news, act-politics, andrew barr, rachel stephen-smith, act, canberra, covid-19, coronavirus, response, garran

Canberra was just emerging from the bushfire and smoke crisis in February when it became clear to Chief Minister Andrew Barr this mysterious virus in Wuhan might be something to really worry about. “I distinctly remember getting a briefing on this disease or virus in China,” he says. “It went from something that was somewhat of a quirky news story to ‘Hang on, this is now a concern.'” As Canberra’s health authorities watched the chaos unfolding in Europe as COVID-19 took hold in March, there was real fear the ACT simply would not be able to deal with similar case numbers. Urgent modelling was completed showing the ACT’s intensive care and emergency departments would quickly become overwhelmed. So deep were the fears that the government even considered closing down Garran Primary School and bringing in the army to run a medical centre on the site. Meanwhile, the Chief Minister and the Victorian and NSW premiers clashed with the Prime Minister as they called for a hard lockdown early. Some inside the Canberra Hospital said extreme measures were needed to shore up the health system. The view was the territory needed to act, and act fast. If not, two in three Canberrans who needed intensive care treatment would simply have to go without. Emails obtained by The Canberra Times under freedom of information reveal the extent of measures the government was considering. These included closing Garran Primary School – opposite Canberra Hospital – and handing over control of the site to the Army Reserves. Greg Hollis – the then clinical director of the hospital’s emergency department – was an army reservist and believed the Australian Defence Force would be well placed to run a medical centre there. He said it should be used to care for COVID-19 patients who were not sick enough to be admitted to hospital but could not return home. The reserves would be responsible for supplying all bedding, food and drink. “Sounds extreme, but after sleeping on it, suggest you consider deciding immediately before further deterioration locally and nationally,” he said to health executives on March 22. An urgent consultation paper from Hollis had also suggested building a pop-up emergency department on the oval opposite Canberra Hospital, to be facilitated by Aspen Medical. Within days the government had approved the proposal. With COVID-19 ultimately controlled across Australia, the $24 million facility has so far never been required, and has only ever been used as a testing site. But Health Minister Rachel Stephen-Smith makes no apologies. It was the insurance policy the ACT needed to have. “In the early days we were really looking at what was happening in other places,” Stephen-Smith says. “There was a great deal of anxiety about whether we had acted fast enough – whether the closure of international borders and stay-at-home orders were going to be sufficient to flatten the curve.” Stephen-Smith says she was on the one hand optimistic Australia had acted quickly enough, but also weary of the scenes playing out overseas. “We had very senior people in our health system, very concerned about what the impacts would be if we did have a second or third wave,” she says. “If we needed it, by the time we needed it, it was too late to build it.” Modelling provided by ACT chief health officer Kerryn Coleman suggested there would be up to 655 ICU admissions across the pandemic, and more than 500 extra emergency department presentations than usual every day. The most presentations Canberra Hospital’s emergency department had ever previously seen in one day was 303. It highlighted the need to urgently acquire more ventilators and build the pop-up hospital. The proposal to build a new hospital was rushed through at high speed. It was on March 20 that Canberra Health Services contacted Aspen Medical to determine if it could build a surge hospital. By March 23 the government had given its in-principle support. “Under a worst-case scenario, the COVID-19 pandemic is expected to exhaust and overwhelm the territory’s health services resources,” Canberra Health Services chief executive Bernadette McDonald told Stephen-Smith in a briefing note. “The Aspen proposal is not cheap. It reflects market conditions and that all governments are competing for the same workforce and capabilities. “If demand does not exceed existing hospital capacity, we could be criticised for committing significant expenditure.” By March 31, Barr had signed off on providing $23 million in funding for the project, and it was publicly announced on April 9. While local health services were scrambling to beef up their responses, Australian leaders were contemplating harsh lock downs. The first national cabinet meetings, held in March, were tense. NSW Premier Gladys Berejiklian and Victorian Premier Dan Andrews, along with Barr, were pushing for hard lockdowns. “The Prime Minister was very unhappy about that,” Barr says. “At various points over the ensuing six months we’ve had our moments; NSW not letting Canberrans home from Victoria, that week was pretty tense. “There were challenging moments between premiers on border closures. “But all throughout this, even though this group of first ministers has had 10 or 15 years worth of COAG meetings all in one year, the group has held together pretty well. “Everyone was commenting on that when we all got together [in person for the first time in December].” Barr says he’s now anxious about the potential rollout of a vaccine nationwide and the challenges it will present. “How will a mass vaccination program be delivered effectively? States and territories will have a role in that,” he says. “What I’m now nervous about is how effective, for how long, vaccines will be.” Barr has been pushing for a way to allow international students – the ACT’s biggest export market – back into the territory. But so far Prime Minister Scott Morrison has not supported the proposals. “Certainly not for lack of asking and putting forward a range of different proposals,” Barr says. “The concession would be a looking at where things are at at the end of January.” Much of the answer may depend on whether demand for Australians to return home from overseas drops in the new year, allowing hotel quarantine resources to be used by international students. “We will keep on asking and putting safe ideas forward,” Barr says. “The earliest [students would return] would be middle to late February. “If it’s not then we’ll just keep asking.” It wasn’t until March that the ACT recorded its first cases of COVID-19. One of the first cases was a parent at Telopea Park School, who had visited while infectious. Anxiety among the community was high, and testing criteria and isolation policies were rapidly changing. A number of Australian National University epidemiologists were parents at the school and wrote to the government urging them to take more action to protect the community. “We would like to ask that the children of the positive case be urgently tested and if found positive, contact tracing via testing of classmates is undertaken,” their email, released under freedom of information, said. “Until the children are found to be negative we would ask that the school is immediately closed to prevent further spread of infection. “If due to the current strict eligibility criteria for COVID-19 testing the asymptomatic children are not considered eligible for testing, we would ask the school to consider closing for two weeks, or at the very least, parents should be informed that this positive COVID-19 case was a parent of Telopea Park School children.” ACT contact tracers have, fortunately, yet to be truly tested by an outbreak. For Stephen-Smith, the fear of an out-of-control outbreak does not go away. “We’ve spent a lot of time not having cases and we’ve never had community transmission in the ACT,” she says. “But you wait for the case update every morning; is this going to be the day when we have a case with an unidentified source of transmission that creates a cluster?” READ MORE: As NSW grapples with a fresh outbreak and other jurisdictions slam their doors shut to it, the state has resisted imposing harsh restrictions or going into lockdown. Stephen-Smith says the question of whether the ACT would take a similar response or favour a hard and fast response would really depend on the circumstances. “But what we’ve really seen in other jurisdictions is a strong quick response,” she says. “At the very least it buys time to understand what is happening. “In South Australia it was a very quick strong response but it didn’t last very long.” The internal documents obtained by The Canberra Times show there was nervousness among key personnel about making a wrong decision on things like the pop-up hospital. Hollis, the emergency department director, urged decisiveness. “In my opinion, in the situation we are potentially facing, a decision now that is OK, is much better than an extensively consulted and revised decision that is too late in a week or two,” Hollis said in an email to executives. Stephen-Smith says the COVID-19 crisis has shown the importance of strong leadership. “You’re not going to have all the information, and you need to … be willing to make a decision in the absence of perfect information and then to change your mind if you get further information,” she says. “What’s really been brought home to everyone is the importance of evidence-informed decisions.” As for what the year to come will bring, she has learnt not to make predictions. “I hope that by this time next year we will be in a new state of COVID-normal, but I think we just have to wait and see what the impact of the new vaccine is … we’ve got our fingers crossed.”

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