NICK COATSWORTH:
Good afternoon everybody. Dr Nick Coatsworth with today’s update on coronavirus disease in Australia. To 12 noon today, there have been 9797 total COVID-19 infections diagnosed. There have been regrettably, 108 people who have died from COVID-19, including another death overnight - a gentleman in his 70s. The number of cases confirmed in the 24 hours to 12 noon is 279, of which 273 are in Victoria. There have been five cases diagnosed in New South Wales - two of those individuals were in hotel quarantine and had acquired their infection overseas, three are local cases who are confirmed who were household contacts of one of the people who contracted COVID-19 in south-west Sydney. Seven thousand seven hundred and twenty-eight people have recovered from COVID-19, and in terms of current hospitalisation 67 people are hospitalised, and 17 of those are in intensive care units.
We have a very specific message today which has been shared with us by our New South Wales health colleagues and their Chief Health Officer, Dr Kerry Chant. Anyone who was at the Crossroads Hotel in Casula in south-west Sydney between the dates of 3 July and 10 July, anyone who visited that particular venue, you are required to self-isolate until 14 days after your visit. Furthermore, if you were at that particular pub between 3 July and 10 July you are strongly encouraged to get tested, regardless of your symptoms. This is because that venue is currently the sub- the hub of the public health investigation into the small cluster in south-west Sydney emanating from the Crossroads Hotel. It is critically important that if you were there during those 3 July and 10 July that you get yourself tested, once again in this case regardless of symptoms. So, whether you have symptoms of a cough or cold or not but you were at that pub, do get yourself tested. That includes people who have now left New South Wales but who may have been at the pub between those dates - hence, we're making it part of this national press conference - including freight drivers because that is a particular venue that is also frequented by people who do transnational freight driving. If you are one of those drivers, whatever jurisdiction you're in, do go and get yourself tested, minimise your contact with others for the 14 days after your visit to the Crossroads Hotel in Casula.
This is a timely reminder that infectious diseases of any sort - particularly ones with pandemic potential, highly infectious ones - do transmit through or do travel through transport hubs, and the Crossroads Hotel in Casula is on the Hume Highway, of course. That is not to say that people can't frequent those venues - of course you can within the restrictions that the state governments have put on numbers of people and density. But people need to be very cautious. Certainly, if you have any symptoms of a cough or a cold and you're on the road, don't drop into the roadhouse and sit down and have a meal; obviously do things like get a takeaway; if the place looks full move on to the next the next venue. These are just important basic things that we are all going to have to do with COVID-19, with the COVID-19 epidemic. So, with that in mind, I'm happy to take some questions.
QUESTION:
Border closure, given that this virus is likely to be around for potentially years to come, is there an alternative to dealing with outbreaks to the sort of lockdowns we're seeing in Victoria and border closures? And do you think the measures that we're seeing in Victoria, are they really sustainable in the long term if a vaccine's not available in the next couple of years?
NICK COATSWORTH:
So, I guess the first thing to say, and one of the positives, is that an immense amount of human capital is being devoted towards developing a vaccine, including a vaccine that is going to-
QUESTION:
[Interrupts] Most people say it's a couple of years off, probably. Is that fair?
NICK COATSWORTH:
I'll just finish the answer. Including the vaccine that was- that has recently gone to human trials from University of Queensland. So, I think you're quite right, that there needs to be some degree of preparation, as I said yesterday, for an Australia that doesn't have a vaccine. So, we hope for a vaccine to come as quickly as possible but it may not come for many months. In that sort of situation, it is the case that movement restriction and decreasing mixing of individuals is one of the main weapons that we have against COVID-19. But the key of course will be to get this under control, and it won't last for many, many months. This will be brought under control by the movement restrictions that Victoria has imposed in Greater Melbourne and Mitchell Shire. We know that because once movement gets to- decreases to a certain level - and this has been the case in any situation of a second wave around the world - that the numbers eventually start to drop again. The key after that of course is to make sure that community transmission stops; that there are no cases of unlinked community transmission; and, that we do our best to maintain the security of our borders through hotel quarantine, and so on, and so forth. So, I think rather than suggesting that we will necessarily have a period of several months or years where we have lockdown after lockdown after lockdown, I don't think that's necessarily going to be the case at all. I think the focus is to get this particularly large- significant outbreak under control in Victoria, and then go back to what we do best which is contacting, tracing, and eliminating small outbreaks.
QUESTION:
So that would be an unsustainable way to deal with it in a, sort of, medium-term basis over more than a year is to, you know, continually lock down places where there are outbreaks?
NICK COATSWORTH:
No, I don't think it would be fair to say that that was an unsustainable way to deal with it. The reduction in movement, the reduction in mixing of people, is something that we- is our main tool to deal with COVID-19. What I'm not- what I don't think we should suggest is that there will be outbreaks of the extent that we've seen in Victoria that would then necessitate the sort of Stage 3 restrictions and the border closures that we've seen in response to this outbreak.
QUESTION:
Dr Coatsworth, given that we now know that people can catch this virus and can transmit it even if they're not showing any symptoms, what's the current advice around asymptomatic testing? And would you like to see that in- more broadly across Australia, especially in New South Wales, given that we're now trying to work out if this Victorian outbreak has moved across the border?
NICK COATSWORTH:
So one of the challenges with COVID-19 is this asymptomatic period, and it's probably better characterised as a pre symptomatic period, before which you'd start to develop symptoms but you're nonetheless infectious. And that informs our national testing and contact tracing guidance of course, that's why we asked who have you been in contact with for the days before your symptoms arose. The likelihood of people who are truly asymptomatic transmitting the disease is not is not known. The reality, from the Victorian experience that we've seen, is that there have been many, many thousands of tests conducted on asymptomatic individuals for very little yield - but when I say yield very few positives out of the asymptomatic testing that's being conducted down there. So your biggest bang for your buck is still to focus your testing on the symptomatic individuals that is still going to be the way that you detect most of the cases of COVID-19 and that's still going to be the way you get control as quickly as possible. The asymptomatic test has a role in places where there's local small clusters, so the Casula case is a very good example. So we don't want to miss any cases in that sort of scenario, therefore we're going to recommend asymptomatic testing. There wouldn't be any value to go elsewhere in New South Wales or in Queensland where there was no COVID-19 and test people with no symptoms - it'd frankly, it'd just be a waste of a test. So, that's the difference, that's a nuance behind asymptomatic testing - we will use it in situations where we absolutely want to guarantee that we don't miss anything, and that will be in the small cluster like we've seen in south west Sydney.
QUESTION:
On masks, I know that you recommend people in Melbourne if they can't socially distance to wear a mask. What is the threshold though for other cities or areas, for example with Casula? Would you be recommending people there wear a mask, considering there is concerns about an outbreak there? Just a bit of your thinking behind when we get to that point that that's necessary.
NICK COATSWORTH:
I understand. And what I understand more broadly as well is that people are looking for thresholds at which we make decisions. It's very hard to provide that, because if you get to a different threshold you might be heading up the curve, you might be heading across, or you might be heading down the curve. And there's various situations- various other contextual matters that we need to take into account that are not just the numbers. The New South Wales Health Department has recommended an increase in personal protective equipment for their hospitals in those local health districts around Casula, so that's a good example of where we're increasing the personal protective equipment use. For community mask use I think you've seen that a switch occurred when Victoria clearly had significant and- significant community transmission. And so, the recommendation remains the same - we watch to see what's happening with community transmission and if it is significant, as it is in those areas of Victoria, we recommend mask use. Masks are part of a suite of measures like we've always said. There is a tendency, and there are those who we might even describe as mask-messiahs, who would put a lot of faith in the ability of the mask to control these outbreaks. We accept as the AHPPC that they have a role, we also know that the main game in controlling COVID-19 is movement restrictions and social distancing.
QUESTION:
Dr Coatsworth, how concerning is the situation in Sydney - more broadly for you and for the committee? The Premier says that the state is at a crossroads, and south west Sydney could become a hotspot. What would it mean if the two biggest states both had significant outbreaks for the rest of the country?
NICK COATSWORTH:
Well, I think the answer to that is unavoidable. It would be it would be a very significant event for the rest of the country, it would be a very significant event for New South Wales where it moved towards the outbreak of a scale as it is in Victoria at the moment. So, we share the concern of the New South Wales Premier, that's why we're meeting on a daily basis to discuss the strategy; to assist the chief health officers of both Victoria and New South Wales in developing that strategy; and ensuring, most importantly, that those small spot fires that have occurred now in south west Sydney are put out as quickly as possible.
QUESTION:
Was it a mistake for Scott Morrison to go the football yesterday? Given that. while it's allowed in Sydney, he's national leader and the message that's been given to Victorians is to stay at home?
NICK COATSWORTH:
The Prime Minister leads the country and the Prime Minister has been very clear, as we have at the AHPPC - and as you asked in your first question - that we will need to be able to live with COVID-19 - live with COVID-19. Do the things that we enjoy doing in states that we're able to do it in, where the restrictions have been lifted. The PM's a fan of the Sharks, there are a lot of fans of the Sharks and other footy teams who are going to the footy at the moment. The PM, he was demonstrating quite clearly to Australians that we can gather in a COVID safe way, in a COVID safe environment, and get on with our lives. So, I have no problem with it at all.
QUESTION:
Dr Coatsworth, just on the changing advice around- or the changing evidence in schools and transmission among young people. What's the AHPPC's current understanding of the way the virus moves through children and in schools?
NICK COATSWORTH:
Well, I'm not sure we're at the point of saying that there's changing epidemiology amongst school students or with regard to child to child transmission. The overwhelming evidence around the world is that children are less affected by COVID-19, there tends to be less onward transmission; and, therefore schools are safer from a COVID-19 perspective than they are compared to influenza for example where school children are the main transmitters. This question clearly has arisen more recently with the Victorian outbreak, mainly from the Al-Taqwa school - but not exclusively - there have been other schools that have experienced outbreaks. What's happened there is that there have been cases of COVID-19 in very young families in the suburbs of Melbourne, very large families in some cases; many of those children go to the same school; and, then that's how those cases get into the school - there has been teacher to teacher transmission, there has been teacher to child transmission. It's more broadly reflective of what's going on in the community than what's actually going on within schools. The most detailed investigation that we have in Australia at the moment is the one that was conducted in New South Wales that provided a lot of reassuring information that there's very little onward transmission from children to other children.
Just to finish that off, because I think it's important to frame that in light of the school closures in Victoria which is primarily about, as I said before, the reduction of movement. As we heard today there's 700,000 Victorians that will move around to get their kids to and from school. We also know from the Israeli experience that part of their second wave was driven by older students, towards the end of their schooling, gathering before and after school. So, it remains the position of the AHPPC that the classroom itself is safe - it's the other things that occur around school that need to be restricted in Victoria at the moment.
QUESTION:
What's your advice too federal politicians and staff as they're in Victoria and needing to come to Canberra for work? I know we saw Victorian ministers here this week, and we're all being told not to move, but some people still are. What's- have you given specific advice to?
NICK COATSWORTH:
So, the Australian Capital Territory of course it has its own chief health officer, Dr Karen Coleman. And I know Karen's been in close touch with the Australian Government, parliamentarians. It's critically going to be an important issue with the next sitting of Parliament of course. There are essential things that need to keep going and, as we as we said earlier, how do we live with COVID-19 into the future? Well, we're going to have to have Parliament sitting at some point. I can't give you any specific advice for what's going to happen in August at the moment, that's a matter for Dr Coleman and the rest of the Australian Government, but suffice it to say that in a democracy our Parliament does need to keep sitting.
QUESTION:
What's the situation along the New South Wales-Victorian border at the moment? Do you have any concerns about the virus spreading across? And what's the testing like along there?
NICK COATSWORTH:
I don't have specific details, that's more a question for New South Wales Health. But as we said before there are specific issues to do with the New South Wales and Victorian border towns that mean that they're almost being treated as their own bubbles at the moment in terms of the ability of people to cross for essential services, for work, for medical care; and, there's certainly high test availability across those border towns.
QUESTION:
How many COVID cases have been identified through the app?
NICK COATSWORTH:
How many COVID cases have been identified through the app? The app doesn't actually identify COVID cases, it identifies contacts.
JOURNALIST:
[Talks over] No well obviously, identified contacts through there where people visit the doctor and get tested. How many people- cases have been identified, initially, through letting- through contacting these people through the app?
NICK COATSWORTH:
Well, I'll just repeat what I said before. The app doesn't actually identify or diagnose the case. I think what you're saying is that, how many actual contacts have been identified by the app that haven't been identified by the contact tracers.
JOURNALIST:
And then tested positive of course?
NICK COATSWORTH:
Well, you can't test - I hate to argue with you, but you can't test positive unless you've already been a contact. So, I think the question is how many have we actually identified on the app as unique contacts? So, there was one case in Victoria that was identified during contact tracing that then, on further enquiry by the disease detectives, was proved not to be a significant contact, so that's the one case that's been identified via the app. Let's look at the underlying premise here. The more people that download the app and have it activated - so, that's the critical thing, we accept that there's a difference between the 6.5 million downloads and the number of people that actually have it activated at any one time - the COVIDSafe app will remind you if it hasn't been activated because it will come up every 48 hours and say that it hasn't detected any contacts. So, what we would ask of people; whilst we accept that there have been issues with battery life and other things to do with the app, it is reality that the battery life is not going to be important as the life of yourself for someone else.
And there has been good independent modelling that was released by the Sax Institute a week and a half ago suggesting that if all Australian smart users downloaded the COVID Safe app and, obviously, had it activated, that there will be a 50 percent reduction, onward reduction, in cases. Based on the current number of downloads, if everyone has it activated, there'll be a 25 percent reduction in cases. So, whilst there's a significant debate about masks at the moment and the relative benefit that that would have, suggest to you that if you are a supporter of mask use, you must also be based on the modelling, a supporter of downloading and activating the app.
JOURNALIST:
[Interrupts] So, these disappointing, underwhelming results? So like, the public was really told, you know, this is going to be a key piece in the armour to fight COVID and there's been very few cases or people identified through it that are of interest.
NICK COATSWORTH:
Well, I'll answer that question and then I'll let your colleagues have a go as well. Look, the time that the app was implemented was a time when our contacts were very, we seldom contacted strangers. And once again we're asking Victorians not to mix with other people. The value of the app, of course; is when you are in contact with someone who you don't know, at close contact for 15 minutes and you don't remember when you when you think back over the 14 days prior. So, because both our cases have been low and we essentially haven't been mixing as much, it's not a big surprise that the app hasn't identified those cases. As numbers go up then the app can come into its own. The contact tracers are still doing such a good job in Victoria at the moment, that the app is not identifying any more cases than they're actually identifying - testimony to the fact that they're on top of their contact tracing, and they're doing a great job.
JOURNALIST:
Dr Coatsworth, if New South Wales risks some kind of outbreak, or potentially going in the same direction as Victoria, is now the time for people to start thinking ahead about maybe routing their movements, if possible? Or taking other steps to protect themselves and other people?
NICK COATSWORTH:
Well, I think that there's a balance here and that the people that we look towards are always the chief health officers of the individual jurisdiction. So, we should look towards Dr Chant, Premier Berejiklian and what they're telling New South Welsh residents to do. And there's no movement restrictions, for anyone, beyond those who have been at the Casula pub, between 3 July and 10 July being suggested at the moment. But obviously that's a very important thing for New South Wales residents and ACT residents to keep an eye on in the coming days. And I'll just take one more question.
JOURNALIST:
Sure. Given the rise in the number of hospitalisations we've seen over the past week and now seen through actual deaths in Victoria, what would you - I guess, what's your concern about our death toll rising significantly, in coming weeks? Given the large outbreak we've had in Victoria?
NICK COATSWORTH:
Well, deaths are a reality of COVID-19 - they're a reality of a pandemic. It is possible that the death toll will increase, there's no doubt about that. And the avoidance of what we've seen overseas which are large numbers of deaths, particularly in elderly members of society, is precisely why we take the measures that we're doing at the moment. We had to do it in February and March - we're doing it again. We have however learnt a lot. I mentioned yesterday that we have amongst the best intensive care doctors and nurses in the country. That extends to other healthcare worker's, emergency physicians, emergency nurses. But, right at the pointy end of intensive care what have we learnt? We've learned that Dexamethasone is an effective drug to reduce mortality in COVID-19 by a significant percentage. We've just recently improved Remdesivir which will have an additive effect. We know a lot more about how to treat patients. We know that patients with respiratory complications from COVID19 actually do better if you stick them on their tummy instead of on their back - so called proning. So there's a lot of things that the intensive care community, which Australia leads in a lot of ways, but it's so connected with the rest of the intensive care community that can provide reassurance to Australians, particularly elderly Australians, when they get COVID-19 that they get the care that they'll need.
Thank you very much.
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