NICK COATSWORTH:
Good Afternoon, everybody. Dr Nick Coatsworth with today's update on COVID-19 in Australia. Going straight to the numbers, the 24 hours to 12 noon today, we have 9553 total diagnoses of COVID-19 since the pandemic began. There have been 227 newly confirmed cases to 12 noon. There has been an additional death, regrettably, overnight, taking our national death toll to 107. Looking at the numbers by state, Victoria has confirmed 216 new cases. Two hundred and twelve of those are currently being investigated, and four of them we know already are part of known clusters and outbreaks. In New South Wales, to 12 noon there had been seven new cases in the previous 24 hours - five overseas, one local transmission, and one from interstate - and we know from the press conference yesterday that that is related to the Liverpool pub. In Queensland, two new cases, both in hotel quarantine from overseas travellers. Western Australia, two new cases, both in hotel quarantine from overseas travellers. There are 55 people hospitalised currently with coronavirus disease, 16 of whom are in ICU.
I wanted to make comment today, as the DCMO but also as a infectious disease and respiratory physician, about a drug called remdesivir. As you know, there have been many, many studies around the world for various drugs in the race to look for an effective treatment for COVID-19. Remdesivir is one of those drugs that has been repurposed, and it has been looked at in a number of international studies. Overnight, the Therapeutic Goods Administration has approved that remdesivir can be prescribed by any medical practitioner in Australia for COVID-19. Remdesivir is an intravenous drug. It has been studied in patients who are hospitalised, who have evidence of lung damage due to coronavirus disease - patients who require oxygen, essentially. And so, these are the patient group that we have required doctor- we have put some caveats around who can receive remdesivir in Australia. It is likely to be prescribed by hospital doctors. Obviously if it's an intravenous drug, it's not going to be available to people with COVID-19 in the community, and it will be prescribed by- largely by infectious disease physicians and intensive care doctors. This is where its main use is going to be.
So, what is it? It's a drug that is a direct-acting antiviral. What does that mean? It means that it stops the virus from multiplying further in the body. The important thing to note about any of these medications, of course, is that none of them, as yet, are a silver bullet. None of the international trials that have been conducted in remdesivir, involving remdesivir, have shown marked results, but they have shown some results that indicate that it might be effective in patients with moderate to severe coronavirus disease. And they include a reduction in the length of hospital stay and a potential reduction in the serious adverse events that coronavirus sufferers can get during their episode of coronavirus disease. Both of those things may be an indicator of positive effect. What we don't know yet is whether it has a conclusive effect on mortality. Nonetheless, the TGA recommendation is significant. It allows the prescription of remdesivir in Australia. It has already been used, as drugs that are pre-approval can be used in Australia, under expanded access programs. So, remdesivir has already been given to patients in Australia, both earlier on in the pandemic and in recent weeks in Victoria. So, that drug is available. That's good news for people who are suffering from moderate to severe coronavirus disease.
But what I would say is that the real advantage, of course, that people have suffering from coronavirus disease in Australia who do get unwell is our expert intensive care doctors and nurses. And really, we have amongst the world's leading intensivists, the world's leading critical care nurses. We have worked to bolster their capacity through the provision of extra ventilators, through extra beds, and through upskilling over 20,000 registered nurses in aspects of critical care medicine in order to prepare for any necessary surge capacity for intensive care. Given that there are only 16 patients, to the latest count, who are in intensive care Australia-wide, we are well within that capacity. And it is the supportive care largely, rather than the drugs, it is the expert care, the expert management of a ventilated patient, the expert management of giving them intravenous fluids and drugs to improve their blood pressure, the administration of dialysis. These are the things that our Australian intensive care doctors and nurses are world experts at. And there's not a week goes by that I don't speak to the President of ANZICS, Anthony Holly, to get updates on the intensive care situation in Australia; to Professor David Pilcher and others down in Victoria; Dr Steve McLaughlin. There are the people that I speak to that reassure me that Australia has the necessary intensive care capacity. So, whilst remdesivir is certainly good news, the best thing that we have in Australia is our skilled doctors and nurses. And I'll take questions.
QUESTION:
What's the global supply like?
NICK COATSWORTH:
So, like anything in the COVID-19 pandemic, we need to be cautious about our supply lines. We've been working very collaboratively with Gilead, and I'd like to thank them for their collaboration with the Australian Government. The current supply within the national stockpile is a donated supply from Gilead. In light of what's going on in Victoria, we will seek to procure more remdesivir from Gilead, and whilst we have comfort in those supply lines, I think one of the things we learnt from February and March is that we're not 100 per cent confident until things arrive on our shores.
QUESTION:
How many people can be treated with the stockpile that we currently have in Australia?
NICK COATSWORTH:
So, we're satisfied that the current stockpile in Australia will be enough for the coming weeks, based on the numbers in Victoria at the moment.
QUESTION:
What are you expecting then, in the coming weeks? Because Victoria has seen increases in case numbers over the last week or so, 216 today. What's the data looking like in terms of the number of people that could be hospitalised, down in Victoria in particular?
NICK COATSWORTH:
Well, I think the important thing is that we've now introduced a number of measures in the past week that we know are very effective in reducing the numbers of coronavirus disease. So that's the first thing to say. The restriction in mixing, the restriction in people gathering, the Stage Three restrictions themselves are intended to decrease the numbers, and what we're likely to see is, as Professor Sutton has said, potentially increased numbers in the coming days, but we will eventually see a plateau. We know that this works. It's worked where there've been second peaks worldwide. It will work in Australia. In terms of the actual numbers that we're seeing, they're actually a little bit less than we saw in February and March in terms of the hospitalisations and the intensive care admissions. Why is that? It's because the demographic of this current epidemic has changed. We're talking about younger patients, and whilst that produces less hospitalisations, that is by no means a caution to young people and young adults out there that they should ignore coronavirus disease. There have certainly been cases of severe COVID-19 leading to death amongst young people. It's just that that particular severity of disease is more common in elderly Australians. So, we're comfortable with the current- we're very comfortable with current capacity down in Victoria at the moment, and obviously it's good that only 16 patients are sitting in ICUs at the moment.
QUESTION:
Remdesivir is, from what we can see online, a fairly costly drug. When it's prescribed, who's supposed to foot the bill for that? And also, why has Gilead donated this stockpile to Australia?
NICK COATSWORTH:
So, in terms of the cost, whilst it is a relatively costly drug, there are cancer and chemotherapeutic agents out there that are manyfold more expensive that we supply through the MBS. So, there's certainly no exception here; this will be paid for by the Australian Government. The donation was particularly generous from Gilead in the early phases. Gilead's done a number of things, as, I guess, as a corporate citizen. Probably the most notable is to look at generic manufacture of this drug for the developing world. That's other pharmaceutical companies that will be able to do that. We need to procure from Gilead.
QUESTION:
If I can just ask you about the cases that we've seen in Sydney in the last 24 to 48 hours. We've seen spikes in hotels and in other parts, particularly from people travelling outside of Victoria when they shouldn't have been. How concerning is it what we're seeing in Sydney now? Is that a consideration that the AHPPC might need to take about further steps that might need to be taken in NSW?
NICK COATSWORTH:
So, we're meeting daily, even on the weekend - we had a meeting at Saturday earlier today. The- obviously, those two cases at the pub in Casula in Sydney's south west are of concern. Those two cases are likely to be linked to the pub in question. It's a timely reminder that COVID-19 spreads in situations of close contact, and whilst we're aware that the pub had a COVID-safe plan, I don't have the specific details of how that virus has gone from one person to another, and that's something that New South Wales Health is investigating. What they do in that situation is look for upstream contacts - so, people who could potentially have given it to those two individuals - and that's going to be the key here. If we're able to find that upstream contact, we'll be able to determine whether it was related to Melbourne travel or not. I think the New South Wales Health Minister and the Premier have made some very clear statements about their preference for Victorians travelling in New South Wales during school holidays. That is an understandable position to take as a protective measure for the people of New South Wales, remembering that this is a shared problem. Whilst, you know, we can think of ourselves as Victorians or Canberrans or New South Welsh, it's not really the case. This is a national problem, and so we need to deal with it with those national solutions.
QUESTION:
In that context, given that what we're seeing is the lag in testing results, and we constantly see a couple of days behind where we might actually be, how critical is the next 72 hours or so for New South Wales and a country as a whole as to whether this thing can continue to cycle out of Victoria?
NICK COATSWORTH:
So, we know that we're all on high alert. So, it is fair to say that the coming days are critical to see what happens across the eastern seaboard. I think that the small number of cases that are being found in the ACT in New South Wales I think the strength of the ACT and New South Wales public health units, particularly the New South Wales pop-up clinics that almost instantaneously turn up wherever there's a test. But most importantly, individual Australians. People who know that they were in that area who develop symptoms, they're actually the ones that are going to make the biggest difference, because if you don't turn up when you've got symptoms at the moment, you could have COVID-19. And of course, we know that one person who doesn't get isolated, if nothing is done, can turn into 400 cases by the end of the month. Obviously, that's not going to be happening in Victoria because we've got Stage Three restrictions, but we don't want anything like that to be happening in any other states on the eastern seaboard.
QUESTION:
Is there any charge or update at this stage for Australians in general about wearing masks? Is that staying just with the Victorian hotspots?
NICK COATSWORTH:
The mask issue absolutely stays the same. The mask recommendation absolutely stays the same, and that is that where you don't have community transmission of COVID-19, the mask is of, very clearly, of limited value. It would be difficult to tell someone in Western Australia at the moment that they should be wearing a surgical mask to the footy game today, I think it is. That said, we have been very clear that when community transmission goes up, masks do have a value, and there's one thing- it appears that the AHPPC is in disagreement with other experts around Australia, but let me characterise it like this: we all say exactly the same thing, which is that masks are part of a suite of protective measures. And that is the absolutely key, so that when the community transmission goes up, you've got your social distancing, you've got your testing when you're unwell, you've got your hand hygiene, you add on top of that masks to give whatever benefit we can get from masks, we need to get it now in Victoria. Because it's got to the situation where it has.
QUESTION:
Couple of things that your colleague Brett Sutton down in Victoria said this morning. One was that a vaccine might not be readily available, widely available, in the world for another 18 to 24 months. Do you share that view? Also he said that he was going to ask the AHPPC to reconsider the suppression versus eradication idea, suggesting that he supported eradication and wanted the AHPPC to follow suit.
NICK COATSWORTH:
So, vaccine first. I think we need to prepare ourselves for a world where the vaccine is not available for potentially 18 to 24 months. That would be a very judicious way of responding to COVID-19. The reality, I think, is that there are so many people looking at a vaccine at the moment. There's at least two novel vaccine development methodologies that are being rolled out - the RNA vaccines themselves. You know, there is so much effort going into this that I think we should be hopeful that we can get a vaccine for COVID-19, but we need to prepare, obviously, for a world without a vaccine. Now, on the suppression versus elimination strategy: the AHPPC's been united on this. That includes Professor Sutton. The suppression strategy to the point of elimination is what we were going for, and that's been achieved in seven out of the eight of our jurisdictions. Now, I think it's important to address, though, the challenges of elimination. We have reached- every time I look, there's another million cases in the world, literally. It's- I thought it was 10, then it was 11 and now it's ticked over to 12. This virus is everywhere in the world. And to think that in the absence of a vaccine that you could possibly push towards successful elimination and then get your country back on any sort of balanced footing, we think is not the right setting for this country. And we maintain that position. So, I would say that it's difficult to hold both positions. It's difficult to hold the position that your vaccine's not going to be there for 24 months, and then hold a position that elimination is your strategy. And we also see whilst it is very challenging what's going on in Victoria at the moment, there is another element to this. If you look at the elimination position in New Zealand, all it took were one or two cases to cause a significant amount of consternation and concern within the community. We have to be able to live with COVID-19. We have to be able to keep it under control at very low levels. We will look towards no community transmission as a goal, but that does not imply elimination. And I'll take one more question on the phone. Hello.
QUESTION:
Just a question about Victoria and contact tracing. There seems to be several hundred cases now. At what point does that system get overwhelmed?
NICK COATSWORTH:
So, the question is there's obviously several hundred cases a day in Victoria. Every one of those needs to be contact traced. At what point does that system become overwhelmed? So, these are significant numbers of cases for any public health unit in Australia to deal with. It is the case that any single public health unit in Australia would need assistance to deal with those sort of volumes, and that assistance is being readily given. So, as I said earlier, this is a national response to COVID-19, and so contact tracers are being mobilised nationally to be able to assist with the Victorians, our colleagues down in Victoria, who, might I add, have been working night and day on this, who have had some real successes in the past week - most notably being able to let the vast majority of residents in the public housing towers to go also to Stage Three restrictions. So, there's some fantastic work being done in Victoria. We know in New South Wales is assisting with contact tracing, and during AHPPC today, we had a discussion about the national capability that can be brought online, both through existing contact traces and also other sectors of government and defence that can help with this critically important issue. Because we need to be able to successfully contact trace these cases. Thank you very much.
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