This article was written by Croakey Professional Services and first published as sponsored content on 23 June 2020.
Australia’s response to the coronavirus pandemic has to date been among the most successful in the world. This outcome is due to Australian governments listening and acting on expert public health advice, the formation of a National Cabinet to coordinate the implementation of national actions, international border closures and quarantine, and the Australian community’s cooperation and acceptance of social distancing to reduce community transmission.
Now facing the unpredictable impact of easing restrictions with few examples from other countries with low prevalence and population immunity, the Commission is developing an Australia-specific evidence base for clinicians on COVID-19 management, medicines and infection control.
Spotlighting relevant, high quality information
The World Health Organization has warned about an “infodemic” of misinformation, disinformation and rumour accompanying the coronavirus pandemic. The sheer volume of scientific literature – projected to exceed 50,000 papers this month, with daily output equivalent to an annual medical specialty conference – is not only daunting to navigate, but also far removed from the Australian context.
“The trouble is, you can actually access anything around the world and become overloaded with information, when often what you need to do depends on the prevalence of disease in your own country,” explains Professor Peter Collignon, one of Australia’s leading experts in infectious disease and microbiology, and chair of the Commission’s Healthcare Associated Infection Advisory Committee.
"There is a lot of panic and poor quality information. It is really is important to try to put accurate information into an Australian perspective, considering our current level of risk and the resources we have to manage this.”
At present, that risk is relatively low. Australia has seen about 7,460 COVID-19 cases since the outbreak began. Only about 10 per cent of these were the result of community transmission and there have been just over 100 deaths. Per capita, this mortality rate is 50 times lower than in Sweden, which has adopted a more laissez-faire herd immunity-based approach.
Responding to a unique situation
The Commission has undertaken intensive work on a number of fronts, consistent with its leadership role in infection prevention and control, and healthcare-associated infection.
In particular, the appropriate use of personal protective equipment (PPE) at the frontline has been a major focus, with the Commission developing resources advising which types of PPE to use in different scenarios and how to properly don and doff to minimise infection risk.
This work has successfully prevented the spread of coronavirus within Australia’s healthcare system, with the exception of two outbreaks. The Commission’s Chief Medical Officer, Dr Robert Herkes, noted that this is “a credit to staff in health service organisations and their adherence to PPE guidance”.
Collignon puts Australia’s situation down to a mix of fortune and policy nous. The fact that the outbreak began in summer provided less opportunity for influenza-like illnesses to propagate undetected than in countries in the middle of their winter influenza season, while our bushfire crisis may have further limited the spread by deterring overseas visitors.
Testing, contact tracing and tracking were all important pieces of the puzzle, as was prompt closure of the borders and quarantine of travellers, he says.
“We are currently in the best position we are likely to be in, I think, for the next year or so,” Collignon says. “We have the ability to stop this, but it requires ongoing diligence – we cannot become complacent.”
Tailoring and collating resources
The Commission has also collaborated with the NSW Clinical Excellence Commission to produce resources such as Break The Chain of Infection for healthcare settings, and advice on screening and PPE as elective surgery resumes following a coronavirus-enforced hiatus across the country.
Dr Herkes highlighted the safe use of medicines in COVID-19, as particularly valuable resources, providing guidance on treatment for the illness and the management of long-standing conditions. These issues emerged early as a significant concern for both doctors and patients, and the Commission responded with short, simple, evidence-based position statements on hot-button topics including the safety of ACE inhibitors and angiotensin-2 receptor blockers, anticoagulants, clozapine, intranasal and nebulised medications.
The Commission also prepared brief position statements on the management of fever, sore throat, oxygen therapy and intubation of coronavirus patients.
As well as symptomatic management, the Commission has compiled a comprehensive dossier of potential treatments being trialled for COVID-19, including monoclonal antibodies, antivirals and anti-retrovirals, anti-infectives, and the controversial antimalarials chloroquine and hydroxychloroquine.
There’s a lot of ‘fake news’ out there, and what we have been trying to do is to distinguish fact from fiction, and to make that information available to clinicians and health administrators so they can make appropriate decisions for their patients,” says Herkes.
"As the lead national agency for safety and quality in healthcare, the Commission holds an important role within the health system, with our resources being sought out by clinicians and by the system; it is therefore imperative that they are accurate, timely and accessible.”
These resources are updated regularly, based on emerging evidence, with a team of pharmacists working behind the scenes to distil the latest research and developments. The Commission also works closely with Australia’s National COVID-19 Clinical Evidence Taskforce to ensure that all updates and advice align with the living guidelines.
“All of the Commission’s resources and advice needs to be clear and consistent,” says Collignon.
Where evidence and guidance already exists, the Commission avoids duplication and ensures that readers are directed to high-quality primary sources, collated into a ready reference directory of Australian and international sites.
Preparing for the long haul
As Australia begins to relax its restrictions under the shadow of a potential second wave, Collignon points to the lessons of the 1918 H1N1 influenza outbreak. Back then, as now, Australia initially managed to avert significant mortality through major restrictions. By the time the second wave hit, people were tired of the restrictions and compliance was low, resulting in a savage and fatal resurgence of disease.
It is a matter of behaviour rather than rocket science, and success rests on convincing those who suffer the least from coronavirus yet are most affected by the measures to control it – working-age people in their 20s and 30s – to continue to comply.
Collignon believes we are “in it for the long haul,” with a vaccine at least 18 months to two years away. There is also no guarantee a vaccine will be successful, safe, long-lasting and able to be manufactured and distributed in sufficient quantities across the globe.
There are also many unanswered questions surrounding the immune response to COVID-19, in particular what proportion of infected people develop neutralising antibodies and how long these last. Experience with other coronaviruses suggests immunity may be short-lived.
"We will have to presume this virus will be around for the next year or two years, possibly longer. We’ve got to change our behaviour and focus on effective prevention and control.”
While the debate can be emotive and mired in politics, Collignon says the basic principles are simple, effective, and haven’t changed in decades: “Washing your hands properly, keeping away from people who are sick, and not going to work when you are sick, will lower the rate of infections.”