Date published: 
21 July 2020
Media event date: 
20 July 2020
Media type: 
Transcript
Audience: 
General public

NICK COATSWORTH: 

Good afternoon, everybody. Dr Nick Coatsworth with today's update on COVID-19 in Australia. To date we've diagnosed 12,097 people with coronavirus, and as of 12 noon today, 296 new cases in the past 24 hours. There has regrettably been one additional death, taking the national death toll to 123 from COVID-19. There are 156 people currently hospitalised with coronavirus disease, 33 of whom are in intensive care units. The vigorous contact tracing going on at the moment across Victoria and New South Wales, assisted by contact tracers at the Commonwealth and in many states and territories working remotely to help support our colleagues in Victoria is being backed up by a remarkable testing framework. We have tested over 55,000 Australians in the past 24 hours. The vast bulk of those in Victoria and New South Wales. It is that ability to test rapidly, to turnaround results rapidly and to identify cases of COVID-19 then to identify contacts and make sure that people are isolated. These are the key elements of getting COVID-19 back under control in Australia at the moment.

The breakdown of the cases, 20 new cases in New South Wales, all of whom were linked to known clusters. 275 new cases in Victoria and one additional case in Queensland. We have also seen an increase in a small cluster down in Batemans Bay, which has school holiday travellers obviously from New South Wales and from the ACT. That occurred at the Batemans Bay Soldiers Club. What we've seen today is a remarkable example of the community getting out in force to get themselves tested. That is a model for how we need to respond to COVID-19, with a vigorous public health response, with pop-up testing clinics. That's replicated in south-west Sydney in the past weeks and on a grander scale in greater Melbourne and Mitchell Shire.

We can't obviously do this on our own as government or governments. The community support that we're getting throughout this second peak of COVID-19 in Australia has been phenomenal and continues to be, I think, a source of great pride for all Australians that we can go through this, again, together, to help the most vulnerable in our community avoid being diagnosed with this virus and potentially getting severe consequences from it.

In that light, we should discuss the hospital capacity at the moment, in particular our intensive care capacity, down in Victoria. In Australia, we have, as I've mentioned at these press conferences before, some of the most experienced critical care doctors and nurses in the world. We have world-class health system, from our emergency departments through to our wards, through to our intensive care units. Health Minister, Mikakos last week mentioned there were 1,000 new beds created since the start of the pandemic for intensive care in Victoria. 1,200 ventilators within their system. Now, at the moment, based on normal capacity in Victoria, only 82 per cent of beds are currently being used. That is mirrored more or less also the case nationally. Now, that's an important number, that 82 per cent. Because in the middle of what we would usually term as our flu season, where our intensive care units would often be close to 100 per cent capacity, we still have existing capacity, within our system, without surging. Down in Victoria at the moment, less than one in 10 patients hospitalised in intensive care units actually have COVID-19. The remaining excess of 9 out of 10 are intensive care for other reasons that you would usually be intensive care, post-operatively, trauma, other infections and so on and so forth, suggesting that we do have significant capacity within our system still before we hit that point where we would actually need to surge. This is great news for those who require intensive care for severe COVID disease.

It is also at least in part one of the reasons why our results, out of intensive care, are so good compared to the rest of the world. Because people can access care for COVID-19 as and when they need it to the point of getting ventilated and cared for by our exceptionally experienced and world-class doctors and nurses. We've learned so much over the past four or five months since this pandemic started. We continue to learn more. But all of those learnings are going into getting the best outcome for patients who are severely affected by COVID-19.

I'll take some questions.

QUESTION:

In Victoria we are seeing a group of cases linked with a lawyers' practice. Are you concerned at all about complacency for white-collar work places feeling like they are not as at risk as compared to say meat works or other facilities where we have seen large outbreaks?

NICK COATSWORTH:

I think every work place needs to be cognisant of their COVID risk, that every work place needs a COVID-safe plan. The fact that there are some affected more than others, there will be specific reasons for that. As I understand it, that particular cluster that you're talking about is around about six people resulting from that work place cluster. But the important message is that there's a responsibility for employers to provide their employees with a COVID-safe work environment. That responsibility extends to all of us, as employees, to consider again, particularly in those lockdown areas, whether we can work from home. So all those principles are critically important and provision of COVID-safe environment is a responsibility that will continue for the coming months.

QUESTION:

Dr Coatsworth, there are now hundreds of people in New South Wales, currently in isolation connected to either the Batemans Bay clusters, the Crossroads Hotel, how critical is it that these people comply to the letter with that 14-day quarantine? Are they New South Wales' last line of defence to not get to where Victoria is?

NICK COATSWORTH:

It doesn't matter whether you're in New South Wales, whether you're in Victoria, whether you're in hotel or home quarantine elsewhere in the country: It is absolutely critical that if a public health official has asked you to do so that you strictly do so. Strictly means that you can't go out. You need your friends or family to help you out for those two weeks, to ensure, and enable you not to go out into the community. And indeed, there are penalties for those that would breach those public health regulations. No-one wants to enforce those.

As I said at the start of the press conference, the remarkable cooperation and patience we've had from the Australian community is a hallmark of the response and our success in combatting COVID-19 so far. But the message is if you are considered a contact of someone with COVID-19, you have been instructed to isolate by a public health official, do so. If you hear on the media that you have been somewhere where there has been COVID-19, but you haven't been asked to isolate- sorry, if you hear from the media that you should isolate, then do so as well. You might not be under a public health order but the recommendation has come out and we should try and follow that it to the letter. Because we know that's it's avoiding the mixing, it's avoiding the contact, that will stop the virus.

QUESTION:

On the issue of masks, it is an evolving policy area but given there is still no evidence that it breeds complacency and now ample supply for medical purposes in Australia, would the AHPPC consider shifting it's footing to broadly recommend to where social distance can't be maintained it is proper and preferable to wear a mask?

NICK COATSWORTH:

Well, I think Claire, you have reiterated the AHPPC policy. What has changed is the degree of community transmission. The AHPPC has always acknowledged that masks represent an important part of a suite of measures against respiratory viruses, COVID-19 being no exception. The issue is the point at which you recommend that for the general community. And as we've said, for many, many weeks now, it's to do with the degree of community transmission. So, there is clearly community transmission in Victoria at the moment. That has reached the point where masks need to be mandated. Mandating something like masks is not a straightforward thing to do, which is why as community transmission has increased, we've moved from saying no, there is insufficient community transmission for mask use, to we encourage mask use, and now we support the Victorian Government's move to mandate mask use in greater Melbourne and Mitchell Shire. So, these are what we have always described as proportionate things to do as part of a suite of measures to combat COVID-19.

QUESTION:

With the clusters we've now seen in further meat works across Victoria, when we saw outbreaks in the aged care facilities, we've seen policy change to try and prevent workers moving across facilities and things like that. Is there anything you could do specifically with meat works to ensure that they can still operate while also not having workers move between facilities? And [indistinct]… explain why.

NICK COATSWORTH:

Well, I think there- the principle, of course, is that there are a variety of work places that have shown themselves to be more- have more transmission potential. It seems that abattoirs and meat works fit that bill. So it's critically important that the employees and the employers in partnership with government have the most COVID-safe plans possible, enable workers not to be there if they are unwell, and to get tested, and that's the way that we're actually going to control the outbreaks in those sort of facilities. Whether there's specific policy that we can implement in meat works is not something we're looking at specifically at the moment, but we're aware that they're an at-risk environment.

QUESTION:

Something that's different in the isolation orders in New South Wales has been New South Wales Health telling people that even if they get a negative COVID test in that 14 days to remain isolated - that's in relation to several clusters. Is that something that you envision will now be applied to any cluster that, regardless of any negative tests that come up in the early days, that you fulfil that 14-day quarantine?

NICK COATSWORTH:

So, if you are a contact of someone with COVID-19 and a public health unit has specifically told you to isolate for 14 days, a negative test does not get you out of that isolation. It never has, and it never will. And the reason for that is that whilst the negative test is certainly encouraging, no test is perfect, and the most important thing you can do to protect others is stay isolated for 14 days. So-

QUESTION:

[Interrupts] But is this still being applied, sorry, to casual contact? So, people that were in the same room at a certain time, not even necessarily a close contact.

NICK COATSWORTH:

The public health units will tell people who need to isolate to isolate for 14 days, and they won't be able to get out of isolation with a negative test. And I've got two journalists on the phone, and then I'll come back. Dana? Dana?

QUESTION:

Hi, Dr Coatsworth. Just on masks, given New South Wales is seeing levels of community transmission that are sort of similar to where Victoria was just a little while ago, should New South Wales mandate the use of masks in all hospitals, given they are a work place where transmission has been seen to occur? And should they consider making masks mandatory for the general public as well to sort of get ahead of the spread? And just on the national medical stockpile, I'm told that the Federal Government has bought up all of the locally-manufactured Victorian masks, and are you able to say whether they're planning to redirect any of them back to Victoria, now that [indistinct]…

NICK COATSWORTH:

So, there's a number of questions there. I'll take the issue of masks in New South Wales first. I think what you've seen from the New South Wales Transport Minister today is a very clear indication on where we put masks in the hierarchy of protection. So, the advice is not to catch public transport and wear a mask. The advice is to completely reconsider how you get to work, if that's possible, and avoid public transport. That's number one. So, it puts distance as the prime method by which we avoid COVID-19. However, if you find yourself having to use public transport - and we acknowledge that there are many, many Australians who travel to work using public transport - then we would encourage mask use.

Then, the second part of your question is, would mandating mask use actually stop or blunt the epidemic curve? I think that it would be a contentious point for anyone, even the most strident mask advocate, to suggest that the current levels of transmission in Victoria could have been avoided with an earlier mask-use policy. And the reason for that is clear in the epidemiology of the infections in Victoria. They originated from household outbreaks. They spread within households, and then out into the community. You don't wear a mask in your household. So whilst we will continue to say the masks do have an effect in reducing transmission, I think the assumption that they significantly blunt an epidemic curve is not one that is supported by the evidence at the moment.

Your second question- your third question, I think, related to whether there should be mandatory mask use in New South Wales hospitals, as there is in the Victoria lockdown areas at the moment. And the answer to that, my understanding is that New South Wales Health in those hotspot areas is encouraging - or indeed ensuring - that healthcare workers are using masks, surgical masks, for every patient interaction. And that is appropriate in the healthcare setting, where the risk of transmission, not only from the patient to the healthcare worker but from the healthcare worker to the patient, is a significant risk.

Now, I missed out on the fourth question there, Dana. Did you want to just repeat that one?

QUESTION:

Yeah, thank you. That was just on the national medical stockpile having purchased masks from Victorian manufacturers and whether those would now be redirected back to that state.

NICK COATSWORTH:

So, the national medical stockpile has purchased surgical masks from a variety of sources. The national stockpile, throughout its personal protective equipment, is very well stocked because of the procurements that have gone on. However, those masks will remain within the stockpile now to be distributed for medical use. And you've seen over the past few days that 6 million masks will be distributed down into Victoria. In particular, we want those masks to be used in residential aged care settings for every interaction with residential aged care clients, of course. That is, again, not simply to protect the healthcare worker or residential aged worker from acquiring COVID-19 from a patient. But also vice-versa, and that's a really important thing to acknowledge. And I'll just take the other call now.

QUESTION:

Yeah. Dr Coatsworth, are you concerned about the level of people avoiding going to the doctor for other issues during this pandemic? And a follow up on that, for cancer, for example, six months can be the difference between life and death, so will we see a higher rate of terminal cancer at the end of the year?

NICK COATSWORTH:

So, it is absolutely critical that during this COVID-19 pandemic that people continue to access medical care for conditions that aren't related to COVID-19. I've just mentioned that over 9 out of 10 patients in Victorian intensive care units are there for conditions other than COVID-19. Cancer is a particularly important and- important condition for which is unforgiving if you leave it for many weeks or months.

So, in those sort of situations, if you have a lung nodule, for example - as you know, I'm a respiratory physician - if you have a lung nodule and it needs to be investigated, and cancer is a possibility, then you need to know that your health system is safe and well-equipped to treat you and that you will be safe going into that healthcare system. You'll need your CT scan. You'll need to talk to a respiratory physician. You'll need your therapy guided by your general practitioner. This sort of thing can't be left for months. It certainly can't be left until COVID-19 disappears or a vaccine turns up. So yes, I am concerned for those patients, but I would want to reassure them as a practicing clinician myself that it is safe for them to attend for CT scans, it is safe for them to get investigated. Particularly if you have concerns about face-to-face appointments, don't forget that telehealth was one of the major reforms that we have introduced at a federal level to enable this sort of thing to occur. So, thanks for that question, because I think it is absolutely critically important that we get that message out there.

QUESTION:

But do you think though that there will be a surge in the number of people diagnosed with terminal cancer by the end of the year or the start of next year, for example?

NICK COATSWORTH:

Well, I'm afraid I don't have enough detail on the data related to cancer presentations to be able to predict that sort of thing. I would certainly hope not. And I would hope that as much as we can get that message out into the community, that they need to seek care through telehealth, through specialist appointments and CT scans that we don't see that increase.

QUESTION:

Dr Coatsworth, from tomorrow, the border measures between Victoria and New South Wales will be strengthened. Is it still the case that the biggest risk for New South Wales is that virus coming from Victoria more so than the community transmission that is being seen at the moment? And if that's the case, how long- or, if you don't know yet, how long will it be until we have a better idea of the epidemiology of the virus in New South Wales?

NICK COATSWORTH:

I think both incursions of the virus into the- any state from Victoria are of concern to all of the jurisdictions and we've seen proportionate border responses in accordance with that risk. But it would be the case that there is equal concern about community transmission in NSW. So, as you can see, there's two things going on. The borders are being tightened, there's more restrictions, but the extreme focus and rapid response of the New South Wales public health unit is to shut down those chains of community transmission and actually stop community transmission in New South Wales.

QUESTION:

Now we've seen more cases become serious in Australia, just wondering if you can talk us through a little bit about how the virus is presenting in most cases? How long it takes from someone getting the virus, first showing symptoms, to if they are [indistinct] hospitalised, being hospitalised, and how does that present [inaudible]…

NICK COATSWORTH:

This virus has a few unusual features that continue to be borne out by our experience clinically in Australia, experience that sadly is growing day by day, but on the other hand, means that our intensive care doctors and nurses are getting more and more experienced in treating patients with severe COVID-19.

The feature- and clearly one that is of concern is that after diagnosis, there can be a short period of improvement or a stability of the disease before people can get rapidly unwell. I think that's something that has characterised COVID-19 presentations around the world, the potential rapidity of decline in someone's health, and the narrow period between when that decline occurs and when they might need a ventilator.

So, the important message out of that for Australians of course is get yourself tested. If you are positive for COVID-19 and you feel like you're getting worse, then urgent medical attention is required, either firstly through a call to your general practitioner, but obviously in an emergency situation, an ambulance and getting taken to hospital. So, vigilance for that, for those patients who are out there and COVID-19 positive is critically important. And I'll just take two more questions.

QUESTION:

Just further on that, [inaudible]… someone in New South Wales in their 30s [indistinct] ICU. What kind of severities are you seeing in young populations?

NICK COATSWORTH:

So, we know that COVID-19 can affect all ages, and it can affect all ages with severe disease. The issue is the proportion of people who get disease at varying age groups and it's a reality that the older someone gets, the more likely they are to get rare disease. And certainly over the age of 70, people into their 80s and 90s, we've seen the devastating consequences that will occur for many of the patients that contract COVID-19 in those sort of age groups. It's not to exempt anyone from the possibility of severe COVID-19 disease. And the fact that we've got two people in their 30s, I'm not sure of the individual cases, I'm not sure if they've got other medical conditions, but assuming that they could well be healthy, it's a real wake-up call for people who are in their 20s and 30s that this virus will not discriminate, and potentially you could become very unwell, critically unwell, life-threateningly unwell.

QUESTION:

Dr Coatsworth, what's your biggest concern about the outbreak we're seeing at the moment in terms of the national impact? And is there anything specific that the AHPPC is preparing advice on for National Cabinet this week?

NICK COATSWORTH:

Well, I think the biggest concern for all of us is that our two most popular states might have sustained evidence of community transmission and increasing cases. That's clearly been expressed by everyone from the AHPPC through to the Prime Minister, which just emphasises that critical importance of every case, every day. Tracking down every case, every day, tracking down the contacts and making sure people are isolated and separated. Whilst that is a concern, I think one of the bright lights of today was that the 20 cases in New South Wales were actually linked to known clusters. So when we have known links to clusters, that is much more comforting than unlinked community transmission, and that's certainly what we will be looking for in New South Wales in the coming week or so. Thank you very much.

QUESTION:

[Inaudible question]

NICK COATSWORTH:

The advice for National Cabinet? The matters that are discussed at National Cabinet, as you know, we don't discuss in detail, but they're- as you know, there's been a lot of discussion on suppression versus elimination. We continue to have a strategy of aggressive suppression in this country, aggressive suppression to the point of no cases of community transmission. This is the aim that the AHPPC has set and will set and will reinforce in the coming days.

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