RAFAEL EPSTEIN:
So, what’s going to happen in South Australia and what’s going to change here, because of what’s happening there? Somethings already happened along those lines. There are a group of medical professionals who are the top-flight experts advising the Federal Government and National Cabinet. Professor Alison McMillian is one of them, she’s the Australian Government’s Chief Nursing and Midwifery Officer. Thanks for joining us.
ALISON MCMILLIAN:
Thanks Raf.
RAFAEL EPSTEIN:
What do you make of the lockdown in South Australia? Have they done the right thing?
ALISON MCMILLIAN:
Well, I think what we’re seeing is that they’ve moved very quickly. They’re responded in a very competent way, there are concerns but they want to prevent any community transmission and they’ve acted very quickly. It’s going to be pretty difficult, as we all know from Victoria, for those people in South Australia in the next few days, and I think we all have sympathy for the challenges they’re going to face.
RAFAEL EPSTEIN:
I really understand that advice and evidence, things shift and change and we learn things. Does this also mean that, with hindsight - and hindsight’s a significant thing - maybe our lockdown should have been harder and have come more quickly? Instead of doing those post-code lockdowns, we just should have gone into hard lockdown?
ALISON MCMILLIAN:
I think you’ve said it Raf, you know, with hindsight, we can always say, well you could’ve, you should’ve or I would’ve, but we are learning, and every time we do this, we’re doing it a bit better and a bit quicker. And that’s what we’re seeing here in South Australia. They have been extraordinarily decisive about this. And we'll see where this takes them in the next few days, where we see the number of cases.
RAFAEL EPSTEIN:
The significant change appears to have already happened that- I think it's everyone involved in hotel quarantine is going to be tested every seven days. Can you explain why that wasn't thought to be effective and why that's changed?
ALISON MCMILLIAN:
I think the best way I can express it, Raf, is that we now can clearly see that increasing the numbers of people returning from overseas, the number of people that we're seeing in hotel quarantine are increasingly positive, either as they return or they develop that in the early days of the quarantine. This is the area of our greatest risk. So, when we've looked at this, we’ve said, okay, let's make sure that we've got absolute confidence in our systems. And that's why we've gone to the seven days of testing of all of the people now working in both hotel quarantine and obviously those other areas, including, for instance, Howard Springs, where we've got a large contingent of people up there who have returned from overseas.
RAFAEL EPSTEIN:
And just explain, I think- tell me if I've got this right. We weren't testing everyone in every state working in hotel quarantine because we were worried that they wouldn't then get tested as soon as they got a runny nose, that they sort of get a false level of confidence from the regular test. Is that what the approach used to be?
ALISON MCMILLIAN:
Well, I think the approach has been variable across different states and territories. Not everyone has been doing hotel quarantine. The program is expanding; we’re seeing ACT, Tasmania, and Victoria will return, I think, to hotel quarantining in the near future. So, we're seeing the program expand. We wanted to make sure that we had national consistency. We discussed it at AHPPC on Monday, and the view was that this is the best approach. You know, how frequently, seven days seemed reasonable with a 14-day incubation period and that will get under way.
RAFAEL EPSTEIN:
Is the virus significantly different in South Australia? Their Chief Public Health Officer seemed to say that it was an unusual strain in that you could get the virus from someone who had no symptoms and then give it to somebody else when you don't have symptoms, in less than 24 hours. And she seems to be indicating that was different to what we had experienced in Australia. Do you know if that's the case?
ALISON MCMILLIAN:
That's certainly what Nicola has been telling us over the last few days, while we’ve been meeting. We know that the people that contracted this were clearly as asymptomatic. We heard an extraordinary story of how this was picked up at a hospital in Adelaide. And we're seeing the transmission pathways appear to be relatively quick. Is this a different strain? Have we seen it evolve? That will come in time as we study the epidemiology. But that's what Nicola is telling us she's seeing, and that's why they've taken this very definitive action, because of what they're seeing.
RAFAEL EPSTEIN:
So, their working assumption is that, this actually moves even more quickly than the other outbreaks we have had?
ALISON MCMILLIAN:
That's what they’ve observed, that's what they’ve seen. And they've seen people- a number of people who have been asymptomatic that have been positive. Now, we've always seen that along the path, but there seem to be potentially more of this in South Australia. Again, too early to tell. This is early in their outbreak.
RAFAEL EPSTEIN:
And at what point- what evidence do you need for that change or that different strain to then prompt a review of everything we're doing? At what point do you go, right, we need to review everything?
ALLISON MCMILLIAN:
We are reviewing everything, all the time.
RAFAEL EPSTEIN:
Oh right. Okay.
ALLISON MCMILLIAN:
So, we continue to look at the epidemiology, we continue to look at the genomics. The ability to track these different pathways of transmission continues to evolve. So increasingly, we are learning from- for instance, we've learnt from New South Wales about the value of genomics and tracing upstream, as we call it. Where did this evolve from, where did it come from? We're continuing to learn and we do that every day.
RAFAEL EPSTEIN:
Professor Alison McMillian is with us, she’s the Government’s- the Federal Government’s Chief Nursing and Midwifery Officer, so that group of medical experts that advise the Federal Government, she’s part of that. And also the AHPPC, the big group of Chief Health and Medical Officers that advises National Cabinet.
Professor, the harder question. We’re 19 days now, in Victoria. I know you’re now in Melbourne, but you move between Melbourne and Canberra for your work. We’re 19 days of a double donut. Do we- is it just sort of inevitable that another case is going to pop up in Melbourne?
ALISON MCMILLAN:
I think we can expect that it's a possibility. We've heard all along both Brett and Allen Cheng talk about this idea that it may still be out there in the community and therefore we need to encourage everyone and anyone who has symptoms to come forward and get tested. It can hide. We know that. So, we need to be vigilant. We know people, for instance, have returned from South Australia into Victoria. So, we need that continuous vigilance and keep on the message that we've been pumping out and everyone's sick of hearing, I’ll say it now, about if you get sick, get tested. But that's how we'll keep this contained. So, if something does happen in Victoria, the action would be prompt, definitive and we’ll contain that spread if everyone does as we ask.
RAFAEL EPSTEIN:
So that means it's entirely possible we could go through a shutdown. If another case pops up, we might go through a shutdown similar to what they're doing in South Australia. That might become the new national way of dealing with things.
ALISON MCMILLAN:
I think the decisions about what- how a jurisdiction responds is based on what they're seeing at that point in time. So, should an outbreak occur here again? I'm sure that the decision makers will act promptly, given the experience that so many of our friends and colleagues and Victorian friends out there have experienced in recent times. So they will want to act and will act very definitively if anything is found in Victoria.
RAFAEL EPSTEIN:
Can we run a hotel quarantine without leakage? I mean, if I was told 2500 people need to come, say, for the Open, all of the players, plus all of the people who come with them. 2500 people in hotel quarantine in Victoria, can that be done without the virus getting out?
ALISON MCMILLAN:
It does rely on us being incredibly vigilant, everyone following every teeny-weeny step every time. But we know that we can't lock ourselves away forever. We do need to learn to live with this virus. And so, what we're seeing here is that, as a consequence, we don't know how the spread occurred yet, but we will in time find. Remember, it can be through contact. It can be through fomite, as we call it, or contact with surfaces, which is why hand hygiene is so important. So, it is a sneaky virus. It will exploit any chink in your armour, and so the vigilance is what's really important. We're adding in an extra layer here now, with the testing of all of that workforce every seventh day.
RAFAEL EPSTEIN:
And I know this is not an issue that is entirely within your remit, because this is very much what the politicians deal with, but either hotel quarantine or aged care, there are still people working part-time across many different sites. It's happening in hotel quarantine in South Australia right now. And I think the money to try and stop that happening in Victoria is about to run out. Isn't the only way we're going to learn to live with the virus if someone who cleans an aged care home or cleans in a hotel only works in one place? Don’t we need the politicians to pick up the bill for that, all of us to pick up the bill for that? Isn’t that one of the number one ways we stop the virus getting out – one worker, one site?
ALISON MCMILLAN:
Raf, it’s certainly been the focus of my attention, given aged care and the workforce in aged care is a particular focus of nursing. We've known in recent times that the one worker, one place has been here. I think, in the long term, we need to look at how we can possibly, where possible, move away so much from that casual workforce and potentially into a more permanent workforce. How can we do that? How can we maintain worker flexibility? A large portion of these workforces, often women, and they work casual in this way because it suits their life and their family. So, we don't want to cause necessary harm by making a decision in one direction, and people have a right to choose about where they work.
RAFAEL EPSTEIN:
[Talks over] But shouldn’t they be offered full-time- surely- I shouldn't use the word surely. It seems to me one of the things that creates a really big wall to stop the virus getting out is that everybody who works in hotel quarantine or in aged care, someone needs to offer them full-time work there, so they don't have to work somewhere else. That's one of the big ways to reduce the risk, isn’t it?
ALISON MCMILLAN:
I think that’s certainly would be something you'd be looking to the employers to do. And as you say, it's a bit out of my remit. But yes. If we can find that they don't work between multiple workplaces, then that may well limit if there is an opportunity where this virus exploits a chink in their armour that it doesn't get spread elsewhere.
RAFAEL EPSTEIN:
And do you and all the other medical experts ever say quietly to the politicians: maybe you should stop having a bit of a go at each other, that might help us in the response. Does that ever come up in conversation?
ALISON MCMILLAN:
No, Raf. No. I think I would- I contain my advice to my political masters to that of health advice, not to how they might interact with their colleagues.
RAFAEL EPSTEIN:
That's why you've got the job you've got. And how confident are you with South Australia? What do you- what does it look like right now? Do you think they've got it?
ALISON MCMILLAN:
I think, yeah. All the signs are that they've got it. We've- we- all of the things that we learnt here- as you know, I was here during the outbreak with the aged care. Everything we learnt about that, we implemented in every other state and territory. As soon as this occurred, we saw that response centre operating, Commonwealth and state people all working together, hospitals leaning into health facilities. So, all the things we learnt in Victoria are being done in South Australia. And it's terrific to see how much we've learnt and how quickly we responded. So, as I say, we continue to learn, we continue to get better.
RAFAEL EPSTEIN:
Thank you for your work. Thank you for your time.
ALISON MCMILLAN:
Thanks Raf.
RAFAEL EPSTEIN:
Professor Alison McMillan. She's the Federal Government's Chief Nursing and Midwifery Officer.
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