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COVID-19 Healthcare Briefing:How to Navigate COVID Snakes and Ladders

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I n t r o d u c t i o n 2

Across the globe, countries are navigating through a painstaking game of COVID snakes and ladders as they look to contain the crisis and re-open their economies. In this report we provide:

a) Our international COVID-19 outlook with key insights on how COVID is playing out in both the developed and developing world

b) Our Australian COVID-19 outlook with key insights from both a health and economic perspective

c) Insights into how countries can successfully navigate their way through their COVID snakes and ladders in the coming months

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INTERNATIONAL COVID-19 HEALTHCARE UPDATE

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Confirmed cases is likely to be significant under-estimate of actual cases given the low levels of testing globally

There are now over 3.8 million confirmed cases of COVID-19 and 269,267 deaths globally

Source: Johns Hopkins Coronavirus Resource Centre

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T h e U n i t e d K i n g d o m i s f a s t b e c o m i n g t h e w o r s t a f f e c t e d n a t i o n i n E u r o p e

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Source: Our World in Data

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Confirmed cases is likely to be significant under-estimate of actual cases given the low levels of testing globally

Source: Johns Hopkins Coronavirus Resource Centre

*Source: National Geographic

USA COVID-19 deaths have now surpassed American fatalities in the Vietnam War*

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A r o u n d t h e w o r l d , m i s i n f o r m a t i o n a b o u t t h e v i r u s i s s p r e a d i n g f a s t a n d p r o v i n g d a n g e r o u s

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P o o r e r c o u n t r i e s h a v e l e s s c a p a b i l i t y t o p e r f o r m m a s s - t e s t i n g

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W i t h o u t t h e r e s o u r c e s t o t e s t a n d c o n f i r m C O V I D - 1 9 , p o o r e r c o u n t r i e s a r e u n a b l e t o r e c o g n i s e t h e s e v e r i t y o f t h e v i r u s

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Source: The Economist

Whilst total unexpected deaths significantly increased in March, very few were attributed to COVID-19, suggesting there is severe under-reporting of COVID-19 related deaths

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E x c e s s d e a t h s g l o b a l l y s u g g e s t d e a t h t o l l s u n d e r - c o u n t t h e t r u e n u m b e r o f C O V I D - 1 9 f a t a l i t i e s

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Source: The Economist

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W h i l s t v i t a l l y i m p o r t a n t , n a t i o n a l C O V I D -1 9 a p p s a r e n o s i l v e r b u l l e t & m u s t b e c o m p l e m e n t e d w i t h m a n u a l t r a c k & t r a c i n g

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Many countries are introducing COVID-19 tracking apps.

Whilst these initiatives should be embraced (especially once early technical glitches are ironed out) they must be complemented with significant investment in manual track and tracing efforts.

Effective contact tracing requires trust and community networks and needs to enable access to people who may not have access to the technology, including the groups identified below:

People with language barriers

People with no address

People without access to technology

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AUSTRALIAN COVID-19 HEALTHCARE UPDATE

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13As of 08 May, there have been 6,896 confirmed cases of COVID-19 in Australia and 97 people have died*

* Source 1: Australian Department of HealthSource 2 : Map from Johns Hopkins Coronavirus Resource Centre

* Our headline figures are based on the latest Australian Department of Health figures – note there is a slight discrepancy between these numbers and the Johns Hopkins numbers shown in the above dashboard

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A u s t r a l i a h a s a c h i e v e d w h a t m a n y c o u n t r i e s a r o u n d t h e w o r l d a r e s t r u g g l i n g t o – a f l a t t e n e d c u r v e

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* Source 1: Australian Department of Health

Cumulative Confirmed COVID-19 Cases

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A u s t r a l i a ’ s g r o w t h f a c t o r n e e d s t o b e c a r e f u l l y m o n i t o r e d a s i t h a s n u d g e d a b o v e 1

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The growth rate needs to be carefully monitored when considering the easing of restrictions.

As long as new cases can be accounted for by known localised clusters, a small uptick in the growth rate is not a major cause for concern.

However, if rates of unexplained community acquired infections begin to quickly rise, this will likely lead to re-introduction of restrictions.

Source – ABC News

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T o k e e p R b e l o w 1 w e m a y s e e a ‘ d a n c e ’ w h e r e r e s t r i c t i o n s ‘ s t e p ’ b a c k w a r d s a n d f o r w a r d s s e v e r a l t i m e s

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Source – Medium

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A s t h e i m m e d i a t e h e a l t h t h r e a t d i m i n i s h e s , A u s t r a l i a n s a r e i n c r e a s i n g l y f o c u s i n g o n e c o n o m i c c o n c e r n s

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Source – McKinsey & Company

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A u s t r a l i a n c o n s u m e r c o n f i d e n c e i n h o u s e h o l d f i n a n c e s a n d e c o n o m i c c o n d i t i o n s i s r e t u r n i n g f r o m r e c o r d l o w s

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Source: Grattan Institute

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C O V I D - 1 9 s h u t d o w n s h a v e h i t b u s i n e s s c o n f i d e n c e h a r d – w i t h t w o - t h i r d s o f b u s i n e s s e s e x p e c t i n g a r e d u c t i o n i n t u r n o v e r o r c a s h f l o w i n t h e n e x t 2 m o n t h s

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Source – Australian Bureau of Statistics

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T h e l a c k o f m i g r a n t s c o m i n g t o A u s t r a l i a w i l l n e g a t i v e l y i m p a c t o u r e c o n o m y

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4 benefits of migration in Australia:

Temporary migrants (e.g. international university students and working holidaymakers) contribute significantly to Australia’s tertiary education and agricultural industries.

Counteracts an ageing population

Fills skill gaps within the workforce

Makes Australia economically stronger

Creates jobs and improves workforce participation rate

Source – Australian Chamber of Commerce and IndustrySource: Guardian Australia

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21F u r t h e r m o r e , s c h o o l c l o s u r e s c a n c a u s e l o n g - t e r m e f f e c t s w i t h m a n y c h i l d r e n ' s e d u c a t i o n d i s r u p t e d

• Nearly half (46%) of Australian children and teenagers are vulnerable to adverse effects of their educational outcomes, nutrition, physical movement, social & emotional wellbeing by being physically disconnected from school

• School closures affect younger students the most as they learn far more when digital study is supervised by an adult

Not considered vulnerable

Families supporting learning in the early years

Working families in COVID-19 context

Newly disadvantaged due to COVID-19 context

Facing persistent disadvantage

Severe social and educational exclusion

46% of Australian children and teenagers are vulnerable to

their education being negatively

impacted from the pandemic

Source – The EconomistSource – Peter Underwood Centre for Educational Attainment and the University of Tasmania

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H e a l t h s e r v i c e a t t e n d a n c e h a s d e c r e a s e d s i g n i f i c a n t l y w h i c h m a y r e s u l t i n l o n g e r -t e r m h e a l t h i s s u e s

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“There is a real risk that we could see a significant upswing in mortality after the pandemic due to deaths from preventable illnesses”

- Dr Chance PistollGP and Melbourne Medical School lecturer

Source: Sydney Morning Herald

GP Practices have reported a 20-30% reduction in patients

There has been a 75% reduction in diabetes tests ordered by GPs in VIC and NSW

New cancer diagnoses have fallen by around a third

Presentations to hospital Emergency Departments have also decreased

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A s A u s t r a l i a h e a d s i n t o w i n t e r , m a n y a r e w o r r i e d h o w t h i s m a y e f f e c t C O V I D - 1 9 c a s e s

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There have not been enough reliable studies to say how COVID-19 responds to temperature and humidity, however, winter may have the following effects:

Winter may give COVID-19 the opportunity to disguise itself as a bad flu or cold

People may be less able to fight the virus due to reduced immunity

People will spend more time together in close proximity indoors

Source: SBS News

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O p p o r t u n i t i e s h a v e e m e r g e d t o a d a p t o u r w o r k p l a c e s a n d h e a l t h c a r e s y s t e m t o w a r d s a n i n c r e a s i n g l y v i r t u a l f u t u r e

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• Having been thrust into the largest remote working experiment, many companies have been able to stress test a remote working set-up and discover pain points to fix within the process

• Furthermore, some companies have found that business travel can, in fact, be replaced by teleconferencing technologies

• The growth of telehealth during the pandemic has helped ease delivery of care and could lead to a permanent shift to utilising such technologies in healthcare

• This particularly benefits patients who find it difficult to access such services, including rural and remote, aged care or Aboriginal medical service settings

Source – ForbesSource: Royal Australian College of General Practitioners

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How to navigate COVID snakes and ladders

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80 79 78 77 76 75 74 73 7172

61 62 63 64 65 66 67 68 7069

60 69 68 67 66 65 64 63 6162

41 42 43 44 45 46 47 48 5049

40 39 38 37 36 35 34 33 3132

21 22 23 24 25 26 27 28 3029

20 19 18 17 16 15 14 13 1112

1 2 3 4 5 6 7 8 109

V A C C I N E

T R A C K & T R A C I N G ( V I R T U A L & P H Y S I C A L )

M A S S T E S T I N GA N T I V I R A L S

D I G I T A L E N A B L E M E N T

P R I O R I T I S EP P E F O R

F R O N T L I N E W O R K E R S

U N C O N T R O L L E D O U T B R E A K S

M I S I N F O R M A T I O N

L E A R N I N G T H E

W R O N G L E S S O N S

R E - I M P O R T I N GI N F E C T I O N S

U N C O O R D I N A T E D H E A L T H R E S P O N S E

26C o u n t r i e s n e e d l e a d e r s h i p , e m p a t h y , j u d g e m e n t a n d g o o d f o r t u n e t o c l i m b t h e C O V I D l a d d e r s w h i l s t a v o i d i n g t h e s n a k e s

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C o u n t r i e s c a n l e a r n f r o m g l o b a l e x p e r i e n c e t o a c c e l e r a t e t h e i r c l i m b u p t h e C O V I D l a d d e r s

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LADDE RS HOW T O A C CELER ATE UP TH E L A DDERS

V A C C I N E

Support calls for Australia to join the global effort to develop an effective vaccine and facilitate accelerated worldwide production and distribution (note more than $8Bn has been pledged by world leaders this week to develop a vaccine)

A N T I V I R A L SSupport investment into the rapid development and deployment of effective anti-virals and other treatments proven to assist recovery

M A S S - T E S T I N GParticipate in mass testing campaigns including asymptomatic people to allow population level surveillance

T R A C I N G A P P

Download the COVID-19 tracing app and encourage others to do so - recognising that (a) technical glitches need ironing out and (b) there are inevitable trade offs between individual privacy and community safety

D I G I T A L E N A B L E M E N T

Support the use of digital applications such as telehealth to improve the safety and reach of healthcare services

A V A I L A B L E P P EPrioritise Personal Protective Equipment for frontline clinical staff and key workers across industries to reduce their risk of contracting the virus

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C o u n t r i e s n e e d t o a v o i d s l i p p i n g d o w n C O V I D s n a k e s w h i c h a r e n o w m u c h b e t t e r u n d e r s t o o d

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SNAKE SHOW T O P R EVENT SL I DING DOW N THE SNAKE S

MITIG ATI O N STR ATE G Y EXAMP LE

M I S I N F O R M A T I O NEnsure information about the virus is backed by credible science

Using advice from health experts to debunk misinformation e.g. refuting disinfectant as a cure

U N C O N T R O L L E D O U T B R E A K S

Identify and suppress outbreaks early through proactive testing, tracing and interventions e.g. national surveillance monitoring of high-risk groups such as frail elderly in aged care homes

Measures used to contain the recent outbreak in North-West Tasmania

R E - I M P O R T I N G I N F E C T I O N

Maintain effective border control e.g. compulsory quarantine of all entrants

Measures being proposed for the reopening of travel between Australia and NZ- aka the ‘Trans-Tasman Bubble’

L E A R N I N G T H E W R O N G L E S S O N S

Fostering a national mindset based on increasing trust, community support, collaboration and integration with a focus on continuous quality improvement

Enquiry into the circumstances that led to the release of passengers on the Ruby Princess cruise ship without screening

U N C O O R D I N A T E D H E A L T H R E S P O N S E

Regions develop mechanisms for interagency and intersectoral health system working

The South Australian approach linking hospital, general practice and aged care responses

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W h i l s t e v e r y c o u n t r y m u s t c a r e f u l l y n a v i g a t e t h e i r o w n C O V I D s n a k e s a n d l a d d e r s , t h e b i g g e s t l a d d e r s c a n o n l y b e c l i m b e d t h r o u g h m e a n i n g f u l g l o b a l c o o p e r a t i o n

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• Countries are playing a painstaking game of COVID snakes and ladders

• Internationally we continue to see a desperate situation in the developing world, with mass under-reporting of cases and COVID-19 related deaths

• Many countries are falling down COVID snakes, such as spreading misinformation, under-testing, under-reporting and reimporting infections

• In Australia, we anticipate a ‘dance’ in the coming months as restrictions fluctuate between being relaxed and then re-imposed as outbreaks disappear and reappear

• Successful reopening of the economy will depend on our ability to step up surveillance efforts, whilst maintaining high levels of community cohesion and trust so that new outbreaks can be quickly identified and quashed (a blame mentality will be unhelpful)

• Countries that successfully climb the COVID ladders whilst avoiding the COVID snakes will reemerge quickest from both the health and economic crisis

• However, ultimately the biggest ladders can only be climbed through true international collaboration that brings together the best minds globally to develop the most effective anti-virals and vaccines

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Annex: Caveats and Disclaimer

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C a v e a t s 31

• This document is based on the most recent science available using trusted international and national news sources, scientific publications, scientific data aggregation sites and the views of Rebbeck Consulting

• The science around COVID-19 is constantly being tested, improved, and refined and some of the estimates and predictions provided today will inevitably be revised over time – the accurate science will only ever be known in hindsight

• Pandemics often see unpredictable waves of infection and therefore the response needs to be flexible and contingent on surveillance data

• We have provided hyperlinks to all our sources throughout this document at the bottom of each page

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D i s c l a i m e r 32

• This document has been issued by Rebbeck Consulting PTY LTD (ACN 609 606 073) (“Rebbeck Consulting”) and is provided for informational purposes only

• While every effort has been made to ensure that the information in this update is accurate, its accuracy, reliability or completeness is not guaranteed. This information does not take into account your particular needs or circumstances and is for informational purposes only. It is not intended to be a substitute for professional advice, and should not be relied on as health, personal or financial advice

• Rebbeck Consulting does not accept any responsibility for loss or damage suffered by any person or body relying directly or indirectly on any information provided in this presentation nor accepts any liability for any decisions made on the basis of the information provided

Rebbeck Consulting

Australia

+61 414 400 524

jay@rebbeckconsulting.com

www.rebbeckconsulting.com