PAUL KELLY:
Good afternoon everybody, Paul Kelly, Deputy Chief Medical Officer here for the daily briefing. I’d just like to introduce Alana, who’s with us for the first time today as our AUSLAN interpreter. So, what we know from the statistics. Unfortunately, the numbers do continue to grow globally. I think almost every country and region in the world now has at least one case, except for the Pacific. So, there's a few countries in the Pacific region that have cases, but for the moment, that's not a major issue for our Pacific neighbours, who are an important consideration for us. But every day that's increasing. Now, over 700,000 cases with over 35,000 deaths. This is a major global pandemic. In Australia, we now have 4093 cases. There for sure will be more that are announced today, and unfortunately 16 of our fellow Australians have now died.
There is some good news in those figures, which I'll talk about in a moment. Of those numbers, so from January up until now, we have 55 cases in our ICU. Sorry, that's today's figure. In fact, 55 cases. So we have some increase there in intensive care, but we still have a lot of capacity in our intensive care units for those people that need that extra care.
On the good news, we have noticed a decrease in the number of cases in terms of the increase every day, if that makes sense. So, whilst we were on this very steep rise a week ago, that has stabilised over the last few days, and that is good news. It reflects probably two things. One, that we are having less people coming from overseas. That measure we took over two weeks ago now is starting to bite. And so very few people, Australians, are coming back from overseas now. So, that is decreasing the numbers we are getting from there.
We have of course seen a large number of people that have come from cruise ships, over 300 now, of which almost 200 of those from the Ruby Princess. So they have been large numbers over recent times. But that stabilisation of numbers is what we are looking to do, that flattening of the curve so that we can have enough hospital and intensive care resources to use over the coming weeks, if indeed we need those. But this is not a time to take the foot off the brake. We really need to redouble our efforts to work as a society to make sure we are doing everything we can to slow the spread of the virus. This is about saving lives and making sure that, particularly our vulnerable members of the community, our elderly people, those with other conditions including lung disease, heart disease, diabetes and other chronic diseases, are protected, and we all have a role in that.
So, just a reminder then of the announcements that were made by the Prime Minister and Professor Murphy last night about those extra limitations on our normal life. So, one of those was that people should agree to limit both indoor and outdoor gatherings to two persons. The exceptions to this limit are people of the same household going out together, funerals - where the maximum is ten; weddings, the maximum of five - and family units. So obviously, families of more than two can continue to have indoor or outdoor gatherings.
There's a strong guidance to all Australians to stay home unless they absolutely need to go outside. So that's for shopping for groceries and other necessary supplies, medical and healthcare needs, exercise in compliance with the public gathering requirements. So therefore, it's just for two people or less. And work and study, if this cannot be done remotely. And people are being encouraged for both work and study to do that from their own homes.
There are a range of other measures in relation to this around playgrounds and skate parks and so on. I won't go into those in details. But the final part of that advice, and this really is advice rather than the others which are actually compulsory, is that senior people- people that are elderly or those with chronic diseases should stay at home as much as possible. So on that one, I really want to stress today that this is another opportunity for Australians to show our true colours in relation to working together as a community. This is a time for you that have elderly relatives, and I would include myself in that, to ask: what is it they need? What are the things that are going to impact their lives with these new restrictions, particularly around shopping, particularly around, for example, picking up scripts for their medications? What can you do for your elderly family members?
For those who have elderly people living close to them, this is a time to ask them - not to be pushy - but to ask them what it is that we can do to support them in a safe way. Particularly in relation to food and medicines and other supplies. And so, this is a time for us to work together on these matters. We are all in this together, and whilst we have some very strong indications that those measures we have put in place so far are starting to have the effect that we were hoping for, this is not a time to stop those but rather to continue to build on those issues and to make sure that we are working together to slow the course of this virus.
Happy to take questions.
QUESTION:
Professor Kelly, just on the 70 and over distinction, as this virus moves through are we likely to see restrictions on older Australians outlast, perhaps those on younger Australians? So we might have lock-downs or shutdowns recommended for people in different age cohorts.
PAUL KELLY:
So definitely the people over 70, in general, we know from our own figures here in Australia but particularly from other countries with a larger epidemic, for example in Europe, the US and indeed in China, that as the age of people goes up, the tendency to more severe disease occurs, and this includes hospitalisation, intensive care and unfortunately death. So in some countries, they have really essentially locked down people in that age group. We're not moving to that at the moment, but certainly there are various things that we could consider to protect that very vulnerable population. Over 70 in the general population. Over 60 with people with chronic disease. And for Aboriginal people and Torres Strait Islanders, over 50 with a chronic disease is the recommendation.
QUESTION:
Professor, there's a company that signed a deal to bring rapid testing to Australia by April. Will the clinical guidelines for testing be changed then so more people can get tested?
PAUL KELLY:
So, I've said previously that people should be very wary of the point of care tests. There's a lot that you can find on the internet. There are a number - I believe 16 so far - and more are being looked at by our Therapeutic Goods Administration. These are the experts we have within the Department of Health in Canberra who very carefully look at the claims that have been made in relation to therapeutic goods, including diagnostic kits, and in this case including point of care tests or rapid tests for this virus. The rapid tests mostly at the moment are based on serology, so that is testing the body's response to the virus, not the virus itself. And so in the acute setting where someone is sick with this virus, actually those tests have a very limited capability to test whether people do indeed have the virus or not. After a week or so they can be very good if they're the proper test, and as I say, 16 have gone through and accepted by the TGA for supply in Australia, and several of those tests are undergoing quality assurance testing in our public health laboratories right now.
QUESTION:
Professor Kelly, just on- in terms of what you were saying about elderly Australians and how we can best care from them in this time, some Australians are now thinking: well, do I bring grandma home from her house or does she stay there and do I care for her from a distance? What's the best thing for them to be doing and what have we learnt from overseas about cross-generational households? Should we bringing the older people and more vulnerable people in with the rest of the family, or should we be separating them?
PAUL KELLY:
Yeah, so that's a very difficult question and it is hard to give a blanket answer to it, but certainly elderly people, as I've said, have a higher risk of having more severe disease. So I think families need to examine that themselves, what is the safest for their own elderly parents. If they're able to look after themselves with support in their home, that may be the best option. But for others, particularly the most frail elderly people requiring, for example, a lot of home-care from outside of the home, it may be best for them to shelter with relatives. Of course, the more people in the household, particularly if the other people are out into the world, as it were, and interacting with others, then the higher the chance of bringing that- the virus into the house and the higher chance of giving that to the elderly person. So, it's a trade-off and I think people have to examine their own circumstances and the circumstance of their elderly relative to make that right decision.
QUESTION:
Professor, from today most health- primary healthcare services will be available by Telehealth. Is it the recommendation of the experts that where it is possible to have that medical care provided by Telehealth rather than in person, that should be the first priority, or is still at discretion of GPs if they're happy to see patients, even if they could've dealt with that person over the phone or by video? What's the advice there?
PAUL KELLY:
So, yes, Telehealth has really been very rapidly expanded and rolled out. So far there are many- thought I had the data here but I don't- lots of Telehealth items have been used already, and those have been expanded over the weekend, so I think that really is an individual clinical decision for people that have relatively simple problem. A repeat script, for example. These things should be done by Telehealth. But GPs and other health providers are the best that know their patients and will be able to make that assessment during that first telephone call.
I've heard many that are using it as a triage, really, looking at whatever they can do by Telehealth, to do it via Telehealth. If there is other concerns that require, for example, a closer physical examination, then of course that can be done over a FaceTime or a Skype interview, for example, but on other occasions actual physical contact and physical examination in the rooms may be required. Of course, if there are other investigations that may be needed - blood tests, x-rays and so forth - that can't really be done at a distance, and so it's an individual thing and I believe the clinicians are best to make those decisions themselves.
QUESTION:
Professor, some private hospitals are concerned about their access to PPE equipment. Will private hospitals be given access to the national stockpile to prepare for the virus?
PAUL KELLY:
Well, certainly there have been a range of issues - and this has cropped up a little bit on the weekend in relation to private hospitals and their preparation for caring for COVID patients. PPE has been one of the issues that has been raised, and I would say that there has been several million more masks, for example, that have come into the country over the last 24 hours, and over 10 million masks have been distributed from the national stockpile or are due to be distributed, mostly to primary care and some to the states and territory health departments.
In terms- the other- private hospitals are not specifically on that list, but as PPE becomes available, we can re-examine that. The other thing that has come up is about training. So I would say that healthcare workers in private hospitals train healthcare workers, they do have infectious disease prevention and PPE use training as part of their undergraduate training, and in their postgraduate training. But we've added some specific training around COVID-19 and requirements for personal protection, and I'd say that the aged care workforce in particular has taken up that opportunity to a great extent. 315,000 people have undergone that online training that has been made available. 50,000 of those are aged care workers. 33,600 are disability workers, and the rest are other [indistinct]. So many of those would be hospital workers in private hospitals. So, that is available and I encourage people in those settings to take advantage of that online training.
QUESTION:
Professor, what discussions have you had with South Australia Health about evacuating vulnerable elders from the APY lands to an Adelaide boarding house to self-isolate?
PAUL KELLY:
So, I have had discussions- it was on Saturday, actually, with SA Health, as well as with Pat Turner from the Aboriginal Controlled Medical Organisation- Health Organisation. I'm aware of the issue. I think it's a complex issue about the protection of elders. It is a very important component and very important, particularly within traditional Aboriginal society and Aboriginal and Torres-Strait Islander throughout the country. They are of course worried on a number of fronts. Elders tend to be elderly, often have many other chronic diseases, therefore are in a very high-risk group for COVID-19 severe illness. So anything that can be done to protect the elders of Aboriginal communities and Torres-Strait Islander communities is really important. And different communities have had a different approach to this. From the national level, we've introduced under the Biosecurity Act, specific restrictions for people who are going into and Torres Strait Islander remote communities, and so that's one thing that has been done. Some of the Aboriginal communities, for example, in the Western Desert, have made a decision to remove their elders to an out station so they are separated not only from the wider society but also their own usual residence. I'm aware of the issue you've raised, but it is complex. What is the safest thing for Aboriginal people from the APY lands, which is a very easily quarantined place in a way, to stop people going in. Is it better for them to be sheltering in place or to come into this hostel in Adelaide? And I'm leaving that at the moment with colleagues in my department, but also those in SA Health.
QUESTION:
And could I just clarify the ICU figures just very quickly, sorry. Is it 55 people currently in intensive care, or over the course of this virus have needed intensive care treatment?
PAUL KELLY:
So, it's 55 as of today. We had updated figures within the last hour from the Australian Health Protection Committee.
QUESTION:
So, sorry- that's over the course of-
PAUL KELLY:
No, no. It's now.
QUESTION:
In hospital at the moment?
PAUL KELLY:
Correct.
QUESTION:
Professor, you flagged that the reduction of people coming from overseas is obviously going to have an impact on our curve. We have had measures incrementally coming in for a few weeks now. When might you expect this two-person gathering reduction to maybe have an impact on that data? And assuming that you and your colleagues are still of the opinion that any measure we have will have to be for six months, are you envisioning that this two-person gathering limit, indoors and outdoors, is a six-month minimum at this stage?
PAUL KELLY:
So how long this will last, I don't know exactly. We have been saying months and I believe it will be months before we get past this epidemic. In terms of the severity of the restrictions, these are very disruptive to Australian society. And so, I am still a believer of having the least disruption that can be done. How we would make that exit strategy is certainly something that we are very much working on at the moment, as much as the escalation strategy, as what we have been experiencing in the past few days. Sorry, I missed the first part of your question.
QUESTION:
When might you expect to see the impact of these measures?
PAUL KELLY:
Yes, so the impact can be somewhat delayed. This is what we know about this virus, and we are learning things every day about it, is that the incubation period, that's the time from when someone is infected to when they start to get symptoms of the disease, and therefore be infectious themselves, is about a week. It can be a little bit longer, sometimes a little bit shorter, but it's generally about a week. So, most of these types of restrictions, when they are put in place, take at least one or two of what is called the serial interval, so this time from infection to infectiousness. And so, it's one or two weeks, essentially, is the short answer to that question.
QUESTION:
Can you elaborate on that exit strategy? What is some preliminary work that might be done there?
PAUL KELLY:
Well certainly, we are hoping the first effect will be a continued flattening of the curve, and as I said cautiously, that the last few days have demonstrated that appears to be happening. But let's see what happens over the coming weeks. Obviously, we want to see the curve not only flattening but starting to bend downwards, and then making that decision about when to take the foot off the brake will be very difficult. Do you take some of the measures of, do you take all of the measures off in places where there are no cases over a period? These are very tricky, and we've seen what's happened in China. It's taken them a couple of months, really, to be feeling that they were under control, and then to start to take those controls off. It is a tricky decision.
QUESTION:
Professor, in New South Wales alone, there is now 228 locally acquired cases where the contact hasn't been able to be identified. Is that number concerning to you, or in the scope of how many cases we are seeing, is that what you would expect? Is that a concern going forward?
PAUL KELLY:
Yes, it is probably the most concerning component of the figures that we have had to date. It is not unexpected that we would start to see locally transmitted cases. We hope that most of them can be very clearly identified with a particular other case or group of cases, what we call clusters, and we have seen some quite large ones that are grouped together. For example, the Ruby Princess, that now famous or infamous wedding in Wollongong, some around the Barossa Valley, for example, in South Australia. So, it is not only in New South Wales that this is an issue. As we start to see the travel-related cases decreasing, we expect to see, obviously, more locally acquired cases. But hopefully, they are mostly also linked to another case that we have already identified. So, this is a really important phase right now for our public health units and our public health capacity, to be able to find those cases, to identify those links, and to get both cases and contacts isolated as soon as possible, to decrease the number of people they infect. This is absolutely crucial, whilst we are also caring for those that are sick and requiring hospitalisation, for example.
QUESTION:
Professor, are you able to speak to the public health impacts of the economic situation Australia is facing in terms of the possibility of millions of people being unemployed, and the other detrimental health impacts if schools and day-care centres were too close on our community?
PAUL KELLY:
Yes, we have talked very much about that, as well as the Prime Minister and the Health Minister have also made mention of this, as well as in various states. It is the main reason why I remain a scalable, proportionate responder. And we cannot underestimate not only the public health effects, but the mental health effects of unemployment, of being stuck in your house mostly, of not being connected closely with other people, at least physically. And on connection, I think that is a really important point you make. I think we have to work differently as a society, but part of that is by being isolated physically, cannot, definitely cannot, mean being disconnected. We have to be connected with each other. It's an absolutely vital human need to do that, and we know that disconnection has physical and mental effects which can be long lasting. So please remain connected with your families, with your friends, work out how to do Skype parties, a virtual book club. My sister-in-law has just started a virtual book club with her daughter, who is in New York, and various other people around the world, and just invited us. So that is a nice thing. That is something we can do together even though we can't have a dinner party, and so forth.
QUESTION:
So on that front, given everything you have just said, would you be prepared to release the modelling that shows the full public health picture of what could happen as a result of a different potential lockdown or shut down situations that Australia faces? Would the Chief Medical Officers see that as helpful and provide that for transparency?
PAUL KELLY:
I think transparency is very important. I think the modelling component is one of those things that is changing very rapidly, and the various components of that modelling is changing. But we have started; as of today, I have asked my staff to organise a meeting later this week where the modelling and the epidemiology and the public health response will be unlocked, and people will be able to ask questions about that. I think we have been quite open with components of the modelling, but I respect that there is a large number of ways that modelling can be done, and so we need to be more transparent, and we will be.
QUESTION:
Are any of the antivirals that are being [indistinct] at the moment showing any promise? If so, what are they? Or is that a bit of a pipe dream at this stage for Australia?
PAUL KELLY:
So, there are clinical trials going on, including here in Australia, of a range of antiviral medications and other treatments. And indeed, of course, a lot of work being done internationally and here in Australia in relation to vaccines. I think both of those will become more clear over the coming weeks and months, but at the moment, just to end, we really need to concentrate on those public health measures, as well as being sure and clear that we are ready for an increase in the numbers going into our hospitals and our intensive care units. As well as getting all of these other range of matters sorted out within primary care. These are our main priorities at the moment, and whilst we wait and hope for specific treatments and vaccines, we need to use the tools that we have right now in front of us. We are doing that in the healthcare perspective, we are doing that in the public health perspective. We need the whole of Australia to be taking care, and to be assisting our elderly, as well as really taking seriously those social distancing messages.
Thank you.
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