Message from the Chief Nursing and Midwifery Officer

Dear Nurses and Midwives,

I’m writing to update you on the COVID-19 outbreak situation in Australia and internationally and to outline the Commonwealth’s current and future support for the central role you are playing in our national response.

Nurses and Midwives on the frontline are fundamental in meeting the community needs in this evolving and complex challenge. I thank you for your efforts so far in containing the spread of this disease, and encourage you to maintain your vigilance in assisting to prevent its further transmission. There is the very real possibility that larger scale community outbreaks will occur across Australia, placing a significant burden on the health and aged care systems, in which you play a critical role.

Communication

There has been a significant amount of advice and information already provided to health professionals. I recognise that the evolving nature of this outbreak has required public health advice to evolve rapidly with the emerging epidemiology. This has made it more challenging for people to keep it up to date and has led to some confusion and a perception of inconsistency of information / information gaps.

We will be undertaking a broad community education campaign on COVID-19, one of the important messages will be value of basic standard hygiene messages (hand washing, cough etiquette, social distancing) in preventing transmission. Nurse and Midwives are very trusted professionals in our community, I am sure that you will play a role in communicating that message to your patients, family and friends along with general balanced information about this virus.

Situation as at 10 March 2020

As you will be aware, the international situation has changed materially in the last few weeks. Cases have now been reported in over 105 countries, some with sustained widespread community transmission. Despite our success in containing the initial cases associated with travellers from China, we are now seeing the expected second wave of imported cases from a number of countries (most notably Iran). We have evidence of limited community transmission in Sydney. New imported cases are being seen every day, some from countries not previously identified as high risk. It is no longer realistic that we will prevent further importation of cases, and further local outbreaks seeded from imported cases are likely.

Disease characteristics

I will share with you our current state of knowledge about COVID-19. It is clear that a great majority of people with COVID-19 infection (>80%) have mild disease, not requiring any specific health intervention. This mild disease contributes to the high transmissibility of the virus, as many people with infection will continue working and interacting with the community because their symptoms are so mild.

There is very little evidence of significant COVID-19 disease in children. Initially, it was suggested that children were less susceptible to infection but more recent evidence supports the fact that children may be infected, in many cases without being aware of symptoms. The role children play in transmission is unknown.

Current approach to response

At present our response, under the Australian Health Sector Emergency Response Plan for COVID-19 (www.health.gov.au/Covid19-plan), is focused on early identification of cases, isolation, contact tracing and quarantine where indicated - under the supervision and direction of the public health unit in each state or territory. 

If more widespread community transmission occurs, the focus will shift to early detection and home isolation of cases to prevent or delay transmission, with less emphasis on identifying contacts who are generally unlikely to be very infectious, unless they themselves also develop symptoms. We will let you know if and when such a shift in the public health response is indicated. Even in a large scale outbreak, isolation of as many cases as possible can play a critical role in flattening the epidemic curve.

Reducing exposure in health care settings

It is clear that, with increasing cases of COVID-19, there is benefit in more sophisticated strategies to prevent the co-mingling of suspect or proven cases with other patients in health care settings. We have previously advised members of the community that, if they believe that they could potentially have or be exposed to COVID-19, they should phone their GP or local health service and seek advice before attending. If followed, this practice has allowed the practice or hospital to make arrangements for isolation and testing.

As case numbers increase, there is a need for new strategies. We will shortly be announcing to the community an expansion of the COVID-19 national hotline (1800 020 080). This hotline will operate 24 hours a day, seven days a week. Expansion of the national hotline is part of our strategy to support general practices manage the flow of cases.

People who believe that they may have been exposed to or have COVID-19 will be encouraged to call the national hotline to seek advice. A standard protocol for the call centre operators will be provided. We will share call centre information and the triage protocol with you shortly, as many GP practices have asked to have the same protocol available for their reception staff to ensure consistent messaging and patient disposition. 

Personal Protective Equipment

There has been some mixed messages about what personal protective equipment (PPE) is required in the clinical assessment of potential COVID-19 cases. All of the evidence currently suggests that droplet spread is the main mode of transmission and that surgical masks are adequate (and much easier to fit than are P2 masks For your reference, the current PPE guidelines endorsed by the expert COVID-19 infection control committee is available on the Department of Health website, www.health.gov.au/Covid19-health-professionals. It is important to emphasise that all current evidence suggests that if you follow the infection control and PPE requirements you and your family will be protected.

Last week we met with aged care and primary care stakeholders and committing to a range of initiatives, we are very aware that additional work is required for vulnerable groups, including Aboriginal and Torres Strait islanders.

No one can accurately predict how the COVID-19 outbreak will develop in Australia. Our collective response has to be flexible and collaborative. The Australian Government has committed to provide the necessary resources to support the response in whatever form it needs to take.

Alison J McMillan

Chief Nursing and Midwifery Officer

Commonwealth Department of Health

10th March 2020