It is Easter Sunday, the 12th April 2020, and the world is in the grips of the worst pandemic in a century.
On the 31st December 2019, just 103 days ago, China notified the World Health Organization (WHO) of an increasing number of cases of a pneumonia‐like illness of unknown cause in Wuhan City, Hubei province. The following day a local seafood market was closed after its dealers and traders were identified among the patient cohort. On 7th January 2020, a novel coronavirus was identified as the causative agent. Initially named 2019‐nCoV, the virus was from the same family as the agents that caused previous severe respiratory illness outbreaks: SARS in Asia in 2002 and MERS in the Middle East in 2012.
Case numbers in China increased rapidly and the first deaths from the illness were reported on 9th January. On 12th January China shared the genetic sequence of the novel virus, enabling other countries to test and track potentially infected people. Within days cases were identified in nearby countries including Thailand and Japan then, on the 20th January, came the first reports of cases in South Korea and the United States.
On 23rd January WHO confirmed human‐to‐human transmission of the virus. At this stage, while there were 222 reported cases in China, including several healthcare workers, and four reported deaths, the WHO Director‐General decided not to declare the 2019‐nCoV (later to be renamed SARS‐CoV‐2) outbreak a public health emergency of international concern. However, Chinese authorities closed the public transport system in Wuhan and several cities went into lockdown that day.
On the 25th January Australia, together with Malaysia, France and Canada, reported their first cases, followed by India and the Philippines on the 30th January. With Chinese cases pushing the 2000 mark, the WHO Director‐General reversed the previous decision and declared the 2019‐nCoV (COVID‐19) outbreak a public health emergency of international concern, noting the disease’s spread to countries with weak health systems. Now, we were dealing with a pandemic.
At the time of writing there have been 1.8 million cases of COVID‐19 disease reported globally, with more than 108 000 deaths reported across 210 countries. Accurate global numbers are lacking but healthcare workers have accounted for 9% of Italy's COVID‐19 cases. The ravages of COVID‐19 are being felt in both rich and poor countries and we have no proven medicines to modify the course of the disease, nor a vaccine to control its spread. Our preventative measures rely upon the strategies humanity has used to control epidemics for centuries – quarantining infected individuals and imposing strict social isolation upon the healthy to reduce transmission. Both globally and locally, early signs of the effectiveness of these measures are emerging although the death‐rate remains shockingly high at 7000 per day. Our understanding of the transmission of infectious diseases and the time‐course of COVID‐19 infection tells us, clearly, that this pandemic will continue into the foreseeable future.
In Australia, the pattern of COVID‐19 disease has largely been driven by the numbers of infected people arriving by air and sea, although transmission within the community is accounting for an increasing proportion of new cases. Our governments, both Federal and State and Territory have imposed strict and far‐reaching controls to limit the spread. Equally, much planning and preparation has gone into equipping our health system to manage the anticipated, and now emerging surge of COVID‐19 cases, especially the severe and critically ill which we expect to account for about 5% of cases.
No one in this country is unaffected and for the nation's healthcare worker the impacts are profound. Our pharmacy departments have had teams broken up and separated, many of us are working remotely, and our roles and tasks have changed. We are developing new ways to provide vulnerable patients with the medicines, information and education they need to allow them to stay distanced and safe, including through the novel use of digital technologies. Others among us are preparing for increasing numbers of severe and critically ill patients in units with increased ventilator numbers and in newly, or yet to be commissioned stand‐by Intensive Care and High Dependency Units. Some are assisting to establish a ventilator capacity in hospitals that have never managed this level of acuity before. Others still are refocussed on managing the human resources, or medicines procurement necessary to respond to a surge in demand, but with certain disruption to the availability of both these crucial resources.
A colleague recently said to me, with some reservation I feel, they had a sense of anticipation and excitement in their seconded role with new and broad reaching responsibility. I agreed, understanding their attitude and sense of expectancy, adding that this state of mind should not bring any sense of misgiving. The cards have been dealt and the challenge is set. It is now up to us to play our hand as best we can, no matter how difficult this proves to be. We have, I hope, a once in a professional life‐time challenge and therefore the opportunity to be the best we can as individuals and as a profession in the most uncertain of times.
Against this backdrop, the Society of Hospital Pharmacists of Australia (SHPA) has swung into action, with a near‐total operational pivot toward ensuring our hospitals, and our hospital pharmacists, are resourced in every way conceivable for the months ahead.
On 12th March, when diagnosed cases in Australia totalled only 161, our first all‐member COVID‐19 update unveiled the COVID‐19 information hub, followed five days later by the COVID‐19 member forum. Unlike existing Specialty Practice pages, we opened the COVID‐19 forum to non‐members and international pharmacists, given the scale and urgency of the crisis and SHPA’s commitment to the free flow of vital information in the interests of patient care.
Synthesising key conversations on the forum, SHPA's COVID‐19 Webinar Series has seen record numbers of (virtual) delegates, tuning in from more than 12 countries, and SHPA’s entire education program has been reconfigured to optimise access in our new socially distant reality.
Bringing the expertise of our leading members together, twice‐weekly COVID‐19 Director of Pharmacy meetings informed the live COVID‐19 Hospital Pharmacy Preparation Checklist document, available to all departments nationally.
Also in March, SHPA was the first to call for willing and available pharmacists to register their interest in supporting understaffed hospitals, attracting over 800 sign‐ups. The COVID‐19 Hospital Pharmacy Relief Register was subsequently energised by state‐based registers and automatic Ahpra re‐registration for those who have recently left pharmacy practice.
To broaden its effectiveness, pharmacists on the Relief Register with less than six months hospital experience were invited to complete free COVID‐19 Hospital Pharmacy Relief: Introductory Training, while a free COVID‐19 Hospital Pharmacy ICU Upskilling Package was also released by SHPA at the start of April.
While our advocacy efforts cover more than ten distinct areas of policy change, each evolving rapidly, our COVID‐19 Emergency Supply of Medicines Quick Guides have ensured pharmacists have instant access to the latest and most relevant information for their state. Most importantly, we have a strong voice at the table regarding the two critical areas of medicines supply and clinical practice, with representation on the TGA Medicines Shortages Working Group and the National COVID‐19 Clinical Evidence Taskforce.
Of course, this is only the beginning.
Just as we are in for the long haul living under new transmission mitigation measures, and as the pressure on hospital staffing, medicines supply and resources will be high for a considerable time to come, SHPA is steadfast in its commitment to our members, their colleagues and the Australians in their care.
COVID‐19 has been shocking in its immediacy and voracity. However, it is my great honour to lead an organisation that has embraced the challenges posed by this pandemic, just as the passion and commitment of the hospital pharmacy workforce has risen around the country.
As it has been for more than sixty years, SHPA is in lockstep with Australia's hospital pharmacists and technicians, proudly fighting for the profession and lifting up every individual.
I believe we will get through this, together, and we will emerge on the other side, stronger.