Latest / The SHEA Podcast / COVID-19 International Perspectives: Australia, 11/12

Transcript

COVID-19 International Perspectives: Australia, 11/12 · The SHEA Podcast

• 0:09
  SPEAKER_02: Welcome to the Rapid Response Podcast brought to you by the Society of Healthcare Epidemiology of America, promoting the prevention of healthcare associated infections, antibiotic resistance, and seeking to advance the field of healthcare epidemiology and antibiotic tourism.
• 0:27
  SPEAKER_02: I am Dr.
• 0:28
  SPEAKER_02: Walee Javed, hospital epidemiologist for the Mount Sinai downtown, and I will serve as your moderator.
• 0:35
  SPEAKER_02: This discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:49
  SPEAKER_02: She is excited to launch this episode of the podcast COVID-19 updates, What We Know Now.
• 0:58
  SPEAKER_02: Today's discussion will focus on international perspectives from Australia.
• 1:04
  SPEAKER_02: Our speaker today is Dr.
• 1:07
  SPEAKER_02: Marion Gaynor, Director of Vestral Health Infectious Disease Unit in Australia.
• 1:13
  SPEAKER_02: Thank you for joining us today.
• 1:15
  SPEAKER_02: Before we start our discussion, I would like to get us started with a brief news and guidance update of the week.
• 1:24
  SPEAKER_01: So thank you, Dr.
• 1:25
  SPEAKER_01: Javade, for that introduction.
• 1:27
  SPEAKER_01: So here's the news and guidance update.
• 1:30
  SPEAKER_01: Over the past week, we've gotten new totals for COVID-19 cases.
• 1:34
  SPEAKER_01: At this point, there have been over 50 million confirmed cases of COVID-19 across the world, including over 1.2 million deaths reported to the World Health Organization.
• 1:45
  SPEAKER_01: Here in the United States, we have approximately 9.8 million cases as of yesterday, as well as 236,000 deaths in the United States.
• 1:53
  SPEAKER_01: What we're seeing across the country are rising rates of COVID-19 in all states, some states seeing much more rapid increases over the past week.
• 2:02
  SPEAKER_01: But I think the general consensus is that rates seem to be uniformly rising across the country.
• 2:08
  SPEAKER_01: As for recent publications, there have been several publications in the MMWR over the past week, which have evaluated several important aspects of the COVID-19 response.
• 2:17
  SPEAKER_01: One publication from November 6th by Kenu et al.
• 2:20
  SPEAKER_01: evaluated the COVID-19 response in the state of Delaware.
• 2:23
  SPEAKER_01: What this study demonstrated is that through using statewide surveillance, they were able to evaluate the impact of several mitigation measures, including the stay-at-home orders and public masking mandates, and the implementation of a statewide contact tracing program.
• 2:38
  SPEAKER_01: And what this study demonstrated was that with these different mitigation measures implemented, there was an 82% reduction in the incidence of COVID-19 throughout the state, an 88% reduction in hospitalizations related to COVID-19, as well as a 100% COVID-19 related mortality during the period of April through June.
• 2:56
  SPEAKER_01: So I think this study, in summary, demonstrates that these interventions can be successful in reducing COVID-19 incidence at the statewide level.
• 3:04
  SPEAKER_01: A study published on November 6th by Grijalva et al.
• 3:08
  SPEAKER_01: evaluated the risk of household secondary transmission of SARS-CoV-2 in Tennessee and Wisconsin using 101 households and symptom screening and PCR testing for household contacts of individuals with confirmed COVID-19 were identified within seven days of a confirmed positive test.
• 3:25
  SPEAKER_01: The study demonstrated that among all household members in which nasal swabs and saliva specimens were collected during the seven-day follow-up period, there was a secondary infection rate of 53%.
• 3:36
  SPEAKER_01: And among all those individuals with secondary infection, approximately 40% of these individuals were symptomatic.
• 3:43
  SPEAKER_01: I think this study highlights the importance of quarantining household contacts immediately after an individual in the house tests positive.
• 3:50
  SPEAKER_01: Another study published in the MMWR on November 6th from Zembrano et al.
• 3:55
  SPEAKER_01: evaluated data from the CDC COVID-19 response pregnancy and infection link outcomes team.
• 4:00
  SPEAKER_01: This study analyzed approximately 400,000 women age 15 to 44 with symptomatic COVID-19 infection and assessed the overall rate of ICU admission, mechanical ventilation, and ECMO, as well as mortality amongst individuals who are pregnant compared to non-pregnant women, and found that all four of these occurred at higher rates among pregnant women compared to their non-pregnant women counterparts.
• 4:23
  SPEAKER_01: So I think this really highlights the importance of counseling pregnant women regarding the risk of COVID-19, including the development of severe infection, and really focusing on measures to prevent infection amongst this patient population.
• 4:36
  SPEAKER_01: A study from the MMWR published on November 9th evaluated the rate of readmissions among individuals with COVID-19.
• 4:44
  SPEAKER_01: This study included over 100,000 COVID-19 infected individuals and found that amongst this cohort who were admitted to the hospital, 9% were readmitted to the same hospital within two months of discharge, including 1.6% who had multiple readmissions during this two-month period.
• 5:01
  SPEAKER_01: Notably, patients who were discharged to skilled nursing facilities and those who were discharged requiring home care were more likely to acquire readmission in the two months after the incident COVID-19 infection.
• 5:12
  SPEAKER_01: I think this study really has important implications when it comes to both discharge planning and resource allocation when caring for patients hospitalized with COVID-19.
• 5:20
  SPEAKER_01: And lastly, I'll mention that this past week the final data from the ACTT trial was published in the New England Journal of Medicine.
• 5:27
  SPEAKER_01: And this was a study evaluating the impact of remdesivir using a randomized controlled trial.
• 5:33
  SPEAKER_01: This included 1,062 hospitalized patients, and those who were given remdesivir had a median recovery time of 10 days compared to 15 days amongst those who had placebo.
• 5:45
  SPEAKER_01: So this study supports that remdesivir can reduce the duration of hospitalization and potentially facilitate earlier recovery among those who received remdesivir.
• 5:54
  SPEAKER_01: It is noted that the mortality rate, although lower in the remdesivir group, did not achieve statistical significance in this trial.
• 6:00
  SPEAKER_01: So that's the update from this past week.
• 6:03
  SPEAKER_01: I'll turn it back to Dr.
• 6:04
  SPEAKER_01: Javade for the moderated discussion.
• 6:07
  SPEAKER_02: I now want to move into discussion with Dr.
• 6:10
  SPEAKER_02: Craden.
• 6:12
  SPEAKER_02: Thank you so much for joining us.
• 6:14
  SPEAKER_02: What is the current state of COVID-19 in your country?
• 6:18
  SPEAKER_00: So in Australia, we now have had a total of 27,610 cases with 907 deaths.
• 6:29
  SPEAKER_00: Australia-wide, we have 15 persons in hospitals and eight new cases diagnosed in the last 24 hours.
• 6:38
  SPEAKER_00: Over the last week, we have had a total of 54 cases that were acquired overseas and 16 that were acquired locally.
• 6:48
  SPEAKER_00: Now I live in the state of Victoria, and we have just had five days in a row with no new cases and no deaths, and only two patients hospitalized, none in intensive care.
• 7:02
  SPEAKER_00: In Victoria, we have now had 20,345 cases with 819 lives lost.
• 7:11
  SPEAKER_00: And in the last 24 hours, we have had over 17,000 tests performed.
• 7:17
  SPEAKER_02: Thank you.
• 7:18
  SPEAKER_02: It seems like very different than what we are experiencing in the United States.
• 7:22
  SPEAKER_02: So, did your country go into lockdown?
• 7:26
  SPEAKER_02: And if so, what did that look like?
• 7:29
  SPEAKER_02: And how early in the pandemic was this implemented?
• 7:33
  SPEAKER_00: So in Victoria, we've actually had two lockdowns.
• 7:37
  SPEAKER_00: Australia-wide, we have had one lockdown.
• 7:40
  SPEAKER_00: The lockdown was combined with closure of borders to prevent repeated viral introductions.
• 7:47
  SPEAKER_00: And so only Australian citizens or permanent residents are allowed to enter.
• 7:52
  SPEAKER_00: And upon entry, then were required to quarantine for 14 days.
• 7:57
  SPEAKER_00: There were also very significant caps placed on the number of passengers that could be accepted per week.
• 8:03
  SPEAKER_00: And this really prevented the ongoing repeated introduction of virus that we had experienced in the first wave.
• 8:10
  SPEAKER_00: So all of Australia went into lockdown early in the pandemic, around about March 23rd.
• 8:16
  SPEAKER_00: And at that time, to put things into perspective, we had about 17 new cases each day in Victoria.
• 8:23
  SPEAKER_00: The very vast majority were associated with overseas travel.
• 8:29
  SPEAKER_00: Our lockdown, which really was implemented in Victoria fully from March 26, included the closure of nightclubs, bars, gyms, indoor sporting venues, indoor places of worship, cafes and restaurants could only provide takeout.
• 8:46
  SPEAKER_00: Grocery stores, drug stores, banks, post office, etc., remained open.
• 8:51
  SPEAKER_00: Beauty parlors were closed, but the hairdressers remained open.
• 8:56
  SPEAKER_00: And then businesses had to adhere to a density quotient of one person per four square meters, and there were limits on indoor patronage.
• 9:06
  SPEAKER_00: Initially a hundred, but that was then reduced fairly rapidly.
• 9:11
  SPEAKER_00: We were at that time going to school holidays, and so they extended their school break, particularly in Victoria.
• 9:19
  SPEAKER_00: But the schools and daycares remained open for children of essential workers, such as healthcare workers and students that had special needs.
• 9:29
  SPEAKER_00: By March 31st, outdoor gatherings in Victoria were limited to two persons, and there were no visitors allowed at home.
• 9:38
  SPEAKER_00: And there were only four reasons to leave a house.
• 9:40
  SPEAKER_00: This is for medical care or caregiving, to attend work or school, for essential shopping and to exercise.
• 9:48
  SPEAKER_00: And this lasted for about six weeks, and then there were easings in mid-May, increasing the number of persons allowed to gather outside to 10 and then 20, and inside to five and then to 10 with restaurants opening with restrictions.
• 10:05
  SPEAKER_00: We were then going into winter, and in Victoria, we then experienced a second wave.
• 10:12
  SPEAKER_00: And this second wave was much, much worse than the first wave.
• 10:15
  SPEAKER_00: And we are just now emerging out of lockdown following that second wave.
• 10:20
  SPEAKER_00: Now, this second wave was actually triggered by the virus escaping hotel quarantine, and genomics show that over 90% of the circulating virus originated from bad failure.
• 10:31
  SPEAKER_00: And there's been an inquest into what transpired here, and we expect the report to be released in the next few weeks.
• 10:37
  SPEAKER_00: Now, this virus after Escape Hotel Quarantine initially appears to have spread by several large family gatherings in large households.
• 10:46
  SPEAKER_00: And initially it appeared to be localized to a few suburbs or zip codes, and an attempt was made to lock down those zip codes for two weeks.
• 10:55
  SPEAKER_00: In addition, the wearing of face coverings was strongly recommended.
• 10:59
  SPEAKER_00: However, that failed, and it was then decided to ring fence Melbourne.
• 11:04
  SPEAKER_00: And we had similar restrictions placed on us to what were happened during the first lockdown, together with these mandated face coverings outside the home.
• 11:15
  SPEAKER_00: On August 2nd, stage four restrictions were implemented.
• 11:19
  SPEAKER_00: I think we had 725 new cases at that time per day.
• 11:24
  SPEAKER_00: And these restrictions were much tougher.
• 11:28
  SPEAKER_00: They restricted travel to a five-kilometer radius and restricted exercise for only an hour a day.
• 11:35
  SPEAKER_00: One person per household could go outside once a day for essentials such as groceries or post office for an hour.
• 11:42
  SPEAKER_00: And travel outside required permits from work.
• 11:46
  SPEAKER_00: There was also curfew, which was introduced from 8 p.m.
• 11:49
  SPEAKER_00: to 5 a.m.
• 11:51
  SPEAKER_00: And then after six weeks, this lockdown was relaxed to two-hour exercise time limit, and then singles could be in a singles bubble.
• 11:59
  SPEAKER_00: And now we're back to stage three restrictions, which we had during our first lockdown with no limits on exercise, and restaurants have now opened with patronage for inside for 10 people.
• 12:13
  SPEAKER_00: We now have a 25-kilometer radius for which we can do our essential shopping, and work permits are no longer required.
• 12:22
  SPEAKER_00: So we're just in Victoria emerging from this second much more severe protracted lockdown.
• 12:31
  SPEAKER_00: There was significant pressure to ease those restrictions at an earlier time, but the health department really relied on modeling on what would happen if we started easing those restrictions.
• 12:46
  SPEAKER_00: And they really held to specific metrics that needed to be met before the lockdown was eased, with the aim of basically having a COVID normal Christmas.
• 13:00
  SPEAKER_00: We did not want to go back into a lockdown.
• 13:02
  SPEAKER_00: And the models were actually pretty good in estimating when we could achieve what numbers.
• 13:08
  SPEAKER_00: So I have to say I was really quite impressed with that.
• 13:10
  SPEAKER_00: And as I said, it's just been just such a delight to now have five days with zero new cases and zero new deaths.
• 13:20
  SPEAKER_02: Wow.
• 13:20
  SPEAKER_02: That's a really good and comprehensive review of the status of COVID.
• 13:25
  SPEAKER_02: Really interesting points you raised about the winter and how the lockdowns were implemented because here in the US, we are in the winter season and the role stage, we are looking at an uptake of the cases.
• 13:38
  SPEAKER_02: So a lot of things that I think we can look at and learn from the Australian model.
• 13:44
  SPEAKER_02: Another important thing you kind of discussed was the area-based travel restrictions.
• 13:49
  SPEAKER_02: So you can't go beyond five kilometers or 25 or something on those lines, which is a very interesting concept.
• 13:56
  SPEAKER_02: And I wonder if those things are being considered in public health circles here.
• 14:00
  SPEAKER_02: So a lot of things we can learn from Australia.
• 14:03
  SPEAKER_02: With that, I'll ask you another question.
• 14:05
  SPEAKER_02: What's the state of the PPE supplies in Australia?
• 14:10
  SPEAKER_00: So fortunately, we have had no real shortages.
• 14:14
  SPEAKER_00: We were always concerned about the supply chains.
• 14:17
  SPEAKER_00: Initially, basically all of our PPE was sourced from overseas, predominantly China.
• 14:23
  SPEAKER_00: And then there have been some investments made into now having local production of N95s.
• 14:30
  SPEAKER_00: They're just now starting to be produced, and they're still making some modifications to the design to enable greater comfort and better fit testing results.
• 14:41
  SPEAKER_00: So they're not a major supply, but there's work ongoing with regards to having a local supply of N95s.
• 14:49
  SPEAKER_00: In Victoria, we have a state supply center that supplies all the hospitals.
• 14:55
  SPEAKER_00: So it's not one hospital beating against each other.
• 15:07
  SPEAKER_00: Predominantly to minimize opportunities for self-contamination during the doffing, in addition to conserving our N95s.
• 15:18
  SPEAKER_02: Another question that we usually are sometimes see a lot of differences within the US is general public masking.
• 15:26
  SPEAKER_02: So are people in Australia masking in general, like everybody's masking, or is it different by different areas?
• 15:34
  SPEAKER_00: So the only place where masking is mandated is in Victoria, where we have a mask mandate outside the household.
• 15:43
  SPEAKER_00: In New South Wales, which is a state where Sydney is, which has had the largest number of locally acquired cases after Victoria, masks are strongly encouraged.
• 15:55
  SPEAKER_00: It is not possible to physically distance and on public transportation, but there is no mandate.
• 16:01
  SPEAKER_00: And I have to say, for a culture in Australia that is not a culture that is used to wearing masks or face coverings, people in Melbourne and in Victoria really took to this.
• 16:13
  SPEAKER_00: So when you walk down the street, 90-95% of people are wearing masks or face coverings.
• 16:19
  SPEAKER_00: I think this is a low-cost intervention that has the real ability to reduce transmission.
• 16:26
  SPEAKER_00: It's a great part of the armament area.
• 16:29
  SPEAKER_02: That's really well said.
• 16:31
  SPEAKER_02: I think a low-cost way to kind of prevent possible outbreak even in these situations.
• 16:36
  SPEAKER_02: That's really very, very good to know.
• 16:39
  SPEAKER_02: How have you mitigated the healthcare worker concerns regarding COVID?
• 16:44
  SPEAKER_00: We have had very, very frequent open, transparent communication with repeated educational activities and communication opportunities for different craft groups.
• 16:57
  SPEAKER_00: So weekly calls with the nurse unit managers, weekly calls with the heads of units of the different departments, multiple grand rounds.
• 17:08
  SPEAKER_00: It's been really helpful to provide anticipatory guidance, stating that the guidance and recommendations will evolve as the science evolved and as our knowledge improved, so that people were primed right from the beginning that recommendations were going to be changing.
• 17:25
  SPEAKER_00: And so I think that helped significantly.
• 17:48
  SPEAKER_00: Of those, about 2,590 odd were acquired in the workplace.
• 17:53
  SPEAKER_00: And nearly half of that were from the aged care sector, and about 30% from hospitals.
• 18:00
  SPEAKER_00: And there has been a healthcare worker infection and well-being task force that was established to really try to get a better understanding of what had occurred and to introduce mitigating strategies and disseminate the knowledge among our hospitals and within the HK sector.
• 18:21
  SPEAKER_02: You really are highlighting another important point is about communication and open and clear communication, especially early on, telling them that the recommendations might adapt to the changing knowledge that we'll acquire for an ongoing pandemic.
• 18:34
  SPEAKER_02: It's an amazing thing that people need to also recognize that recommendations evolve as our knowledge evolves.
• 18:41
  SPEAKER_02: So, what has been the most challenging part from the infection prevention standpoint of responding to COVID-19?
• 18:50
  SPEAKER_00: Probably has several challenges here.
• 18:52
  SPEAKER_00: Within our healthcare service, we don't have testing on site.
• 18:57
  SPEAKER_00: And so that initially resulted in a laboratory turnaround time of up to 72 hours.
• 19:02
  SPEAKER_00: And that really presented significant challenges in bed management because we don't have many negative pressure rooms, and our number of single rooms is really quite limited.
• 19:14
  SPEAKER_00: And this has resulted in us having to cohort patients in two and four bedrooms.
• 19:20
  SPEAKER_00: And so, unfortunately, we have seen patient-to-patient transmission occurring due to our requirement to cohort patients.
• 19:29
  SPEAKER_00: And in an ideal setting, we would never have cohorted those.
• 19:32
  SPEAKER_00: In addition, our hospitals are not the newest, and our air handling systems are older, and the number of ear exchanges may not be optimal in all patient care and staff areas.
• 19:45
  SPEAKER_00: And then I think everybody has found a challenge with regards to the amount of space available for staff amenities, such as break rooms, and that has really required us to think outside the box and set up marquees outside with heaters because we were in the Victorian winter.
• 20:04
  SPEAKER_02: Yeah, I think that's an important point when winter is here already in the US, looking at how we can make sure people are compliant with the mandates we put in place, like the utilization of heaters, as you're saying.
• 20:16
  SPEAKER_02: I think all those would really be important things we can look at Australia to learn from.
• 20:22
  SPEAKER_02: What have you learned from COVID-19 that has changed your practice?
• 20:27
  SPEAKER_00: I think one thing which became apparent to us is that elderly patients may have very, very few symptoms, or certainly don't vocalize those.
• 20:36
  SPEAKER_00: And so I now would have a very low threshold for extensive testing on a ward if one suspects a potential transmission event.
• 20:46
  SPEAKER_00: We recognize just how frequently our patients move from bed to bed and ward to ward.
• 20:53
  SPEAKER_00: And so trying to limit that movement is really important to try and prevent the spread of COVID to other areas of the hospital.
• 21:02
  SPEAKER_00: One other thing that we have recognized is what we have termed the phrase aerosol generating behaviors.
• 21:09
  SPEAKER_00: And these are really well recognized outside of healthcare, but we have not really always thought about these within healthcare.
• 21:16
  SPEAKER_00: And so this is if there's shouting or screaming or picking or singing on behalf of patients.
• 21:23
  SPEAKER_00: And this we have seen particularly in elderly patients experiencing delirium.
• 21:29
  SPEAKER_00: And if ventilation is suboptimal when your air handling units may not be getting the number of air exchanges that you would like, then these kinds of aerosol generating behaviors can result in super spreading events to other patients and staff.
• 21:45
  SPEAKER_00: And so that really has influenced our use of M95s.
• 21:50
  SPEAKER_00: And in fact, we probably have had more patient to staff transmission from aerosol generating behaviors than aerosol generating.
• 22:00
  SPEAKER_00: Procedures.
• 22:00
  SPEAKER_00: And that's probably because aerosol generating procedures, we preferentially placed patients into negative pressure rooms, but we have severe limits on the number of negative pressure rooms that we have available.
• 22:12
  SPEAKER_00: And so these aerosol generating behaviors would occur on wards with suboptimal number of ear exchanges.
• 22:19
  SPEAKER_00: Probably also learned that this is a virus that really spreads in clusters.
• 22:23
  SPEAKER_00: And so it's really important when we do our contact tracing to not only look forward in terms of who was the infectious staff member in contact with during their infectious time period and quarantine any close contacts, but also to look back and understand how this staff member or how did this patient become infected to prevent ongoing unrecognized change of transmission, to do what we call acquisition testing around that area, and then in addition to also gain knowledge on where there are opportunities to improve use of personal protective equipment or to modify any particular behaviors.
• 23:07
  SPEAKER_00: In addition, MAMAs really necess is the necessity of invention.
• 23:12
  SPEAKER_00: In our healthcare service, we have two open plan intensive care units, and each of these only has a single negative pressure room.
• 23:21
  SPEAKER_00: And so one of our ICU staff members, together with the engineering department from the University of Melbourne, developed these personal ventilation hoods with a HEPA filter that protect staff and other patients.
• 23:32
  SPEAKER_00: And this has allowed us to use high-flow oxygen and other non-invasive ventilation in the intensive care unit, which I think has resulted in much, much better patient outcomes.
• 23:42
  SPEAKER_00: And we ideally would like to introduce these personal ventilation hoods now onto our general ward as well as the emergency departments.
• 23:52
  SPEAKER_00: So there's currently some work being done in evaluating those.
• 23:57
  SPEAKER_02: Well, that's very good information to have.
• 24:15
  SPEAKER_02: Question we have right now is how are you preparing for the next wave of COVID-19?
• 24:21
  SPEAKER_02: Or the influenza season.
• 24:23
  SPEAKER_02: But based on your location, I would imagine the influenza season is towards the end.
• 24:27
  SPEAKER_02: So what have you seen and what is the preparation for COVID-19 upcoming season or possible season?
• 24:33
  SPEAKER_00: We have just come out of our normal influenza season, and we basically have seen no influenza.
• 24:40
  SPEAKER_00: It has been our most quiet influenza season in decades.
• 24:45
  SPEAKER_00: We had prepared and were really concerned about the intersection between COVID-19 and influenza, and so there was a very, very strong push for influenza vaccination uptake among staff and patients and the general public.
• 25:00
  SPEAKER_00: We had, however, very, very little influenza, and I would ascribe that probably due to the fact that our borders were closed.
• 25:10
  SPEAKER_00: Essentially, people who came in were in quarantine for 14 days.
• 25:14
  SPEAKER_00: And then in addition, we had all the physical distancing, the mask wearing, the better hand hygiene.
• 25:22
  SPEAKER_00: And so we really saw very, very little influenza.
• 25:26
  SPEAKER_00: As we're now sort of coming out of this lockdown, we're sort of thinking about reviewing our surge plans in light of the new knowledge gained.
• 25:37
  SPEAKER_00: Initial surge plans were really created back in February, March, and I think we've learnt a lot since then.
• 25:43
  SPEAKER_00: And I think we need to really think about what we would do if we had a big surge similar to what is currently being experienced in the US and Europe.
• 25:56
  SPEAKER_00: Because our healthcare system honestly has been really protected by the community measures which were taken.
• 26:01
  SPEAKER_00: The public health measures really protected our hospitals from being overwhelmed.
• 26:06
  SPEAKER_00: The healthcare system in which I work is the in the epicenter.
• 26:09
  SPEAKER_00: We have seen the largest number of patients admitted to our intensive care units.
• 26:15
  SPEAKER_00: We treated the largest numbers in Australia.
• 26:17
  SPEAKER_00: But in comparison to the pressures placed on healthcare systems in Europe and the United States, we've really been very, very much spared that due to really the actions of our community in protecting the healthcare system.
• 26:33
  SPEAKER_02: Do you have any advice based on what country has either done well or done poorly that you would like to share broadly with us?
• 26:43
  SPEAKER_00: I think border control using quarantine measures to prevent repeated introductions from high-risk areas is really important.
• 26:51
  SPEAKER_00: And that was illustrated Australia-wide in March and now with the outbreak in Victoria.
• 26:56
  SPEAKER_00: It really prevented spread to the rural areas of Victoria and to other states.
• 27:01
  SPEAKER_00: I think that's an important opponent.
• 27:04
  SPEAKER_00: Leadership with politicians, listening to signs and evidence is really important.
• 27:09
  SPEAKER_00: Our Premier and Chief Health Officer have made themselves available every day during the lockdowns for press briefings that often went one and a half to two hours that were live streamed and patiently answered their questions.
• 27:23
  SPEAKER_00: Epidemiologists and modelers were really crucial in informing the initial lockdown as well as the lifting of restrictions from our second lockdown to allow us to have hopefully a COVID-normal Christmas.
• 27:37
  SPEAKER_00: And as I stated, we've now had five days in a row with zero cases in Victoria.
• 27:43
  SPEAKER_00: In Australia, there has been significant support for businesses and individuals during the lockdowns.
• 27:51
  SPEAKER_00: And then specifically in Victoria, there's also cash payments to encourage people to get tested and to then self-quarantine until those results would become available or stay in isolation.
• 28:06
  SPEAKER_00: And so that has been done really, really well so that people could do the right thing and they were not placed at a significant financial disadvantage.
• 28:16
  SPEAKER_00: A more casualized workforce, such as that for nursing homes, also has been encouraged to really work at an individual institution rather than moving between institutions.
• 28:29
  SPEAKER_00: I think we've really learned that investments in public health and contact tracing efforts are critical, and public health here has been underfunded for a long time in Victoria.
• 28:39
  SPEAKER_00: But with this pandemic, significant investments were made in beefing that up.
• 28:44
  SPEAKER_00: And so I'm really, really grateful for that.
• 28:46
  SPEAKER_00: Community engagement is critical, and I think the willingness of our community to follow the rules has been absolutely essential and has really saved our healthcare systems.
• 28:56
  SPEAKER_00: But we still have opportunities to do better, and so we're working hard at better engaging our very culturally and linguistically diverse communities.
• 29:06
  SPEAKER_00: Another thing which has been really helpful has been the load sharing, which was really introduced for our intensive care unit patients.
• 29:15
  SPEAKER_00: So within Melbourne, the number of cases admitted with COVID to our hospitals is very uneven.
• 29:22
  SPEAKER_00: And so, in order to ensure that there was load sharing, every morning at 9 o'clock, we would identify patients in our intensive care unit that could be safely transferred to other hospitals, whether they had COVID or non-COVID, so that we could be ready to be able to admit other patients who would deteriorate on the ward or who came to our emergency department to that intensive care unit.
• 29:49
  SPEAKER_00: And so our intensive care units were busy, but they were not crazy busy.
• 29:55
  SPEAKER_00: We had the decent staffing.
• 29:57
  SPEAKER_00: And I think the data from Australia regards to the outcomes in our intensive care units is second to none.
• 30:04
  SPEAKER_00: I think we've got a 14% mortality rate in our intensive care units.
• 30:08
  SPEAKER_00: And that is probably in large part to the fact that we could treat patients and give them the care that they needed without being absolutely totally overwhelmed.
• 30:22
  SPEAKER_00: And so I think that load sharing, I think, is a concept that I would strongly encourage.
• 30:28
  SPEAKER_00: I think the other thing is don't make assumptions.
• 30:30
  SPEAKER_00: We were really shocked when they did their door knock to see whether patients who were supposed to be quarantining inside their homes or isolating at home, whether they were actually at home.
• 30:41
  SPEAKER_00: And we found that 30% were not at home.
• 30:45
  SPEAKER_00: And so our control measures can't work if those people are out and about.
• 30:49
  SPEAKER_00: And so that really prompted us to look really carefully at ensuring that the appropriate community supports were available and people were not financially disadvantaged for doing the right thing for society.
• 31:03
  SPEAKER_00: And so I think actually evaluating how well people are able to adhere to public health advice and then ensuring that it is easy for people to do the right thing is really important.
• 31:16
  SPEAKER_00: Probably one other thing is that I'm still trying to get my head around this exponential growth.
• 31:23
  SPEAKER_00: I think our brains are just not wired to think in exponential growth.
• 31:27
  SPEAKER_00: And so the numbers may start off low, but within a really short period of time, they just can become astronomical.
• 31:34
  SPEAKER_00: And so acting hard and fast is really, really important.
• 31:38
  SPEAKER_00: And so speed is everything with this virus.
• 31:41
  SPEAKER_00: One needs to act really rapidly, I say, for everything except for when you're doffing or removing personal protective equipment.
• 31:49
  SPEAKER_02: That's an important element.
• 31:50
  SPEAKER_02: Speed is gonna be everything or is everything in our response.
• 31:54
  SPEAKER_02: It's really interesting to see your public health and the hospital-based perspective.
• 31:59
  SPEAKER_02: It's interesting to know.
• 32:00
  SPEAKER_02: Actually, related to what you were telling us, in your quarantine process, is there any ability to test out of quarantine?
• 32:08
  SPEAKER_02: Like test within the 14 days period, and if they're negative twice, is people able to come out of quarantine?
• 32:15
  SPEAKER_00: Not at the present time.
• 32:16
  SPEAKER_00: So we have now actually instituted that you actually have a day 11 test before you can come out of quarantine, even if you're asymptomatic.
• 32:24
  SPEAKER_00: So you have to have a test on day 11 or later that is shown to be negative before you can come out of quarantine.
• 32:31
  SPEAKER_00: So, no, you can't test yourself out of quarantine at the present time.
• 32:34
  SPEAKER_00: I do think we need to look at that data more closely and see if there are some opportunities to reduce the amount of time that people are in quarantine to make it easier.
• 32:46
  SPEAKER_00: We have actually now introduced not only quarantining close contacts, but also quarantining secondary close contacts.
• 32:57
  SPEAKER_00: So the close contacts of the close contact.
• 33:00
  SPEAKER_00: And those we can get out of quarantine if the primary contact tests negative 48 hours after breaking contact with the secondary contact.
• 33:11
  SPEAKER_00: Our numbers are now so low that we can actually go and do that.
• 33:14
  SPEAKER_00: And that has definitely saved us in our healthcare system.
• 33:19
  SPEAKER_00: We have found, especially if healthcare workers may be married, have partners, or get housing with other healthcare workers.
• 33:28
  SPEAKER_00: And so we would have a very low threshold for actually quarantining those other healthcare workers until we get additional information with regards to the primary contact.
• 33:39
  SPEAKER_02: That's so amazing to know.
• 33:42
  SPEAKER_02: Thank you very much to our speaker, Dr.
• 33:44
  SPEAKER_02: Kahner, for sharing your perspective and experiences.
• 33:48
  SPEAKER_00: Thanks so much for the opportunity and for everything that Shay does to support its members.
• 33:55
  SPEAKER_02: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 34:04
  SPEAKER_02: You will also find resources such as the recorded webinars, healthcare facility, outbreak, preparedness, and the SHA COVID-19 town hall.
• 34:14
  SPEAKER_02: You can now receive 50% of 2021 SHA membership using the coupon code WELCOME2021 during checkout.
• 34:24
  SPEAKER_02: That concludes this episode of Rapid Response Podcast.
• 34:28
  SPEAKER_02: Thank you for tuning in.