Australia’s deputy chief medical officer Paul Kelly has announced on Q+A that new protocols determining who can be tested for COVID-19 will be revealed in the coming days.
- Testing criteria will move away from only those who have recently travelled, to others with symptoms
- Authorities urged to consider smartphone apps and open data to track the spread of coronavirus
- The deputy chief medical officer denies major ICUs will soon be at capacity at the current rate of spread
Monday night’s episode of Q+A was dedicated to discussing the coronavirus crisis and featured the ABC’s Dr Norman Swan, Professor Kelly and leading infectious diseases expert professor Sharon Lewin. As in recent weeks, the episode was filmed without a studio audience.
The Government’s response to the coronavirus outbreak was being put under the microscope when senator Rex Patrick, the fourth Australian politician to have a confirmed case, appeared via video link.
The South Australian senator, in quarantine for the past eight days, said he had most likely been infected by Liberal senator Andrew Bragg at a Senate inquiry, where Senator Bragg was displaying flu-like symptoms.
Senator Patrick asked Professor Kelly why Senator Bragg could not have been tested sooner; the current testing regimen limits tests to those who have travelled overseas within 14 days of the onset of symptoms, or come in contact with such a person.
“He had flu-like symptoms but he did not qualify for a COVID-19 test because he hadn’t been in contact with anyone who was a known COVID-19 carrier,” Senator Patrick said.
“A week later he became aware of others that had gone to a wedding that he had been to that had contracted coronavirus, and at that point, he did qualify for a test.
“If he had been tested when he first had symptoms, I would not have spent eight days working in country South Australia.
“Why is the test criteria so strict? Can you see how 10 minutes two weeks ago could have saved so much time and significantly reduced the risk of my infecting anyone?”
@QandA: Why are we not testing everyone who presents with flu-like symptoms? #QandA
Professor Kelly initially deflected the question, saying the wedding in question was a “super-spreading” event and the virus was more infectious than the flu.
But when host Hamish Macdonald pushed Professor Kelly to be more direct, he announced that changes to the testing protocol were imminent.
“We’ll be removing the traveller component, but we’re working on that at the moment,” he said.
“There will be announcements about that over the coming days.”
Professor Kelly indicated that authorities were investigating many measures in terms of how they responded to the current crisis.
Australia must ‘get over fear of data’
The show opened with Professor Kelly stating that health authorities in Australia “have been preparing for many years for a pandemic similar to this”.
It was a comment that soon came back to bite him.
After a viewer called in to condemn what he considered to be lax control measures at Australian international airports, Singapore’s response was discussed.
There, the Government is tracking the movement of potential cases using a smartphone app with Bluetooth functionality.
Macdonald asked Professor Kelly: “Why is tracking and apps not something you already have at your disposal?”
Professor Kelly said apps were one tool at the Government’s disposal, but was cut off by Dr Swan.
“Sorry, you already have that technology available to you?” Dr Swan asked.
“Well, we all have mobile phones and location services are on mobile phones — these are difficult decisions to make in terms of people’s privacy,” Professor Kelly responded.
Dr Swan was less than satisfied.
“Paul, you haven’t introduced these technologies. Singapore has,” Dr Swan said.
“You’ve had weeks to introduce those technologies and they haven’t been done.
“We should be testing every single person that comes off one of these planes, because the asymptomatic spread is what we need to be worried about.
@QandA: Why aren’t Australian airports testing the temperatures of people arriving home from all parts of the world?
“Then, at least, you have a baseline. You know if they get off the plane and are positive or not.
“Symptoms we’ve seen with the Diamond Princess and South Korea are not a good sign of the people who might spread the virus.
“Everybody coming off a plane or a boat should be tested regardless of whether they’ve got symptoms or not.”
Professor Kelly defended the testing measures and said they did the job, especially when Australians were returning from China, as very few had tested positive.
It was mentioned that in Taiwan they are also using smartphone apps to track data, including where people have been to, and Dr Swan suggested Australia should forget about privacy concerns and do the same.
“The big message from Taiwan is that they’re unashamed and unembarrassed about using data, linking data and actually quite personal data for the public good,” he said.
“We’re too nervous in Australia to link, we do link some data but we could now be using this opportunity to link data on a massive scale and be able to do something similar to Taiwan so that we know what’s going on and we can actually measure things.
“We need to actually get over our fear of data.”
‘We’re not Italy’
Another key issue discussed was whether schools should be closed.
Prime Minister Scott Morrison has been against taking that step in recent days, despite closing pubs, clubs and most other places where people gather.
Professor Kelly said if schools were to close it would be for “at least the next six months, probably for the whole school year”.
Dr Swan said modelling out of London’s Imperial College showed that closing schools would help “flatten the curve”.
“The Imperial College London group found that closing schools — in their model, and they’re some of the best modellers in the world — actually had the biggest effect,” Dr Swan said.
“It’s an appalling decision to have to make, but they showed that it was the biggest thing you could do to make a difference to the curve.”
The looming stress on Australia’s public health sector was another point of disagreement.
“The prediction is, at the moment, if the hockey stick [trend line] doesn’t change that much … we’ll be out of ICU beds in New South Wales, Victoria will be behind that, by April 10,” Dr Swan said.
“And in that case, ICU physicians will be faced with some very difficult decisions.
Asked if the prediction was accurate, Professor Kelly said ICUs could potentially triple their capacity.
@QandA: Will older people who catch the virus be denied a ventilator if there’s a shortage? #QandA
He pointed out Australia did not bear comparison with Italy, which had recorded more COVID-19 deaths than anywhere else, with nearly 5,500 fatalities.
“We have strategies also to take pressure off the hospital system more broadly, not just intensive care units,” Professor Kelly said.
“We are not Italy. I’ve seen some people say when they look at the curves of what Norman is referring to, the epidemiological curve that we’re two weeks behind Italy.
“We are not two weeks behind Italy.
“We’ve been testing and finding many more mild cases.
“Italy mainly tested the top of the pyramid, the very serious cases that came into hospital. That’s what their first 1,000 were.
“Our first 1,000 were mainly community cases. Mostly involved with travel from overseas. We’ve only had 20 people through this whole period that have been in intensive care.”
What about a vaccine?
Professor Lewin, who is a leading infectious diseases expert and involved in working on vaccines, said a vaccine for COVID-19 could arrive in “12 to 18 months”, but she was more hopeful that treatments could be developed sooner.
“We haven’t spoken a lot in the public around treatments and I think that they may play a very important role while we’re waiting for a vaccine,” Professor Lewin said.
@QandA: Are we prepared for winter and the spikes that will come with it? #QandA
“We have no specific treatment for the virus.
“People get better on their own, or they get better because they receive supportive care in hospital.
“If we had a treatment, an antiviral drug, that blocked replication of the virus, it could potentially do two things: it could potentially improve the outcome — people don’t get so sick and don’t die — or also reduce transmission because most virus transmission is related to how much virus you have onboard.
“Just recently, we’ve become aware of one drug in particular.
“It’s an arthritis drug. A very small study but being tested quite widely, showing the drug reduced the amount of virus that we could measure in someone’s swab.
“We can actually measure the amount of it accurately, and it definitely decreased with this particular arthritis drug.
“One thing we might see in the not-so-distant future is a lot of understanding about drugs that block replication and that could have implications for both clinical outcome as well as how infectious you are.
“I’m a little optimistic about that.”
Health department clarifies comments
After the episode had finished, the Department of Health issued a statement explaining Professor Kelly’s comments around testing protocols.
“As we learn more about the virus, we have continued to review the testing criteria,” a spokesperson said.
“In light of our stronger travel restrictions, the focus logically moves to the community with COVID-19 symptoms, on top of returned travellers and close contacts of cases.
“Professor Kelly flagged that the Communicable Diseases Network Australia will change the testing guidelines for public health units in the near future.”
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