As cases of human-to-human transmission of coronavirus rise outside of China health experts in Australia argue a global coronavirus pandemic “is very likely, if not inevitable”.
Some say the world is already in the early stages of a pandemic, which is defined by the World Health Organisation as a disease spreading across two continents.
Clusters of Covid-19 – the illness caused by Sars-CoV-2 – are emerging all over the world, with some showing no obvious link to China, leaving experts struggling to determine where they started and how they have spread.
Globally, there have been 78,973 confirmed cases of Covid-19 and 2,466 deaths. The vast majority of infections and deaths have been in mainland China, centred around central Hubei province.
How does a country like Australia, geographically remote and with a limited number of mild cases – all of which have been traced back to their origin – counter a pandemic?
Early stages: health screenings and travel bans
The “initial action” response, when cases are first identified in Australia, is focused on “minimising transmission” and “managing initial cases”. It involves border measures such as health screenings at airports and ports, escalating to travel bans, which are currently in place for travellers from mainland China.
Confirmed cases are tracked backwards to find points of infection, and potential contacts – such as fellow passengers on flights – alerted to the potential that they have been exposed to the disease.
Those who have been exposed to suspected cases are asked to self-isolate at home. Citizens and permanent residents returning from known hotspots face periods of enforced quarantine.
Escalation: surge staffing and ‘fever clinics’
If, and as, cases escalate, hospitals can be advised to consider bringing in additional “surge staff” and state governments asked to consider establishing “fever clinics” or other alternative models of care “to minimise the burden on the health system”.
Places where outbreaks could spread especially rapidly, or could impact upon vulnerable populations – residential aged care facilities, schools and prisons – can be given extra support and staff to investigate and manage outbreaks.
Australia’s Covid-19 plan draws from the Australian Health Management Plan for Pandemic Influenza, which contemplates a novel coronavirus from which the Australian population would have little immunity.
“Currently, there are no effective anti-virals available and there is no vaccine. Availability of a customised novel coronavirus vaccine would be the greatest tool in reducing the impact. It is still not known if or when this might be available,” the emergency response plan reads, noting that this is still no vaccine available for the other major coronaviruses Sars and Mers.
Increasing ‘social distancing’ measures
Government-directed social distancing measures may increase from reactively – or, if necessary, preemptively – closing schools if it appears children are particularly susceptible; encouraging, or potentially mandating, workplace closures and working from home; and cancelling large public events.
And Australia will also attempt to insulate itself from any growing pandemic with increasing travel advisories for countries that are experiencing significant outbreaks.
Already, the Department of Foreign Affairs has raised the travel advisory for China to the highest level: “Do Not Travel”, and told its citizens already in the country they should leave the country as soon as they are able.
On Monday, the Australian government raised its travel advice for both South Korea and Japan.
“Based on advice from Australia’s chief medical officer, we now recommend you ‘exercise a high degree of caution’… due to a heightened risk of sustained local transmission of coronavirus (Covid-19),” Dfat said of both countries.
What individuals can do
Risk communication experts Jody Lanard and Peter Sandman have argued that with the rise in cases globally, “it’s a good time to think about how to use the ‘P-word’ (pandemic) in talking about Covid-19”.
“The most crucial (and overdue) risk communication task for the next few days is to help people visualise their communities when ‘keeping it out’ – containment – is no longer relevant. The P word is a good way to launch this message.”
Lanard and Sandman say there are measures individuals can take to prepare for and deal with a potential global outbreak.
They advise people with medical conditions to “get ahead” on prescriptions if possible “in case of very predictable supply chain disruptions, and so they won’t have to go out to the pharmacy at a time when there may be long lines of sick people”.
Lanard and Sandman also recommend people slowly starting to stock up on non-perishable food “to last their households through several weeks of social distancing at home during an intense wave of transmission in their community”.
“And the example we like the best, because it gives every single person an immediate action that they can take over and over: right now, today, start practicing not touching your face when you are out and about!
“You probably won’t be able to do it perfectly, but you can greatly reduce the frequency of potential self-inoculation. You can even institute a buddy system, where friends and colleagues are asked to remind each other when someone scratches her eyelid or rubs his nose.”
Preparing for a pandemic
The government’s emergency response plan says Australia is well placed globally to respond to any widespread outbreak, but that the risks should not be under-estimated.
“The novel coronavirus outbreak represents a significant risk to Australia. It has the potential to cause high levels of morbidity and mortality and to disrupt our community socially and economically.”
This month, the Australian government updated its Australian Health Sector Emergency Response Plan for Novel Coronavirus (Covid-19). The plan outlines a staged response to a worsening pandemic: Australia is currently in the “initial action” stage.
The emergency response plans says impact of the outbreak will be determined by:
the clinical severity of the outbreak (how severe cases are, and many people need to be hospitalised)
its transmissibility (how easily it is spread, currently it has a preliminary reproduction number of 1.4 to 2.5)
the capacity of the health system to treat infected patients
the effectiveness of interventions to treat the illness or stop it spreading
Victoria’s chief health minister, Dr Brett Sutton, said all Australian states, along with the commonwealth government, have been working on pandemic preparedness for weeks.
“It’s clear that with local transmission in several countries a pandemic is very likely, if not inevitable. We are working rapidly on planning and surge with our health sector.
“We’ve provided guidance to practitioners and many communications materials but are now focused on the models of care that will need to be in place – clinics, phone triage, home care, right through to ICU and aged care.”
“Victoria and Australia nonetheless remain completely in containment mode,” Sutton said, “identifying any possible case; isolating those who are infectious; and quarantining contacts. Regardless of developments internationally, this gives all of us time and space to plan and prepare.”