Friday 28 February 2020

Australia points to the future: mass vaccinations and stadium quarantine

Australia's coronavirus 

pandemic plan: mass 

vaccinations and stadium 


Australian evacuees from Wuhan arrive at the Manigurr-ma village in Darwin, 9 February 2020
27 February, 2020

Governments may order mass vaccinations of entire suburbs, cities or groups of people; sports stadia may be sequestered as quarantine sites; and police could be ordered to guard critical medical supplies under Australia’s pandemic health plans.

Under worst-case scenarios being contemplated by state and federal governments, forecasts say a pandemic outbreak could last up to 10 months, and 40% of the country’s workforce could be sidelined by illness or caring for family members. Australia’s GDP could take a 10% hit.

The pandemic plans have not yet been scaled up to their highest levels: Australia remains in containment mode and governments have consistently said that Australia is well-placed to deal with any outbreaks.

Currently, out of 81,000 confirmed Covid-19 cases worldwide, which have caused more than 2,700 deaths, just 22 have been identified in Australia, with zero deaths.

Pandemic influenza can cause significant disruptions to the way we live as it has the potential to result in high levels of illness and death,” the Victorian government has warned in its action plan for influenza pandemic.

The social distancing measures that may be required will have wide-ranging effects, with closure of schools and childcare services, and cancellation of public events. It is estimated that up to 40% of the workforce may withdraw from work at any one time due to illness, the need to care for family members or the fear of contracting the virus in the workplace or on public transport.

One study estimated that in a worst-case pandemic influenza scenario, Australia’s gross domestic product could suffer a decline of greater than 10%.”

State and federal governments have had pandemic plans in place for years, prepared for the possibility of a novel coronavirus or a wide-scale influenza outbreak.

The publicly available plans emphasise that predicting the length, severity and impact of a coronavirus – such as SARS-CoV-2 – outbreak is difficult, given a large number of unknown and variable factors.

The impact of a pandemic depends on how sick the virus makes people (clinical severity), the ability of the virus to spread between people (transmissibility), the capacity of the health system, the effectiveness of interventions and the vulnerability of the population,” the New South Wales government’s human influenza pandemic plan says.

As humans will have little or no pre-existing immunity to a pandemic virus and influenza viruses can be transmitted among people without symptoms, prevention is not considered realistic.”

But the NSW Health plan makes a number of fundamental assumptions about a pandemic outbreak in Australia:

The disease is likely to originate overseas and be imported into Australia by infected travellers.

As infected travellers may have no symptoms on their arrival into Australia, border screening of incoming passengers is unlikely to be of benefit in preventing a pandemic influenza strain entering the country,” NSW Health says.

If and as a pandemic worsens, contingencies could see the ordering of schools closed and of public transport altered in order to implement social distancing measures. Mass gathering events, such as sporting events or concerts, may be cancelled.

People may be advised – or even ordered – to work from home if possible.

People will be forced off work if they are ill, to care for family members, or by advice – or orders – to self-isolate.

Hospitals may need to set up screening stations outside emergency departments and designate specific “flu areas” within hospitals to ensure coronavirus patients are isolated from others. If hospitals are overrun, operating theatres or general wards could be requisitioned as intensive care surge areas and children may be able to be treated and managed at adult hospitals.

Overflow facilities are used to accommodate patients when it is impractical to manage them at home or in a hospital,” NSW Health says. “Healthcare facilities, including private hospitals, would be used preferentially. However, schools, warehouses, convention centres, hotels or sports arenas may be alternative sites.”

I think it’s much, much safer that way,” Sutton said. “We have to proceed with planning on the basis it is inevitable and we can and should expect more cases in Australia in the coming weeks or months. I don’t want to see us get caught out at all.”

Sutton said hospital contingency plans would adapt depending on the severity of the outbreak.

That might look like cohorting where you have a respiratory ward for coronavirus patients in hospitals,” he said. “It might have a separate stream for emergency department patients.”

There is currently no vaccine for Sars-CoV-2 – the novel coronavirus that causes Covid-19 – but work is under way to develop one.

When an effective vaccine is developed, the NSW Health pandemic plan outlines two potential scenarios: “vaccination of priority with a candidate or pandemic-specific vaccine, or mass vaccination for the wider local health district population with a pandemic-specific vaccine”.

In the event of a severe pandemic outbreak, police forces may be drafted in to protect key medical supplies, with responsibility to “plan and implement security of the national medical stockpile and state medical stockpile … of anti-influenza medicine and personal protective equipment”.

Social distancing strategies, voluntary at first but enforced if necessary, could be implemented across the country. That might include quarantine in designated secure sites (such as the Manigurr-ma village in the Northern Territory); home isolation; exclusion, where people are asked to exclude themselves from childcare, school, educational facilities, workplace

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