"It's one thing to fight Covid but, when there's no Covid, there is a phenomenal amount of work to keep it out," said Dr Niall Conroy, director of public health in Wide Bay, Queensland, Australia. He was speaking at a webinar to the School of Public Health at University College Cork on Monday morning.
The Irish-born consultant in public health said that a lot of people think that Covid hasn't affected Australia at all, but the country "crushed the curve" of the first wave and had a bigger second wave that was confined to the state of Victoria. Up until March 2021, there have been about 1,400 cases in the whole of Queensland, which is about the size of Ireland.
He credits the success of Australia’s response to Covid-19 to a well tested disaster/emergency public health infrastructure, strict hotel quarantining, free walk-in Covid testing (no GP referrals or appointments needed) and a strong legislative framework.
“Australia was ready for this. It has a superb disaster management system from dealing with deadly diseases and natural disasters. There are annual pandemic plans which are pressure tested. And we have state-wide Covid-19 incident management teams which co-ordinate the response,” Dr Conroy said.
Each Australian state has its own chief health officer [equivalent to Ireland’s chief medical officer] and public health units which are part of the acute hospital groups.
“Free walk-in Covid testing centres were open daily from 7.30am-5.30pm and could be extended to 6am-9pm with staff from acute hospitals at short notice. You have to go out into the community to chase cases of Covid and walk-in testing allows vulnerable groups who don’t have GPs to come at times that suit them,” he added.
Hotel quarantine
Speaking about the strict hotel quarantine system which has operated in Australia from the early days of the Covid-19 pandemic, Dr Conroy said: “People love it or hate it. Any problems with it are very high profile – like you’re seeing in Ireland now – but of the 250,000 travellers who have used it, 0.6 per cent have tested positive.”
He said he can’t imagine what Australia would have done if these people had been released while still infectious. “I shudder to think what life would have been like without hotel quarantine. Without vaccination, you can’t suppress the virus if you don’t have hotel quarantining and most Covid-19 cases in Australia were a result of hotel quarantine breaches,” he added.
Looking at a society where everything is currently open, Dr Conroy says that environmental health officers have a crucial role in Covid-compliance. “They are the perfect people to inspect cafes [and] restaurants and ensure there are Covid-safe plans for big [indoor and outdoor] events. They have the powers to call the director of public health and close events down and they have stopped an enormous amount of Covid in the community here,” he said.
Welcoming recent moves in Ireland to establish consultant contracts for public health doctors, he said the lack of the consultant contract for this specialism was the reason why he left Ireland. “Public health doctors need the autonomy and authority to make their own decisions as they need to act quickly.”
Vaccine delays
And as the Covid-19 vaccine rollout in Australia faces delays due to its reliance on AstraZeneca vaccines – for which there are new guidelines on age cohorts due to rare side effects of blood clots in younger age groups – Dr Conroy admonishes countries with vaccines to "vaccinate their population five times over, when vaccination isn't even on the radar of people in countries like Sierra Leone".
"The international Covax initiative aims to vaccinate 20 per cent of people in low-income countries by the end of the year, but it doesn't have enough funds yet. Even if you don't believe in vaccine equity, self-interest must lead you to say that if the virus rages in Sierra Leone, a vaccine escape variant could set back plans across the world."
And while he is looking forward to visiting family back in Ireland, he doesn't see it happening any time soon. "The bubble between New Zealand and Australia opened up today and I think we will start other bubbles with low-incidence countries, but it will be a very gradual thing with vaccine certificates and negative Covid tests. We'll have to see how it all goes and watch every step to see if the strategy is working."
