an emphasis on communication – always the key to ensuring people don’t rely on misinformation on social media.
The three stages in the government plan are initial action, targeted action, and – what we’re all waiting for – stand down. When disease information is scarce, public health units all come into play. They’re now trying to quarantine people who might have been exposed to stop it from spreading further. It’s a lot of work, but done properly, it can give an enormous amount of time to health facilities. If you can keep it contained at that point, it slows everything down.
During the targeted phase, when enough is known about the disease to take measures, the plan is to ensure a proportionate response, maintain quality care, communicate and build confidence to reassure the community, and provide a coordinated, consistent approach.
Finally, stand down is when the public health threat can be managed within normal arrangements. We don’t know when that will be for COVID-19, but one key feature is monitoring for a second wave of the outbreak. During outbreaks, pandemics, and epidemics, if precautions are repealed too early, a second wave can occur, in which case protections need to be ramped up again.
Citizens Must Do Their Part
We need to ensure two things: no complacency, because all age groups are at risk, and that the community understands the given messages and acts accordingly. The general public’s aim should be working together to reduce the risk of contracting the virus and spreading it. The total numbers need to be kept down, which will greatly help our health services. This situation will cause great morbidity among the broader population; anything people can do at a personal level to not get it is a positive thing.
The public needs to keep hearing about the risk: The more time we spend around people, the higher the risk of catching the virus. The more people who are sick, the higher risk of hospitals not coping and more people dying. Everything we can do to reduce even one case leaves one more ICU bed open and may save one more life. That’s the message that everyone must understand.
Flattening the curve might mean the same number of people overall getting sick, but it allows health services to better manage what cases do present, give people more time on ventilators, and save lives. After all, there’s a finite capacity of ICU beds across the country.
This won’t be over until the health system can cope, prompting the stand-down, and that may only happen after the development and implementation of a vaccine, which may take up to 18 months. It may come sooner – the Queensland government announced $17 million in funding to fast-track a vaccine within six months. Other means of treating people with COVID-19 are being investigated as well, such as passive immunization (using immunoglobulin from immune people).
So how do we respond? With social solidarity and an understanding that what we do directly or indirectly impacts others. Deliver this message and making people understand it loud and clear is key. The next question, then, is will Australia be next in line for lockdowns? It’s clear we’re moving that way. To control case numbers and spread, we must do our best to mitigate the disease and provide any additional strategies for suppressing it.
Australia has already seen travel bans, quarantines, recommendations for social distancing to ensure four meters squared around each person, bans on large and small gatherings, and a push for shutdowns. The government recommends canceling nonessential travel; Victoria and New South Wales are locking down nonessential activities; Tasmania has imposed self-isolation for 14 days; South Australia and Western Australia’s borders will be closed; Darwin Hospital is postponing elective surgery; and travel restrictions to 76 remote indigenous communities in the Northern Territory are in place.
It’s likely that localized stronger suppression measures may be implemented to enforce social distancing rules or in cases where there are disease hotspots. Schools may shut down soon. People working from home may face the reality that they don’t go back to the office for several months. Government financial packages will be important to mitigate the situation and assist people who risk losing their jobs or businesses.
Let’s Do Our Part to Flatten the Curve
Thousands of doctors across Australia have signed letters and petitions calling for more drastic lockdown measures to reduce the chance of an Italy-style coronavirus catastrophe. The tragic situation in Italy is a warning, and what was written in the New York Times is relevant here: That country’s experience shows that steps to isolate the coronavirus and limit people’s movement need early implementation with absolute clarity and need to be strictly enforced.
We must heed authorities’ messages to keep this situation as manageable as possible. In Australia, it’d be great if enforcement wasn’t necessary. We will manage this pandemic best with community solidarity and by working together.
About Kathryn Weston
Associate Professor Kathryn Weston comes from a strong research background in immunology and cell biology, having worked at Harvard Medical School in the USA, and at the University of Technology, Sydney where she gained her PhD in the area of immunotoxicology and cell biology. Prior to her academic appointment at UoW, she worked as a senior infectious diseases and vaccination public health officer with NSW Health in western Sydney, with experience in disaster management, epidemiology, and health protection.
This article is adapted from the March 23 GLG webcast “COVID-19: Assessing the Current Situation in Australia.” If you would like access to this teleconference or would like to speak with John Case or any of our more than 700,000 experts, contact us.