metro north covid-19 response plan...the purpose of this pandemic response plan (metro north...

1 May 2020 Printed versions are uncontrolled

Metro North Hospital and Health Service

COVID-19 Response Plan Seventh Edition 1 May 2020

1 May 2020 Printed versions are uncontrolled of 53

Version control

Version Date released 1 17 March 2020 2 27 March 2020 3 3 April 2020 4 9 April 2020 5 17 April 2020 6 24 April 2020 7 1 May 2020

Published by the State of Queensland (Metro North Hospital and Health Service), May 2020


This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au © State of Queensland (Metro North Hospital and Health Service) 1019 You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Metro North Hospital and Health Service). For more information, contact: Metro North Emergency Management and Business Continuity, Metro North Hospital and Health Service, Block 7, RBWH, Herston QLD 4029, email [email protected], phone 07 3646 3743.

Disclaimer:

The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.

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Contents Contents ........................................................................................................................................................................... 4

Abbreviations ................................................................................................................................................................... 6

1 Introduction....................................................................................................................................................... 8 1.1 Situation .............................................................................................................................................................. 8 1.2 Purpose .............................................................................................................................................................. 8 1.3 Authority ............................................................................................................................................................. 8 1.4 Scope ................................................................................................................................................................. 9 1.5 Assumptions ....................................................................................................................................................... 9

2 Pandemic phases ........................................................................................................................................... 10 2.1 National and State policy decisions ................................................................................................................. 11

3 Overview of risk and modelling .................................................................................................................... 13 3.1 Demographic modelling .................................................................................................................................... 14 3.2 Infrastructure .................................................................................................................................................... 15

4 Community and Stakeholder engagement .................................................................................................. 15

5 Roles and responsibilities ............................................................................................................................. 16

6 Activation ........................................................................................................................................................ 17 6.1 Command and communication......................................................................................................................... 17 6.2 Reporting .......................................................................................................................................................... 18

7 Response ........................................................................................................................................................ 18 7.1 Triggers and response activity ......................................................................................................................... 18 7.2 Human resources ............................................................................................................................................. 31 7.3 Aboriginal and Torres Strait Islander people .................................................................................................... 36 7.4 Vulnerable groups ............................................................................................................................................ 37 7.5 Financial management ..................................................................................................................................... 39 7.6 Private Hospitals .............................................................................................................................................. 40 7.7 Influenza ........................................................................................................................................................... 40


8 Control ............................................................................................................................................................. 40

9 Recover ........................................................................................................................................................... 41

Appendix 1: Intelligence Sources ................................................................................................................................ 42

Appendix 2: National and State policies ..................................................................................................................... 44

Appendix 3: Metro North HHS Aboriginal and Torres Strait Islander Health Unit’s COVID Response Plan ........ 48

Appendix 4: Resources for people with disabilities .................................................................................................. 51


Abbreviations AEFI Adverse Events Following Immunisation AHPCC Australian Health Protection Principle Committee BAU Business as Usual CE Chief Executive, Metro North Hospital and Health Service CHO Chief Health Officer CISS Community, Indigenous and Sub-acute Services DDC District Disaster Coordination (Queensland Police Service) DDMG District Disaster Management Group EMP Emergency Management Plan EOC Emergency Operations Centre ERP Emergency Response Plan GP General Practitioners HC Hospital Commander HEOC Metro North Hospital and Health Service Emergency Operations Centre HIU Health Improvement Unit HIC Health Incident Controller HLO Health Liaison Officer IAP Incident Action Plan ICT Information and Communication Technology ICU Intensive Care Unit ILI Influenza-like Illness IMS Incident Management System IMT Incident Management Team LDMG Local Disaster Management Group MN – EMC Metro North Emergency Management Committee MN – EMP Metro North Hospital and Health Service Emergency Management Plan MN - EMU Metro North Emergency Management Unit MN – ERP Metro North Hospital and Health Service Emergency Response Plan MN – IMT Metro North Hospital and Health Service Incident Management Team MN Metro North MNHHS Metro North Hospital and Health Service MNPHU Metro North Public Health Unit MOU Memorandum of Understanding NDIS National Disability Insurance Scheme NDRRA Natural Disaster Relief and Recovery Arrangements NMS National Medical Stockpile PACH Patient Access and Coordination Hub PCR Polymerase chain reaction PPE Personal Protective Equipment


QAS Queensland Ambulance Service QDMA Queensland Disaster Management Arrangements QHIMS Queensland Health Incident Management System RACF Residential Aged Care Facilities RBWH Royal Brisbane and Women’s Hospital SET Senior Executive Team (Metro North Hospital and Health Service) SHECC State Health Emergency Coordination Centre SITREP Situation Report SMEAC Situation, Mission, Execution, Administration, Communication TPCH The Prince Charles Hospital


1 Introduction

1.1 Situation In December 2019, China reported cases of viral pneumonia caused by a previously unknown pathogen that emerged in Wuhan, China. The pathogen was identified as a novel (new) coronavirus (recently named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)), which is closely related genetically to the virus that caused the 20003 outbreak of Severe Acute Respiratory Syndrome (SARS). SAR-CoV-2 causes the illness now known as Coronavirus disease (COVID-19). Currently, there is no specific treatment, vaccine or antiviral against new virus.

1.2 Purpose The purpose of this pandemic response plan (Metro North COVID-19 Response Plan (MN-COVID-19-PLAN)), is to ensure continuity of health services and minimise the community impact within Metro North Hospital and Health Service (Metro North HHS) of COVID-19. Given the rapid rate that the situation is changing, this will remain a live document updated as decisions are made throughout the pandemic. The strategic objectives for Metro North HHS in response are:

• the safety of staff by minimising risk to staff responding to COVID-19 through appropriate training, personal protective equipment (PPE) and infection control practices

• the safety of community by minimising the transmission of COVID-19 within the Metro North community and within healthcare settings through proactive identification and testing, effective infection control activities, and community messaging

• ensuring the HHS maintains critical services continuity

• maximise the health outcomes of peoples with COVID-19.

1.3 Authority The World Health Organisation (WHO) declared that outbreak of COVID-19 a Public Health Emergency of International Concern on 30 January 2020. Nationally, the Biosecurity Act 2015 and the National Health Security Act 2007 authorises activities to prevent the introduction and spread of diseases in Australia and the exchange of public health surveillance information (including personal information) between state and territory government, the Australian Government and the World Health Organisation (WHO). The Queensland Department of Health declared a public health event of state significance under the Public Health Act 2005 on 22 February 2020. The issue of Public Health Agreements are issued by designated Emergency Officers (Environmental Health Officers) under this act. The issuance of a Detention Order by an Emergency Officer (Medical) (Public Health Physicians) is also under this Act.

The Chief Health Officer (CHO) directed all health services to:


- Provide health staff to screen and conduct clinical assessment of passengers identified by Australian Border Force including the transfer of symptomatic persons to emergency departments for testing / treatment and/or supporting access to government provided accommodation where travellers are identified as not being able to isolate in the same location for 14 days.

- Via Public Health Units:

o Issue isolation agreements to travellers at points of entry who meet coronavirus case definition; suspect case definition or close contact case definition o Provide information and guidance to general practitioners and the public regarding testing and isolation requirements o Contact trace any persons who may have been in contact with confirmed cases o Support the clinical management of persons who are in isolation

- Plan for new or expanded models of care (such as telehealth, virtual medicine, hospital in the home and treatment of people with chronic conditions at home)1.

The COVID-19 response within Metro North HHS is authorised by the Health Incident Controller (HIC) under the Metro North Emergency Management Plan.

1.4 Scope This pandemic response plan covers the health sector response to COVID-19 to ensure the continued delivery of critical clinical services to existing patients and the Metro North community. This plan is supported by detailed subplans for Directorates, clinical streams and corporate functions.

1.5 Assumptions This plan was developed based on the following assumptions:

• the incubation period of COVID 19 is up to 14 days (in line with current WHO advice) • routes of transmission will be via large droplet or fomite route • Metro North HHS will comply with national and state rules regarding identifying, testing, self-isolation and clinical management for COVID-19 • telecommunication networks (or adequate redundancies) are operating • the Queensland Health ICT Network remains operational • support services (e.g. Australian Red Cross Blood Bank, eHealth, Health Support Queensland (HSQ) (including linen and central pharmacy), Queensland Urban

Utilities, Unity Water and ENERGEX) remain available albeit at potential reduced capacity • there will be impacts to Metro North HHS staffing • Metro North HHS will participate in Local Disaster Management Group and District Disaster Management Group activities.

1 25 February 2020


2 Pandemic phases

Phase Description

ALERT OS3

A novel virus with pandemic potential causes severe disease in humans who have had contact with infected animals. There is no effective transmission between humans. Novel virus has not arrived in Australia.

DELAY OS4/OS5/OS6

Novel virus has not arrived in Australia. OS4 Small cluster of cases in one country overseas. OS5 Large cluster(s) of cases in only one or two countries overseas. OS6 Large cluster(s) of cases in more than two countries overseas.

CONTAIN AUS 6a - January 2020

Pandemic virus has arrived in Australia causing small number of cases and/or small number of clusters.

SUSTAIN AUS 6b – 25 March 2020 (Metro North HHS)

Pandemic virus is established in Australia and spreading in the community.

CONTROL AUS 6c Customised pandemic vaccine widely available and is beginning to bring the pandemic under control.

RECOVER AUS 6d Pandemic controlled in Australia but further waves may occur if the virus drifts and/or is re-imported into Australia.

Note 2008 Australian Phases version used over 2019


2.1 National and State policy decisions National and State policies published prior to 20 April 2020 are listed in Appendix 4. On 20 April 2020:

• The Director-General of WHO announced: o WHO is providing technical, scientific and financial support for the rollout of sero-epidemiological surveys globally o WHO is working with partners such as the Fountain for the Innovative New Diagnostics, and the Clinton Health Access Initiative to increase the production

and equitable distribution of diagnostics to nations in need. o WHO is leading research and development efforts with over 100 countries participating in the Solidarity Trial to evaluate therapeutics for COVID-19. 1,200

patients have been randomised from the first five countries. It is anticipated that more than 600 hospitals will be ready to start enrolling patients this week. On 21 April 2020:

• National Cabinet met and agreed that from 27 April 2020 category 2 and some important category 3 procedures can recommence across the public and private sectors. They agreed that the following procedures can recommence:

o IVF o Screening programs (cancer and other diseases) o Post cancer reconstruction procedures (such as breast reconstruction) o Procedures for children under 18 years of age o Joint replacements (inc knees, hips and shoulders) o Cataracts and eye procedures o Endoscopy and colonoscopy procedures.

• Dentists can move from level 3 back to level 2 restrictions (such as fitting dentures, braces, non-high speed drilling fillings and basic fillings). • Noted data confirming measures have succeeded in slowing and reversing the growth of cases in Australia. • Noted that the National Medical Stockpile does not replace state, territory or private process to source and deliver PPE to meet their needs. • Restates the principles regarding visits to residential aged care facilities (RACF), discussed the lessons learnt from recent outbreaks in RACFS and acknowledged

the importance of infection prevention and control measures. • Re-emphasised the one person per four square metres rule does not apply to classrooms. • The Australian Government is finalising the development of a voluntary Coronavirus tracing app to help map the spread. The app has been modelled closely on a

similar Singaporean Government app and will: o Digitise the current contract tracing that public health officials manually carry out when an individual tests positive to Coronavirus. o Identify close contact with an infected person when contact is made for a period of 15 minutes or more o Be subject to a Privacy Impact Assessment, the highest level of cyber security assurance, and is only available to health professionals for identifying people

at risk of CVOID-19. The information of close contacts will: Only be shared with health authorities after an individual has tested positive to coronavirus and consents to it, mirroring current information provided

to public health officials during contract tracing. Be fully encrypted and stored securely and anonymously on the mobile phone (cannot be access by anyone, including the user).

• New Chief Health Officer Public Health Directions: non-essential business, activity and undertaking closure direction no. 6 – under this direction: o An exception has been provided to the ban on massage therapy that is for the management or prevention of a disease, injury or condition. o Clarity regarding attendees at funerals, maximum of 10 mourners and 3 funeral officials o Clarity regarding religious services, maximum of 5 people may attend, including officials and if relevant, camera operator o Direction No. 6 replaces the Non-essential business, activity and undertaking closure direction no.5.

On 22 April 2020:


• Queensland Parliament passed the Appropriation (COVID-19) Bill 2020 which provides funding of more than $4 billion over two years for emergency measures to support Queenslanders, the business community and the industries which will deliver the State back to economic prosperity after the coronavirus pandemic.

• The Premier announced that there is no need for Queensland aged care homes to be in lockdown, advising that families should be able to visit their loved ones. • From 1 May 2020 visitors to residential aged care facilities must be up-to-date with an influenza vaccination, if the vaccination is available to them.

On 24 April 2020: • The Chief Health Officer and Queensland Minister for Health announced expanded testing will be implemented across the whole state for anyone who had a fever

(or history of fever) OR acute respiratory symptoms. • A new public health direction ‘Point of Care Serology Tests’ was published on the Queensland Health website, which provides advice on who is permitted to

administer point of care serological (blood) testing. • National Cabinet met and received an updated briefing on new modelling, Australia’s case detection rate (93 per cent) and projections of case numbers (below lower

bound modelled estimates); o Noted data that confirms success of implemented measures in slowing and reversing the growth of cases in Australia; and o AHPPC advice that wearing of face masks by the general population is not currently recommended o Discussed the outbreaks of COVID-19 in residential aged care facilities and reiterated AHPPC advice to not implement complete lockdowns or bans of visitors

other than during a specified facility outbreaks; and o Agreed to nationally expand testing criteria to all people with mild COVID-19 symptoms o With updated AHPPC advice that the “venue density rule” of no more than one person per four square metres is not appropriate or practical in schools, nor

maintaining 1.5 metre between students during classroom activities; o To develop nationally-consistent, industry-specific work health and safety guidance on COVID-19, accessible via a central hub provided by Safe Work

Australia; and o The “National COVID-19 Safe Workplace Principles”.

• The Minister for Health announced that online and phone support services for people experiencing drug and alcohol problems will receive an additional $6 million from the Australian Government during the COVID-19 pandemic.

• The Minister for Aged Care and Senior Australians announced that Commonwealth Home Support Programme providers are being supported to fund personal monitoring technology for Senior Australians during self-isolation.

• The Minister for Aged Care and Senior Australians and the Minister for Communications, Cyber Safety and the Arts announced the availability of free daytime webinars to help improve the online skills of Senior Australians.

On 25 April 2020: • Testing criteria expanded to be conducted on anyone who presents with a fever (or history of fever) OR acute respiratory symptoms. A person being tested should be

isolated pending test results. On 28 April 2020:

• The CHO Public Health Direction for o Self-isolation for Diagnosed Cases of COVID-19 Direction (No.2) clarifies that a further direction to self-isolate me be given for persons still symptomatic 14

days after a COVID-19 diagnosis; and aligns the meaning of “emergency” for which a person can leave their place of isolation with that used in other Directions.

o Restricted Access to Designated Areas Direction (No.2) has been updated to provide exemptions from the requirement to self-quarantine upon entry into a designated area if a person has been in a COVID-19 hotspot. The exemptions provided are consistent with the exemptions in the Border Restriction Direction (No. 4).


3 Overview of risk and modelling Metro North HHS has a local population of over one million people (1,046,494 - 2019 preliminary estimated resident population), in an area stretching from the Brisbane River to north of Kilcoy. Clinical services are provided at The Royal Brisbane and Women’s (RBWH), The Prince Charles Hospital (TPCH) Redcliffe Hospital, Caboolture Hospitals, Kilcoy Hospital and at the Woodford Correctional Facility. Mental health, oral health, Indigenous health, subacute services, medical imaging and patient services are provided across many sites including hospitals, community health centres, residential and extended care facilities, and mobile service teams. Metro North HHS has a dedicated Public Health Unit.


There are 341 general practices in the Metro North HHS region2. Over one quarter of general practices (26.1 per cent or 89 practices) are located in the Brisbane Inner City sub region, followed by the Brisbane North sub region, with 19.6 per cent (67 practices). There is a total of 7,113 residential aged care places in the region, representing 73 residential aged care places per 1000 people in the region3. There are 23 private hospitals in Metro North, 7 hospitals with general overnight beds, 14 with day surgery facilities and 3 mental health facilities.

Hospitals overnight beds Day surgery facilities Mental Health facilities Brisbane Private Hospital Caboolture Private Hospital Peninsula Private Hospital St Andrew's War Memorial Hospital St Vincent’s Private Hospital Northside The Wesley Hospital North West Private Hospital

Chermside Day Hospital Eye-Tech Day Surgeries Marie Stopes Australia Bowen Hills Day Surgery Montserrat Day Hospitals (Indooroopilly) Moreton Day Hospital North Lakes Day Hospital Pacific Day Surgery Centre Queensland Eye Hospital Rivercity Private Hospital Samford Road Day Hospital Spring Hill Clinic Spring Hill Specialist Day Hospital Westside Private Hospital

New Farm Clinic Pine Rivers Private Hospital Toowong Private Hospital

3.1 Demographic modelling The Metro North HHS population was estimated at 1,046,494 in June 2019. The WHO provided demographic modelling related to estimated incidence of COVID-19 early in the pandemic. However, the incidence of transmission seen in Europe and America has not been realised in Australia. The Australian Government has produced modelling, and this continues to be refined and applied to the Australian context. On 1 May 2020 there were 1,033 confirmed cases of COVID-19 in Queensland, including 6 deaths. Confirmed cases for Metro North HHS were 325 (0.03% population). Over the course of the event 90 patients have been admitted to a hospital bed (28%) and 6 patients have been admitted to an ICU bed (1.8%). There have been 3 deaths (0.9%). On 1 May 2020 Metro North HHS COVID-19 related activity was as follows.

2 Brisbane North PHN, 2019 3 Department of Health, 2016


Confirmed COVID-19 Cases Number of fever clinics Presentations

Virtual Ward Inpatient Ward Inpatient ICU Recovered Yesterday 23 3 3 291 4 227

3.2 Infrastructure This section provides an overview of the baseline infrastructure across Metro North HHS relevant to the pandemic response.

Total beds ED treatment spaces

ICU beds Isolation rooms

Mortuary

Metro North HHS 1,944 155 68 438 61 Adult RBWH 834 47 36 163 19 adult, 17 baby TPCH 569 56 18 209 18 Redcliffe 289 27 9 27 15 Caboolture 231 25 8 37 9 Kilcoy 21 0 0 2 0

*bed alternatives excluded

4 Community and Stakeholder engagement Given the widespread nature of the pandemic, a community-wide response will be required. In order for Metro North HHS to enact this pandemic response plan, a wide range of partners and key stakeholders will need to be communicated with and engaged with. A communication strategy has been developed to support dissemination of information to the partners and stakeholders. The key partners and stakeholders include:

• Metro North Board • Metro North and Directorate Clinical Councils • Department of Health/Chief Health Officer • Queensland Ambulance Service • Queensland Police Service (Chair of Brisbane DDMG) • Local Councils (Chairs of LDMGs – Brisbane, Somerset and Moreton Bay) • Brisbane North Primary Health Network • General Practitioners (GPs)


• Private hospitals • Community pharmacies • Aged care sector • Australian Red Cross • Public Health Units • Australian Defence Force • Non-government organisations • Critical infrastructure and suppliers • Academic institutions • Consumers • Volunteers.

Consistent, succinct and contemporaneous communication will be provided. A weekly email will be circulated from the Office of the Chief Executive to our partners with updates on activities within Metro North HHS. A twice weekly update from the Chief Executive to state and federal members of parliament has been instigated starting 3 April 2020. The Executive Director Medical Services will provide a daily update to all staff on current status and topical issues. Briefings are being provided as requested to a range of clinical and consumer groups as well as the Metro North HHS Board. The Metro North HHS intranet site is updated on a regular basis with the latest information as well as a range of factsheets and handouts to support staff and visitors. A community hotline has been established to assist switchboards to manage phone call enquiries from the general public.

5 Roles and responsibilities

In line with the Queensland Health Pandemic Plan, the Department of Health leads the overall response to pandemic within Queensland and will coordinate and direct response requirements at a system level. Metro North will coordinate and lead the implementation of response requirements at an HHS level and will support Directorates. Under the Australian Coronavirus (COVID-19) Response Plan responsibilities include, but are not limited to: Sector Partners State/HHS National Planning X X X Monitoring communicable disease activity domestically and internationally X Collecting surveillance data to contribute to national picture and state response X X Coordination of national resources X Development of new models of care and COVID-19 triage criteria X X Maintaining public health services, public hospitals and laboratories X Residential Aged Care Facilities X Contact Tracing X Coordinating distribution of pharmaceuticals X Implementing social distancing measures as per national recommendations X X X Implement infection control guidelines X X X


Sector Partners State/HHS National Establish systems to promote the safety and security of people in aged care X Develop and validate specific Coronavirus tests X Implement testing protocols to support case management X Undertake testing X X Support implementation of boarder measures X Establish and manage jurisdictional medical stockpile X

6 Activation

6.1 Command and communication Metro North HHS has activated its Emergency Management Plan and its Health Emergency Operations Centre (HEOC). All incident communication is to be via EOC accounts.

Metro North [email protected] Redcliffe [email protected] Caboolture EOC-Cab&[email protected] TPCH [email protected] COH [email protected] RBWH [email protected] Clinical support [email protected] Mental Health [email protected] Public Health [email protected]

Metro North COVID-19 planning activity is being coordinated by Metro North Planning and Strategy through the Executive Director, Planning and Strategy. This planning team is an extension of the Metro North HEOC. Eight Metro North-wide working groups have been established to coordinate planning activities, develop procedures, protocols, models of care, communication materials, digital solutions and support implementation of the plan. The working groups are: digital, workforce, service models, clinical management COVID-19, finance, procurement and logistics, infrastructure and assets, clinical operational support and partners and communication. Directorate have key contacts to lead local planning and interface with Metro North working groups. Key contacts are listed below.

Metro North [email protected] [email protected]

Redcliffe Christina Wilkinson Caboolture Scott Kitchener TPCH Michelle Gardner COH Keren Harvey RBWH Mark Mattiussi

mailto:[email protected]



Mental Health Dianne Burrows Clinical Support Adam Scott Public Health Daniel Francis

6.2 Reporting Metro North EOC is responsible for providing HHS-wide reporting to the State Health Emergency Coordination Centre (SHECC) as indicted by SHECC. This reporting is currently provided daily via [email protected] As per the Metro North Emergency Management Plan all incident reporting is to use EOC email accounts with Metro HEOC being the single point of contact for all external reporting. The SHECC Sitrep will be distributed as it is received to all Directorates via EOC email accounts, Executive Directors (Metro North and Clinical Directorates). Each EOC provides a daily Sitrep to the Metro North EOC.

7 Response

7.1 Triggers and response activity Response planning has been considered from the business as usual (BAU) state, Contain Phase, with three further escalation points Sustain Tier 1, Sustain Tier 2 and Sustain Tier 3 as the transmission of COVID-19 increases. Triggers are determined for each phase, however they may vary for each facility depending on their baseline capacity and capability. In the rapidly changing situation, a value/metric has not been applied to triggers and instead will be used as a guide for transition between Tiers. The responses are categorised into Reception - fever clinics and ED and Definitive Care - inpatient and ICU care. Fever clinics are established both onsite at acute facilities and in community locations, as well drive-through clinics and home-based testing. The ED will continue to provide care for non-COVID-19 related illnesses and trauma, as well as treatment of unwell people with COVID-19. Inpatient care is being considered for people with non-COVID-19 and people with COVID-19 and includes increasing acute medical bed capacity, isolation of positive patients where able, as well as increasing community services to support the increased service demand such as hospital in the home (HITH) and virtual wards. Residential aged care facilities (RACF) will be managed through the increased capacity of HITH with the intention to minimise any transfer from RACF’s to acute hospitals where able. In addition, ICU capacity will be increased in line with the tiered approach, drawing on physical space adjacent to the ICU’s as well as utilising surgical recovery areas. Elective procedures

BAU+/ CONTAIN SUSTAIN - TIER1 SUSTAIN - TIER 2 SUSTAIN - TIER 3



including outpatients, medical procedures, dental procedures, endoscopy and elective surgery will be reduced in a tiered approach both for increased physical capacity as well as reallocation of workforce. The Metro North HHS Virtual Ward was stood up on Saturday 14 March following the decisions that people who were positive for COVID-19 and well could be managed in their own homes. This service was managed from TPCH and RBWH and on 30 March a central service was commenced. The TPCH and RBWH services will manage existing patients then close. Category 3 and 6 elective procedures and surgery were suspended on 19 March. On Wednesday 25 March, Metro North HHS moved from Contain Phase into Sustain Tier 1. Category 2 and 5 non-urgent procedures and non-urgent dental procedures were suspended on 26 March. Breastscreen services were ceased on 30 March 2020. From 1 April all elective procedures except Category 1 and 4 were suspended. Metro North HHs libraries are closed except for virtual access. From 22 April 2020, exercise stress tests were to recommence in facilities that had temporarily ceased this service. Fever clinics at Brighton Health Campus and Caboolture Hospital will be suspended at close of business 22 April 2020 and resumed in line with demand. On 27 April 2020, Metro North HHS recommence rebooking outpatient appointments one week at a time for category 1 and 2 referrals and for long wait category 3 referrals. These appointments are to be done virtually where able. As well as resumption of category 2elective surgery and category 5 elective procedures, BreastScreen services and some oral health services. The recommencement of several services in the context of very low levels of community transmission has prompted Metro North HHS to define “Sustain Tier 0”. In addition, planning for Tier 4 and 5 responses has ben initiated. Tier 4 is activated when extreme levels of community transmission occurs, and Metro North HHS has exhausted all public sector capacity and calls on expanded access to the private sector. Tier 5 is when levels of transmission reach a crisis and a cross-HHS approach is required.

Response Contain Sustain Tier 0 Sustain Tier 1 Sustain Tier 2 Sustain Tier 3 Tier 4 Tier 5 Definition Travellers, no local

transmission Very limited community transmission

Limited community transmission

Moderate community transmission

Significant community transmission

Extreme levels of community transmission

Crisis level of transmission and response

Trigger Trigger metrics may vary hospital to hospital

presentations with influenza like illness (ILI)

• presentations to ED

• admissions to hospital

• admitted patients with COVID-19




• medical beds with COVID-19 patients

• ICU beds and acuity




• medical beds with COVID-19 patients















Response Contain Sustain Tier 0 Sustain Tier 1 Sustain Tier 2 Sustain Tier 3 Tier 4 Tier 5 Fever clinic – asymptomatic or mild/moderate ILI symptoms, Drive-through and home-based assessment capacity additional to physical spaces General Practice and IUIH respiratory clinics

In or adjacent to ED, community-based, home – increase based on demand Increase and/or reallocate staff Capacity RBWH –16 TPCH - 7 Redcliffe – 20 (8+12) Caboolture – 16 (2+8+6) Brighton – 13 Pine Rivers – 22 (2+20 drive through) Total 94 Adjusted based on demand

Adjacent to ED, community-based Capacity RBWH –16 TPCH - 7 Redcliffe – 20 (8+12) Caboolture – 16 (2+8+6) Brighton – 13 Pine Rivers – 22 (2+20 drive through) Total 94 Adjusted based on demand

Adjacent to ED, external to ED, community-based - increase based on demand Increase and/or reallocate staff Capacity RBWH - 24 TPCH – 18 Redcliffe - 26 Caboolture – 20 – (suspended on 22 April 2020). Brighton – 13 – (suspended on 22 April) Pine Rivers – 22 (2+20 drive through) Total 123 + primary care

External to ED, community-based, home – increase based on demand Increase and/or reallocate staff Capacity RBWH - 24 TPCH - 35 Redcliffe - 26 Caboolture - 12 Brighton – 13 Pine Rivers – 42 (2+40 drive through) Home based – as required Total 152 + home +primary care

External to ED, community-based clinic, home – increase based on demand Increase and/or reallocate staff Capacity RBWH - 24 TPCH - 35 Redcliffe - 26 Caboolture - 12 Brighton – 13 Pine Rivers – 60 (2+ 58 drive through) Home based – as required Total 170 + home based + primary care

External to ED, community-based clinic, home – increase based on demand Increase and/or reallocate staff Capacity RBWH - 24 TPCH - 35 Redcliffe - 26 Caboolture - 12 Brighton – 13 Pine Rivers – 60 (2+ 58 drive through) Home based – as required Total 170 + home + primary care

External to ED, community-based clinic, home – increase based on demand Increase and/or reallocate staff Capacity RBWH - 24 TPCH - 35 Redcliffe - 26 Caboolture - 12 Brighton – 13 Pine Rivers – 60 (2+ 58 drive through) Home based – as required Total 170 + home + primary care

ED – ILI patient requiring ED treatment or non-ILI patients requiring ED assessment

Repurpose locations in ED for patients with ILI symptoms e.g. fast track Increase and/or reallocate staff

identified locations in ED for patients with ILI symptoms Increase and/or reallocate staff

Relocate ED patient cohorts to alternate location outside ED e.g. fast track to OPD, to allow space for ILI patients to be separated Increase and/or reallocate staff Commence Virtual ED

Expansion of ED spaces to other locations e.g. into SSU and relocate SSU to accommodate all patients maintaining separation of patients Increase and/or reallocate staff

Expand ED spaces into adjacent areas to accommodate all patients maintaining separation of patients. Increase and/or reallocate staff. Divert patients to private sector

Expand ED spaces into adjacent areas to accommodate all patients maintaining separation of patients Increase and/or reallocate staff Divert patients to private sector – private capacity to be determined.

Expand ED spaces into adjacent areas to accommodate all patients maintaining separation of patients Increase and/or reallocate staff Divert patients to private sector and field hospital(s) – location(s) in Metro North –


Response Contain Sustain Tier 0 Sustain Tier 1 Sustain Tier 2 Sustain Tier 3 Tier 4 Tier 5 Capacity RBWH - 47 TPCH - 56 Redcliffe - 27 Caboolture – 44 Total – 174

Capacity RBWH - 59 TPCH - 63 Redcliffe - 33 Caboolture – 51 (6 COVID, 45 non-COVID) Total 206

Capacity RBWH - 59 TPCH - 63 Redcliffe - 33 Caboolture – 51 (6 COVID, 45 non-COVID) Total 206

Capacity RBWH - 74 TPCH - 85 Redcliffe – 38 Caboolture – 55 (29 non-COVID, 26 COVID) Total 252

Capacity RBWH - 108 TPCH - 95 Redcliffe – 61 (21 COVID, 40 non-COVID) Caboolture – 55 (29 non-COVID, 26 COVID) Total 319

Increase virtual ED capacity to enable calls from the public. Capacity RBWH - 108 TPCH - 95 Redcliffe – 61 (21 COVID, 40 non-COVID) Caboolture – 55 (29 non-COVID, 26 COVID) Total 319 + private sector capacity

capacity to be determined. Capacity RBWH - 108 TPCH - 95 Redcliffe – 61 (21 COVID, 40 non-COVID) Caboolture – 55 (29 non-COVID, 26 COVID) Total 319 + private sector capacity + field hospital capacity

Inpatient – COVID-19

Single rooms, isolate suspected/confirmed COVID-19 patients Capacity: RBWH: 16 TPCH: 12 Redcliffe: 4

Single rooms, isolate suspected/confirmed COVID-19 patients Capacity: RBWH: 16 TPCH: 12 Redcliffe: 4

Single rooms, isolate suspected/confirmed COVID-19 patients. Assess need for Designated 1 COVID-19. Capacity: RBWH: 36 TPCH: 72 Redcliffe: 18

Designated COVID-19 ward(s) Capacity: RBWH: 60 TPCH: 125 Redcliffe: 48

Multiple designated wards or floors or designated COVID-19 hospital Capacity: RBWH: 136 TPCH: 217 Redcliffe: 82

As for Tier 3 plus Overcensus bed areas e.g. gyms, non-clinical areas – numbers to be determined. Utilise private hospitals designated wards for COVID-19 – capacity to be determined. Capacity: RBWH: 136 TPCH: 217 Redcliffe: 82

As for Tier 4 plus establish field hospital(s) with designated COVID areas –capacity to be determined. Capacity: RBWH: 136 TPCH: 217 Redcliffe: 82


Response Contain Sustain Tier 0 Sustain Tier 1 Sustain Tier 2 Sustain Tier 3 Tier 4 Tier 5 Caboolture: 8 TOTAL: 40

Caboolture: 8 TOTAL: 40

Caboolture: 28 Community: 8 Mental Health: 24 (7 Caboolture, 7 RBWH, 10 TPCH) TOTAL: 186

Caboolture: 28 Community: 8 Mental Health: 24 TOTAL: 293

Caboolture: 58 Community: 28 Mental Health: 24 TOTAL: 545

Caboolture: 58 Community: 28 Mental Health: 24 TOTAL: 545 + overcensus + private hospitals

Caboolture: 58 Community: 28 Mental Health: 24 TOTAL: 545 + overcensus + private hospitals + field hospitals

Virtual ward – for COVID-19 Increase and/or reallocate staff

Virtual ward – for COVID-19 Increase and/or reallocate staff Capacity: 800

Virtual ward – for COVID-19 Increase and/or reallocate staff Capacity: 800

Virtual ward – for COVID-19 including RACF Increase and/or reallocate staff Capacity: 1600




Inpatient – non COVID-19

Reduce or suspend Category 3 and 6 surgery, medical and dental procedural activity Cease accepting outpatient Category 3 referrals Suspend surveillance Endoscopies unless patient is cancer sensitive Deliver virtual outpatient consultations Cease accepting Outpatients internal referral (except those that would avoid an ED presentation) Suspend or Discharge all non-

As per Contain Phase plus suspend Category 3 and 6 surgery, medical and dental procedures. Continue BreastScreen services. All non-urgent review appointments to be done virtually.

As per Tier 0 plus suspend non-urgent Category 2 and 5 surgery, medical and non-emergency dental procedural activity Cease accepting semi-urgent (Category 2) outpatient referrals Reallocate staff Repurpose surgical wards to medical wards Repurpose outpatient areas

As per Tier 1 Outpatients Category 1 Only Outsource increased scope of services to private sector

As per Tier 2 Utilise campus wide clinical areas (partner organisations) Convert non-clinical areas to clinical

As per Tier 2 – emergency activity only. 40 beds QIMRB (Nucleus Network) on Herston Campus. Utilise private hospitals for emergency medical and surgical activity only. Utilise other facilities such as Residential Aged Care Facilities – Beachmere 100 beds, Corinda – 40 beds for NDI

As per Tier 2 – emergency activity only. Utilise private hospitals for emergency medical and surgical activity only – capacity to be determined. Establish field hospital(s) for emergency activity only – possible locations TBD – capacity to be determined.


Response Contain Sustain Tier 0 Sustain Tier 1 Sustain Tier 2 Sustain Tier 3 Tier 4 Tier 5 urgent outpatient review patients back to the community Outsource elective surgery and endoscopy to private sector Increase and/or reallocate staff Review category 2 and 5 activity in line with workforce availability

and/or GEM patients still requiring medical care.

Critical services – dialysis, cancer care, maternity and neonatal care, mental health, transplant services, burns service, trauma services, emergency surgery, Category 1 and 4 surgery/procedural work – maintain

Maintain as is. Maintain activity and critical referrals in from other HHSs. HITH - 25% increase in capacity including virtual capability Increase and/or reallocate staff

Maintain activity and critical referrals in from other HHSs. HITH - 50% increase in capacity including virtual capability Increase and/or reallocate staff




ICU Maintain as is. Capacity RBWH - 36

Maintain as is. Capacity RBWH - 36

Expand in ICU footprint. Increase and/or reallocate staff Children requiring ICU treatment will be transferred via QAS to Queensland Children’s Hospital Capacity RBWH - 36 TPCH - 27 Redcliffe - 16

Expand in ICU footprint and into adjacent areas (RBWH only). Review need to expand into PACU and operating theatres. Increase and/or reallocate staff Capacity RBWH - 54 TPCH - 38 Redcliffe - 16

Expand into PACU and operating theatres. Increase and/or reallocate staff Utilise private hospital ICUs for COVID-19 patients Capacity RBWH - 82 TPCH - 50 Redcliffe - 16

Expand into other areas. Utilise private hospital ICUs for COVID-19 patients – capacity to be determined. Capacity: RBWH: 102 TPCH: 54 Redcliffe: 31

As per Tier 4. Establish field hospital with ICU capacity – capacity to be determined. Capacity: Total – 212 + private


Response Contain Sustain Tier 0 Sustain Tier 1 Sustain Tier 2 Sustain Tier 3 Tier 4 Tier 5 TPCH - 18 Redcliffe - 7 Caboolture – 7 Total - 68

TPCH - 18 Redcliffe - 7 Caboolture – 7 Total - 68

Caboolture – 8 Total - 87

Caboolture – 8 Total - 116

Caboolture – 17 Total – 165

Caboolture: 25 Total – 212 + private providers

providers + field hospitals.

7.1.1 Clinical management Rationalisation of patient contact to essential activities is paramount. Maximal use of phone/skype/video interactions should be used if physical examination is not required. The clinical spectrum of infection with COVID-19 ranges from mild disease with non-specific signs and symptoms of acute respiratory illness, to severe pneumonia with respiratory failure and septic shock. Deterioration, when it occurs is often rapid, leaving little time for discussions around appropriate levels of care. For this reason, it is wise to develop a therapeutic pathway for each patient should they deteriorate based on previously agreed “ceilings of care”. In this way there will be a clearly documented agreement around which patients will be referred to ICU. The below outlines inpatient care principles:

• For patients on the “critical care pathway” every attempt should be made to make this transition, should it be required, as smooth and predictable as possible. o Develop appropriate resuscitation plans o Detect and manage deterioration early, preferably in daylight hours o Avoid Medical Emergency Team (MET) calls, emergency Intubation and resuscitation by obtaining early ICU review

• For patients on the conservative pathway

o Ensure adherence to the AHD and avoid MET calls o Proactive, supportive discussions with patients and families should include prognostic information, the potential for reversibility of symptoms and the potential burden of non-beneficial interventions. It will help to understand the patient’s values and preferences regarding life-sustaining interventions o In such discussions avoid assumptions based on chronological age or incomplete understanding of health status. Careful consideration must be given to co-morbidities, underlying frailty, quality of life and anticipated lifespan when determining appropriate management. o Involve palliative care clinicians to help identify, triage and support patients in need of specialist palliative care management. This may include triaging patients who may benefit from transfer to a palliative care unit, transfer home (with palliative or home support if indicated), to another hospital or to an alternative care facility. o Involve GP’s, community services and outreach services as required. o Accelerate uptake of advance care planning among older at-risk populations in hospital, community settings and RACFs so that advance care plans stipulate circumstances where hospitalisation or aggressive life-support interventions in hospital would constitute forms of futile and inhumane care and unnecessary use of hospital beds.

• For patients who are resident in an RACF:


o Patients with confirmed or suspected COVID-19 who live in residential aged care facilities (RACF) should in general be managed on a conservative pathway (see above). Every effort should be made by hospital outreach services (RADAR) to support RACF staff to provide isolation and care in the resident’s “home”.

“The Queensland ethical framework to guide clinical decision making in the COVID-19 pandemic” can be found at https://www.health.qld.gov.au/__data/assets/pdf_file/0025/955303/covid-19-ethical-framework.pdf This Framework supports clinical decision making and should be used by Metro North HHS staff to assist during the pandemic.

7.1.1.1 PPE for staff It is expected staff will comply with standard precautions, including hand hygiene (5 Moments) for all patients with respiratory infections. In addition:

• patients and staff should observe cough etiquette and respiratory hygiene • comply with transmission-based precautions for patients with suspected or confirmed COVID-19:

o contact and droplet precautions for routine care of patients o contact and airborne precautions for aerosol generating procedures

• if patient transfer outside the room is essential, the patient should wear a surgical mask during transfer and follow respiratory hygiene and cough etiquette.

For most inpatient contacts between healthcare staff and patients the following PPE is safe and appropriate and should be put on before entering the patient’s room. For hospitalised patients requiring frequent attendance by medical and nursing staff, a P2/N95 mask should be considered for prolonged or very close contact.

Droplet - Contact and Standard Precautions for Standard Care i.e.:

• surgical mask • long sleeve impermeable gown • gloves • protective eyewear / face shield

Airborne - Contact and Standard Precautions for aerosol-generating procedures (for example, taking respiratory specimens, suctioning, intubation, nebulisers), patients with significant respiratory illness, or prolonged exposure (i.e. > 15 minutes face-to-face contact or in same room for > 2 hours).

• negative pressure room where possible • P2 / N95 mask • long sleeve impermeable gown • gloves • protective eyewear / face shield.

PPE Clinical Advisory Group (CAG) has endorsed the guideline that outlines the levels of PPE to ensure the safety of staff and our patients when interacting during the COVID-19 pandemic. The guideline includes when to use standard infection control measures, when to COVID-19 specific measures of contact and droplet precautions or contact and airborne precautions. Videos and vidcasts are being established for staff to assist and support interpretation and application of the guidelines. The guidelines are reviewed and updated weekly by the CAG. Metro North HHS has commenced creating in house supply chain for PPE with three streams of work:

1. Faceshields - TGA approval obtained for our design. User acceptance testing in progress and 3D printing underway

https://www.health.qld.gov.au/__data/assets/pdf_file/0025/955303/covid-19-ethical-framework.pdf


2. Facemasks - N95 and flat surgical masks, in design and testing phases

3. Gowns - In design phase.

PPE will be stored securely with daily inventory of stock. Further details on the resource management aspect of PPE is detailed in section 7.1.3.1

7.1.1.2 Patient disposition MET calls and emergency resuscitation carry a very high risk of staff contamination and infection. For this reason, every attempt should be made to eliminate this process from management. Minimising emergency resuscitation will entail:

o development of an Advanced Health Plan (AHP) for every patient on admission o clarity of information within wards on every AHP available to staff 24/7 o early recognition of deterioration o early placement in a single isolation room o early consultation with ICU.

For patients with comorbid disease, escalating or intensive care management of COVID-19 may necessitate communication on care decisions. This may include which therapies should be continued and which therapies should be paused or discontinued. Proactive, supportive discussions with patients and families should include prognostic information, the potential for reversibility of symptoms and the potential burden of non-beneficial interventions. It will help to understand the patient’s values and preferences regarding life-sustaining interventions. Palliative care clinicians should be involved to help identify, triage and support patients in need of specialist palliative care management.

7.1.1.3 Reception Patients can present at a number of locations including:

• onsite fever clinics • offsite fever clinics • general practice • emergency department • home.

As at 27 March 2020, there were fever clinics located at RBWH, TPCH, Redcliffe and Caboolture Hospitals, Brighton Health Campus and Pine Rivers. The Federal government has provided funding to the Primary Care to establish pop-up clinics. GP-led respiratory clinics are operating in Morayfield, Nundah and Kenmore. IUIH clinic established in Caboolture for Aboriginal and Torres Strait Islander peoples.

7.1.1.4 Diagnostics for Reception Patients presenting to the Fever Clinics will be assessed for testing in accordance with the Communicable Diseases Network of Australia (CDNA) guidelines. These guidelines change frequently and can be accessed here (link). Those who meet the current criteria will be tested with a single swab passed to the back of both the nose and the throat. The swab will be referred to the laboratory for testing labelled NCV-PCR. All patients who meet criteria and are subsequently tested are defined as “suspect cases” and should return home to self-isolation. It is important that clinicians in Fever Clinics ensure that this is viable prior to discharge. Alternate accommodation can be arranged via the local


HEOC. Discharged patients must be informed that test results may take 48 hours and should be given literature describing their responsibilities as well as pathways to seek help while in isolation. COVID-19 is a notifiable disease. Following testing of the specimen, patients who are positive will be notified to both Metro North Public Health and also to the Metro North “Virtual Ward.” The patient will be contacted by both services – Public Health to serve an Enforceable “Public Health Order” to self-isolate and the Virtual Ward to ensure ongoing care and early identification of deterioration. Patients who test negative will be notified of this by Text message. It is important to note that patients must continue in isolation if they fulfil the criteria laid down by the Australian Government such as recent return from overseas.

7.1.1.5 Diagnostics for Patients admitted to Hospital All patients admitted with suspected COVID-19 should have nasopharyngeal and oropharyngeal (throat) swabs performed (unless this has already been performed prior to the admission) by staff trained to properly perform these procedures in order to maximise the sensitivity of real-time PCR (RT-PCR) testing that is currently the diagnostic test of choice. RT-PCR testing has a turnaround time of 4 to 6 hours but can be significantly delayed by overload within the laboratory. Rapid PCR testing is in development and should be available in coming weeks. Presentations with COVID-19 are often indistinguishable from other respiratory viruses so additional testing with a full “respiratory panel “is often appropriate. Recent reports suggest that combining RT-PCR testing with CT scans of the chest (which may reveal COVID-19 changes such as ground-glass opacities, multifocal patchy consolidation, and/or interstitial changes in peripheral distribution) may improve sensitivity up to 93%. In patients with very recent onset of symptoms, RT-PCR tests may take up to 6 days to become positive, and hence the sensitivity of the initial test may be no more than 70%. How often RT-PCR testing should be repeated in suspected cases has not been established but repeat testing at 24 and 48 hours is reasonable in patients with risk factors and/or suggestive clinical features and/or non-response to effective antibiotics in cases of atypical pneumonia where other pathogens have been excluded. In patients who already have lower respiratory tract infection and have a productive cough, after they have rinsed their mouth with water, a deep cough sputum sample should also be expectorated directly into a sterile container. A serology specimen should be collected during the acute phase of the illness (preferably within the first 7 days of symptom onset), stored, and when serology testing becomes available, tested in parallel with convalescent sera collected 3 or more weeks after acute infection. Viral cultures and serological tests have no utility in diagnosis and should not be requested.

7.1.1.6 Virtual Care A range of virtual care models have been developed. The Virtual ward commenced operations on 14 March 2020 and provides support for patients who are confirmed COVID-19 positive but are well and able to manage at home. A Virtual ED is ready to be stood up in Metro North HHS on 20 April 2020. The service is designed as an in-reach service for health professionals to have direct real-time consultations with ED clinicians regarding patients under their care. The service is a clinician to clinician consultation only. Targets clinicians are:

• GPs

• QAS


• Registered nurses at residential aged care facilities (RACF)

• Clinicians from Residential Aged Care Assessment and Referral service (RADAR)

• Metro North Community Health clinicians.

7.1.1.7 Baseline for admission Patients with significant clinical symptoms requiring inpatient care should be admitted under full isolation precautions pending testing for both COVID-19 and a full respiratory screen. A decision to admit will depend on the clinical presentation, for example:

• mild to moderate symptoms – admit to low acuity care • major symptoms, altered vital signs, saturations <92% - admit to cohorted ward or single room • Deteriorating vital signs, incipient respiratory failure – admit to ICU if appropriate

The decision to either admit, or manage via “virtual ward” will be made on a case-by-case basis, considering:

o the patient’s ability to engage in home monitoring o the ability for safe isolation at home o the risk of transmission in the patient’s home environment.

7.1.1.8 Treatment The clinical spectrum of COVID-19 ranges from mild disease with non-specific signs and symptoms of acute respiratory illness, to severe pneumonia with respiratory failure and shock. There have also been reports of asymptomatic infection with COVID-19. Clinical management for hospitalised patients with COVID-19 is focused on supportive care of symptoms and complications, including advanced organ support for respiratory failure, shock, and multi-organ failure. Patients with COVID-19 are not permitted visitors. Hospital visiting for other patients is restricted to one visitor to minimise risk of infecting others.

7.1.1.9 Clearances Patients must be free of symptoms including fever for 48 hours prior to clearance. There is no longer a requirement for additional testing. Refer to CDNA SoNG for latest updates. Coronavirus Disease 2019 (COVID-19) CDNA National guidelines for public health units: https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm

7.1.2 Digital resources

7.1.2.1 Syndromic activity board – COVID-19 A dedicated syndromic activity board for COVID-19 has been developed to support clinical management in key areas.

https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm



7.1.2.2 COVID-19 dashboard This dashboard is designed to provide daily information on patients presenting to MNHHS with an “influenza like illness” (ILI) to assist facilities and directorates to ensure service continuity and minimise the impact on critical clinical services provided by MNHHS, specifically during the seasonal influenza surge. The dashboard provides Directorates the total ILI presentations to Emergency Departments per facility, age group and geographical distribution. The information will be provided as:

• total ILI presentation as proportion of total presentations • ILI presentation via ED per discharge disposition • SSU admitted, D/C or Transferred • ILI presentations by Geographic distribution • age group distribution.

7.1.2.3 COVID-19 intranet site A dedicated intranet site to enable all staff access to a single point of truth and resources for influenza has been developed and will be regularly updated based on the phase of current activity. It can be accessed here: (https://qheps.health.qld.gov.au/metronorth/flu).

7.1.2.4 Software Digital Metro North have been looking at how to support increased capacity in ED and ICU, including adding new locations and beds in EDIS and new ICU beds in MetaVision. Alerts have been added into Patient Flow Manager and Wardview for COVID-19 positive patients. Software has been configured to support virtual ward (H care) and virtual ICU (HENRI).

7.1.2.5 Digital apps Incoming Passenger app – this has been developed to support screening and registration of people at any Brisbane airport. DcoVA – this application has been developed to enable statewide registration of patients with COVID-19, and support management of patients under Public Health Orders (PHOs). It has a direct feed from AUSLAB for COVID-19 results and there is further potential for natural language processing of medical imaging results. WAT- workforce attendance tracker. This allows real time reporting of staff absences.

7.1.2.6 Virtual care digital resources The virtual care website (https://qheps.health.qld.gov.au/metronorth/digital-metro-north/virtual-care) lists the videoconferencing applications that are available to use in virtual care, including for patient consultations, multi-disciplinary meetings and discussions with external stakeholders.

https://qheps.health.qld.gov.au/metronorth/flu


7.1.3 Resource management

7.1.3.1 PPE stockpiles and clinical consumables Each Directorate will manage PPE stockpiles and clinical consumables to determine and ensure appropriate stock levels are available to support BAU as well as expected surge. The provision of PPE most focus foremost on staff but is also required for patients and visitors in certain circumstances. PPE appropriate for COVID-19 includes:

• disposable gloves, • long sleeve gowns, • goggles • surgical/N95 masks and • alcohol hand gel.

PPE is to be made to available and placed at the entrances/triage desks within all publicly accessible areas – particularly in ICU, Emergency Departments and wards being used to accommodate COVID-19 patients. Clinical consumables notable for management of COVID-19 include flocked swabs for viral polymerase chain reaction.

7.1.3.2 Internal hospital signage Each Directorate will develop signage templates for use in clinical areas to direct and inform patients about any changes made to entry/exit requirements (such as alternate ED triage), expectations regarding use of masks (within wards, ED etc) and where to access additional information. In addition, general signage to support good hand hygiene, respiratory hygiene and cough etiquette will be strategically placed around the facilities and included in information provided.

7.1.4 Operational support Clinical Support services principles:

• Minimise movement of inpatients with confirmed or suspected COVID-19 within wards and across the hospital. If required, the patient should wear a surgical mask during transfer and adhere to respiratory hygiene and cough etiquette. • Minimise inter-hospital transfers of suspected or confirmed COVID-19 cases unless care in a higher service capacity hospital is clinically indicated. • Minimise movement of staff within wards and across the hospital by having general medicine units that comprise medical, nursing and allied health staff housed in specific wards. • Use of investigations or procedures requiring transportation of patients to other departments should be scrutinised very closely and wherever possible portable, bedside x-rays or ultrasound should be requested • All blood collection and ancillary services should be managed within the dedicated ward. • Central pharmacy has increased stock for the drugs known to be used to manage severe respiratory illness. • Each hospital will consider the allocation of one CT scanner for patients with suspected or confirmed COVID-19.

Food, Linen and Waste management


i.The risk of transmission of COVID-19 when handling food, linen or waste is low. Each of these procedures should be completed using Queensland health and Metro North Guidelines

ii.Consistent and scientifically based procedures will be utilised. iii.Use of PPE will be in accordance with current Queensland Health and Metro North Guidelines

Environmental cleaning of patient care areas:

i.Cleaners should observe contact and droplet precautions signage ii. Environmental cleaning and disinfection of infection control areas will occur in line with current Queensland Health and Metro North HHS Guidelines ii. Frequently touched surfaces such as doorknobs, bedrails, tabletops, light switches, patient handsets in clinical areas and patient room should be cleaned daily iii.Frequently touched surfaces such as doorknobs, bedrails, tabletops, light switches, patient handsets in non-clinical areas will be cleaned more frequently iii.Perform terminal cleaning of all surfaces (as above plus floor, ceiling, walls, blinds) after a patient is discharged iii.A combined cleaning and disinfection procedure should be used; this is either

• 2-step - detergent clean, followed by disinfectant; or • 2-in-1 step - using a product that has both cleaning and disinfectant properties. Any hospital-grade, TGA-listed disinfectant that is commonly used against norovirus is suitable, if used according to manufacturer’s instructions.

7.1.5 Isolation Metro North Public Health Unit will provide advice to suspected and confirmed COVID-19 cases on quarantine and isolation requirements in line with the current phase of the pandemic. Health Workers suspected or positive with COVID-19 will be managed and isolated in accordance with the Metro North Public Health Unit advice.

7.1.6 Contract tracing Metro North Public Health Unit will undertake contact tracing for all positive COVID-19 people, ensuring contact is made with these people and they are monitored to assess risk of development of symptoms.

7.1.7 Elective procedures There has been a reduction in elective procedures (outpatient consultations, endoscopy and elective surgery and dental) and suspension of endoscopy surveillance procedures. This will allow for increased acute medical beds through conversion of surgical wards to medical wards, as well as reallocation of workforce and preservation of PPE.

7.2 Human resources The health, safety and wellbeing of all healthcare workers is a priority for Metro North HHS. A staff management portfolio has been established which will manage and monitor the reallocation of staff, ensuring allocation to priority areas and matching of skillsets. A survey to identify staff able and willing to be reallocated has been conducted and distributed to the Directorates. Directorates staff management team/coordinator will management staff within their Directorates and access Metro North team as required. A wellbeing strategy is being implemented with the aim to ensure staff feel support and that their wellbeing is at the forefront of everything we do during the pandemic. A wellbeing executive has been appointed to oversee and manage staff wellbeing during this time. This strategy will also link staff to available resources and tools to assess and

https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/industry/resources-and-fact-sheets-for-industry/waste-management-for-health-facilities-and-waste-contractors

https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/industry/resources-and-fact-sheets-for-industry/covid-19-cleaning-and-disinfection-recommendations


support their wellbeing. A peer support line to provide psychiatrist led support to medical specialists working in ICU, Emergency departments, respiratory wards and the aneasthetists has also been established.

7.2.1.1 Staff management A range of strategies to ensure adequate workforce are available during the pandemic will be implemented including:

• new rostering models • recruiting retired or semi-retired clinicians • reassigning healthcare workers out of their usual work area • utilising healthcare students as assistants • reviewing scope of practice • increasing casual pools and temporary staff • increasing hours of part time staff on voluntary basis • active leave management including absenteeism and fatigue • accelerated recruitment processes.

Metro North HHS is also supporting efforts to curtail the spread of COVID-19, including shifting to flexible-working arrangements and working from home where possible. A flexible working arrangements factsheet and guidance for best practices in working remotely and tips for success have been developed to support managers and teams to work effectively and efficiently.

Additional resources include a factsheet on privacy and confidentiality considerations when working with patient information from home and a telecommuting safely checklist for employees and managers to complete.

Digital Metro North have developed a range of resources to support working virtually.

MNHHS has developed COVID-19 Guidance for staff in vulnerable groups for staff in vulnerable groups to assist with identification of higher risk groups and associated precautions.

Flexible Work Arrangements Information provides a reference for managers and team members involved in or affected by the COVID-19 virus pandemic who may need to consider flexible work arrangements to manage associated risks.

7.2.1.2 Staff training and information Medical Officers and nursing staff receive infection control training as part of orientation, induction and work unit training programs including periodic refreshers as per Directorate requirements. Strict personal and workplace hygiene is essential and relevant to all staff including clinical and non-clinical team members. The following are critical during pandemic response:

• frequent handwashing for at least 20 seconds • use of hand sanitiser before and after all activities • wiping down of personal phones/iPads

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/03/flex-work-arrangements.pdf

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/04/covid-wfh-tips-success.pdf

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/03/covid-confidentiality-working-home.pdf

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/03/fwa-telecommute-checklist.pdf

https://metronorth.health.qld.gov.au/extranet/working-from-home

https://qheps.health.qld.gov.au/__data/assets/pdf_file/0031/2488171/covid19-guidance-staff-vulnerable-groups.pdf

https://metronorth.health.qld.gov.au/extranet/coronavirus/hr-resources


• wiping down of hard surfaces, keyboards, desk phones, lift buttons, door handles with approved alcohol based wipes.

Strategies to segregate staff: • restrict staff movement within and between hospitals • develop staff teams and minimise contact between teams where possible • separate inpatient and outpatient teams • avoid face to face clinical and non-essential meetings • work remotely • discourage congregation of staff in tearooms or other areas to avoid close physical contact.

A COVID-19 HR Hotline has been developed for any Human Resources issues relating to COVID-19 which is staffed 8am-5pm, Ph: 3647 2819, E: [email protected]

Vidcasts commenced 30 March 2020 for staff to access executive and a range of expert clinicians to ask questions or voice their concerns.

7.2.1.3 Managing ill workers Ill or quarantined workforce will be managed in line with the Queensland Health Human Resources Guidelines available on the intranet. Refer to section 7.2.1.1 for details on managing vulnerable workforce.

Leave, Returning and returning to work

Different leave types, either paid or unpaid, may be granted to employees directly affected by this event. Refer to the MNHHS COVID-19 Virus Pandemic Factsheet for information regarding specific leave options .

Quarantine

All MNHHS staff impacted by isolation / quarantine must be registered with the MNHHS Emergency operations Centre via [email protected].

7.2.1.4 Staff wellbeing strategy

A Metro North Staff Wellbeing Strategy and portal has been launched. The Metro North Wellbeing Strategy – COVID-19 covers the emotional, financial, physical and social domains of wellbeing.

Metro North’s values of compassion, integrity, respect, teamwork and high performance form the foundation of decisions and actions relating to the wellbeing strategy during COVID-19. The position of Chief Wellbeing Officer has temporarily been established from April 2020 and is accountable for the strategy.

The aims of the strategy are to ensure staff feel supported and have their wellbeing considered, link to existing resources and provide access to new initiatives tailored to COVID-19.


https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/03/leave-provisions.pdf


https://metronorth.health.qld.gov.au/extranet/coronavirus/staff-wellbeing

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/04/mn-wellbeing-strategy.pdf


New initiatives include:

• COVID-19 HR hotline • Peer responder program to provide psychological first aid • RUOK’ERS to provide a collegiate support network • COVID Staff Psychology Support – a tailored onsite counselling service for any employee who has increased risk to their mental wellbeing resulting from working directly with COVID-19 patients

Profession focussed support and initiatives are outlined in the Metro North Wellbeing Strategy as well as professional association support included below:

• Medical Professional Association Support • Nursing Professional Association Support • Allied Health Professional Association Support

Metro North’s Employee Assistance Service (EAS) provider Benestar is offering expanded support as part of the Staff Wellbeing Strategy.

7.2.1.5 Industrial relations Engagement with the various unions is occurring and will continue throughout the pandemic.

7.2.1.6 Reallocation

Metro North HHS may be required to reallocate staff in response to the COVID-19 activities. These reasons could include (but are not limited to) are:

• vulnerable staff that are unable to be reallocated within their own teams, • service changes including reduction or closure of services, • reduction in workload due to business focus changes.

A range of resources are under development with some already published on the Metro North extranet page, that support the process of staff reallocation ensuring a streamlined approach. Resources include:

• Orientation Handbook has been developed to support reallocated (deployed) staff. All reallocated (deployed) staff are required to complete the Orientation Handbook to comply with Workplace Health and Safety, patient safety and scope of practice requirements. • Checklist to support reallocation of Metro North workforce during COVID-29 pandemic • A Nursing and Midwifery factsheet has been developed to assist nursing and midwifery decision-making in respect to Scope of Practice, Reallocation and Deployment of nurses and midwives during a COVID 19 pandemic response.

*More forms and processes will be developed (as the need arises) in response to COVID-19.

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/04/mn-wellbeing-strategy.pdf

https://metronorth.health.qld.gov.au/extranet/coronavirus/staff-wellbeing/medical-professional

https://metronorth.health.qld.gov.au/extranet/coronavirus/staff-wellbeing/nursing-professional

https://metronorth.health.qld.gov.au/extranet/coronavirus/staff-wellbeing/allied-health-professional

https://qheps.health.qld.gov.au/metronorth/staff-wellness/benehub

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/04/covid-hr-staff-orientation-handbook-redeployed.pdf

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/04/reallocation-checklist.pdf

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/04/covid-hr-socp-reallocation-factsheet.pdf


A central process has been developed to prioritise and manage the reallocation of staff across the HHS. Each Directorate has stood up a workforce unit to coordinate this locally, with central oversight by Metro North Executive.

Metro North has also established Directorate Workforce Coordinators (DWC’s) that are supported by the Metro North Emergency Operations Centre (EOC) Logistics – Workforce team to assist and support with the reallocation process of employees.

7.2.1.7 Workplace health and safety

Workplace health and safety precautions are being taken in line with the Chief Health Officers advice. Public Health surveillance, rapid response teams and case investigation will be available. A range of COVID-19 specific health and safety checklists and factsheets have been developed on local induction, workplace injuries (for employees and line managers), QSuper and Workcover.

7.2.1.8 Recruitment and onboarding All Staff Orientation for COVID-19 has been described in a factsheet and will be delivered to each new starter as an online module. During the COVID-19 emergency response period any new starter joining Metro North will still need to undertake their mandatory training. These will be assigned to them in the Metro North Learning Management System (LMS) as per the Policy. This will include the new Metro North Orientation module. The information provided on the Mandatory Training page outlines legislative and mandatory training requirements, standards and assessments, including the frequency of training that must be completed to enable a safe working environment for everyone, including our patients and consumers.

7.2.1.9 Fatigue Management Management of Fatigue across MNHHS occurs in accordance with the MNHHS Fatigue Risk Management Procedure and the Department of Health Fatigue Risk Management Policy I1 (QH-POL-171). A summary document has been developed which outlines the general management of fatigue. Specific guidelines for relating to fatigue risk management for Medical and Nursing and Midwifery professional streams has also been developed.

7.2.2 Points of entry – cruise ships, airports, ports Metro North Public Health Unit is responsible for supporting health screening activities at the Brisbane Airport. At present, Border Force will screen travellers as they arrive and refer any requiring further assessment to the health workers who will undertake further assessment and if people meet criteria will be referred to an Environmental Health Officer who will issue a notice to isolate, or if the person is symptomatic send them to a fever clinic (TPCH or RBWH via ambulance transfer). The Public Health Physician is available for further consultation as needed. Changes to isolation requirements for travellers returning from overseas came into effect on Monday 16 March and Metro North HHS has continued to support the roll out of these requirements at the ports. Daily reporting on number of people screened is provided to SHECC as well as reporting the number of positive cases.

https://metronorth.health.qld.gov.au/extranet/coronavirus/hr-resources/directorate-workforce-coordinators


https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/03/covid-staff-orientation-fsheet.pdf

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/04/fatigue-management-general.pdf



7.2.3 Education and training Staff will be trained in the correct level of PPE to use based on the risk in the environment or the procedures to be undertaken. Training in the safe use of PPE will also be increased particularly correct donning and doffing procedures. Training materials include posters, videos and demonstrations. All non-mandatory education and training will be cancelled from Contain Phase onwards. Occupational violence training will continue adapted for the current environment.

7.3 Aboriginal and Torres Strait Islander people All Aboriginal and/or Torres Strait Islander peoples are considered part of a Vulnerable group when considering ILI and COVID-19. Practitioners should assess all Aboriginal and/or Torres Strait Islander peoples presenting with ILI for chronic diseases and other risk factors. Health professionals should keep the following points in mind when assessing and treating any patients who may have COVID-19.

• Need to actively identify Indigenous person of Aboriginal and/or Torres Strait Islander origin.

• The high prevalence of chronic disease in Aboriginal and/or Torres Strait Islander populations that may predispose to severe outcomes.

• The social circumstances and needs of patients that are identified as Aboriginal and/or Torres Strait Islander origin.

• The possibility that the patient may be residing with a person who is vulnerable, for example, due to the presence of chronic disease(s).

• Would the patient benefit from support by the Indigenous Hospital Liaison Officer?

• Is the Information provided in a culturally appropriate manner, so that the patient, contacts and community understand the information by using culturally specific posters, brochures and pamphlets?

The First Nations COVID-19 team have developed a range of resources to support HHS’s to address the COVID-19 needs of the First Nations Queenslanders, including checklists and guides which are available online at https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/first-nations. These resources include:

1. COVID-19 Preparing for your community: Information for Mayors 16 March 2020.

2. COVID-19 HHS preparedness checklist for Queensland’s First Nations people. 16 March 2020.

3. COVID-19 Protection and Containment Considerations for First Nations Communities: Information Resource. 25 March 2020.

4. Attachment 1: Community and health service action checklist (as at 25 March 2020).

5. Attachment 3: Intersection of community and HHS COVID-19 planning

https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/first-nations


6. Fact Sheet Cleaning of quarantine accommodation in First Nations communities.

7. A range of screensavers, hospital posters and fact sheets for hospitals and for the Hospital and Health Service.

7.3.1 Infection control for Aboriginal and Torres Strait Islander people Challenges to infection control in Aboriginal and/or Torres Strait Islander communities are acknowledged. As such, isolating cases from those who are more vulnerable to severe outcomes and recommending keeping a distance of one metre from others may be a more manageable approach to preventing spread of disease.

• The voluntary home isolation of patients with infection is strongly recommended to reduce transmission but consideration must be given to who else is at home.

• Other measures such as patients using masks can be considered depending on the vulnerability of contacts and living circumstances.

• Information about hand hygiene (Hand washing and drying) and cough etiquette should be promoted to patients, contacts and community and are explained in a culturally appropriate manner.

7.3.2 Community engagement for Aboriginal and Torres Strait Islander people The Aboriginal and Torres Strait Islander Health Unit, in conjunction with Metro North Communications is developing a suite of culturally specific resources for COVID-19. In addition, the Unit has a clear communication and engagement strategy on how to educate their own staff as well as their consumers on the virus, how to prevent the spread, how to manage illness and what to expect during the pandemic. The Unit are also working closely with partners to try ensure cohesion and consistency of messaging. The Unit’s plan can be referred to in Appendix 3. The Mental Health Directorate has a range of strategies to increase support to Aboriginal and Torres Strait Islander consumers with mental health issues during the pandemic.

7.4 Vulnerable groups Communities and individuals identified as being vulnerable, and in which mortality and morbidity is expected to be higher, include people with complex and chronic disease, culturally and linguistically diverse people, older persons and persons in residential aged care. Specific plans are in place for residential aged care facilities within Metro North HHS in line with guidelines from the Commonwealth.

7.4.1 People with Mental illness The Mental Health Directorate has plans to support people with mental illness and homeless people. These strategies include identification of at risk consumers and providing increased support to them, identification of at risk carers who may need additional support as well as identification of consumers who will refuse to self isolate. The Chief Psychiatrist has also made a temporary amendment to the Mental Health Act during this time. Details of the amendment can be found https://qheps.health.qld.gov.au/mentalhealth/mha/mha/mha2016-covid-19 (available internal to QH only). There is active engagement with the Brisbane/Moreton Human-Social subgroup of QDNA to work with a range of partner organisations to support community wellbeing.

https://qheps.health.qld.gov.au/mentalhealth/mha/mha/mha2016-covid-19


The Qld government through the Department of Housing and Public works has made available $24.7mil for COVID-19 responses in housing and homelessness. The Queensland Department of Housing and Public Works has contracted Q Shelter to lead the 12-month Queensland Service Integration Initiative in providing a state-wide backbone support role to nine priority locations. The initiative involves strengthening front-line care coordination groups responding to homelessness and housing need. The locations in Metro North are Moreton and Brisbane. This initiative aims to build capacity for integrated, front-line responses to people with multiple needs who are homeless, or at risk of homelessness. The care coordination groups will also play their part in strengthening regional responses to COVID-19. The Mental Health Directorate strategies are:

• Mental Health Homeless Health Outreach Team (HHOT) is providing outreach to the homeless, twice a day, in citywide sweeps (The HHOT catchment is 5 km of the General Post Office). All referral sources remain active.

• HHOT continues to provide access to depot medication and mental state reviews for consumers who sleep in the CBD. The Valley mental health drop-in clinic is running business as usual (Monday to Friday 9am-4pm).

• An outreach clinic to crisis shelters is continuing on a reduced model in the morning and afternoon with urgent reviews where required. Teleconferencing is being set up in all crisis shelters.

• The HHOT Indigenous Mental Health Worker is providing information to Aboriginal and Torres Strait Island populations regarding COVID-19 symptoms, risk of comorbidities and hand washing.

• Mental Health are involved in sector-wide meetings with NGO’s and other service providers regarding support and referral pathways. • COVID-19 positive management:

o All HHOT homeless consumers have a personalised management plan identifying requirements for medication, assessment, whether they have phone access and planning if they are not able to be located.

o Agreements have been made with a number of crisis shelters around provision of services to COVID-19 positive consumers.

7.4.2 People with disabilities The federal and state government have been investigating options for ensuring adequate support for people with disabilities during COVID-19. In line with this Metro North HHS is transitioning National Disability Insurance Scheme (NDIS) eligible patients as well as ineligible patients who are medically fit for discharge to safe and support alternative accommodation and working with key stakeholders to expedite discharge to permanent accommodation with appropriate supports. Queensland Health is in the process of developing guidelines to support clinicians with processes around this. The DoH has also developed a range of resources for people with disabilities https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/people-with-disability-and-carers. In addition the NDIS and other organisations have also developed resources – links to these can be found in appendix 4.

7.4.3 People who are culturally and linguistically diverse (CALD) Metro North HHS is a culturally diverse HHS with a large CALD community. These people may have limited English, limited support networks and limited understanding of the health system and the current pandemic. A number of translated resources are available in a range of languages including Vietnamese, Arabic, traditional Chinese, Italian, and Greek. These resources range from providing an overview of COVID-19 through to symptom management.

https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/people-with-disability-and-carers

https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/people-with-disability-and-carers


7.5 Financial management All directorates and services have been advised of cost identification and capture processes, including enacting of two incident response cost centres in facilities and COH (one for screening and indirect costs and one for direct costs of patient care). Metro North HHs is adopting an overriding principle that anything previously in cost of treatment will go to existing cost centres and only expenditure in addition to normal will be captured separately/centrally. Costs are to be collected by directorates (including supporting documentation) and claimed by Metro North HHS via DoH. Funding (to offset actual expense) will be accrued at end of month by Health Funding and Data Insights team. This will be allocated to directorate level against incident cost centres. Adjustments have been made to monthly performance reports to identify incident related costs. Increasing COVID-19 activity is expected to have a negative impact on total Weighted Activity Units (WAUs) for Metro North HHS. Baseline performance metrics have been collated for key metrics and the impact of these have been modelled in line with escalation of activity in line with the response plan. Selected staff have been issued with emergency corporate credit cards to be used for identified Emergency Events. The financial delegation matrix in S/4 has been updated to ensure that online orders against emergency event cost centres will workflow to appropriate delegates. Additional financial delegates have been identified at each facility.

7.5.1 Medicare ineligible patients All patients are to receive the required testing and treatment irrespective if they are Medicare eligible or ineligible. The provision of commonwealth funding under the National Partnership Agreement with the States will be at 50 per cent of the costs to provide testing, housing or treatment of all patients.

7.5.2 Activity capture

Inpatient activity To be sourced via Digital Metro North (DMN) data set current being implemented – based on matching pathology results with inpatient data. Retrospective capture of information / patients to be achieved through coded patient information and application of specific COVID 19 ICD code.

ED activity To be sourced via DMN data set based on reporting flags within EDIS. Existing dashboards and reporting frameworks to be updated to incorporate.

Outpatient activity Initial screening activity to be sourced via EOC (manual data collection at this stage) and information collated by HFDI for reporting.

• COVID19 Tier 2 clinic code has been issued and business rules issued to support its use.


• DNA - Likely to utilised specific reason codes for DNAs across all sites.

• DoH advice / guidelines received and provided to directorates.

• Fever clinics - Likely to be scheduled / registered using local tool (eg. ESM, HBCIS, HCare or EDIS).

Outpatients Tier 2 clinic cancellation codes Please be advised that two new cancellation codes have been created in the HBCIS APP Module to accurately reflect reasons for appointment cancellations relating to COVID-19. These codes are:

Cancellation Code Description Start Date 31 Pub Health Alert Pt Initiated 05 MAR 2020 32 Pub Health Alert Hosp Initiated 05 MAR 2020

7.6 Private Hospitals On 1 April 2020 an agreement was reached between the Commonwealth and private hospitals to support delivery of health services during the pandemic. Queensland Department of Health will sign an Agreement with private providers setting out all contractual arrangements. Metro North HHS has commenced discussions with the private facilities in the HHS to explore what services, equipment and resources they could assist with. A framework and operational guidelines are being developed to support the implementation of this initiative.

7.7 Influenza The Metro North HHS influenza plan has been activated and staff vaccinations for influenza has commenced. Metro North HHs is actively encouraging all staff to receive the flu vaccination this year. As per the Aged Care Direction No.2, no visitors will be allowed to enter an aged care facility after 1 May 2020 if they have not had a 2020 flu vaccine.

8 Control The Control Phase is characterised by the pandemic beginning to be brought under control demonstrated through decreasing pandemic activity, whilst there is uncertainty if additional waves will occur. The focus during this phase is to:

• evaluate the response – what did we stop, what did we start, what did we do differently (clinical and non-clinical and corporate activities) • determine recovery strategies – what do we continue, what do we stop and when, what do we restart and when, what needs to be “caught up” • prepare for a possible second wave.


Metro North HHS is developing an evaluation framework to determine the effectiveness of the innovative models that have been developed to manage the pandemic to determine what models should be incorporated into the new normal business environment. Metro North HHS is developing a phased approach for resuming business activities and determining strategies to assist with “catching up” where necessary.

9 Recover The Recovery Phase is characterised by the pandemic being under control in Australia however further waves may occur if the virus drifts and/or is reimported into Australia. During this phase there is ongoing evaluation of the response, revision of plans and activation of recovery strategies. The Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) outlines activities associated with this phase including:

• support and maintain quality care

• cease activities that are no longer needed, and transition activities to normal business or interim arrangements

• monitor for a second wave of the outbreak

• monitor for the development of resistance to any pharmaceutical measures

• communicate to support the return from emergency response to normal business services

• evaluate systems and responses and revise plans and procedures. Metro North will work with other government agencies to consider whether the community require additional services to enable full psychological, social, economic, environmental and physical recovery from the effects of the COVID-19 outbreak. At-risk groups may need additional support. Analysis of available data to evaluate the epidemiological, clinical and virological characteristics of the pandemic will be undertaken and ongoing surveillance measures will be considered and incorporated. Newly developed policies and procedures will be reviewed to determine their ongoing applicability and be updated accordingly.


Appendix 1: Intelligence Sources Australian Department of Health

• https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert

• https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm

• Emergency Response Plan for Communicable Disease Incidents of National Significance: National Arrangements (May 2018)- This whole of government plan focuses on assisting non-health agencies to anticipate the activities of the health sector and clarifying the expectations of agencies across government in supporting the health response and maintaining essential services. It identifies governance and communications coordination mechanisms, roles and responsibilities. It will operate in parallel to the health sector communicable disease plan (the Emergency Response Plan for Communicable Disease Incidents of National Significance).

• Australian Health Management Plan for Pandemic Influenza (2014)1 — national health influenza pandemic plan - outlines Australia’s strategy to manage an influenza pandemic and minimise its impact on the health of Australians and its health system

Queensland Department of Health

• https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19

• QUEENSLAND HEALTH Pandemic Influenza Plan (May 2018) - The purpose of the Queensland Health pandemic influenza plan (the plan) is to provide a strategic outline of Queensland Health responses to an influenza pandemic. It does not include detailed operational procedures

• Queensland Health Disaster and Emergency Incident Plan QHDISPLAN June 20163- details health emergency management arrangements and the hierarchy of plans within Queensland Health. The Queensland Health pandemic influenza plan is a sub-plan of this plan.

• Health Service Directive QH-HSD-046: management of a public health event of state significance.6

• Health Service Directive QH-HSD-003:2017 Disasters and Emergency Incidents7.

Metro North Hospital and Health Service

https://qheps.health.qld.gov.au/metronorth/coronavirus • MNHHS Business Continuity Management Plan • MNHHS Emergency Management Plan • RBWH Pandemic Plan • Redcliffe Hospital Pandemic Plan • TPCH Pandemic Plan • Caboolture Hospital Pandemic Plan

https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert


http://www.health.gov.au/internet/main/publishing.nsf/Content/DD8490093CA39594CA25834D0014EF99/$File/Nat-CD-Plan-Nov18.pdfhttp:/www.health.gov.au/internet/main/publishing.nsf/Content/DD8490093CA39594CA25834D0014EF99/$File/Nat-CD-Plan-Nov18.pdf

http://www.health.gov.au/internet/main/publishing.nsf/content/ohp-ahmppi.htm

https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19

https://www.health.qld.gov.au/__data/assets/pdf_file/0030/444684/influenza-pandemic-plan.pdf

https://www.health.qld.gov.au/directives

https://www.health.qld.gov.au/__data/assets/pdf_file/0021/151158/qh-hsd-003.pdf

https://qheps.health.qld.gov.au/metronorth/coronavirus


Reference Links • World Health Organisation COVID-19 Strategic Preparedness and Response Plan: Operational Planning Guidelines to Support Country Preparedness and Response

(DRAFT as of 12 February): https://www.who.int/docs/default-source/coronaviruse/covid-19-sprp-unct-guidelines.pdf

• Queensland State Disaster Management Plan - 2018 (prepared by Queensland Disaster Management Committee)- details emergency arrangements within Queensland Government. Annexure B: Agency Roles and Responsibilities identifies Queensland Health as the functional lead agency for a pandemic influenza health response

https://www.who.int/docs/default-source/coronaviruse/covid-19-sprp-unct-guidelines.pdf

https://www.disaster.qld.gov.au/cdmp/Documents/Queensland-State-Disaster-Management-Plan.pdf


Appendix 2: National and State policies

14 March 2020 – 20 April 2020 On 14 March 2020:

• the Queensland Chief Health Officer announced that people who were positive for COVID-19 and did not medically require hospitalisation could be managed within their own home.

On 20 March 2020: • Travel restrictions were imposed by the Prime Minister where all foreign travellers will be banned from entering Australia and Australians entering Australia were

required to quarantine for 14 days following arrival. On Sunday 22 March 2020:

• the Federal government imposed a range of “lock down” rules in an attempt to reduce the community spread. These rules included closures of gyms and indoor sporting venues, restaurants and cafes to only provide takeaway services, closure of pubs and clubs, places of worship, stronger measures to encourage and monitor social distancing and limits imposed on the number of people who can attend social gatherings.

• Travel is restricted to a number of remote Indigenous communities. From 23 March 2020:

• Queensland Corrective Services will cease personal visits to prisoners. • Surgery Connect will no longer accept category 3 referrals in accordance with the National Elective Surgery Categorisation Urgency Guidelines.

On 24 March 2020: • further restrictions were imposed including closure of pools, beauticians, food courts, cinemas and entertainment venues, outdoor and indoor markets, as well as

restrictions to the number of people who can attend weddings and funerals. Restrictions begin 111.59 pm 25 March. On 25 March 2020:

• Queensland Chief Health Officer signed two new Public Health Notices reflecting restrictions advised by the Premier and Prime Minister. • There is a ban on international travel for all Australians other than for essential or compassionate grounds. • The Prime Minister announced all elective surgery other than category one would be cancelled. • The Queensland Government announced camping grounds would be closed on 26 March.

On 26 March 2020: • the Queensland Government announced that schools will close for non-essential workforce on 27 March, with the following week being pupil free days. • Chief Health Officer approved non-essential business, activity and undertaking Closure Directive (No.2) and Hospital visitors Direction prohibiting non-essential visits

to hospitals to prevent the spread of COVID-19. • Queensland border restrictions were introduced. • The Chief Health Officer (Queensland) issued revised visitor guidelines stating no more than one visit per patient per day (maximum of 2 people) and no visitors for

COVID-19 positive or suspected patients. • From 23:59pm 28 March anyone arriving from international travel will be quarantined in state accommodation for 14 days in whichever state their international flight

arrives. • The Prime Minister announced on 15 March 2020, a ban on cruise ships from foreign ports from arriving in Australia. The initial 30 day ban has been extended until

15 June 2020. On 29 March 2020:


• the Prime Minister announced Public gatherings now limited to two people and all public spaces including parks, playgrounds, skate parks and outside gyms will be closed from midday 30 March 2020

• People must stay at home except for four circumstances which they need to minimise – for food and essential supplies; medical or care needs; exercise; work or education

• Strongly advises Australians over 70 years old, over 60 years old with chronic illness and Aboriginal and Torres Strait Islander People over 50 years old to self isolate to the maximum extent possible.

• National Cabinet agreed to limit both indoor and outdoor gatherings to two persons only. Exceptions to this include: people of the same household; funerals (a maximum of 10 people); weddings (a maximum of 5 people); or family units.

On 30 March 2020: • National Cabinet clarified arrangements for vulnerable people in the workplace:

o Where vulnerable workers undertake essential work, a risk assessment must be undertaken. Where risk cannot be appropriately mitigated, employers and employees should consider alternate arrangements to accommodate a workplace absence.

o Special provisions apply to essential workers who are at higher risk of serious illness and, where the risk cannot be sufficiently mitigated, should not work in high risk settings.

On 31 March 2020: • a partnership between the Australian Government and private hospital sector was announced to support healthcare delivery at this time. • the Australian Government approved a number of changes to medicines regulation to ensure Australian can continue to access the PBS medicines they need, as the

COVID-19 outbreak unfolds: • Continued dispensing agreements for ongoing supply of PBS subsidised medicines without a prescription extended to 30 June 2020. • Home delivery service for PBS and Repatriation Pharmaceutical Benefits Scheme (RPB) medicines is now in place. • Ongoing work with pharmacists, GPs and States and Territories to allow medicine substitution the pharmacist in the event of a shortage, • Restrictions on the quantity of medicines that can be purchased to prevent unnecessary medicine stockpiling.

On 1 April 2020: • the Commonwealth Minister for Health released a statement encouraging all Australians to vaccinate against seasonal influenza in April. • Queensland Police Service was give authority to issue on-the-spot fines for people breaching the quarantine/social distancing laws.

On 2 April 2020: • Queensland relaxed visitation rules to allow 2 visitors to a private residence. • The Minister for Fire and Emergency Services amended the regulation: Disaster Management (Extension of Disaster Situation COVID-19) Regulation 2020. The

amendment extends the period of the disaster situation for an additional 14 days. On 3 April 2020:

• The Prime Minister stated Australia is now in the suppression phase of the response, which will last for some time. Restrictions will be reviewed regularly and planning for medium to long-term has begun. Social distancing measures to slow the spread of the virus need to be sustainable for 6 months.

• Australians should be aware that social distancing must continue at Easter and agreed that Australians should stay home this Easter and not undertake unnecessary holiday travel.

• Churches and other places of worship will be considered places of work so that services can be live-streamed to the community. • People who are self-isolating were encouraged to register on the COVID-19 app. • An advisory group has been established to guide development and implementation of a response plan focusing on the unique health needs of people living with

disability during the coronavirus pandemic. • The advisory group, endorsed on 3 April 2020 by the Australian Health Protection Principal Committee (AHPPC), will develop and implement the Management and

Operational Plan for People with Disability.


• The first meeting was held on Friday 3 April 2020 with an aim to deliver the Plan to the AHPPC on Thursday 9 April 2020 for immediate action. On 4 April 2020:

• the Commonwealth Minister for Health announced a $1.5 million investment to support clinical management of COVID-19. That National COVID-19 Clinical Evidence Taskforce will receive this funding from the Medical Research Future Fund (MRFF) to deliver “living guidelines” on the clinical management of patients with suspected or confirmed COVID-19 infection across primary, acute and critical care settings.

On 6 April 2020: • New Chief Health Officer Public Health Directions restricting cruise ships from entering Queensland waters came into effect at 11.59am. The Direction details that the

operator of a foreign flagged cruise ship must not allow the ship to enter Queensland waters before 15 June 2020 unless permitted under the Biosecurity Determination 2020.

• The Commonwealth Minister for Regional Health, Regional Communications and Local Government chaired the second special roundtable conference with members of the Rural Health Stakeholder group to discuss the Australian Government response to COVID-19 and priorities for rural and remote communities.

• The Chief Health Officer advised that testing for COVID-19 in Brisbane, Cairns and Gold Coast will be expanded to help determine any levels of community transmission. Anyone who presents to a GP or fever clinic/hospital in these regions who has respiratory symptoms indicative of COVID-19 will now be tested for COVID-19.

• The Queensland Whole-of-Government Pandemic Plan was published on the Queensland Health website. Queensland Health was reviewing interstate data and heat mapping to determine any areas interstate that should be prescribed as “hot spots” for the purpose of the Chief Health Officer Public Health Directions. Once a ‘hot spot” is declared and published on the Queensland Health website, any person seeking to enter Queensland who has travelled from a hot spot would be required to enter self-quarantine. There would continue to be exemptions for essential needs such as freight and emergency personnel.

• The Queensland Government announced a $17.5 million plan to provide frontline healthcare workers with free accommodation if they want or need to self-isolate. The funding will provide accommodation over six months, for staff working in ICU and dedicated COVID-19 wards.

On 7 April 2020: • New Chief Health Officer Public Health Directions on Self-quarantine for persons arriving in Queensland from overseas. The Direction provides an exemption to self-

quarantine at nominated premises, but still requires quarantine at their home or another facility, for the following people returning to Queensland from overseas: o Airline and maritime crew – maritime crew has been defined to exclude crew and employees of a cruise ship o Unaccompanied minors o Consular employees and o People unable to live independently without ongoing support.

• Prescribing, dispensing or supply of Hydroxychloroquine. This Direction restricts dispensing of hydroxychloroguine, to ensure it continues to be available in cases where there is a therapeutic need for the continuing treatment of a chronic condition or the supply is in accordance with a research protocol for an approved clinical trial.

On 9 April 2020: • New Chief Health Officer Health Directions for Truck driver rest facilities. Recommends continuation of normal operating hours of the facility to assist safe movement

for road freight, heavy vehicle drivers and essential road users. Non-essential business, activity and undertaking Closure Direction (No.5): Updated provisions. On 10 April 2020:

• New Chief Health Officer Health Directions for Border Restrictions Direction (No.4) from 12.01am Saturday 11 April 2020 a person who lives in Queensland from another State or Territory of Australia will not be allowed to enter Queensland, unless they are an exempt resident or exempt person.

On 13 April 2020: • The Commonwealth Minister for Health announced a further $3 million funding to support frontline health workers with training and information in treating COVID-19

patients: o $1million in funding from MRFF to artificial intelligence, web-based technology that uses CT scans to enable healthcare professionals to accurately diagnose

COVID-19.


o $2million in funding from the NHMRC to the Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APRISE). On 13 April 2020:

• The Premier of Queensland announced that Queensland schools will reopen in Term 2 for the children of essential workers and vulnerable children, with the rest of the student population to learn at home for the first five weeks. The home-based learning model will start at the scheduled commencement of Term 2 on Monday 20 April 2020 and be in place until at least Friday 22 May 2020.

• Queensland is providing the clinical lead for AUSMAT that is being deployed to assist Northwest Tasmania following quarantine of 1,000 healthcare workers. The Queenslander is a Retrieval Services Queensland staff member and will be deployed on Tuesday 14 April 2020.

• Testing criteria was updated to include Queensland Police Officers as a category along with workers in schools or formal child care settings with acute respiratory infection.

On Thursday 16 April 2020: • National Cabinet met and agreed that

o Australia will continue to progress a successful suppression/elimination strategy for the virus o new modelling that has confirmed that measures to suppress the virus have largely been successful in slowing and reversing the growth of cases in Australia o agreed to a framework for future actions to plan the pathway for next steps in responding to the virus and conditions for relaxation, agreeing to AHPPC’s

advice on seven precedent conditions to any further relaxations, with work to continue over the next four weeks. o agreed with the AHPPC health advice that “on current evidence, schools can be fully open” along with additional advice from AHPPC provided school leaders

to even further reduce the “relatively low risk” of transmission in schools. o Agreed to a series of National Principles for School Education.

• The Minister for Health announced $3.3 million to establish a rapid coronavirus (COVID-19) Remote Point of Care Testing Program for remote and rural Aboriginal and Torres Strait Islander communities.

• Discussions on elective surgery will occur next Tuesday (21 April). On 17 April 2020:

• The Federal Minister from Aged Care and senior Australians announced immediate testing for COVID-19 at three aged care facilities in Tasmania’s North West Coast following a worker tested positive for COVID-19.

• The Federal Health Minister has made determinations under the Biosecurity Act 2015 to prevent price gouging of essential goods (PPE), preventing persons from entering designated remote communities, subject to exemptions, and to close some retail outlets at airports (exception to food outlets and chemists).

• Aged care residents will continue to be allowed one visit per day, for no longer than two hours. Only two visitors are allowed per visit. • From 1 May 2020, visitors will not be allowed to enter an aged care facility if they have not had the 2020 flu vaccine.


Appendix 3: Metro North HHS Aboriginal and Torres Strait Islander Health Unit’s COVID Response Plan PHASE STEPS CONSIDERATIONS TASKS

Engage and Educate

Internal: A&TSI staff, Indigenous services, A&TSI patients and families, Target MN services with high cohort of patients

Ensuring all patients have access to information

Building confidence within the A&TSI patients to further educate community upon discharge

Ensuring opportunity to engage with Identified staff to voice concerns for cultural safety

Clarify roles and responsibilities with staff members

Support staff safety

Ensure appropriate representation of A&TSI leadership in executive planning

Raise awareness of key messaging via appropriate a communication plan via various medium including social media

Develop COVID-19 Factsheet that is culturally appropriate

Disseminate and Educate staff to deliver messaging with appropriate resources (antibacterial wipes & factsheet)

Organise an all staff forum to develop action plan and response for each service and staffing area to support appropriate implementation

External: Aboriginal medical centres, PHN, Aboriginal community services, Indigenous email networks, Elder groups, A&TSI community members,

Avoid duplication of efforts, ensuring consistent messaging.

Support ease of access, open communication working collaboratively across sectors.

Disseminate and Educate staff to deliver messaging with appropriate resources (antibacterial wipes & factsheet)

Utilisation of the Better Together Health Van to be a presence within community to support trust, engagement and appropriate education/awareness

Supports collaboration with our external partners to ensure consistent messaging between health sectors


PHASE STEPS CONSIDERATIONS TASKS

Assist

Patient and Consumer

Assess need for increased social supports e.g. housing, social work, Centrelink, family responsibilities, transport, isolation

Rural and Remote patients

Patients at risk with co-morbidities, aging population, children and pregnant mothers

Determine the financial and resourcing implications to support demand in services

Develop assistance pathways and points of contact

Plan for further support required for rural and remote patients including escorts

Determine level of need and support needed to minimise exposure and risk

Staff and Services Support staff in keeping well

Support external services in delivery of care ensuring appropriate pathways between health sectors

Regular meetings and communication to staff

Planning for staff absences, work priorities and contingency planning

Develop a collaborative working group between IUIH/PHN/MNHHS to create a workplan outlining responsibilities, resources and clear timelines


PHASE STEPS CONSIDERATIONS TASKS

Broader Impacts

Potential for reduction of health services for A&TSI patients with poorer health status

Potential of increased community spread with rural and remote hospital transfers

Risk to A&TSI community or increased self-exposure due to social determinants of health

Further planning for preparedness and response of emerging risks


Appendix 4: Resources for people with disabilities

NDIS NDIS Q&S Commission QDN https://www.ndis.gov.au/coronavirus

This site provides information on:

• Latest Advice From the NDIS • Information for Participants • Information for Providers • What happens when ….. • Auslan Videos • Animations • NDIS Office Operations • Partner Office Operations

https://www.ndiscommission.gov.au/resources/coronavirus-covid-19-information


Updates and advice: Australian Government

• Australian Government COVID-19 updates • Coronavirus Australia app • Department of Health updates • NDIS Commission fact sheet: Our fact sheet,

Coronavirus (COVID-19)

Participant information

Coronavirus (COVID-19) webpage for people with disability for links to updates about COVID-19 and resources for NDIS participants.

Provider Information

• Training module: Infection prevention and control for COVID-19

Provider alerts and communications

• Provider alerts: For information about coronavirus, including provider obligations, how to reduce the risk to participants, and links to updates and resources, please see our Provider Alerts about COVID-19.

• Letter to registered providers: The NDIS Quality and Safeguards Commissioner wrote to providers on 10 March 2020 drawing providers’ attention to the COVID-19 Provider Alert and pointing out that it is

https://qdn.org.au/home/covid-19/


GET THE FACTS

• Latest news on COVID-19 • Easy English Information and where to go for trusted information

on COVID 19, health, NDIA and getting the help you need

MAKE A PLAN

• Practical tools, resources and tips for developing your own COVID-19 preparedness plan.

• Resources to help you stay safe

STAY CONNECTED

• Information on how to stay socially connected • Important contacts and phone numbers

https://www.ndis.gov.au/coronavirus

https://www.ndis.gov.au/coronavirus/latest-advice-ndis

https://www.ndis.gov.au/coronavirus/participants-coronavirus-covid-19

https://www.ndis.gov.au/coronavirus/providers-coronavirus-covid-19



https://www.ndiscommission.gov.au/participants/covid-19-people-disability

https://covid-19training.gov.au/

https://www.ndiscommission.gov.au/news-media/provider-newsletters#alerts

https://www.ndiscommission.gov.au/document/1951

https://qdn.org.au/home/covid-19/


NDIS NDIS Q&S Commission QDN essential that providers remain subscribed to all NDIS Commission communications.

• Notification of changes letter to providers: about the new form they must use to notify of any change or event specified in section 13 or 13A of the NDIS (Provider Registration and Practice Standards) Rules 2018 that relate to the impact of COVID-19.

• Fact sheet – Behaviour support and restrictive practices

• Fact sheet – Information on the use of Personal Protective Equipment (PPE)

Notification of changes and events related to COVID-19

Registered providers should use the Notification of event form – COVID-19 (Registered providers) to notify the NDIS Quality and Safeguards Commissioner of change or events resulting from the COVID-19 outbreak.

Advice for registered providers and auditors

Commission has advised approved auditors to:

• review their audit practices to ensure these are provided in a way that minimises the risk of exposure to COVID-19 for participants, providers and auditors

• where audits are scheduled to occur, engage with providers to confirm their availability to continue where practicable to do so.

• delay or reschedule audit dates where providers are not in a position to proceed with these.

Links to government resources

The Australian Government has developed the following resources for providers and workers in the disability sector.






https://www.ndiscommission.gov.au/providers/notice-changes-events/notification-covid-19

https://www.ndiscommission.gov.au/providers/notice-changes-events/notification-covid-19


NDIS NDIS Q&S Commission QDN • Residential care facilities: National guidelines for the

prevention, control and public health management of COVID-19 outbreaks (Communicable Diseases Network Australia). These guidelines provide some useful information for disability providers to apply in the context of the settings where they deliver support to people with disability. Not all of these recommendation are feasible in a disability context, and we are working with the Department of Health to refine guidance to address the particular needs of the disability sector

• COVID-19 preparedness webinar for in-home and community aged care (Australian Government Department of Health)

• Department of Health videos and campaign resources: The Australian Government Department of Health has released a series of short videos, posters and audio about COVID-19 and the steps we can all take to protect ourselves and those most at risk, and help stop the spread.

https://www.health.gov.au/resources/publications/coronavirus-covid-19-guidelines-for-outbreaks-in-residential-care-facilities

https://publish.viostream.com/app/s-n3f4rpt

https://www.health.gov.au/resources/collections/coronavirus-covid-19-campaign-resources

https://www.health.gov.au/resources/collections/coronavirus-covid-19-campaign-resources