As millions of people in greater Melbourne cope with a renewed lockdown and escalating COVID-19 cases, residents of Tasmania’s north-west would have a fairly good idea of how they’re feeling.
- Tasmania faced a COVID-19 outbreak in a regional hospital in April
- Victorian health authorities are following a similar response model in Greater Melbourne
- Experts warn the outbreak response must be adapted to suit the local community
The region endured weeks of lockdown under what were at the time Australia’s strictest restrictions, after an outbreak in a Burnie hospital.
The outbreak grew to 131 COVID-19 cases, was associated with a dozen deaths and forced the closure of two hospitals.
So can Victorians trying to respond to the current outbreak learn anything from the Tasmanian experience?
How similar are the Tasmanian and Victorian outbreaks?
The north-west Tasmanian outbreak began in a hospital and mainly affected healthcare workers and patients, and their close contacts.
Professor Raina MacIntyre from the University of New South Wales says the Melbourne outbreak is different because it’s being driven primarily by community transmission.
“Because [the Tasmanian outbreak] was inside a hospital it was relatively easier to track or contact and identify who was exposed and put a stop to the epidemic, it did not take off substantially in the community,” she said.
“In the case of Melbourne, it’s a different situation where the initial epidemic started in the community.
“By the time it was realised there was an epidemic there was quite substantial spread and we don’t yet actually know the extent of the spread.”
How do you respond to a COVID-19 outbreak?
Despite the differences in the outbreaks, the responses have been broadly the same.
Professor Dale Fisher from the National University of Singapore says there are consistent elements in every effective outbreak response.
“There are really four big pillars, which is case management, epidemiology, logistics, and risk communications and community engagement,” he said.
“With these pillars, they just need to be adapted to the local context.”
In a recent opinion article published on the Victorian health department’s website, Australia’s Acting Chief Medical Officer Professor Paul Kelly said Victoria’s strategy of testing, tracing and isolating COVID-19 cases was the same as the response in Tasmania.
“That’s what the Tasmanians did successfully in the north-west of their state. And it’s what the Victorian team is doing now,” he wrote.
“Implementing the north-west Tasmania model in an urban setting has challenges but the action being taken by Victoria is appropriate and proportionate.”
Was the Tasmanian response successful?
The University of South Australia’s Professor Adrian Esterman assesses the Tasmanian response as effective.
“Clearly it was [successful] because the number of cases died right down and you haven’t had any new cases for a long time,” he said.
“And it was done quickly. Speed is of the essence.”
Professor Esterman said Tasmania had some natural advantages when it came to responding to a COVID-19 outbreak.
“Tasmania is lucky in the sense that it’s an island. Island’s do extremely well in epidemic situations,” he said.
“That part of Tasmania [where the outbreak occurred] is fairly isolated, which would have made it hard for it to spread down to Hobart for example.
“It’s a totally different scenario in Tasmania than it would be in Victoria.”
The director of the Menzies Institute for Medical Research, Professor Alison Venn, says the Tasmanian outbreak demonstrated the need to provide support to people to help them comply with public health advice and restrictions.
An interim report on the outbreak found some hospital staff had continued to attend work even though they were experiencing COVID-19 symptoms.
“There are a whole range of reasons why people might rationalise that it’s okay, for example, to go to work, even if they’re displaying mild symptoms,” Professor Venn said.
“We need to learn from where those things have happened and anticipate them as much as we can for the future, and put in as many strategies as we can to mitigate those risks.”
Lean on me: How Tasmania taught other states to ask for help
Australia’s Deputy Chief Medical Officer Dr Nick Coatsworth says every outbreak in Australia so far has provided lessons.
He cited Tasmania’s decision to ask for help from the Australian Defence Force and the use of Australian Medical Assistance Teams (AusMAT) personnel to run parts of the affected hospital when it reopened.
“Our willingness to use cross-jurisdictional support to support any state originates from north-west Tasmania”, Dr Coatsworth said.
“The concept that for this public health emergency we should not be considering ourselves as individual states, but we know that anything that goes on in an individual place is going to be a national problem.”
Dr Coatsworth said the success of most Australian states and territories in suppressing or eliminating COVID-19 cases meant they could afford to offer resources to help in the Victorian outbreak.
“You’ve got all that contact-tracking capacity that can now be diverted remotely into Victoria to assist with some pretty serious numbers that require a lot of effort to do the contract tracing,” he said.
“I think it would be fair to say that our understanding of the cross-jurisdictional support was tested first in north-west Tasmania.”
Why does communication matter?
While the basic model of responding to an outbreak remains the same, it has to be adapted to the unique circumstances and settings of each outbreak.
The communities in which the Tasmanian and Victorian outbreaks happened look very different.
According to the latest census data, about 114,000 people live in the mainly rural area of north-west Tasmania and only about 20 per cent of residents were born overseas.
Greater Melbourne has a population of nearly five million people, with about 40 per cent born overseas and one third speak a language other than English.
Many of the outbreak clusters in Melbourne have happened within culturally and linguistically diverse communities, and Dr Margaret Heffernan from RMIT University says health authorities have struggled to effectively communicate with them.
When responding to an outbreak, communications have to be adapted to the language, culture and beliefs of affected communities, and asking community leaders to help shape those public health messages is vital.
“The lesson learned from Tasmania is a swift response is critical, but it’s got to be tailored to the specific characteristics of the community which you’re expecting to respond and comply,” she said.
“It’s critically important that we have what we call a self-determined approach where the community leaders need to be very involved right from the start.”
Why should Victoria pay close attention to its healthcare workers?
Professor Fisher says healthcare workers could provide the first signs that an outbreak might be happening, which can help authorities to quickly respond.
“It’s often the healthcare workers who herald an outbreak. Tasmania didn’t invent this,” he said.
“So if a couple of staff have suddenly got atypical pneumonia then someone would go, ‘hey, how did that happen? Let’s do a COVID test, it’s positive, let’s see if there’s some patients.'”
Professor MacIntyre says the Tasmanian outbreak’s origin in a hospital shows the importance of protecting healthcare workers during an outbreak.
“That’s something I think we all need to stand up and take note of, because we’re seeing dozens of healthcare workers getting infected in Victoria,” she said.
“I think we really need to question the assumption that only a surgical mask is needed by health workers treating COVID-19, and we need to take a more precautionary approach.
“We saw in Burnie, when one healthcare worker gets infected, you might have to quarantine dozens of others, which is a massive impact on the health workforce.
“You can imagine in a huge city like Melbourne, if we had to close down the Royal Melbourne Hospital or St Vincent’s because they’ve got an uncontrollable outbreak, that’s going to have a massive impact.”