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Australia Inside Brisbane's COVID-19 crisis at the Princess Alexandra Hospital

02:16  03 april  2021
02:16  03 april  2021 Source:   abc.net.au

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Another nurse at the Princess Alexandra Hospital has been diagnosed as having had COVID - 19 , with Chief Health Officer Jeannette Young saying the historical case is the "missing link" in one of Brisbane ' s recent clusters. Key points: Nurse caught the virus after treating a "superspreader" returned traveller. She is labelled the "missing link" in community transmission, passing the virus from the hospital , to her partner. Close contact of COVID patient takes off from hospital , but has been returned by police.

'Missing link' in Brisbane ' s original COVID - 19 cluster found. By Lara Pearce • Senior Producer. The missing link is a nurse who worked at the Princess Alexandra Hospital . (Nine). Queensland Health believes that the nurse, who resides in North Brisbane , then transmitted the infection to her partner, who spread the infection to his social network. Dr Young said the nurse's partner came forward "out of the blue" to get tested, leading to the discovery of the missing chains of transmission.

In the disarming afterglow of vaccines arriving, Brisbane's Princess Alexandra (PA) Hospital has become an unlikely source of COVID-19 outbreaks that have crossed a state border.

a person posing for the camera: Queensland's COVID-19 outbreaks have experts questioning how the virus breached PPE at Brisbane's Princess Alexandra Hospital. (Pixabay) © Provided by ABC News Queensland's COVID-19 outbreaks have experts questioning how the virus breached PPE at Brisbane's Princess Alexandra Hospital. (Pixabay)

The hospital has long boasted "one of the best infection control programs" around, according to Mary-Louise McLaws, a professor of epidemiology at the University of New South Wales.

"They have a reputation of being very much on top of their game," she said.

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Brisbane ' s Princess Alexandra Hospital has been placed into lockdown after a staff member contracted COVID - 19 off a patient. The staff member had contact with the patient in the early hours of Wednesday and was infectious in the community on Thursday, Queensland Health said in a statement on Friday night. The Emergency Department will remain open but people are urged to receive care at other hospitals or at a GP if possible. Staff will have to wear masks at all times as will patients unless it is not clinically appropriate. Non-urgent outpatient bookings and elective surgery will be postponed.

Queensland has recorded no community transmission of COVID - 19 on Good Friday, a day after the greater Brisbane region was seeing out the last hours of a snap three-day lockdown. Premier Annastacia Palaszczuk said there were eight new cases of coronavirus in Queensland overnight One was a historical case, which was believed to be the missing link to the original cluster recorded at the Princess Alexandra Hospital in early March. Chief Health Officer Jeannette Young said the historical case was a nurse who was infected by an overseas traveller. The traveller, a man who came from

That image has been shaken since the PA emerged as the source of two separate clusters, thrusting the Queensland capital into lockdown and putting the state's punch-drunk tourism industry on tenterhooks on the eve of Easter holidays.

A doctor and a nurse at the PA hospital have been the primary sources for two community outbreaks of COVID-19. © ABC News A doctor and a nurse at the PA hospital have been the primary sources for two community outbreaks of COVID-19.

A doctor and a nurse became infected on the job weeks apart, then unwittingly took it home to create the two clusters, one of which spread south of the border to Byron Bay.

On Good Friday, a historical case emerged — a second PA Hospital nurse.

She and the doctor caught the virus while treating the same returned traveller at the hospital.

That traveller has been described as a superspreader.

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The previously unidentified nurse, who also works at the Princess Alexandra Hospital , treated the same returned traveller who infected a doctor earlier in March. Anyone who has been to any of these locations at the relevant times, including those more than 14 days ago, should get tested immediately if they have COVID - 19 symptoms and quarantine at home until receiving the test result. Anyone who visited the sites but has no symptoms is advised to visit a GP next week to arrange a blood test for COVID - 19 serology.

Brisbane ' s Ground Zero: 'Large number' of nurses and hospital staff in coronavirus-infected Ward 5D at besieged hospital are plunged into isolation – as millions fear an Easter lockdown. All staff who entered infectious disease ward at centre of outbreaks must isolate. Ward 5D at Brisbane ' s Princess Alexandra Hospital the On Wednesday, it emerged a vaccinated nurse working at the hospital had tested positive to Covid - 19 after likely catching the virus from a returned traveller. Another nurse who is part of the same cluster went to a hen's party in Byron Bay, northern New South Wales, where they

She is the "the missing link" case, deemed to have spread the virus to her partner in the community unwittingly while she was asymptomatic.

All cases in the two clusters are most likely to have been found and the COVID-19 crisis has been averted for now.

Authorities are confident in having connected the dots with the 20 known cases of community transmission.

A record 34,711 tests turned up just a single case in the final 24 hours of a snap three-day lockdown that Chief Health Officer Jeannette Young had indicated she would rather not have to impose, now a vaccine rollout was underway.

At midday on Thursday, the state government gave the 2.5 million residents of Greater Brisbane an early pass out of lockdown.

But infection control failures at the major public hospital that kicked it all off remain a source of bewilderment to experts such as Professor McLaws.

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The Princess Alexandra Hospital sent an email to staff labelling the incident as a 'moderate risk' and urged anyone who showed symptoms to stay home. 'As you may have heard, a positive case with unknown origin has been detected in the Metro South Health catchment,' the email read. 'The case is a medical officer at the Princess Alexandra Hospital .' The doctor had contact with Covid -infected patients on the morning of March 10 before leaving the hospital and being in the community for the next 24 hours. The lockdown conditions include banning non-essential visitors and mandatory masks

Brisbane ' s Princess Alexandra Hospital has been placed into lockdown after a staff member contracted COVID - 19 off a patient. The staff member had contact with the patient in the early hours of Wednesday and was infectious in the community on Thursday, Queensland Health said in a statement on Friday night. The lockdown means all non-essential visits to patients will not be allowed and anyone needing to attend the hospital will be required to wear a mask. The Emergency Department will remain open but people are urged to receive care at other hospitals or at a GP if possible.

"I'm gobsmacked how [the doctor] came to be infected," she told the ABC.

"It really makes you wonder."

Questions remain 

On March 12, the infectious disease doctor at the PA tested positive to the highly-transmissible B117 variant of COVID-19.

This was two days after she did a face-to-face assessment of a returned traveller who had been admitted after testing positive in hotel quarantine.

Had genetic sequencing not matched up between doctor and patient, Professor McLaws said, "I would've said she caught it in the community".

She said the doctor would have known to wear a mask and eye protection before entering the room to treat the patient.

And the PA's ward 5D, where COVID-19 patients are treated, would almost certainly meet World Health Organization guidelines around proper ventilation, Professor McLaws said.

"She's an infectious disease doctor, and they know how to don and doff their personal protective equipment (PPE) correctly," Professor McLaws said.

"Unless she forgot to wear eye protection – because you can catch COVID through the eyes – or she had contaminated hands and inadvertently wiped her eyes or her face when removing her PPE, which would be unusual, I cannot for the life of me work out how she got it."

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Professor McLaws said the key lesson was yet to be learned: How did an outbreak begin in the state's premier infection control facility?

She suggested that when the PA doctor at the centre of the first cluster was well enough, health officials "should walk her through", retracing her movements and actions on March 10 to try to answer that.

"In Hong Kong with SARS, we found infections came when doctors were busy saving lives, or when they were exhausted,"  Professor McLaws said.

"Healthcare workers do get distracted looking after their patients.

"But I find it very difficult to work out how this doctor caught COVID-19 at the PA."

What led to the lockdown

On March 11, the unsuspecting and asymptomatic doctor went to a café, gym, pub and a McDonald's drive-through in Brisbane's inner-south.

A sore throat the next day prompted a test.

By March 19, more than 600 contacts had been tested without a new case and Dr Young declared the outbreak under control.

Unbeknown to authorities, by then, the virus had spread to an unidentified north Brisbane man.

It is now believed the newly traced second nurse unwittingly transmitted it to this man, her partner.

He gave it to his brother, a Stafford landscaper, who was infectious but showing no symptoms.

The landscaper, 26, visited a string of venues, from a major shopping centre in Brisbane's south to a restaurant in Redcliffe to the city's north-east.

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He worked on March 22 while infectious, but thankfully was outdoors, Dr Young noted.

He came down with symptoms that day then stayed home sick most of the week before getting tested at a clinic in Nundah on March 25.

On March 27, his friend, a Strathpine man, tested positive.

Two of his colleagues tested positive on March 29, including one who had been in Gladstone while infectious for the previous three days.

This prompted Dr Young to call a snap three-day lockdown.

The same day, on March 29, a new cluster emerged: this time a nurse from PA hospital, who had infected her sister.

This first nurse was believed to have caught the virus from a returned traveller from India while working an overnight shift on March 23.

She had been in Ward 5 that night but not Ward 5D, set aside for COVID patients, according to a hospital source.

Staff say they're panicking

One woman who works at the PA, speaking on condition of anonymity, said the hospital's second infection control failure in the space of a few weeks had left some staff "panicked".

The first nurse, unlike the doctor weeks earlier, had received her first vaccination dose when she tested positive.

But the PA staffer told the ABC it was not lost on frontline health care workers that many of them still had not been given their first vaccine dose, unlike many senior administrative hospital staff who have no direct contact with patients.

As late as Thursday, doctors seeking Pfizer vaccinations on site were being knocked back, she said.

"Some doctors have gone to outside GPs to get their [AstraZeneca] shots," she told the ABC.

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Professor McLaws said this was far from ideal, in part given the longer wait for a second dose with AstraZeneca.

"One dose is better than no dose; and the Israelis found one dose of Pfizer reduces viral loads," she said.

"You don't want any impact on the health of frontline healthcare workers.

"The effects can be long term."

The second cluster grew when the first nurse and her sister went to a hen's party at Byron Bay from March 26 to March 28.

On March 30, it was announced that another five people who had been at the hen's party, held in an Airbnb rental, had tested positive.

They included a Gold Coast tradie moonlighting as a hen's party "entertainer".

The 'perfect case' helped lockdown lift

Colourful details aside, the numbers were grim news for greater Brisbane in its first 24 hours of lockdown, and many braced for an Easter holiday at home under restrictions.

The tradie's return to the Gold Coast, which included visits to an aged care facility and a surf lifesaving championship at Tugun attended by hundreds of competitors, set off a number of contact tracing alerts.

There were signs of a silver lining: all residents at the aged care home had already received their first vaccination dose.

On March 31, two more community cases were revealed, both also guests at the hen's party.

One was another PA nurse, who had not returned to work, and the other her housemate.

Premier Annastacia Palaszczuk said the absence of unexplained cases amid more than 33,000 tests in 24 hours was "very encouraging".

This raised hopes the lockdown would not linger into Easter.

On April 1, the final scheduled day of lockdown, only one new case emerged.

Dr Young described it as a "perfect case": it was another guest at the hen's party, who had isolated immediately after her return home to Wide Bay three hours north of Brisbane.

In the end, eight of 11 people at the Airbnb at Byron Bay caught COVID-19.

The Premier declared the result "fantastic news" and the lockdown was lifted early at midday – a gesture to avoid the rush of holidaymakers seizing the opportunity to flee Brisbane for the Easter holidays.

The record rates of people coming forward for testing — and the fact those at the root of both coronavirus clusters fronted up for tests in the first place once they felt unwell – weighed heavily in the capital's favour in avoiding a lengthy stint of tough restrictions.

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