ROS CHILDS:
We're taking you live now to Canberra, where Deputy Chief Medical Officer Nick Coatsworth is giving a COVID-19 update.
[Live cross]
NICK COATSWORTH:
…There are 77 Australians in intensive care units around Australia and 43 of those are having their breathing assisted by being on ventilator machines. Obviously, they're critically unwell and it's a very concerning and challenging time for their family and friends, and additionally for the healthcare workers who are looking after them.
This is a period of maintaining the gains that we've made. It may feel, to a lot of us, like limbo, but I can assure you that it's not. Charting a way out of where we are now with COVID-19 will be very challenging and perhaps, even more challenging than the way in. But the way that you, as Australians, can help us meet that challenge is to actually stick with us- stick to the physical distancing restrictions that we've got in place, stick to the hygiene advice that we have been providing to you, doing all the things that Australians have been doing to help lower those case numbers. And they remain low today. And as we, as the health advisors to government, deeply and thoroughly explore the options and consider how the virus may behave in our community, as those various options are considered or implemented.
And whilst it's good news again, in terms of the total numbers, we acknowledge that there are Australians in a region of Australia, in northwest Tasmania, where the case numbers are increasing, related to the hospital outbreaks there. And it is a sobering reminder of the realities of a new virus in a community where there is no immunity, that that virus can behave unpredictably and that we are not immune. The Tasmanian Government is doing everything in its power to ensure that Tasmanians in northwest Tasmania have ongoing access to medical care, and the Commonwealth has been assisting, and there is an Australian Medical Assistance Team, or AUSMAT, supported by the Australian Defence Force, who are ensuring that emergency care can be maintained in the northwest of Tasmania whilst many staff are isolated and in quarantine. And I'm happy to take questions.
QUESTION:
Dr Coatsworth, from a health perspective, has the World Health Organization dropped the ball on wet markets, and do they need to close?
NICK COATSWORTH:
Wet markets have been a contentious issue with regard to infectious diseases for longer than the COVID-19 outbreak. There have been calls for many years for their regulation and there is evidence in the current outbreak that wet markets may well have been involved with the inception of COVID-19. So, I suspect those calls are not new. They will continue. And the regulation of wet markets will be a matter for discussion with the World Health Organization and those governments where wet markets are prevalent.
QUESTION:
Dr, your colleague Michael Kidd this morning said that if you had symptoms of any kind, like a sniffle, runny nose, you should go seek a test. Now, that's not currently the advice on the website. What are the specific requirements for getting a test? What symptoms do people need to be displaying to go and get one?
NICK COATSWORTH:
Okay. So let's bring it back to the principle. When you will definitely get a test is if you have cough, fever, respiratory symptoms, and you're hospitalised. That is clearly on the Communicable Disease Network Australia website. However, it's been very clear from the deputy CMOs and the CMO and chief health officers around Australia that public health units now need to pivot towards a broader testing regiment. So that whilst the national guidance remains the same, there are certainly individual public health units that are taking a broader view of the symptoms that might be required, and maybe we should say milder symptoms can get you a test in some jurisdictions. A good example was the Bondi Beach pop-up clinic that happened a week ago in response to outbreaks. So that's actually part of a nuanced approach which reflects the difference in density or of infection around Australia. So that's what my colleague was reflecting on this morning.
QUESTION:
Just back on the- sorry. Obviously, with the wet markets, that's just something that's happened, but as well, the US has said they're going to pull funding. Is there beginning to be an erosion of trust there in that national body, and also an inconsistency internationally regarding how much that body will be listened to and trusted?
NICK COATSWORTH:
Well, when there's a pandemic affecting every nation in the world, one needs a multinational organisation, and the Australian Government, you've heard today, 100 per cent backs the role of the World Health Organization in providing a key role in managing this COVID-19 pandemic.
QUESTION:
Dr Coatsworth, as states now look to potentially encouraging teachers and therefore students to return to school, could you provide what the latest research advice, case examples are of both potential child-to-child transmissions of the virus in a school environment? And also teacher-to-child transmission - how prevalent is that, or is it remaining the case that it has not [indistinct]?
NICK COATSWORTH:
This virus is a very challenging one conceptually for any parent or teacher that goes through any winter period, where their children bring home respiratory viruses and they circulate within the schools. There is something different about COVID-19. It quite clearly affects a lower proportion of children, and we know - in Australia - that about 136 children between the ages of 5 and 18 have been affected, representing only two per cent of our total number of cases. So, those raw numbers alone demonstrate the lower propensity or likelihood of children to get infected. In terms of the potential outbreaks that have been associated within schools, it's also clear - through investigations in some jurisdictions - New South Wales, South Australia - that single, or one or two cases, of child-to-child transmission, or teacher-to-child transmission, have not resulted in the sort of widespread outbreaks that we've seen amongst adults, either at weddings, for example, or indeed in our elderly population in residential aged care facilities.
QUESTION:
Continuing on the issue of schools, obviously there are concerns about the workplace health and safety of teachers. Would the AHPPC be in a position to consider specific kind of practical measures that schools could implement? Will that be left exclusively to states? Do you see value in there being a nationally consistent set of advice and guidelines given to schools?
NICK COATSWORTH:
So it's the view of the Australian Health Protection Principal Committee that schools are safe places because of the low rates of transmission. However, I can confirm today for you that the AHPPC has indeed been considering how to make schools even safer - even safer for staff, for teachers, in their such essential role in this COVID-19 epidemic, and that that advice is being considered by National Cabinet this week.
QUESTION:
Dr, just on the output that is being developed by the Government, who will it be intended for? Like, would you have to be tested positive to be part of the tracking? Does it need a particular take-up rate to be effective? And is it a replacement for human contact tracing?
NICK COATSWORTH:
So I'll address the last question because I think that's the most pertinent. It's certainly not. The contact tracing app is not a replacement for human contact tracing. It's designed to, you might say, be a forced multiplier for the already hundreds of contact tracers that we have in public health units to streamline the contact tracing. What the app would actually do is be able to determine who you had been close to for greater than a 15-minute period, which is what we can fine as close contact through Bluetooth technology, and that that information would be stored locally and privately on an individual's mobile phone, only to be released if the person became- was diagnosed with COVID-19. So, with that in mind, you can imagine the contact tracers have to call individuals and their recollection of contact might not be perfect, so it provides an added information technology source of that information so that the contact tracing can be even better than it already is at the moment.
QUESTION:
Thank you. Could I ask two slightly technical questions? What can you say about the current effective reproduction rate- I think it's called the REF? What level are we aiming for, is it Level 1? Are we below that now?
NICK COATSWORTH:
The idea of the effective reproductive rate, or R0 in this sort of epidemic, is that if it's below one, the numbers of cases will gradually decrease, and if it is above one, you'll get increases in the number of cases. The R0 that we did our initial modelling on was around about 2.6 or 2.7, which was the international experience. Leading, as you know, to the really challenging scenarios in New York, Italy, et cetera. So, given what we know about the behaviour of the virus at the moment, the R0 is likely below one, but that is being determined. And one of the challenging things about understanding our R0 is that so many of our cases are travel-related and so much fewer of them are community-related. So we need almost to have a little bit more time to work out what our R0 is. But the overall principle is that the curve is flattening and that the measures that Australians are coming on board with are actually working.
QUESTION:
With regards to the outbreak in northwest Tasmania, it's the first broader-scale example of this rings of containment idea where you have a widespread but localised shutdown. Is that a model that would, in your opinion- the opinion of the AHPPC, be best applied of there were outbreaks in other pockets like specific parts of Sydney or specific parts of regional Australia? What lessons are you hoping to take from the management of that outbreak that could be applied elsewhere?
NICK COATSWORTH:
Well, I'd say that the outbreak is in its very early stages and that the control and investigation of how the outbreak occurred are in the very early stages. As a model, it is forming part of a classic epidemiological investigation, and all the measures that we're doing are exactly the ones that we've advised - isolation, quarantine, and then there'll be a reintroduction of staff back into the hospital. So, should there be outbreaks in other parts of Australia, the response will be dependent entirely on where that is. Obviously outbreaks in very well-resourced urban areas compared to remoter areas, or rural and regional Australia areas, will engender a different response that will be tailored to give the best access to care.
I'll just move over to this side.
QUESTION:
Just on the R0, you said we were going to need more time to understand that sort of new transmission. How much more time before we understand how that's changed(*)?
NICK COATSWORTH:
Well, you can certainly get an R0 based on the number of community cases that we've got. It's whether that represents something that's accurate or not, because the lower number of cases you have, the less accuracy you'll have there. The most important thing at the moment is actually what the curve is doing and the number of cases, which is continuing to be very low, and the percentage number of cases - the new cases as a percentage of the total - continues to be very low. So you can infer success of our measures based on those numbers.
QUESTION:
Dr Coatsworth, is there any merit to having fees waived for nurses who are currently out of work to encourage them back into the workforce? And any that have let their registration lapse - have we put at risk losing those nurses?
NICK COATSWORTH:
Look, I think that's probably a matter for the Australian Health Practitioner Regulatory[sic] Agency to answer. What we do know is that there are a large number of nurses within the Australian workforce that don't actually practise front-line clinical nursing. And a lot of those have put up their hand to be able to come back and be part of the COVID-19 response, so that's a fantastic outcome.
QUESTION:
Could we possibly see teachers in schools being issued with some kind of PPE? Would that be practicable? Is that something being considered by National Cabinet or by the health advisory board?
NICK COATSWORTH:
Look, I think what we've got to remember is personal protective equipment is the last thing you use in your risk mitigation strategy. It's not something we've considered for schools, because there are a whole range of risk mitigations that you can put in place before them. The most notable that's been put in place at the moment is that schools are closed and it's the Easter holidays. So, no, we're not considering that at this point. But what we would say, as well, is that whether you're a teacher or a parent with a child who's sick, any sort of respiratory symptoms, you have to stay away from school. That's the base level of protection that we've got.
QUESTION:
Just on the issue of children and the role of children transmitting the virus, what does the data say so far, and how many children have been confirmed cases in Australia?
NICK COATSWORTH:
So, as I said, it was 136 children between the ages of 5 and 18. That's the data that I can give you today. In terms of transmission, there's been some detailed investigations done by the various jurisdictions that I'm going to let them comment on specifically. But there are not larger outbreaks within schools as a result of those. So, as I said before, that's an important indicator, because you can contrast that. A single or two cases of schools does not appear to lead to large school outbreaks. However, in the adult context, when you get cases, they are clearly leading to more significant outbreaks and even more so in the elderly, which is why we're so concerned about our residents of residential aged care.
QUESTION:
Can we rule out new cases coming out of schools, given now we're one of- probably, or possibly one of the few parts of society that would be back up and running, in some sense, if that's the decision by National Cabinet tomorrow?
NICK COATSWORTH:
No, it's not possible to rule that out at all. And it's clear, from what I've just said, that there will be cases amongst children. The question becomes - how many of those are actually going on? And, what transmission happens as a result of that? And it seems, from what we understand at the moment, that that transmission is very low.
QUESTION:
Could I just ask, from a, perhaps, personal point of view, how would you encourage - or what would you say to Australians - about the app that's being proposed? Why should they take it up, given the privacy concerns?
NICK COATSWORTH:
Well, I can say, both from a personal and a professional point of view, that the way forward with COVID-19 - living in an environment where we're not immune - is entirely based on building our capacity within the health system and our capability to detect the cases. So, the app will offer an enhanced capability for case detection and interruption of those transmission chains. And with any sort of infectious disease, that's our fundamental weapon at the moment in the absence of a vaccine. So, if we have that weapon, we need to closely and carefully consider its merits, particularly in relation to privacy, we couldn't agree more, but that- it is a potential important tool at our disposal.
QUESTION:
Should a more cautious approach be taken on schools, given we don't know exactly the role asymptomatic children can play in spreading the illness?
NICK COATSWORTH:
Asymptomatic transmission is a key point of investigation. So, that is being looked at by public health units around Australia. And I think what you're seeing at the moment is certainly a demonstration of that cautious approach. So, I'll take one more question now... I've exhausted everyone. Okay. Thank you all.
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