In trying to make sense of what might seem like confusing or inconsistent decisions around #COVIDー19 interventions at the population level it might be helpful to look at the different phases of a pandemic and what type of control measures happen during each phase. This is.... 
....the Australian pandemic plan. It’s publicly available. Ireland will have a VERY similar plan, though the names of the phases might be different. PHASE 1: Preparedness; This is when planning happens. It’s ongoing, with meetings, desktop exercises and pressure testing.....
.....PHASE 2: Standby; This phase kicks in when there’s sustained transmission overseas. When China saw the situation get bad, most countries stepped into this phase. It’s enhanced level of preparation. Lots of banal work goes on behind the scenes, from making sure local plans...
...are up to date,to making sure everyone’s airport credentials are in date. We also do things like count the number of ventilators nationally. It’s where we tick a lot of boxes to make sure that we’re ready. We sometimes get as far as this bit and step down if things calm down..
...PHASE 3: Action; Subdivided into two phases. Action (initial) is usually declared when we see our first case arrive. It might be called “contain” in Ireland. At this stage, things change daily and we usually don’t have enough info to make decisions about what things will be...
...like in 2 weeks. So in the absence of good local data we focus on doing the basics well. We aggressively contact trace and isolate new cases while we work out the pattern of national spread. Lots of modelling and number crunching happens! Data at this stage usually suggests...
...that we don’t do big ticket interventions like banning mass gatherings because there are usually not enough cases for that to be effective. In this phase public health are swamped but hospitals/GP are usually not yet overwhelmed. The kind of thing we might do at this stage...
...would be to close an individual school or workplace if there was a case identified. These are small, focused interventions aimed at known cases while we wait for more info. Ireland is probably at the latter stages of this phase I’d guess...
....Action (targeted) is part of phase 3 but is pretty distinct. It’s what happens when we have lots of cases and we have an idea what’s driving transmission. Eg during swine flu it became apparent that school cases were driving the epidemic. So we shut schools...
...we start to know how many people are likely to end up in hospital or ICU. During this phase we start to really target our interventions based on the data. We might curtail mass gatherings if we felt these were driving spread (eg if we had lots of superspreaders)...
But note the prominence given to “proportionate response” in the document. Getting through an epidemic with 20% unemployment at the end isn’t a great result if it wasn’t needed. Sometimes we stop widespread testing in this phase to protect GPs and labs. We also shift focus from..
...well people who are infected to vulnerable populations eg outbreaks in nursing homes or prisons. Supporting EDs and ICU should be a priority. Fever clinics might happen. But the key to this phase is looking at the epi, deciding what’s driving the outbreak and then...
...deciding whether we need to take some of the actions that a lot of people are baying for at the minute. We have limited resources so a data driven approach is very important. Though politics and public concern do end up driving some of the decisions in this phase inevitably...
...The final phase is STAND DOWN. This is what it says on the tin. It’s when things die down and we look at returning to business as usual. But we need to keep a close watch on things for a while, as there can be a bounce in cases when resources are scaled back....
....at the end of this phase, the minister for health in Ireland usually forgets their public health physicians exist and leaves them floundering in professional limbo on a contract that’s worse than that of any other group of specialists. Hopefully @SimonHarrisTD or whoever...
...takes over will look at this outbreak and realise, like all other English speaking countries, that we should be treated the same as other consultants in Ireland. The phase where this doesn’t happen has been dubbed the “IGNORE” phase and is the final phase in Ireland....
....so it’s difficult to do a “pandemics for Twitter” thread. I’ve definitely missed some stuff out and simplified for brevity. So it’s not gospel. But they key is that we shouldn’t constantly judge what we’re doing against what other countries are doing because they are often...
...in a different phase of the pandemic or have different drivers of spread. The epidemiology and drivers are not the same in Wuhan and Western Australia and Donegal. Your local friendly public health physicians do this all the time, though on a smaller scale, and we have lots...
...of amazing colleagues in virology and epidemiology and community and hospital medicine to help. Most countries are in good hands and will be ok. This too will end!
