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Coronavirus, part one: The frontline

Mar 23, 2020 • 13m 50s

As the number of confirmed coronavirus cases grows in Australia, Dr Nenad Macesic describes how doctors are handling the pandemic and what the future holds. This is part one of a five-part special.

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Coronavirus, part one: The frontline

187 • Mar 23, 2020

Coronavirus, part one: The frontline

RUBY:

From SM, I’m RJ, this is 7am.

As the number of confirmed coronavirus cases grows in Australia, hospitals are gearing up for a spike in admissions.
Today, we speak to Dr Nenad Macesic, an infectious diseases physician who works at a major hospital in Melbourne.
He tells us how doctors are handling the pandemic… and what the future holds. We will be covering a different part of the coronavirus outbreak every day this week, from the economics of panic, to government failures and the hunt for a vaccine.

This is part one… The frontline.

RUBY:

Hi Nenad it’s Ruby from Schwartz Media. Hello.

NENAD:

Hi, how are you Ruby?

RUBY:

I'm good. How are you going?

NENAD:

I'm well, thanks.

RUBY:

Are you ready to start?

NENAD:

Mm. Sounds good.

RUBY:

And we’re all good here? Great. So Nenad, you work in infectious disease in a major hospital in Melbourne. Can you tell me a bit about what your job involves?

NENAD:

Yeah so, infectious diseases is a little bit different to other sorts of fields of medicine, because what we deal with a lot of the time are things that are emerging.

So as opposed to, you know, being a cardiologist, where generally the conditions that you're going to see are sort of relatively well defined for us every couple of years, there's a whole new challenge that arises and that we have to contend with.

And we go through this process of first not knowing much about the disease at all, then not knowing how far it will extend. And then we sort of gather knowledge and it becomes part of our repertoire, if you like. But that's one of the sort of crucial differences to other fields, medicine.

RUBY:

Ok so Nenad, when did you first hear about coronavirus?

NENAD:

Yeah, so there was already in November, I guess, as mentions of this novel coronavirus in China that had emerged.

And so I think my initial response when I heard about this new coronavirus was that it was likely to be contained regionally. But once we started to see the thousand thousands of cases in really the industrial heartland of China that's globally connected to almost all regions in the world, I think that's when the alarm bells started to ring.

RUBY:

Tell me about how coronavirus started to change things at the hospital you work at here in Australia?

NENAD:

Yeah, I think there was one afternoon, early February, where our regular meeting was canceled and instead we opted to revisit donning and doffing of PPE, which is personal protective equipment which involves masks, gowns, gloves as well as goggles.

And that was really something that was quite out of the usual. The last time that we had to do that was during the time of the Ebola epidemic. And I think at that point was that was the sort of first signal that we were going to enter this sort of cascade events in which we find ourselves today.

RUBY:

And when did your hospital get its first coronavirus case?

NENAD:

I would say about three weeks ago now, so far, the cases that we've seen not been particularly severe. They've not required things like ICU admission. But clearly, given the reports overseas, we are bracing for an influx of patients with more severe disease.

So far, what we've done in place, these patients in negative pressure rooms, which basically means that the air is sucked into the room and does not spread to other parts of the hospital. Obviously, these rooms, a single patient rooms that are isolated, and I think the biggest sort of issue is also testing of suspected patients.

So, so far in several hospitals, we've had to set up clinics that we refer to as fever clinics where patients that are suspected of having coronavirus are being assessed. And this has created a huge amount of workload and has a lot of down flow effects on things such as our pathology systems. So it's quite far reaching consequences for the hospital as a whole.

RUBY:

Mmm so what do you think is going to happen next?

NENAD:

Yeah. So it I think we've been lucky in Australia because we've had possibly some lead time compared to, for example, some of our Asian neighbours, such as Korea or Japan and also compared to our colleagues in Europe. And I think we've tried to use that time really to prepare as much as possible for a variety of scenarios and some of the things that we've been trying to plan ahead for. As you know, what are we going to do if there are five patients admitted with coronavirus? What if we need to move 50 patients or 500 patients? And how are we going to cope with that?

RUBY:

Nenad, how do doctors on the frontline feel about our level of preparedness at the moment?

NENAD:

Yeah. So I think doctors on the frontline...I think us as infectious diseases doctors, we've obviously been on the pointy end of this because we've had to stop seeing these patients make decisions about who should be screened, who needs to be isolated when they're a suspected case and that kind of thing.

But as the number of patients grows, we're going to see the effects ripple out to the rest of our medical colleagues.

And I think at the moment, we have definitely had things under control. But obviously, there are a lot of anxieties about some of these scenarios that could emerge. And especially when we look towards what's been happening in Italy, that's credit. A lot of anxiety for people because you just have these reports of the Italian hospital system being overwhelmed with the number of cases that they're seeing.

And so what we're trying to do at the moment is figure out from a staffing perspective how we're going to contend with those scenarios, how are we going to change our staffing arrangements to avoid burnout.

RUBY:

We’ll be back in a moment.

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RUBY:

We’re talking about frontline services dealing with coronavirus. Can you tell me about the risks and implications for doctors and nurses working in hospitals?

NENAD:

By being in contact with patients that have coronavirus unfortunately there is a risk and we do our best to mitigate that risk through use of personal protective equipment as well as isolation of patients in the hospital. But unfortunately, none of these procedures are really 100 percent, not to mention the fact that they're also just the risks that the general population are experiencing. And health care staff, you know, have to be commuting to and from work and probably will end up having a lot more contact with the population at large as well. So, there’s an additional risk from that perspective.

RUBY:

Nenad I’m interested in understanding the differences among the medical community about how this pandemic should be treated?

NENAD:

Yeah, well, I think the challenge is that we are so early on in terms of our experience with this virus and we can try to apply lessons from previous epidemics or pandemics, but there are obviously very, very significant differences.

And in some ways, what we're sort of experiencing now is is a once in a lifetime event. I don't think that we've seen anything like this epidemic in living memory for us. And this is an unforeseen challenge, really.

So as a result of that, people will obviously...do have differences of opinion. And because we don't have the experience that there isn't a huge amount of data that we can use to guide us. And obviously, we are always trying to use the best evidence to guide our practice.

RUBY:

When patients are coming into hospitals now in Australia having tested positive for coronavirus... are they receiving medication? Are they being intubated? Like, what is it that's actually happening?

NENAD:

It is too early at the moment to have any definitive data about what therapies we should be using. And so in order to best understand what we should be doing, any kind of therapies that we give, we're going to be trying to do within a randomised clinical trial. Already, there has been an effort in Australia to launch a trial that looks at hydroxychloroquine, which is was originally a drug used for malaria treatment, as well as for a ton of very low Penalosa, which is a medication used for HIV, but was also found to have acted against SARS. These medications may have some activity against coronavirus and because these therapies are investigational, we want to give them to patients.

But we wanted to do it in a structured way. And so there has been an effort to launch a trial across Australia where patients are randomised to receiving some of these therapies. And what we're trying to do is really answer what is the most effective therapy that we can give to patients.

RUBY:

What impact is this going to have on our hospitals and our health system more broadly?

NENAD:

There is already a significant impact at the moment just because of the impact that it's having on services. All the testing that's going on at the moment and I think at this point it's very difficult to predict exactly what trajectory Australia will follow. I think in a best case scenario, we will see additional cases.

Obviously, we're going to see a number of patients hospitalised and possibly have severe disease. But what we're hoping for is that the hospital system is not overwhelmed by this influx of patients in a worst case scenario. I think we can sort of look towards what's happening in northern Italy, where they are having to make some very difficult decisions about…

NENAD:

… Which patients to treat and also how they're going to allocate their resources and we're definitely trying to avoid that sort of situation.

And so considering those sorts of different scenarios, we've had...had to really reconsider how the hospital potentially may need to run it as a whole. And how are we going to create that extra capacity to accommodate these patients. And one of the things that I think is emerging is that we are probably going to see disruptions as some regular medical services as a result of this.

So nonessential things like outpatient clinics, for example, elective surgery, all of these things may actually end up having to take a backseat while we deal with the influx of patients with coronavirus. And unfortunately, we don't have a good sense of how long we will be dealing with this pandemic. But I think we are bracing ourselves for anywhere from three to six months or possibly longer.

RUBY:

Thank you so much for talking to me today.

NENAD:

My pleasure Ruby. Thanks for checking in.

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The government response to the coronavirus outbreak continues to ramp up. In a press conference last night the Prime Minister announced that from midday today, pubs, clubs, cinemas, casinos, nightclubs and places of worship will all be closed. Restaurants and cafes will be limited to takeaway sales. The measures have been introduced in order to enforce social distancing, and they’re expected to last for six months. The Prime Minister said that the health advice for schools hasn’t changed and they would remain open, however parents who wish to keep their children home may do so. The prime minister has also advised against all non essential travel.

The government also unveiled another round of economic measures to buffer the economy. The 66 billion dollar package includes a temporary doubling of Newstart allowing people to access almost 10,000 dollars from their superannuation and small businesses loans up to 250,000 dollars. Not for profits and small businesses for the turnover under 50 billions dollars, will receive a tax free cash payment of up to 100,000 dollars.

And the AFL has cancelled the remainder of the AFLW season and postponed the men’s season until may 31. Meanwhile, the NRL announced yesterday that the season would continue as scheduled.

As the number of confirmed coronavirus cases grows in Australia, hospitals are gearing up for a spike in admissions. Today, Dr Nenad Macesic on how doctors are handling the pandemic and what the future holds. This is part one of a five-part special.

Guest: Contributor to The Monthly, Dr Nenad Macesic.

Background reading:

Behind the coronavirus masks in The Monthly
The Saturday Paper
The Monthly

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7am is a daily show from The Monthly and The Saturday Paper. It’s produced by Ruby Schwartz, Atticus Bastow, and Michelle Macklem. Elle Marsh is our features and field producer, in a position supported by the Judith Neilson Institute for Journalism and Ideas. Brian Campeau mixes the show. Our editor is Osman Faruqi. Erik Jensen is our editor-in-chief. Our theme music is by Ned Beckley and Josh Hogan of Envelope Audio. New episodes of 7am are released every weekday morning. Make sure you don’t miss out by subscribing on your favourite podcast app. I’m Ruby Jones, see you tomorrow.

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187: Coronavirus, part one: The frontline