As much as no-one would ever want to spend two weeks in hotel quarantine with no ability to venture outside, or months under strict lockdowns, it is these severe preventative restrictions that have allowed countries including Australia to eventually suppress the spread of the COVID-19 virus and pandemic.

In particular, Melbourne, Victoria endured some of the longest and strictest lockdowns in the world in late 2020. And just weeks before Christmas 2020, Sydney’s Northern Beaches faced (and continue to face) strict restrictions and lockdown measures in order to reduce the spread of a surge in cases originating from an Avalon cluster.

When the World Health Organisation (WHO) declared the coronavirus outbreak as a Public Health Emergency of International Concern (PHEIC) on the 30th January 2020, (Kantis et al 2020) strict lockdowns weren’t the immediate response. However, it didn’t take long before world leaders began to make unprecedented decisions to prevent the spread of the virus including closing international borders, restricting all non-essential internal travel, enforcing social-distancing measures, and mandatory quarantining of travelers (BBC News 2020).

In order to appreciate how strict lockdowns and quarantining was and continues to be necessary in aiding the prevention of the spread of the COVID-19 virus, its important to understand how the virus is spread.

The virus can spread from person to person through:

close contact with an infectious person (including in the 48 hours before they had symptoms)
contact with droplets from an infected person’s cough or sneeze
touching objects or surfaces (like doorknobs or tables) that have droplets from an infected person, and then touching your mouth or face (Australian Government Department of Health 2020).
It is also known that symptoms may appear 2-14 days after exposure to the virus, meaning that infected people can spread the virus while not even knowing they are infected (Centers for Disease Control and Prevention 2020). This fact combined with the fact that there is no known immunity within our community means that coronavirus has the ability to spread widely and quickly.

Therefore, Quarantine was and is applied to people who are well but may have been in contact with someone with COVID-19, have returned from overseas, or are entering a state or territory that has a required a quarantine period, requiring them to isolate from other people for 14 days in order to prevent the spread of the virus (Department of Health 2020).

Lockdowns of varying levels were also enforced across Australia in order to prevent the spread of COVID-19. By closing businesses, restricting numbers of people at large social gatherings, sending schooling online, limiting visits between family members, preventing visits to nursing homes, canceling sporting events, enforcing strict social-distancing measures, and almost all public life in Melbourne ceasing to exist for 111 days of lockdown (among many other restrictions), people had very limited exposure to each other, thus limiting the ability for the COVID-19 virus to spread amongst the community.

Prior to Sydney’s recent Northern Beaches outbreak, Australia had been referred to as a ‘pandemic success story’ as towards the end of 2020, it was close to eliminating community transmission of COVID-19 while many other counties were seeing infections surge (Odysseus 2020). This is said to be largely due to our leaders urging Australians to take the pandemic seriously from very early on, and Australians’ willingness to give up civil liberties that had never been lost before (Odysseus 2020).

While many lives have sadly been lost and there will of course be many ongoing and long-lasting effects of the pandemic mentally, emotionally and financially, Australians’ respect for and compliance with (albeit some errors) quarantining, lockdowns and unprecedented social restrictions has allowed us to largely gain control over the spread of Covid-19 as many countries around the world continue to struggle to gain control over the virus.

REFERENCES

Australian Government Department of Health. Quarantine for Coronavirus, 2020. https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/how-to-protect-yourself-and-others-from-coronavirus-covid-19/quarantine-for-coronavirus-covid-19 (accessed December 2020).

BBC NEWS. Coronavirus: The world in lockdown in maps and charts, 2020. https://www.bbc.com/news/world-52103747 (accessed December 2020).

Centers for Disease Control and Prevention. Symptoms of Coronavirus, 2020. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html (accessed December 2020).

Kantis C, Kiernan, S, Socrates Bardi J. Think Global Health. UPDATED: Timeline of the Coronavirus. A frequently updated tracker of emerging developments from the beginning of the COVID-19 outbreak, 2020. https://www.thinkglobalhealth.org/article/updated-timeline-coronavirus (accessed Oct 2020).

Odysseus Patrick, A. Washington Post. Australia has almost eliminated the coronavirus — by putting faith in science. https://www.washingtonpost.com/world/asia_pacific/australia-coronavirus-cases-melbourne-lockdown/2020/11/05/96c198b2-1cb7-11eb-ad53-4c1fda49907d_story.html (accessed December 2020).

Odysseus Patrick, A. Washington Post. The secret to Australia’s success in beating the coronavirus? Being an island helps, 2020. https://www.washingtonpost.com/world/asia_pacific/coronavirus-australia-borders-quarantine/2020/10/01/29e53608-0223-11eb-b92e-029676f9ebec_story.html (accessed December 2020).

On the 3rd of January 2020, China officially notified the World Health Organisation (WHO) of an outbreak of viral pneumonia of unknown cause (Xinhuanet 2020). Cases and deaths around the world rose astronomically over the coming days and weeks, specifically in China. By January 25, a man from Wuhan, China who had flown to Melbourne on 19 January became Australia’s first confirmed case of coronavirus (Ministers Department of Health 2020).

By the 30th January 2020, the WHO declared the coronavirus outbreak as a Public Health Emergency of International Concern (PHEIC) (Kantis et al 2020). World leaders began to make major and unprecedented decisions to prevent the spread of the virus by closing international borders, enforcing travel bans and mandatory quarantining of travellers.

Since the outbreak of what has become known as the coronavirus COVID-19 global pandemic, the virus has thrown the world into complete upheaval in every sense of the word, flooring healthcare systems, entire countries, industries, economies, families and life as we know it.

As of early October 2020, 214 countries have had COVID-19 cases, over 36.7 million cases have been confirmed globally, and over 1 million deaths have been confirmed worldwide (Kantis et al 2020).

Australia’s COVID-19 battle has included nationwide lockdowns, border closures, major governmental blunders involving cruise ships and hotel quarantining, critical issues regarding a lack of PPE and government direction faced by healthcare workers, mental health and employment crises, and Melbourne undergoing one of the strictest and longest lockdowns in the world (Fernando 2020).

Melbourne has been under social restrictions since 16 March in line with the national restrictions. These were initially extended to 11 May, but on 8 July, Melbourne’s restrictions were reimposed following significantly increasing COVID-19 cases. By 2 August, a state of disaster and an 8pm-5am curfew was ordered (Fernando 2020).

 

To date in Victoria;

817 people have lost their lives to COVID-19

20,320 total number of cases

122 active cases

11 cases in hospital

no cases in intensive care

19,313 people have recovered

(Victoria State Government 2020).

While our state government leaders have been praised for implementing strict restrictions and social distancing laws to reduce the spread of COVID-19, they have also been widely criticised regarding issues faced by healthcare workers including a lack of PPE, support and direction.

Along with the extreme dependence on frontline healthcare workers over the past ten months, inadequate national safety guidance resulted in an inconsistent and non-standardised approach to airborne precaution PPE across health care settings, with some making their own independent safety recommendations to their staff (The Conversation 2020).

A lack of available PPE including adequate face masks and shields, hand sanitiser, gowns and gloves put the lives of these healthcare workers at risk and indeed lead to large numbers of cases in the sector (Grenfell 2020). Furthermore, the Royal Australasian College of Physicians (RACP) found that 20% of health workers across the country lacked access to the most basic protective equipment including masks, with some reports of staff being forced to reuse disposable equipment (RACP 2020). This is something that no healthcare worker should be asked to do, ever. Equally as troubling, the survey also found that only 61% of respondents reported having had recent workplace training in the use of PPE which is crucial to the prevention of transmission (RACP 2020).

RACP President and Respiratory Physician Professor John Wilson said,

Our Government must be doing everything they can to provide them with sufficient protective equipment. We must do everything we can to ensure that healthcare workers are protected from infection while at work – and that includes urgent PPE training for all hospitals who have not yet rolled this out .

(RACP 2020)

As our country endeavours to pull itself from the grasp of an economic, employment and mental health crisis, it is imperative that we learn from the mistakes made in order to improve national policies surrounding our response to such a devastating pandemic as that of COVID-19.

Professor Nick Talley, Editor-in-Chief of the Australian Medical Journal, said the outbreaks in the two states (NSW and VIC) are actually the first wave of the virus in the pandemic.

People talk about the 2nd coronavirus WAVE. It’s NOT the 2nd in Australia.

We essentially never had serious community COVID transmission. Until now.

Please see full article for clarification here – https://7news.com.au/lifestyle/health-wellbeing/coronavirus-outbreak-seen-in-victoria-and-nsw-is-actually-australias-first-covid-19-wave-expert-says-c-1166607

REFERENCES

1. Fernando, G. SBS News. Is Melbourne’s coronavirus lockdown really the longest in the world? Here’s how other countries stack up, 2020. https://www.sbs.com.au/news/is-melbourne-s-coronavirus-lockdown-really-the-longest-in-the-world-here-s-how-other-countries-stack-up (accessed Oct 2020).
2. Grenfell O. World Socialist Web Site. Twenty percent of Australian health workers lack PPE as infections in the sector soar, 2020. https://www.wsws.org/en/articles/2020/08/10/vict-a10.html (accessed Oct 2020).
3. Kantis C, Kiernan, S, Socrates Bardi J. Think Global Health. UPDATED: Timeline of the Coronavirus. A frequently updated tracker of emerging developments from the beginning of the COVID-19 outbreak, 2020. https://www.thinkglobalhealth.org/article/updated-timeline-coronavirus (accessed Oct 2020).
4. Ministers Department of Health. Media Release: First confirmed case of novel coronavirus in Australia, 2020. https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/first-confirmed-case-of-novel-coronavirus-in-australia (accessed Oct 2020).
5. Royal Australasian College of Physicians. RACP survey: 20 per cent of physicians in public hospitals sourcing their own PPE – calls for greater transparency on government stockpile, 2020. https://www.racp.edu.au/news-and-events/media-releases/racp-survey-20-per-cent-of-physicians-in-public-hospitals-sourcing-their-own-ppe-calls-for-greater-transparency-on-government (accessed Oct 2020).
6. The Conversation. PPE Unmasked: Why health-care workers in Australia are inadequately protected against coronavirus, 2020. https://theconversation.com/ppe-unmasked-why-health-care-workers-in-australia-are-inadequately-protected-against-coronavirus-143751 (accessed Oct 2020).
7. Victoria State Government Health and Human Services. Media Release – Coronavirus Update for Victoria – Tuesday 20 October, 2020. https://www.dhhs.vic.gov.au/coronavirus-update-victoria-20-october-2020 (accessed Oct 2020).
8. XINHUANET. https://www.linkedin.com/redir/general-malware-page?url=www%2enews%2ecn%2e China publishes timeline on COVID-19 information sharing, int’l cooperation, 2020. http://www.xinhuanet.com/english/2020-04/06/c_138951662.htm (accessed Oct 2020).

How will the COVIDSafe app work?

A user voluntarily downloads the app from the app store. The user registers to use the app by entering a name, phone number and postcode, and selecting their age range. They will receive a confirmation SMS text message to complete the installation of the app. On the basis of this information, an encrypted reference code is generated for the app on that phone. That code is changed every 2 hours to make it even more secure.

The app uses Bluetooth to look for other devices that have the app installed. It takes a note when that occurs, securely logging the other users’ encrypted reference code. The date and time, distance and duration of the contact are generated on the user’s phone and also recorded. The location is not recorded.

This information is securely encrypted and stored on the phone.

The app uses a rolling 21 day window to allow for the maximum 14 day incubation period, and the time taken to confirm a positive test result. The rolling 21 day window allows the app to continuously note only those user contacts that occur during the coronavirus incubation window. Contacts that occurred outside of the 21 day window are automatically deleted from the user’s phone.

The contact information on the phone is not accessible by anyone (including the user of the phone), until the user is diagnosed with coronavirus and they upload the contact information to a highly secure information storage system.

The uploaded information enables state or territory health officials to contact the user and close contacts to provide advice on actions they should take to manage their health.

This cycle continues if a user of the app who was a close contact subsequently tests positive.

What will the app do?

The COVIDSafe app will allow state and territory health officials to contact you if you have been in contact with someone with COVID-19 (coronavirus). They tell you:

• what to look out for
• whether you need to quarantine
• how, when and where to get tested, and
• how you can protect yourself and your family and friends

 

If you become infected with coronavirus, the app will assist state and territory health officials to notify people with whom you have had close contact and advise them about self-quarantine and getting tested.

This will speed up current manual processes and make it quicker to stop the spread of the virus, particularly if restrictions are eased.

The app operates on a person’s phone as they go about their day.

It securely logs the encrypted reference codes of devices of other people who are using the app who have been in close proximity to you.

The close contact information can only be accessed by relevant health officials if there has been a positive case to help alert those who may need to be tested.

The app will never track your location.

Is there a risk that people may report false positives?

Information collected by the app that is uploaded to the highly secure information storage system will only be accessed by state and territory health officials once a user has a positive diagnosis. This positive diagnosis must be verified by health officials.

Who is a ‘close contact’ for notification purposes?

State and Territory public health officials will have the contact information for other users who have been within approximately 1.5 metres of the infected user for 15 minutes or more.

How does the app know a ‘close contact’ has occurred?

When 2 (or more) app users come into close proximity their phones exchange Bluetooth signals and make a series of ‘digital handshakes’.

The app records the encrypted reference code, time and proximity of 2 users, through the strength of the Bluetooth signals. This allows the approximate distance between the users and the duration the contact occurred to be determined once the data is uploaded to the highly secure information storage system.

The proximity for a close contact is approximately 1.5 metres, for a period of 15 minutes or more.

To be effective, users should have the app running in the background of their phone whenever they are coming into contact with people. Users of the app will receive daily notifications to ensure the app is running.

Why does the app only notify close contacts in the last 21 days?

The average incubation period for someone who contracts COVID-19 is typically 5 to 6 days, however the World Health Organization currently estimate that the incubation period can be up to 14 days.

The app uses a rolling 21-day window to allow for the maximum 14-day incubation period, and the time taken to confirm a positive test result.

The rolling 21-day window allows the app to continuously monitor only those user contacts that occur during the coronavirus incubation window.

Contacts that occurred outside of the 21-day window are automatically deleted from the user’s phone.

What information is captured by the COVIDSafe app?

The app only uses the information that’s needed to alert close contacts and allow health officials to make contact with them.

This information is only the encrypted reference code, date, time, duration and proximity of contacts.

At registration, the user provides their name, phone number and postcode, and selects their age range, which generates an encrypted code

All further information about contacts collected by the app is encrypted and stored within the app on the phone. Users cannot access contact information stored on their phone.

If the user deletes the app, all contact information is deleted.

The contact information on the phone is not accessible by anyone, unless the user is diagnosed with coronavirus and they upload the contact information to a highly secure information storage system.

Can a user or health official view the information stored on the phone including the contact log?

No. All information that is stored on the phone is digitally encrypted and cannot be accessed or viewed by any users or health officials.

Contact information older than 21 days on your phone is automatically deleted.

Can the app be used to track a user or contact?

No. It does not record an individual’s location or movements. The app only records that a contact occurred to allow health officials to contact those users to enable them to quickly self-quarantine and/or seek medical attention.

The app cannot be used to enforce quarantine or isolation restrictions or any other laws.

Commonwealth and state/territory law enforcement agencies will not be allowed to access any information from the app, unless investigating misuse of that information itself.

Do I have to use the COVIDSafe app?

No. Its use is entirely voluntary but using it will help save lives.

For the app to work, it must be running in the background on your phone. Other apps can be used at the same time.

You can delete the app from your phone at any time. This will delete all the app information from your phone.

At the end of the Australian pandemic, users will be prompted to delete the app from their phone. This will delete all app information on a person’s phone. The information contained on the highly secure information storage system will also be destroyed at the end of the pandemic.

If a user receives a close contact notification, will they be advised who the contact was?

No. This will operate in the same way as existing contact processes run by State and Territory health officials.

A phone call will be made to users who have had close contact with another user once that user is independently confirmed as having COVID-19. This phone call will be made by State or Territory health officials.

Close contact information is only available to State and Territory health officials once a user is confirmed as coronavirus positive, and the user securely uploads the information stored on their phone.

These calls will only be made to close contacts that have occurred in the 21 days before the information has been uploaded. This early notification allows users to quickly self-quarantine and seek medical attention.

Why should I use the COVIDSafe app?

Receiving early notification that you may have been exposed to coronavirus means you can be tested or go into quarantine, so your health and others’ is protected.

Without the assistance of technology, finding people who may have been exposed to the virus relies on people being able to recall who they have been around and knowing the details of every individual they have been in close contact with. In many cases, we don’t know the names and contact details of those we’ve been in close contact with (for example, at the supermarket or on the train).

The COVIDSafe app uses technology to make this process faster and more accurate.

The COVIDSafe app has been developed to ensure your information and privacy is strictly protected.

The unprecedented situation that has been brought upon the world by the rampant spread of COVID-19 has forced hundreds of thousands of frontline medical staff to adapt to new and unfamiliar work routines, procedures and expectations surrounding the provision of health care.

While we take off our hats to medical staff working in hospitals, primary care and ICU units while placing their own health in unchartered territory, other medical staff have essentially been removed from normal healthcare settings to instead perform consultations via virtual offices in order to reduce the chance of transmission of this disastrous and debilitating virus.

Never in our lifetimes have we been faced with such a critical situation that has warranted international border closures, office and community lock-downs, business closures and global concern about the long-term social and economic consequences. But these new rules are necessary and compliance is crucial, as social distancing and enhanced hygiene practices are the most significant ways to slow the spread of COVID-19.

Below is a graph outlining the total confirmed COVID-19 cases by sex and age in Australia.

Across the world, there have been more than half a million confirmed cases of COVID-19 in 201 countries, areas or territories (according to the WHO Coronavirus Disease (COVID-19) Situation Dashboard.)

Occupational Health & Safety and COVID-19 – a Duty of Care

In the most recent RACP (Royal Australasian College of Physicians) President’s message, Associate Professor Mark Lane states,

“In these very difficult times, many members of the community are looking to us for advice and for leadership.”

With so much information surrounding COVID-19 now available, access to timely and accurate health advice from credible sources of information is critical for not only the general public, but for health professionals providing health care and advice regarding COVID-19. Accurate information regarding minimising exposure to COVID-19 in the workplace and early intervention for suspected cases will complement public health measures while reducing disruption to businesses.

Businesses and organisations have a duty of care to reduce the rate of transmission of COVID-19 in the workplace and community. To assist with this need, the RACP has outlined a number of recommendations to guide employers in their response to this global health pandemic including;

1. Prioritising the health and wellbeing of workers and their families
2. Showing leadership
3. Effective two-way communication between employers and workers
4. Showing empathy and compassion
5. Applying innovative thinking
6. Being responsive to the changing situation, and
7. Planning ahead

When it comes to Planning Ahead, the RACP is urging businesses to continue to ensure the health and safety of their workers in this changing environment, as it is anticipated that this disruption will last for a significant period.  As such, employers are beginning to focus on what their future business might look like, and how to ensure that together with their workers and the nation more broadly, they can survive and thrive once the pandemic ends.

Working from home our new norm

The recommendations outlined in the RACP’s Applying Innovative Thinking specifically emphasise adopting new and innovative solutions that comply with the current official advice including social and physical distancing and self-isolation (i.e. staying at home only with people who usually live in the home, not going to public places including work, school, childcare, university or public gatherings and not seeing visitors).

These innovative solutions include adopting flexible working hours, working from home, or creative use of technology, all of which allow workers to continue to undertake their work roles as far as feasibly possible, whilst limiting contact with their colleagues and the general public as much as possible.

However, it is also highlighted that employers will also need to acknowledge that depending on employees’ personal circumstances, working from home may impact on productivity and there may be an increased need for flexibility in working arrangements.

Occupational Physicians in the Climate of COVID-19

As specialist doctors in the health and wellbeing of workers and the working population more broadly, Occupational Physicians are well placed to assist in this situation.

In order to assist employers in creating work environments and conditions that are beneficial to the health and wellbeing of their employees during this challenging time,

Occupational Physicians can incorporate organisational structures and workplace specifics into each your COVID-19 response.

This insight and guidance will be very useful in helping to provide employers with targeted workplace-specific advice and solutions amidst this unprecedented health crisis marked by hundreds of thousands of worldwide fatalities globally.

For further access to timely and accurate COVID-19 Health Information

CLICK HERE for the central resource that informs all official public health advice in Australia.

CLICK HERE to see the Australian Government’s Department of Health Coronavirus (COVID-19) health alert. This page includes information about how the Australian Government is monitoring and responding to the outbreak, how you can help slow the spread of COVID-19 in Australia, and what to do if you have symptoms. It also includes the latest official medical advice and case numbers.