Professor Carol Hodgson knows first-hand the challenges facing frontline health workers, researchers and guideline developers in the time of COVID. A few months into 2020, she was already working on international guidelines for the management of COVID-19 patients in acute settings with fellow physios and other clinicians from around the world. By May, in her role as Deputy Director of the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) at Monash University, she had registered a clinical trial on long term outcomes for COVID patients. And throughout this year of extraordinary demands, Carol continued to care for critically ill patients in her role as a leading specialist ICU physiotherapist at Melbourne’s Alfred Hospital.
These combined roles reflect the wealth of experience, expertise and close connections with multidisciplinary colleagues around the globe that Carol has brought to the National COVID-19 Clinical Evidence Taskforce. Her dual roles of Deputy Chair of the Critical Care Panel and representative for Allied Health Professions Australia (AHPA) on the Taskforce Leadership Group have been part of an extraordinary personal commitment and professional contribution to local, national and global efforts to understand, treat and stop the spread of COVID-19.
‘We all know this has been a terrible year and devastating situation worldwide,’ Carol says. ‘But if there’s a positive you can take out of this pandemic, it’s the fact that clinicians and academics everywhere have pulled together to truly collaborate and combat it. We’ve shared this amazing collegiality and unity of purpose – be that to find effective treatments or vaccines or to develop guidelines to help frontline healthcare workers. I’ve actually been so grateful for that shared sense of purpose, because going into work has been incredibly stressful for everyone on so many different levels.’
‘From an ICU perspective, communication is critical to managing very complex patients,’ Carol explains. ‘With COVID, suddenly everything was made even more difficult. You can’t carry a paper and a pen to write notes and do handover, you can’t communicate clearly with a mask and face shield on, and you have to minimise the number of staff that you need to have around you. It’s an incredibly challenging, stressful and draining way to work day in, day out. But at the same time there’s been this inspiring sense that we’re all in this together. I certainly felt that in the Taskforce, and with all my work with fantastic colleagues around the world. We feel that and we’re all looking after each other.’
Carol’s broad program of research and clinical work is all about looking after both patients and fellow health workers in critical care and allied health. Locally, she has attended weekly meetings for Victorian ICU physios throughout the year, disseminating the national COVID-19 guidelines in a really tangible way for staff in different hospitals with diverse practices and policy challenges. This was especially important when case numbers were so high around metropolitan Melbourne just a few months ago.
Nationally, Carol’s focus has been on the long-term outcomes of critical illness due to COVID. This has included the COVID-Recovery Trial, which in collaboration with intensive care physiotherapists, around Australia, now includes over 40 hospitals nationally, and also the AFTERCORE study which assesses long-term function as part of the global COVID-19 Critical Care Consortium. ‘We know that Australia has some of the highest survival rates of COVID-19 so far, but we don’t yet know about the morbidity or the long-term outcomes of our patients. So we’re collecting patient reported outcomes at six months on things like disability, cognitive, psychological and physical function and return to work. We already have data on these outcomes for a comparative group of non-COVID ICU patients who were critically ill with acute respiratory failure – so we can look at the data and see if and how COVID might be different compared to the recovery following any other critical illness. Hopefully these findings will inform future Taskforce recommendations, given both early ICU and later rehabilitation have been flagged as emerging areas.’
Looking ahead, Carol believes the challenges of dealing with COVID will continue to unfold for some time yet, regardless of a vaccine. ‘We don’t have a magic bullet yet, but we do have data and we’re learning so much from it. We’ve shown that with dexamethasone – which is going to save the lives of hundreds of thousands of critically ill patients. We saw this in our Australian SPRINT-SARI registry led from ANZIC-RC ANZ. As soon as the Recovery Trial was published everybody started using dexamethasone – demonstrating the rapid uptake of evidence as soon as it’s generated. Ultimately, we’re all looking for the best and latest high quality information amongst this deluge of research, which is a big part of the reason why I love being involved with the Taskforce. It’s made up of such considered people who have the right expertise to assess and use it. It’s just been a fantastic effort that continues to deliver week in and week out.’
Carol has been a key contributor to this collaborative effort this year, but remains characteristically humble. ‘Really, I’ve just done what I needed to… and honestly I know a thousand people who’ve done more than me. The academic and the clinical community that we work in has been absolutely amazing, as have my family. My twins are in year 12 this year and have missed out on so many rites of passage, given they completed the school year largely at home through remote learning. My older children supported us in all sorts of ways too, especially with meal prep while I sat through late meetings!’ Carol laughs. ‘The four of them remained so positive, and are really just extraordinary.’ It must be in the genes.