What has society learned about infection prevention and control during the pandemic?
It has been over 100 years since Spanish Flu last tested our global pandemic response. COVID-19 has exposed cracks in our society’s infection prevention strategies.
Whilst provisions such as the two-week hotel quarantine program have been critical in reducing international transmission, positive cases, including new international variants, have continued to break into the broader public.
Australia has been home to one of the world’s most rigorous infection prevention regimes. Yet there were 16 hotel quarantine exposures over the five months from November 2020 and April 2021. [1]
The review into Victoria’s quarantine program found that 90% of the state’s pre-delta cases were gnomically linked to a family who had completed their 14 days in hotel quarantine. [2]
Tragically, efforts to contain outbreaks in aged care fell short; more than 75% of domestic COVID-19 deaths took place in aged-care facilities. [3]
There have been four fundamental tenants for infection prevention that this pandemic had abruptly brought to our attention
Plan for the worst, early.
Early COVID-19 IPC protocols underplayed the possibility of airborne transmission. Instead, measures like hand hygiene, surgical mask-wearing, and social distancing were primarily centred on the belief that droplets and fomites on surfaces were the leading cause of spread.
The delayed finding of aerosol transmission has cost society; earlier IPC strategies had not pre-empted this outcome. Global Health Experts, including the Australian Chief Medical Officer, Professor Paul Kelly, never denied the role of airborne transmission. However, other experts maintained that its role is minimal.
It is critical that, in order to be pandemic-prepared, Governments must plan for all eventualities; ensuring society has adequate stockpiles of both aerosol and surface infection prevention products is critical.
Be prepared, well-stocked, and even better trained.
Many global experts have criticised pre-existing IPC plans designed for healthcare-associated infections (HAI) like norovirus, saying they lacked the detail and rigour needed to combat a global pandemic.
Governments worldwide quickly found that existing stocks of infection prevention products were inadequate, and not all staff had received adequate training in their use. As the pandemic has progressed, training has increased, and stockpiles have grown.
It would be prudent for Governments to maintain this new minimum level of training and supply to help prevent future infections.
Compliance is Key.
COVID-19 has been a moment of behavioural change for many; when it was once acceptable to work with a sniffle, now it is expected that people will call in sick or at least work from home.
“People have been saying that you shouldn’t come into work with a ‘sniffle’ for a while now, but it is only through COVID that we have started to take this advice seriously,” said Kathy Dempsey of the Clinical Excellence Commission in NSW.
As a society, we have learned the importance of complying with infection prevention procedures. These have included more regular testing, staying home whilst sick, and even more minor things such as wiping down a desk after use or using hand sanitisers in cafés.
Expect a long fight.
Whilst the above measures have protected Australia from the early spikes and mass casualties of Europe and the US, it has been our tenacity in maintaining our infection prevention procedures that have continued to keep Australia’s deaths to below 1500. When Australians have ignored or grown tired of these procedures, we have seen correlating spikes in COVID-19 activity.
It remains critical that to continue to combat COVID-19 or future infections, including annual influenza outbreaks, proper infection prevention products and procedures must be part of our national plans.
Ensuring adequate levels of highly effective infection prevention products are stockpiled and able to be distributed, as needed to adequately trained individuals must be a critical tenant of Australia’s infection prevention strategy.
References:
[1] https://theconversation.com/more-than-a-dozen-covid-leaks-in-6-months-to-protect-australians-its-time-to-move-quarantine-out-of-city-hotels-159808.
[2] https://www.theguardian.com/australia-news/2020/aug/18/hotel-quarantine-linked-to-99-of-victorias-covid-cases-inquiry-told.
[3] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32206-6/fulltext.