The COVID 19 Playbook

    Christopher McGowan
    CEO SA Health

    The COVID 19 Playbook

Disease and virus outbreaks across the world are watched carefully by the Public Health teams in all jurisdictions. So when COVID19 started to take hold in Wuhan, Chief Public Health Officers across Australia switched to “alert but not alarmed” status pretty quickly.  It changed to “alarmed” within a few days. On the 15th of March I declared a Public Health Emergency under the   under the SA Public Health Act 2011, then, a week later, the Police Commissioner declared a Major Emergency under the Emergency Management Act 2004. These Acts give both the Police Commissioner and the CE of Health extensive powers to make directions necessary to respond to the respective emergencies.

Looking back now, some decisions seemed obvious, however, at the time, we were taking decisions that cut to the heart of our society in anticipation of what was likely to come.  Our Chief Public Health Officer was fearless in asking to mandate the closure of public gatherings, limiting access to vulnerable nursing homes and, although unthinkable at the time, significantly restricting cross border travel – probably the single most impactful decision.

We aimed to confront this virus by targeting three levers; firstly to reduce the speed of transmission of the virus to ensure our health system had time to prepare and to reduce the peak demand on our health system, particularly intensive care beds.  Secondly, to create capacity and optimise the effectiveness of the health system so it would cope and, thirdly, bring the population with us as we moved forward.  It is the behaviour of the population that is the key to managing this virus – it doesn’t spread by itself, humans spread it. As we saw the events in Italy, Spain, and the United States our decisions were validated and our community realised the importance of their role in managing this challenge.

The support of both the federal and state political leaders has been outstanding and we couldn’t have asked for more. An amazing discovery for me has been the exceptional capacity of the public service.  The emergency management systems from across government including, the Police Department, Emergency Services, Dept. Defence, Dept. Education and Dept. Human Services all meet daily in a very disciplined governance structure to ensure we all row in the same direction.  Health Department navigate, the Police are at the wheel but all Departments engaged and active in the engine room.

The SA Police Department deployed some of their best people into the Department of Health and Wellbeing to support us as we created the State Control Centre on the third floor.  Staff from across the state public service, defence forces, public as well as private agencies all working together to achieve our three objectives. At the time of writing this, we are in an enviable position, much better than I feared might be the case. The spread of the virus in SA has not only been slowed, but significantly curtailed meaning we have had the time to prepare our health system.  The community have been amazing, but this is a marathon not a sprint and it is critical we hold the course. We are confident the health system is now ready. Our models show we should have enough ICU capacity and ward beds to cope. We have effectively integrated the entire private hospital system with the public system in SA (with Commonwealth support) giving us an additional 1700 beds.  In addition we have the re-fitted Wakefield and College Grove hospitals in reserve and the Repat will be on line by early June. Over one thousand additional nurses and doctors have expressed an interest in coming back in to the workforce. Our supply chain remains an issue with a shortage of surgical masks to ensure our staff are safe.  We are in a race to keep mask usage to a safe but minimum level until we can source more or commence local manufacture in SA.

I reflect as we turn our minds to what is next, which is a balance between minimising the risk of losing control of the virus and trying to resume social life, I think our initial response has been significantly better than I could have hoped for. However, challenges are ahead. This is everyone’s virus, not just the health system’s and we will only succeed in defeating it by acknowledging we are all in it together.