You are here

Health – Covid

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Monday, 6 June 2022

Tags: COVID-19, Health

Dr WOODRUFF - Thank you. Minister, this time last year there were zero cases of COVID 19 in Tasmania and 13 people had died of COVID disease. Since the borders reopened, there has been 167 774 people infected with Omicron, 66 extra people have died and Tasmania continues to have one of the highest reported rates of infection in the world.

COVID 19 is the highest cause of death in Australia now and we are learning more every day about the disabling and sometimes deadly effects of long COVID. Do you think your response since reopening the borders has done everything possible to keep Tasmanians safe?

Mr ROCKLIFF - We prepared as well as we possibly could, in terms of hospital preparedness. Of course, we based our modelling on the Delta variant. Our opening on 15 December 2021 did present challenges when it comes to the Omicron variant and other variants such as BA.2. You mentioned the number of people who have had COVID 19. I would also point to our relatively low hospitalisations compared to other jurisdictions, as well as relatively low death rates compared to other jurisdictions. As I said this morning, I am sure for the family and friends and loved ones of people who have passed away with or of COVID 19, that provides no comfort. Except I would point to the fact that we have continued to manage as best as possible the pandemic in terms of our measured easing of restrictions - you'll probably recall I named them protections, as Ms O'Conner does - but it has been done in a methodical measured way with the safety of Tasmanians in mind, first and foremost. We are guided by the best of Public Health advice and these discussions also happened at a national level through AHPPC and we will continue to be guided by Public Health advice.

Dr WOODRUFF - Why have you continued to focus on the short-term deadly effects of the SARS COV-2 virus and refused to include the potential serious risk of long-term complications from COVID infections in the Government's response and the aims for managing coronavirus in Tasmania?

Mr ROCKLIFF - Are you talking about long COVID?

Dr WOODRUFF - I'm talking about long-term complications, long COVID; post-viral illness is a post-viral complication. The long-term complications of COVID are many and we'll get to that in a minute, but your Government's response is focused only on hospitalisations, which is the acute, immediate risk of death or serious illness from COVID. Why have you not focused on long-term complications?

Mr ROCKLIFF - We have been focusing on the immediate needs of Tasmanians and ensuring that we have the health system and services as prepared as possible. That includes not only increasing our capacity in terms of hospital beds and indeed staff and our focus on vaccination, which we've consistently done very well with, but also investing in areas such as COVID@home, which has ensured we've been able to support people in their home and therefore easing the pressures off our hospital system. I am advised that has worked very well to date and will of course continue.

Dr WOODRUFF - The majority of people in Tasmania would be walking around under the misbelief that getting vaccinated against COVID is all they need to do to keep themselves safe. That is because your Government continues to reinforce that vaccines are the best protection against COVID infection. Do you agree that that approach deliberately ignores the reality of the waning effectiveness of vaccines and also of long-term COVID complications from being infected with the virus?

Mr ROCKLIFF - When it comes to people who are hospitalised with a COVID-19 diagnosis in Tasmania, I am advised that those unvaccinated are more likely to die than those who had received two or more doses of a COVID-19 vaccine. That is why getting vaccinated and keeping up to date with a booster continues to be the best defence against COVID-19. The vaccination is available at over 100 pharmacies around Tasmania, 100-plus GPs and state-run clinics across Tasmania as well. I want to reiterate that we are removing restrictions safely, sensibly and in line with national and Tasmanian Public Health advice. While I understand the lifting of restrictions may be concerning for some, it is another important step in our ongoing transition to live with COVID as we continue with our COVID-safe behaviours.

Dr WOODRUFF - What you just said, that vaccines continue to be our best defence against COVID, is exactly my point. When you say that, what you're talking about is the risk of serious illness and hospitalisation. You are not talking about the risk of infection from the virus itself and therefore you are not talking about the risk to people of potentially serious long-term disabling and deadly COVID infection outcomes. Are you ignoring long COVID and long-term complications?

Mr ROCKLIFF - No, I'm not ignoring it at all. The understanding of long COVID internationally of course is still evolving. It is a syndrome that may affect a variety of body systems to varying degrees and symptoms of long COVID are highly variable from individual to individual. As you would appreciate, the dominant strain of COVID-19 in Tasmania is the Omicron variant and the current view is that the presence of long COVID associated with Omicron is less severe, but this is not to say -

Dr WOODRUFF - You're talking about long COVID, not about long-term complications of SARS COV-2 infection. There are many of them and they're are potentially very serious and can cause death, disabling, dementia, diabetes, cardiovascular disease, lung disorders, a whole range of things.

Mr ROCKLIFF - Our understanding of long COVID is that it is still evolving, Dr Woodruff.

Dr WOODRUFF - Minister, this might be a question for the Director of Public Health. Vaccines provide a form of protection against serious illness and death and, to a very small degree, against infection. What do you estimate the current population level is of vaccine effectiveness against severe illness and COVID 19 infection, separately for each of the vaccine age groups? We have the nought to four, who do not get a vaccine, we have five to 11, 12 to 16, 16 to 50, over 50. What is the estimated effectiveness of vaccine coverage for those age groups?

Mr ROCKLIFF - COVID-19 vaccines?

Dr WOODRUFF - COVID-19 vaccines.

Mr ROCKLIFF - Dr Veitch, if I could invite you to the table, as indicated by Dr Woodruff. Mark Veitch is the Director of Public Health. Dr Veitch, did you hear the question?

Dr VEITCH - Yes, I did. It is going to be difficult to calculate all of those figures in Tasmania simply because the number of severe outcomes such as hospitalisation and deaths becomes very small once you get into the younger age groups in our population. We can look at the vaccine efficacy from having had two or more doses of vaccine versus having had no vaccine. If we look at the data, you will see the portion of cases who have had no doses of vaccine who have died is about three times that of the people who have had two or more doses of the vaccine. That calculates out to a vaccine efficacy against the outcome of death across the whole population of around 90 per cent, which is consistent with the findings in other jurisdictions worldwide. That does not break it down by age or particular vaccine but it is encouraging evidence that supports the information elsewhere about the protective effect of vaccine against severe outcomes.

Dr WOODRUFF - What I am trying to understand is, over the winter period, what our dropping vaccine efficacy will be across different population groupings. Maybe you don't have enough numbers, as you say, to provide that information by those age groups. But what is the department's understanding about where different populations are up to in their vaccine take up? There has been a number of months since people have had booster shots, some many months depending on where people were when ATAGI approved boosters to be available for different groups. We are having waning efficacy of vaccines. Where is your estimate that we are up to in terms of the effectiveness of vaccines? And where do you think we will be by the end of winter?

Dr VEITCH - The honest answer is that I don't think I know and I don't think that is currently knowable. I think it is best not to speculate. What I would observe is that, along with having had vaccine provided to a large proportion of the population, probably half or more has experienced COVID-19 infection in the last three or four months. We have a situation with a high level of vaccination boosting, the winter doses to the most vulnerable and also recent experience with actually having had, for most people, fortunately, a modified form of COVID 19 illness as a result of being vaccinated. There is a large number of things there contributing to population immunity.

The other thing I would note is that, at the moment, nationally and in Tasmania, we are seeing a drop off in cases down back towards under 100 per 100 000 per day in most jurisdictions. That, I think, probably reflects some modest level of herd immunity that is making transmission a little bit less prominent at the moment.

We have to be wary of the possibility of another wave of infection later in the year, as you observe. But I think we do have good surveillance mechanisms in place, both for COVID 19 generally and for variants of COVID 19, that will give us a warning of variants of public health significance.

Dr WOODRUFF - Could you tell me, by each vaccination group, what proportion of Tasmanians are not fully vaccinated at the moment according to the ATAGI definition of full protection?

Dr VEITCH - We will need to find -

Mr ROCKLIFF - Age group?

Dr WOODRUFF - Yes. Zero to four, no one is protected because there is no vaccine. Five to 11, 12 to 16, 17 to 50 and over 50.

Mr ROCKLIFF - I've got the clinical severity and deaths reported. COVID-19 cases by age group in terms of - that is a surveillance report though. Vaccination coverage.

Dr WOODRUFF - I’m asking for the 'not covered' proportion.

Mr ROCKLIFF - Right. I have some percentages, so we can probably reverse the percentages, if that makes any sense. The five to 11 age group, population of which is 45 033, 63.99 per cent have had their first dose and 22 599 people have had their second dose, which is 50.18 per cent of the population. This is 1 May again.

Dr WOODRUFF - That is 48.2 per cent who are not fully protected?

Mr ROCKLIFF - Yes. For 12- to 15-year-olds, total population of 26 300, we have 87.18 per cent having their first dose and 83.04 per cent with their second dose. In the 16 and above -

Dr WOODRUFF - That is 17 per cent not fully protected.

Mr ROCKLIFF - Yes, 16.96 per cent. In the 16 and above, the population is 444 277, percentage of vaccination is above 99 per cent and the second dose percentage is 98.84 per cent.

Dr WOODRUFF - And the booster?

Mr ROCKLIFF - I have 306 508 Tasmanians 16 and above, as at 1 May, with a booster, which is 69.63 per cent.

Dr WOODRUFF - So, that is 31 per cent in that age group not fully protected. And over 50?

Mr ROCKLIFF - If we go to today's figures, boosters for the 50 and above age group, 85.9 per cent.

Dr WOODRUFF - And the number of people, what is the actual absolute number of people in the 50 over?

Mr ROCKLIFF - I haven't got that figure but if we have got 71.36 per cent of what would be 44 000, which I've mentioned, this population figure here. But that might have changed since 1 May as well. But we can provide that number if you would like us to.

Dr WOODRUFF - Thank you, I will put that on notice.

Dr WOODRUFF - Can you summarise for us, please, what you understand to be the main long-term health potential health complications of COVID-19 infection? I am talking here, not about the post-viral syndrome, but particularly the research into impacts on the cardiovascular system, the brain, immune system, et cetera.

Could we have a statement from the Director of Public Health about what we understand about this?

Mr ROCKLIFF - Well, I think we are still learning a lot about this matter, Dr Woodruff. I am not sure if Dr Veitch has had these discussions at a national level at AHPPC.

Dr WOODRUFF - Or just from his own research.

Mr ROCKLIFF - Or Dr Veitch's own research, potentially. I invite Dr Veitch to answer the question if he can.

Dr VEITCH - I would love to have time to do my own research, I have to say. A number of national bodies are scanning the research, providing input to AHPPC, and to clinical advisory groups at a national level. They are throwing their net widely, so they are not just focussing on the, as yet fairly ill-defined, condition of long COVID.

Dr WOODRUFF - To be quite clear, I am not talking about the post-viral long COVID, I am talking about the more prolonged multiple organ damage, which is, I think, a different matter.

Dr VEITCH - I think you are right, Dr Woodruff. There is evidence of reduced lung function months out after COVID; there is evidence of changes to microvasculature that can have effects both in the cardiovascular system and potentially neurologically; there is active work going on to try and find immunological markers that may contribute to ongoing infections that could be precipitated by COVID-19. I think it is probably best that I don't try to profess to have a greater knowledge than that broad scan of the information, but that information will be able to feed into national guidance and inform the specialists who will be engaged as part of the Tasmanian response.

Dr WOODRUFF - Thank you, minister. There is some very strong suggestive evidence that COVID-19 infection, even in people who don't have express symptoms, can have long-term heart problems. For example, some research published in the British Medical Journal is quite clear in raising concerns about that. There is also very strong evidence of other cardiovascular outcomes so there is a lot of evidence now that there are issues we need to be very cautionary about. Can you tell me whether you have modelled any of the potential probable burdens of disease for some of these issues in Tasmania? I am thinking of cardiovascular disease, the increased risk of diabetes that suggested and other issues relating to brain function and dementia.

Mr ROCKLIFF - I am not aware of any modelling specific to your question. I am not sure if Dr Veitch is aware of it happening within the nation or not.

Dr VEITCH - I am not aware of that but I know there is intense interest in the long-term outcomes of COVID-19, so I would be surprised if once the risk of those outcomes was better defined such as the numerical model could be applied to it, that people didn't do that sort of work. It would also be very important to look at the other contributing factors, particularly in the Tasmanian context, to those common cardio-respiratory outcomes we are all concerned about. I think it has to fit into a more comprehensive model as well as take into account any consequences of COVID-19.

Dr WOODRUFF - Do you accept that there is the potential for serious long-term health complications, potentially disabling or causing early death from COVID-19?

Mr ROCKLIFF - I would like see the evidence that supports that, Dr Woodruff.

Dr WOODRUFF - I tabled some of it in parliament once.

Mr ROCKLIFF - You have said you have suggestive evidence there but there is evidence and data that you can present. I am sure there is lots of research in respect to this matter worldwide and it will be of intense interest to not only Dr Veitch and others in Public Health but also within the health system when we go about the clinical design of our services we provide as well into the future.

Dr WOODRUFF - A total 167 000 Tasmanians have been infected with COVID-19 since you reopened the borders. Aren't you concerned to be as careful as you can, given what the evidence is telling us about the potential long-term serious disabling impacts of COVID-19 infection? Why aren't you asking people to wear masks? Why is there no public education campaign about what effective mask-wearing looks like?

Mr ROCKLIFF - We are not discouraging people from -

Dr WOODRUFF - You're not encouraging them.

Mr ROCKLIFF - But we are not discouraging people from wearing them.

Dr WOODRUFF - You're doing nothing.

Mr ROCKLIFF - I have been reminded of the health pathway which I think I mentioned already today. Would you like to speak about that, Mr Webster?

Mr WEBSTER - The pathway for people who develop the longer-term symptoms, not just long COVID-19 but longer symptoms of it, is to make sure that we have the connections that flow through our primary care system, because GPs are the most likely to pick them up in the first place, through to our specialist services within the Tasmanian Health Service. We have worked on that pathway with primary care and that has been endorsed. In fact, we are the first state to complete that work.

As the Premier announced, the second step is then to have a navigational referral service within the Tasmanian Health Service, recognising that this is a range of symptoms. As you said, it's anything from dementia to cardiovascular and you can't have one clinic that can service all, so we're setting up a room navigation referral service that can navigate the patient from the GP to the particular service they need and we will have that in place by September. It is an evolving area. I understand that the Doherty Institute are doing national research into this which will inform the AHPPC's response and all our governments' response, but we're so small in numbers that at this stage there is no local research.

Dr WOODRUFF - Returning to the long-term health impacts of COVID infection, there is a lot of research. I want to point to some research published in the British Medical Journal earlier this year that reported on some research in nature medicine that found that even one year after infection with SARS-COV-2 people were at a higher risk for a range of cardiovascular disorders. For example, there was a 72 per cent increased risk of heart failure, a 63 per cent increased risk of heart attack and a 52 per cent increased risk of stroke, compared with controls. That was an enormous study of 154 000 cases of COVID-infected people. They are big numbers and the researchers found that this was independent of the types of groups, so younger people, older people, African-Americans, non-African-Americans, people with obesity, people without, all had an increased risk. Their conclusion was that if you have been infected with COVID, there is a substantial increased risk of cardiovascular disease, and the most important thing to do is to prevent infection in the first place.

Minister, despite findings in multiple studies, I think we know enough. The early evidence is very strong that there are serious potential risks across a number of health disorders. Why are you continuing to stay with a public health response which just looks at avoiding hospitalisations? Why aren't you looking at what we need to do to avoid people becoming infected in the first place?

Mr ROCKLIFF - Out of interest, did the study talk about the variant in terms of Delta versus Omicron, in that 154 000?

Dr WOODRUFF - That was research done on the Delta variant, but other research I have is looking at the Omicron variant. There's no good news from any of the variants we have information about.

Mr ROCKLIFF - The number-one priority of the Government has been to keep Tasmania safe. We have done that all the way through. We based our 15 December opening on the Delta variant, which is far more severe. Omicron hit our shores, which was highly transmissible, but it would appear less severe than Delta.

Dr WOODRUFF - In the acute phase of the disease, yes, but this is about the long term. It is not unknown, it is actually increasingly known and increasingly concerning.

Mr ROCKLIFF - Well, there is a lot more research to be done and we will be more than open and willing to avail ourselves of that research and the impacts on our health system and the health provision we need to provide our population. You mentioned cardiovascular disease in more vulnerable communities and I am mindful of the fact that in my neck of the woods, the north-west coast, we have a high rate of cardiovascular disease, so I am interested in what you're saying, but I think you're also saying that our response hasn't been the response you would have had if you were health minister or director of public health or whatever you'd like to be.

I believe we've managed the pandemic from the start to now - and of course we're transitioning - well and we'll continue to manage it well through sensible lifting of restrictions. We've often waited to see the impacts of lifting restrictions on the mainland. We chose to open our borders with a vaccination rate of 90 per cent, not 80 per cent as other states have done, to ensure that our best line of defence was really up in that 90 per cent level.

I accept your criticism that you would have done it perhaps another way but I believe we've managed well through the best national advice and indeed local Public Health advice which has been guided by the very best of expertise. I would have to say that if you were in another state and you were questioning the minister for health of the day or the premier of the day on why there was a separation between the public health advice and response and the government response, then you might have some argument, but we have always maintained we are very closely guided by Public Health officials in this matter.

Dr WOODRUFF - Minister, you continue to talk about a period which is long past now, which is the period where we had almost no infections in Tasmania. It is a different time, 167 000 Tasmanians have been infected with a virus that the research is increasingly telling us has the potential for serious long-term health complications. For Tasmania from the hospital budget point of view, if we are talking about increases of that scale for cardiovascular disease, for example, that's a big concern for a hospital budget looking ahead into the future.

Thinking about what can be done for people's lives, it's pretty clear and there's some evidence that was published only this week in Nature Epidemiology that vaccination against SARS-CoV-2 only lowers the risk of infection with the virus by about 15 per cent. In other words, vaccination is not your pathway to avoiding becoming infected; in fact 85 per cent of people according to this 13 million people cohort study are not protected against infection. The only thing that can protect people is good ventilation and wearing masks indoors, so why haven't you changed your advice to make it crystal clear to Tasmanians what effective mask-wearing looks like and are setting a standard of requiring people to wear masks indoors?

Mr ROCKLIFF - Again, we have had a very sensible lifting of restrictions. I might also say that in high-risk settings we are still required to wear masks and that will no doubt continue for the foreseeable future. We still have masks worn in high schools, for example. I get many emails a day from people who are less than satisfied with our policy that continues with respect to wearing masks in high schools. I've put a lot of social media posts up and irrespective of the subject matter of the day there is considerable commentary on mask-wearing generally, in that sense -

Dr WOODRUFF - It's partly because we've dropped the ball in terms of leadership. We're not modelling it. When you went to the footy, a photo of you in the newspaper. You went to the footy, the next day, I am sorry to hear, that you were infected with COVID-19 and were sick. The press release that was handed out by your department said zero about mask wearing. Nothing in this press release that was reported here mentioned the recommendation that people wear masks.

Why? Obviously, to protect you from the embarrassment of the fact that you were sitting in close proximity with people, and got infected It's just a numbers game. There is nothing perfect here. We cannot possibly hope to prevent all infections. No-one is suggesting that. But reducing all the possibilities that we can, will mean less people infected, and less people at risk of long-term complications and all the other things that go with that. Why aren't we encouraging people to wear N95 masks? Why aren't we mandating people do that in indoor closed spaces?

Mr ROCKLIFF - I could refer you to Dr Veitch; however, I repeat that we have lifted restrictions sensibly, in line with advice, and we still have masks in high-risk settings, such as a high school. I hope that would be a signal to you that we do take this seriously. But also, we are not saying to people they shouldn't wear masks. People can wear masks in whatever setting they like.

Dr WOODRUFF - Modelling helps. We all need to model good behaviour and Premiers, Ministers for Health especially need to model good behaviour. That is what they are doing in the US, everyone wears masks in the US.

Mr ROCKLIFF - That's no massive endorsement of a COVID-19 pandemic response. It has improved since President Biden.

Dr WOODRUFF - Its improved since Biden administration. It had a long way to catch up from.