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Australia activates pandemic plan as COVID-19 outbreak gathers pace

As the novel coronavirus outbreak gains a global foothold and experts warn the world is ill-prepared for escalation of the epidemic, Australia has endorsed and activated its pandemic preparedness plan, warning the disease poses a “significant risk”.

With sustained local transmission linked to clusters in South Korea (977 cases, 10 deaths), Japan (157 cases, 1 death, plus almost 700 cases from the Diamond Princess and 4 deaths), Iran (61 cases including the deputy health minister, 15 deaths) and Italy (more than 300 cases, 7 deaths), and the first cases reported in Afghanistan, Iraq, Bahrain, Oman, Austria, Croatia and Switzerland, as well as an outbreak on the Canary Island of Tenerife, there is a growing consensus that it is a matter of when, not if, a COVID-19 pandemic is declared.

World Health Organization chief Dr Tedros Adhanom Ghebreyesus said the WHO did not believe COVID-19 constituted a pandemic — yet — though it certainly had the potential to become one:

Our decision about whether to use the word, pandemic, to describe an epidemic is based on an ongoing assessment of the geographical spread of the virus, the severity of disease it causes and the impact it has on the whole society.

For the moment we are not witnessing the uncontained global spread of this virus and we are not witnessing larger scale severe diseases or death.

Does this virus have pandemic potential? Absolutely it has. Are we there yet? From our assessment, not yet.

So how should we describe the current situation? What we see are epidemics in different parts of the world affecting countries in different ways and requiring a tailored response. The sudden increase in new cases is certainly very concerning.”

Bruce Aylward, who headed the WHO’s COVID-19 mission to China — epicentre of the virus outbreak — warned earlier today that the rest of the world was ill-prepared for the epidemic to spread, and urged countries to begin communicating the risks to their population and ways they should prepare.

“Think the virus is going to show up tomorrow,” Aylward said in a press conference in Geneva. “If you don’t think that way you are not going to be ready.”

In a piece published at Croakey earlier this week, risk communication specialists Jody Lanard and Peter M Sandman argued that it was past time to shift focus with the public from containment to mitigation, suggesting measures and messages that should be taken.

‘Significant risk to Australia’

In Australia, the number of cases has remained relatively stable since the outbreak began, with 15 confirmed COVID-19 diagnoses — all with links to China — and another seven people evacuated from the Diamond Princess.

But chief medical officer Brendan Murphy warned this week that, with the evolving global picture, we could soon enter a new pandemic phase of COVID-19.

“In Australia, there is no community transmission of this virus at the present. There is no reason for people to feel concerned at present, but we are certainly aware of the international developments,” Murphy said. “We have a global pandemic plan, which is based on our pre-existing and long practised pandemic influenza plan, and we are certainly preparing as a nation, for every eventuality.”

This blueprint, the Australian Health Sector Emergency Response Plan for Novel Coronavirus COVID-19, was endorsed by the Australian Health Protection Principal Committee (AHPPC) on February 17.

The AHPPC said were a global COVID-19 pandemic to develop, it would be “almost impossible to prevent widespread community transmission in Australia”.

“Accordingly, AHPPC and all health and government agencies have been, and will continue to be, engaging in pandemic preparedness activities,” the AHPPC said in a statement earlier this week.

“A significant local outbreak of COVID-19 would place very substantial pressure on the health system. Further planning and preparation at all levels of the health system is required to cover all potential scenarios.”

The AHPPC, which comprises all state and territory Chief Health Officers and is chaired by the Australian Chief Medical Officer, is meeting daily, and said the public should expect that messaging around the coronavirus outbreak “will change over time”.

Australia’s COVID-19 pandemic plan describes the outbreak as posing a “significant risk to Australia”, with the “potential to cause high levels of morbidity and mortality and to disrupt our community socially and economically.”

The plan is currently in its “initial” phase, with a focus on minimising transmission, preparing and supporting health system needs, understanding more about the disease in the Australian context, and confirming and supporting governance arrangements.

The COVID-19 outbreak has significantly slowed the Chinese economy, with supply chain effects to be felt across the globe. The export of raw materials for and domestic production of health sector essentials such as masks and pharmaceuticals are of particular concern.

Australia’s plan invests primary responsibility for the COVID-19 response with the states and territories. It stresses the need for “proportionate” responses informed by an ethical framework balancing equity (particularly for Aboriginal and Torres Strait Islander and culturally and linguistically diverse populations), individual liberty, privacy and confidentiality, proportionality, protection of the public, provision of care, reciprocity, stewardship and trust.

It explores three outbreak scenarios: low clinical severity, moderate clinical severity and high clinical severity.

  • low: special support for at-risk groups such as Aboriginal and Torres Strait Islander peoples, remote communities, immunocompromised, aged care, infants, those with comorbidities; impact likely similar to the 2009 H1N1 pandemic
  • moderate: severe pressure on primary care and hospital services requiring scaling back and cancellation of non-urgent operations, surge capacity and alternative models such as fever clinics and cohorting; health care workers at risk; additional legislation may be required
  • high: capacity to be severely stretched across the health sector, including pharmacies, aged care, blood banks, mortuaries, primary and acute care, with health care workers also at risk; health emergency legislation may be required; impacts similar to the 1918 H1N1 pandemic

The plan notes that primary care, ACCHOs, aged care and pharmacists will see and manage the bulk of COVID-19 cases. It also foreshadows the establishment of an Aboriginal and Torres Strait Islander clinical advisory group to support communications and provide feedback to inform decision-making. The plan says close cooperation with the aged care and child care sectors will also be essential.

The COVID-19 plan is intended to be implemented and interpreted in conjunction with the Emergency Response Plan for Communicable Disease Incidents of National Significance (National CD Plan) and the COVID-19 CDNA National Guidelines for Public Health Units, which is being regularly updated and is current at February 23.

The priorities of the initial pandemic plan phase are detailed below. The plan will be escalated to “targeted action” stage at the discretion of the AHPPC, and triggers may include a pandemic declaration by the WHO, or credible evidence of sustained community transmission.