Stamp out the state’s weakest link

We can’t afford to risk transmission by letting positive cases go home, says John Burgess

THIS is no time for complacency, but let’s start seriously planning for how and when we can safely get Tasmania’s society and economy working again in a sustainable new normal.

We are seeing the early signs of successfully containing the coronavirus. Still, we are also seeing areas of emerging risk, such as in Tasmania’s NorthWest. To paraphrase Winston Churchill’s wartime quote, this is not “the beginning of the end. But it is, perhaps, the end of the beginning” of our war against the coronavirus.

We remain stalked by the spectre of community transmission. Still, with each day, we should gain degrees of confidence that we can crush the epidemic curve and keep our foot firmly on the neck of viral spread. Right now, we need to contain any early phase of community spread of coronavirus with formal and tight restrictions on travel between Tasmania’s regions over the next few weeks.

Any early phase of community spread of COVID-19 in the North-West must be locked down and contained by immediate action. By early May we should aim to be able to reduce these more stringent travel restrictions. We will know by the end of May if our strict hygiene measures, social distancing, comprehensive contact tracing, infectious case isolation and border quarantine programs are sufficient to prevent a chain reaction of epidemic spread in this state.

But even with early successes in our fight, there remains the ever-present reality that new COVID-19 cases will periodically emerge in Tasmania. This reality will most likely be with us over the next 18 months until an effective vaccine against the coronavirus is developed, clinically tested, mass-produced and delivered to the entire population. Make no mistake; this will take time. However, we can and must now start planning for our community’s recovery, while keeping diligent quarantine, isolation and containment of the virus.

Before looking at how we tentatively start emerging from near-lockdown, let’s correct an area of national weakness where Tasmania must show leadership. It’s a well-understood weakness that must be urgently remedied.

Despite our rigorous interstate traveller quarantine processes, we continue to take an unnecessarily high risk by permitting home self-isolation of Tasmanian patients actively infectious with COVID-19. This risk is laid bare when we consider the following, a Tasmanian returning from interstate is now placed into mandatory quarantine for two weeks. No going home until two weeks of quarantine is completed — no ifs, ands or buts. While the majority of these travellers will not turn out to have COVID-19, we still must enforce strict supervised hotel quarantine to reduce the possibility of coronavirus entering our community and triggering uncontrolled community transmission. We don’t take unnecessary risks with the coronavirus.

But here’s the paradox, we currently allow patients diagnosed COVID-19 who are actively infectious to return to the community for home selfisolation. This makes little sense. It’s an apparent inconsistency if not an absurdity that a person in mandatory supervised hotel quarantine for 14 days could potentially be released early back into their community for home self-isolation on the basis they are diagnosed with COVID-19. Meanwhile, those not so diagnosed must remain supervised in hotel quarantine.

When patients are infectious, they can directly transmit the coronavirus to others by cough, sneeze and droplet spread. The droplets also leave a trail of active viral contamination on surfaces such as household fittings, fixtures and furnishings. This surface contamination as much as direct and indirect household contact with family members is an unacceptable infection control risk. Surface contamination can last for days after the patient has recovered and is themselves no longer infectious.

Self-isolation at home is the weak link in our plan to sooner rather than later emerge out of economic and social lockdown. The best option for getting to a brighter new normal is to, as much as possible, stamp out the potential for coronavirus community transmission. To do this, all patients infectious with COVID-19 need formal, clinically supervised isolation care – hospital-based if seriously ill, medi-hotel provided if not sufficiently ill to require hospital care. This must become our standard of practice for all patients actively infectious with the COVID-19 coronavirus.

If we intend to reach a brighter future sooner rather than later, the inconsistent approach to viral isolation and containment must cease.

I do believe we can do something unique in this state. Not just in the near term of 12-18 months, but long term by comprehensively reshaping our state’s future; a future built on a clean, green, clever reputation, a reputation that will be enhanced by our success in medically, socially and economically managing an agile and responsible re-emergence from the current COVID-19 crisis. Tasmania can become known as a place of high-quality agriculture, arts, manufacturing and education. Rather than returning to high volume mass production tourism, let’s focus on being a high-value destination and service provider. This new normal is within our grasp. There is real potential for Tasmania to show agility and leadership right now as we recover from the current coronavirus crisis faster and better than other jurisdictions. We must start planning for a tentative reemergence from the stringent lockdown. We can do this if we can get through this next month without emergence of COVID-19 community transmission.

So, let’s continue to leverage every ounce of our natural advantage as an island and as a resourceful people to ensure we forge our path to a better future and do it right now.

WE CONTINUE TO TAKE UNNECESSARILY HIGH RISK BY PERMITTING HOME SELF-ISOLATION OF TASMANIAN PATIENTS ACTIVELY INFECTIOUS WITH COVID-19

Dr John Burgess is a Hobart endocrinologist and University of Tasmania professor and is president of the Australian Medical Association Tasmania.