‘Make it work on the ground’: Meet Australia’s pandemic whisperer-By Rachel Clun
ANU Associate Professor Kamalini Lokuge has worked hard behind the scenes on Australia’s COVID-19 response.CREDIT:ALEX ELLINGHAUSEN
Source:SMH
High-tech hospital wards and advanced medical treatments were not going to save Australia from the ravages of a previously unknown virus, as Associate Professor Kamalini Lokuge well knew.
Three basic things would be key: preventing the virus from entering the community, tracing all cases of the disease, and most importantly of all, ensuring the public understood and trusted the government’s health messaging.
“In some ways it was a near miss, what happened in Australia,” Professor Lokuge said.
“Like almost all developed countries Australia was very confident, given the past track record, that they could manage with technology, with therapeutic intervention: there wasn’t a [widespread] understanding that for this, the only intervention was prevention.”
Kamalini Lokuge is not a household name. But thanks in part to her work as a field epidemiologist, assisting with tracking and halting Ebola outbreaks across central and western Africa over the last 15 years, Professor Lokuge has been a crucial figure in Australia’s pandemic response.
“She was very, very rapidly able to identify that this obviously wasn’t the flu,” WA’s Chief Health Officer Dr Andrew Robertson said.
Victorian Chief Medical Officer Professor Brett Sutton said Professor Lokuge was an “absolutely genuine field epidemiologist”.
“Even though she’s got a great academic career, all of her work and all of her advice is informed by the reality of making that stuff work on the ground,” he said.
Every year for the last decade, the Australian National University epidemiologist travelled to countries including Sierra Leone, Guinea and the Democratic Republic of Congo to support the response on the ground to Ebola outbreaks, and then used what she learnt in subsequent outbreaks.
“I’d go out, help control the outbreak and come back and think, ‘what did we learn from that? How could we do it better?’” Professor Lokuge said.
On her first 24 to 48 hours on the ground, she would start to work out how each person got infected and map the path of the disease.
“Once you’ve tracked all those transmission chains, you can be confident that you know how the disease has moved so you know who everyone who’s potentially at risk of becoming infectious and isolate those people,” she said.
Professor Lokuge coined the terms upstream and downstream contact tracing – looking at who has become infected from a particular case but also how that case became infected.
Australia routinely conducted contact tracing for various diseases like measles before the pandemic, but ANU colleague Professor Emily Banks said the upstream and downstream ways of thinking about it were new.
“She coined those terms, specifically to emphasise that in COVID it’s very, very important to do upstream contact tracing, because you go back and you find cases who would then have transmitted it to other people,” she said.
As well as contact tracing, modelling done by Professor Lokuge and colleagues recently published in BMC Medicine also gave health authorities a solid scientific reasoning for focusing on testing people with symptoms, rather than general widespread testing.
Dr Robertson said this work has been vital throughout Australia’s pandemic response.
“[While] those public health measures have had some significant impact on society, they have been very effective in stopping any further spread of the disease and being able to return to normality in a relatively short period of time,” he said.
Professor Lokuge’s expertise was especially pertinent during Victoria’s second wave.
Professor Sutton, who first met Professor Lokuge while they were both working for Medecins Sans Frontieres in Afghanistan during the Taliban’s uprising in the late 1990s, said she was laser-focused on helping trace the growing outbreaks.
“She really sharpened the focus on how best to direct our energies to get on top of some of those challenging outbreaks,” he said.
She also understood the challenges of communicating with diverse communities.
“It very much came down to the similar issues with Ebola, which is how do you manage to engage with traditionally harder-to-engage populations?” Professor Sutton said.
Victoria’s second wave was no surprise to Professor Lokuge. At one point people were calling her prophetic for predicting it, Professor Banks said, but added that the term ‘pandemic whisperer’ suited better.
“Pandemic whisperer to me, was about that person who had this very special kind of understanding of not only what was going on, but how to change it, how to do something about it,” Prof Banks said.
But to Professor Lokuge, the most important people in the pandemic response have been the community. By accepting a lockdown early in the pandemic, the community gave the country time to build up the testing and tracing capacity it has today.
“We were very fortunate … that the community, by and large, trust what they’re told,” she said.
“[When] we locked down the borders, we actually had a lot of cases in the country, and a lot of transmission at that point, that’s why we had to ask the community to basically go into lockdown.
“Without that, all we would have gained from the border closures was a few weeks head start on Europe in the US.”
