Looking back on recent weeks, there is no question that we have been in the midst an incredibly fast-moving and evolving situation. We’re all feeling it. Just how rapidly have things developed? A summary of some key milestones and dates gives an idea:

31 December 2019 – Pneumonia of unknown cause reported to World Health Organization (WHO) China Office.
10 January 2020 – WHO issues its first guidance on the novel coronavirus.
13 January 2020 – The first case of novel coronavirus outside China is confirmed in Thailand.
25 January 2020 – The first case in Australia is recorded.
30 January 2020 – WHO declares a public health emergency of international concern. 
28 February 2020 – The first case in New Zealand is recorded.
1 March 2020 – The first death is reported in Australia.
11 March 2020 – WHO declares a global pandemic.
29 March 2020 – 4985 cases in Australia (16 deaths), and 514 confirmed and probable cases in New Zealand. New Zealand reports its first death on this day.
30 April 2020 There have been 3.2 million cases recorded worldwide and more than 227,000 deaths. New Zealand and Australia seem to have squashed their curves with social isolation (amongst other) measures.
1 May 2020 – Australia has recorded 6,753 cases (91 deaths) and New Zealand has 1,479 confirmed and probable cases (19 deaths). Both countries have a fraction of cases and deaths recorded in places like the United States, Italy, United Kingdom, Spain and France which have all recorded well in excess of 20,000 fatalities per nation.

Clearly, an enormous amount has also occurred in between each of these dates, particularly on the ground for us in our work as emergency physicians. Nevertheless, the snapshot above provides some sense of escalation and scale. The sheer speed and scope of developments and changes has presented momentous challenges, and plenty of anxiety, uncertainty and stress. There have been major and ongoing changes to the way we live and work; and we continue to contend with the fact that COVID-19 remains a significant threat.  

Despite what has happened, it is important to celebrate at least some success in this situation. Our two nations, at this stage, look on track to avoid some of the devastating scenes we have seen unfolding around the world. Even so, there is no room for complacency.

We don’t know precisely when things might reach a new ‘normal’, if such a thing is possible, and we continue to acknowledge and support colleagues in Australia, Aotearoa New Zealand and internationally, who have endured, and continue to experience, some incredibly tough times. Tough times in our clinical work, but also socially and economically.

Notwithstanding the upheaval, disruption and heartache that the coronavirus has caused, as we continue on this marathon, it is important to look for signs of optimism and hope. If we were to look for positives in our current situation, I would suggest that the way forward is perhaps just that little bit clearer now than it was even a couple of weeks ago.

As we continue to work, and remain hopeful of avoiding the so-called tsunami of COVID-19 patients which has eventuated elsewhere, it feels as though we have now moved on somewhat from the ‘crisis phase’ of this event, and into the ‘chronic phase’. While the threats are far from over, we have put ourselves in a more manageable situation, and given ourselves a little bit of breathing room. Even still, we remain vigilant and prepared to address the swathe of potentially unmet acute and chronic healthcare needs which may have been simmering under the surface, whilst most of the resources, and much of the focus has been directed at the pandemic.

It is important to acknowledge that our current, slightly improved, situation hasn’t happened by accident. The significant public health measures put in place by our various governments have proven effective so far, and we thank our communities for largely embracing social distancing measures which have contributed to flattening the curve.

It is also the work all of you have done in your daily roles as emergency physicians, as well as through the College, which has contributed so significantly to strengthening our position.

I have been in awe of the contributions of so many who have stepped up into leadership positions as part of your local, jurisdictional, state and national planning and response efforts. It is testament to the crucial and valuable expertise we, as emergency physicians, bring to the table.

I must also thank the many who have played such key roles in working with College staff across so many aspects of our response to COVID-19. From participation in developing and updating the ACEM COVID-19 Guidelines; to involvement in Faculty work and advocacy activities; to facilitation of and participation in  webinars; to the development and issuing of our joint statement advocating for culturally safe care for Māori during the COVID-19 pandemic and support for ACEM’s Te Rautaki Manaaki Mana, the Maori Health Equity Strategy. There are too many highlights and achievements to list individually; but I extend my gratitude for the roles you have played in each of them.

If there is another positive to come from this situation, it is realising what we can achieve so efficiently and professionally when we stick together and support each other. In recent weeks we have also experienced unprecedented collaboration with our colleagues across the health sector, and we must strive for this spirit of collaboration to be maintained as we continue confronting COVID-19 and approach our new normal.

Our health systems in Australia and New Zealand have done very well in creating capacity during the pandemic and this has helped flow in EDs (although we are still hearing of some lingering instances of access block in some locations). Whilst not so busy in our EDs, it has become clear that this is an amazing opportunity to re-set how we operate, and get us back to our core business of dealing with emergency care, rather than picking up the pieces of unmet healthcare need from other systems.

We must do everything in our power to never go back to access block, 24-hour (and longer) stays in EDs resulting in crowding, patients in corridors, human suffering and the most vulnerable patients waiting for admission. We have got to get to a point where people do not come to the emergency department unless they need urgent medical care.

No turning back.

Clearly we’re not out of the woods yet. As many challenges remain, your College remains with you. Be it through our advocacy to national and jurisdictional governments and health officials, education and training support, wellbeing initiatives and support for members and trainees, we are doing our utmost to help you through.

I continue to meet regularly with the College’s executive leadership and Board, as we monitor and respond the situation. Our commitment remains to communicate with you as openly and regularly as is needed, in order to ensure you are updated with developments as they come to light.

As we continue to keep you informed via email and other College channels, I also encourage you to regularly check the College’s dedicated coronavirus website, where all our COVID-19 resources and communications are housed.

This includes pertinent information in relation to College operations and activities, including training and examinations. We remain ever mindful of the uncertainty and disruption this ongoing situation has had on trainees and we continue seeking to mitigate this as much as we are able. Whilst in March we reduced the pressure on trainees to complete WBAs and attend structured teaching, in April we have had the most WBAs performed in a month ever and virtual teaching has been tremendously popular. Could this be a sign of what our new normal looks like?

Our commitment to trainees remains that we will continue to monitor and respond to issues as they arise, provide reassurance and relieve anxieties where we can, and explore options that are flexible and pragmatic.

As always, I am eager to know what the College can do to continue supporting you during this difficult time, so please do let us know.

We must get back on track to both clinical and training business as usual, to a new normal as quickly as we can. We acknowledge COVID-19 has taken over and we must take some of the silver linings from this crisis into our new normal.

It can be tough, but a constant that remains is the need to be kind to ourselves, our colleagues, our family and patients.

We must also keep looking after our wellbeing.

These are the things that will help us get through. There is a new normal at the end of this and we will be richer for it.

Thank you again for the sacrifices you continue to make as we confront the challenges of COVID-19. Your communities are lucky to have your skills, professionalism, passion and compassion in these extraordinary times.
Kia kaha – be strong

Dr John Bonning
ACEM President