Date published: 
13 August 2020
Media event date: 
12 August 2020
Media type: 
Transcript
Audience: 
General public

NICK COATSWORTH:

To date there have been 22, 127127 people diagnosed in Australia with coronavirus disease. In the past 24 hours to 12 noon today 429 newly confirmed cases of COVID-19. 18 of those were diagnosed in New South Wales, one was overseas acquired, 13 were locally acquired but were contacts of a known case. Two have been acquired locally and the contact has not yet been identified and two were locally acquired and were travellers. Victoria today reported 410 new cases. 72 of those were locally acquired and 338 of those remain under investigation. There was one case diagnosed in Tasmania today which is currently under investigation. There were 21 new deaths overnight from coronavirus disease and I extend my condolences to the families of those victims of COVID-19. 352 people have died in Australia from COVID-19 during this pandemic.

I did want to reflect on something that I've noticed over the past days to weeks as I personally have been in touch with Australian scientists and clinical researchers who have been involved in the research effort for COVID-19 in Australia. I have spoken to colleagues who are clinician researchers in infectious diseases, I have spoken to people who are benchtop researchers there in the lab looking towards new treatments for COVID-19, looking at vaccines for COVID-19 and I am constantly astonished by the speed and the pace with which the global community is racing towards finding effective vaccines and treatments for COVID. In Australia, I've reflected before about how we learn every day in the clinical sense how to treat patients with COVID-19 in hospitals and intensive care units.

But on this research effort, the Australian Government has provided $330 million towards COVID-19 research, which is an extraordinary amount. There's just been a new medical research fund; immunological studies grant opportunity, funding round close and that will provide more research projects for COVID-19. We are everyday becoming more and more optimistic - cautiously optimistic - but optimistic nonetheless of a COVID-19 vaccine being produced. And a number of Australian organisations, University of Queensland and Flinders University are deeply involved in that. Today the Federal Government announced that there is another $3.8 million being devoted to COVID-19 related research. $1.5 million of that will go to a fast testing facility at Bio Platforms, a Government entity at Macquarie University. $1 million will go to Phenomics Australia at the Australia National University for genome related research, and $1.2 million to translating health discoveries which is shared between eight universities and will pay for five full-time staff to work on COVID-19 projects. So all this very positive news in what is a difficult time for Australia, for Victorians, but that our top line, world class clinician researchers, scientists are working towards a vaccine and effective treatments for COVID-19.

I will take some questions.

QUESTION:

On the Russian vaccine that was reportedly announced overnight, what do we know about it at this stage? How legitimate is it and would Australia at this point be looking to obtain supplies of that to manufacture our own version of that?

NICK COATSWORTH:

We know very little apart from the media reports, of course. As we reflect on our own experience with research and development in COVID-19, the critical principles of the scientific method, which would include making sure that data is openly available for scrutiny, particularly with a vaccine, the importance of regulation of safety and efficacy studies, these are all bits of information that you need to be able to understand about a vaccine. So the more information we get about any vaccine produced by any country the better and we have held a consistent position as a nation that no matter who wins this race, that any effective, safe vaccine needs to be immediately provided to the world and countries around the world allowed to manufacture it.

Claire.

QUESTION:

Dr Coatsworth, the guidelines issued by the Commonwealth to aged care providers was to prepare for 20 to 30 per cent losses in staff if they had an outbreak. Newmarch had over 80 per cent and we have seen since then places like St Basils lose their entire staff. Why wasn't that advice updated given that even though there was a surge capacity on offer from the Commonwealth, even the Prime Minister said they weren't expecting to lose that many staff from a single facility?

NICK COATSWORTH:

I think you have hit the nail on the head, Claire. The anticipated staff losses were in the order of one fifth to one third, which is still an enormous number to have to contingency plan for. You know, what went on at St Basils and some of the other facilities that have been markedly affected has been entire shifts of staff, entire facilities worth of staff not being able to work either because they are affected by COVID-19 themselves, acquired largely from the community, or they've been furloughed as a decision to protect residents and what that has led to is entire facilities being without a workforce. I just ask everybody to reflect as they consider what the Federal Government plans were and what providers planned for. There are very few organisations in Australia, in fact, I'd struggle to name one, that has a business continuity plan for their entire workforce being absent. Now what did the Federal Government do in response to that, in response to that crisis in workforce, in Victoria, in conjunction with the Victorian Department of Health and Human Services, well we have reflected on that on a number of occasions. But it is timely to talk again about the Victorian aged care response centre. This is a multi-jurisdictional, whole of Government response to a deeply concerning and very significant event in aged care in Victoria that has involved Governments from federal to state, has involved the Australian Defence Force, has involved residential aged care providers themselves and the Australian Commission for Safety and Quality in Aged Care. This sort of response, we use the word, unprecedented a lot. This is unprecedented. I haven't heard of that sort of vigour of response to prevent further deaths in aged care nearly anywhere in the world when faced with this sort of outbreak. So the response when faced with those very high numbers of furloughed staff has been exceptionally vigorous. It is ongoing. We have our Australian medical assistance teams there now and just another example of the partnership model that the Victorian Aged Care Response Centre has achieved between the DHHS and the Federal Government, the partnership that has led to tertiary hospitals in Victoria offering support both by sending their geriatric services into residential aged care facilities and also receiving patients who require care.

QUESTION:

I'm sorry, with respect that wasn't entirely what I asked. I wanted to know if the guidelines are going to be updated because it may have been unprecedented at Newmarch, but you therefore had an idea that you could have these huge workforce losses by the time the Victorian outbreak took place. Will those guidelines, that 20 to 30 per cent recommendation, be updated or reconsidered by the AHPPC?

NICK COATSWORTH:

Well Claire, I think there are a lot of things that are being reconsidered by the AHPPC at the moment and every single jurisdiction is considering the document that was presented to National Cabinet at the last National Cabinet which was lessons learned from the Victorian aged care outbreak. I just draw your attention back though - I'm sorry I didn't fully answer your question on the first go - I draw your attention back to the fact that when you have a community-level outbreak of the extent we have had in Victoria and many other nations in the world on the first or second wave, residential aged care workers and health care workers are a significant part of our workforce, a very significant part of our workforce as a proportion so when the proportion of COVID is high in your community the number of affected facilities is very, very high and no Government in the world as yet has been able to prevent the incursions of COVID-19 into residential aged care facilities, when you have a COVID outbreak of that sort. Our Government, both state, federal, our Aged Care Quality and Safety Commission has been able to mount an exceptionally vigorous response with some of our leading doctors and nurses with AUSMAT founded on a principle of great patient care for the residents who are both affected by COVID-19 and ensuring that their care needs are met. That has been the vigour of the response and that response is continuing down in Victoria at the moment.

QUESTION:

Dr Coatsworth, at the Aged Care Royal Commission today, the Western Australia state secretary of the United Workers Union said training and PPE use among aged care workers had been neglectful. We've also had responses to questions on notice that show that prior to the Victorian outbreak, just one and five aged care workers across Australia had completed the Government's PPE training. Are you concerned by the lack of training and do you think the Government should have done more to ensure preparedness among frontline aged care workers?

NICK COATSWORTH:

I'm always keen on training in infection prevention control as an infectious disease physician, but what I'm going to point out is that the precautions that we are asking people to take with personal protection equipment, be they residential aged care workers or health care workers, these are not new, of course. These, what we call contact or droplet precautions or airborne precautions, have been part of residential and aged care and healthcare well before the COVID-19 outbreak. Every year we have influenza outbreaks in residential aged care. So, the base level of training was required to have been given by the Australian Commission of Safety and Quality in Aged Care, as it is in the Australian Commission of Safety and Quality in Healthcare. All professionals are required under the national standards to be able to understand that. There is nothing new that we've implemented in terms of any new techniques that need to be learned as a result of COVID-19. What we did was then provide extra online training which has been undertaken by over 100,000 people since the pandemic began. We ensured through a self-reported survey that providers were aware of the need and to assess themselves against their ability to provide infection prevention control. I would point out that those surveys were conducted during the first wave when the Quality and Safety Commission were not able to visit residential aged care facilities. I will also point out that in areas of Australia now where there is no community transmission of COVID-19, that the Aged Care Quality and Safety Commission is now conducting those in-person spot visits again to determine compliance of providers with national standards.

QUESTION:

The Aged Care Royal Commission also said today that hundreds of residents will die prematurely because of a lack of action, that there's been a look of urgency and attitude and futility towards those in aimed care, would you dispute that and can you articulate what could have been done differently in regards to aged care?

NICK COATSWORTH:

Look, I think the first thing to say is that there were many words used in the royal commission witness statements today that perhaps don't reflect the totality of the Government's response, both at federal and state level to preventing deaths in aged care.

This is a virus that disproportionately affects the aged in our community. That is not a statement of futility, it is a statement of fact. It's a statement that our most vulnerable in the community needed to be protected. From January of 2020, federal and state governments around Australia and Chief Health Officers recognised the propensity or likelihood of COVID-19 to cause severe morbidity and mortality in our aged population. Even if you don't refer to the plans - and I will get to the plans in a moment - we have locked down once across an entire nation to be able to protect our most vulnerable. So, the assertion that there was an attitude of futility towards deaths in residential aged care in Australia is frankly insulting to the entire Australian community who locked down to prevent deaths amongst our most vulnerable.

And now, similarly, to Australians who are in Victoria who are in Stage 4 and Stage 3 lockdown, because of the effects, in part, that we have seen of a community outbreak on our most vulnerable in residential aged care. We have to shut down that community outbreak and we have had to go to Stage 4 restrictions. In answer- in direct answer to the question: will there be more deaths amongst our elderly residential aged care population because of COVID-19? The answer is yes. And every one of those deaths will have an impact on husbands and wives, sons and daughters, grandsons and granddaughters. And that is why we are doing all we can at the moment to bring the outbreak in Victoria under control.

QUESTION:

Can I just- a follow up on what Claire was asking before. How did you come to that 20 to 30 per cent figure, and was it a mistake to not have that as a higher estimate of how many aged care workers might be taken out of the workforce because of isolation quarantine reasons and so forth?

NICK COATSWORTH:

I think the 20 to 30 per cent figure, as I have said in response to Claire's question, that's a very high proportion of any workforce. That was in many ways what we thought was the higher end of what might happen. Clearly, when you've got a single outbreak in a facility like Newmarch and you have 80 per cent of your staff furloughed, then it is possible to supplement those - and the Commonwealth did, particularly through Aspen, and so did the New South Wales health service. When you have single outbreaks like that, it's possible to supplement up to 80 per cent of the workforce. When you've got multiple outbreaks across many facilities in a metropolitan area like Melbourne where you get workforce absences of 80 to 100 per cent, as it has been in some facilities, then you require an extraordinary response, an extraordinary response that was not in the plans, and that is clear. Anyone who has read the plans would see that. But an extraordinary response that was based around Australia's ability to bring Government departments together rapidly, quickly and actually does have a plan attached to it - it's called COMDISPLAN, or Com Disaster Plan, which was activated on 23 March by the Director-General of the Emergency Management Australia. So, we are articulating well as government, we are articulating well as a nation, as a community to bring this under control.

QUESTION:

Are you able to clarify something for me? What are the current protocols when an aged care worker falls ill? So, let's say they do the right thing when they feel sick, they self-isolate. Many in Victoria are still waiting up to a week to receive their test results, so are you concerned that over the course of that week, their close contacts and maybe their colleagues could then be spreading the virus around that home. What is the protocol there at the moment?

NICK COATSWORTH:

The specific protocol of course is that a person who has COVID-19 and who is a residential aged care worker is obviously removed from that facility, that their contacts are determined within the facility, the close contacts of colleagues that occurred without personnel protective equipment, then those staff need to be furloughed. That has to be done on an individual basis by the public health unit. But at the moment within the Victorian aged care response centre there is an epidemic intelligence unit, several senior epidemiologists seconded by the Commonwealth to work with the Victorian DHHS and public health unit to make those decisions as quickly as possible. So with the Victorian Aged Care Response Unit and that epidemic intelligence unit, and their workforce management unit. They are the units that are actually managing furlough in Victoria at the moment.

One from Claire and then I've got to go to the phone.

QUESTION:

Dr Coatsworth, thank you. Yesterday the royal commission heard that if an aged care home that has an outbreak can get a very high level infection-control practitioner on the ground within 48 hours, that has a beneficial effect as having a single source of truth and advice for the workers. It happened at Dorothy Henderson Lodge, it did not happen at Newmarch. And the Dorothy Henderson Lodge report has recommended that a mechanism be established to have that expert on the ground. Is that something that you would consider one of the more urgent recommendations given the midst of the pandemic is still upon us, and do you think that it is possible to have that kind of high-level expert dispatched to every single aged care home within that 48-hour window?

NICK COATSWORTH:

So in response to that question Claire, I might take in it three parts. The first one is that that idea of having high level infection prevention control response was part of the paper that went to National Cabinet and is certainly been considered- the capacity to do that is being considered by Chief Health Officers and state health systems at the moment. With regard to Victoria, would that have been able to have happened? Well, clearly the volume is an immense challenge to be able to have high level infection control advice in a very short period of time. That said, one of the functions of the AUSMAT flying squads who- some of the members of whom went to north-west regional Tasmania and whilst not infection prevention specialists themselves have been trained in residential aged care infection prevention and control, is to go in and support those infection prevention control decision points. Now that is not simply training, although training is clearly a part of in it the appropriate use of PPE. One of the crucial decisions is the layout of each facility which is different. The decisions to cohort patients who have COVID-19, the decisions to decant patients, as we say, or transfer patients to hospitals. And that might be for a number of reasons, whether their care needs can't be met in that particular facility, they may be COVID positive and in need of care.

So there's a variety of things that senior infection prevention control specialists do. And so, yes, in an ideal situation where there are not many, many, many concurrent outbreaks then that is a desirable thing to happen.

I will just go to the phone now.

QUESTION:

Hi, I've just got one question back on the issue of vaccines. The Commonwealth has previously said that it's in advanced procurement negotiations with leading vaccine candidates around the world. How close is Australia to signing a deal with manufacturers to secure supplies of any future vaccine, and is it responsible to be spending taxpayer money to secure supplies when no vaccine might not actually ever eventuate?

NICK COATSWORTH:

I will have to take the first question on notice, I'm afraid. I'm not across how close we would be to signing advance procurement nor how much it would cost. But to the point about whether it would be responsible, I think one of the things that our vaccine strategy group is doing, it has a very, very close eye on which vaccine candidates are the most promising. And so we are confident that any Australian - a single Australian taxpayers' dollar that is spent - will be absolutely in the interest of the Australian taxpayer.

I will take one more question.

QUESTION:

Yourself and Professor Kelly said in recent days that there are a number of candidates around the world that are getting close to stage 3 trials, and that sort of thing, a few promising candidates. Generally what sort of- say for instance there's a situation where a couple of vaccines all become discovered or become- get to a certain point at around the same time, how do we decide which one we want to get? Like what actually are the guidelines around choosing one or do we choose a couple and get a couple and send them out into the community, how does that actually work?

NICK COATSWORTH:

Well I think like a lot of these things in a pandemic, these processes aren't entirely established but I think the question is what would we do if there were two successful candidates? Well we would, like every nation, want to see those two successful candidates used in Australia and vaccinate Australians with those candidates. But the important thing of course is that that's done in a- these will be novel vaccines for a novel virus. And the important of having the sort of robust, regulatory framework that we have in Australia around vaccine safety, which is informed by our national vaccination group, ATAGI as well as the Therapeutic Goods Administration that's going be one of the crucial next steps. So once the phase 3 trial results are in, if there are two successful vaccines, we would call for those vaccines, as we have done, to be available to every nation in the world.

QUESTION:

Sorry, just one more question from another outlet. Sorry.

NICK COATSWORTH:

Yes, Claire.

QUESTION:

Today the royal commission also heard examples of critical PPE shortages, workers being told to only use one glove instead of two. That was early in the pandemic in March, what's your response to those claims? Are you confident that the PPE was available when needed or has that issue now been addressed where we're at now with the outbreak?

NICK COATSWORTH:

Well I mean any story or piece of evidence that reflects people only being able to use one glove instead of two is obviously unacceptable and those PPE shortages, if they're happening, are appropriately being discussed at the royal commission at the moment. With regard to what's happening now, the supply of personal protective equipment to residential aged care through the national medical stockpile is plentiful. We are dispatching tens of thousands if not hundreds of thousands of gowns, gloves, and millions of surgical masks t residential aged care facilities. And indeed in Victoria at the moment where there is a significant community outbreak and patients and residents are being treated in some cases in the residential aged care facilities, we've moved the guidance to include M95 P2 respirators as well, and those are being dispatched through the national stockpile.

Thank you.

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