Open letter from Australian doctors to Australian federal and state governments re. coronavirus COVID19 emergency response

This letter was initiated by Dr Greg Kelly (his twitter feed)

Open letter from Australian doctors to Australian federal and state governments re. coronavirus COVID19 emergency response
To: Australian Prime Minster Hon. Scott Morrison MP
CC: Australian Health Minster Hon Greg Hunt MP, Australian Chief Medical Officer Dr Brendan Murphy, State Premiers and Health Ministers

Monday 16th March 2020

Dear Prime Minister

We, the undersigned Australian medical doctors, are writing to you today because of our grave concern regarding the threat that novel Coronavirus 19 (COVID19) represents to the lives of Australians. We believe that Australian federal and state governments can avert disaster by heeding the lessons of other countries.

This means:

1. Immediately implementing the strict measures of lockdown and social distancing that have been shown to be effective at slowing the spread of COVID19 and,
2. Preparing our health systems for a surge of COVID19 and critically ill patients.

Taken together, these measures would reduce the numbers and presentation rate of COVID19 patients and allow our health system to cope.

International experience is that the COVID19 virus behaves in a relatively predictable way with the number of cases doubling every 3-5 days before strict lockdown and social distancing measures are implemented. Data from China, Europe and now Australia support this assertion. Exponential growth of this kind leads to relatively small numbers of infected patients to become large numbers at first slowly and then very, very quickly.

On current growth rates the 370 cases in Australia today will be 750 on Friday, 1500 on Tuesday next week, 3000 next Saturday, 6000 on the 1st of April and 12 000 by the 4th of April. This is less than 3 weeks from now and puts us in a worse position than Italy is currently in. Experience from China and Italy has also shown us that social distancing changes implemented today will take 2 weeks to show an effect on the numbers of diagnosed new cases due to the lag between initial contact and development of severe disease. We are especially concerned about impacts on Indigenous communities given their high rates of pre-existing illnesses and limited health infrastructure.

While we applaud the measures that have been taken by Australian authorities so far we know that they are not enough. The Italian government believed that they were acting decisively with their first local lockdowns at just 21 confirmed national cases, far lower than the current rates in Australia. Many of us are in contact with colleagues in Italy, Spain and France and they are begging us to learn from their mistakes.

The Italian authorities are reporting much higher rates of critical illness in their population than reported in Wuhan, China. This is likely related to an older population demographic with more pre existing illnesses. Australia is much more similar to Italy than Wuhan in this respect. Patients with critical COVID19 illness require admission to an intensive care unit for respiratory support and require highly specialised staff, equipment and locations, all scarce resources that cannot be easily increased. The Italian region of Lombardy which is currently hardest hit by COVID19, is one of the richest areas in Europe with a health system equal to that of Australia's. Our colleagues there have made herculean efforts to increase their capacity to care for critically ill COVID19 patients. Despite their efforts their systems are completely overwhelmed with corresponding very high death rates and inability to provide intensive care to previously healthy seventy year olds. They describe their situation as like being "in a war zone." With access to intensive care the death rate from COVID19 is likely less than 1%, but in an overwhelmed system without access to intensive care the death rate approaches 4%. Today, Italy has reported over 2100 deaths.

Fortunately, experience shows that COVID19 transmission rates can be significantly reduced if we heed the lessons of other countries. Chinese provinces outside Wuhan are excellent examples of this, as are Singapore, Korea and Taiwan. Widespread economic lockdown and social distancing are what is required. Transmission still occurs but the number of severely ill people remains within the capacity of our health system to treat them. The international experience has been that this decision cannot be averted, only delayed, and that the cost of delay in economic and human terms is higher than the cost of acting early and decisively. Furthermore, due to their experience with SARS, countries like Singapore can teach us valuable lessons about minimising economic effects from such epidemics.

Our second request is that urgent preparations are made to prepare our health systems for an unprecedented surge of COVID19 infected and critically ill patients. Such measures include an immediate reduction in elective work, increased frequency and intensity of hospital cleaning, measures to temporarily increase intensive care capacity and increasing personal protective equipment for staff.

With these immediate measures, Australian doctors and health care workers stand ready with their communities to face COVID19.

Sincerely

Related: Covid_19: Open letter from Italy to the international scientific community

As you surely know, Italy is suffering a dramatic spreading of the coronavirus.

In just 3 weeks from the beginning of the outbreak, the virus has reached more than 10.000 infected people.

From our data, about 10% of patients require ICU (Intensive Care Unit) or sub ICU assistance and about 5% of patients die.

We are now in the tragic situation that the most efficient health system of the richest area of the country (Lombardy) is almost at its full capacity and will soon be difficult to assist more people with Covid-19.

This is the reason why an almost complete lockdown of the country has been ordered: to slow down and hopefully stop the contagion as soon as possible.

The virus is spreading at maximum speed, doubling the number of infected people in just 2,4 days[1].

As it emerges without a doubt from the data available, all the European countries are in fact experiencing the same rate of contagion speed and that they are just a few days behind on where it is Italy now [2].

The beginning of the outbreak had the exact same number of infections in China, Italy, and other countries. The difference is that China strongly and quickly locked down Wuhan and all of the Hubei region 8 days before Italy [3].

Just 8 days of delay for the Italy lockdown will result in an enormous increase in the number of total deaths in Italy with respect to China.

This exact same initial dynamic in the number of new cases can also be observed in every country outbreak.

It’s hard for non-specialists to intuitively grasp the way an exponential rate increase can get out of control.

So it’s very difficult to realize the tragic consequences that an exponential growth can have in a contagion like this one.

As a scientist, you surely do understand it. You do also understand that, as long as the rate of increase is exponential, no linear solution to contrast it will work (I.e. increasing x times the number of ICU machines, etc.)

Similarly, just imposing a limitation on people from staying together in large groups is not a sufficient solution.

This is an appeal to you, as a member of the scientific community, to urge your government to act now for actively stopping the virus!

In most EU countries you have enough time to make a lockdown similar to China or South Korea to quickly slow down and stop the contagion with much less effort and cost of what is now needed in Italy.

If Italy had strongly acted just 10 days ago, and that is more or less where you are now, there would have been much fewer deaths and economic tumble.

South Korea and China should be taken as the example to follow to stop this epidemic.

There is no other way.

So please, make your best effort to urge your government to act now! Time is our common enemy as the virus is very fast and really lethal.

Every minute is exceptionally important as it means saving lives. Don’t waste it!

Take care.