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Getting COVID Under Control And Keeping It That Way · The SHEA Podcast

• 0:07
  SPEAKER_01: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, Shea, promoting the prevention of healthcare-associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:23
  SPEAKER_01: I'm Dr.
• 0:24
  SPEAKER_01: Chrissy Woods, hospital epidemiologist at Mount Sinai West, and I will serve as your moderator.
• 0:29
  SPEAKER_01: 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.
• 0:38
  SPEAKER_01: Shea is excited to launch this episode of the podcast, COVID-19 Updates, What We Know Now.
• 0:44
  SPEAKER_01: Today's discussion will focus on ways to get COVID under control and how to keep it that way.
• 0:49
  SPEAKER_01: We're pleased to have Dr.
• 0:50
  SPEAKER_01: Marion Kaner, Director of Western Health's Infectious Diseases Unit in Australia back on our podcast today.
• 0:56
  SPEAKER_01: Thank you for joining us today.
• 0:58
  SPEAKER_01: Before we start our discussion, I would like to turn it over to Dr.
• 1:01
  SPEAKER_01: Jennifer Hanrahan to get us started with a brief news and guidance update for the week.
• 1:05
  SPEAKER_00: As of July 6, 2021, there have been 183,934,913 confirmed cases of COVID-19, including almost 4 million deaths reported to the World Health Organization.
• 1:18
  SPEAKER_00: As of July 6, a total of almost 3 billion vaccine doses have been administered.
• 1:23
  SPEAKER_00: To date, 67.1% of adults in the U.S.
• 1:26
  SPEAKER_00: have had at least one dose of vaccine, and 47.5% of the population is fully vaccinated.
• 1:31
  SPEAKER_00: An MMWR report on myocarditis in mRNA COVID vaccine recipients was published July 6th.
• 1:38
  SPEAKER_00: This report includes a summary of the recent Advisory Committee on Immunization Practices meeting from June 23, 2021.
• 1:45
  SPEAKER_00: Using myocarditis cases reported to the vaccine adverse event reporting system with onset within seven days after dose 2 of a messenger RNA vaccine, crude reporting rates per million second dose recipients were calculated using National COVID-19 vaccine administration data as of June 11, 2021.
• 2:01
  SPEAKER_00: Per million second doses of messenger RNA COVID-19 vaccine administered to males aged 12 to 29, 11,000 COVID-19 cases, 560 hospitalizations, 138 ICU admissions, and six deaths due to COVID-19 could be prevented compared with 39 to 47 expected cases of myocarditis after vaccination.
• 2:21
  SPEAKER_00: Among males aged 30 or greater, 15,300 COVID-19 cases, 4,598 hospitalizations, 1,242 ICU admissions, and 700 deaths could be prevented compared with three to four expected myocarditis cases after vaccination.
• 2:36
  SPEAKER_00: This analysis did not include the potential benefit of preventing post-COVID-19 conditions such as prolonged symptoms and MISC.
• 2:43
  SPEAKER_00: The Advisory Committee on Immunization Practices also reviewed population level considerations regarding vaccination.
• 2:49
  SPEAKER_00: No alternatives to messenger RNA COVID-19 vaccines for adolescents will be available for the foreseeable future, and vaccination of adolescents offers protection against COVID-19 that can be important for returning to educational, social, and extracurricular activities.
• 3:04
  SPEAKER_00: An article was published in the New England Journal of Medicine June 30th on the safety and efficacy of Novavax COVID-19 vaccine.
• 3:11
  SPEAKER_00: Novavax is a recombinant nanoparticle vaccine against SARS-CoV-2.
• 3:17
  SPEAKER_00: A total of 15,187 participants underwent randomization in this randomized observer-blinded placebo controlled trial conducted at 33 sites in the United Kingdom for adults between ages of 18 and 84, and 14,039 were included in the per-protocol efficacy population.
• 3:35
  SPEAKER_00: Infections were reported in 10 participants in the vaccine group and in 96 in the placebo group for a vaccine efficacy of 89.7%.
• 3:43
  SPEAKER_00: No hospitalizations or deaths were reported among the 10 cases in the vaccine group.
• 3:47
  SPEAKER_00: Five cases of severe infection were reported, all of which were in the placebo group.
• 3:51
  SPEAKER_00: A post hoc analysis showed an efficacy of 86.3% against the B117 or alpha variant, and 96.4% against non-B117 variants.
• 4:01
  SPEAKER_00: Reactogenicity was generally mild and transient.
• 4:04
  SPEAKER_00: The incidence of serious adverse events was low and similar in the two groups.
• 4:08
  SPEAKER_00: An article published in the British Medical Journal examined the effect of COVID-19 pandemic in 2020 on life expectancy across populations in the USA and other high-income countries.
• 4:19
  SPEAKER_00: The study evaluated the U.S.
• 4:20
  SPEAKER_00: and 16 other high-income countries using data from 2010 to 2018 and 2020.
• 4:26
  SPEAKER_00: Between 2010 and 2018, the gap in life expectancy between the U.S.
• 4:31
  SPEAKER_00: and the peer country average increased from 1.88 years to 3.05 years.
• 4:36
  SPEAKER_00: Between 2018 and 2020, life expectancy in the US decreased by 1.87 years, 8.5 times the average decrease in peer countries, widening the gap to 4.69 years.
• 4:47
  SPEAKER_00: Life expectancy in the U.S.
• 4:49
  SPEAKER_00: decreased disproportionately among racial and ethnic minority groups between 2008 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic white populations, respectively.
• 5:03
  SPEAKER_00: In Hispanic and non-Hispanic Black populations, reductions in life expectancy were 18 and 15 times the average in peer countries, respectively.
• 5:10
  SPEAKER_00: The authors concluded that the U.S.
• 5:12
  SPEAKER_00: had a much larger decrease in life expectancy between 2018 and 2020 than other high-income nations, with pronounced losses among the Hispanic and non-Hispanic black populations, a long-standing and widening U.S.
• 5:24
  SPEAKER_00: health disadvantage, high death rates in 2020, and continued inequitable effects on racial and ethnic minority groups are likely the products of long-standing policy choices and systemic racism.
• 5:35
  SPEAKER_01: Thank you, Dr.
• 5:36
  SPEAKER_01: Hanarhan.
• 5:37
  SPEAKER_01: I now want to move into the discussion with our speaker.
• 5:39
  SPEAKER_01: Dr.
• 5:39
  SPEAKER_01: Kainer, thank you so much for joining us.
• 5:41
  SPEAKER_01: Can you tell us what the situation is like in Australia at this point?
• 5:45
  SPEAKER_02: So Australia overall has been very fortunate.
• 5:48
  SPEAKER_02: We have had no deaths of COVID in 2021 from people who acquired COVID in Australia.
• 5:56
  SPEAKER_02: We have had one death in a person who acquired COVID overseas and was identified in our hotel quarantine.
• 6:02
  SPEAKER_02: New South Wales, one of our states in Australia, is currently experiencing a significant outbreak of the Delta variant with about 16 to 35 community transmissions per day.
• 6:18
  SPEAKER_02: In Victoria, which is the state which Melbourne is located in, we have now had seven days of zero community transmission after having had an outbreak of both Kappa and Delta variants.
• 6:33
  SPEAKER_02: And we are just emerging out of our fourth lockdown.
• 6:37
  SPEAKER_02: We, in general, in Australia, believe in very short, fast, rapid lockdowns in order to get control of a virus very rapidly.
• 6:46
  SPEAKER_02: So many of our other states, both in Western Australia, the Northern Territory, and Queensland, over the last two weeks also have had very short lockdowns of about three to four days just to assess the situation and ensure that there were no additional community transmissions, unknown chains of transmission.
• 7:07
  SPEAKER_01: Thank you for walking us through that.
• 7:09
  SPEAKER_01: I think we can all appreciate that it's very difficult to make sort of generalizations for any country.
• 7:15
  SPEAKER_01: And I'm sure that their situations there are very variable from area to area.
• 7:19
  SPEAKER_01: But I do think that overall, what we can say is that when we look at the data, we see that it's been almost a year since Australia's last major wave.
• 7:28
  SPEAKER_01: And I think everyone would be interested to know what Australia's been doing to prevent another one from taking place.
• 7:35
  SPEAKER_02: So Australia has really focused a lot on preventing incursion and very strong border controls.
• 7:44
  SPEAKER_02: So we have a hotel quarantine system.
• 7:49
  SPEAKER_02: So any travelers returning from overseas at the present, regardless of vaccination status, spend 14 days in quarantine, which in most of the states is in hotel quarantine.
• 8:01
  SPEAKER_02: Hotel quarantine is not perfect.
• 8:04
  SPEAKER_02: It is not built for that purpose.
• 8:06
  SPEAKER_02: The hotels are not fit for purpose.
• 8:08
  SPEAKER_02: And we have seen transmission occurring within hotel quarantine from returned travelers to staff and also between return travelers.
• 8:18
  SPEAKER_02: So people have actually acquired virus within hotel quarantine.
• 8:23
  SPEAKER_02: So even if they have come from a place which has a higher incidence of COVID than Australia does, they were not infected when they came in and they were infected within hotel quarantine, which I think is a terrible reflection of our duty of care.
• 8:38
  SPEAKER_02: I think we've learned a lot about airborne transmission and how easily this virus spreads.
• 8:45
  SPEAKER_02: And a lot of focus has been on strengthening hotel quarantine with regards to that.
• 8:52
  SPEAKER_02: So in Victoria, there has been an extensive ventilation assessment of each single room to try and ensure that these rooms are not at positive pressure to the corridor, ensuring that the return traveler is tested very frequently.
• 9:10
  SPEAKER_02: The staff are wearing personal protective equipment, which includes N95s and face shields, and are tested on a daily basis.
• 9:20
  SPEAKER_02: When a return traveler exits hotel quarantine in Victoria, they also get tested on day 17 and day 21 to ensure that they have not actually acquired COVID within hotel quarantine, and that has actually sometimes identified that there has actually been transmission which has occurred.
• 9:40
  SPEAKER_02: We have used the time to build up infrastructure with regards to testing and ensuring a rapid turnaround in testing, built up infrastructure with regards to a public health response in having a much more agile test, trace, and isolate system, additional community engagement, and now, of course, also concentrating on vaccination rollout.
• 10:07
  SPEAKER_02: And unfortunately, our vaccination rollout is not going as rapidly as we would like.
• 10:12
  SPEAKER_01: With regards to the hotel quarantine and the cases that you're seeing that are acquired within that, is the thought that it's mostly because of shared ventilation of some sort, or is the thought that it's from some of the staff that the quarantine travelers are interacting with, or is that still not very clear?
• 10:29
  SPEAKER_02: We believe the very vast majority is through ventilation.
• 10:33
  SPEAKER_02: And so there have been experiments performed which show that the air is leaking out from under the door into the corridor and then potentially into another person's room.
• 10:49
  SPEAKER_02: The transmissions in general have occurred at the ends of corridors where air exchanges have not been as great.
• 10:57
  SPEAKER_02: So in addition, we have also started to implement HEPA filters to try and increase the effective clean air exchanges.
• 11:09
  SPEAKER_02: We have also seen feeder fog going from one room to another by light fittings.
• 11:15
  SPEAKER_02: So there seems to be significant leakage occurring.
• 11:19
  SPEAKER_02: The leakage which we're seeing is usually in rooms which are fairly close to each other.
• 11:25
  SPEAKER_02: So it doesn't appear to be long distance aerosol transmission, but certainly over fairly short distances.
• 11:33
  SPEAKER_02: The buildings in Australia or in Melbourne at least are much more leaky.
• 11:38
  SPEAKER_02: So that even the wind, a strong wind on one side of a building can actually change the pressure differentials, which makes things a little bit challenging.
• 11:57
  SPEAKER_01: What were some of the biggest lessons that you learned from your previous waves?
• 12:01
  SPEAKER_01: And how has that translated into a low number of average daily cases since?
• 12:06
  SPEAKER_02: I think one of the biggest lessons that we have learned is to react very, very swiftly, to get on top of things very, very rapidly.
• 12:18
  SPEAKER_02: We have learned the importance of infrastructure, ventilation, the number of air exchanges, the airflow directionality is also really important.
• 12:30
  SPEAKER_02: And really understanding that built environment.
• 12:33
  SPEAKER_02: In several of our wards and in Australia, we still have wards with rooms which may be multi-occupancy, for example, four bedrooms and two bedrooms in particular.
• 12:45
  SPEAKER_02: We have seen that there has been the airflow goes into those rooms, but there is no register to go out.
• 12:53
  SPEAKER_02: So the air actually goes into the corridor to the nurses station.
• 12:57
  SPEAKER_02: And that really, I believe, helps to explain why we actually had a significant number of healthcare workers that were infected, that were not in direct contact with patients, but just at the nurses station, despite wearing surgical masks as well as eye protection.
• 13:17
  SPEAKER_02: So we are trying to remediate that, including the use of HEPA filters.
• 13:24
  SPEAKER_02: The other thing which we have really learned is how important community engagement is to ensure that our population recognizes symptoms and gets tested very early in their course so that we can identify them and our public health colleagues can do the appropriate test to trace and isolate.
• 13:46
  SPEAKER_02: We have gone to not only identifying their close contacts and exposure sites, but then also the close contacts of close contacts and try to quarantine those to stay ahead of that virus.
• 14:00
  SPEAKER_02: And that has been very resource intensive, but highly effective in keeping our numbers low.
• 14:07
  SPEAKER_02: And our philosophy has been to really try to keep transmission as low as we possibly can while we are increasing the vaccination coverage among our population.
• 14:20
  SPEAKER_01: Thank you so much for sharing that.
• 14:21
  SPEAKER_01: I think we're all learning that a combination of different efforts is really the thing that's most important in trying to gain control over the virus.
• 14:28
  SPEAKER_01: And I think one thing that we're seeing globally is not only the emergence of the delta variant, but certainly how quickly it's actually overtaking in certain areas as the more common circulating variants.
• 14:40
  SPEAKER_01: What impact is the delta variant having in Australia?
• 14:43
  SPEAKER_01: And what is the country doing to try to prevent it from creating another significant wave?
• 14:48
  SPEAKER_02: Preventing incursion, so preventing this virus from entering.
• 14:52
  SPEAKER_02: So via hotel quarantine, that is one piece, and ensuring the transportation of return travelers from the airport to hotel quarantine.
• 15:01
  SPEAKER_02: And then we're in the hope of building alternate quarantine stations, which are built for purpose, is one piece of this.
• 15:10
  SPEAKER_02: In addition, we have recognized that transmission can occur in places where we have not previously seen transmission, with the alpha variant or the early wild type Wuhan virus.
• 15:27
  SPEAKER_02: Transmission seems to occur a lot more frequently now in shopping centers.
• 15:34
  SPEAKER_02: And these retail settings are not areas where we typically saw transmission in the past.
• 15:39
  SPEAKER_02: So with both the Kappa and the Delta variant, transmission seems to occur on occasion within 10, 12 seconds of people crossing each other, being in each other's airspace.
• 15:54
  SPEAKER_02: And this is something which we have not seen earlier.
• 15:57
  SPEAKER_02: And we have multiple episodes where we have documented this through review of CCTV and are able to track it by genomics to see that that is where transmission appears to have occurred.
• 16:10
  SPEAKER_02: So our previous understanding of what do you consider an exposure has really changed.
• 16:18
  SPEAKER_02: Previously, you know, use the 15 minutes aggregate exposure, that does not appear to be something which we can use for delta.
• 16:27
  SPEAKER_02: We need to cast a wider net with respect to that.
• 16:46
  SPEAKER_02: We have seen multiple episodes where we have seen four or five generations of virus or chains of transmission occurring in the space of eight to ten days.
• 16:58
  SPEAKER_02: So this means one has to react extraordinarily rapidly to try and contain this virus.
• 17:05
  SPEAKER_02: So very, very infectious, recognizing other places of transmission where we have not traditionally seen it occur.
• 17:15
  SPEAKER_02: So these are the shopping centers.
• 17:17
  SPEAKER_02: We even have now had an outbreak occurring in an apartment complex where the exposure appears to have been in a shared stairwell where people didn't have direct face-to-face contact, but they used a shared stairwell.
• 17:32
  SPEAKER_02: So that has influenced our public health response.
• 17:37
  SPEAKER_01: That's very alarming and also very interesting.
• 17:39
  SPEAKER_01: Again, I think this highlights the need to have these discussions to find out what we're learning in different places and share the information so that we can all make actionable changes.
• 17:47
  SPEAKER_01: I do actually have one more other thing to go and add.
• 18:26
  SPEAKER_02: And I think that is an important thing to consider with adultivariate.
• 18:30
  SPEAKER_02: And this has also been borne out by the outbreaks in Singapore, where the outbreak at Chengi Airport and in one of our hospitals were from fully vaccinated staff who then started off the chains of transmission.
• 18:45
  SPEAKER_01: I think that's an incredibly important piece of data.
• 18:47
  SPEAKER_01: And I think it makes the whole conversation around vaccines complex in so many ways, because I think the public is hoping that the vaccines will prevent transmission altogether and will allow a certain amount of normalcy to resume, like it has in some very small parts of the world, really, when you consider the globe as a whole.
• 19:04
  SPEAKER_01: And I guess segueing into a conversation about your own experience with vaccine rollout, the news agencies, at least here, have been reporting that the vaccine rollout in Australia has been slow, somewhat chaotic.
• 19:16
  SPEAKER_01: There have been some reports of mixed messaging.
• 19:18
  SPEAKER_01: And I know you alluded to the fact that you had hoped that it would have progressed a little bit more quickly.
• 19:23
  SPEAKER_01: Can you share a little bit more of your own opinion on how the rollout is going and what you think is happening?
• 19:28
  SPEAKER_01: And do you have any of your own suggestions on what can be done both within your state and within your country to improve the vaccine rollout?
• 19:35
  SPEAKER_02: So I have to say the vaccine rollout in Australia has been very disappointing.
• 19:40
  SPEAKER_02: I think the major issue which we're currently facing is that of supply.
• 19:46
  SPEAKER_02: And this probably relates to early decision making and putting too many eggs into too few baskets and not having sufficient diversification.
• 19:56
  SPEAKER_02: And so in Australia, we have the ability to manufacture AstraZeneca locally, and we are now churning out between 800,000 to a million doses per week.
• 20:07
  SPEAKER_02: And that is really helpful.
• 20:09
  SPEAKER_02: AstraZeneca was going to be the backbone of our vaccination effort.
• 20:14
  SPEAKER_02: Unfortunately, however, the problem with thrombosis and thrombocytopenia syndrome has arisen, which then had resulted in a restriction of when AstraZeneca could be used.
• 20:28
  SPEAKER_02: Initially, it was only in those aged over 50, and now it's only able to be used in those over the age of 60, unless Pfizer, which is our other product, is not available for those under the age of 60, and there are compelling reasons.
• 20:44
  SPEAKER_02: So Pfizer is our other product that is sourced from overseas, and we only have very small quantities coming in.
• 20:53
  SPEAKER_02: And that supply issue has really been hampering our vaccine rollout.
• 21:00
  SPEAKER_02: We have overwhelming demand for the vaccine, for Pfizer in particular, but are just unable to meet that.
• 21:08
  SPEAKER_02: So that's not the overall supply issue.
• 21:11
  SPEAKER_02: The Commonwealth or federal government was responsible for vaccination of residential HTL residents of skilled nursing facilities and their staff.
• 21:22
  SPEAKER_02: Every skilled nursing facility has been visited at least twice and residents have been offered vaccination.
• 21:30
  SPEAKER_02: We don't have full transparency on how good that take up is on an individual skilled nursing facility level, although I've been told it around about 85% have accepted vaccination.
• 21:43
  SPEAKER_02: Unfortunately, the staff of those residential aged care facilities were not included in that rollout.
• 21:50
  SPEAKER_02: And so we have some very significant gaps in the vaccination status of the staff of skilled nursing facilities.
• 22:00
  SPEAKER_02: Probably the only between 18 to 30% of skilled nursing facility staff have been vaccinated with at least one dose.
• 22:09
  SPEAKER_02: The messaging, I think, could have been better.
• 22:13
  SPEAKER_02: I think people in Australia or our political leaders really initially said this is not a race because we felt comfortable.
• 22:21
  SPEAKER_02: We didn't have the horrendous outbreaks that many of others around the world were experiencing.
• 22:28
  SPEAKER_02: And in the registration process, it was felt that they didn't want to undergo an EUA.
• 22:36
  SPEAKER_02: They really wanted to have a full registration process.
• 22:40
  SPEAKER_02: And so that is what has happened.
• 22:42
  SPEAKER_02: And the rollout really started in February.
• 22:45
  SPEAKER_02: But at the present time, supply has been really the major, major issue, specifically of Pfizer.
• 22:54
  SPEAKER_02: And then having the issues surrounding AstraZeneca with regards to the blood clots with low platelets has resulted in significant vaccine hesitancy in those that are still able to go and obtain that vaccine.
• 23:12
  SPEAKER_01: I think we all have a lot to learn from each other on how to how to deal with the vaccine hesitancy issue.
• 23:18
  SPEAKER_01: And certainly, you know, I didn't mean to imply that the vaccine is only important to prevent transmission.
• 23:24
  SPEAKER_01: I think the important thing to highlight is the fact that it does make a significant impact on the severity of the disease.
• 23:29
  SPEAKER_01: And as you pointed out, that even amongst your vaccinated populations and the skilled nursing facilities that they're seeing mild disease, I think that's that's really reassuring.
• 23:37
  SPEAKER_01: I know one of the things we've seen here is that it's often the younger folks who are now actually eligible for vaccine that are interestingly slightly more hesitant to actually step forth to get it.
• 23:46
  SPEAKER_01: And so I hope that as the messaging continues in Australia, that you might be able to think of a good way to persuade the younger people that this is really something that's important to do.
• 23:56
  SPEAKER_01: And hopefully you won't encounter some of the same patterns of hesitancy that we've seen here in the United States.
• 24:02
  SPEAKER_02: I think we have some additional opportunities, especially among our culturally and linguistically diverse communities, where on social media there has been misinformation, and we are actively trying to counter that with community engagement and trusted leaders.
• 24:19
  SPEAKER_02: In terms of our vaccination status, if case that is of interest, in our 16-plus population, Australia-wide, 31% have received one dose of vaccine, and 90.8% have received two doses.
• 24:35
  SPEAKER_02: In our 70 plus population, 71% have received one dose and 20% are fully vaccinated.
• 24:42
  SPEAKER_02: So we still have some very significant gaps to fill, especially now with the Delta variant, where two doses of vaccine seem to be especially important.
• 24:54
  SPEAKER_01: Absolutely.
• 24:54
  SPEAKER_01: And I think that's going to be a large part of the messaging going forward.
• 24:58
  SPEAKER_01: And certainly in the United States, we've seen similarly that low-income areas and communities of color are really some of the communities that are getting specialized outreach because we really want to make sure that individuals there have access to the best information as opposed to a lot of the misinformation that unfortunately is making its rounds on social media.
• 25:17
  SPEAKER_01: With all of these complex things in mind, do you have any thoughts on how healthcare providers from other countries can work together to help get the virus under control?
• 25:26
  SPEAKER_02: I think we have different public health infrastructures and also the built environment may be different, which provides additional challenges and opportunities for us to learn from each other.
• 25:38
  SPEAKER_02: I think many of our hospitals in Victoria, at least, are older and the ventilation may not be as up to date as we would like.
• 25:48
  SPEAKER_02: And these come with significant costs if you were to try and rectify those.
• 25:56
  SPEAKER_02: And so looking at other methods of mitigating that risk, I think are important.
• 26:02
  SPEAKER_02: And so we have been really investing quite a bit of time and effort in looking at the value added of HEPA filter portable air cleaners as an adjunctive measure.
• 26:13
  SPEAKER_02: And some of our colleagues between Western Health and the University of Melbourne have actually also developed a personal ventilation hood, which has been a godsend for us in the second wave, where Western Health looked after the most patients requiring ICU admission in all of Australia.
• 26:33
  SPEAKER_02: And we have two intensive care units, which are open plan ICUs.
• 26:37
  SPEAKER_02: And these personal ventilation hoods really kept patients and staff really safe in that particular environment.
• 26:44
  SPEAKER_02: So I think sharing of those is an important piece.
• 26:49
  SPEAKER_02: I think understanding how these new variants behave, how are they behaving differently, especially when you overlay the impact of vaccination status on that is also something that is really important.
• 27:04
  SPEAKER_02: I think public health and their efforts need to be supported everywhere.
• 27:09
  SPEAKER_02: And increasing support for public health, public health infrastructure, supporting test trace and isolate is really important as well.
• 27:18
  SPEAKER_02: So I think we can learn absolutely from each other.
• 27:22
  SPEAKER_02: And I have been a regular attender of the Shape podcast.
• 27:27
  SPEAKER_02: And so I have learned so much from everybody who has so generously shared their information.
• 27:33
  SPEAKER_02: So I'm very grateful for that.
• 27:35
  SPEAKER_01: Absolutely.
• 27:35
  SPEAKER_01: I think you said it best.
• 27:36
  SPEAKER_01: I think this really presents an opportunity for us to reach out to our colleagues globally and to really learn as much as we can from each other.
• 27:43
  SPEAKER_01: I think it's really going to be the only way that we're going to get a good, strong handle on how to move forward and how to collectively move beyond this pandemic.
• 27:51
  SPEAKER_01: And with all the difficulties that have come around, with all the different variants, with all the things that we're learning so quickly and having to respond to so quickly, I do think that on balance, when we see what's been happening in Australia, it does appear that you are doing a good job of keeping the virus under control.
• 28:05
  SPEAKER_01: And if you could give somebody very high-level bullet points of what you think is the most important or a series of the most important things that they can do to keep the virus under control, what would those final recommendations or bullet points be?
• 28:18
  SPEAKER_01: I think number one, get vaccinated.
• 28:20
  SPEAKER_02: Number two would be stay at home when you're sick, get tested very, very rapidly if you have even the mildest of symptoms.
• 28:29
  SPEAKER_02: Source control is really important.
• 28:31
  SPEAKER_02: A layering of interventions is really critical.
• 28:35
  SPEAKER_02: Don't forget about airflow, directionality, as well as the number of exchanges, ventilation is also important and really support public health.
• 28:45
  SPEAKER_02: Vaccinate your community, your staff, and we really need to also ensure that countries around the world have access to vaccines so that we don't continue to spin off variants which can come back and bite us.
• 28:59
  SPEAKER_01: I think those are all really great pieces of advice.
• 29:02
  SPEAKER_01: Dr.
• 29:02
  SPEAKER_01: Kahner, thank you so much for speaking with us and for sharing your perspective and your experiences.
• 29:07
  SPEAKER_01: This podcast can be accessed on Shay's online education center, learning CE, under the Rapid Response Program.
• 29:14
  SPEAKER_01: You will also find other resources which include recorded webinars such as the SHA COVID 19 town halls.
• 29:20
  SPEAKER_01: This concludes today's episode of the Rapid Response Podcast.
• 29:23
  SPEAKER_01: Thank you for tuning in.