Politics with Michelle Grattan: Paul Kelly on the risk of a COVID-19 second-wave

Paul Kelly on the second-wave of coronavirus.

Speaking as an expert in epidemiology, Deputy Chief Medical Officer Paul Kelly is candid about the prospects of a second-wave of coronavirus in a society that hasn’t developed herd immunity.

“There is a very large risk of a second wave. We need to do this very carefully,” he says, as Australia starts to roll back restrictions.

“We are potentially victims of our own success here because we have been so successful in minimising the first wave of infections, the vast majority of Australians have not actually been exposed to this virus in a way that could develop immunity in people or herd immunity in the population”.

“There is that sense that people want to just get back to doing what what they did before. But it’s going to be a new normal. We have to decide as a society, what does a COVID-safe society look like? And there will be changes…”

“This is a big change in the way we’re going to live. I think we’ve seen that in human history. The changes that pandemics have brought, back to [how] the 1918 flu changed the world. The HIV/AIDS pandemic has changed the world. And this one will change the world.”

Kelly, in his role as an adviser to the government, praises Australia’s response to the virus as one of the most effective in the world - comparable to the successes of Taiwan and New Zealand. But he also acknowledges the marked difference in policy between the Tasman neighbours.

“New Zealand very early on decided that they could and wanted to eliminate the virus altogether as a public health issue. And so they’ve gone very hard with their social isolation policies and so forth…they really are on a path to not having any virus in the country at all.”

“On our side of the Tasman, we went for a suppression approach, which meant that we didn’t go quite as hard with the lockdown measures that have been introduced, on the basis that the economic and social impacts of that were not proportionate to the threat of the virus.”

If, as both governments would like, a trans-Tasman “bubble” is established for travel, Kelly agrees that, in terms of risk, it would be the New Zealanders who’d have to be more careful about inviting Australians in rather than the other way around.

“But I think it’s definitely achievable. ”

Describing himself as a glass half-full person, Kelly says: “So with my glass half full, I will hope that sometime in 2021 we’ll be talking about vaccines. And then our challenge will be getting enough of them available to the people that need them, not only in Australia but throughout the world and particularly in the poorer nations of the world, so that we can have an equitable distribution of something that could change a lot of people’s lives.”

Transcript (edited for clarity)

Michelle Grattan: Paul Kelly, it seems the situation in Australia is in a very good place compared to many other countries. Can you just give us some idea of the comparisons?

Paul Kelly: Well, I think there’s some interesting things about this virus. We’ve looked no as the first wave came and went in China and what’s happening in many other countries over the last couple of months and we can see in Australia, we’ve had an epidemic here in Australia for a couple of months. It rapidly increased in the numbers of cases we were seeing each day and then fairly rapidly, but not quite as rapidly as the increase, has decreased in this flattening of the curve that people have heard about a lot now. So there’s a similarity there in the shape of the of the curve. But when you look at some of the other countries around the world where, for example, in the US, over 1.2 million cases, in several parts of Europe over 200,000, rapidly rising epidemics in Russia and Brazil, we’re certainly in a much better place than there. And I’d say if we were to pick a top three so far in terms of response and decreasing the number of cases or keeping the number of cases to a minimum; Taiwan, New Zealand and Australia would probably be that top three. So it’s a good place to be.

MG: What is it about Australia’s policy specifically that has meant that we’ve suppressed the virus, when a country like the United States has had a very bad run?

PK: So I think if I was to think through what’s happened in the last couple of months, the ability of the executive government to listen to the experts and to take that advice very seriously and essentially enact it in policy has been an extraordinary contrast to several other countries. I think that’s one of the key components. I think another component is our public health system, both in the wider sense of prevention and the public health system outside of health care, but also our health care system and the strength of Medicare. I think all of those things have been very helpful and in stark contrast to the US. The ability to work as a nation and the formation of the national cabinet early on in the epidemic, under the leadership of the prime minister but all the premiers and chief ministers of the states and territories all involved in that decision making. Again, an extraordinary time, this never happened in the history of the Federation of Australia, and that’s in stark contrast, again to other federated bottles, particularly the US. I think another element of our success really, though, is probably luck in so far as the virus hit us in the summer months rather than in the winter. And we still need to see how that will play out as as it is starting to get cooler in the southern parts of Australia at least as to what might happen with this epidemic. But really, I think that rapid and bold decision making by government, guided by expertise, has been an absolutely crucial component.

MG: So just dwelling on the US for a moment, do you think if the policy response had been better in the US, and it obviously was flawed, that they could have been in the sort of position Australia’s in, or would the differences in the systems, the health system in particular, have meant that they were always going to be worse off?

PK: I think they started from a lower base in terms of collaboration throughout the states and nationally that there’s an issue of trusting government. I think also in the US, I think that’s reasonably well understood. And and I think that also has played into the way that the Australian public has responded extraordinarily well to all of these restrictions that have been put in place. It’s hard to tell, you know, if the US had, if this virus had emerged in the US summer, whether that would have made a difference, I’m not sure. But certainly there are many structural issues in the US that are problems for them. We don’t share them necessarily here in Australia. I think other countries and the US probably didn’t recognise the threat early enough, as in Australia we did and made very rapid changes to our border to have border restrictions for example, on 1 February, within several hours of us realising that that it seemed that the situation in China had gone beyond Wuhan. The decision was made by the national cabinet to close the border to non-Australians coming from China. And so that was a very large step, which has been repeated several times. And now we find ourselves really an island in the Pacific and cut off from the rest of the world. But two months ago, that was almost unthinkable, really. And so that very brave and rapid policy decision, amongst others, has really put us in a good place. So when you look at the epidemiology of the virus in Australia up to now, still two thirds of the of the cases have come from overseas. And really the local situation has not in any way got out of control in community transmission.

MG: Just on the point about China and the talk about where the virus originated, are you confident that it can be located in a wildlife wet market?

PK: I think that’s the most logical and likely answer to that question, but I think for the moment I’m really very much concentrating on the virus as it is now. And what we know about the virus is that it spreads very readily from human to human, so that original origin would be valuable and will be valuable in the future to help us to plan in relation to future pandemics that we know what this pandemic is now. It’s a human to human transmission. And in a sense, that origin conundrum is not such an important component of control at the moment.

MG: There’s been a lot of debate about the World Health Organisation. In terms of actually getting information from the WHO and interacting with it, has it been cooperative?

PK: Yes, definitely from our point of view. We were first alerted to this, this issue that was emerging at that time at Wuhan on 1 January. So that was within 24 hours of the World Health Organisation being notified by China. So that initial information came to us very quickly, and we’ve been kept up to date in a very timely fashion from the WHO. I know there’s been a lot of debate about how open China may or may not have been in those early days, about person to person transmission, for example, and the extent of the epidemic emerging in Wuhan. But that’s the sort of thing that will come out in the future about how that might be improved. I know that the World Health Organisation needed to work very closely with China in those early days to get that information. And the fact that the virus genome was shared within days of it being worked through in China, shared through WHO and through them to the rest of the world, meant that Australia and many other countries were able to be very prepared with testing in those early weeks of January. So when the first cases did in fact arrive in Australia in late January, we were certainly prepared with tests and really understanding, at least from that point of view, what was happening with the virus.

MG: Did the medical authorities feel a little frustrated when the World Health Organisation, for example, was slow to declare a pandemic and also was advising against the closing of borders?

PK: They’ve got a longstanding reason to think about not closing borders, to do with with trade and and movement of people. And, you know, in many ways, they have a point that once you do start fiddling with borders, it does cause unintended consequences. And we we know that from our own perspective, in terms of of supply chains, of personal protective equipment and so forth, for example, out of China. So the closures of borders has affected those things. But we took a decision or we certainly gave the advice from the Australian Health Protection Committee and myself and Brendan Murphy spoke with a health minister and then the prime minister on 1 February about closing the border to China on the basis that we felt this was the best for human health in the short term. So in terms of keeping the virus out, I think it was a fundamental decision and the right decision. So we went against the WHO in that regard. In terms of him declaring a pandemic, yes, we were well ahead of that declaration. So on 21 January, I think it was, Brendan Murphy declared this disease a listed human disease under the biosecurity legislation, which meant that we essentially felt this was likely to be a pandemic at that point. And it became quite clear in the week or two after that that that was indeed what was occurring even by the World Health Organization’s own definition. So spreading across several countries into several regions in the way that it could be seen as as affecting the health care and health care response in multiple countries. And so that’s indeed what was happening in early February and has continued to happen up to now.

MG: Now, you mentioned public cooperation, another country that’s had a high level of cooperation from its people is New Zealand. There’s now talk of possibly by mid-year having a travel bubble between the two countries. Yet they do have different policies. New Zealand wants to eliminate the virus while Australia’s policy is suppression. Do you think that there’d be any health risks from such a bubble? I suppose the health risks would be more on the New Zealand end, wouldn’t they?

PK: Yes, so we do have slightly different, well, we have different policy objectives, as you’ve said. So New Zealand very early on decided that they could and wanted to eliminate the virus altogether as a public health issue. And so they’ve gone very hard with their social isolation policies and so forth. And I have a sister in New Zealand, so she keeps me up to date about what’s open and what’s not. And essentially for several weeks there, nothing was open. Not even takeaway coffees were available. So they went very hard. They have not completely gone to zero in terms of their case finding. So they’re still finding the occasional case, but they’re really on a path to not having any virus in the country at all. On our side, we went for a suppression, on our side of the Tasman, we went for a suppression approach, which was not which meant that we didn’t go quite as hard with the lockdown measures that have been introduced on the basis that the economic and social impacts of that were not proportionate to the threat of the virus, as it’s turned out, several states and so South Australia, NT, WA, those three in particular are very close to to declaring elimination, I would say, they’ve had virtually no cases in any of those states for several weeks now. I think it’s 11 days in WA, other than ones that have come in to quarantine from international destinations. So they’ve kind of achieved that without going directly for that end. So in terms of the trans-Tasman bubble, yes, I think the New Zealand, the New Zealanders, that would have to be more careful about inviting us Australians in rather than the other way around in terms of risk, I think. But I think it’s definitely achievable. I know that both Prime Ministers Ardern and Morrison are very keen on having a trans-Tasman bubble and indeed could be extended to other parts of the Pacific where there’s been either no or very few cases and they’ve come under control. And the places in the islands nations of the Pacific, in the places where there have been a few cases, for example, Fiji and a couple of other countries in the Pacific.

MG: Now we’ve started our roll back and there’s been warnings from the government and from you and the other health officials that there will be any increase in cases. You are obviously managing expectations here. You just wonder how much real risk is there or a serious second wave?

PK: There is a very large risk of a second wave. We need to do this very carefully. The reason I say that is because we’re in a sense and I’ve said this before, that we are potentially victims of our own success here because we have been so successful in minimising the first wave of infections, the vast majority of Australians have not actually been exposed to this virus in a way that could develop immunity in people or herd immunity in the population. So we have very little immunity in the population. And so therefore, we’re at great risk of a second wave of the virus. Now, we think it’s always been three ways that we’ve been trying to to mitigate this epidemic or pandemic in Australia. The first has been the closure of the borders. And so if we kept the borders closed, that obviously will minimise the chance of the virus coming back in once we get to extremely low levels as we have done to date. So once we open the borders, though, assuming that the virus is still circulating in the rest of the world, as appears to be likely and without the development of of an effective vaccination, which we could roll out to the majority of the population, then we are likely to see more cases and that could spark a second wave. So that’s that’s one way it may play out there. The other ways we’ve been trying to well, we’ve been successful in decreasing the numbers of cases in Australia has been our case finding through laboratory testing and contact tracing, which has led and then keeping people isolated whilst they’re potentially infectious or potentially going to develop the disease in the case of contacts. And I think that’s going to have to continue. And then the third element is the social distancing. So as we start to decrease or lift those restrictions over the coming weeks and months, then we need to be really vigilant about what’s happening in terms of the epidemiology of the virus in Australia. And so if things were to develop into a second wave, then we do have that option still to reintroduce some of the measures that we’ve had in place these last few weeks. We really hope that won’t happen. And it may well be that we do that in a very measured and localised way. If there are outbreaks, even if they are reasonably large but are geographically defined, then it may not be the whole of the state or the whole of the country that would need to have those controls reintroduced. But they’re certainly there for use, if needed, into the future.

MG: Do you think, though, that the population really has taken on board what you say is a very great threat of a second wave or indeed the politicians? You sort of get the feeling after Friday that people think somehow this is over, it’s just that we have to come out of it gradually. And certainly you get the feeling that the politicians will be pretty reluctant to reintroduce controls.

PK: Yeah, I think they’re fair comments, Michelle, but we’ve been very clear with with the politicians and I know my colleagues who we meet on a daily basis at the Australian Health Protection Committee, so all of the chief health officers and equivalent throughout the country have been very clear within their own states that this is a marathon, not a sprint. And until such time as we have a vaccine, we remain susceptible. And we need to have that eternal vigilance, too, which will be the price of survival for us. So that’s always been very clear. And yes, of course, people want to get back to normal. And economically, it’s important that we we do as well as socially. And from a mental health point of view, as well as a physical health point of view, we want to return to some sort of normal state. But this vigilance will allow us to to consider whether we’re going too fast. And once we have opened up, hopefully in the next couple of months, whether we need to reintroduce those things. It will be hard. And the economists tell us that particularly for many small businesses there, that would be a very difficult time if that was to happen. So we want to avoid that. And so going gradually and getting those messages to the general public . Not to go wild in a sense, so, really taking this measured approach is something, it’s hard and I can see from a sociological point of view, that is the really difficult message to put out there and say, yeah, things are okay, but not quite back to normal. That’s a very difficult concept and we just need people to be patient.

MG: Do you get the feeling that people want to sprint back to the pub and the health officials might be trampled in the roadway as they go?

PK: There there is that sense that people want to just get back to doing what what they did before. But it’s gonna be a new normal. We have to decide as a society. What is a COVID safe society look like? And there will be changes. I think people will be continuing to wash their hands much more often than they used to. And that’s a good thing, not just for COVID, but for all sorts of infectious diseases. I think the extra cleaning messages and other hygiene messages they’re here to stay. People maybe remain wary of close physical contact.

MG: So in a year, they won’t be hugging?

PK: I hope they are, I do miss hugging. But it’s, you know, people may be wary and that may be reasonable to be wary, particularly if you’re in a vulnerable group. So older Australians and some people with other chronic diseases may need to consider about hugging and being very careful about hugging. This is a big change in the way we’re going to live. I think we’ve seen that in human history. The changes that pandemics have brought, back to the 1918 flu changed that changed the world. The HIV/AIDS pandemic has changed the world. And this one will change the world.

MG: Now, of course, there’s been a lot of debate about the app, and I think you’re still short of whatever that elusive but undefined target is for downloads. However, has the data started to be used from that app?

PK: So I think the latest figure I saw this morning was a bit over 5.5 million people have downloaded the app. And I think that’s…

MG: Not enough.

PK: Well, it’s about it’s about a third of adults that have mobile phones, as I understand it. And so some people say that’s enough. I think anything more than a few is is better than not having any at all. I’d certainly like to see it as a higher figure, but I think people willl as we go through it, particularly if we were to get a second wave, I think people will understand the importance of having the app and the importance is that it’s it’s a tool for our contact traces in the public health units in the states and territories to be able to rapidly get the minimum amount of data that they need to improve on their contact tracing efforts. It certainly makes it much quicker. Having done contact tracing myself, it’s a very labour intensive but important public health skill. To be gifted multiple phone numbers to start that investigation off or to augment it would be extremely valuable. In terms of, has the data started flowing, no, the plan was for that to happen this week and it’s on track to do so in the coming days.

MG: Given what you say about this crisis, really having a very long tail, will people in the foreseeable future, in a year or whatever, be told to turn off the app, to get rid of the app, or will we be with the app for forever?

PK: So the apps there for this pandemic and there’s some very specific wording in the legislation that’s going to parliament this week about how the how the app will be turned off. The chief medical officer with the Australian Health Protection Committee, will be the ones giving that advice to the minister for health, who is the owner of the app. And on that basis. And so how long is this pandemic going to b, is a bit like the classic how long’s a piece of string? Because we don’t know really. And it depends a lot on what happens with the vaccine, but also what happens in terms of treatments. And so it’s still feasible that this pandemic will will morph into a an endemic disease, just like we have learned to live with flu. Perhaps that’s how we will have to find a way of living with COVID into the future if there’s no effective vaccine.

MG: So the app could be there forever?

PK: Let’s hope not, and I think it won’t, because the app’s really there whilst we are dealing with this disease as a pandemic. And so if it was to become a seasonal virus, I don’t think the app would be of use. We wouldn’t be doing that sort of very detailed contact tracing exercises for that. If we were seeing the disease like that, so we don’t we don’t do contact tracing for flu, for example, we do do it for measles and for other diseases that we see as epidemic, that that come rapidly in a very infectious, but are then able to be stamped out through vaccination or some other method. So, that’s a that’s a crystal ball thing. We don’t know where that’s going to go over time. But the general principle is that the app will be there for as long as it’s needed to deal with this epidemic in in the way we deal with epidemics and so and once it isn’t useful, it will be switched off and the data will be removed.

MG: The virus cluster at the abattoir in Victoria has shown us just how the disease can escalate, the number of cases can escalate quite suddenly. If you are expecting clusters to break out as we remove restrictions, are you confident that the health system can cope with this? I know that there’s been great expansion of the facilities and so on. But you could run into trouble quite rapidly, couldn’t you?

PK: So the Cedar Metas outbreak as we have seen has has increased to to a relatively large number, so 76 would be over 1 percent of our total cases in just a few weeks. And so it really demonstrates how infectious this disease can be in certain circumstances. That being a workplace, the couple of residential aged care facility outbreaks we’ve seen, the north west Tasmania cluster was an even larger group in a larger geographic area that these have been really helpful in framing what we would do and how we would do it in terms of reacting to outbreaks. We hope that they wouldn’t get that big before, you know, the reaction could take place into the future. But some of these settings are very difficult and they infectiousness of the virus makes it difficult to get on top of immediately. So, yes, I am. Well, first first of all, I’m sure there will be outbreaks. There will be further cases. We aim to keep them small and contained. And we’ve certainly done a lot in the last couple of months in terms of of training, of capacity building in our public health workforce. The app itself will be part of that, that extra capacity we’ve had, we have and of course, the much expanded laboratory testing capacity that is now available to Australia will really help to keep us in good stead in terms of not only finding cases and their contacts, but also responding to those outbreaks if they occur.

MG: There was some alarming modelling released last week about possible suicide numbers. If this crisis went on especially really, from the restrictions as much as anything else. I wonder, though, do you have any real time data on suicides? Has the pandemic seen a rise in suicides? Actually, as opposed to modelling.

PK: Yes, so, all good modellers would say that models are all wrong, but sometimes they’re useful. And I think in our infectious diseases modellers say the same thing. They certainly have been useful, but whether they are actually completely predictive or an explanation of current information is always contested. In terms of the suicide thing. Of course, you know, every single person that that dies from suicide is a tragedy. And we all want to avoid and prevent that as much as we can. The data on suicide, though, in Australia, getting timely data on suicides is very difficult. And so to give a straight answer to the question you’ve asked, Michelle, I don’t know whether it has increased or not. There are other ways of of looking at mental health. And so some of the mental health indicators that we do have a better feel for have shown signs that the COVID-19 effect is not just a physical one, but also a mental health one. So levels of anxiety, depression, loneliness, not surprisingly, when we’re talking about social isolation, when we know that for mental health, the key component of prevention and support for people who have mental health issues is indeed connectedness. So, it’s not surprising that when we’re we’re talking about keeping apart and avoiding those hugs that we mentioned before, that many people will become anxious, lonely, depressed, and that can lead to severe consequences, including suicide. But in terms of the actual data, we don’t have a signal at the moment that that’s a problem. But I certainly wouldn’t discount that it was. We will only know that in hindsight.

MG: We don’t have, for example, anecdotal evidence on this. You’re not getting feedback on this?

PK: No. Well, occasionally, yes. But nothing that you could really, you know, absolutely say is that there’s the answer. So I think theoretically, yes, it’s likely to be an issue in terms of mental health. We know we have increased in many ways the support that we’re putting out in various mental health packages prior to this in the bushfire response, but also now within the COVID response. And so hopefully those things are are assisting. But they’re difficult times for many people. I know particularly young people are suffering because of the increased unemployment from the lockdowns and the other social isolation, social distancing measures we’ve put in place and and older people alone in their homes feeling more vulnerable. Yes, I know that from my own family that’s an issue and way we have we have to all try to think about those things and to support where we can and to at least use. There are other ways of connecting that we have now, which we never had in previous pandemics, the ones that I mentioned before in terms of zoom parties and zoom meetings and otherways of keeping connected.

MG: Do you do any zoom parties yourself?

PK: Yeah, I’m getting to see more of my sisters that I that I’ve had for quite a long time. One lives in Auckland, as I mentioned, and another one in Perth and one in Sydney.

MG: And we know they’re teachers. We know a lot about your family these days.

PK: I’ve given them a promise, I’ll try to mention them at least once.

MG: Now, on the hopefully more optimistic side of this whole thing. What what do we know about the progress on the vaccine, not just here but internationally?

PK: So a lot of progress, going at an extraordinary rate. So well over 100 potential vaccines now in various levels of testing and some of them already in human trials. So I think there’s at least 10 that are in phase one or phase two human trials, some of them very innovative. So there’s a few there that have never, never…few ways of making vaccines, which, if they are successful, will result in the first ever human vaccines made in that way. So they’re quite innovative. Some some of those more experimental vaccines, if you like, would be able to be scaled up very rapidly, much more rapidly than standard ways of making vaccine. There are more standard vaccines that are also in testing, so progressing well. The Australians are part of that process. And so CEPI, the Coalition for Epidemic Preparedness Innovation and the chair of that is Jane Houlton, used to run the Health Department here in Australia and she, she’s in touch with us on a regular basis. The University of Queensland led consortium in Australia is one of nine vaccines that is being funded by CEPI, which demonstrates that they are seen as very hopeful. They’re at an earlier stage of testing, still testing in animals but the first in this race are a vaccine. The ones that start first aren’t necessarily the ones that get to the finish line. So we’ll be watching with great interest when those vaccines get developed and we hope as quickly as possible to be able to have an effective vaccine, because that’s going to change the world completely.

MG: So you think we will get it? Because some say we may never get it.

PK: I think anything between never and sometime before the end of the year has been suggested. I think the latter is highly unlikely. I’m hoping that the former is unlikely also. But we do have to be realistic. There’s never been a vaccination against the coronavirus for humans. And so this would be an absolutely fundamental shift in vaccinations if we were successful. We know that some of the vaccines that have been developed or attempted to be developed for some of the other coronaviruses like SARs and MERs at least some of them, as they were being developed, demonstrated that you could actually make the disease worse rather than preventing it. And so that’s a concern because we have seen some immunological reactions to the COVID-19 virus. Certainly that seems to be one of the reasons why people get to get very sick in the second weak, and that’s luckily only a small proportion. But those that do develop severe symptoms, it seems to be at least partially due to an immunological reaction. And then we’ve seen this syndrome similar to kawasaki disease that has developed in a couple of the countries that have got larger numbers of of cases in young children. So it’s still not clear whether that is, in fact, due to COVID-19, but those are a couple of concerning signs about the immunology of this virus, which we’re still just starting to understand.

MG: Just to sum that up, you are hopeful of a vaccine, relatively confident of the vaccine, and what perhaps next year?

PK: Yeah, I’m much more confident than I was even a few weeks ago. I think seeing that the numbers of vaccines that are in development and to the numbers of pharmaceutical companies that are involved with national governments and philanthropy, all trying to work very cooperatively in this endeavour. That certainly makes me hopeful on many fronts that we are making progress. And I’m very hopeful that that it could go quicker than we first imagined because of these innovative ways that they’re looking to develop vaccines. But look, I like to be a glass half full person. And so so with my glass half full, I will hope that that sometime in 2021 we’ll be talking about vaccines. And then our challenge will be getting enough of them available to the people that need them, not only in Australia but throughout the world and particularly in the poorer nations of the world, so that we can have an equitable distribution of something that could change a lot of people’s lives.

MG: Just finally, in the early stages of this crisis, we had the distinct feeling that the health authorities thought we were clearly under resourced in terms of simple things like masks and less simple things like ventilators. Do you think Australia needs to be a lot more self-sufficient in its medical supplies generally?

PK: So, yes, it was it wasn’t a secret that we had a triple whammy, if you like, in terms of personal protective equipment in particular and masks in particular in those early weeks. And I think the triple whammy I would say the first is a huge increase in demand not only in Australia but around the world because of the threat of the virus as it spread really to almost every country. We had a severe disruption in supply that for all sorts of reasons, those supplies were not able …normal suppliers were not able to fulfil orders that were even of long standing. And the third element of the whammy, if you like, is that there’s an extraordinary irony that Wuhan, the epicentre of of the epidemic or the pandemic early on, and Hubei Province more generally is a powerhouse of the manufacturer of masks in particular. And so that all of the of the factories in that place were in lockdown for several weeks just at the time when we really needed them to be supplying the world. I think it’s really demonstrated or led to a re-examination of of how we get our our medical supplies, whether that will lead to an increase in the in long term manufacturers of said supplies in Australia remains to be seen. But certainly part of our capacity building has indeed been looking at expanding our, what was a very small factory that was supplying masks in Victoria and then looking at other states that have developed other supply mechanisms within Australia. It’s certainly a component. Ventilators similarly, we we did have we do have a ventilator supply in Australia, much smaller than the many other countries, but that was there and that they were able to increase their supply to redirect their supply as well. So that was that was a value. We’ve seen very innovatively but and and very welcomed a redirection of the rather large amount of alcohol that is manufactured in Australia for other uses being repurposed into into hand sanitizer. And so many of our small distilleries in particular have have come to the fore on that. So, yes, I think we need to look at that. I think we need to look at the way we are very dependent on on a particular one, one single country as a supplier of many of these absolutely fundamental things.

MG: And drugs more broadly to, not just tests. PK: Yes, exactly.So, many of our most of our medical supplies come from from overseas sources. And so so it’s certainly a wake up call to consider how we do that in a way that is not a threat. And I think also to re-examine, as we’ve done in the last couple of months, what’s in our national stockpile. And whilst we did have a national stockpile and that stood us in good stead early on, it’s clearly when we’ve had massive disruptions like this, we need to consider, you know, what the size and the components in that stockpile should be in the future. That’s certainly a lesson we’ve learnt and we’ll continue to learn as we go through this pandemic phase and.

MG: And more self-sufficient, not just have a stockpile from somewhere else, but make things here.

PK: Well, yes, and that’s certainly in terms of masks. We’ve done that, some types of masks, not all types of masks. And it’s always got to be a weighing up of the cost and so forth. And so I’m not an economist, so I’ll leave that to others to to consider. But, certainly there are some things that are fundamental to our running a health system, which we need to consider, how we make sure that we do have those supplies when we need them.

MG: Paul Kelly, thank you very much for talking with us today.

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A List of Ways to Die, Lee Rosevere, from Free Music Archive.

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