Doorstop interview on 14 October 2020
Read the transcript of a doorstop with Minister Hunt and Professor Michael Kidd on Wednesday 14 October 2020.
The Hon Greg Hunt MP
Minister for Health
Thank-you very much everyone for joining us. I’m delighted to have with me today the Deputy Chief Medical Officer, in particular with responsibility for primary care, Professor Michael Kidd.
I specifically want to address the challenge of mental health during what has been one of the most difficult years Australians have faced since the Second World War, if not the most difficult year.
We know now with the latest data that's been released that the challenge of lockdowns, the challenge of loss of employment or uncertainty of fears about our health has all contributed to an increase in mental health presentations across the country and an increase in people seeking support through our different organisations such as Beyond Blue, Kids Helpline, Lifeline, Headspace.
In particular, what we have seen in just the last four weeks, on the latest data provided to me by the Department of Health, is there's been a 31 per cent increase in Medicare mental health services in Victoria compared to the same time last year.
So, one state, one four week period, during the most difficult of times, I know having been in Victoria, representing an electorate in Victoria, with family and friends and numerous constituents and people from across the state, that this pressure is real and significant.
So that 31 per cent increase, that compares with a national total of 15 per cent or across the rest of the country when you take out Victoria, so it’s the reference case, a nine per cent increase. And that's still a difficult time.
So many people have economic uncertainty and because of that there are stressors, strains, anxieties and in many cases, sadly, depression which have come from it.
With regards to the helplines, for example, if we compare Victoria with the rest of the country, then what we see is that for the four weeks to the fourth of October, Victoria's use of helplines was significantly higher than that for the rest of the country.
Beyond Blue shows that there's a 77 per cent higher per capita use in Victoria compared with the rest of the country.
Lifeline is 16 per cent higher than the rest of the country over that comparable period and Kids Helpline, 24 per cent higher than the rest of the country.
So, against that background, what I want to emphasise is the support that is available and I am pleased to be able to announce that the budget measure of the doubling of Better Access services is now in place already around the country.
So, it's available to people around Australia.
And I think that's a very important step forward and I would urge those that need to access the additional psychological services to work with your GP, to consult your doctor.
I'd also note that the front-line for anybody seeking mental health services is, of course, the GP and coupled with the Better Access support services, this is a very significant pathway.
Then of course, there is the telephone, and the Beyondblue National Coronavirus Hotline is a very important number for Australians; 1800-512-348.
And then online, there are two very important but complementary resources; Headtohealth.gov.au. That's the national resource. And that national resource is about giving people access to any of the different channels.
It may be in relation to eating disorders, where very sadly we have seen significant increases in the number of people presenting, it may be in relation to anxiety or depression or youth or Indigenous needs. And Headtohealth.gov.au can help you find even in the dark of the night at 3:00am a pathway to help.
And then there is HeadtoHelp.org.au for Victorians. And this is about helping you access the 15 new mental health centres that have been set-up during the course of the pandemic. And they're specifically there to help Victorians in this most difficult of times.
On top of that, I would just provide a brief national report.
We know that globally there are now over 38 million cases that we’ve seen the highest days in terms of officially recorded numbers in the last week - four of the highest days have occurred in the last four weeks.
In fact, the four highest days have occurred over the last week.
There's now over a million and 84,000 lives officially lost and inevitably a far higher real number.
And in Australian cases, 27,337 cases and tragically, 904 lives lost.
Across the country, there are 28 people in hospital, one in ICU and I'm delighted to be able to say – none on ventilation. There are no Australians on ventilation.
We prepared with 7500 ventilators and that's an immensely important national achievement.
We're not out of the woods, there's still a lot of work to do, but the fact that no Australian is on ventilation on the official advice of the National Incident Centre before joining you is I think a huge achievement.
In terms of our testing, 8.1 million cases including 39,000 in the last 24 hours, but we’d still urge Australians to be tested.
Tracing - the system is strong around the country. It continues to improve in Victoria, but they have acknowledged that they are going through continuous improvements with some additional work to be done.
But I want to acknowledge what has been done. I think it's very important to acknowledge those improvements.
And then in terms of the distancing, we see in New South Wales what's been able to be done with cautious, careful step-down distancing rules whilst maintaining a rolling average of under 10 cases a day in terms of the community.
And so, they’ve done that very well and that provides a model for many.
So I'll turn to Professor Michael Kidd, both in terms of mental health and also other general health matters and keeping those checks up. Michael.
Thank you, Minister. We’ve known since the beginning of the pandemic that there were going to be concerns about the impacts on the mental health of people right across Australia, but also an impact on the physical health and wellbeing and the risk of people delaying seeking health and advice for new symptoms or for the management of chronic health concerns.
As a GP, I'm very concerned about the numbers of people who are experiencing mental health concerns as reflected in the figures that the Minister has outlined, but I'm also heartened that so many people are utilising the resources which have been made available to them throughout the pandemic to reach out for help and assistance.
People who are feeling very anxious, people who are feeling depressed, people who are just not coping with the impact of the pandemic with the job losses, the disruption to our daily life.
And my message to all Australians is if you are experiencing these symptoms, please reach out.
Reach out to your general practitioner; you can use Telehealth, of course, to gain access to your GP, if you have one of the mental health plans, gain access to your therapist.
Reach out to the national resources, which have been established by Beyondblue, by Lifeline and by the other organisations, which are offering support.
There are people waiting right now to talk to you to provide you with assistance, and to help you get through what are very troubling times for many people.
At the same time, as well as looking after our mental health, we need to look after our physical health and well-being.
And we’ve reinforced many times during the pandemic the importance that if you have new symptoms, please reach out to your GP - again you can use Telehealth - to describe what's happening and to make sure that you are receiving the prompt care and advice.
If you have a chronic health condition, please make sure you’re continuing to get access to the regular management that you have, make sure you’re continuing to take your medications, keep your prescriptions up to date.
And if you’re due to have screening – especially screening for cancer, don't delay this either. Our cancer screening services are now all functioning for bowel cancer, breast and cervical cancer.
Today is World Skin Health Day. And it's a really important reminder for Australians about the health of our skin and particularly in our country with very high rates of skin cancer including melanoma.
Today is a good reminder that if you’re due to have a check of your skin because you have had past skin cancer don't delay that, make sure you arrange that.
And if you have new problems with your skin which have developed again, please reach out to your GP, if your GP is doing Telehealth using video consultations, that can be utilised as well.
Happy to take questions. Dana?
Yeah, thanks Minister. Just on this Medicare data, so it was a 15 per cent increase nationally. What was the increase in New South Wales?
Okay. So, let me have a look. What we’ve had in New South Wales- a 33 per cent increase- a 31 per cent increase nationally (correction Victoria), 10 per cent increase in New South Wales, 9 per cent in the other six states and territories and 15 per cent national total. So, 31 per cent Victoria, 10 per cent, New South Wales, 9 per cent, the other six states and territories and an average of- a weighted average of 15 per cent across the country.
And with those additional services, were they heavily weighted towards GP consultations providing mental health plans as opposed to actual psychology sessions?
So that’s the full spread of mental health services. I’ll seek that additional detail.
The reason I asked is because it’s well known that there are workforce issues in mental health. Are you worried, given that the increase in demand, that there won't be enough psychologists delivering services? And what’s your plan to address that?
So, what we’ve done is be able to provide support right across the sector. It's been overwhelmingly welcomed both by the AMA, the RACGP and by the psychological services providers.
So, at this stage, we haven't had any significant indications. I don't know, Michael, if you’ve had anything beyond that. But demand is being met.
For example, in Victoria, where we started earlier with the additional MBS items, we’ve provided the double better access support. There are now 35,000 additional services to those who otherwise wouldn't have received which have been provided over the last six weeks.
So, as far as we can tell, the demand is being met, and the supply is there.
Well, we’ve been meeting weekly with the Australian Psychological Society along with all the allied health providers across Australia.
Strong advocacy for the need to increase the number of sessions in order to meet the mental health needs of many, many people who are seeking support from psychologists and from other therapists.
At the moment, the demand appears to be being met according to our colleagues.
Why are our rapid antigen tests not being more widely used? Do you think that more people would be more to get tested if they could get a result quicker?
Sure. So we’ve approved four, through the Therapeutic Goods Administration, they have approved four rapid antigen tests. There are two different types of rapid tests as it were. They’re the antibody test and the antigen tests.
The antigen tests have been approved by the regulator and they’re actually now being assessed for their utility and effectiveness by the medical expert panel.
So, the AHPCC, the Australian Health Protection Principal Committee, is receiving advice on that from the public health laboratories and others.
I think Michael’s actually part of that process. So, there are no barriers. It's gone through the first stage. The one thing though is we have been very cautious in Australia about making sure there are gold standard tests, because that is one of the things which set our testing part.
The London School of Hygiene and Tropical Medicine identified us as one of the world’s not just broadest but most accurate testing nations. But no barriers.
Michael, just on that assessment process by the medical experts?
Yep. So absolutely. It’s absolutely essential that we make sure that any tests which are going to be used are as efficient and effective and are going to meet the gold standard requirements in Australia, and it's a process we’re going through at the moment.
You said you wanted restrictions eased earlier in Victoria. Josh Frydenberg suggested that they should be lifted by this weekend. Do you think the numbers are sufficiently low in Victoria to ease restrictions by the weekend?
Well we have a Commonwealth definition in terms of hotspots, and that's a rolling average of less than 10 cases. Victoria is below that rolling average.
In fact, today, Victoria's numbers were below New South Wales with regards to community transmission. I think the figures I have before me were 11 cases within the community in New South Wales, seven in Victoria.
And so, they have passed the national threshold. So from our perspective, the 10 case threshold would be an appropriate one for Victoria to utilise. That’s the national threshold.
New South Wales has, for some months, been able to carefully, cautiously progressively, lift restrictions. They are still using the national roadmap. They’re still using the 4 square metre rule. They’ve announced some future changes yesterday.
And so, the Commonwealth standard but with the New South Wales model would respectfully provide a way forward for Victoria, and Victoria has already reached that Commonwealth standard.
So, there’s no medical reason, in your view, why pubs and restaurants can't be opened this weekend?
On timing, they’ll obviously- that’ll will be a matter for Victoria. But in terms of the threshold, Victoria has reached the Commonwealth standard to go to the next stage.
And we note that in the last few days, the Premier and the Chief Health Officer in Victoria have indicated, as we did early on, that the five case cumulative and five case rolling average and the zero case standards may not be achievable in the immediate future.
Against that background, we know that the 10 case rolling average is achievable because Victoria is under that standard right now.
So, Melbourne is at a rolling average, 14-day average of 9.6 cases, regional Victoria is at 0.6 cases. So, to their credit, they’ve reached the national standard, the epidemiological standard, set by the Chief Medical Officer of Australia and that gives them the chance to follow the pathway which New South Wales has set.
I would note, New South Wales was able to operate at a greater than 10 case rolling average for 24 days during the latter part of July and the early part of August.
But I understand they want a clear standard; that's the standard which we would commend to Victoria.
Minister, is the risk that the unachievable goals that have previously been set by Victoria are going to keep the economy closed longer than necessary? Is that your view?
Yes, but much more importantly than that, even more importantly, is the risk to mental health.
We know that the World Health Organization has set out its concerns about prolonged lockdowns. Lockdowns have been an important part of this. Difficult, agonising.
The first wave and the national approach, but then secondly, we supported the move into Stage 3 and Stage 4 as a national government in Victoria.
We regretfully acknowledge the need because of the numbers and where the contact tracing was, but we’ve also acknowledged that the pathway out, the roadmap out, has to be achievable.
And we expressed our concerns, the Prime Minister, the Treasurer, myself in writing, when the first and second rounds of the exit roadmap for Victoria were announced, about the five and zero case threshold.
The Victorian Government has come to that position, and we welcome that. And the simple way forward is the national standard of a rolling average of less than 10 cases and they are there, and that will make a profound difference to people’s mental health.
Minister, keeping on Victoria, a Melbourne truck driver has spread coronavirus to Kilmore and Shepparton, failed to tell contact tracers that he had even been to Shepparton. Authorities did not take any steps to confirm the man’s movements other than to ask him. Is that acceptable, and should they have done more?
So, it’s not acceptable. As to whether or not that’s an issue for the authorities or for the individual, I’m not in a position to provide that advice. I just don't have that insight.
But what I can say is there has been very significant improvement in Victoria. Their official data is that they are keeping up with the contact tracing. There are obviously individual cases and stories.
But, around the country, if you ask me what is my number one public health focus at the moment, it’s to make sure that the improvement in Victoria's contact tracing continues. So, there has been significant improvement, but honestly, there’s more to go.
(Inaudible) GPS tracking or phone data need to be used?
I think there are three things that they can do. One is to complete the move to localised public health unit assessment models. That’s underway, and they did that very well in the city of Casey.
Two, is to complete the digitisation.
And three, is to have an entirely granular approach to each case, where they are using all of the available tools, in order to track them down.
Minister, we’ve just had thousands of families travelling around for school holidays. Is there a potential that that could be a spreading event? And what's your message to people who have been away from their homes during school holidays? Should there be mass testing, do you think?
Well, we want to encourage people – and I’ll ask Michael to speak to this – but we want to encourage people to continue being tested.
I mean, Australians have done an amazing job and I would like to take this opportunity to thank Australians for their individual work on being tested, where they’ve had symptoms or been in contact. But also, for keeping the distancing.
But the job’s not done. This virus will still be with us for a long time, notwithstanding the vaccine. We still have to manage it.
And so, those distancing rules and recommendations remain fundamentally important.
So, Michael can speak to the question of asymptomatic testing but more generally, if somebody has any symptoms, please continue to be tested.
I think it’s really important people who have been travelling around are keeping an eye on the definitions of the hotspots for community transmission in the state or the territory where they’re based.
And if there are recommendations that people get tested, to arrange the testing and to go into isolation as requested.
But of course, we all need to still be doing what we’re doing to remain COVID safe and that includes the physical distancing, even when we’re on holidays.
Do the experts have anything specific in mind when- you knew school holidays were coming up. Did you have any sort of contingency planning or anything around the potential for quite a lot of spread during that period? And the aftermath?
Certainly we’ve been sending out the public health messages around school holidays.
So, reinforcing the importance of personal responsibility for each person, making sure that people are protecting their own health and wellbeing and that of their families, and also of the communities which they’re visiting as part of the school holidays.
Minister, just confirming. With the changes to the subsidised mental health plan sessions, when exactly do those take effect? And for those who are already partway through, say, a 10-session plan, do they have to go back to their doctor to get the extra sessions. How’s that going to work?
So, automatically you get 20. We would like people to go back after 10 sessions in any event. The changes commenced as of Friday, so they’re in place.
It was one of the budget measures across the country which we were able to introduce and implement at the fastest of rates.
Minister, just between January and September, the Health Department said 1.14 mental health treatment plan items were accessed, but that was compared to 1.08 items for the same period last year. So that’s actually not a big difference, it’s about 25,000.
Some mental health experts have said that that raises questions about whether the Government has poorly targeted funds by increasing the Medicare-funded psychological services. So, I just wanted your response to that.
So, I’ll look at the overall figures because people will move between different classes of services.
Overall, from 16 March to 4 October, there were 7.43 million MBS-subsidised mental services. And this compares with 7.0 million services for the same period last year. So, at the national level what you’ve seen is an additional 430,000 services, or a 6 per cent increase in mental health provision, over that entire COVID period.
Then there are the additional services to support lines and help lines, which takes it to approximately an increase of 1 million presentations or actions where people are seeking support.
And then, in particular, what we’ve seen is that acceleration within Victoria in the last month.
But the criticism has been levelled, given that there has only been 25,000 extra mental health treatment plans being accessed this year compared to last year. The criticism has been levelled at why the Government has chosen to double the number of Medicare-subsidised mental health plans.
I understand that there are some really fine people who may take a different view.
But, overwhelmingly the AMA, the College of General Practitioners, the psychiatric and psychological communities, have welcomed it.
And even in the mental health community, sometimes there are respectfully and in good faith, differences of views.
The fact that there’s an extra 430,000 MBS-subsidised services, an extra million mental health services or support calls, indicates that I think what we’re doing is important.
And there’s a mixture of two things I would say in that. One is greater need, but also a greater willingness to present.
Minister, on a different topic. Your colleagues, Craig Kelly and George Christensen, are still talking about hydroxychloroquine in terms of COVID. They wrote a letter to the Queensland CHO a few weeks ago, asking her to expand, I guess, availability of that drug. That letter’s now being distributed to letterboxes around Queensland.
Now, Mr Christensen said that he’s not behind the distribution of that letter but the original letter – is it appropriate for, I guess, elected officials to be undermining official public health advice? That is, considering how widely this drug has been debunked as a COVID treatment.
Look, we set out very clearly the medical positions and rules.
And I think one of the hallmarks of what has happened in Australia this year is that, right from the outset, we’ve had the Chief Medical Officer, the Deputy Chief Medical Officers, we’ve had the medical expert panel alongside and informing the Australian Cabinet, the national security committee of the Australian Cabinet and the National Cabinet of Prime Minister and Premiers and Chief Ministers.
And so, that’s the way we’ve approached it.
But, in just the same way that I was referring to respectful differences in the mental health community, there are others who are entitled to put their views.
It’s not something that we have adopted. We will follow the medical advice.
We have also, though, again on medical advice supported a clinical trial of hydroxychloroquine through no less an institute than the Walter and Eliza Hall Institute in Melbourne, and that’s led by Professor Doug Hilton – arguably, one of the world’s great medical researchers and an institution which has had Nobel laureates within its numbers over the years.
So, they’re pursuing a clinical trial, we’re pursuing the evidence-based medical policy.
Minister, you mentioned.
Minister, your colleagues are using the Commonwealth coat of arms to write to voters about a drug that has been at least criticised, really debunked. They’re spreading a conspiracy theory. Is that the strongest criticism you’ve got for them?
My view is very clear. We set out the medical policy based on the medical advice. Others will set out their views and I’ll leave it to them on their views, but I’m very clear that our policies are determined on the basis of medical evidence and medical advice.
Minister, what’s the approximate average age of death in Australia, of someone who’s passed away with COVID-19?
85. And that was- I had that updated just in the last few days. We keep a watch on it, so 85 is the average age.
What’s the approximate percentage of those people who’ve been in high-dependency aged care?
So, actually, I can give you a precise figure. Of the 904 deaths in Australia, 690 have been in either residential care or home care.
And do you know approximately what percentage, or how many of those people, had other serious comorbidities?
I don’t have that advice in terms of comorbidities versus being a general resident. That’s not something that’s been provided to me. Michael, do you have anything?
Do you think comorbidities and knowledge and the data and awareness of that would be an important consideration for policy-makers when they’re deciding how to respond to this virus?
Well, let me ask Michael on the comorbidities question. Not about the policy side, but about the importance of it, but also the ability to separate and identify it out, and then I’ll address the policy side.
Certainly we know many of the people- obviously if you’re in your 80s, many people have significant comorbid conditions, and this is not surprising at all.
What we don’t know is the specific conditions affecting the people who’ve died from COVID-19.
By definition, if somebody is in a high-dependency, if they’re in a nursing home or they’re in home care, they have significant needs.
So, amongst those people, by definition everybody will have some form of additional need which is precisely why they’d be determined as qualifying for it. But I’m happy to seek some additional advice and come back to you.
The National Cabinet meets on Friday. What do you know of the agenda for that? Is the Government again seeking to get confirmation from the states on the hotspot decision, or is that basically a Commonwealth position and you’ve just (inaudible)?
That’s a Commonwealth position and, beyond that, the agenda for the National Cabinet is respectfully one for the leaders to air. I’m still bound by the rules of Cabinet, but good try. Fi?
Would you be open to the idea of workers in high-risk workplaces getting tested regularly, even if they didn’t have symptoms?
So, we do do that. We have some aged care testing for asymptomatic, interstate trucking- I don’t know, Michael, it’s really a medical question. But there’s no policy position against it.
So, we have been looking at this in a number of settings. Particularly if it would be appropriate in areas where we get significant community transmission occurring, which of course is the time when we’re more likely to see outbreaks starting to occur in high-risk areas like residential aged care.
So, there are those two. And of course, the most obvious one beyond that would be hospitals.
And if states and territories choose to do that, then we would certainly be supportive.
And we have the testing capacity now. That's the really important thing. When the rest of the world had a collapse in testing capacity – or much of the world, much of the world had a collapse – we were able to maintain that. But we've been able to steadily build that capacity.
And you remember the Minderoo discussion back in April. That provided us with enormous additional testing capacity as a country and we've been able to maintain that capacity.
Minister, (inaudible) for one. Can I ask you about Thalidomide?
Obviously, in the budget, there was a fair wack of money for Thalidomide survivors, members of that community, that sort of thing. I know this is a topic that you’ve done a lot of working with, I guess, (inaudible) community. People say that they're very welcome of that funding, but say that it doesn't quite go as far as they might have hoped, that it won't get them into the kind of higher specialised care that they might have been hoping for.
Do you think that sort of funding might be (inaudible) some more, that sort of funding along the way to kind of get those people into sort of the care that you’ve been talking about?
So, Thalidomide justice was a really important issue, and I think, an unaddressed Australian wound, if I may put it that way.
And it's been over half a century since these beautiful Australians were failed by the system.
And so we followed all of the recommendations of the Senate inquiry. We worked with the Thalidomide community.
But to be honest- and we significantly expanded and increased the package after I met with Lisa McManus, who's probably the leading voice in the Thalidomide community.
And so, no amount of money can ever compensate for what they've had to live. But the funding that is there goes into three pools.
Firstly, there is lifetime compensation, which is graded as they requested, and as the Senate recommended based on the needs. And that will be between 75,000 and 500,000.
Then there will be an ongoing lifetime support package and then there's a medical support package. In addition to that, there’s NDIS and other Australian pension items.
So, they're very, very significant items. But we're also working with Diageo, and I welcome this, which is indicated that they will commence talks with the victims on an extension beyond 2028.
They're not committing, but they've agreed to commence those talks in 2022. And Grunenthal, and those are the two companies with the historic antecedents that trace back to the use of Thalidomide.
So that's the pathway to the additional support. So, I'll take two more questions.
Thanks, Minister. On Victoria’s contact tracing, you suggested improvements, still needs to improve more, Do you think that's one of the reasons why they're still reluctant to open up, because they don't quite have the confidence to do it in that system? And also, they've had months to do this. Why hasn't this been done sooner?
It has been improving. And I do want to acknowledge that. We brought 400 ADF to assist with the situation. And it is significantly better. And the official figures are that they're keeping up.
But as was mentioned, there are individual cases that are raised, and we want to trace them to the ground.
We actually have, I think, significant confidence that Victoria’s contact tracing system can manage with restrictions being cautiously, carefully lifted in line with the national guidelines, and in line with the New South Wales model. And I think that that is important.
So we have that confidence. But that's not to say that it can't be better. And I don't say that critically, I say that optimistically.
That we've seen significant improvement. But with the localised, the digitised, and then the granular assessment, it can absolutely reach that that gold standard.
Thanks, Minister. Just another question on rural health. We've had a tragic case reported this week of a woman who bled to death at a regional hospital. There were no doctors on site. The Rural Doctors Association says this highlights the need for more rural generalists to be trained up and incentivised to work in these areas, which have been historically, sort of a state-federal issue.
Do you think that the State Government needs to chip in more funding to these issues?
So, we struck what's known as the Collins Grove Agreement to expand the rural generalist pathway. Michael, you're living and breathing this. Do you want to give a little bit of update on that and then I'll respond on the policy side?
Certainly. We've been working with two colleges, the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners, to very significantly boost the number of recent medical graduates who are training to become rural generalists, training in rural communities like the one you described to be able to deliver that comprehensive medical services, which are so needed by those communities.
So in addition to COVID, obviously, because, you know, that job will be with us right throughout 2021.
The next two biggest priorities that I have beyond the Productivity Commission and the Royal Commission on Mental Health and Age are the work on the sustainability of private health and rural workforce.
So that's right at the top of my list. I'm meeting with the AMA tomorrow to commence the next round of work on that and delivering the rural generalist pathway, which we're now very, very significantly advanced on as part of that.
Last question. Greg?
Is there any evidence, now that we know more about the virus, that people do feel a natural immunity from COVID-19 once they've recovered from it?
Ah, I'll start with the medical expert first and then I'll give my advice; not medical.
Certainly, an area where there's continuing research, as we're all aware, and continuing announcements are being made as new discoveries are happening.
What we don't know about COVID-19 is the individual response. So, what happens with each individual who's been infected? What sort of immune response each person is able to generate and sustain, and how long that lasts and provides protection against further infection.
So, we are now starting to see reports of people who have been infected more than once. And as we've seen with the report that you're alluding to, at least one person who had a more serious disease the second time around.
So, of the advice that I've received, and I recognise that there are different views around the world, the balance of the advice is that the vast majority of people are not likely to be re-infected over the medium term.
The long-term medical history will determine that in the years to come.
But it's clear, and there are increasing examples, that it's not 100 per cent the case.
It may well be that there is a very small percentage of the population that can be re-infected, all for whom the immunity fades earlier. So that's the difference.
On the advice we have, the best knowledge is that once infected, you are overwhelmingly likely to have immunity, but that it may not be lifetime immunity.
And these cases might either be somebody who's in the very small percentage that didn't develop immunity or for whom that immunity has faded earlier.
But all up, today's an important day in terms of hope.
What we've seen in terms of the numbers in Victoria, it being below the Commonwealth, rolling average of 10 cases per day, and that gives it the pathway, the licence, the ability to take the steps out.
And that is an important milestone for Victoria, but also to the Premier, who can now be in a position to carefully, sensibly move in line with the national guidelines and in parallel with the New South Wales response for giving Victorians access to greater freedoms, better health, and better mental health.
Thank you very much.