NICK COATSWORTH:
So, the numbers for coronavirus disease in Australia today: thus far, we have diagnosed two- 21,084 individuals in Australia with COVID-19. In the 24 hours to 12 noon today, 404 newly confirmed cases. In New South Wales, there were 10 new cases reported. One was overseas acquired in hotel quarantine. Seven were contacts of a confirmed case. Two were locally acquired, and the contact has not been identified and is still under investigation. In Victoria, 394 new cases were reported in the past 24 hours. Forty-nine were contacts of a confirmed case; 345 remain under investigation. There were 17 more deaths overnight from COVID-19, bringing the total number of deaths nationally to 295. Six hundred and fifty-eight people are hospitalised at the moment, and 51 of those are in intensive care units.
On Friday, the National Cabinet considered Australia's- the Australian Government's vaccine and treatment strategic approach for COVID-19. This was a critical document and is a critical document developed by the Commonwealth Department of Health, in partnership with other agencies. It demonstrates the need during this COVID-19 epidemic to not only focus on the now, and there are clearly things we need to achieve now both in Victoria and in other states around Australia to bring the epidemic under good control, but importantly we also need to plan for the medium and the long term. And clearly one of those important planning elements is how we acquire, procure, manufacture, roll out a vaccine. The strategic approach that was presented to National Cabinet is focused on these main domains: research and development, purchase and manufacturing, international partnerships. The crucially important element for immunisation of regulation and safety, particularly when we're talking about a novel vaccine for a novel pandemic strain virus, and administration of immunisation and monitor thereafter. The Commonwealth is well-placed and well-advanced in a number of areas, including advanced purchasing agreements, including manufacturing agreements, and, more broadly, international and multilateral agreements, which are critically important because they are going to support and facilitate access, not only for Australia, but also for our partners in the region. Australia is committed to ensuring that there is equitable access to a COVID-19 vaccine around the world, and that point was made very strongly by Prime Minister Morrison and Chief Medical Officer Paul Kelly at their press conference on Friday. And it's important that we reiterate that it is not going to be acceptable for any single country to have the vaccine, and Australia is joining with a number of different other countries around the world through the Gavi initiative to ensure that any vaccine that is developed is available.
In the Australian context, we have a number of vaccine candidates that are actually under human trials in Australia at the moment. One of them is from the University of Queensland, one of them's been developed by Flinders University and the Adelaide company Vaccine, and two of them have been developed by international companies Novavax and Clover. It's very exciting, the pace with which a vaccine is being developed for COVID-19. Clearly, at the moment we have only blunt tools to rely on to control the virus, tools like extreme social distancing and the Stage 4 restrictions that are in place down in Victoria at the moment. It reminds us that around Australia we need to, even in places that have no COVID-19, in the absence of a vaccine, as we prepare, as we trial vaccines, as we prepare for the possibility of a vaccine, we must at the same time keep our distance. We must at the same time get ourselves swabbed and tested if we're at all unwell and stay away from our colleagues, co-workers, or schoolmates if we're unwell. We must continue our excellent hygiene practices that we've developed as a nation, and we must continue to encourage our friends and family. I saw reports today that there are clearly members of the community that do not engage in traditional media or even social media. There are doubtless many millions of Australians that don't necessarily watch Dr Nick Coatsworth press conferences on a Sunday afternoon. But with one or two degrees of separation and the community engagement. So for example, if you are a mother or a father whose teenager or 20-year-old doesn't appear to be getting the message, then now is of course the time to encourage them. We have to, as a community, all be moving in the same direction here, and there is nowhere that's more important in that regard than down in Victoria at the moment. And, again, as we will do every single day when Victoria, Greater Melbourne and Mitchell Shire are under Stage 4 restrictions and the remainder of Victoria is under Stage 3 restrictions, we acknowledge the challenges, the disruption to their lives that Victorians are undergoing at the moment, essentially for the benefit of Victoria and the broader Australian community. What Victorians are doing at the moment is for all of us, and- so if you know anyone in Victoria, as I do, just pick up the phone. Check in. Check in how they're going. Give them your support. Sometimes that phone call is what brightens an otherwise dull day, and just check in on how your friends and family and colleagues are going on down in Victoria. And with that, I'll take some questions. Claire.
QUESTIONS:
Dr Coatsworth, you talk about the blunt instruments we have to control the virus, but there's also been improvements in the treatments, and the death rate now is a lot lower than the initial estimates even a few months ago. Where is it at in terms of what Australia believes to be an accurate death rate? And what are the factors in treatment specifically that you think are helping to lower that?
NICK COATSWORTH:
Well, Claire, I haven't seen the latest mortality rates for COVID-19 over the past two or three weeks, but it is the case that Australian results appear to be better than around the world, and there's a number of reasons for that. The first one is, of course, that our intensive care units, our doctors and nurses in our ICUs, have always been world-leading, and that doesn't just apply to intensive care, but it also applies across the range of our healthcare system, whether it's in primary care, whether we're talking about nurse practitioners, whether we're talking about those brave doctors and nurses at the front of shop down in EDs, emergency departments, in Victoria at the moment, who really don't know what's coming through the door at any given time. So, the quality of our healthcare system's important. But moreover, we're learning more and more. We're applying new treatments. We're applying dexamethasone, which is the steroid that's been demonstrated in a recovery trial to actually decrease mortality. We have at our disposal remdesivir, which shortens length of stay for a certain group of patients, and there's more evidence on the way for that. We have our specialists, who are backed up by a national network of communication through the Australia and New Zealand Intensive Care Society, who are actually discussing on a daily basis the clinical treatment of patients who are gravely ill with COVID-19. How you ventilate them in particular has been a challenge, and this concept of proning, when you actually ventilate someone on their tummy, rather than on their back, has proven to be a critically important thing. But the timing that you do that, the timing that you intubate someone. And I guess the complexity of the answer demonstrates that there are so many things that are going into this. There's certainly no one thing, but I think the one thing that we should remember is that the capacity of Australia's health system, including Victoria's health system at the moment, to manage even the number of COVID-19 cases in Victoria at the moment is sufficient that people have access to the care when they need it. And I think if I wanted to pick any difference Australia and some of those countries that suffered so badly under the first wave, that would be it. Richard.
QUESTION:
Dr Coatsworth, how many- is there any update on how many cases have been using- investigations have been using the COVIDSafe app? The Prime Minister said that it's been quite successful in New South Wales recently with their community transmission?
NICK COATSWORTH:
Yes. So, COVIDSafe has had a number of recent and notable successes. I guess the most significant one was the identification, not just of some contacts, but of an entire transmission event, so to speak, that wasn't identified through the contact tracing interview, and that involved some 544 contacts in the west of Sydney being identified through the app. And of those, two of those tested positive in the short space of time afterwards. I don't have any updates whether there's been any more after that. Subsequently, that there have been more modest numbers of contacts detected with COVIDSafe that were not detected with the interviews that are going on. In Victoria at the moment, so, we know that the COVIDSafe app is functioning because when it's unlocked it's detecting contacts. But once again in Victoria, it appears that because COVIDSafe's been reintroduced at a time of lockdown and people are more aware of the number of peop- who they've been in contact with, in Victoria it is once again not revealing any new contacts as far as I know that otherwise wouldn't have been identified. So, why is that the case that we've suddenly gone from an app that appeared not to be working to one that is? Well, the first thing to say is the app was always letting off its digital signals and pinging. There have been updates and improvements to the algorithms that the Digital Transformation Agency would be able to describe more fully. But that has undoubtedly had an effect. And then finally, we see what happens when you have an essentially open economy as you do in New South Wales, and that's where COVIDSafe comes into its own because that's where you're in touch with people who are strangers, potentially for prolonged periods of time, and it's very difficult to identify who you were in touch in the past 14 days. So my encouragement to all Australians at the end of the response to that question is we've had close to - potentially even over - 7 million downloads, or close to it. It's not just the downloads. We want that application activated on your phones. So if you've got an iPhone, if you've got an Android, if you've downloaded the app, get on right now and activate it. And once again, if you've got children, if you've got teenagers, young adults, encourage them to download it and activate it as well. Claire.
QUESTION:
With regards to New South Wales being more open, an issue that's emerging is venues are saying that their responsibility for people social distancing only really starts once people are inside the venue, and they're not able to police- we've seen people crowding and not social-distancing while lining up outside the venues. What is your advice? Has the AHPPC given any recommendation about whose responsibility that becomes? And I guess to what extent is it actually personal responsibility of those individuals who aren't social distancing?
NICK COATSWORTH:
Well, Claire, we won't get down as the AHPPC into the detail of what individual jurisdictions do with their venue, but I think a general response is that it's always a combined responsibility. So, whilst a venue may say - and they may be correct in saying - that they can't control what people do outside their venue, they nonetheless would make a very good demonstration of being COVID-safe and therefore more attractive to their customers, I would have thought, if they actually did ensure social distancing. So, I don't run a pub or a club, but if I did, I'd be making very sure that on the way in people were socially distancing and outside on the pavement. On an individual level, of course, I mean, if you're standing closer than one arm's length to someone as you're trying to get into a venue, you're too close. And the final thing is if you go somewhere - and this was one of the best quotes I heard out of the Crossroads Hotel outbreak, which was a patron that went in and said: We looked at it. We thought it wasn't safe, and we went in anyway, and we wish we hadn't. So if you go into a venue in New South Wales at the moment, and you think it's not COVID-safe, find a venue that is COVID-safe.
QUESTION:
Dr Coatsworth, the average, the 70 average of the cases in Victoria seems to have dipped below 500. Is this a positive sign that the effects of lockdown are finally beginning to be seen? Or are we still going to have to wait until at least two weeks before we know if Stage 4 is working?
NICK COATSWORTH:
I think the challenging thing about COVID, of course, is that you never really know where you are on the curve. Where can we be relatively confident of where Victoria is? We know that the basic reproductive number is one, or just below one, and we heard that from Professor Sutton over the past couple of days, and that certainly accords with the federal modelling of the Victorian epidemic. So, it appears that we're on the plateau. What we're looking for is the inflection point that tells Victorians that their efforts are being rewarded, that we see numbers going down. And we haven't seen that yet., but I have no doubt that we will see it. I mean, if you consider that Stage 3 restrictions had a sort of almost at a plateau, then the Stage 4 restrictions will produce a result. The extent of that result really depends on how low that reproductive number can be bought, and the ideal situation would be if we could see the reproductive number at 0.5. We don't have enough data at the moment from the numbers to see whether that's approaching 0.5, but hopefully in the coming days to week we will see that.
NICK COATSWORTH:
To your knowledge, [indistinct] the vaccines you mentioned that there's positive signs of human trials in Australia. As these companies start approaching Australians to be involved in these trials, if someone is approached, what should they be considering before they potentially say yes or what are some of the, I guess, recommendations around human trials at this early stage?
NICK COATSWORTH:
Well, I mean, I think that's an excellent question because there are people being approached to be in human trials in Australia, and there are already people who've had the vaccine. And I think as a general rule, whether you're involved in a COVID-19 vaccine trial or whether you're involved in the trial of a new medicine - often Australians get approached when they're in hospital to be on novel medicines when they have severe illnesses such as cancer or other- or blood disorders like leukaemia. But for whatever reason, any of those, the most important thing is to deliver informed consent, and informed consent means that you get as much information as you can about that medication or that vaccine. Accepting, of course, that the reason you're on a trial is because we don't know everything about it. So, I would say that the companies that I've mentioned that are trialling the vaccines and the academic institutions, these are clearly reputable institutions. We have allowed them to perform the trials in Australia, which is governed by a very rigorous research architecture. And so with that in mind, that should provide people with reassurance about being on human trials for COVID vaccines. And I might just go to the phones. I'll just pick one up. Sorry to move off camera there. Yes. Hello. Josh. I'll go with Josh first, sorry.
QUESTION:
Hi, thank you very much, doctor. On mental health, Victoria officials revealed today that presentations in emergency departments for self-harm and acute mental health issues had spiked this year compared to this time last year, most notably for people under the age of 18. Are you aware of any national data on that at this point? Obviously it's an in-progress issue, but- or are there any other statistics that you could sort of share around that sort of issue? And I guess on a related note, why do you think specifically there has been such a spike in younger people specifically presenting with these issues in Victoria?
NICK COATSWORTH:
Well, Josh, I'm not aware of more broad national data that's demonstrated a spike, but that's certainly something that I'll take on board. I think that the answer to the question lies in we were aware that the second round of restrictions, wherever they occurred in Australian were going to result in a more severe impact than the first, whether that was a social impact, an economic impact, or indeed a mental health impact. I think- for those of us who aren't in Victoria at the moment, it's actually really difficult to imagine how challenging this is. Having been sensitised to it in the first wave, to then be in a situation that you have to go through it again and then some in those areas that have Stage 4 restrictions is going to produce a whole range of undesirable effects, and one of those is clearly in the mental health space. So I think the question needs to be what can we do about it? And once again, this is a multi-layered approach. What can government do about it? I understand Premier Andrews announced $60 million worth of additional funding today for Victorians' mental health. The federal programs have been up and running for many, many months now, and Prime Minister Morrison announced an extra $12 million. It's not simply about making these announcements of course. The Government can provide the services, but it also requires people to access them. So, how do you access mental health services? It can be through the internet, the Black Dog Institute of course, Beyond Blue. Some of these really famous names now in mental health because there has been a deep focus on mental health in the Australian community over the past decade. And then the critical and crucial role of your general practitioner, speaking from personal experience, the experience of others. The general practitioner is a fantastic resource if you have any sort of concerns about your own mental health and they're your port of call. And of course there are some people who won't be accessing those, and the people we are most concerned about are the people who either haven't recognised the mental health consequences for themselves or people that don't know how to access services or are afraid of accessing services. And for those again - I'll go back to what I said at the start of the press conference - that's where community has to be part of this. That's where friends and family have to observe changes in people and reach out and be aware that those services are there and remember the urgent numbers of Lifeline and Kids Helpline which are widely available to be able to seek the sort of urgent attention if you do find yourself in a mental health crisis and also of course not the first line but the last line as you've said, Josh, emergency departments as well. But there are a whole range of ways to help manage that, and it is a considerable focus of the federal and state governments at the moment. And I'll just go to the- Jane Norman. Yes.
QUESTION:
Hi, Dr Coatsworth. Thanks for taking these questions. Just picking up on the youth mental health angle again, obviously younger people haven't been as badly affected by COVID-19 as elderly Australians, but I'm just wondering what you deem to be the kind of longer lasting harm, [indistinct]… focus on particularly Year 12 students, those studying first-year uni, yeah, what kind of psychological effects do you think could be the legacy of this COVID-19?
NICK COATSWORTH:
Well, I think the first thing to say is that your question, Jane, is a really good opportunity to move away from simply the hospitalisations and death rates as the consequences of COVID-19. Clearly you don't have to get COVID-19 to be affected by COVID-19. You might lose your job because of COVID-19. You might develop a new mental health issue because of COVID-19. You might be socially or economically affected by COVID-19. There are a whole range of issues. This is not simply what happens at the pointy end of course. I think it's very hard to speculate on what might happen to a whole, say, generation of Year 12s, and that's certainly a focus for education ministries around Australia, including Victoria at the moment, what to do with VCE students. But there are a number of ways that people are supporting students, and whilst that's slightly beyond the health realm, I'm aware that there's a high degree of awareness of the need to support students either at university or at secondary school level. So, once again, we recognise that there's a whole range of COVID-related, not necessarily the disease itself, but negative outcomes, and it's critically important that we're on top of them just as much as we are on top of the disease itself. Richard. Sorry, I think Tamzin's(*) on the line as well.
QUESTION:
Thanks, Dr Coatsworth, I just have two questions if I could. Last week, the National Cabinet met and was- Professor Kelly said that they were talking about P2 and N95 masks and preventing further infections in healthcare workers. I was just wondering if you had an update on that. And then also, I understand that a lot of work is being done, and there's going to be a report to the Victorian response to COVID-19 specifically looking at aged care. I was just wondering at this stage if there were any learnings from Victoria that were already being implemented in other states to prevent further devastation like we've seen in Victoria.
NICK COATSWORTH:
Okay, thanks, Tamzin. So, firstly, on the P2/N95 respirator use and the guidance therein. So, this relates to whether we think that the predominant mode of transmission for COVID-19, a respiratory virus, is via what we call contact or droplet, where very large particles come out of the mouth and are deposited on surfaces, and then you acquire it through contact with mucous membranes, or whether there might be an airborne transmission component. Now, traditionally, airborne diseases like measles, varicella, which is chickenpox, or tuberculosis, these diseases are transmitted- their infected particles stay suspended in the air for many hours after someone- they come out of someone's respiratory tract. So, to simplify that a little bit, it is clear that for respiratory virus, a new paradigm is emerging that there is a continuum between contact and droplet and what we would say is traditional airborne transmission. So, in recognition of that, but more importantly in recognition of some specific cases that happened in Melbourne at one of the major tertiary hospitals, and those cases actually involved very experienced infectious disease clinicians and registrars, who were using standard PPE, including a surgical mask, and still acquired COVID-19, in recognition of that, the circumstances under which P2/N95 respirators, which protect you from airborne particles, has been expanded by both the Victorian Department of Health and Human Services and also by the Infection Control Expert Group. Specifically in instances where COVID-19 patients are hospitalised or in residential aged care, where the environment is uncontrolled, so, COVID-19 wards where people can deteriorate, or they might be on what we call high-flow oxygen, that can aerosolise COVID-19 people, should be wearing in N95/P2 masks. So that guidance from ICEG is actually on- the Infection Control Expert Group is on their website, and the guidance from the Victorian DHHS is on their website as well. Just finally to reiterate that that updated guidance was in direct response to talking to frontline clinicians- frontline infectious disease physicians in Melbourne about the transmission dynamics of COVID-19. Now, on the second question, which was residential aged care and the learnings that were presented to National Cabinet. So, I'll give one or two examples of instances where those learnings are already being implemented around Australia. One of them is the communication that's required between the residential aged care sector, which as you know is Commonwealth-funded and regulated and largely run by private providers. So communication with that sector and the hospitals and health systems, which are state run. So, the critical planning between those two sectors in states around Australia is going on as we speak. That was something that was discussed at the AHPPC last week, and all chief health officers are very well aware of the need for that ongoing planning. So there were a number of other examples in that document, but on a number of levels, chief health officers are taking a forward-leaning stance, a very forward-leaning stance. From the Commonwealth's perspective, of course, we've had over 100,000 people trained in infection prevention control. We're reviewing the current infection prevention control guidance. The Commonwealth regulator Janet Anderson has- is reviewing infection prevention control guidance and precisely what she will be doing to make sure that providers are ensuring that their staff are up to date on that critical aspect, that critical aspect of control within aged care facilities, which is making sure it's not spread through the use- through the appropriate use of personal protective equipment. I'll take two more questions from Richard and Claire
QUESTION:
Doctor, are you particularly concerned about the number of healthcare workers getting infected at work in Victoria and the effect that that might have on this second wave?
NICK COATSWORTH
So, on one level I'm very concerned about the number of healthcare worker infections, yes. When we hear that, I think it was 140 out of 459 yesterday were either residential aged care workers or healthcare workers, that is very concerning. That clearly has flow-on effects to the workforce, and it is certainly putting strain on individual health services. We're aware of that in Victoria. What is clear, though, is that despite that strain, the system is coping in Victoria with the current number of cases, as I said about 650 hospitalisations and 51 people in intensive care, and that's remained relatively static since the second wave started in Victoria. So, the key, of course, is to take healthcare workers' infections on three levels. The first one is if there isn't the degree of community transmission, there won't be health care worker infections, and that's how the community is helping reduce that number. Number two is what the individual health care workers and employers can do to prevent healthcare worker to healthcare worker transmission, which is likely to be a significant part of this. And thirdly, of course, personal protective equipment, which we just discussed with N95/P2 masks. Information is key. It's very difficult for our colleagues to hear when all we can say to them is 140 healthcare workers and residential aged care workers got an infection. We have to work towards being able to provide more information about how that is being acquired. That is certainly a priority for me. I know it's a priority for my colleagues down in Victoria as well. It's challenging when you have so many, but the more- the deeper the information, the more we can share with frontline health care workers, the more trust we build, and the easier it is for them.
QUESTION:
[Inaudible question]
NICK COATSWORTH:
Well, look, clearly, with sort of 10 to 15, occasionally 20 infections a day, that is not a second wave in New South Wales. What we would all like to see, and what I'm sure Chief Health Officer Kerry Chant would like to see, is those numbers dwindling away. They're not at the moment. That suggests that whilst the chains of transmission are being brought under control, there are still one or two instances where there's onward transmission of COVID-19 within the community in New South Wales. The fact that in a city of 7 million or so we've been able to- or New South Wales have kept this under control for this length of time is just an exceptional public health response. There's no doubt about that. But like Dr Chant, all of us at the AHPPC would like to see those numbers going down. Thank you very much.
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