Ryde Hospital,where a doctor was diagnosed with COVID-19.Credit:Rhett Wyman
Once media revealed the story,we had the added the anxieties of family,friends and patients,with constant calls,texts and questions,worrying about us,worrying about themselves,asking for advice and for the knowledge we didn't have.
We were monitored each day by the public health unit of our local health district. They checked that I was well,and isolated. Yes,and yes.
I needed fresh air and exercise,meticulously avoiding others if I left home. Night walks with the dog. Thank heavens for the dog. And for friends and family who left my coffee and the shopping on the yellow chair outside the front door.
We were watchful for new cases at work and elsewhere. Obsessed. We were amazed we hadno spare time!
NSW Health Minister Brad Hazzard and Chief Health Officer Kerry Chant have tried to explain and update transparently to the general public the situation as it is evolving. However,given my own experience with this virus and the challenges of predicting and detecting it,I am concerned that our efforts to control it are not ramping up quickly enough.
I am concerned that preparations within healthcare for the cases to come are already behind the level of need. Healthcare workers are ill,or in isolation,or worried to go to work. Healthcare workers have died elsewhere. Facilities are short-staffed. Work safety,especially in smaller institutions or general practice,is threatened by lack of consistent guidelines,inadequate protective clothing,design of safe places for changing gowns,and by the fact they cannot know which patients may be carrying the virus. Retired doctors can’t fill gaps in service. Already out of practice by definition,by age they are in a high-risk group.
NSW Health Minister Brad Hazzard,left,and NSW Chief Health Officer Dr Kerry Chant.Credit:AAP
There are many reasons to suspect there is under-diagnosed community spread of COVID-19 because this is a new disease that is unfamiliar. We know COVID-19 illness can be mild or asymptomatic. Not all people have fever. Not all people have a cough. Some have abdominal pain. Those infected don’t know they have it. We know people are not necessarily honest or careful about their travel history. (In Singapore,lying about travel history has been made a criminal offence.) As I write,we still don’t know how hard it is to catch,how my colleague became infected,whether people are infectious before showing signs of illness (we think they are but for how long:one day? Two days? More?) Other unanswered questions:Are they infectious after they “recover”? Can they get it again?
Given this uncertainty,to protect everyone,especially the elderly and vulnerable,we should do what Italy is finally doing and China has done before - isolate everyone,in major population centres,at home for two weeks where that is possible,to try to contain spread.
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Two weeks now will be difficult and expensive,but at least most people will be well. Taking this action later will be much harder. People half-expect strong government action similar to other affected countries. We should close schools,universities and many businesses to reduce new cases,enable preparations,ramp up arrangements for protective and supportive equipment,increase capacity in hospitals,free and create ICU beds for life support. We can isolate returning travellers,work from home. Most of all we must properly guide and protect our health workers.
Already we advocate avoiding unnecessary travel and close personal contact,efficient hand-washing and responsible cleaning of surfaces and body fluids,and for health workers and carers,using masks,gowns,gloves and eye protection of high quality. These are our current defences.
Committing to isolation to slow the disease spread at this critical stage,and reducing close contact when possible,may help us to manage the weeks and months before we have a vaccine,or forms of treatment,to lessen the impact of COVID-19 disease. If not now,when?
Cathie Hull is a career medical officer in emergency in clinical practice and an associate of the Menzies Centre for Health Policy,University of Sydney,with a background in public health,medical education and health promotion. A version of this article appeared in the blog John Menadue - Pearls and Irritations.