As those of you who subscribe to this site will know, I have committed to work with the Department of Health here in Australia to try and control the spread of COVID-19. Part of that role has been working within the disaster management framework to implement the provisions of the Public Health Act 2005 on social distancing. In the two weeks I’ve been involved, I have witnessed some truly mystifying events, and I thought I’d take some time to share them with you.
At the time of writing this, Australia currently has 5550 confirmed cases of the disease and there have been 1,192,028 cases worldwide. The latest population figures for Australia suggests that there are 25,203,198 people living here right now, which means that 1 person in every 4,541 have contracted COVID-19. It has been widely reported that the rate of spread in the United States of America is very high, so perhaps a comparison with their ratio of COVID-19 infections per capita might give us some idea of how well Australia is managing the disease. Currently there are 330,534,156 people living in the US and there are 305,820 cases. A simple calculation shows that 1 in every 1,080 people in America has contracted the disease. That is a rate 4 times higher than Australia is achieving currently. (https://coronavirus.jhu.edu/map.html)
So, I take heart that the long hours and stressful work, the putting ourselves at risk day in and out is paying off, but with all that said, I have still been left dumb struck by many people’s failure to grasp the concept behind social distancing.
Returning home
Public Health Unit staff all over Australia have spent hundreds of hours stood in airport arrival halls, waiting to greet travellers returning to Australia from overseas. From early March it has been the case that depending on a traveller’s point of origin prior to arriving in Australia, restriction of movement would apply to them. These restrictions have been getting progressively tighter up until last Saturday night, when complete supervised isolation was introduced for all arrivals. My faith in humankind was restored when reports of willing and thankful travellers came through… mostly.
Even in the face of a pandemic, which has claimed 64,316 people’s lives so far there were still travellers who were uncooperative, unwilling and in some cases abusive to Public Health staff. Yes, we all understand that people had travelled, in many cases over long haul distances and are tired, but the aim is to stem the influx of a deadly disease. Over two thirds of all cases of COVID-19 recorded in Australia have been imported via returning overseas travellers.
Confirmed
Since 24 March, with the increasing spread of the disease, revised testing recommendations were released. (available here)
This step has been taken to attempt to control the rate of spread whilst focussing the available testing resources where they can be most useful. But this means certain compromises and assumptions must be made.
First, if you are to be considered a confirmed case, you will have tested positive to a validated specific SARS-CoV-2 nucleic acid test or have the virus identified by electron microscopy or viral culture. In other words, you’ve been tested by having a swab or other potentially invasive test and returned a positive result. With limited numbers of test kits available, and incredibly busy clinical staff, full testing has been restricted to those who represent the biggest risk to the community. Yes, there are (poorly named) ‘fever clinics’ set up to make this testing more efficient and more available, but ultimately we still need to be extremely frugal with these services right now.
If you find yourself in the horrible position of being diagnosed with COVID-19 and you are not so sick as to need hospitalisation, then self-isolation within a suitable home environment is necessary. Public Health staff will direct you to follow some requirements designed to prevent the spread of the virus. If you have someone who can look after you, and you have access to a separate bedroom, access to food, have masks and gloves and don’t live with anyone at risk, you will be directed to isolate at home. You need to wear a mask whenever anyone else is present, such as to bring you food or give you other care. It is not possible for you to attend any public places or have visitors during this period. It’s absolutely horrible isn’t it? But it’s absolutely necessary if we are going to crack this thing together.
Here’s the kicker, due to how rapidly the virus can spread and that it takes 48 hours to get test results, people who are quite likely to be carrying the virus need to behave as though they definitely have the virus. Many people who start to feel unwell, are dashing around to do and see as much as possible, prior to receiving the dreaded diagnosis, thinking that its best to get lots done before being isolated completely. I can’t stress enough that this is such a crazy approach, if you are coming down with the virus, and have developed symptoms, you are very likely to be highly contagious to other people… you know, older and already sick people who could die.
Probable
If you have a fever (at or above 38°C) or have recently had a fever, including night sweats or chills, or if you have a nasty cough, shortness of breath or sore throat and you are in the same household as someone with the disease, then you probably have COVID-19. What we all really need from you right now, unless you need medical care, is to absolutely assume you do have COVID-19 and stay in your house, completely isolated from anyone at all. That means, if there are people in your house who aren’t feeling sick, you should completely isolate yourself from them. While testing resources are available, you are very likely to be tested, but in the coming weeks, that may not be possible. But you’ll still need to behave as though you have the virus.
Suspected
What about everyone else? To try and get a handle on this thing, the testing guidelines attempt to capture anyone else who may present a potential transmission risk. So, here you would be classed as a ‘suspected’ case if you have any of the symptoms described above and:
- You have been in close contact with a case or a probable case within the last 14 days or have travelled internationally or been on any cruise ship in the last 14 days. Or
- You live in any of the following settings where two or more confirmed cases have developed: Aged care or residential care facilities, Military operational settings, Boarding schools, Correctional facilities, Detention centres or Aboriginal rural and remote communities.
If you fall into this category, whether or not you have access to a testing facility, you will be directed to self-quarantine. This isn’t as strict as self-isolating but means that, other than for medical attention, you must stay in your home (or hotel if that’s where you have been directed to) and not leave for the 14-day quarantine period. Only people who usually live in the household should be in the home and there should be no one visiting the home either.
What’s the point?
We need to completely change our attitude about self-isolation. The purpose of self-isolation is to prevent the spread of the disease to the wider community. It is not to prevent you from becoming sick as an individual. This is a subtle but very significant difference, and I believe this confusion is why many of us are struggling to follow the more general social distancing principle effectively.
To try and illustrate the difference here, I’d like to share an experience with you. A young woman returned from overseas travel, and was quarantined in her home for a period of 14 days. This young woman lived in a shared house, with four other university students, all studying science subjects, some at PHD level.
The other four students went about their lives, within the limits of current social distancing rules and carried on attending their classes. After several days, the young traveller started to develop a fever and a cough. Following the guidance, she had been given, she phoned ahead and then later attended her GP surgery and received a test. She was advised to return home and await the results.
Her results took two days to come through. In the meantime, the four other students carried on interacting with her and moving in and out of the house, interacting with countless other people. They were all now in close contact with a ‘suspected’ case but failed to change their behaviour in any way. Now, strictly, they weren’t breaking the rules as such, except when asked, one of the housemates commented, “well, if she has it, we all already have it, so there is no point us quarantining ourselves now…’
This illustrates my point. These were intelligent adults who couldn’t recognise the core principle behind what we are trying to achieve. It was indeed very likely that they all had been exposed to the virus, so surely, it is obvious that there is all the more reason to limit their own movements to protect those around them.
Light at the end of the tunnel
Having been working long hours on the front lines with other Public Health and medical clinicians trying to get control of this, I can only beg all of you to think long and hard about what is going on here. When we are asked to only leave the house for essential purposes, honestly, they really mean essential. Of course, we need to protect ourselves, but if life is ever going to get back to something close to how it was before, we must try and protect each other too.
A recent article in the BMJ (https://www.bmj.com/content/bmj/369/bmj.m1375.full.pdf) suggested that as many as 78% of all COVID-19 cases had no symptoms at all and could potentially be the reason transmission is so rapid. For this and all the reasons I have already mentioned, all of us, with or without symptoms need to drastically limit our movements in every way possible. There may be certain things you are ‘allowed’ to do under the current social distancing rules, but the current rules aren’t the whole picture.
If almost 80 percent of people who can spread the disease don’t even know they have it, then we need to operate under the principle that each of us has it, and it is our duty not to give it to another single person. Regardless of any rules, it would be great if we could all just stay away from anyone else at all, only then will the light at the end of the tunnel come flooding in.
See you for the next article!
Greg Bennett is a Public Health Professional and
Leadership Coach
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