Be Patient

They’re two simple words with incredible implications. But they’re why South Australia dodged the COVID19 bullet.

Be prepared. They’re two simple words with incredible implications. But they’re why South Australia dodged the COVID19 bullet.

“We in Australia had the good fortune to watch - with a growing sense of dread - what was happening initially in China and then across to Iran and Europe,” says SA Pathology ClinicalService Director Dr Tom Dodd. “We could see what was coming here. We knew we might not have much time.”Dodd and his team of scientists, nurses and support staff at SA Pathology are the state’s first line of defence. Together with the Communicable Disease Control Branch’s (CDCB) contact tracing efforts, their testing is the only weapon - alongside dramatic social distancing measures - available to combat the pandemic.Because of their efforts, we’re the envy of the world. Everything we needed was already in place. Efficient and adaptable testing procedures had long been established. Investments had been made in equipment and skills. “We knew that at some point there would be a major epidemic,” Dodd says. “And as a result, we were well placed.”It wasn’t easy. “Nobody knew when it would come,” he says. “Only that it would. And that it will again”.

RAPID RESPONSE SA Pathology’s Acting Directorate Services Manager, Microbiology & Infectious Diseases,Trish Hahesy says they watched the pandemic coming. “We were following the evolution of the infection during late December, early January, so we started contingency planning even then.”This isn’t out of the ordinary.“Both Trish and I have been through the Swine Flu epidemic and the H1N1 epidemic,” saysSA Pathology’s Clinical Director, Microbiology Infectious Diseases Dr Ivan Bastian. Even though Ebola didn’t get to Australia, we still needed to prepare in-house in case it came here.”What was new were the particular characteristics of COVID19.Dr Bastian says he remembers getting a tweet in mid-January when China released the first genome sequence of the virus. This was its blueprint. It revealed the virus’ unique features.And tests could be tailored to identify these.“I forwarded that (tweet) to Mark Turra  (Head of Public Health and Epidemiology) and, three days later, he’d actually designed the primers (chemicals to identify the virus). We immediately put in an order, and there was a three-week delay in getting it out of the US. Bu that was why we were up and running with a test on the fifth of February.”It was just in time.Dr Dodd had been in talks with SA general practitioners in January. They were worried their practices could quickly become hotbeds of contagion.“So it became quite evident even back then that we needed to make a service rapidly available to help them to swab patients,” he said.First, SA Pathology established a domiciliary collection service where nurses visited the homes of patients. Then, once the number of cases began to pick up, doctors could refer patients to drive-thru and district COVID clinics.

CURVE FLATTENERSLong hours. Late nights. Enormous workloads.“To be honest, it’s actually quite energising,” says SA Pathology’s Director, BusinessDevelopment & Strategy, Craig Martin. 

He points to several SA ‘firsts’ as a source of revitalising achievement. The first state to test3 per cent of its population. The country’s first (and world’s second) drive-through COVID clinics. It was by no means a worry-free experience.It’s just that a decade of planning had kept the challenges to manageable levels.“On the testing side, most of any work that was required was about adapting for scale rather than needing to do anything new for the first time,” he says. “If this capability had to be created or significantly modified, it wouldn’t have happened as quickly as it did.”Dr Dodd says he would visit lab staff early in the morning and late at night. “The lab was able to expand from doing about 150 tests a day up to beyond 2000 a day with greatly reduced turnaround times. We’re down to about 14 hours, which is incredible. I’ve visited them early in the morning and late at night. Everyone’s just really cheerful, getting on with the work.”SA Pathology had stockpiles of vital materials held in contingency for a sudden outbreak.Sourcing replacement chemicals are a cause of late-night international phone calls, Hahesy says.  But the ability to conduct a diverse nature of tests means the state isn’t beholden to any single supplier.One early lesson to emerge from the pandemic is the need to prepare coping mechanisms.“For me, it’s to stock up on more chocolate to get me over that 3 o’clock dip. Both pm and am,” Martin says. Hahesy found serendipity in Easter. “ I’m glad it was Easter time as I had lots of hot cross buns. I don’t normally eat butter. But I had lots of Hot Cross Buns with lots of butter.”Bastian did something completely different: I”m old enough to be a grandfather. And I’m trying to learn some woodworking skills. So, on my days off, I’ve been at home in the evenings building a wooden play kitchen for my granddaughter just to stay sane.”

END OF THE BEGINNINGS A is on top of COVID19. “But we might be putting out spot fires for the next few months,”says Dr Bastian. “So we need to maintain our testing capability.”Dr Dodd agrees.  “We’re in a very fortunate position,” he says, “but COVID is going to be around in the world for a while yet. There is no vaccine. We’re all susceptible. None of us is immune. So we’re going to have to continue to test and test and test. This will inevitably go on for months.”But SA is in an ideal position because of preparedness, and a willingness to go in hard and fast.“I’d be saying to my grandkids, you’re alive because everyone in South Australia dug deep to make sure the impact of COVID19 was so minimal,” Martin says. Hahesy says physical distancing was the lynchpin. “I was very happy that they introduced it, and I think it was the right time,” she says. “It’s because of this that we have been able to get the number of positives right down. That was probably my biggest fear.”Dr Bastian says he’s proud at the way Australia instinctively pulled together.“I think we’ve demonstrated, like the old Diggers, that despite political, social and other differences that we remain a cohesive society that cares for each other,” he says. “We have politicians that have led well while accepting expert advice. And we have a community that has accepted isolation and other hardships for the benefit of others. We don’t need to look too far to find other societies that haven’t had that.”

Originally published as Be Patient