Last updated 07/02/2020 - health.gov.au...Australia’s whole-of-government communicable disease...

Last updated 07/02/2020

AustralianHealthSectorEmergencyResponsePlanforNovelCoronavirus(COVID-2019)3

Contents

PART1:OVERVIEWOFTHENATIONALAPPROACH.....................................................1

1. ExecutiveSummary...............................................................................................1

2. Introduction...........................................................................................................5

3. Escalation.............................................................................................................14

4. Governance.........................................................................................................16

5. Implementation...................................................................................................24

6. Communications..................................................................................................29

PART2:OPERATIONALPLAN......................................................................................37

Initialactionstage......................................................................................................38

Targetedactionstage.................................................................................................42

Standdownstage........................................................................................................45

PART3:ATTACHMENTA–GLOSSARY........................................................................48

PART 1 Overview of the National Approach 1. Executive Summary

Context Viral respiratory diseases have the greatest potential to cause pandemics and the key threat ofemergenceofapandemicstrainofvirusliesatthehuman-animalinterface.Everysooftentherehasbeenemergenceofnovelinfluenzastrainsinanimalssuchasbirdsandpigs,suchasH5N1,H1N1andH7N9,andtheseviruseshavecausedsignificantmorbidityandmortalityinhumans.Todatenoneoftheseviruseshavecausedsustainedhumantohumantransmission.

Pandemic influenza remains a key global health threat and the Australian Government and thebroader Australian health sector is well prepared to respond to an influenza pandemic. TheAustralian Health Management Plan for Pandemic Influenza (the AHMPPI) is the key nationallyagreeddocumenttoguideAustralia’sresponse.

In December 2019, China reported cases of a viral pneumonia caused by a previously unknownpathogenthatemergedinWuhan,acityof11millionpeopleincentralChina.Theinitialcaseswerelinked to exposures in a seafoodmarket inWuhanwhere a large range of live animal and animalproducts were sold. The pathogen was identified as a novel (new) coronavirus (recently namedSevereacuterespiratorysyndromecoronavirus2(SARS-CoV-2)),whichiscloselyrelatedgeneticallytothevirusthatcausedthe2003outbreakofSevereAcuteRespiratorySyndrome(SARS).SARS-CoV-2 causes the illness now known as Coronavirus disease 2019 (COVID-19). Currently, there is nospecifictreatment(novaccineandnoantiviral)againstthenewvirus.

Givenwhatweknowaboutpandemicpreparedness,responseandthesignificantglobal impactsofthe SARS outbreak in 2003, the influenza pandemic in 2009 and the Middle East respiratorySyndrome(MERS)in2013andagainin2015,wecannotaffordtobecomplacent.

DuetoheightenedglobalconcernsaroundthepandemicpotentialofCOVID-19,followingameetingof theWorld Health Organization (WHO) International Health Regulations Emergency Committee,theDirector-GeneraldeclaredtheoutbreakofCOVID-19aPublicHealthEmergencyofInternationalConcernon30January2020.

Australia iswellpreparedandhasexcellenthealth systems todealwith this virus.All areasof thehealthsectorarewellinformedandactivelyengagedinthenationalresponse.

Whilethereisstillmuchwedon’tknowaboutthecharacteristicsofSARS-CoV-2,Australiahastakenaprecautionaryapproachinlinewithpreparednessandresponseguidanceforapandemic,workingcollaborativelywithstateandterritoryandwholeofgovernmentpartnerstoimplementstrategiestominimise disease transmission through strong border measures and widespread communicationactivities.


The plan This,thefirstAustralianHealthSectorEmergencyResponsePlanforNovelCoronavirus(theCOVID-19Plan)isdesignedtoguidetheAustralianhealthsectorresponse.Itshouldbeconsideredalivingdocument that will be periodically updated. Aswe learnmore about the virus and its key at riskgroups, and as potential treatments become available such as antiviral drugs and vaccine,we cantarget resources and public health interventions to most effectively protect the health of allAustralians.

ThenovelcoronavirusoutbreakrepresentsasignificantrisktoAustralia.Ithasthepotentialtocausehighlevelsofmorbidityandmortalityandtodisruptourcommunitysociallyandeconomically.ThenationalapproachtothisplanhasbeenbasedontheAHMPPI,notingthattheresponsetothenovelcoronavirusoutbreak isnow in the InitialActionstage.Accordingly, thepreparednessandstandbystageshavenotbeenincluded.

Australiawillapproachthisnovelcoronavirusoutbreakbyundertakingactivitiesto:

• monitorandinvestigateoutbreaksastheyoccur;• identifyandcharacterisethenatureofthevirusandtheclinicalseverityofthedisease;• researchrespiratorydisease-specificmanagementstrategies;• respondpromptlyandeffectivelytominimisethenovelcoronavirusoutbreakimpact;• undertakestrategiestominimisetheriskoffurtherdiseasetransmission;and• contributetotherapidandconfidentrecoveryofindividuals,communitiesandservices.

Theactivitiesrequiredtosupportourcommunityduringthisnovelcoronavirusoutbreakwillinvolvestateandterritorygovernments, theAustralianGovernmentandmanyotherhealthsectorparties.Coordination and communication at the national level will be particularly important during ourcurrentactiveresponse.

Response stages Toclearlyshowhowtheapproachwillchangeoverthecourseofrespondingtoanovelcoronavirusoutbreak,theCOVID-19Planisdividedintoseveralstages.

ThefollowingtableoutlinesthekeyactivitiesineachoftheCOVID-19Planstages.

Table1:KeyactivitiesineachoftheCOVID-19Planstages

COVID-19PlanSTAGES

ACTIVITIES

Action Actionisdividedintotwogroupsofactivities:

Initial(wheninformationaboutthediseaseisscarce)• Minimisetransmission;• Prepareandsupporthealthsystemneeds;• Manageinitialcasesandcontacts;• Identifyandcharacterisethenatureofthediseasewithinthe

Australiancontext;• Provideinformationtosupportbestpracticehealthcareandto

empowerthecommunityandresponderstomanagetheirownriskofexposure;and

• Confirmandsupporteffectivegovernancearrangements.Targeted(whenenoughisknownaboutthediseasetotailormeasurestospecificneeds)• Ensureaproportionateresponse;• Supportandmaintainqualitycare;• Communicatetoengage,empowerandbuildconfidenceinthe

COVID-19PlanSTAGES

ACTIVITIES

community;and• Provideacoordinatedandconsistentapproach.

Standdown • Supportandmaintainqualitycare;• Ceaseactivitiesthatarenolongerneeded,andtransitionactivitiesto

normalbusinessorinterimarrangements;• Monitorforasecondwaveoftheoutbreak;• Monitorforthedevelopmentofresistancetoanypharmaceutical

measures(ifbeingused);• Communicatetosupportthereturnfromemergencyresponseto

normalbusinessservices;and• Evaluatesystemsandreviseplansandprocedures.

Once response activities are completed arrangements will return to the Preparedness stage, tomonitor for any future novel coronavirus outbreaks; maintain plans and response agreements;researchnovelcoronavirus-specificmanagementstrategies;andensureresourcesareavailableandreadyforarapidresponse.

Objectives and activities Thestrategicobjectivesacrossallstagesandactivitiesproposedinthisplanwillbeto:

• IdentifyingandcharacterisingthenatureofthevirusandtheclinicalseverityofthediseaseintheAustraliancontext;

• Minimisetransmissibility,morbidityandmortality;• Minimisetheburdenon/supporthealthsystems;and• Inform,engageandempowerthepublic.

The activities which should be implemented will be selected by the Australian Health ProtectionPrincipalCommittee(AHPPC),inconsultationwithrelevantpartiesandonadvicefromexpertbodies.

Reflectingaflexibleapproach,choicesonimplementationofpublichealthmeasuresmayvaryacrossstates and territories to reflect the jurisdictional context, particularly in relation to timing ofimplementationandstanddown,howevernegotiationwithinAHPPCwillensureacoordinatedandconsistentapproach.

Proportionate response Akeygoalofthedecisionmakingprocessistoachievearesponsethatisproportionatetothelevelof risk, acknowledging that the risk is not the same across population groups. A response that isappropriatetothelevelofimpactthenovelcoronavirusoutbreakislikelytohaveonthecommunity,and on vulnerable populations within the community, will make the best use of the resourcesavailableandminimisesocialdisruption.

Although itwill onlybepossible toquantify theoverall impactof theoutbreakonce it has run itscourse, toassistplanners,anestimateof theanticipated levelof impactwillbedevelopedearly intheresponse,andupdatedasnewdatabecomesavailable.Thisestimatewillbeusedto:

• guidetheallocationofresources,toensureresourcesarenotwastedandareconservedforuseas longaspossible (includinganticipationofwhentheyareneeded,asthiswillchangeovertime);

• putinplacestrategiestosupplementlikelyshortfalls(e.g.innovativeoptions);• reducetherisktovulnerablepeople.


The level of impact that thenovel coronavirus has on theAustralian communitywill dependon anumberoffactors.Themostinfluentialwillbetheclinicalseverityandtransmissibilityofthedisease,andthecapacityofthehealthsystemtocopewiththedemandandtheneedforspecialistservices.

Communication and consultation Themanagementofanovelcoronavirusoutbreakwill requiregovernments,healthsector industryand the community towork together.Communicationwill beapriorityunder thisplan, toensurerespondersareprovidedwithtimely,accurateandcomprehensiveclinicalinformationandadviceinorder toeffectivelymanagepatients; implementnovelcoronaviruscontrolmeasuresandminimisetheir own risk of exposure. Consultation with responders and with the public will be essential toinformdecision-making.

Public communicationwill be used to provide an opportunity both to address any public concerncaused by the novel coronavirus outbreak and to engage the public in strategies to manage theimpactofthedisease.Bygivingthepublicuptodate,consistentandaccurateinformationaboutthestatus of the disease overseas and in Australia they can participate inmanaging the outbreak bytakingstepstoreducetherisktothemselvesandtheirfamilies.Theycanalsomakemoreinformeddecisionsaboutworkandtravel, takinguphealthrecommendationsandplanning forpeople inat-risk groups. Information about the implementation of activities and arrangementswill be used tobuildpublicconfidenceinthecapacityofhealthservicestomanagetheresponse.

2. Introduction This section outlines the aims of this plan, key factors in the approach taken, the context withinwhichithasbeendevelopedandmethodsofachievingaresponseproportionatetotheriskposedbythecurrentnovelcoronavirusoutbreak.

ThisplanhasbeendevelopedspecificallytomanagethenationalresponsetotheoutbreakofnovelcoronaviruswhichcommencedinChinain2019.ItisheavilybasedontheAHMPPI,asdiscussionofkey committees and expert groups have agreed the approach and activities of the AHMPPI arerelevantandbroadlyapplicabletothenovelcoronavirusoutbreak.

Muchisstillunknownaboutthenovelcoronavirus,howeverourunderstandingisgrowingdaily.Thisplan is a living document which will be updated as needed and as new information becomesavailable.

2.1 Aims of the national response to the novel coronavirus outbreak 2019/20

Australia’s whole-of-government communicable disease frameworks, at Australian, state andterritorygovernmentlevels,aimtoprotectAustralia’ssocialfunctionandeconomy.

Duringthenovelcoronavirusoutbreak,thehealthsectorwillaimtominimisetheoutbreak’simpacton the health of Australians and our health systems. This, the COVID-19 Plan, is the Australiannationalhealthsectorplanfortheoutbreakofnovelcoronavirus2019/20,andcontributestotheseaimsby:

• clarifyingtherolesandresponsibilitieswithinthehealthsectoroftheAustralianGovernmentandstateandterritorygovernments;

• identifyingareaswherenational guidanceand coordinationwill beprovided, andhow thiswillbeachieved;and

• supporting decision makers to respond in a manner that is flexible, informed andproportionatetothecircumstancesatthetime.

2.2 Key aspects of this plan Thekeyfactorsinthisplan’sapproachinclude:

• the use of existing systems and governance mechanisms, particularly those for otherrespiratorydiseases(suchasinfluenza)andhumanbiosecurity;

• aflexibleapproachthatcanbescaledandvariedtomeettheneedsexperiencedatthetime;• evidence-baseddecisionmaking;• stronglinkageswithemergencyresponsearrangements;• clearstrategicapproachestothecollectionofnationalsurveillancedata;and• anemphasisoncommunicationactivitiesasakeytoolinmanagementoftheresponse.

2.3 Comprehensive approach Thisplantakesanemergencyresponseapproachasitsframework.Thisapproachwillallowittobereadily integrated into broader emergency arrangements. It will also assist those who areimplementingactivitiesduringahealthemergencytocommunicatemoreeasilywithothersoutsidethehealthsector.

Consistent with Australia’s strategic approach to emergency management, the COVID-19 Planacknowledges the importanceof seeing themanagementofallhazardswithinanongoingcycleofactivitiesinthefourareasof:


• Prevention;• Preparedness;• Response;and• Recovery.

(Use of these terms with the initial letter in bold will indicate these areas of the emergencymanagementcycleinthisplan.)

ThisplanwillfocusprimarilyontheareaofResponse,tomeetthegreaterneedforcoordinationandguidance at a national level for COVID-19. To reflect the changes in priorities as the outbreakresponseprogressesand facilitate themoredetailedplanning required,Responseactivitieswill befurtherdividedintotwostages:

• InitialActionandTargetedAction;and• Standdown.

Table2indicatesthegeneralfocusofactivitiesineachstageoftheCOVID-19Plan.Thecurrentstatusofthevirusineachstageisnotedinitalics.Toensurethatflexibilityismaintained,thesestagesaredeliberatelybroad.Tomakeiteasiertorelateactivitiestothesestages,colourshavebeenallocatedtoeachandusedasmarkersinthisplan.

Table2:KeyactivitiesineachstageoftheCOVID-19Plan,commencinginAction,asAustraliaalreadyhascases.

COVID-19PlanSTAGES

ACTIVITIES

ActionCasesdetectedinAustralia

Actionisdividedintotwogroupsofactivities:

Initial(wheninformationaboutthediseaseisscarce)• minimisetransmission;• prepareandsupporthealthsystemneeds;• manageinitialcasesandcontacts;• identifyandcharacterisethenatureofthediseasewithintheAustralian

context;• provideinformationtosupportbestpracticehealthcareandtoempower

thecommunityandresponderstomanagetheirownriskofexposure;and• confirmandsupporteffectivegovernance.Targeted(whenenoughisknownaboutthediseasetotailormeasurestospecificneeds)• ensureaproportionateresponse;• supportandmaintainqualitycare;• continuetocommunicatetoengage,empowerandbuildconfidenceinthe

community;and• provideacoordinatedandconsistentapproach.

COVID-19PlanSTAGES

ACTIVITIES

StanddownThepublichealththreatcanbemanagedwithinnormalarrangementsandmonitoringforchangeisinplace.

• Supportandmaintainqualitycare;• ceaseactivitiesthatarenolongerneeded,andtransitioningactivitiesto

seasonalorinterimarrangements;• monitorforasecondwaveoftheoutbreak;• monitorforthedevelopmentofresistancetoanypharmaceuticalmeasures

beingused;• communicatetosupportthereturnfrompandemictonormalbusiness

services;and• evaluatesystemsandreviseplansandprocedures.

2.4 Whole of government planning to support the novel coronavirus response

Thisplanoutlinesthehealthsectorapproachtorespondingtothenovelcoronavirusoutbreak.ItissupportedbytheEmergencyResponsePlanforCommunicableDiseasesIncidentsofNationalSignificance:NationalArrangements(NationalCDPlan)(https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-nat-CD-plan.htm).

The National CD Plan outlines how non-health sector agencies will support the health sectorresponse and how agencies across Australian, state, territory and local governments will worktogethertoprotectAustraliafromthethreatofamajorcommunicablediseaseoutbreak.

GuidanceonthepublichealthmanagementofnovelcoronavirusisavailableintheCommunicableDiseasesNetworkAustralia(CDNA)NationalGuidelinesforPublicHealthUnitsintheSeriesofNationalGuidelines(SoNGs)(https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm).


The COVID-19 Plan acknowledges that the primary responsibility for managing the impact of thenovelcoronavirus lieswiththestateandterritorygovernmentsandthateach jurisdictionwillhaveitsownplansandprotocols.Thereforethemajorityofoperationaldetailwillbefoundintheseplans.

2.5 Legal framework AlthoughCommonwealthbiosecuritylegislationandstateandterritorypublichealthandemergencyresponse lawsprovidea legislativeframeworktounderpinactionsthatmayberequired,measureswill rely on voluntary compliance rather than legal enforcement wherever possible. The principalareasoflegislationavailabletosupportresponseactionsaredescribedinthefollowingsubsections.

The Biosecurity Act 2015 TheBiosecurityAct2015authorisesactivitiesusedtopreventtheintroductionandspreadoftargetdiseasesintoAustralia.Peoplereasonablysuspectedtohavealistedhumandisease(LHD)specifiedunder the Act are required to comply with a range of biosecurity measures and requests forinformationasdirectedbytheDirectorofHumanBiosecurity(DHB),Australia’sChiefMedicalOfficer(CMO);MinisterforHealth;orabiosecurityofficialorhumanbiosecurityofficerasstipulatedintheAct. The Governor-General also has the power to declare a human biosecurity emergency, whichauthorises theHealthMinister to implementabroad rangeofactions in response.Thesecouldbeappliedtorespondtoaseriousinfectiousdiseaseoutbreakorapandemic.‘Humancoronaviruswithpandemic potential’ is an LHD. Diseases can be added to the list of LHDs (as declared in theBiosecurity(ListedHumanDiseases)Determination2016)atanytimebytheDHBatshortnotice.

The National Health Security Act 2007 The National Health Security Act 2007 (NHS Act) authorises the exchange of public healthsurveillanceinformation(includingpersonalinformation)betweentheAustralianGovernment,statesand territories and the WHO. The National Health Security Agreement supporting the NHS Actformalisesdecision-makingandcoordinatedresponsearrangementsthathavebeenrefinedinrecentyearstoprepareforhealthemergencies.

State and territory government legislative powers States and territories have legislative powers that enable them to implement biosecurityarrangements within their borders and that complement Australian Government biosecurityarrangements. They also have a broad range of public health and emergency response powersavailableunderpublicandemergencylegislationforrespondingtopublichealthemergencies.

International legislative obligations TheInternationalHealthRegulations2005(IHR)isaninternationalpublichealthtreatythatcommitssignatory countries to take action to prevent, protect against, control and provide a public healthresponsetotheinternationalspreadofdisease.Asasignatory,Australiahasarangeofobligations,including reporting and maintaining certain core capacities at designated points of entry andinformingtheWHOifanymeasuresimplementedinterferewithinternationaltradeortravel.

Therapeutic Goods Act 1989 The Therapeutic Goods Act 1989 establishes a framework for ensuring the timely availability oftherapeutic goods (i.e.medicines,medical devices and biological products) that are of acceptablequality,safetyandefficacy/performance.Thereareprovisionswithinthelegislationthatoperateatan individual patient level andat aprogram level (suchas themaintenanceof aNationalMedicalStockpile (NMS)) toallowfor the importationandsupplyofproductsandtheuseofnew,disease-specific in vitromedical diagnostic tests that have not been approved for use in Australia. Theseproductsmayberequiredtodealwithanactualthreattoindividualandpublichealthcausedbyan

emergency thathasoccurredor tocreateapreparedness todealwithapotential threat tohealththatmaybecausedbyapossiblefutureemergency.

2.6 Ethical framework In2008,AHPPCagreedonanethicalframeworktoguidehealthsectorresponses.Thesevalueswillbetakenintoaccountwhenplanningandimplementingactionsunderthisplan,andcanbeoutlinedas:

Equity - Providing care in an equitable manner, recognising special needs, cultural values andreligiousbeliefsofdifferentmembersofthecommunity.Thisisespeciallyimportantwhenprovidinghealth services to vulnerable individuals, suchasAboriginal andTorres Strait Islanderpeoples andpeoplewhoareculturallyandlinguisticallydiverse.

Individualliberty-Ensuringthattherightsoftheindividualareupheldasmuchaspossible

Privacy and confidentiality of individuals - Is important and should be protected. Underextraordinaryconditionsduringapandemic,itmaybenecessaryforsomeelementstobeoverriddentoprotectothers.

Proportionality-Ensuringthatmeasurestakenareproportionaltothethreat.

Protectionof thepublic -Ensuring that theprotectionof theentirepopulation remainsaprimaryfocus.

Provisionofcare-Ensuringthathealthcareworkers(HCWs)areabletodelivercareappropriatetothesituation,commensuratewithgoodpractice,andtheirprofession’scodeofethics.

Reciprocity - Ensuring thatwhen individualsareasked to takemeasuresorperformduties for thebenefitofsocietyasawhole,theiractsareappropriatelyrecognisedandlegitimateneedassociatedwiththeseactsaremetwherepossible.

Stewardship-Thatleadersstrivetomakegooddecisionsbasedonbestavailableevidence.

Trust-Thathealthdecisionmakersstrivetocommunicateinatimelyandtransparentmannertothepublicandthosewithinthehealthsystem.

2.7 Proportionate response Prior to 2009, planning for pandemics and major communicable disease outbreaks was aimed atrespondingtoaworstcasescenario.The2009influenzaA(H1N1)pandemicshowedclearlytheneedfor the flexibility to scale the response tobeproportionate to the riskassociatedwith thecurrentdisease.

2.7.1 Outbreak Impact ThelevelofimpactthattheoutbreakhasontheAustraliancommunitywilldependonanumberoffactors.

Theclinicalseverityofthediseasewillaffectthenumberofpeoplethatpresenttoprimarycare,andwho need to be hospitalised (and consequently the burden on the health system). The clinicalseverityalsoaffectsthenumberofdeathsandthelevelofconcernwithinthecommunity.Asclinicalseverity increases, the visibilityof thedisease (i.e. howeasy it is tobe awareof cases) is likely toincrease.Greatervisibilityofcasestomedicalservicesmakesthemmoreamenabletomeasurestomanagethedisease’simpact.

Thetransmissibilityofthevirusbetweenhumanswillaffectthebreadthandspeedofspreadacrossthe globe and the Australian community. The transmissibility of the novel coronavirus is as yetunknown.Asat6February2020, theWorldHealthOrganizationhasestimatedthevirus tohaveapreliminaryreproductionnumber(R0)of1.4to2.5.


Thecapacityofthehealthsystemwillinfluencethewaythathealthcareisprovided.Australiahasanexcellenthealthsystem.However,thereisalimittotheservicesthatareabletobeprovided,whichmay well be tested during an outbreak of a novel coronavirus with pandemic potential. In someareas, the health system already reaches capacity at peak times, such as during severe influenzaseasons.Amajoroutbreakwillincreasethedemandonspecialistexpertise,particularlyinacutecare,suchasintensivecarenursing,emergencymedicineandambulanceservices.Itmayalsoincreasethedemandonspecialistequipment,someofwhichrequiresspecialist trainingto implementand isoflimited availability, such as extracorporeal membrane oxygenation (ECMO). Demand on primaryhealthcarewillalsoincrease,exacerbatedbytheneedtoattendtopatientsaffectedbythechangesinavailabilityofservicesathospitals.

The effectiveness of interventions will affect individual health and the levels of morbidity andmortalitythatneedtobemanagedbythehealthsystem.Currentlytherearenoeffectiveantiviralsavailableandthereisnovaccine.Availabilityofacustomisednovelcoronavirusvaccinewouldbethegreatesttoolinreducingtheimpact.Itisnotknowniforwhenthismightbeavailable.Thereisstillno vaccine available for theothermajor coronaviruses SARS andMERS. Interventions that changebehaviours,suchashandhygiene,isolationandsocialdistancingwillalsoinfluencetheimpactofthedisease.Earlyclinicaltrialsofcandidateantiviraldrugsinseverecaseswillbeofgreatimportancetodetermineifanyofthemhaveclinicalefficacy.

The vulnerability of our population will influence the spread and clinical severity of the disease.Vulnerability is unique and will make comparisons with the experience of the outbreak overseasindicativeonly.Astheoutbreakiscausedbyanovelvirus,thelackofimmunityinthepopulationwillmake itmore vulnerable thanwould be the casewith diseases such as seasonal influenza (wherethereisusuallysomecross-immunityfrompreviousseasonalstrains).Caseinformationtodatehasindicated that people with underlying illness or immunocompromised conditions are likely toexperiencemoresevereoutcomes.

2.7.2 Application of outbreak impact levels to decision making Although itwill onlybepossible toquantify theoverall impactof theoutbreakonce it has run itscourse, informed by surveillance activities, an estimate of the anticipated level of impact will bemade early in the response, and continually updated as data availability allows, and used to helpplanners:

• allocateresourceswheretheyareneeded(includinganticipationofwhentheyareneeded,asthiswillchangeovertime);

• putinplacestrategiestosupplementlikelyshortfalls(e.g.innovativeoptions);• reducetherisktovulnerablepeople;• minimisethedisruptiontothecommunity;and• providearesponsethatisproportionatetothelevelofimpact.

Characterisation of the virus will be undertaken as early as possible in the outbreak, includingongoinganalysisofsequencinginformationthatcouldindicateviralmutation,andrevisedregularlyasmoreinformationbecomesavailable.Whileallthefactorsmentionedabovewillbeconsideredaspartofthedecisionmakingprocess,theywillhavedifferentdegreesofinfluence.

Clinicalseverity:Clinical severity is likely to be critically important inmaking an estimate of impact. Itwill stronglyimpact on the morbidity and mortality at an individual and population level, the burden on thehealth system and the concern within the community. Explanations of impact in terms of clinicalseverityarealsoeasilyunderstoodatapersonalandpublichealthlevel.Asclinicalseverityincreases,thefollowingwillalsoincrease:

• the demand for high end services, such as Intensive Care Unit (ICU), paediatric andrespiratory care (associatedwith this will be increased demand for specialized equipment

andhealth care professionals, such as ECMOand ICUnurses).High end services are areaslikely to increase the demand on support services, such as laboratories, muchmore thanincreaseddemandingeneralwards;

• thedemandforservicesassociatedwithmanagementofthedeceased;• theimportanceofinformingandsupportingat-riskgroups;• the importance of measures to promote prompt presentation and diagnosis, while

minimisingopportunitiesfortransmission;• theimportanceofbuildingconfidencewithinthecommunity;• the proportion of infected individuals seeking treatment, which means the public health

interventionstoreduceongoingtransmissionthatrelyonidentificationofcaseswilllikelybemoreeffective.

Transmissibility:Followingclinical severity, transmissibilitywillbeconsidered, tohelpdeterminethe likelyspeedofspread and the timing of the demand on health services, and further define the impact of thepandemiconthepopulationasawhole.Astransmissibilityrises:

• the timeliness of measures to limit spread becomes more critical (as the window ofopportunityissmaller);

• thedemandforhealthservicesrisesmorequickly;• healthservicesandresponsemeasuresneedtobescaledupmorequickly;• thepeakburdenandfinaltotalburdenonthehealthsystemwillbehigher;• theoveralldurationofthepandemicwillbeshorter;• assessments and decisions will need to be made more quickly (epidemiological and

individual).

Figure1providesanexampleofhowpreviousrespiratorydiseaseoutbreakscouldbecharacterisedintermsofclinicalseverityandhuman-to-humantransmissibility.

Figure1:ContributionoftransmissibilityandseverityonpopulationimpactofestimatedrangeofCOVID-19tootherrespiratoryoutbreaks


Thesignificanceof transmissibilitywill varydependingon thestageofprogressof theoutbreak. Itshouldalsobeconsideredthat,asthenovelcoronavirusoutbreakiscausedbyanewvirus,therewillbe high vulnerability in the population to the virus. There is no evidence of sustained human-to-humantransmissioninAustraliaandthisisbeingcarefullymonitoredandcouldchange.Thewindowof opportunity for measures aimed at controlling transmission are proving successful but maybecomemorelimited.

Itissuspectedthatindividualswiththenovelcoronavirusmaybelessinfectiouspriortotheonsetofsymptomsthanthosewithinfluenza.Thiswouldmakeisolationofidentifiedcasesmoreeffectiveatreducingonwardspread.

Thecapacityofthehealthsystemwillalsobeconsideredtodeterminethedegreetowhichsystemswillbeabletomanagetheincreaseddemandandwhichmeasureswouldneedtobeputinplacetobestuseavailableresources.

Indicators such as notifications, hospitalisations and availability of ICU beds may be used todeterminethetransmissibility,clinicalseverityandhealthsystemcapacityrespectively.

2.7.3 A qualitative description of three different levels of outbreak impact Eachoutbreakisuniqueandtheclinicalseverityandtransmissibilityislikelytovaryeachtime.Healthsystem capacity will vary between andwithin jurisdictions, according to the season and betweendifferenthealthservices.Toillustratehowdifferencesinthesethreefactorsmayimpactdifferentlyon the community, and therefore require different approaches and levels of resources, threescenarioshavebeendescribedinthefollowingsections.

Scenario one

Ifclinicalseverityislow

Themajority of cases are likely to experiencemild tomoderate clinical features. People in at-riskgroupsand thosewithcomorbiditiesmayexperiencemoresevere illness.Strategies tosupportat-riskgroups,once theyare identified, maybe required (e.g.peoplewithunderlying illness,peoplewith immunocompromised conditions, aged care, infants, Aboriginal and Torres Strait Islanderpeoples,remotecommunities).Atthepeakoftheoutbreak,andincreasinglywhentransmissibilityishigher,primarycareandhospitalservicesmaybecomestretchedinareasassociatedwithrespiratoryillnessandacutecare.Existing legislation is likely tobesufficient tosupportactivities.The levelofimpactonthecommunitymaybesimilartosevereseasonalinfluenzaorthe2009influenzaA(H1N1)pandemic.

Scenario two

Ifclinicalseverityismoderate

Peopleinat-riskgroupsmayexperiencesevereillness.Asthenumberofcasesgrowsthenumberofpeople presenting for medical care is likely to be higher than for severe seasonal influenza andprimarycareandhospitalserviceswillbeunderseverepressure,particularlyinareasassociatedwithrespiratoryillnessandacutecare.Non-urgentproceduresandactivitiesmayneedtobescaledback.Surgestaffingandalternatemodelsofclinicalcare,suchascohortingand/orestablishmentofflu-likeclinicsmayneedtobeemployedtocopewithincreaseddemandsforhealthcare.Pressureonhealthserviceswillbemoreintense,risemorequicklyandpeakearlierasthetransmissibilityofthedisease

increases. Healthcare staffmay themselves be ill or have to care for ill familymembers, furtherexacerbatingpressuresonhealthcareproviders.

Additionalstrategiestosupportat-riskgroupsmayberequired(e.g.peoplewithunderlying illness,people with immunocompromised conditions, aged care, infants, Aboriginal and Torres StraitIslander peoples, remote communities). New and/or existing health emergency legislationmay beneededtosupportoutbreakresponsespecificactivities.

Scenario three

Ifclinicalseverityishigh

Widespreadsevereillnesswillcauseconcernandchallengethecapacityofthehealthsector.Areassuch as primary care, acute care, pharmacies, nurse practitioners and aged care facilities will bestretched to capacity to support essential care requirements.Heavy prioritisationwill be essentialwithin hospitals to maintain essential services andmortuary services will be under pressure. Thedemand for specialist equipment and personnel is likely to challenge capacity. Pressure on healthserviceswillbemoreintense,risemorequicklyandpeakearlierasthetransmissibilityofthediseaseincreases. Healthcare staff may themselves be ill or have to care for ill family members, furtherexacerbatingpressuresonhealthcareproviders.

Secondarycareservices,suchasbloodservicesanddiagnosticserviceswillbechallengedtomaintaincapacities and the community focus will be on maintaining essential services. Health emergencylegislationmaybeneededtosupportoutbreakspecificactivities.Thelevelofimpactmaybesimilartothatofthe1918H1N1‘Spanishflu’.

ThesescenarioscharacterisetheimpactontheAustraliancommunityasawhole.

2.8 Participating parties ThisplaniswrittenforgovernmentdecisionmakersandwillbeusedtoinformoperationalplanninginstateandterritorygovernmentsandthebroaderAustralianGovernment.

TheprimarypartiestotheCOVID-19PlanwillbetheAustralianGovernmentDepartmentofHealth(DepartmentofHealth)andStateandTerritoryHealthDepartments.

Theparticipationof,orcoordinationwithothergovernmentagenciesatAustralianGovernmentandStateandTerritoryGovernment levelwillalsobenecessary to implementmanyof theactivities inthis Plan. Commitment to this process is captured in the National CD Plan. The AustralianGovernmentDepartmentofAgriculture,WaterandtheEnvironmentwillbeparticularlyimportantinthe implementation of border health measures. The Department of Home Affairs (includingEmergencyManagementAustralia)andtheDepartmentofPrimeMinisterandCabinetwillalsobeinvolved.

Non-government parties, such as general practitioners (GPs), nurses and pharmacists will also beinvolved inrespondingtoapandemic. It isacknowledgedthathealthcarepracticeswill relyonthehardworkof teamsof individuals to implementpandemicmeasures and that these teamswill bemadeupofpeoplewithabroadrangeofskills.

2.9 Review and amendment TheCMO,afterappropriateconsultation,mayapproveamendmenttotheCOVID-19Planasneededtomeetthecurrentcircumstances.


3. Escalation ThischapterexplainswhenarrangementsundertheCOVID-19PlanwillbeusedandhowescalationthroughtheCOVID-19Planstageswilloccur.

3.1 Existing communicable disease arrangements The novel coronavirus is a respiratory illness. GPs and other health providers, such as nurses,Aboriginal Community Controlled Health Services (ACCHSs), pharmacists and aged care providersmanagethebulkofpeoplewithrespiratoryillnesseswithinthecommunity.Publichealthunitsandcommunicablediseasecontrol services instateandterritoryhealthdepartmentsmanageoutbreakresponse, collect public health surveillance data, administer vaccination programs, develop andimplementhealthpromotionandpubliccommunications,andprovidesignificantsupporttoclinicalservicesandagedcarefacilities.Ambulanceservices,hospitalemergencyandrespiratorywards,andintensivecareunitssupportpeoplewithcomplications.Laboratoriesprovidetestingservices,adviseonmanagementofresourcesandpublichealthapproaches,andparticipateinresearch.Surveillancesystems and public health units investigate and support management of outbreaks and provideimportantpublicinformationonriskreducingstrategies.

Thesesystemsarewelldevelopedandprocessesarerefinedcontinuouslyasoutbreaksaremanagedeachyear.

3.2 Escalation from existing arrangements These existing arrangements form the basis for the clinical and public healthmanagement of thenovelcoronavirus.Emergencymanagementprocesses,inparticulartheAustralianGovernmentCrisisManagementFramework (AGCMF),willbeusedas thebasisofgovernancearrangements.Existingsurveillancesystemswillbeupdatedandadapted tomonitor theemergenceofnovel coronavirus,andformthebasisforgatheringinformationtoguidedecisionmakingthroughouttheoutbreak.

While there aremany similarities to pandemic influenza, there are also differences inmanaging anovelcoronavirusoutbreak.Commonobjectives tominimise transmission,morbidityandmortalitywillremain,butkeyareasinwhichtheimplementationofactivitieswoulddifferare:

• ongoingcharacterisationofthevirusandtheclinicalseverityofthediseaseintheAustraliancontext;

• increasedimportanceofidentificationofcasesandisolationactivities(asitissuspectedthatindividuals may be less infectious prior to the onset of symptoms, making isolation ofidentifiedcasesmoreeffectiveatreducingonwardspread).

• coronaviruses spread more slowly than influenza, allowing a window of several days toidentifyandisolatecaseswhiletheyarestillinfectious.

• case isolationwill continue tobe important to reduce spread through thewholecourseoftheresponse.

• thelikelihoodthat,duetothelongerserialinterval(timebetweensuccessivecasesinachainof transmission), it will be necessary to sustain the response for longer. This will havesignificantimplicationsforthesustainabilityofresources.Itwillalsoincreasetheimportanceoflookingatalternativemethodsforcontroloftransmissionandcarefullymonitoringwhenactionsshouldbescaledbackorceased.

Existingsystemswillneedtobeadaptedandenhancedtosupportnewpriorities.Somesystemsmaybe extended (such as through surge staffing) and, where outside the normal scope, somewill beaugmented(throughmethodssuchasrecruitmentofadditionalexpertise).Thegreatercomplexityofsystems required to respond to thenovel coronavirusoutbreakwill increase theneed fornationalcoordination.

The COVID-19 Plan provides an agreed approach to provision of a coordinated and consistentresponseandadecisiontoescalateundertheCOVID-19Planfromexistingarrangementswillsignalthatparticipatingpartiesshould:

• commenceuseofagreedgovernanceandcommunicationarrangementstomanagethistypeofthreat;

• undertaketheirrolesandresponsibilitiesasdetailedinthisplan;• advisestakeholdersoftheapproachthatwillbetakenbynational,stateandterritoryhealth

departmentstorespondtothesituation;and• putinplaceaprocesstoallocateresourcesandjustifyre-prioritisationofexistingactivitiesto

supporttheoutbreakresponse.

3.3 Escalation across stages Theplan is currently in thephaseof InitialActionandcanbeelevated toTargetedAction stage ifAHPPCconsidersthiswarrantedbythecircumstances.

TriggersExamplesofeventsthatmightwarrantescalationinclude:

• declarationofaPublicHealthEmergencyofInternationalConcern(PHEIC)orapandemicbytheWHO;and

• advice fromacredible source that sustainedcommunity transmissionofanovelviruswithpandemicpotentialhasoccurred.

TheNational IncidentRoom(NIR) intheDepartmentofHealthwill functionastheNationalHealthSector Emergency Operations Centre and the National Focal Point (NFP) under the InternationalHealthRegulations.

3.4 Activation of other plans TheCOVID-19Planstageswillbeindependentofactivationofwhole-of-governmentorjurisdictionalplans.

WhiletheCOVID-19PlanremainsinInitial/TargetedActionorStanddownstages:

• theNFPintheDepartmentofHealthwillliaisewiththeWHO;• theNIRwillprovideagencieswithregularSituationReports;• theNIRwilladviserelevantAustralianGovernmentandstateandterritoryhealthservicesof

anychangeofstage;• theNIRwillcoordinatecommunications;• TheDepartmentofHealthwillcoordinateliaisonwithotherAustralianGovernmentagencies;• TheDepartmentofHealthwilladvisetheMinisterforHealthofprogressunderthePlan;• S/THDwill coordinate liaisonwithothergovernmentpartiesand response stakeholders in

theirjurisdiction;and• Communicationswillbeconductedasoutlinedin‘Communications’below.


4. Governance This chapter outlines the roles and responsibilities of stakeholders and key committees, anddescribesdecision-makingandconsultationprocesses.

4.1 Roles and responsibilities A clear understanding of the roles and responsibilities between parties responding to a novelcoronavirusoutbreakwillsupportquickdecisionmakingandefficient,coordinateduseofresources.ThissectionsummarisestherolesandresponsibilitiesoftheAustralianGovernmentinkeyaspectsofmanaging a novel coronavirus outbreak, the roles and responsibilities of the state and territorygovernments, and where roles and responsibilities are jointly shared by these two parties. Toreinforce important linkageswith these stakeholders, this chapter also outlines thebroad roles ofotherhealthsectorparties.

4.1.1 Planning MinimisingtheimpactofanovelcoronavirusoutbreakonAustraliancommunitiesandonthehealthsystemrequirescoordinatedandcarefulplanningofmeasurestocontrolthespreadofthedisease.The Australian Government maintains the COVID-19 Plan to prepare for and respond to a novelcoronavirusoutbreak,with input fromstatesand territories,andotherhealth sector stakeholders.Thisplanwillberegularlyreviewedandupdatedasmoreinformationaboutthenovelcoronavirusisdetermined.

States and territories also develop consistent and comprehensive operational plans for the publichealthresponse,andthehealthserviceresponsewithintheirjurisdictions.

Other health sector stakeholders are responsible for developing their own response plans inaccordance with national and jurisdictional arrangements and for incorporating communicablediseaseoutbreaksintooverallbusinesscontinuityplans.

Atall levels,planningwillconsiderwhat isneededtoprotectthemostvulnerablemembersofourcommunities,andaddresstheneedsofspecialgroups,suchastheagedcaresectorandAboriginalandTorresStraitIslanderpeoples.

4.1.2 Surveillance The Australian Government is responsible for developing and maintaining systems to monitorcommunicable disease activity domestically and internationally and for communicating relevantinformation. Once a novel coronavirus with pandemic potential has arrived in Australia, thesesystems will be used for monitoring and analysis. Working together with state and territoryrepresentatives,theAustralianGovernmentwillassesstheriskofanypotentialoutbreakthreatstoinformdecisionmakingaboutappropriateactions.

Stateandterritorygovernmentsareresponsibleforcollectingsurveillancedatatocontributetothenationalpictureandtoinformthejurisdictionalpublichealthresponse.

Otherhealthsectorstakeholderswillalsoplayakeyroleinsurveillanceactivitiesandcontributingtothenationalcharacterisationandunderstandingofthenovelcoronavirusofconcern.

4.1.3 Provision of clinical services The Australian Government will coordinate allocation of available national resources required forclinicalcare.

TheAustralianGovernmentandstateandterritorygovernmentswillworktogethertodevelopnewmodelsofcaretomanagepatientsandagreeonnovelcoronavirustriagecriteria(ifrequired);tailorinfectioncontrolguidelinestotherisksrelevanttothevirusasrequired;ensureprovisionofprimary

healthcare isadapted toanychanges in theneedsofvulnerablegroupsduring theoutbreak;andconsiderandrespondtorequestsforhealthassistance.

Stateandterritorygovernmentshaveprimaryresponsibilityforestablishingandmaintainingpublichealthservices,publichospitalsandlaboratories.Theyareresponsiblefortheoperationalaspectsofclinical care responses and have primary responsibility for the management of cases. They willcollaboratewith relevantorganisations to fill identifiedserviceprovisiongaps; supporthospitals incopingwith increaseddemandbyconsideringopeningmorebeds, changing staff topatient ratios;cancelling elective procedures or working in partnership with local private hospitals to manageurgentcaseswhereappropriate; implementnewmodelsofcareas required;coordinateallocationwithin their jurisdictionof available resources required for clinical care; andwherepossible, shareclinicalresourceswhereandwhenneeded.

Other health care stakeholders are responsible for service provision and linking with andparticipatingintheclinicalcarenetworkbysharingresources;implementingnationalcareguidelines(including triage protocols if required) and delivering outbreak control measures where required.They will implement patient triage, manage patients and provide after-hours care as required;coordinatelocallybetweenservices;collaboratewithstateandterritoryhealthauthoritiestoidentifyand fill local gaps in services, particularly where there are vulnerable populations and implementnewmodelsofcareaccordingtoanovelcoronavirusoutbreakpolicy.

4.1.4 Implementation of public health measures TheAustralianGovernmentisresponsibleforensuringtheresourcesandsystemsrequiredtomountan effective national response are readily available; for international border activities; and forensuring that Australia meets its international obligations. This includes maintaining the NIR, theNMSandIHRcorecapacitiesincludingmaintenanceoftheNFP.

TheAustralianGovernmentwillalsoberesponsibleforresidentialagedcarefacilities;workingwithotherhealthcareproviderstosetstandardstopromotethesafetyandsecurityofpeopleinagedcareand other institutional settings; and establishing and maintaining infection control guidelines,healthcaresafetyandquality standards.TheAustralianGovernmentwill fast-trackassessmentandapprovalofacustomisedvaccine,shouldthisbecomeavailable;procurevaccines;developanationalnovel coronavirus vaccination policy and a national novel coronavirus immunisation program; andcommunicate immunisation information on the program to the general public and healthprofessionals.

TheAustralianGovernmentandstateandterritorygovernmentswillworktogethertoprovideadviceand leadership on the appropriatemethods and timing for implementing public healthmeasures.Theywilldevelopcommunicationstrategiesandresources fornovelcoronavirus immunisationandcoordinateimplementationofnovelcoronavirusimmunisationprograms.Theywillalsocontributetobuildinglinkagesbetweenhumanandanimalhealthresourcesandactivities.

State and territory governments are responsible for the operational aspects of public healthresponses. They will undertake contact tracing; coordinate distribution of antiviral drugs anddisseminateprotocolsontheuseofantivirals;implementsocialdistancingmeasuresaspernationalrecommendations and local risk assessment; and implement infection control guidelines andhealthcare safety and quality standards. They will establish systems to promote the safety andsecurityofpeople in aged care andother institutional settings and supportoutbreak investigationandmanagementinresidentialagedcarefacilities,schools,prisonsandotherinstitutions.

Stateandterritorygovernmentswilldevelopandvalidatespecificnovelcoronavirustests;undertakenovelcoronavirus laboratorytestingasrequiredtomonitortheoutbreakandfor individualpatientcare;implementtestingprotocolstosupportcasemanagement,surveillanceneedsandtopreservelaboratorycapacity;supportandundertakenovelcoronaviruspointofcaretestingifrecommended.


State and territory governmentswillmaintain IHR core capacities and communicate public healtheventsofnationalsignificancetotheNFP;supportimplementationofbordermeasuresbyprovidingdisease control expertise and health care services to ill travellers; implement the national novelcoronavirusimmunisationprogram(shouldonebecomeavailable);managejurisdictionaldistributionoftheNMSandassesstheneedfora jurisdictionalmedicalstockpileand, ifrelevant,establishandmaintainit.

Other health sector stakeholders will contribute to IHR core capacities; provide input on needsrelated to national stockpile items;maintain stocks and use of, personal protective equipment asappropriateforinfectioncontrolrequirements;andreportadverseeventsfollowingimmunisationorfollowing the administration of antiviral drugs (should relevant antivirals become available) to thestatehealthauthorityand/ortheTherapeuticGoodsAdministration(TGA).

Otherhealth sector stakeholderswill implement infection control guidelinesandhealthcare safetyandqualitystandards;andimplementprotocolsandprocedurestopromotethesafetyandsecurityofpeopleinagedcareandotherinstitutionalsettingsaccordingtonationalstandards.Theywillalsoadministernovelcoronavirusvaccineaccordingtonationalguidelines(shouldonebecomeavailable);and provide community education on novel coronavirus vaccination programs including educationwithhard-to-reachgroupsandat-riskpopulations.

4.1.5 Researching, planning and building specific novel coronavirus outbreak control strategies

The Australian Government will commission research on the effectiveness and impact of publichealthmeasures.National,stateandterritorygovernmentswillusethisinformationtoinformtheirplans. Other health sector stakeholders will provide advice on the feasibility and impact of novelcoronavirusoutbreakcontrolmeasures;andsupportdisseminationandimplementationofnationaladviceonthemeasures,suchastheuseofantiviraldrugsandnovelcoronavirusvaccines.

4.1.6 Communication TheAustralianGovernmentisresponsiblefornationalcommunicationstothepublicandthehealthcaresectoratanational level,withdirect responsibility forcommunicationswith theprimarycaresector and at our international borders. It is also responsible for reporting to and liaisonwith theWHOasrequiredundertheIHRandsharinginformationfromtheWHO,fromsurveillanceandothersources with relevant stakeholders. The Australian Government will also disseminate relevanttailored information to aged care and other residential facilities through approved providers andregulatoryprocessesandliaisewithAustralianGovernmenteducationauthoritiesconcerningpublichealthmeasuresrelatedtoschools.

The Australian Government and state and territory governments are jointly responsible for thesharinginformationonresourceavailabilityandprovidingadviceoncaseandcontactmanagement,antiviral drug utilisation (if shown to be of benefit), quarantine/isolation and outbreak riskassessment.

Stateand territorygovernmentsare responsible for jurisdictionaland local communications to thepublic and the health care sector. They are also responsible for reporting issues to theNIRwhichmightrequireacoordinatedresponseand/orasrequiredforreportingundertheIHR.

Other health care stakeholders have a responsibility to provide input into decision-making and tocommunicatenovelcoronavirusoutbreakinformationandkeymessagestothepublic.

4.1.7 Coordination The Australian Government will coordinate national novel coronavirus outbreak measures andallocateavailablenationalhealthresourcesacrossthecountry.Itwillsupportthehealthresponseinany jurisdiction, through AHPPC to coordinate assistance, if jurisdictional capacity becomesoverwhelmed.

The Australian Government and state and territory governments will work together to considersurveillance,resourceandpoliticalinformationtodeterminewhetherandwhenanationalresponseis required; advise on thresholds for escalation; share information on resource availability andcoordinateaccesstoresourcestomaximisetheeffectivenessoftheresponse.

State and territory governmentswill coordinate andprovidenovel coronavirushealthcare servicesincludingassessmentandtreatmentcentresasrequired.

Other health care stakeholderswill deliver novel coronavirus outbreakhealthmeasures as part ofthecoordinatedresponseandmaintainbusinesscontinuityofessentialservices.

4.1.8 Standdown and evaluation The Australian Government will coordinate the stand down of enhanced measures; manage thetransitionofnovelcoronavirusoutbreakspecificprocessesintonormalbusinessarrangements;andundertakepubliccommunicationregardingchangingriskandthestanddownofmeasures.

The Australian Government and state and territory governmentswill work together to determinewhentoceaseorreducemeasuresandagreeappropriatemessagingforrespondersandthepublicconcerningscalingdownofmeasures.

Stateandterritorygovernmentswill implementstanddownofmeasures takenwithin thestateorterritory; manage the transition of novel coronavirus outbreak specific processes into normalbusiness arrangements; andundertake jurisdictionalpublic communication regarding changing riskandstanddownofnovelcoronavirusoutbreakmeasures.

Other health care stakeholderswill advise on the timing and impact of reducing enhanced clinicalnovelcoronavirusoutbreakservices;supportstanddownofmeasuresandmanagethetransitionofnovelcoronavirusoutbreakspecificprocessesintobusinessasusualarrangements;andparticipateincommunicating public messages regarding changing risk and stand down of novel coronavirusoutbreakmeasures.

Allpartieswillberesponsibleforevaluatingnovelcoronavirusoutbreakprocessesandimplementingchangesasappropriate.


4.2 Decision making and consultation Figure2:WholeofGovernment,healthsector,healthadvisoryandconsultativecommitteesinvolvedindecisionmakingforanovelcoronavirusoutbreak.

Themanagementofanovelcoronavirusoutbreakwill requiregovernments,healthsector industryandthecommunitytoworktogether.Consultationwillbeessentialtoinformdecisionmaking,whichwillneedtoberapidandcoordinated.

4.2.1 Whole of Government (WoG) decision making structure A severe novel coronavirus outbreak will disrupt Australia’s social and economic functioning.Maintainingessentialservicesmayrequireawhole-of-governmentresponse,incorporatingagenciesat the Australian Government and state and territory government level. For a novel coronavirusoutbreak, decision making and consultation at this level will be in line with existing emergencyarrangements described in theAGCMF. The primary forum for coordinating the cross-governmentresponse will be the National Crisis Committee (NCC). The NCC will consolidate information andcoordinateinformationexchangeandadvicetoministers.Itwillalsocoordinateministerialdecisionsacross the Australian Government, State and Territory and local governments. The AustralianGovernmentCrisisCommittee(AGCC)willcoordinatetheresponseacrosstheCommonwealth.

TheNationalCDPlanoutlinestherolesandresponsibilitiesoftheAustralianGovernment,StatesandTerritories and Local Governments. It also details agreed coordination arrangements for themanagementofcommunicablediseasesofnationalsignificanceandtheirconsequences.

When information obtained and activities implemented under the COVID-19 Plan may haveimplications outside the health sector, advice regarding this will be forwarded to the NCC forconsideration.

4.2.2 Ministerial responsibilities Under the AGCMF, the Australian Government Minister for Health is the lead minister for theAustralianGovernmentresponsetoaseriousinfectiousdiseaseoutbreak.AsamemberoftheCOAGHealthCouncil (CHC),theMinisterforHealth isalso involvedintheapprovalof responseactivities,throughtheendorsementofplansandarrangements.

TheAustralianGovernmentMinister forHealthalsohaspowersunder theBiosecurityAct2015 toassist with managing the risk of an LHD entering, emerging or establishing itself in Australianterritory.Theseinclude:

• Determininginternationalentryrequirements(andexitrequirements)• Determiningpreventativebiosecuritymeasures• Recommending the declaration of a human biosecurity emergency under the Act (and

utilisingtheemergencypowersonceanemergencyhasbeendeclared)

Shouldcircumstanceswarrantit,theAGCMFnotesthatthePrimeMinistermayassumeprimaryresponsibilityforleadingtheGovernment’sresponse.Underthesecircumstances,thePrimeMinisterisalsolikelytoconsultwiththeleadersofaffectedstatesandterritoriestoensureacoordinatednationalresponse.

4.2.3 Health sector decision making structure For the development of policy related tomanagement of a novel coronavirus outbreak, the CHCrepresents the highest decisionmaking body. AHPPCwillmanage implementation of the nationalhealthsectorresponse,inconsultationwithrelevantstakeholders,andprovidehealthsectoradvicetotheAGCCandNCCasappropriate.

4.2.4 Health sector advisory groups Thefollowingkeycommitteeswillsupportdecision-making:

• PHLNwillprovideleadershipinguidinghumanhealthmicrobiologyandlaboratorypractice;• CDNAwillprovideleadershipinsurveillance,theanalysisofepidemiologicalinformationand

strategiesrelatedtomanagementofcommunicabledisease;


• NationalSurveillanceCommittee(astandingcommitteeunderCDNA)willprovideleadershipin guiding the implementation of novel coronavirus specific surveillance activities andstrategies;

• theNational ImmunisationCommitteewillprovide leadership inguiding implementationofimmunisationmeasures;

• AustralianTechnicalAdvisoryGrouponImmunisationwillprovideadvicetechnicaladviceonimmunisationissues;and

• ChiefHumanBiosecurityOfficers (CHBOs)will provide advice to theCMO (as theDHB) onhumanbiosecuritymattersattheinternationalborder.

4.2.5 Health sector consultation Consultation will be integral to decision making regarding the approach to managing a novelcoronavirus outbreak. Wherever possible, this will be conducted through existing channels. Keyadvisory committees, in addition to providing expert advice will also be used as vehicles forconsultationintheirfieldofexpertise.

Consultative fora and peak bodies, such as aged care peak bodies, key national primary careorganisations, national nursing organisations, representatives of medical specialist colleges andpharmaceutical organisations will be used to reach key non-government health sector areas.Feedbackfromtheseorganisations-whichwillreflecttheon-the-groundexperienceofhealthsectorandpublicconcerns,andevidenceoftheeffectivenessofapproachesandspecificinterventions-willbeinputintodecision-makingprocessestobettertailortheresponsetocommunityneeds.

4.2.6 Decision making processes under the COVID-19 Plan TheCOVID-19Planwillguidethemanagementofanovelcoronavirusoutbreakatthenationalhealthsector level, representing an approach agreed between the Australian Government and state andterritorygovernments.

KeydecisionswithinthescopeoftheCOVID-19Planwillprimarilyconcernthefollowingissues:

• theoverallresponseapproach;• theappropriatestagefortheCOVID-19Plan,accordingtothecurrentcircumstances;• theselectionofmeasuresappropriateforimplementationatthatstage(includingstanddown

ofexistingactivities);• keymessagesforcommunicationmeasures;and• coordinationofsharingofresources.

Reflectinga flexibleapproach, choicesmayvary to reflect the jurisdictional context,particularly inrelationtotimingofimplementationandstanddown,howevernegotiationwithinCOVID-19Planwillensureacoordinatedandconsistentapproach.

4.2.7 Selection of public health measures The selection of public healthmeasureswill be one of themost important functions of COVID-19Plan.Thefollowingquestionsmaybeusedtoguideselection:

1. Willthisactioncontributetomeetingthestrategicobjectives?2. Willitbethebestuseofcurrentresources?3. Willthisbeproportionatetothelikelyimpactofthenovelcoronavirusoutbreak?4. Whenwoulditbemosteffectivetoimplementthismeasure?

To ensure that the appropriate expertise is available to support AHPPC, relevant health advisorybodiessuchasCDNA,PHLNortheDepartmentofHealth,willprovideasetofrecommendationsforconsiderationatkeydecisionpoints.Onlyabroadrecommendationwillbemadeforquestion2,asthis will depend on the resources available at the time in the Australian Government or relevantjurisdiction.

The continuing appropriateness of measures will be regularly reviewed as more informationbecomes available across the progress of the novel coronavirus outbreak. A regular set time forreview(frequencywilldependontheprogressofthepandemic),suchasweekly,willassistbuildingawarenessofchangesmade.


5. Implementation ThischapteridentifiestherecommendedapproachtomanaginganovelcoronavirusoutbreakintheemergencymanagementareasofResponse:

• InitialandTargetedAction;and• Standdown.

Additional detail to support implementation at anoperational level is provided in theOperationalPlanatPart2oftheCOVID-19Plan.

5.1 Response activities

5.1.1 Initial Action stage Initialactivitieswillfocuson:

• minimisingtransmission;• preparingandsupportinghealthsystemneeds;• managinginitialcasesandcontacts;• identifyingandcharacterisingthenatureofthevirusandtheclinicalseverityofthedisease

withintheAustraliancontext;• providinginformationtosupportbestpracticehealthcareandtoempowerthecommunity

andresponderstomanagetheirownriskofexposure;and• supportingeffectivegovernance.

By definition, a novel coronavirus would be associated with a relative lack of immunity withincommunities. Though the transmissibility of the disease will be an important limiting factor, thecombination of this lack of immunity with the rapid movement possible through moderninternationaltransportsystemsmakeitlikelythatonceanovelcoronavirusachievesefficienthumantohumantransmission,itwillspreadacrosstheglobeincludingtheAustralianpopulation.

Many of the measures which can be applied in response to a novel coronavirus with pandemicpotentialmustbe implementedearly tobemosteffective.Action shouldbe takenbefore there isevidence of sustained transmission of the novel coronavirus disease within the Australiancommunity,itwillbeimportanttocommencemeasuresasquicklyaspossible,eventhough,duetothe novel nature of the virus, it is unlikely that we will yet have a good understanding of theepidemiology,clinicalseverityandvirologyofthedisease.Actionto identifyandisolateearlycasesandquarantinecontactscanminimisetheriskoffurtherspreadandmaycontroltheoutbreak.

Though informationwill initially be scarce, some predictions of the course of the disease and thedemandsitmaymakeonourhealthsystemsandwidersocietycanbemadeincomparisonwithpastoutbreaks of international concern (pandemic influenza, SARS, MERS in particular). Using thisinformation,alisthasbeendeveloped(seetheOperationalPlan)ofmeasureswhichwouldbelikelytoeffectivelymeettheobjectivesoftheCOVID-19Planintheabsenceofdetailedknowledgeofthedisease.

As all outbreaks are different, at the time of implementation, the appropriateness of theserecommended measures should be examined in the light of what is known of the current novelcoronavirus , thevulnerabilityoftheAustralianpopulation(particularlyat-riskgroups),andcurrentresourceconstraints.Tosupportandmaintainhealthsystemcapacity,considerationofmeasurestoprotectthehealthcareworkforcewillbeofkeyimportance.

5.1.1.1 Proportionate response: Initial measures Wheninitialmeasuresarecommenced,thelikelylackofinformationaboutthediseasewillmakeitdifficulttopredictthelevelofimpact.Evidencefromoverseaswillgivesomeindication,howeverthiswillnottakeintoaccounttheAustraliancontext,andinternationalreportsofepidemiology,clinicalseverityandvirologyofthediseasefromoverseasmaybeunreliable.

As the potential consequences of initially implementing measures aimed too low are moresignificant,theinitialmeasuresrecommendedbelowshouldbeimplementedatalevelappropriatefor a disease of moderately high impact. Measures will then be scaled up or down as moreinformationbecomesknown.Byreviewingmeasuresregularlyandearlytheconsequencesofaimingtoohighwillbemitigated.

Theriskofaimingatnovelcoronavirusoutbreakoflowimpactandneedingtoscaleupisthat:

• theopportunitytomanagethespreadofthediseaseislost;and• deathorseveremorbidity(especiallyinat-riskgroups)maybegreater(asmeasuresto

reducetransmission,reduceclinicalseverityandraiseawarenessofsymptomsbyhealthcareworkersandthegeneralpublichavenotbeenfullyemployed).

Theriskofaimingatanovelcoronavirusoutbreakofhighimpactandneedingtoscaledownisthat:

• resourcesmaybewasted(usedwithoutmuchgain,ordivertedtopandemicactivitieswheretheycouldhavebeenbetterusedelsewhere);

• unduestressandconcernmaybeimposedonHealthcareworkersandthecommunity;and• perceptionofhavingover-reactedmaymakestakeholderslesswillingtoparticipatein

future.

ActivitieswhichcouldbeconsideredfortheInitialActionStageareoutlinedintheOperationalPlanatPart2oftheCOVID-19Plan.

5.1.1.2 Novel Coronavirus Vaccination Vaccination is an effective way to prevent infection with respiratory viruses such as influenza.However,withanovelcoronavirusthereisnovaccinecurrentlyavailable.Asyet,thereisalsostillnovaccineavailableforSARSorMERS.Itisunlikelythatavaccinewillbeavailableduringthecourseofanovel coronavirus pandemic, unless the pandemic is long lasting and vaccine development isextraordinarilyfast.Developmentsinthisareawillbecloselywatched.

5.1.2 Targeted Action stage TheTargetedActionstagewillcommencewhenthere issufficient informationcollectedduringtheInitial Action stage to inform refinement of the novel coronavirus outbreak response measuresalreadyimplemented.Measureswillberegularlyreviewedasmoreinformationbecomesavailable.

Data on the clinical severity, transmissibility, epidemiology and antiviral resistance pattern (ifantivirals are available) of the virus will inform decisions on effective and proportionate novelcoronavirus outbreak response measures. CDNA/PHLN will provide advice to AHPPC on whichindividualmeasuresshouldbe:

• continued;• modified(includingscaledupordown);or• wounddownandceased.

CDNA/PHLNwillalsoprovidearecommendationofanynewmeasureswhichshouldbecommenced.Wheremeasuresaretobeceased,anexitstrategywillbeincluded.


Targetedmeasureswillfocuson:

• ensuringaproportionateresponse;• supportingandmaintainingqualitycare;• communicationstoengage,empowerandbuildconfidenceinthecommunity;and• providingacoordinatedandconsistentapproach.

TheflexibleapproachoftheCOVID-19PlanmeansTargetedActionmeasuresneednotbeadoptedbyalljurisdictionsconcurrently.Similarly,measuresmaybeimplementeddifferentlywithindifferentgeographic regions of jurisdictions. Each jurisdiction will consider the recommendations made byCDNA/PHLN and select measures which meet their own requirements, reflecting the differingprogress of the novel coronavirus outbreak, resource parameters and community needs in theirjurisdiction.

Astheoutbreakbecomesmorewidespreadandthedemandsonresourcesincrease,closetailoringoftheselectionofresponsemeasurestocurrentneedsandregularreviewoftheireffectiveness incontributing to the strategic objectives will be essential to promote the efficient use of availableresources.Measuresthatfailtodemonstratethiswillbeceased.

Assessmentsofeffectivenesswillbebasedonavailableresearch,andonfeedbackfromhealthsectorstakeholdersandthepublic.Reviewwillbeconsideredatkeymilestones,orasindicatedbyfeedbackreceived.

Identificationmeasureswillmove to collecting coredata fromestablished surveillance systems inorder to detect any changes in the epidemiology of those getting sick, the clinical severity of thedisease or characteristics of the virus. Jurisdictions will continue to collect enhanced data andmonitorforoutbreaksinnewsettings.

Communicationmeasureswillcontinuetobeimportant,followingthesameapproachasoutlinedinthe Initial Action section above. Key messages should be timely and consistent and reviewedregularly to ensure they reflect current information about the response, the disease itself andrecommendedmanagementstrategies(bothforrespondersandthepublic).

Activitieswhichcouldbeconsidered for theTargetedActionStageareoutlined in theOperationalPlanatPart2oftheCOVID-19Plan.

5.1.2.1 Proportionate response: Targeted measures Regularly reviewing measures and tailoring their use during this stage as more becomes knownabout the disease in the Australian context will allow measures to be adjusted to be moreappropriatetothelevelofrisk.Itwillalsobepossibleandimportanttobettertailormeasurestothespecificneedsofourmostvulnerablepopulations.

AsInitialmeasuresareaimedatrespondingtoanovelcoronavirusoutbreakwithamoderatelyhighimpactlevel,tailoringofmeasuresintheTargetedActionstageislikelytoinvolvescalingback.

5.1.3 Standdown Stage IndividualactivitieswillberegularlyassessedandstooddownwhentheynolongercontributetotheCOVID-19Plan’s goals. The trigger for theCOVID-19Planas awhole tomove into theStanddownstagewilloccurwhenadvicefromCDNAindicatesthattheoutbreakhasreachedalevelwhereitcanbemanagedundernormalbusiness arrangements.As the risk and impact experiencedwill notbehomogenousacrossAustraliaenhancedactivitiesmayneedtocontinuelongerwithsomevulnerablepopulations.

Standdownactivitieswillfocuson:

• supportingandmaintainingqualitycare;• ceasingactivitiesthatarenolongerneeded,andtransitioningactivitiestonormalbusiness

orinterimarrangements;• monitoringforasecondwaveoftheoutbreak;• monitoringforthedevelopmentofresistancetoanypharmaceuticalmeasures,ifanyare

beingused;• communicationactivitiestosupportthereturnfromemergencyresponsetonormal

businessservices;and• evaluatingsystemsandrevisingplansandprocedures.

Enhancedarrangementsplaceanadditionalburdenonhealthsystemsandindividualsandshouldbescaledbackwhennolongernecessary.ThepurposeoftheStanddownstagewillbetomanagethesmoothwithdrawalofenhancedarrangementsandtransitiontoseasonalsystemsandprocedures.

Communicationmeasureswillbeimportantto:

• reassurestakeholdersthattheywillstillhaveaccesstothesupporttheyneed;• shapeawarenessofthepossibilityoffurtheroutbreaksandthecontinuityintothefollowing

twotothreeyearsofseasonalinfluenza;and• ensurethatthepublicunderstandthevirusisstillcirculatingandthattheythereforeneedto

continuetobeawareofmeasurestoprotectthemselvesatanindividuallevel.

Theevaluationof the response,andupdatingof/adaptationof systems,which ispartof this stageensuresthatasmuchaspossible,thelessonsfromthepandemiccanbeappliedtofutureoutbreaks.As subsequentwavesof theoutbreakmayoccur, rapid implementationof evaluationprocesses isessentialtopreparedness.

Itislikelythatthehealthsectorwillcontinuetorequiresupporttoenableservicesto“catchup”.Thecommunity may also require additional services to enable full psychological, social, economic,environmental and physical recovery from the effects of the novel coronavirus outbreak. At-riskgroupsmayneedadditionalsupport.

Atsomepoint theDepartmentofHealthwilladviseAHPPCthatallenhancedmeasureshavebeentransitionedtonormalbusinessarrangements.WhileacknowledgingthatRecoveryactivitieswillbetakingplacewithinthehealthsector,thiswillbethetriggerforAHPPCtoconsiderde-escalatingtheCOVID-19Plantopreparednessandmonitoringactivities,whichwillbeongoinguntilthereisagainaneedtorespondtoanovelcoronavirusoutbreak.

ActivitieswhichcouldbeconsideredfortheStanddownStageareoutlinedintheOperationalPlanatPart2oftheCOVID-19Plan.

5.2 Recovery activities Wherever possible during the novel coronavirus outbreak, response activitieswill be selected andimplementedinamannermost likelytopromoterobustrecovery.SomecommunitiesandsystemsmaybeabletocommenceRecoveryactivitiessoonerthanothers.

Theprimaryresponsibilityformanagingtherecoveryprocesswithinthehealthsectorwillrestwithstateand territory governments.National coordinationand support requiredduring this stagewilloccurthroughexistingemergencymanagementchannels.

The Australian Government Disaster Recovery Committee, chaired by the Department of HomeAffairswillcoordinateRecoveryeffortsatawholeofgovernmentlevelifrequired.Governmentswillwork together with affected individuals, community groups and industry to restore services andcommunitywellbeing.


5.3 Resilience Building preparedness within Australia’s health systems will contribute to the resilience andsustainabilityofoursystems.Theresilienceofindividualswillbepromotedbyempoweringthemtomanagetheirownexposuretothediseasethroughpublicmessagingabout:

• thestatusofthediseaseinAustraliaandinternationally;• hygieneandcough/sneezeetiquette;• diseasetransmission;• understandingofhowtorecognisethesignsandsymptomsofthediseaseandwhentoseek

medicalassistance;and• accesstosupportandadvice,includingmentalhealthservices.

Tobuildresiliencewithinourmostvulnerablepopulations,communicationswithinthehealthsectorwillbeusedtoraiseawarenessofat-riskgroupsandtheirassociatedneeds.Measureswillalsobeimplementedwithconsiderationofnecessaryadaptationstomeettheneedsoftheseindividualsandcommunities. Theneedsandchallengesof communicatingwith lowsocio-economiccommunities,whichmayhavereducedaccesstohealthcare,willalsobeconsidered.

6. Communications Thischapterprovidesaguidetocommunicationactivitiesacrossstakeholders.

Acomprehensivecommunicationsstrategy, implementedacrossallstagesoftheoutbreak, isakeycomponentofasuccessfulresponsetoanovelcoronavirusoutbreak.AsthepresentationofanovelcoronavirusoutbreakinAustraliawill inevitablybecomplexandvarieditwillbeaprioritytoputinplace arrangements to support a consistent, informative message. The communications strategydescribed in this chapter is designed to reach the broad range of stakeholders involved in andaffectedbyanoutbreak, fromhealthauthoritiesandthemedicalprofession, to thepublicandthemedia.

Sharing information between those managing the response will enable the coordination ofresources,betterinformdecisionmakersandprovideaccesstoexpertguidanceontheapplicationofresponsemeasures.

Communication with the public, through the media and other sources, will shape the publicperception of risk and the way in which the public is engaged in measures to address the novelcoronavirusoutbreak.

6.1 Key principles: Thefollowingkeyprincipleswillbeappliedacrossallourcommunicationactivities:

• opennessandtransparency;• accurateriskcommunication,includingwherethereisuncertainty;• communicationsasatwo-wayprocess;• useofexistingcommunicationchannelsandprotocols,wherepossible;• consistent,clearmessages;• regular,timelyprovisionoftailoredinformation;• earlyreleaseofpublicmessages;• timelyresponsetoqueries;• useofsocialmediawhereappropriate;• useofspecificcommunicationmethodstofacilitatecommunicationwithvulnerable

populations;• flexibleselectionofmethodsappropriatetothesituationatthetime;and• useofawiderangeofcommunicationmethodstoreachabroadaudience.

Itshouldbenotedthat,whilethischaptermakesreferencetocommunicationactivitiesindifferentstagesoftheoutbreakresponse,itisthegoaloftheCOVID-19Plantomaintainandenhanceflexibility.Itemsfromdifferentstagesmaythereforebeusedconcurrentlyornon-sequentiallyastheirpurposedemands.

6.2 Information gathering InformationaboutnovelvirusesinAustraliaandinothercountries iscollectedroutinelyeveryyearby the Australian Government and State and Territory Governments. Sources of such informationmay include seasonal influenza surveillance systems, Australian embassies, other governments,Australian international disease experts and the WHO, which provides information about novelviruses,orotherviruseswithpandemicpotential,throughcommunicationsystemssuchastheWHOEventInformationSite.

Asagreedunder the IHR,Australia reports to theWHOanyeventofpotential internationalpublichealthconcern,includingspecificallyifthereisnovelcoronavirusoutbreakwithinAustralia.


The information gathered from these sources is used to advise Australianswhomay be travellingabroad, thoseconsideringoverseas travel,and to informsurveillanceandcontrolof thedisease inAustralia.Diseaseinformationwillalsobesharedwithstakeholders.

Duringthenovelcoronavirusoutbreak, informationwillbegatheredabout thehealthsector itself,such as current health service capacity; whether the management of acutely unwell people withnovel coronavirus has meant that other routine services have been ceased temporarily; andabsenteeismamongHCWsand/orsupportstaffduetoillness,caringforfamilyorfearof infection,where possible. The information gathered will be critical to informing decisions about novelcoronavirusoutbreakresponsemeasuresandforprioritisinghealthserviceslocallyandatthestateandnationallevels.

6.3 Sharing information between those involved in managing the response

Audience:Thissection isaimedatcommunicationbetweenAustralianGovernmentagencies, stateandterritorygovernmentagenciesandotherkeystakeholdersinvolvedinprovidingahealthsectorresponsetoanovelcoronavirusoutbreak.

Purpose:Tosupportcoordinationofresources,betterinformdecisionmakersandprovideaccesstoexpertguidanceontheapplicationofresponsemeasures.

Aims:

Action(Initial&Targeted):• buildawarenessacrossthehealthsectorofthemostup-to-dateandaccurateinformationabout

the disease, to support effective diagnosis and treatment, and better informed managementdecisions;

• promotea consistent approachbyensuringall keypartieshave the same information, thoughrecognisingthatdiseasespreadmaybevariableacrossthecountry;

• supportbestpracticebydisseminatingguidanceinkeyareasdevelopedbyexpertbodies,suchasCDNA/PHLN;

• shareeffectivestrategies,avoidingtheneedforthemtobedevelopedseparatelybyallparties;• inputfeedbackontheeffectivenessoftreatmentoptions,sideeffectsandotherclinical/public

healthinformationintodecisionmakingprocessestosupportrefiningtheapproach;• inputfeedbackonhowwellthehealthcaresystemiscoping;and• maintaintrustandconfidence.Standdown• continue to support awareness of the most up-to-date and accurate information about the

disease, to supportmoreeffectivediagnosisand treatment,andbetter informedmanagementdecisions;and

• clarifyarrangementsfortransitioningtonormalbusiness.

6.3.1 Challenges: • Sharinginformationinatimelymanner;• Ensuringpeoplearegettingaccesstotheinformationtheyneed;• Ensuringaconsistentmessageacrossmediaandauthorities;• Consistentmessagingwithinaflexibleresponsewheretheresponsestrategiesareat

differentstagesacrossthecountry;• Communicationofinitialdecisionseventhoughinformationaboutthevirusmaybesparse

and/orunreliable;• Communicationoftheuncertaintyofwhattheimpactofthenovelcoronavirusoutbreakwill

be;

• Initialinformationmaybebasedonthebehaviourofthediseaseinanothercountryandnot100%relevanttotheAustraliancontext;

• Makingsenseoffeedback,consolidatingthisandincorporatingitintomessaging;and• Managingstakeholderexpectationsofwhenandhowtoreceiveinformation.

6.3.2 Australian Government and state and territory governments TheAustralianGovernmentandstateandterritorygovernmentswillshareinformation,viaexistingchannels,about:

• thesituationoverseas;• advicefrominternationalbodies,suchastheWHO;• thestatusandimpactofthenovelcoronavirusoutbreakinAustralia;• theepidemiology,severityandvirologyofthedisease;theimplementationandimpactof

measurestomanagetheresponsetothenovelcoronavirusoutbreak;and• deploymentoftheNMS.

Communication between Australian Government agencies relevant to the response will becoordinated by the Department of Health. Communication between relevant state and territorygovernmentagencieswillbecoordinatedbystateandterritoryhealthdepartments.

Cross government linkages are also supported by representation on the NCC, which would beconvenedbytheAustralianGovernmentintheeventofamajorcommunicablediseaseoutbreak.

SpecificinformationonthestatusoftheoutbreakandkeyresponsedocumentswillbepostedontheDepartmentofHealthhomepage(www.health.gov.au).

6.3.3 National Incident Room TheDepartmentofHealth‘sNIRprovidesapointofcommunicationwiththeAustralianGovernmentforhealthincidents.

DuringtheInitialAction,TargetedActionandStanddownstagestheNIRwillprovidetimelysituationreportstorelevantAustralianGovernmentagencies,stateandterritoryhealthauthoritiesandotherrelevantstakeholders.

6.3.4 Other key health stakeholders (healthcare workers, health and social service providers)

Healthcare workers and providers need access to timely, accurate and comprehensive clinicalinformation and advice in order to effectively manage patients; implement novel coronavirusoutbreakcontrolmeasuresandminimisetheirownriskofexposure.SuchadvicewillbeprovidedbyCDNAandotherclinicalgroupsasappropriateandendorsedbyAHPPC.

Nationalcommunicationwithhealthcareworkerswillprimarilybethroughexistingchannelsviatheirrelevant peak body. Peak body websites will be particularly important vehicles for disseminatinginformation. Additionally, S/T HD will consolidate communication with healthcare workers andproviders (bothgovernmentandnon-government, suchasprivatehospitals)and includestateandlocal level information via their own communication channels. Communication may either targetclinicaland/oradministrativeaspectsofhealthservices,accordingtothenatureoftheinformationtobedelivered.

Novel coronavirus outbreak planning support and advice is available for GPs and other primaryhealthcareprovidersinfactsheetsavailableontheDepartmentofHealthwebsite.

InformationfromhealthserviceproviderstotheDepartmentofHealthandS/THDabouttheimpactofthenovelcoronavirusoutbreakontheirservicecapacityisessentialtoinformpandemicresponsedecisionmaking.Theseperceptionsandexperienceswillbeinputintodecision-makingprocessesviasurveys,consultationwithpeakbodiesandbroaderconsultativeforums.


6.4 Public communications Audience: This section considers communication by governments with the general public,businesses,thenon-governmentsector,industrygroups,andarangeofotherrelevantstakeholdersandaudiences.

Purpose:Toprovideinformationtothepublictoinformtheirunderstandingoftherisk,engagethemeffectivelyinpublichealthmeasuresandguidetheirownmanagementoftheirexposuretorisk.

As the key communication channels to the public are via television, radio, print, online and socialmedia outlets, effective media engagement strategies will be required to ensure the key publicmessagesareconveyedtothepublic.

Aims:Initial&TargetedAction:• Build andmaintain public trust and support by providing consistent, clear, informative public

messaging;• Ensuremessagesinclude:thisiswhatweknow;thisiswhatwedon’tknow;thisiswhatweare

doing;andthisiswhatyoucando;• Encourage behaviours and attitudes that will contribute positively to reducing the spread of

diseaseandminimise thepsychological, socialandeconomic impacts includingassistingothers(neighbours,family,friendsetc.);

• Managethediseasethreatbyincreasinguptakeofrecommendedactions;• Buildpublic confidencebykeepingpeople informedof thecurrent situationandwhat isbeing

done to address the impact of the outbreak and through transparency around resourcing andsuccessofinterventions;and

• Empower individuals by increasing their understanding of the seriousness of the disease;knowledge of what to do to avoid/minimise exposure; ability to recognise symptoms andknowledgeofwhattodoifsymptomspresent.

• Ensure individuals, communities and specific stakeholders understand the reasons whyinterventionsmight bemodified and tailored to bestmeet the needs of the situation and/orspecificpopulationgroups;

• Supportessentialservices;and• Provideinformationtoat-riskgroups.Standdown:• Supporttransitiontobusinessasusualservices;and• Shapeexpectationsofservicesandcircumstances,suchasthepossibilityoffurtheroutbreaks.

6.4.1 Challenges • Publicconcernmaybehigh;• Scientificknowledgewillbelimitedatthebeginningofthenovelcoronavirusoutbreak;• Uncertaintywillbehigh;• Balancingearlyreleaseofpublicmessageswithaccuracyofinformation;• Balancingpublicreleaseofinformationwithprivacy/confidentialityforthoseinvolved;• Accuratecommunicationofriskinasituationofuncertaintythatisrapidlychanging;• Consistentmessagingwithinaflexibleresponsewheretheresponsestrategiesareat

differentstagesacrossthecountry;• Coordinationandconsistencyofmessagingwheretherearemultiplespokespeople;• Ensuringtwo-waycommunication;• Meetingmediarequestsintimetomeettheneedsof24hournewsmedia;and• Mediaoutletsarecommercialagenciesandtheirprimepurposeisnotnecessarilytoprovide

consistentpublichealthinformation.

Public communication provides an opportunity both to address any public concern caused by thepandemic and to engage the public in strategies to manage the impact of the disease. Thedissemination of up to date, consistent and accurate information about the status of the diseaseoutbreak overseas and in Australia can help people understand the real risk and make moreinformed decisions about work and travel, taking up health recommendations and planning forpeople inat-riskgroups. Informationabout the implementationofactivitiesandarrangementscanbuildpublicconfidenceinthecapacityofhealthservicestomanagetheresponse.

Providing thepublicwith informationabout thenatureof thedisease canempower individuals totake steps to reduce the risk to themselvesand their families.Thiswillbothalleviate concernandlead to more appropriate use of recommended measures. Increasing rapid presentation ofappropriatecases toamedicalpractitionerwill lead to reducedmorbidityandmortality.Reducingpresentationofthe‘worriedwell’willdecreasetheburdenonhealthsystems.Informationgatheredfrom the public about concerns, issues with measures and information gaps is also important toinformdecision-making.

Totakestepstomanagetheirriskduringanovelcoronavirusoutbreak,peoplewillneedto:

• Understandtheseriousnessofthedisease;• Knowwhattodotoavoid/minimiseexposure;• Recognisesymptoms;and• Knowwhattodoifsymptomspresent.

6.4.2 Coordination: Developing a consistent message A wide range of information will be available to the public should a novel coronavirus outbreakoccur. The Australian Government and State and Territory Governments will have to positionthemselvesasauthoritativesourcesfromveryearlyonintheoutbreak.Enlistingthecooperationofkey spokespeople in thenon-government sector (e.g. university academics, theAustralianMedicalAssociation)willbeimportantforbuildingconfidenceintheresponsestrategies.

A number of coordination mechanisms have been put in place to ensure consistency of publicmessaging.Guidelinesandprocessesforthecoordinationofpublic informationrepresentingbroadwholeofgovernmentissuesareoutlinedintheNationalCDPlan.

Key health sector novel coronavirus outbreak messages and advice regarding requirements forchanges of communication strategies to reflect the progress of the outbreak will primarily bedetermined by AHPPC. AHPPC will develop these messages using recommendations from CDNA,PHLNandotheradvisorybodies.

TheDepartmentofHealthwillworkcloselywithS/THDCommunicationandMediaUnits;relevantAustralianGovernmentagencies,nationalmedicalcollegesandassociations,theNationalAboriginalCommunityControlledHealthOrganisation(NACCHO)andselectpartsoftheprivatesectordirectlyinvolved inemergencyhealthmanagement. It is coordinatedby theCommunicationBranchof theDepartmentofHealth. Itsrole istokeepthepublicandthemedia informedduringnationalhealthemergenciesbyprovidingconsistentandcoordinatedmediaandpublicresponses.

Communicationregardingissuesoutsidethehealthsector,suchasschoolclosures,willbemanagedbytheNCC.

TheMediaUnitwithin theNIRwill bea contactpoint for coordinationwith states and territories.Coordinationofpubliccommunicationswithin jurisdictionswillbe inaccordancewith jurisdictionalarrangements.

MediacommunicationregardingtheAustralianGovernmentactivitiesrelatedtomanagementofthenovelcoronavirusoutbreakwillbecoordinatedbytheDepartmentofHealthCommunicationBranch,which will work with relevant Australian Government agencies to ensure a consistent, whole ofgovernmentmessage.


6.4.3 Media engagement strategies Themediawillbethemainsourceofinformationforthepublicduringanovelcoronavirusoutbreak.Building strong relationships with media contacts is essential to foster positive representation ofresponseeffortsandaccuraterelayofpublichealthmessages.

Media contactswill be notified early in thenovel coronavirus outbreakof amedia enquiry phonenumbermanagedbytheNIRMediaUnit,whichwillbeavailable24hoursaday,sevendaysaweek.Asharedemailaddresswillbeestablishedforquickresponsetomediaenquiries.

Keymedia engagement strategies thatwill be used in the various stages of the novel coronavirusoutbreakmayinclude:

• duringtheInitialActionandTargetedActionstages:o regularly update the Department of Health homepage (www.health.gov.au) with

situational information, important healthmessages, updates of case numbers anddeaths,media alerts,media releases, transcripts ofmedia interviews, streamingofcommercials, print resources, communications materials, questions and answers,informationonrelevantsocialmedialinksetc.;

o use the Department of Health’s existing social media accounts (Facebook, Twitterand YouTube) to provide up to date notifications on health emergency mediaopportunitiesandnovelcoronavirusoutbreakinformation;

o makeavailableappropriatespokespeopleformediainterview;o developanddisseminatevia the Internetpre-recordedbroadcastquality radioand

TVgrabsusingexistingmediareleaseaudiomailbox;o applysimilarstrategieswithinS/THD;o procureacreativeagency;o activate a media campaign targeting people affected and at high risk of infection

with informationonappropriatehygienepracticesandpreventionfromcontractingthedisease;

o paid advertising, including television, radio, print, out of home (GP clinics, transitmediaandshoppingcentres),andsocial/digitalsearch(e.g.couldconsideranationalQRcode);

o developcontentforplacementincommunityserviceradio(includingABCradio),in-flightannouncements,airports,boardingpasses,taxisanddigitalscreens;

o Considercommunicationsthroughairlinephoneappsandanyrelevanthealthapps;o Televisionannouncementbanneralerts;o Partnershipwithradiostations(e.g.ABCRadio);o UpdatedinformationfortravellersontheSmartTravellerwebsite;o InformationforEDandGPwaitingroomtelevisionscreens;o Regular videos from the CMOor relevant health officials to be provided tomedia

outletswhichwill be addressing things that arise, the use ofmasks, good hygieneandspecificsforhealthprofessionals;and

o DevelopanonlinetoolkitforS/THDtoaccesskeyresources(e.g.socialmediatiles,factsheetsetc.);and

o Key messages communicated to border agencies and airports/ airlines/ seaports/shippingandcruiselines.

• during stand down, provide advice to the media of the transition to normal mediaengagementarrangements.

To promote presentation of a consistent message between government statements and mediacommentary, informationwill bemade available regularly to themedia from government sourcesboth at regular predictable intervals and upon request. Information tailored to key audienceswillalsobeproducedwherepriorityneedsareidentified.

6.4.4 Spokespeople Arangeofspokespeoplewillbeavailableduringtheresponsetotheoutbreak, includingallHealthMinisters,theCMO,ChiefHealthOfficers,mediaunitrepresentativesandspokespeopleidentifiedatthelocallevel.

Therelevantspokespersonwilldependonthestageofthenovelcoronavirusoutbreakandtheaimofcommunications.When the focusof themessage is related toeventsandactivities ina specificjurisdiction,thespokespersonwillbedeterminedbythatstate/territory.Whencontent isconfinedto Australian Government activities, the spokesperson will be identified by the NIR Media Unit.Where key groups are to be targeted, peak and representational bodies will be consulted, forexample,NACCHOwillassistinnominatingappropriatespokespeopleforAboriginalandTorresStraitIslandercommunities.

Under the AGCMF, the Prime Minister may assume primary responsibility for leading theGovernment’s response, including acting as primary Government spokesperson. Under thesecircumstances, the PrimeMinister is also likely to consult with the leaders of affected states andterritoriestoensureacoordinatednationalresponse.

6.4.5 Ensuring two way communication It is essential that public awareness and attitudes be monitored to inform refinement of publicmessaging. This is critical to achieving the right balance between motivating risk-mitigatingbehavioursbyraisingpublicawarenessofpotentialrisks,andreassurancethatthesituationisundercontrol.Itmaybethatdifferentgroupswithinthecommunityareatoppositeendsofthisspectrum,andmessagesmay thenhave tobe targeted appropriately tomanage this. Listening to thepublicalsohelpstoidentifycommunityconcerns,informationgapsandmisconceptionsormisinformation,which can then be addressed within public communications. Communication with at-risk groups,suchasAboriginalandTorresStrait Islanderoragedcarecommunities, isparticularly important totailormeasurestotheneedsofpeoplewithgreatervulnerability.

Methodstogaugepublicawarenessandattitudesthatmaybeusedinclude:

• marketresearchonknowledgeandattitudestoanovelcoronavirusoutbreakthreat;• comprehensivemarketresearchundertakenbytheDepartmentofHealthattheoutsetand

throughoutthenovelcoronavirusoutbreak;• feedbackfrompeakbodiesviausualcommunicationchannels,suchastheGPRoundtable,

ClinicalStakeholdersForum,AgedCareproviders’peakbodies,PrimaryHealthNetworksandNACCHO;

• monitoringofmediasitesbyMediaUnitsinNIRandS/THD;• monitoringofsocialmedia,includinglarge,opensocialmediasites;• useofsocialmediaoraninteractivehealthemergencywebsitewheremembersofthepublic

cansharecontent,commentandaskquestionswhichwillbeansweredonline,basedonanagreed“questionandanswer”formula;and

• feedbackfromawiderangeofstakeholdersregardingtheimpactandeffectivenessofthepandemicresponsemeasuresthathavebeenundertakenobtainedbytheDepartmentofHealthandS/THD.

6.4.6 Other communication methods Information tailored to key audiences will be produced where priority needs are identified.Disseminationofthisinformationwillalsobetailoredtothespecificaudience,e.g.useofspecialisedAboriginalandTorresStraitIslandermediaoutletstocommunicatekeymessagestargetingpeopleinremoteAboriginalandTorresStraitIslandercommunities.

Paidadvertisingmaybeused,particularlyifthereisaneedtorapidlymobilisethecommunity,suchasfornovelcoronavirusoutbreakvaccination.


Print resourceswhich can be distributeddirectly to stakeholderswho interactwith the publicwillalso be used widely, including information for patients from HCWs; information for familiesdistributed via schools; information for travellers made available at travel agencies and airports;informationdistributedthroughorganisationsassociatedwithmasstravelforspecificpurposessuchasinternationalsportingeventsandreligiousgatheringsetc.Printedandelectronicinformationmayalsobedisplayed at targetedplaces such asGP clinics, travel agencies and airports.Materials canalso be made readily available for responders and the public at a centralised web location e.g.AustralianGovernmentandS/THDwebsites.

Socialmediamessagescanbeusedtodeliverkeymessages(e.g.diseaseinformation,behaviourstobe promoted, situation changes) in a timely manner to responders and the public. Social mediamessagescanbeupdatedonaregularbasistoensurecurrencyof information.Theuseofexistingsocialmediatrendingtagsmaybeconsideredtomaximisethereachofsocialmediamessages.

TheDepartmentofHealthandtheAustralianGovernmentDepartmentofForeignAffairsandTradewill work together to provide information for Australians considering overseas travel and forAustraliansoverseaswhenconsideringwhethertoreturnhome.

HCWsplayan importantrole inexplainingandreassuringtheirclientsaboutthenovelcoronavirusoutbreak.InformationprovidedtoHCWswillincludekeymessagesforthepublicaswellasprovidegreater detail about the rationale behind outbreak decisions to enable HCWs to appropriatelycounseltheirclients.

6.4.7 Supporting at-risk groups Communicationwill alsobe tailored tomeet theneeds rangingacrossourcommunity,particularlythose with a higher risk of complications from the disease. Support for mental health needs ofvulnerable individuals and the community as a whole will also be considered. As important astailoringofmessageswillbecarefulselectionofchannelsofcommunicationtoensurethatmessagesarereachingasmanygroupsacrossthepopulationaspossible.Engagingandsupportingcommunityleaders in relevant target groups will be a key strategy to promote implementation of desiredpracticesandinvolvementinpublichealthmeasures.

In the aged care sector the Department of Health will work closely with aged care providers.AboriginalMedicalServicesandotherservicesforAboriginalandTorresStrait Islanderpeopleswillsupporttheneedsofthisvulnerablegroup.AnAboriginalandTorresStraitIslanderclinicaladvisorygroupwill bebrought together andused to support communications to theAboriginal and TorresStrait Islander community and to provide an avenue for feedback to inform decision makingprocesses.Theneedforprovisionofadviceinotherlanguages,attheborder,anddomesticallywillalso be considered. As infants are also likely to be a high risk group and a vector of disease,coordinationwithchildcarefacilities isalso important.Communityoutreachservices,suchasnon-government organisations and churches will be used to support communication with vulnerablepeoplewhomaynothaveaccesstomainstreamhealthservices.

PART 2 Operational Plan This Operational Plan has been adapted from the AHMPPI Operational Plan. Though an influenzapandemic plan, the detailed guidance in the AHMPPI is used regularly as the basis for Australia’sbroadercommunicablediseaseplanning.Itisparticularlyrelevantforrespiratorydiseaseoutbreaks,such as the novel coronavirus and preliminary consultation supports that it remains broadlyapplicable.

The considerable investment in pandemic preparedness in the AHMPPI benefits from studies andmathematical modelling conducted on influenza and Sudden Acute Respiratory Syndrome (SARS),another coronavirus.Although thenovel coronavirus is behavingdifferently in someways to bothinfluenzaandSARS, theprinciplesbehind the responsemeasuresused tomanage the response totheSARSoutbreakandpandemicinfluenzaareusefultoinformthisresponse.

TheobjectiveoftheOperationalPlanistoprovideadditionaldetailtosupporttheimplementationofactivities under the COVID-19 Plan at an operational level. It can be used by planners prior to orduring an outbreak as an operational checklist of activities that could be considered forimplementation.

AcrossallactivitiestheStrategicObjectivesofthisresponsewillbeto:

• IdentifyingandcharacterisingthenatureofthevirusandthediseaseintheAustraliancontext;

• Minimisetransmissibility,morbidityandmortality;• Minimisetheburdenon/supporthealthsystems;and• Inform,engageandempowerthepublic.


Initial action stage Initialactivitieswillfocuson:

• minimisingtransmission;• preparingandsupportinghealthsystemneeds;• managinginitialcases;• identifyingandcharacterisingthenatureofthevirusandthediseasewithintheAustralian

context;• providinginformationtosupportbestpracticehealthcareandtoempowerthecommunity

andresponderstomanagetheirownriskofexposure;• bordermeasures;and• supportingeffectivegovernance.

IntheInitialActionstage,thefollowingmeasurescouldbeconsideredforimplementation:

Minimising transmission Minimisingtransmissionthrough:

• Bordermeasures(seebelow);• Isolationofconfirmedcases;• Quarantineofclosecontactsandsuspectedcases;• Caseandcontactmanagement;and• Quarantineofrepatriatednationalsandapprovedforeignnationals

uponarrivalintoAustralia.

Preparing and supporting initial Health System needs & managing initial cases Resources(HR&stockpile)

• ProvidePPE,asappropriate(healthcareworkers/borderworkers);• Organisedeliverytopointsofuse(statesandterritories);• Considerprioritisationofresources;• MaintaintheNIR(staff,equipment,managementsystems);• DeploystockpileitemsfromstoragesitestoStateandTerritory

deliverysitesreadyforuse;• Monitorhealthsystemcapacity;• Healthsystemtoprepareforpotentialneedtoengagesurgestaff.• Considerneedsforadditionalsupporttohealthsystemsinremote

communities;• Maintainessentialhealthsystemactivities.

Clinicalcare&publichealthmanagement

• Managecasesandcontacts;• Encouragevoluntaryisolationofcasesandquarantineofclose

contactsandsuspectedcases;• Monitorandsupportneedsofatriskgroups(whenidentified);• Encourageadvanceplanningdirectivesofagedcareprovidersand

residents;• Healthsystemtoprepareforpotentialneedtoengagesurgestaff;• Considerstrategiestoreduceroutinehospitaldemandsuchas

differentmodelsofhealthcareprovision;• Developanddisseminatetriagealgorithm;• Developcohortstrategy.

Clinicalcare&publichealthmanagement(cont.)

• Supportoutbreakinvestigationandmanagementinresidentialcarefacilities,schools,prisonsandotherinstitutions;

• Considertheneedtoimplementalternativemodelsofcareto

minimisetheburdenonthehealthsystemforexample,feverclinics.

Infectioncontrol • Confirmwithresponderstheapplicationofstandardinfectioncontrolstrategies(orprovidealternateadviceifappropriate);

• Provideadvicetothepubliconrespiratoryhygieneandhand-washing.

Identification Surveillance • Identifyanddescribetheepidemiology,clinicalseverityand

virologyofthediseaseinAustraliathroughenhancedsurveillanceofconfirmedcases.

• Conductcontacttracing(whereneedisidentified);• Developandrefinecasedefinitionsasneeded;• Confirmidentificationofatriskgroups;• AnalyseandreportAustralianandmajortrendsininternational

data;• Maintaincasenotificationsystem;• Activateacademicstudiesusingenhanceddatatotestassumptions;

and• Monitorsustainabilityofsurveillancesystems.

LaboratoryCapacity • Isolatethevirus;• Undertakelaboratorytestingasrequiredtomonitortheoutbreak

andforindividualpatientcare;• Implementtestingprotocolstosupportcasemanagement,

surveillanceneedsandtopreservelaboratorycapacity;• Maintainlaboratorycapacity/capabilitytodetect/testfornovel

virus;and• Undertakespecialistcharacterisationandgenomicsequencingof

thevirustounderstanditsevolutionandenablestudiesonantiviralsusceptibilityandvaccinedevelopmenttooccur.

Communications Informationshouldbeprovidedasearlyaspossibleandacknowledgeanyassociateduncertainty.

Sharinginformationbetweenresponders

• Providepublichealthmanagementguidance(e.g.SeriesofNationalGuidelines);

• Provideclinicalhealthmanagementguidance(primarycareandhospitalbased);

• Shareinformationonthestatusofdiseasespreadandthecurrentresponse;

• Raiseawarenessofatriskgroups(whenidentified);• provideanyinformationtoWHOrequiredunderInternational

HealthRegulations(IHR)reportingarrangements;and• Liaisewithotherinternationalcounterparts.

PublicCommunications • CoordinateWhole-of-Governmentmessagingtoprovideinformationonthestatusofdiseasespreadandthecurrentresponse.

• Providespecificinformationforgroupsatriskorwithspecificneedswhenidentified.(e.g.culturallyandlinguisticallydiverse(CALD),


agedcareorAboriginalandTorresStraitIslanderpeople,schools,suspectedcases,universitiesandvocationaleducationtrainingsector,hospitalityandtourismindustry,employers,airlineandair/seaport,healthprofessionals).

• Monitorfeedbackandrefinecommunicationstoaddressissuesandconcernsidentified;

• Providemediawithaccesstodailyupdatesonthestatusofdiseasespreadandthecurrentresponse;

• Provideaccesstobackgroundinformation.• Makespokespeopleavailable;• Respondtomediarequests;• Provideadviceon:

o respiratoryhygieneandhand-washing;o maskwearing(ifappropriate);o howtofindoutmoreinformation;and

• Hotlinedetails.

Border measures Bordermeasures • Implementenhancedbordermeasures,suchasenhancedentry

screening,non-automaticpratique,preventativebiosecuritymeasures

Communications • Provideinformationtotravellersthrougho in-flightandon-arrivalannouncementso factsheets(incomingtravellers,borderworkers,airlines,

cruiseindustry)o communicationmaterials(e.g.printedandelectronic

media)attheborder;ando socialmedia.

• Provideguidanceforborderworkers,theairlineandmaritimeindustryon:

o thediseaseandpersonalrisko respiratoryhygieneandhand-washingo appropriateuseofPPEwhileassessingilltravelers;ando wheretofindmoreinformation.

Travellerclearances • Maintainrequirementsforcustoms,immigrationandbiosecurityclearances(includingforAustralianDefenceForcePersonnel);

• Enhancefortravellersidentifiedaspotentiallyhigherrisk.

Governance AHPPC

• Coordinateallocationofnationalresourcestosupportqualitycareandpublichealthmeasures,asneeded;

• ConsiderwhetheranysocialdistancingorbordermeasuresshouldbeimplementedandadviseNCCasappropriate;

• SupporttherepatriationofAustraliansfromoverseas,asrequired;• Managerequestsforexitscreening;and• CoordinateprovisionofAustralianMedicalAssistanceTeamsin

responsetorequestsforinternationalassistance(ifappropriate).Wholeofgovernment • ConvenetheNCCandotherrelevantexpertcommitteesas

required;and• MinisterforHealthassumesemergencypowersunderthe

BiosecurityAct2015,ifrequiredtosupportpandemicresponsemeasures.

Legislation • DeclareahumanbiosecurityemergencyundertheBiosecurityAct2015,ifrequiredtosupportpandemicresponsemeasures(GovernorGeneral);and

• Undertakeanystatebasedlegislativeprocessesrequiredtosupportimplementationofdiseasecontrolmeasures.

Internationalobligations • MeetIHRreportingrequirements.


Targeted action stage TheTargetedActionstageofresponsewillcommencewhenthereissufficientinformationcollectedaboutthevirustoinformtherefinementoftheoutbreakresponsemeasuresalreadyimplemented,such as the scaling down or ceasing of somemeasures. The key objective of the Targeted Actionstage is ensuring a proportionate response to the outbreak, so scarce resources are properlyallocatedwheremostneededandthattherisktosusceptiblepeopleinthecommunityismitigated.

The effectiveness and appropriateness of measures taken will be regularly reviewed by theAustralianGovernmentinconsultationwithkeycommitteesandstakeholders,asmoreinformationonthecharacteristicsofthevirusbecomesavailable.

Targetedmeasureswillfocuson:

• ensuringaproportionateresponse;• supportingandmaintainingqualitycare;• communicationstoengage,empowerandbuildconfidenceinthecommunity;and• providingacoordinatedandconsistentapproach.

Identificationmeasureswillmove to collecting core data from established surveillance systems inorder to detect any changes in the epidemiology of those getting sick, the clinical severity of thediseaseorcharacteristicsofthevirus.Jurisdictionswillcontinuetocollectenhanceddataonupto10casesperweekandforoutbreaksinnewsettings,topreservethesustainabilityoflaboratorytestingcapacityandothersurveillanceresources.

Communicationmeasureswillcontinuetobeimportant,followingthesameapproachasoutlinedintheInitialActionstage.Keymessagesshouldcontinuetobereviewedregularlytoensuretheyreflectcurrent information about the response, the disease itself and recommended managementstrategies(bothforrespondersandthepublic).

IntheTargetedActionstage,thefollowingmeasurescouldbeconsideredforimplementation:

Ensuring proportionate response Bordermeasures • Regularlyreassessbordermeasuresimplementedduringthe

InitialActionstageforcountriesdeemedhighrisk,inconsultationwithkeycommitteesandstakeholderssuchasCHBOsandAHPPC.

Minimisingtransmission • Supportingisolationofidentifiedcasesandquarantineofsuspectedcasesandclosecontacts;and

• Ongoingcaseandcontactmanagement,asrequired.

Supporting and maintaining quality care Resources(HR&Stockpile)

• Monitorhealthsystemcapacityandestablishtriggersandthresholdsforwhencapacitywillbeoverwhelmed;

• Healthserviceswillimplementsurgestaffarrangementsasneeded(andwherepossible);

• Healthserviceswillprioritiseservicestobestmeetdemandforacutecare;

• Stateandterritoryhealthdepartmentswillundertakeurgentassessmentandcoordinationofavailablespecialistequipmentbasedonoutbreakpredictionsandgeographicspread;

• MaintaintheNIR(staff,equipment,managementsystems).Resources(HR&Stockpile)(cont.)

• ProvidePPEand/orvaccines(ifavailable)asappropriatetohealthcareworkersandotherapprovedstakeholdersasdeemed

necessary;• DistributeitemsfromtheNMS;• Provideadditionalsupporttohealthsystemsinremote

communitiesasneeded(andwherepossible);and• Tailormeasurestotheneedsofremotecommunities(including

remoteAboriginalandTorresStraitIslandercommunities)1.Thismayincludearrangementsforadditionalhealthcareworkers.

Clinicalcare&publichealthmanagement

• Isolationofconfirmedcases;• Encouragevoluntaryquarantineofclosecontactsandsuspected

cases;• Triageandcohortpatients,asnecessary;• ManagecontactsasagreedbyCDNAandAHPPC;• Supportoutbreakinvestigationandmanagementinresidential

carefacilities,schools,prisonsandotherinstitutions;• Considerusingdifferentstrategiestotreatmildcaseswhere

resourcesareoverwhelmed;• Newmodelsofcaremaybeinstitutedtomanagenovel

coronaviruspatients,forexample:o innovativemethodsforcontacttracinganddiagnostic

testing(callcentres,at-homespecimencollectionetc.);o homebasedcare,whichmayrequirecontingency

communityservicessupport(potentiallytelephonesupport);

o feverclinicsstaffedpredominantlybynursesviamanagementprotocols,withonsiteortelephonemedicalsupport;and

• AdjustmentofICUstaffingratiosandopeningofnewICUbedsornegativepressurerooms,whereavailable.

Infectioncontrol • Isolationofconfirmedcases,andquarantineofrepatriatednationalsandapprovedforeignnationalsasrequired;

• Encouragevoluntaryquarantineofclosecontactsandsuspectedcases;

• Continueapplicationofagreedinfectioncontrolstrategiesappropriatetoincreasingknowledgeoftransmissibility;and

• Continuetoprovideadvicetothepubliconrespiratoryhygieneandhand-washing.

Governance AHPPC • Servicesineachjurisdictionwillprovideinformationontheir

capacitytoStateandTerritoryChiefHealthOfficers(CHOs)to

1Note:Greatdistanceswillpresentdifficultiesfortransportofresources,personnel,patientsandcommunications.Someremotehealthcareserviceswillalreadybechallengedbypoorhealthhardwareandhighratesofovercrowding.Theadditionalburdenofevenamildpandemicwillstresscapacity.Incombinationwithhigherratesofchronicillnessthesefactorspredisposepeopleintheseareastomoresevereoutcomesfrominfluenza.Culturalandenvironmentaldifferenceswillinfluencetheeffectivenessofcertainmeasures,suchashomequarantine.Thisremotenessmayhowevergivegreateropportunitiesforeffectivelymanagingtransmissionintothecommunity.


allowstatelevelcoordination.Inturn,CHOswillreporttoAHPPCtoenablenationalcoordinationandsharing/allocationofresourceswhereneededandwherepossible;

• AHPPCmemberswillworktogethertocoordinatetheavailabilityofresourcesandtodevelopstrategiesforalternatesourceswhereneeded;

• Wherepossible,AHPPCmemberswillworktogethertoensureallneedsaremetandaconsistentapproachandmessageismaintained;

• DiscussionandnegotiationthroughCDNAandAHPPCwillachievecoordinationofmeasuresandprovideavehiclethroughwhichjurisdictionscannegotiateapproachesandensurethatwhendifferentstrategiesareoperatingacrossjurisdictionstheyarestillsupportiveofeachother;

• ConsiderwhetheranyborderorsocialdistancingmeasuresshouldbeimplementedandadviseAGCC/NCCasappropriate;and

• ContinuesupportingtherepatriationofAustraliansfromoverseas,ifrequired.

WoG • MakerecommendationsthroughWoGchannelswhenimplementationofmeasuresoutsidethehealthsectorshouldbeconsidered,suchasschoolorworkplaceclosures,orcancellationofmassgatherings.

Internationalobligations • MeetIHRreportingrequirements.

Standdown stage IndividualactivitieswillberegularlyassessedandstooddownwhentheynolongercontributetotheCOVID-19 Plan’s goals of the outbreak response. The trigger for the COVID-19 Plan response as awholetomoveintotheStanddownstagewilloccurwhenadvicefromCDNAindicatesthatthenovelcoronavirus outbreak has reached a level where it can be managed under normal healthcarearrangements.

Standdownactivitieswillfocuson:

• supportingandmaintainingqualitycare;• ceasingactivitiesthatarenolongerneeded,andtransitioningactivitiestonormalbusinessor

interimarrangements;• monitoringforasecondwaveoftheoutbreak;• monitoringforthedevelopmentofresistancetoanypharmaceuticalmeasures,ifanyarebeing

used;• communicationactivitiestosupportthereturnfromemergencyresponsetonormalbusiness

services;and• evaluatingsystemsandrevisingplansandprocedures.

IntheStanddownstage,thefollowingmeasurescouldbeconsideredforimplementation:

Communications Sharinginformationbetweenresponders

• Adviseofthecommencementoftransitiontonormalarrangementsandhowthiswillbemanaged;

• Thankrespondersfortheirengagementintheresponse;• AcknowledgetheRecoveryeffortsthatwillbeoccurring;• Provideinformationaboutthereviewprocess;and• (AttheendofStanddown)notifystakeholdersofthetransitionto

ongoingvigilancetoensurewearewellplacedtorespondinfuture.

Publiccommunications • Coordinatepublicmessagingthroughmedianetworks;• Notifythepublicthatserviceswilltransitiontonormal

arrangementsandthereasonforthis;• Providespecificinformationforgroupsathighriskorwith

specificneeds(e.g.CALD,agedcareorAboriginalandTorresStraitIslanderpeoples)aboutthetransitionofservices;

• Thankthepublicfortheirengagementintheresponse;• Provideinformationaboutthereviewprocess;• (AttheendofStanddown)notifyofthetransitiontoongoing

vigilancetoensurewearewellplacedtorespondinfuture;• Monitorfeedbackandrefinecommunicationstoaddressissues

andconcernsidentified;• Providethemediawithaccesstoinformationregardingthe

changeofthestatusofdiseasespreadandthetransitionoftheresponse;

• Makespokespeopleavailable;and• Respondtomediarequests.

Supporting and maintaining quality care Resources(stockpile) • Assessthestatusofstockpilesandequipment(PPEandantivirals,

ifused);


• Reviewprocessesandpolicies;• Replenishstocksasappropriate;and• Updateplansandprotocolsinlinewithlessonsobserved.

Resources(HR) • Implementinterimarrangementsifrequired;and• Supportanyresourcesthataredepleted,inordertomeet

remainingdemand.Clinicalcareandpublichealthmanagement

• Implementinterimarrangementsifrequired;• Transitiontriageandcohortingsystems;• Resumeelectiveprocedures(hospitals);• Resumenon-urgentwork(primaryandsecondarycare);• Reviewprocessesandpolicies;and• Updateplansandprotocolsinlinewithlessonsobserved.

Legislation • Prepareandactionanylegislativeinstrumentsrequiredtoreturnlegislativepowerstonormal.

Identification Surveillance • Monitorforasecondwaveorchangeinthevirus;

• Continueacademicstudiesandanalysisofdatafrombothenhancedandroutinesurveillancesystemsasnecessary;

• Reviewprocessesandpolicies;and• Updatesurveillanceplansinlinewithlessonsobserved.

Laboratorycapacity • Monitorforasecondwaveorchangeinthevirus,includingmonitoringthegenomicevolutionofthevirus;

• Reviewprocessesandpolicies;and• Updateplansandprotocolsinlinewithlessonsobserved.

Border activities Bordermeasures • Standdownenhancedbordermeasuresandreturntobusinessas

usualhumanbiosecurityarrangements.Communications • Updatein-flightandairportannouncementstoreflecttransition;

• Implementsignage(suchascrawlersoncustomsscreensorposters)explainingtransition;

• Updatesocialmediamessagesfortravellers(ifused);• Reviewanydisease-specificcommunicationmaterials;• Reviewprocesses;and• Updateplansandprotocolsinlinewithlessonsobserved.

Liaison • Adviseairline/airport,seaport/shippingindustriesandborderagenciesoftransitiontonormalbusinessarrangements.

GovernanceAHPPC • Servicesineachjurisdictionwillprovideinformationontheir

capacitytoStateandTerritoryGovernmentCHOstoallowstatelevelcoordination.Inturn,CHOswillreporttoAHPPCtoenablenationalcoordinationandsharingandallocationofresourceswhereneededandwherepossible;

• Coordinatetheavailabilityofresourcesanddevelopstrategiesforalternatesourceswherespecificareasaredepleted;

• Ensureaconsistentmessageismaintained;• CoordinatethetransitiontoStanddown,asthismaydifferamong

jurisdictions;• Directandparticipateinreviewprocesses;and• Considerupdatingplansandprotocols.

WholeofGovernment • MakerecommendationsthroughWoGchannelswhereimplementationofmeasuresoutsidethehealthsectorshouldbestooddown,suchasschoolorworkplaceclosuresandenhancedbordermeasures;and

• ParticipateinWoGreviewprocesses.Internationalobligations • MeetIHRreportingrequirements.


PART 3 Attachment A – Glossary

Term Definition

ACCHS Aboriginal Community Controlled Health Services. ACCHSs operate in the metropolitan, regional, rural and remote areas of all states and territories in Australia. ACCHSs are controlled by, and accountable to, Aboriginal people in those areas in which they operate. ACCHSs aim to deliver holistic, comprehensive and culturally appropriate health care to the community that controls it.

Acute Care Health services (usually hospitals) that provide care or treatment of people with short-term serious injury or illness. Medical conditions requiring acute care are typically periodic or temporary in nature, rather than long term.

AGCC Australian Government Crisis Committee

AGCMF Australian Government Crisis Management Framework

Aged Care Peak Bodies Associations of groups or industries that advocate for and provide quality support, services, representation and policy development in the aged care sector.

AHMPPI Australian Health Management Plan for Pandemic Influenza

AHPPC Australian Health Protection Principal Committee

At-Risk groups

Groups at increased risk of experiencing complications from COVID-19.

Australian Government The Federal Government of Australia

CALD Culturally and linguistically diverse communities

Case definition A set of uniform criteria used to define a disease for public health surveillance

CDNA Communicable Diseases Network Australia

CDPLAN Emergency Response Plan for Communicable Disease Incidents of National Significance

CHBO Chief Human Biosecurity Officer

CHC COAG Health Council

CHO Chief Health Officer

CMO Chief Medical Officer of Australia

COAG Council of Australian Governments

Commonwealth The governments of Australia – Australian Government and state and territory governments collectively

Community transmission Community transmission is the passing of a disease

Term Definition

from an infected individual to another individual outside of a known group of contacts, and outside health care settings.

Communicable Capable of spreading disease or a disease that is capable of spreading (also known as infectious).

Contact tracing The process of identifying and managing people who have been ‘in contact’ with someone who has an infectious illness.

Cough and sneeze etiquette Measures individuals can take when we cough, sneeze or blow our nose, to reduce the change of spreading the virus. This is sometimes referred to as respiratory hygiene.

COVID-19 Coronavirus disease 2019. An illness caused by the SARS-CoV-2 virus that was first identified in December 2019. Formerly known as 2019-nCoV.

CSF Clinical Stakeholders Forum

Department of Health Australian Government Department of Health

DHB Director of Human Biosecurity (Australia’s CMO)

ECMO Extracorporeal membrane oxygenation

Epidemic An outbreak or unusually high occurrence of a disease or illness in a population or area

Fever clinic Fever clinics are specially planned facilities that will be set up during an outbreak for safe medical assessment and management of people with suspected COVID-19.

GP General Practitioners

GP Roundtable A consultative forum made up of GPs organised by the Department of Health.

HCW Health Care Worker (defined as doctors, nurses, paramedics and other front line medical personnel)

Health sector The health sector is government departments responsible for health, the public and private health system, in addition to the private and public health system, and health professionals.

High Risk groups

Groups at increased risk of experiencing complications from COVID-19.

HR Human resources

ICU Intensive Care Unit

IHR International Health Regulations 2005

Infectious Capable of spreading disease or a disease that is capable of spreading (also known as communicable).

Isolation Separating people who are ill from those who are healthy to help stop the spread of an infectious/ communicable disease.


Term Definition

LHD Listed human disease. A disease which the DHB considers may be communicable and cause significant harm to health. LHDs are determined in the Biosecurity (Listed Human Diseases) Determination 2016, enabling a range of powers and measures to become available to manage the risk under the Biosecurity Act 2015.

MERS Middle East respiratory syndrome. A viral respiratory illness caused by Middle East respiratory syndrome coronavirus (MERS-CoV).

Morbidity State of disease. The term morbidity rate refers to the numbers of cases of illness in a population divided by the total population considered at risk of that illness.

Mortality Mortality rate is the measure of the number of deaths (in general, or due to a specific cause) in a population scaled to the size of that population, per unit time.

NACCHO National Aboriginal Community Controlled Health Organisations

National The Australian Government, and State and Territory governments

National CD Plan Emergency Response Plan for Communicable Disease Incidents of National Significance: National Arrangements

National Surveillance Committee

A standing committee under CDNA.

NCC National Crisis Committee

NFP The area or areas within the Department of Health, designated under the Act, as the IHR National Focal Point to liaise with and facilitate actions by national and international bodies to prevent, protect against, control and respond to a Public Health Event of National Significance or a Public Health Emergency of International Concern.

NHS Act National Health Security Act 2007

NIR Department of Health National Incident Room

NMS The National Medical Stockpile. Administered by the Department of Health.

NNDSS National Notifiable Diseases Surveillance System

Non-automatic (negative) pratique

Aircraft commanders must report the health status of passengers on board before landing, rather than the normal reporting by exception.

Novel coronavirus A novel (new) coronavirus that has not been previously identified in humans or animals.

NSC National Security Committee of Cabinet

Pandemic An epidemic on a global scale.

Term Definition

PHLN Public Health Laboratory Network

Point of care The place where three elements come together: the patient, the HCW, and care or treatment involving contact with the patient or his/her surroundings (WHO Guidelines on hygiene in healthcare)

Post-exposure prophylaxis A dose or doses of a drug (usually antibiotic or antiviral) given immediately after exposure to a disease (such as influenza), but before onset of illness.

PPE Personal Protective Equipment (gowns, gloves, masks)

Primary care Health services providing initial care of a patient before they are referred to transferred elsewhere. General practice surgeries and emergency departments are common sites for primary care.

Primary Health Networks Organisations that link and integrate parts of the health system to improve health outcomes, delivery of and access to health services for their local area.

Public health unit Teams of specially qualified people who prevent or limit the spread of illness and disease, and improve the health of the community.

Quarantine The limitation of freedom of movement for a period of time of well persons who are likely to have been exposed to the virus (contact) to prevent their contact with people who have not been exposed.

Resilience The capacity to cope with stress or change, and capacity to adapt.

S/T HD State and territory health departments

SARS Severe acute respiratory syndrome. A viral respiratory illness caused by a coronavirus called SARS-associated coronavirus (SARS-CoV).

SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2. The virus that causes COVID-19.

Serial interval Average length of time between an initial primary case developing symptoms and subsequent secondary cases developing systems.

SoNGs SoNGs Series of National Guidelines. CDNA National Guidelines for Public Health Units on the control of communicable diseases.

TGA Therapeutic Goods Administration

WHO World Health Organization

WoG Whole of Government

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