With 100 domestic cases as of March 10, federal and state governments and health authorities face daunting challenges posed by COVID-19 in coming weeks and months - securing a workforce of nurses and doctors to treat the sick, ensuring enough testing facilities to meet a rapidly growing demand, and stemming the spread of the virus, to the maximum extent possible.
As Chief Medical Officer for the federal government, Professor Brendan Murphy is confident about maintaining enough health staff, including in nursing homes.
“You can find a health workforce if you look hard enough, and if you can fund the surge. So I think we will find them.”
Murphy is also optimistic the present self-isolation period of 14 days can be shortened at some point, as the incubation period of virus is now thought to be “probably around five to seven days”.
When will the virus peak in Australia? Murphy says: “If we had widespread and more generalised community transmission, I would imagine that would be peaking around the middle of the year, in the middle of winter. … But that’s really our best guess of the modelling at the moment. And it’s very, very hard to predict.”
Murphy re-iterates that only people in certain categories need to be tested; in the last few days there has been a “significant surge” of people with flu-like symptoms but outside these categories who have been seeking testing, placing pressure on facilities.
With eyes on Italy’s lockdown, could a single region of Australia be locked down?
“It’s potentially possible, absolutely. If we had a city, a major city that had an outbreak of some thousands, and the rest of the country was pretty unaffected, we could very easily consider locking down a part of or a whole town or city.”
Transcript (edited for clarity)
Michelle Grattan: Since the outbreak of the coronavirus in December, we’ve witnessed the escalation of COVID-19 to a worldwide health crisis, which is now flowing over to a potential economic crisis. There have been about 100 confirmed cases in Australia and the government is preparing for the situation to get much worse in health terms. On the economic side, it’s about to announce a stimulus package to try to keep the country out of recession. To discuss the health issues we have today, Professor Brendan Murphy. He’s Australia’s chief medical officer and the government’s key health adviser on this crisis. He is also due to move on to a new job as secretary of the federal health department, as soon as the government feels it can release him from his current tasks. Brendan Murphy joined us from Sydney by telephone. Professor Murphy, we’re seeing the escalation of cases in Australia. Is it possible to estimate when we might see the peak of the crisis and how long after that peak might we expect some sort of de-escalation?
Professor Brendan Murphy So it’s not possible to accurately predict. We have modellers who are doing mathematical modelling based on the behaviour of this virus that we’ve seen so far, particularly in China. And what’s happening with the development of cases in Australia at the moment. The critical trigger point for an escalation would be when there is widespread community transmission in Australia, which we haven’t seen at this stage. We have only one real instance of community transmission in North Sydney at the moment. But if, for example, over the next month we moved into a phase where there were a number of community outbreaks, then that could escalate in the worst case scenario into an epidemic across the country, which could last as an epidemic from anything from around 8 to 12 weeks. The modellers predict. So if if that happens and I reiterate that we are going to try and contain and isolate and limit the scale of community transmission. But if we had widespread and more generalised community transmission, I would imagine that would be peaking around about the middle of the year and in the middle of winter, that sort of time. I think that that’s that’s really our best guess at the modelling at the moment. And it’s very, very hard to predict.
MG: And what’s your best guess as to your ability to limit this community transmission? Because as you say, the containment has been pretty good at the moment, most of the cases have been people coming from abroad, but somewhere like Italy, for example, obviously it got out of hand.
BM: So I think what happened in Italy is probably the same as what happened in Iran. I think what happened was some cases came out of Hubei province of China, probably in late January, and they spread widely in those communities in Iran and Italy without them realising it. One of the features of this virus is that it’s quite mild for most people. And so it can spread quite easily with people not even being particularly sick. And it’s only when you start to see, unfortunately, a lot of elderly people or people with chronic disease who unfortunately get a more severe disease and might even die that they twigged. So the other interesting information is coming out of the experience that China has had outside of the Hubei Province when they have really seemingly brought under control outbreaks of a thousand or more cases in many places. And also the experience in the Republic of Korea, where whilst they have had a very large outbreak, they are seemingly managing to isolate it in one area. So that gives us some hope that if we had some outbreaks in Australia, we could try to isolate those and control and limit the further spread.
MG: We’ll come back to some of that, but you’ve repeatedly stated the need for people to act calmly and keep things in proportion. Notwithstanding some unseemly supermarket scenes, do you think that the Australian community is responding appropriately, or is there still too much alarm?
BM: I think there is a lot of alarm, but people are alarmed about, you know, the changing international situation and they’re hearing stories. But I think we need to remember that we have a really strong health system in Australia. And as I said, more than 80% of people have a very, very mild illness. We’ve had three unfortunate deaths in Australia, but they were all elderly people with some underlying conditions in a couple of cases. The rest of the one hundred cases in Australia, really have had very mild disease. So if one did get this condition, it would be for most people just a nuisance, because at least initially we would be trying to isolate you and stop you spreading it. So I think there’s obviously concern, but it’s silly to go off and stock up with weeks supplies of lavatory paper and food and all that sort of stuff. And certainly at this stage, you know, in early March, there is really no reason to for anyone to be wearing masks when they’re walking around the streets because we don’t as yet have community transmission.
MG: You’ve mentioned older people being vulnerable and obviously certain sections of the community, such as those in nursing homes and those in indigenous communities are particularly at risk. Are you satisfied that enough is being done to protect them?
BM: So we’re obviously very concerned about both those groups and we are doing a very large amount of planning and preparation. We had a workshop with the aged care sector very recently and we’re planning a whole lot of contingencies, including the ways to provide additional workforce to look after people. If they happen to be, to pick up the infection, and developing a range of protocols to protect residents if infection does become in the community. But the same applies to the Aboriginal and Torres Strait Islander communities, where particularly for the remote communities, we’re very focussed on trying to see if we can protect some of them from the virus coming in at all.
MG: Lockdown, in other words?
BM: Well, to some extent, particularly looking at making sure that people who fly in and fly out to provide services, are properly screened and make sure that they don’t bring the virus in with them.
MG: Well, you mentioned the nursing home workforce. Where do you get additional people?
BM: Well, there are a range of….There are over 300,000 nurses in Australia, and probably an additional workforce would be largely nursing, and there are lots of nurses who work part-time. And some of the people who work in nursing homes have limitedworking hours because of their visa conditions, we’re looking at whether we can do something to relax that, and a range of strategies. You can find a health workforce, if you look hard enough and if you can fund the surge. So I think we will find them, but obviously the challenge might be as if you had a lot of sick leave in hospitals as well as nursing homes at the same time.
MG: Now, on the testing front, do we have sufficient testing facilities to accommodate the likely spread in the community? And at the moment, are too many people coming forward to be tested?
BM: So I think taking the second part of your question first, I think there has been am just in the last few days, a significant surge in people requesting testing, some of whom don’t meet our criteria for testing at the moment. In part, that has related to some misinformation in the media suggesting that everyone who had flu-like symptoms in the community should be tested. We’re not saying that at the moment. We’re simply saying that people who are returned travellers who develop acute respiratory symptoms or people who have been contacts of confirmed cases who develop acute respiratory symptoms should be tested. So I think some of the surge recently, some of the pressure on the testing facilities has related to that. In terms of the availability of testing. This is a very new test, it was developed experimentally and we set it up initially in Australia with our public health plan. They’ve done well over 10,000 tests now, but the public health laboratories won’t be able to cope with the demand for testing in a bigger outbreak. So government is working through ways of significantly expanding that over the next week or so by being online or in private pathology services, which have a wide network and large range of testing capability. So you will have enough testing to meet whatever demand there is.
MG: This is all going to cost a lot of money in the end isn’t it? Do you have any estimate yet of the additional costs to the health system of the virus?
BM: Not that I can share publicly at this stage. I think government will be progressively sharing information about investments and the economic impact of the health impact. But suffice it to say, it’s many hundreds of millions of dollars, the impact of this virus has a significant outbreak.
MG: And it’s already announced, of course, that it will put in money to support the state’s efforts.
MG: Now could we just talk about the practicality of self-isolation. What do you recommend for people who share accommodation, other family members being in the household? Should those family members try to relocate? And won’t many self-isolating people have trouble sourcing their food and other provisions and therefore be tempted to dash to the shops? BM: Yeah, so I think self-isolation can be tricky. What we’re saying is that it’s okay to be with your family, we would recommend that you try to avoid close contact with your family. Generally speaking, if you’re keeping, you know, more than a metre or a metre and a half away from someone, that’s sort of social distancing is safe enough to prevent droplets spread, which is the way this virus gets spread. And obviously everyone in the house should practice very good hygiene, washing their hands and washing surfaces properly, getting provisions again where people obviously who have lived with others or who have friends can bring in provisions for them. We would discourage people from going out to the shops. We really would prefer people self-isolated to just only go out to medical appointments, and even then it would be nice to wear a mask if they did that.
MG: It is going to be difficult though, for some people, isn’t it, to look after themselves for a fortnight?
BM: And it is, indeed. And one of the things, that’s isolating if you’re a contact and we are looking at whether that 14 day period could be shortened to be closer to what we think the incubation period is.
MG: Which is what?
BM: Well it’s probably around five to seven days, but you need a margin for error. So, we’re looking to see internationally whether this, the current recommended quarantine period is 14 days, and at some stage I think there will be a recommendation to reduce that.
MG: And that will be fairly soon, do you believe?
BM: There’s ongoing discussion, so I can’t really predict, but I hope so. Yeah.
MG: Now, the government has said it’s preparing a mass communications campaign, advertising campaign. Broadly, what will that cover and when do you think we will see that? Because it does seem quite tardy in coming out.
BM: There’s been a lot of communication information available and there’s a national hotline and there’s much information on websites. But we need to push information out into every household and that’s a strong focus of government at the moment. So, that campaign material is is being finalized and it’s going to be coming out progressively over the next few weeks, including information, as I said, to to every household, to having a social media information. So the messages will be how to protect yourself, how to practice good hygiene, if we do get an outbreak, what you should do if your own a well, where where to go if you want to, f you think you’ve got the infection, how to get tested and how to get advice. So there’s a range of things in that comms package, which will be, as I said, rolled out over the next couple of weeks.
MG: And that will be on television and in the letterbox?
BM: Potentially, yes. So we haven’t made absolute final decisions about all the media that it will go in. But it’s wide, wide access is planned.
MG: And on the topic of communications, do you believe the media have been responding proportionately?
BM: There have been elements of the media that have sensationalised things, but on the whole, we’ve been pretty good. I’ve found that I’ve not been misreported much in the many press conferences I’ve done. I sometimes get troubled when the headlines continue to refer to this “killer virus”. It can kill people, but so can flu. So I think on the whole, it’s not been too bad. Those elements of the media that you might expect to sensationalise have probably done so a bit.
MG: Now the medical profession was sympathetic to the Melbourne doctor who treated patients after returning from America with the sniffles. He was later tested positive for the virus, although he didn’t appear to be in the high risk category. But many people will be concerned going to their doctor as things get worse. Will there be tighter checks on medicos as the virus spreads?
BM: Well, it’s very hard, to actually check. As much as we expect people to act responsibly, and we’re certainly making it very clear to all health care professionals that particularly, if they’re a return traveller or if there’s more community transmission, that it is their responsibility if they develop acute respiratory symptoms to immediately get tested and to not continue working unless they’ve tested negative. So, you know, I don’t really know the full circumstances of this particular case or how unusual it was.
MG: But you could make it routine that doctors who had certain symptoms, even if they hadn’t been travelling, got the test.
BM: Well, I think we are considering now whether not just doctors, but all health care workers who have significant symptoms like a fever and respiratory symptoms, we are considering that they should probably be included in the group that should be tested at this time. Yes. That’s a discussion that’s happening at the moment with peak medical advice committee.
MG: Now in Italy, we’ve seen the near collapse of their intensive care facilities under the pressure of this virus. How well equipped are Australia’s hospitals in this intensive care area? Is it break down at all possible?
BM: We don’t think so. We we in some of the modelling that we’ve done, it would suggest that it would demand for intensive care beds could exceed our current intensive care capacity. So for that reason, we’re doing a lot of forward planning to see how we can expand our intensive care capacity. And there are good options for expansion into other wards with different workforce models and getting well ventilated. So that’s a very active planning phase now. So we want to make sure we’ve got very good surge capacity just in case we do have a larger scale outbreak that puts a very big demand on intensive care beds.
MG: How much will the onset of the flu season make it harder to manage this situation?
BM: It is tricky that the two come together. We are seeing a bit of inter-seasonal flu again this year. So most people who have flu like illnesses at this time have flu probably rather than the COVID-19 disease. So we will probably be recommending that people with acute respiratory symptoms have both the flu tests and the COVID-19 at the same time so that we can distinguish between the two. And we’re very strongly recommedning that this is a reason for everyone to make sure they get their flu vaccination this year.
MG: Now, different states currently have different containment measures in place and in some cases have issued differing advice. Are you concerned about this variability and is much being done to promote state coordination?
BM: Well, the state and territories meet with me every day, every afternoon for the last nearly two months now, we’ve had a daily teleconference and we basically agree on all of the advice and protocols as a consensus group. So I don’t know that there are any differences in our policy positions and our consensus advice. We have seen some slightly different interpretations, for example, on how our active quarantine orders have been used in one state rather than just voluntary quarantine in another state. Isolation practices should be consistent that we have had occasions where there might be somewhat different messages.
MG: Maybe it’s the politicians.
BM: Well, I wouldn’t. But occasionally, sometimes they can go a little stronger than the expert advice in what they say. But in the main, we have been very collaborative with a strong consensus.
MG: Now, going back again to the case of Italy, which is a whole country in lockdown, could we reach the point where we have a lockdown in a region in Australia?
BM: It’s potentially possible. Absolutely. If we had a city, a major city that had an outbreak of some thousands and the rest of the country was pretty unaffected, we could very easily consider locking down a part of or a whole town or city.
MG: Do you think we’ll reach the stage of big events being cancelled or postponed? At the moment the message is everything’s fine in relation to sporting events and the like, but could that change quite quickly?
BM: It could change, probably not very quickly, but it could change over a period of a couple of weeks. And again, the trigger for that would be evidence of widespread community transmission, where attendance at a public event could accelerate that transmission. So at the moment, we’re certainly not in that space, but we could get there. Absolutely.
MG: And just finally, before we finish, Professor Murphy, is this the toughest professional challenge that you’ve faced in your career? And, when do you expect to move to that new job as secretary of the health department?
BM: It’s certainly been a very…it’s a marathon. You know, it’s been all consuming for the last few months. I have been appointed to that new job, but it’s really up to the prime minister and the government to decide how long they want to have me leading the chief medical officer response. And I will follow the direction of government on that. I’m pleased to be doing what I’m doing now and obviously looking forward to the other job.
MG: Well, good luck with the present job and the new job. Professor Murphy, thank you very much for talking with The Conversation today.
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