Case study: Pivoting Health Protection NSW branches to support local public health unit responses to significant infectious disease threats during the COVID-19 pandemic

Health Protection NSW consists of the Communicable Diseases (CD), Enterics Zoonoses and Multi-resistant Organisms (EZMRO), and Environmental Health branches. These branches are designated with strategic control of infectious disease and environmental health threats in NSW. As COVID-19 cases emerged in NSW, most staff were immediately redeployed to the response given some skillsets for the response directly aligned with those of staff within these branches (particularly those of the CD and EZMRO teams). A small team representing less than one-sixth of usual full-time employees across these branches remained in business as usual (BAU) to support the essential control of all other infectious disease threats and routine immunisation activities.

The CD BAU Branch immediately established the Communicable Diseases Guidelines for Public Health Workload Prioritisation during Covid-19. This became the ‘what to drop’ authority for public health units (PHUs). This guideline aimed to ensure PHUs had clear guidance on what priority conditions, besides COVID-19, required public health controls to keep people safe from the most serious and transmissible infections; outlined key contact details of staff remaining on BAU; and articulated where the CD BAU Branch had skills and access to relevant clinical systems enabling support to PHUs. This protocol was revised twice with new waves of COVID-19 ameliorating the pressures on PHUs.

The CD BAU Branch assumed a range of routine operational functions normally provided by PHUs to protect the population of NSW from disease threats. This included:

• assistance with follow-up of infectious syphilis in women of reproductive age, pregnant women with syphilis and possible congenital syphilis cases, and bloodborne viruses/sexually transmissible infections in children aged under 16 years
• hepatitis health undertakings
• foodborne outbreak investigations
• interviews to support investigation of other potential disease clusters (for example, Legionella pneumophila)
• laboratory follow-up, including working with reference laboratories to provide additional testing on specimens where case interviews could not be routinely conducted (for example, whole genome sequencing of Shiga toxin-producing E. coli infections to rule out potential for missed clusters)
• mass contact tracing (including text messaging).

This was either operationalised as routine under the guideline (in the case of foodborne outbreaks) or was available on request once PHUs identified competing priorities and the need to prioritise the most critical issues. More complete assistance to PHUs was not possible since the CD BAU Branch did not have full access to the suite of clinical systems available to local PHUs, particularly eMR.

Despite significant human resource challenges, the CD BAU Branch developed innovative ways of working, such as:

• rebuilding standard operating processes so that all functions could be completed remotely
• integrating new technologies to create efficiencies in processes (SMS technology through Whispir)
• daily reprioritising of tasks across available resources.

The rapid re-pivoting of the CD BAU Branch to identify the most essential public health interventions and to provide support for PHUs was critical to maximising local surge capabilities during the pandemic. Staff demonstrated strong leadership under difficult conditions, flexibility, and exceptional commitment to public health principles at a time of dispersed resources.