Australian Public Health Conference 2020
It’s being dubbed Australia’s coronavirus success story – open borders, open businesses, slow infection rates and relatively few lives lost.
Prime Minister Scott Morrison described the NSW test and trace strategy as the ‘gold standard’ in COVID-19 suppression. At the 2020 Australian Public Health Conference, we heard from some of the people behind the NSW response. And each readily admit, it has been a magnificent team effort which is ongoing.
- Dr Andrew Milat, Director Evidence and Evaluation, NSW Ministry of Health
- Dr Kate Mcbride, Senior Lecturer School of Medicine, University of Western Sydney
- Dr Sarah Alland, Operations Team Leader, NSW Public Health Response Branch
- Michael Nelson, Senior Biostatistician, NSW Health
MEETING THE SURGE CAPACITY NEED
The arrival of the pandemic at the start of 2020 tested Australia’s public health system like never before. In NSW, one of the success stories was the ability to ‘surge’ the numbers on the frontline needed to cope with the growing threat.
Dr Andrew Milat said the response in the first seven months of the pandemic demonstrated the importance of the investment made in the public health workforce over many years. This included strategic ongoing investment in training dating back 30 years which helped facilitate the rapid deployment of public health trained staff.
The NSW COVID-19 Public Health Response Team operated with two shifts a day, seven days a week, and the workforce responding to the pandemic surged in numbers as the case numbers grew in March and April. With 15 NSW health districts, each with a public health unit, this broad network enabled both a state-wide and local surge when required.
The surge was made possible via a number of factors: the redeployment of public health and Ministry of Health staff; targeted recruitment to fill gaps; the employment of students; an additional trainee intake; and an external EOI process conducted by NSW Health.
Dr Milat said more than 1,000 people worked in the public health response between February and September and the nature of the surge changed over time as case numbers rose and then fell. Contingent workers made up the largest part of the workforce (54%) followed by public health staff and trainees (24%) in September.
The surge response strategy included: daily rostering and HR huddles; a central staff register; streamlined end to end recruitment (including HR and rostering processes); onboarding packages; a staff welfare strategy; and HR kiosks to answer questions.
Amongst the many lessons learnt: population health trainees formed a critical part of the surge workforce in the initial response and it provided a large alumni to tap into; a central recruitment, HR and rostering function enabled rapid skills assessment and placement of staff, minimising disruption to frontline staff; and creation of a shadow organisational structure for pandemic response with its own industrial instruments that remains dormant until required would have been very helpful.
COVID CASE INVESTIGATIONS
Everyone is now familiar with the importance of contact tracing to help limit the spread of the pandemic. Dr Kate Mcbride outlined the success of a pilot COVID-19 case investigation training module which she described as a ‘collaboration supporting disease containment’ particularly in western Sydney as case numbers grew.
Dr Mcbride said containment of COVID-19 required rapid identification and isolation of infected individuals and their contacts to prevent disease transmission. This was only made possible by the provision of ‘competent, sustainable, multidisciplinary surge workforce capacity’.
‘While standardised training existed for contact tracing, it wasn’t the case for case investigations,’ Dr Mcbride said.
Through partnerships with local universities and a one day face-to-face workshop, the numbers of case investigators grew. As a result, new systems are now in place, including online and on-the-job training to skill up and help deploy surge capacity.
NSW now has an established training program; a casual pool of surge capacity staff (students and allied health) and partnerships have been created between public health units and med schools for future workforce/joint initiatives.
PROTECTING FRONTLINE HEALTH WORKERS
While the aged and people with pre-existing health conditions were identified as being amongst the most vulnerable to COVID-19, across the world many thousands of health care workers have contracted the virus. These include close to 200,000 in the USA and more than 3,000 in Victoria.
Dr Sarah Alland said in 70% of these cases, COVID-19 was contracted in the workplace.
As a result, NSW Health developed a protocol for the investigation of possible healthcare worker acquisition of COVID-19 in a healthcare setting. The investigation is led by the local health service, involving both infection control and public health unit staff.
‘The aim is to identify the likely source of infection and if the source is in the health facility, how this occurred and how to prevent it in the future,’ Dr Alland said.
The investigation considered the following: possible sources of infection; contact with known or suspected COVID-19 cases; PPE training and use; identification and testing of close contacts; and whole genome sequencing of specimens.
A healthcare worker expert panel was also created to review investigations, identify lessons learnt and make recommendations on how to prevent future infections.
Dr Alland said the NSW investigation protocol could be adapted by other jurisdictions, and had already been shared with the Commonwealth Department of Health and DHHS Victoria.
‘The lessons learnt, policy changes and recommendations that arise are improving the safety of health care workers and may prevent further COVID-19 transmission in NSW.’
VITAL DATA CAPTURE
According to biostatistician Michael Nelson, the creation of the Centre for Health Record Linkage (CHRL) for NSW and ACT in 2006 provided vital data linkage services, online resources and bespoke advice when the pandemic hit Australia.
He provided case studies which demonstrated the importance of the CHRL. It assisted with the case and contact management among cruise ship passengers on seven cruise ships which docked in Sydney in March 2020. It also helped capture testing rates among Aboriginal residents living in NSW, airline passengers arriving in Sydney from overseas, and any special characteristics of people hospitalised with COVID-19.
Mr Nelson said enabling legislation combined with an up-to-date Master Linkage Key provided the rapid and responsive record linkage to support the NSW COVID-19 response.