April 7, 2020

Q&A with Dr Christian McGrath on COVID-19

When COVID-19 pandemic started, Dr McGrath, General and Infectious Diseases Physician took the role of clinical leadership for the COVID-19 response at Northern Health. He has been answering staff questions through regular Chief Executive Forums which were live streamed across campuses.

Today, he further explains how we are preparing our pandemic response and offers some advice and guidance to our staff. 

What is your role in managing COVID-19?

I got the role of the clinical leadership by being at the wrong place at the right time, if I can say that. I have experience in dealing with emerging infectious diseases, as I was working at the Department of Health during the Ebola outbreak response. Infectious diseases physicians are familiar with these scenarios and have acted in numerous roles to stop infections from spreading in health service environments.

What is Northern Health doing to prepare?

There are a few aspects.

Today, there is a number of things we need to have in place: we have to keep our staff safe, but also care for the community. That includes applying new case definitions to identify cases, making sure all precautionary measures are in place to keep our staff safe from an infection control point of view; and there is also planning, which allows us to continually evolve and adapt.

Some of the examples of our preparation include not forgetting there are other patients too, so planning to be able to continue our other operations is still happening. In terms of COVID-19 patients, our core areas are ED, the wards and ICU. The Fever Clinic now acts as an area where people at the risk of COVID-19 can be treated safely. As the number of cases increases, we can cohort patients together on a dedicated ward.

ICU also have significant plans to expand their capacity to look after a large number of patients, as required. As the situation progresses, we are making sure to identify patient populations at risk of infection and making sure we are not getting COVID-19 cases in other hospital  populations.

What are we seeing at this stage? Where are we at now?

The good news is that the total number of cases we are seeing in the populations we are testing is coming down, as a rate. Even though the overall numbers are still going up, the rate of increase is dropping, and that’s what flattening the curve means.

Part of that can be attributed to the fact that there are fewer international travellers returning to the country, which do make up the bulk of the cases. The part that we now need to keep an eye on is the number of cases in the community in people who haven’t travelled overseas or had a close contact. The whole point of social distancing is reducing that community spread.

What can be the turning point?

If the 25 million variables, which are the people of Australia, practise social distancing very well and people don’t congregate, there is no way for the virus to spread. That is how we can get control of these viruses. All these measures together, and testing widely to identify those cases, will act to reduce the risk of a significant spread. One measure can’t work on its own, it’s a number of things working together. This way of life will become a new normal for at least a few months.

Everything that has been done in Australia so far is done to prevent us from becoming like New York, Spain or Italy. There are really good and promising signs we are not going to be like Italy or the US, as we have all these measures brought in so early. In all these places, and Wuhan as well, a lot of these measures were brought in place when community spreading had already started.

What are some of the lessons you would like to share?

Infectious diseases is a really tricky space, especially when they are emerging and when we can’t rely on the normal pathways of peer-reviewed journals or articles. We are now relying even on Twitter feeds to keep us up to speed on what’s happening. That is a whole new world and a whole new way of looking at medicine.

That said, we have learnt a lot from previous infections like this, like MERS or SARS and I think while we need to be dynamic and innovative, we need to be careful that we have a measured, pragmatic response that fits our circumstances. We are in a completely different set of circumstances to the US or Italy so just because they are doing something, that doesn’t mean that is right for Australia too. But we can learn from it.

What are some of the things you would like our staff to know?

Firstly, the whole reason for having a COVID-19 response plan is to make sure we can look after our patients safely whilst also protecting our staff. That’s what it’s all about. We need to work within the physical environment that we have and the resources that we have. It’s about knowing that there is a lot of things that go into infection control to keep us all safe. That includes things like physical changes to the building, changes to the way the air is handled throughout the building and early case detection, using PPE, and increased cleaning. We can’t make this a zero-risk environment, but we are doing the best we can to ensure we are safe as we can be to do what we need to do. For that reason, we will be well set up to care for our patients much better compared to some other places around the world.

What are some of things medical professionals can learn from a pandemic like this?

I think it will reinforce something a lot of us already know, and that is that working in a health care service is at the best of times a challenge due to resource limitations and the like. The minute we face a challenge like this, it exposes just how thin some parts of the health system are and I think a lot of clinicians will be feeling that, and the stress and anxiety that comes from that. We are here, we are with you and we will do the best we can to look after our community.

You mentioned stress and anxiety. What are some of the things you do to de-stress and what would you advise staff?

It is a challenging time and all this is unprecedented in our lifetime. It’s normal to be anxious.

To get my mind off COVID-19, I now have a habit of turning off my emails on my phone when I get home. I am purposefully restricting how much media I read and I try to stick with the facts.

I do have a lot of friends who are non-medical who are helping me with this. We go for bike rides or fitness in the park, respecting social distancing. I recognise that stress and anxiety is a big part of all this, and part of this is because we don’t know what is coming. Getting actual facts from reliable sources really helps with that.

Knowledge is power.