Q&A: Lessons From the COVID Frontlines … of New Zealand

Dalilah Restrepo, MD: “I think now infection preventionists should be part of a school board, should be part of any executive board, of any corporate area, because there is no way that you can expect this expertise to just come about for other folks that aren’t trained in infection prevention.”

New Zealand is dealing with another outbreak of coronavirus disease 2019 (COVID-19) these days, even having to move parliamentary elections back four weeks and putting lockdown measures into place. It’s quick, forceful actions like these that made healthcare experts consider New Zealand’s reaction to COVID-19 to be one of the best in the world. Dalilah Restrepo, MD, was the clinical leader of the infection control team for New Zealand’s hospital task force when the country first dealt with COVID-19. Restrepo recently sat down with Infection Control Today® to discuss what lessons the United States might learn from New Zealand’s experience, and how the place of infection prevention—and infection preventionists—will never again be the same.

Infection Control Today®: New Zealand really did have arguably the best response in the world. Is there something that you learned over there that you can relate to infection preventionist over here that might help them do their jobs better?

Dalilah Restrepo, MD: Really having been a part of the New Zealand experience has been quite a privilege. I can’t say that we have done things that are way too different, so to speak, then what infection control or infection preventionists do elsewhere in the world. They do tend to move quite fast here and quite aggressively and in unison. I think that has really resonated and it really has impacted. Even a small move, when the entire country does it together, it has a lot more impact. I think the unity is something that might be really telling of New Zealanders.

ICT®: Has COVID-19 ensured that infection preventionists will have a seat at the table of hospital leaders?

Restrepo: I think COVID put us in a different light, that’s for sure. Infection preventionists are always kind of the quiet folks in the back telling people to wash their hands and use hand sanitizer and advocating for standard precautions. But we’re not really invited until there’s a crisis. So, definitely COVID has put us in the spotlight. And I think going forward, it is going to be very important and we are having a seat at the table at the moment. Really, for me, the environmental and infection preventionists are the pillars of a hospital or an institution because honestly, without that you really can’t function everywhere else properly. It is important from the moment that you even design a hospital, infection prevention should be on board. I do believe that.

ICT®: Do you see COVID-19 changing the place of infection preventionists in healthcare as a whole forever?

Restrepo: I do believe it will. I think we have a big role in education, in managing PPE, in implementing policies and structures to prevent infection and I think that with this new pandemic, it really shone a light as to how important it is. Because it isn’t our last pandemic and it won’t be the last bacteria or virus or organism that we’ll have to deal with.

ICT®: We’re hoping it’ll be the last one that stops everything cold like this one seems to have done.

Restrepo: That would be very nice. Yes, it would. Yes. We’re all suffering tremendously.

ICT®: Is there an early warning system that you think will be put into place worldwide?

Restrepo: Well, I think that would be very important. It’s also how we have amended, right? I mean, our standard precautions used to be gloves or hand washing, but now it’s moved on to cough etiquette and maybe masks as well. Right? So, that’s all brand new. And we should think about that going forward, because many of our pandemics are viral and respiratory illnesses. And, and so part of standard precautions probably will be some sort of mouth or nose covering to prevent mucosal entrance. It really does kind of…. It’s compounding and it’s additive. And I think as new experiences come by, we supplement what we thought we knew, and so I think that’ll be important. Definitely infection preventionists will play a key role.

ICT®: What surprised you the most about the response to the pandemic? Both in New Zealand and in the United States?

Restrepo: Different things surprised me in different areas. We all have seen apocalyptic movies and things like that. And it always seems like the world comes together when there’s a common threat. And for some reason, I didn’t get that feeling. I thought that if anything, we became more divisive. And so that was really disheartening because if anything, I thought all our differences would go away for at least a second and let’s get together and combat this virus and I didn’t get that sense. In New Zealand, though, I do believe there was some more commonality and some more union. And even here, there are differences politically and different parties, etc. And still, despite that everyone came together to address the threat. So that was important to see. Restored my faith a little bit to see that kind of response here.

ICT®: When do you think we’ll ever get back to normal and what will normal look like?

Restrepo: I think normal won’t be the pre-normal, the pre-COVID era for quite some time. I know people were really waiting for January or just a new year and kind of a new slate. I don’t think it’ll be that quick. But eventually it will. I think we will learn to live with the virus for some time. I think even if a vaccine came about it would be many months to a year before we had enough people vaccinated that it would make a difference. And even still, it wouldn’t change the infection preventionist standard precautions because no vaccine is 100%. Or at least up until now unless something changes with the advances in research. But I don’t expect it to be 100% effective. We’ll still have to rely on standard precautions. And so, there are still many unknowns. I anticipate that this will be a couple of years of dealing with this and changing our world and having to evolve, having to evolve with our new normal.

ICT®: Does it concern you that during the COVID-19 surges the infection prevention rulebook had to get sort of thrown out the window? That you’re going to have to re-educate people on proper infection control standards?

Restrepo: What concerns me is that people didn’t expect that. I mean, that is the norm. When something’s new, you’re going to learn and change, and learn and change, and learn and change until you finally get it. There is no way that we could have known what we know today, six months ago, nine months ago. So, of course, things are going to change. What’s striking and what’s concerning is that it’s so difficult to change the minds of people once you’ve said something. It’s almost like it just ruins your credibility from the get-go. And in reality, it should be actually helping because imagine, we were still saying the things we were saying nine months ago, right? So that part is a bit concerning. And believe me, a lot of my days are spent in re-educating and kind of changing the dogma of yesterday, which is no longer. Unfortunately with this, it would be wrong to not change our minds every so often. I think we just have to keep going, keep going, keep learning, and eventually, we will learn more about COVID. And I think that will be the new normal when we finally have a better understanding of it. Transmission management. Who gets infected and who gets really sick, for example. All of these things will really be part of our new normal. And then we’ll be able to deal with this virus properly without having it affect the economy and having it shutting down cities and things like that.

ICT®: Do you see infection preventionists, or at least infection prevention expertise, migrating out of the hospitals and healthcare system and more into the general public?

Restrepo: Yes. Thank you for asking that. Yes, indeed. It actually started. For me, for example, just to give an example and the few colleagues that I speak to, it started as really a kind of a friendly advice from friends that were either on school boards or executive boards of companies or corporate areas or law firms, etc. Just how do we come back and how do we reopen our workplace? And we really started to see how infection preventionists see the world in a different way. We walk around and we see risk everywhere. And we’re always managing that balance of risk benefit and so it really became something a skill that was very, very useful outside of the hospital. And I guess really, we never thought about it. A lot of us apply it at home. For example, I always wash my produce when I come home from the supermarket. That was pre-COVID. Little things that you do that were just kind of automatic, because we were used to dealing with the microbial layer of things that have really resonated with the corporate world and outside in the private sector. I think that it will be very important. I think now infection preventionists should be part of a school board, should be part of any executive board, of any corporate area, because there is no way that you can expect this expertise to just come about for other folks that aren’t trained in infection prevention.

ICT®: Are there enough infection preventionists to go around with such an expansion? If not, how would you add to the ranks of infection preventionists?

Restrepo: I would imagine that there aren’t enough of us to go around, but there are some companies that are getting folks together and creating webinars and things like that and doing some education. It’s really difficult also, because every area is different. Every workplace is different, and the parameters might be the same. There might be two or three things that you have to adhere to: the handwashing, social distancing, staying home when you’re ill, and how do you bring folks back after they’ve been sick. Right. There might be some clear guidelines to that, but how you apply it to your workplace is going to be totally different depending on your area. And it’s not wrong. It’s just that there are many ways to skin a cat as they say. It is important to do maybe a run-through and have someone just kind of evaluate your workflow and see where there are places that you can intervene. And that can be very specific to a place. I see this as an opportunity to grow.

ICT®: Do you think after this is over, there’ll be a push to make sure that a full time infection preventionist is on the staff of every nursing home or other long-term care facility?

Restrepo: Yes, I think so. It’s even with flu season every year. There are many things that we’re doing now for COVID that when we think back, we’ll think, “Well, why weren’t we doing this anyway?” It's just a of complacency when you have a vaccine, when you have antivirals, when you have management control of something. You become complacent. This is for sure. I think this is a time when we should relearn these processes and remember how important they really are. Also, that learning curve when a new pandemic comes about really highlights our vulnerabilities. And we see now how important for healthcare workers it is to keep this in mind. This is why we were the most to get sick initially, because we’re just in the trenches, and we’re just learning, and we don’t have all the parameters and it becomes this really vulnerable period for the healthcare worker as well. Or groups of vulnerability like the elderly in long-term care facilities. This definitely has to be something to be thought of. Having said that, every pandemic is different and next time we might be dealing with a totally different organism that is not transmitted through droplet or respiratory droplets. It’ll change our policy. Again. It’s just a constant surveillance really.

This interview has been edited for clarity and length.