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14 Mar 2020

Transcript:   AMA President, Dr Tony Bartone, and AMA Federal Councillors, Doorstop, Canberra, Friday, 13 March 2020

Subject:   Coronavirus and National Public Health Emergency


TONY BARTONE: Okay. Good afternoon everyone and welcome. Obviously as some of you know, Federal Council, the head policy making of the Australian Medical Association has been meeting here today. As Australia deals with this evolving health crisis that is COVID-19, it is important to acknowledge the announcement that is currently being made by the Prime Minister in terms of cancelling mass events. It is a significant and serious measure, but my message to the Australian population, the Australian community, is to say that it is a necessary health measure. It's a necessary measure to continue to protect and provide the leadership and the information required at this time.  

I'm here today with you all in the presence of all my State and Territory leaders of the Association, and clearly we are united as one. Federal Council has today looked at all the necessary responses that we need as we continue to lead, based on scientific and available evidence, the importance of the response of Government to these measures at the moment.

Cancelling mass events is going to be a significant and difficult message for some of the population to deal with. But it is necessary at this time. If we look at what's been happening overseas, we can see that we have been in sync with many western countries in terms of our public health response to this measure- to this evolving COVID-19. But unless we take the significant and necessary hard steps at this moment, we will find ourselves continuing along a trajectory which sees us following other western countries and not being able to contain the advancing spread of COVID-19 such as countries like Singapore and Hong Kong have been able to achieve.

In addition to that, we today met to applaud the introduction of telehealth and consultation measures to continue the access of the Australian population to the necessary health care during this time. But we are furthermore calling for, and ensuring that the wide continuance of consultations for not only general practitioners, but non-GP specialists, continues to be available to allow our community the access to the care that they deserve and expect. Especially during this time and to continue to protect and indeed look after the nation's most vulnerable people, especially, to continue their access to the care in that time.

I'm now going to  ask all of my State and Territory representatives to join me and individually one by one, and I'll call them here to make any additional comments that they wish to make at this time. So I'll start off with the President of AMA Victoria, Julian Rait.

JULIAN RAIT: Thank you very much, Tony. Many of you would have seen overnight that there were nine additional COVID-19 cases in Victoria, and also the first example of community transmission in Victoria. And so I think that the announcement today by the Chief Medical Officer is very timely. Like the Federal President, I believe that improved social distancing at this time, including the cancelling of large events of over 500 people is required. And we look forward to continuing cooperation with the Commonwealth to implement any further measures that they see necessary.

TONY BARTONE: Dr Danielle McMullen from New South Wales, representing the New South Wales President. 

DANIELLE MCMULLEN: Thanks. As I'm sure you're all aware, there's also been evidence of community transmission in New South Wales. So in addition to our strong support for the cancelation of mass events, we'd also like to encourage businesses and schools in particular to consider the burden on healthcare systems and really rethink their requirements for unnecessary visits to GPs in particular, around getting health certificates and sickness certificates for their staff- staff and students. So allow your staff and students to be home from school or work if unwell, but to only seek medical assistance if they need it, rather than just for a sick note.

TONY BARTONE: Dr Dilip Dhupelia from AMA Queensland, President.

DILIP DHUPELIA: Queensland AMA is working very closely with the Queensland Government during this crisis. One of the issues we've got in Queensland that I would like to see addressed is that we've got such a geographical wide varied landscape, that we want to ensure that our rural and remote communities are very well looked after by ensuring that the spread is constrained and held back from spreading across Queensland. Now, we are working with the State and Health Emergency Coordination Centre. The other aspect that I would like to ensure is the health of our providers, our specialists, and our general practitioner specialists to make sure that they are safe, so they can look after these vulnerable communities during this crisis, and to ensure this business continuity by extended use of telehealth and video conferencing facilities. Thank you.

TONY BARTONE: Dr Antonio Di Dio, President of AMA ACT.

ANTONIO DI DIO: Hello, thank you all for your attention today, we really appreciate it very much. It's been an incredibly difficult and challenging time for all of the people in this group today, partly because so much of what we've had to say and agitate for has not been popular with so many people. That's because it is our job to say things which are unpopular and unpalatable, but ultimately we hope to be sensible and to save lives. We're especially grateful to our relevant State and Federal authorities for listening to us and for caring and for their incredible professional and hardworking conduct.

In the ACT in particular, we have been very keen to avoid unnecessary spread. And we've had our first case and it's likely to be a person to person case. We encourage all people to use health resources sparingly, GPs to be involved, and to be congratulated for their use of telehealth and the care that they give to all. And thanks to everyone.  

QUESTION: Dr Di Dio, just very quickly, we've seen the Prime Minister saying that we don't want- necessarily gatherings of more than 500 people. Parliament is due to sit in a couple of weeks. Do you have any views on whether or not Parliament should be sitting?

ANTONIO DI DIO: My views on that will differ to my senior colleagues.

TONY BARTONE: Can I just continue on with the rest of the Presidents, just in due respect, and then I'm happy to take questions. Dr Helen McCardle, representing John Burgess from AMA Tasmania.

HELEN MCCARDLE: Well, we're a small State and we've had relatively few cases, only four to date. But four is a lot for us. We’ve been working very closely with the public health department and the Health Department put in place strategies and that's been going very well. We welcome the announcement today about mass gatherings. As some of you may already know Dark Mofo, which is one of our iconic festivals, was cancelled late last week. So I think we need to keep moving on things like school closures, looking at what we do with universities, because in a small state like ours, it doesn't take much to overwhelm the acute hospital system. Thank you.

TONY BARTONE: Dr Chris Moy from South Australia.

CHRIS MOY: I'll keep it simple. Look, this is unprecedented. This is serious. But instead of people panicking and looking to their own needs, what we really need is the community to come together right now. And that means listening to the medical advice and the medical leadership about what we need to do and to make sure that people understand that there is a sacrifice in the cancelling of these events, but this is something that needs to happen to blunt the actual effect of this, which may be very serious.

And the other thing is that everybody can do their part. General hygiene, wash your hands, clean your surfaces, cough into your elbow or into tissues, and make sure that you keep some sort of distance if you are unwell. Make that difference, because we can all do our part and understand that we will all have to come together make some level of sacrifice in all of this time to make the difference. Thank you.

TONY BARTONE: Professor Omar Khorshid from Western Australia, representing the President there, Andrew Miller.

OMAR KHORSHID: Thank you. The AMA in Western Australia, like the AMA nationally, is working very closely with government to do what we can to achieve a good outcome from this crisis. What we're realising now is community transmission is happening. We are on a trajectory now for an outbreak in this country, but we have a choice; a really clear choice. If we don't do enough, we will end up like Italy where the health system is completely overrun by COVID-19 and by pneumonia.

If we do the right thing, if we cancel mass gatherings, if each individual takes on their responsibility, we can protect the vulnerable in our community, and we can achieve a far better outcome for every Australian, and in particular every Western Australian. It's not just about hospitals, not just about doctors, it's about every single one of us taking the steps that we need to take. Thank you.

TONY BARTONE: And finally, Professor- Dr Kris Rallah-Baker from the Australian Indigenous Doctors’ Association - I'm sorry, not finally, one more to go - from the Australian Indigenous Doctors Association.

KRIS RALLAH-BAKER: Thanks very much. As many of us know, Aboriginal and Torres Strait Islander populations represent some of the most vulnerable community groups in Australian society. It's important, going forward now, that there is community spread to minimise non-critical or unnecessary travel to our rural or remote communities, and also for funding support for the community controlled sector and any health services delivered need to be culturally safe and appropriate in order to minimise the impact that this will have on Indigenous communities.

TONY BARTONE: Thank you, Kris. And Rob Parker from the Northern Territory.

ROB PARKER: The Northern Territory supports everything that's been already said, particularly in respect to mass gatherings. The Northern Territory has particular challenges in respect to virus, as far we have a very large Indigenous population and also a very large homeless population that provide particular challenges to the Health Services controlling this appalling virus issue that is facing Australia. AMA NT continues to work with the NT Government to try and deal with these issues as they occur, and we're very supportive of the issues that have already been raised in this press conference today.

TONY BARTONE: So there you are. I'm surrounded here by my colleagues from the various States, all specialists in different areas of the medical practice, but we are united as one at this time to reassure the Australian public that we can follow an evidence based approach to try and help them to protect themselves from the advancing efforts of this COVID-19 pandemic. We are going to have to take very serious measures and we make no apologies for advising that, because our patients' well-being and our patients' overall health and safety is our concern, and that's what we are here today.

We want to assure the public that is not a time for panic, it's a time for collective and responsible alertness in terms of what they can do. You've heard my colleagues tell you about the need for reports and the importance of appropriate handwashing, appropriate cough etiquette, and appropriate other measures when it comes to social distancing. The measures announced today by the Prime Minister just now are just necessary and difficult, but necessary, step in terms of the response is required, and we will continue to work both with the Chief Medical Officer and the various State and Territory health officers to ensure that the community is best prepared and best protected at this important time.

And I'm happy to take questions now. 

QUESTION: Dr Bartone, are you satisfied with the amount of time it's taking the Federal Government to roll out the information campaign, the cancellation of mass gatherings will be done actually [indistinct] advice to the public [indistinct]?

TONY BARTONE: Two days ago, the Government announced $30 million in terms of the campaign and grant around the continued messaging and improvement on the communications; that's necessary. We welcomed that at the time and it's been a result of continual advocacy, in particularly from ourselves, in terms of the need to have a consistent and loud and penetrating, managed message right through the community in all different forms and all different for a including: social media, including television, newsprint, community gatherings wherever they might be, to get the message across. We've been very strong on that right from the outset and we're glad to see that they have announced that. And indeed I believe that there is further more activity coming in that space very, very soon.

QUESTION: Dr Bartone, should Parliament go ahead next week?

TONY BARTONE: So we will follow indeed the best possible public health mass information and evidence in that respect. We will work with both the Chief Medical Officer and indeed this State's, this Territory's Chief Health Officer to ensure that the welfare and safety of all those that work in Parliament, in the Government, on the hill behind me can be protected during this time. And we'll be very frank in that discussion.

QUESTION: [Indistinct question]

TONY BARTONE: So the evidence around schools can be somewhat difficult to interpret clearly, and we need to be understanding and follow the evidence in that respect. So we will work with, again with the Chief Medical Officer and the other health officers to ensure the timeliness of that. Clearly, where there's been an outbreak in, or in the case, identified in the school, while we're in this case identification, isolation and containment phase, it's appropriate that certain schools will be put into quarantine during that time. However, as we get deeper into the evolving pandemic response and effects, we will have to work with the best possible evidence.

Now, we've seen in some countries around the world where they've instituted those measures, and clearly they've had an appropriate response at the time. But understanding that, if we are to flatten the curve -and by that, I mean to delay both the peak and the amount of people that actually sustain the complications of evolving COVID-19 - we are going to be- would get ahead of the curve, so to speak, and to ensure that we reduce the rate of community transmission while we allow our public hospital system to prepare itself and deal with the complications and indeed, the significant medical complications in that space and in an appropriate manner. If we do nothing, if we turn a blind eye, our public hospital system will be overrun, and that is not in the interest of anyone in our community at all.

QUESTION: Dr Bartone, this mass gathering ban doesn't start until Monday. Is that good enough or should the Prime Minister [indistinct question]?

TONY BARTONE: I'm sure that the Prime Minister will be appropriately informed about his decision and whether he should or shouldn't attend the football on the weekend. We'll present the information and the evidence that we believe is appropriate and we would like to ask him to lead by example at this time, when he's asking the rest of the community to take on these very difficult measures.

Let me be very clear. We've been calling for this and we now acknowledge and agree with the Government in calling for the cancellation of mass events, and it's time that we brought the community along with us by clearly informing to them about that and then leading by example.

QUESTION: Does that mean the Prime Minister should not go to the football? Is that what you're saying?

TONY BARTONE: I am saying that the Prime Minister obviously has made an announcement today, and messaging and optics is very important in that space, and really, I would like to think that he will follow the advice of his Chief Medical Officer.

QUESTION: Dr Bartone, how concerned are you about the number of ventilators in hospitals and the capacity of [indistinct]. Should hospitals be cancelling elective surgery now?

TONY BARTONE: Clearly, the number and the capacity of our public hospitals in terms of ventilator units is going to be a significant issue as we get deeper in an uncontrolled response to COVID-19. The idea is to try and minimise the effect of the scarcity, the relative scarcity, in terms of the expected potential demand if things progress outside of the control that we're hoping to instil by such measures as we're announcing- as it's been announced today. Clearly, we'll never have enough to cope with a health emergency, a national health emergency, of the scale that potentially this could evolve to. But by putting in the measures today, we'll make sure that the resources we have in place are more effectively and more appropriately and more timely used to protect the Australian public as they deal with the effects of that COVID-19 progression.

QUESTION: Should we be going to a mass event on this weekend, and what would you be advising Australians to do? Should they go to the football this weekend?

TONY BARTONE: My advice to Australians is as follows: clearly, if you have any respiratory symptoms, you should not be going out into any massive gatherings this weekend or until any stage from now. Number one.

Number two, I would advise all my vulnerable patients in the community to make a decision and consider whether they should attend and whether they, rather than waiting for Monday, make that necessary step now. Clearly, we've had an evolving and rapidly changing information that has led to the announcement today, and it has been pleasing to see the announcement been made.

But Monday, today, at the end of the day, everyone needs to understand that this is a serious health emergency and that we need to act accordingly. Every decision we make that potentially puts a person at further risk of contracting COVID-19, especially in a vulnerable age group or a vulnerable population or age group, is going to put further pressure and further speed to the spread. Every day we delay in acting on the necessary need to reduce and cancel the attendance, we will then see a potentially significant increase in the peak capacity when we finally achieve and identify the peak of the COVID-19 spread into the community.

QUESTION: Can you just explain to people what a mass gathering is? I mean, is it just [indistinct] sporting events? What about big churches with more than 500 people [indistinct]? Can you provide some clarity as to what exactly mass gathering is?

TONY BARTONE: Well, what we'll work through with the Chief Medical Officer, indeed, all the State and Territory health officers, is that we've got clarity for the community to know exactly what we mean by a mass gathering. Clearly, 500 people is clearly represented by very large church churches and we know what the evidence suggests there. So, we will be working clearly to make sure there is no ambiguity about what is meant by that.

QUESTION: And were you satisfied with that number? Because in the United States, States have opted for 250 people some have opted for 1,000. Are you satisfied with the 500 number?

TONY BARTONE: The 500 number is obviously in response to the advice of the Chief Medical Officer and all the information that is brought to the table in response to this. Now, at this stage, we are working through one of the most unprecedented times when it comes to this pandemic, and I don't think that there's really anything to be gained by trying to be very, very theoretical about what is the right number. I think the message is more important than the number. And the message is that if you don't need to be out in a mass gathering, in a gathering of a significant number of Australians, reconsider, whether it's 500, 250 or 100. If you're vulnerable, think about that. If you live with people who are in a vulnerable population or age group, think about what you bring to the table by putting yourself at risk of contracting from the majority of Australians - and let me re-emphasise that the majority of Australians will have very mild, self-limiting symptoms which will not pose, more than 80 per cent of the population, any ongoing discomfort other than a period of rest at home.

But for those people that we've already identified clearly, this will present a significant health issue for them and indeed, will result in, unfortunately, many members of our community having to deal with the potential- the loss of life.

QUESTION: Would the coronavirus have to lower for you to be comfortable with the Parliament to sit [indistinct]?

TONY BARTONE: I'm sorry. Could you repeat that question? 

QUESTION: So, would the risk of coronavirus spread have to diminish in order for you to be comfortable for politicians and staff of 5,000 people to be in Parliament House?

TONY BARTONE: As more and more Australians indeed develop the COVID-19 infection, obviously, the risk to continued community transmission progresses and escalates. So, obviously, until we're well past that peak and well past the infectivity in terms of the large cohort of the population having the necessary underlying immunity to that, it would be appropriate to consider that we maintain the status quo. But of course, that will be a decision that we will continue to seek the advice of our chief medical officer, and all the other state and territory counterparts.

QUESTION: [indistinct] we're unlikely to get to that peak in a week. That would be unlikely?

TONY BARTONE: Unlikely to get to that peak in a week? Yeah, absolutely.

QUESTION: Okay. So if Parliament's sitting in a bit more than a week, then do you think we need to be seriously talking about reconsidering whether that's appropriate?

TONY BARTONE: I think that Parliament will have to look at and review its sitting agenda.

QUESTION: The NRL's going ahead with two games tonight, one in Canberra, one in Townsville. They're not following the leads of both Cricket Australia and the F1 this morning as well. You [indistinct]- disappointing. Should they be cancelling these games, and should bodies like the NRL be taking more of a lead here?

TONY BARTONE: I think all organisations and associations, sporting or public or otherwise, have to consider what they can do to help their community and their constituents deal with the effects of the evolving COVID-19, and the threat to the Australian public. Everyone's got a role to play and it's important at this time that we follow their health advice and the medical advice of senior clinicians of this country, including the people represented here in front of you today, and make the necessary changes, and indeed the necessary information and advice according to those events.

QUESTION: If they asked for your advice, what would your advice be? Should those games be cancelled?

TONY BARTONE: Our advice has been very clear and unambiguous to all of those authorities already.

QUESTION: Dr Bartone, there have been some reports of supply issues with the chemical reagents used to make the coronavirus test. Are we going to run out of these tests?

TONY BARTONE: The shortage of reagent chemicals is indeed a real one, and indeed is one that is being addressed as we speak. That is why it's important that as a community we understand the importance of testing and who should be tested. It's not at all in anyone's interests to have a test because you are, what we would call, a worried well person with indeed no contact, no travel history. But of course, as time goes on, that group will increase significantly. So we need to address that shortage as quickly as possible. And indeed, I believe there are measures afoot as we speak to ensure the timely and appropriate supplies, we go deeper into this episode.

QUESTION: Should the telehealth item numbers be extended to cover all types of GP visits so that we can clear GP waiting rooms and contain the virus?

TONY BARTONE: Yes. 

QUESTION: Is it counterproductive that schools and- you know, are still going to be going ahead, and public transport? I mean, if we're going to stop mass gatherings, wouldn't it be worthwhile just saying, you know, for now, people should stop going to school, people should stop going to public transport, stop going to work. Like, wouldn't it be better if we just go all in?

TONY BARTONE: As we progress into this evolving response to a national health emergency, we will see changing messages day by day, and they will be part of, obviously, the necessary advice and messages that will occur in the perhaps not the too distant future, when and if the time and the evidence suggests that it's time to go. We will continue to work with the Chief Medical Officer and all the State and Territory health officers to ensure that that consultation, and indeed that information, is shared as timely, as quickly and as effectively with the community to protect them during this time.

QUESTION: Has the Government provided the AMA with the modelling of how many Australians could get this virus [inaudible]…

TONY BARTONE: Sorry, I missed the first part of your question. 

QUESTION: Has the Government given the AMA its modelling showing how many Australians will get this virus in the first wave, and is it likely [inaudible]…

TONY BARTONE: We have not seen Government modelling, but we have seen multiple different models through different scientific channels that present a variety of scenarios. I think it's a brave person that's going to predict the pattern and indeed the future development of where this virus goes to from here. We need to be prepared as best we can by doing the simple stuff, by doing the simple measures, by doing the hand washing, the cough etiquette, the issues around protecting our vulnerable in the community, as well as the announcements today regarding mass events to try and minimise when and where those- the projected modelling might actually be come to fruition. We can flatten that curve-

QUESTION: [Interrupts] Has it be done? Are they keeping it secret?

TONY BARTONE: Sue, I don't- I don't know about whether they're keeping it secret or not, and indeed we were going to meet with the Chief Medical Officer's assistant- or deputy today, Professor Paul Kelly, before the Prime Minister called the press conference that he did. But we will work to get that modelling.

But again, I kid you not, I think that it's a brave person to try and predict where that modelling might go and which model is right. Anyone that wants to create a name for themselves by trying to predict, you know, that it's X per cent or Y per cent is purely being that - brave. We need to prepare ourselves, we need to prepare the community, we need to prepare our patients for whatever eventuality might arise, and ensure that the health system is as best prepared to deal with whatever is thrown its way as we deal with the outcomes of this COVID-19 response.

QUESTION: Dr Bartone, a lot of the doctors in your group have copped a lot of criticism for calling for mass gatherings to be banned. Do you feel vindicated by today's decision?

TONY BARTONE: I'm not interested in vindication. I'm interested in informing and leading both the medical profession, as well as the response to the Australian community, indeed our patients, about trying to protect them as well. Today is not a day about point scoring, today is about moving on, rolling up our sleeves and doing the best by our patients and indeed the community.

QUESTION: Dr Bartone. This might be a better question for your West Australian counterpart, but I just want to ask about Indonesia, the low number of tests being conducted there. Do we need to have enhanced screening measures or a travel ban against Indonesia?

OMAR KHORSHID: There's no doubt that the huge number of West Australians who travel to Bali is going to pose a threat in terms of the control of this virus as we go forward, and similar to the ban on mass gatherings. We need to reconsider all non-essential travel, particularly to places where we're unsure of exactly how many COVID-19 cases are there. We understand that there are not enough tests being done in Indonesia. We just have no clear view as to how many people in Bali and other Indonesian cities have the disease, and that makes travel to those places potentially dangerous for the rest of the West Australian population.

QUESTION: Dr Bartone, do you think the decision to delay the ban on mass gatherings until Monday is a face-saving measure for the Prime Minister who said he was going to the football on the weekend?

TONY BARTONE: That's a question for the Prime Minister. 

Okay? Alright. So thank you again, and clearly we are united here as one as we deal with the effects of a national health emergency. I thank you for your time, and no doubt we'll speak again soon.


13 March 2020

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Published: 14 Mar 2020