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Health – Covid

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Monday, 5 June 2023

Tags: COVID-19, State Budget

Dr WOODRUFF - Minister, are you aware of the advice that has been released by the Victorian Chief Health Officer to Victorians to help them recently protect themselves in the COVID-19 wave that we are having at the moment? The advice consists of wearing a mask, getting a 2023 booster, letting fresh air in, opening windows and doors to reduce the spread of the virus, getting tested, staying at home if a person has COVID 19, staying at home for at least five days, or until they have no symptoms, and talking to their doctor. Are you aware of that advice?

Mr ROCKLIFF - Well, that's advice to the Victorian people. We have our winter plan, which encourages vaccination as well and COVID 19 safe behaviours.

Dr WOODRUFF - Do you agree that's potentially life-saving advice that the Victorian Government CHO has provided?

Mr ROCKLIFF - We're managing respiratory infections during winter this year. This includes all respiratory illness, particularly influenza and COVID-19. The winter strategy aims to ensure the state is prepared to manage respiratory infections during winter, with a focus on health system preparedness, infection prevention, detection and early treatment to minimise health harms and health system strain. The strategy is accompanied by a comprehensive communication campaign, encouraging Tasmanians to take steps to reduce their risk of winter illness.

Implementation of this strategy includes the following key elements, which I'm sure you would be very interested in, Dr Woodruff: supporting health system readiness to respond to demand through enhanced statewide coordination, escalation planning and increased bed capacity where possible; influenza and COVID-19 vaccination coverage; testing and surveillance; working with priority groups such as aged care, disability care, education and early childhood to optimise vaccination coverage and to plan for and manage outbreaks of infections. We are supporting Tasmanians to access testing treatment and care by maintaining hospital capacity and providing community-based care alternatives, such as COVID@homeplus. COVID@homeplus will continue to provide a 24 hour seven day a-week service to provide care and support to vulnerable or high risk Tasmanian people with COVID 19 and other respiratory infections in the community.

Dr WOODRUFF - Minister, I was talking about advice to individuals about how they can protect themselves during the current wave.

Mr ROCKLIFF - I agree.

Dr WOODRUFF - The current and ongoing level of community transmission is substantial but Public Health Tasmania hasn't released the sort of accessible high quality advice that the Victorian Government has. The advice from our Public Health is to take personal responsibility; to keep your hands clean by washing with soap and water or by using alcohol based hand sanitiser; covering coughs and sneezes, which doesn't protect you from other people's infections; and staying at home when you're sick. No advice on how long to stay home for, no advice not to leave if you have symptoms. Can you see that there's a problem with the quality of the advice being provided in Tasmania?

Mr ROCKLIFF - The winter strategy is supported by the comprehensive public information campaign which is currently underway.

Dr WOODRUFF - I have a copy of it here from the newspaper and that's what it says.

Mr ROCKLIFF - I remind everyone to please receive your annual influenza vaccine; keep up to date with your COVID 19 vaccinations; make early plans with your GP to access testing and antiviral medication, if eligible, before you become unwell; stay at home when unwell; maintain hand hygiene and cover coughs and sneezes; access the most appropriate care if you become unwell, including primary care, COVID@homeplus and, if you are severely unwell, please present to a hospital. We have quite a comprehensive winter strategy plan here from the Department of Health.

Dr WOODRUFF - I'm talking about advice to -

CHAIR - Order, Dr Woodruff.

Dr WOODRUFF - I'm not interrupting him; he's stopped speaking. I'm clarifying; I'm not talking about what the Government is doing. I am talking about the advice to Tasmanians during the current winter wave of COVID 19 about how they can keep themselves safe.

Mr ROCKLIFF - Yes, exactly, so the Winter Wellness campaign supports the 2023 winter plan. It uses an integrated multi-channel approach and encourages Tasmanians to take steps to minimise their risk of severe respiratory illness through winter. So, prepare by being up to date with your vaccinations. They will boost your immunity against COVID 19 and the flu to reduce severe illness if you get sick. Plan. If you are at high risk of severe illness, make a plan with your healthcare provider for access to testing and antiviral medication if you get sick, as I said. Protect yourself and others by washing your hands, covering your coughs and sneezes, and staying at home if you are unwell.

Dr WOODRUFF - Can you see that people have pointed with a great deal of concern about your repeated failure to provide advice to people to wear masks? All you talk about is to wash your hands, which is almost ineffectual in an airborne virus. Why do you continue with not telling Tasmanians to protect themselves by wearing a mask and staying at home if they have any symptoms?

Mr ROCKLIFF - I point you to Dr Veitch's media statement on 1 June regarding a number of matters. Of course, separate to that, we would encourage the wearing of masks, particularly around vulnerable Tasmanians. Masks are more commonplace now than they were pre COVID 19. Personal responsibility is very important so we also encourage individuals to register their positive result for COVID 19 and offer registration in COVID@home, receive individual instructions on treatment and isolation. So, there is a lot of information when it comes to COVID 19, Dr Woodruff.

Dr WOODRUFF - Minister, I am concerned at the degradation of the advice provided to Tasmanians about how to protect themselves from COVID-19 over the past year by your department. I have in front of me from October last year, which is only nine months ago, public health advice telling Tasmanians that if you are a positive case or contact, ask your workplace about their COVID-19 policy for your return to work. If you have COVID-19 or respiratory symptoms, you should avoid contact with high-risk settings for seven days. If you need to leave home wear a mask. You should wear a mask in indoor public places and avoid those places for seven days if you have COVID-19 or symptoms. At the moment the advice available is to stay at home when you're sick, wash your hands, cover coughs and sneezes and talk to your doctor if you're in a high-risk group.

This is a huge degradation in the advice. What is the basis for that? Maybe the Director of Public Health would like to provide some advice to us about this? We do have a hardening of evidence about the risks of infection and reinfection of COVID-19 and long COVID-19 symptoms. It was the third biggest killer of Australians last year. We are finding out more about the dangers of COVID-19 infection, not less. But, your advice is getting worse.

Mr ROCKLIFF - I don't accept any degradation of advice.

Dr WOODRUFF - Well, it is. Why don't you tell people to wear a mask in crowded settings, or stay at home if they have any respiratory symptoms?

Mr ROCKLIFF - I've always said I encourage people to.

Dr WOODRUFF - That’s not the advice.

CHAIR - Dr Woodruff, can you please let the Premier answer the question?

Mr ROCKLIFF - I think you'll find that it is most likely the advice. Dr Veitch would you like to come to the table and talk about the current state of play with respect to COVID-19 advice. I referred to Dr Veitch's media statement before. That was in relation to an increase from low to moderate. That was the reason for the release, as I understand?

Dr VEITCH - In the first instance I would refer Dr Woodruff to our website, which provides the advice she is seeking. It tells us that people who have symptoms or a respiratory infection are encouraged to get tested, to stay home while they're ill, to register a positive RAT, knowing if they have a positive PCR the lab will notify it and ensure that any predetermined pathways to care are followed up. So if they are seriously unwell, or at risk of becoming unwell, they will get anti-virals quickly. They are recommended to stay at home while they have symptoms. They are recommended to wear a mask if they are outside their home for seven days, at least, after their diagnosis. This advice is in keeping with the Victorian advice. We called it the COVID-19 risk level, but it's more useful to consider it as the winter respiratory illness risk level. COVID-19 has increased steadily since February, but we are seeing far fewer cases than we were at almost any time last year.

However, the cases had increased and we had seen a modest increase in the number of people hospitalised. We'd seen a number of infections in residential aged care, but again, nowhere near as many as we were seeing last year. We thought it was prudent to give the public advice to be more vigilant, undertake protective actions because we know that every winter, with the exception of the extraordinary winters of 2020 and 2021 when we were locked down, we'll see an Influenza epidemic go through. That will happen quite quickly.

The reason for raising public awareness last week was more than COVID; it was also to be ready for a winter epidemic of influenza which typically comes on very quickly and gets quite high, quite quickly - within two or three weeks; much more quickly than COVID has increased in recent weeks. And also there's respiratory syncytial virus which has also had a modest increase. We were providing advice to the public to reinforce a lot of the messages we provided over the last few years.

Mr ROCKLIFF - And the website says - if you test positive by RAT, register your result; stay at home while you still have symptoms, as I believe I alluded to; wear a mask in indoor public places for 7 days after your positive test; and, if you have COVID-19 or cold or flu-like symptoms, do not visit high-risk settings or people at high-risk from respiratory illness for at least 7 days. Then it goes through covering coughs and sneezes as well as saying that public health recommends wearing a face mask in crowded indoor spaces, on public transport and when visiting people who may be at risk of severe illness.

Dr WOODRUFF - Well, that's a change because when the information that I've got was printed, at the time it was raised to moderate didn't say anything like that. So, clearly, something is breaking through. We are the only state that hasn't had a chief health officer or a director of public health or premier address their population about COVID-19 in the last 6 years. We've had -

Mr ROCKLIFF - The website was updated on 4 May.

Dr WOODRUFF - Okay, fine; but we've had the Australian Chief Health Officer; we've had New South Wales only a few weeks ago; Queensland; South Australia; ACT - all the other states are addressing people about COVID-19 and associated risk levels and how to keep safe. We've had nothing from you, as the minister; nothing from the Director of Public Health in his role. There's no visibility. It might be that there's something on a public health website - and there obviously is now - but that hasn't been the case and it's not a public campaign to vaccinate. We have children under 5 years-of-age completely unvaccinated. There is no advice to Tasmanians, telling them to stay home. Will you accept that Victoria sets a good standard by advising people to stay home for at least five days if they have COVID-19 and until they have no symptoms?

Mr ROCKLIFF - It sounds like we have stronger advice, with the seven day advice I referred to there. I think it aligns -

Dr WOODRUFF - And no symptoms?

CHAIR - Dr Woodruff, can you let the Premier answer your question, please.

Dr WOODRUFF - Well, there's two parts to that advice.

CHAIR - Order, Dr Woodruff. Thank you.

Mr ROCKLIFF - We also have COVID@homeplus which is a very helpful service. I know that Dr Veitch launched the winter plan and answered a number of questions at that point in time. We have a comprehensive website as well as social media for public consumption; so I believe we are doing well in terms of information presented. Tasmanians have become very accustomed to accessing their Coronavirus information

Dr WOODRUFF - But they can't get a test, for love nor money; not a PCR - thanks to you.

CHAIR - Dr Woodruff.

Mr ROCKLIFF - I think you can get a PCR test; but we're also still issuing RATs.

Dr WOODRUFF - Not publicly available.

Dr WOODRUFF - Premier, COVID-19 vaccinations are increasingly effective at reducing people's risk of serious acute disease. But we know now that serious illness, hospitalisations, ICU admissions are just a tiny tip of the iceberg of the impacts that COVID 19 can have on people's health. The evidence of the long-term risks of neurological diseases, neurodegenerative, advanced ageing, cardiovascular disease and impacts on every organ in the body appear to be substantially increased. COVID-19 was recorded as the third biggest killer last year and that was not from the acute infection deaths. Do you agree that the long-term health impacts, both for individuals and for the population of Tasmania, are likely to be significant from COVID 19?

Mr ROCKLIFF - I'm very interested in long COVID so I hear your question. While I'm advised that most people who have COVID-19 will recover within a few weeks, there are some that may experience long-term symptoms. Internationally, the understanding of long COVID is still evolving but I am advised that people who are up to date with their vaccinations are less likely to experience long COVID. Vaccinated individuals who do experience long COVID typically experience symptoms that are less severe and that last for a shorter period. I would encourage all eligible Tasmanians to remain up to date with their COVID 19 vaccinations as a consequence.

In June last year, we announced a $400 000 investment to establish the operation of a statewide long COVID navigation service. The long COVID service commenced on 19 September last year to support Tasmanians who have long COVID, access appropriate care and manage their ongoing symptoms. The long COVID navigation service has been established as an extension of the COVID@homeplus program. The objective of the service is to optimise post-COVID 19 care within primary and tertiary healthcare settings. Its goals include improved access to timely care, reducing inequalities, helping management provide guidance and decision support for primary care, delivery of coordinated and patient-centred care, and improve patient outcomes. The navigation service is available to patients statewide through a referral from their GP.

The service is an extension, as I say, of the COVID@homeplus program. It has received 108 referrals in its first six months, with 46 referred on for specialist medical assessment.

I am just wanting to find some further information without repeating what I've just said. We have the federal government long COVID inquiry report. That's the standing committee on health, aged care and sport report. It aims to improve Australia's response to long COVID, an often debilitating condition possibly affecting hundreds of thousands of Australians. I have mentioned some of the figures more locally for us.

A national long COVID parliamentary committee on long COVID and repeated COVID 19 infections made nine unanimous recommendations aimed at strengthening the Australian Government's management of long COVID. That includes the definition of long COVID for use in Australia; evidence-based living guidelines for long COVID, co-designed with patients with lived experience; a nationally coordinated research program for long COVID and COVID-19; the vaccination communication strategy; access to antiviral treatments for COVID-19; support for primary healthcare providers; focus on indoor quality and ventilation. And the committee recommended, given the multiple questions that have risen during the inquiry, that the Australian Government consider a comprehensive summit into the COVID-19 pandemic and Australia's past and current response, including by all governments at all levels. If that comes to fruition, of course we would want to participate.

We have vaccination data -

Dr WOODRUFF - Probably not one I'm interested in, thank you. My question was not about long COVID. Do you understand the distinction between what's generally termed long COVID, what you just read out, which is serious and important. But the other very serious impacts for individuals and the health system of the long-term impacts on people's organs that, without them necessarily expressing any other symptoms, can at a later date lead to a much higher risk of diabetes, Alzheimers disease, heart attacks in young people, a whole range of other diseases, events, and death that can occur because of prior COVID infection, even in the absence of any other symptoms? Do you understand that that is actually the case and what is your advice about the impacts in Tasmania on our health system with the increased risk of what we're expecting from the evidence? Diabetes, heart attacks, Alzheimer's, ageing and a whole range of other things.

Mr ROCKLIFF - Thank you, Dr Woodruff.

Dr WOODRUFF - Do you understand the distinction between the sort of long COVID symptoms you just read out, also serious, and this other big increased risk of every other organ disease from the coronavirus?

Mr ROCKLIFF - From the way you've presented that, there appears to be a distinction and -

Dr WOODRUFF - It's obviously blurry, but yes. I'm trying to get to this part -

Mr ROCKLIFF - Perhaps I'll go to Dr Veitch first and then if Professor Lawler could add any value to Dr Veitch's comments perhaps Professor Lawler could speak as well.

Dr VEITCH - Thank you, Premier. Dr Woodruff, you're drawing attention to the distinction between people who've got a series of symptoms, often with pronounced fatigue and poor concentration, the concept of brain fog, which is a fairly familiar clinical syndrome occurring after significant illness. It occasionally occurs after influenza and in glandular fever it's a fairly familiar experience for clinicians and it appears to be relatively common after COVID infections, perhaps as many as 5 per cent, although most of those people resolve symptoms within the following six to nine months, and it is more common in people who are unvaccinated, people who've got severe COVID and people who have conditions before they get sick. That has certainly been a prominent focus.

You draw attention to the probably incompletely understood phenomenon of a range of chronic conditions, often with an underlying degenerative or vascular basis, that is currently the subject of fairly intense epidemiological and pathophysiological research. I think we're probably not in a position to be able to conclude that this is going to be a long-term, ongoing tail of serious illness, but I think we obviously have to be mindful of that possibility. We have to have our surveillance for those conditions in place. We do have surveillance for all causes of mortality associated with the last couple of years and it's certainly the case that the number of excess deaths that occurred in the course of particularly 2022 is higher than the actual number of deaths that are attributed purely to COVID.

Dr WOODRUFF - You could tell us that number, if you wouldn't mind.

Dr VEITCH - I don't have the number.

Dr WOODRUFF - I believe the number is in the order of 10 per cent higher than average years, which has been, I understand, by many people attributed to COVID.

Dr VEITCH - I think it's in the order of 10 per cent, Dr Woodruff.

Dr WOODRUFF - That's a lot, isn't it?

Dr VEITCH - I think it's very important for people to understand that every year in Tasmania around 3500 to 4000 people die, mostly of substantial age at the end of their lives, and there is year-to-year variation in the number of people who die. I think it's too soon to necessarily say that all of that 10 per cent was directly or indirectly due to COVID, but at least half of it is probably due to COVID.

Dr WOODRUFF - Other people have said that. Other Australian health experts have made that assessment. I don't put myself in that category, obviously, I'm just repeating what has been expressed and believed by the Institute of Health and Welfare who did some of that research, but thank you for that. Are you saying then - through you, minister - that you don't think the evidence being accumulated on a regular basis by Nature, Science, The Lancet¸ Journal of American Medicine, et cetera of the increasing risks on organs from coronavirus is a concerning or a significant matter?

Dr VEITCH - I certainly did not say that.

Dr WOODRUFF - No. What are we doing about that evidence and what it's pointing to increasingly, this consistent story of the impacts of coronavirus damaging organs and the need to protect ourselves from the virus in the first place where possible?

Dr VEITCH - I think you're drawing attention to the burden of chronic disease in Tasmania, which is a very significant issue for us. We have relatively more risk factors in our population and relatively high rates of chronic disease, including heart disease and diabetes. I think it's absolutely critical that we have, if you like, all-cause prevention and all-cause care for those people so that we don't put all of our eggs in the COVID basket. You also attend to things such as people's smoking, their behaviour that may increase their risk, and we provide a comprehensive approach to that care. I think Tasmania is a modest player in medical research but probably kicks above its weight, certainly in areas such as cardiovascular disease. We've done excellent research over the years and we would be looking to the cumulative advice from the 300 or so papers that are published every day on COVID to really understand the significance of these factors over the long term.

Dr WOODRUFF - Thank you. Minister, I'm concerned that you're equivalising the risk of being infected with the flu with being infected with the coronavirus. I'm concerned that the message of your Government is to put them in the same bucket. Of course they're both concerning but why aren't you talking to Tasmanians about the particular risks of infection and the increased risk of reinfection with the coronavirus, which is different to other respiratory viruses?

Mr ROCKLIFF - I pointed to the comprehensive information on the website including weekly statistics, testing, staying well and the matters -

Dr WOODRUFF - Does it talk about reinfection risk?

Mr ROCKLIFF - Would you like to talk about reinfection, Dr Veitch?

Dr VEITCH - The simple thing about reinfection is that just about all infections now are reinfections because we've almost all been infected at least once with COVID, so the concept of reinfection is really akin to what we experience with a range of other viruses where we have multiple infections over our lifetime and slightly different strains of those viruses. Of course we have to be vigilant for what may occur after sequential infections. We maintain surveillance for COVID and we will continue to do so. As possibly the most intensely investigated and researched condition in human history, we're probably going to find the answer to the consequences of reinfection. Clearly, if you get reinfected you're going to do relatively worse if you are older, if you haven't been vaccinated and if you lack access to treatment. Maintaining vaccination, boosters, early access to testing and treatment are the key things to avoiding the worst consequences of future infections and reinfections with COVID.

Dr WOODRUFF - Are we still requiring hospitals to report hospital acquired COVID cases?

Mr ROCKLIFF - In the management of outbreaks is the answer as I understand it.

Dr WOODRUFF - As in all the time?

Mr ROCKLIFF - Would you like to talk about that, Dale, or clinical services planning?

Dr VEITCH - I just note that our surveillance system captures who are reported as hospitalised.

Dr WOODRUFF - No, do we collect data on hospital-acquired COVID infections?

Dr VEITCH - We do.

Dr WOODRUFF - And report that?

Dr VEITCH - I will turn to Mr Webster on the reporting.

Mr WEBSTER - We continue to monitor outbreaks within our hospitals, including hospital-acquired infections, and that is reported internally through us and we provide that data through Public Health as well on a regular basis. We are also monitoring outbreaks in residential aged-care facilities ongoing as well.

The minister mentioned clinical services planning. I am going to the studies you're talking about and those sorts of things. It is really important that we take them into account in terms of planning for our future needs in Tasmania.

We have a process of clinical services planning that picks up those changes in the health demographics within our population. A crude example, 50 years ago we wouldn’t have planned for as much dementia in our hospital systems as we have in the last 20 years with the aging population. Those sorts of changes to the system in what we can expect in disease in our population are part of our long-term plan but also part of our ongoing clinical services planning so that we know what we need within our system.

Mr ROCKLIFF - I understand, Dr Woodruff, the COVID@homeplus asked you whether you have been positive before. There will be a survey that is taken into account with clinical advice which is information on reinfection as well.


Dr WOODRUFF - I have some questions on paediatric COVID-19 that may or may not be appropriate for Dr Veitch. It might also be someone at the table who answers them - Prof Lawler?

It's in relation to some research published by the Journal of the American Medical Association Network Open that suggests children who acquire COVID-19 infection are at increased risk of type 1 diabetes development. Some additional research in the Journal of Paediatrics suggests there's been a significant increase in paediatric diagnoses of type 2 diabetes since the start of the pandemic.

I expect Tas Health keeps data on the incidents of diseases like diabetes, hepatitis and heart conditions in different cohorts.

Are data available on the incidents of these diseases in paediatric patients before and after the onset of the pandemic? Have we identified any increase or spike in childhood diabetes, hepatitis or heart conditions since the onset of the pandemic?

Mr ROCKLIFF - Thank you, Dr Veitch. Perhaps we could commence the answer to the question from yourself.

Dr VEITCH - I am aware of the paper that’s been published on increased incidents of diabetes in young children in America, which I think has come out in the last month.

I'm aware of the paper that was published about the increased incidents of type I diabetes in young children that's been possibly attributable to COVID-19 infection. Bearing in mind that almost all young children will have had COVID-19 infection.

I am not aware of the mechanisms in Tasmania for surveillance for new onset diabetes among young children. It would be a question that we would need to seek advice from the paediatricians on their surveillance of that.

Dr WOODRUFF - We don't collect data on the incidents off diseases like diabetes and hepatitis by age cohort?

Dr VEITCH - I don't know what the mechanisms are. Neither of those are notifiable diseases under the Public Health Act, but they're certainly significant diseases and I think I would seek advice on that from the paediatricians.

Dr WOODRUFF - Could you table that advice? How would you seek advice, through you, Premier? You mean you might do this as a formal mechanism.

Dr VEITCH - It is not something I plan doing, to be honest. Surveillance in the management of paediatric diabetes is not normally within the province of public health surveillance. The first way to understand that would be a discussion with the paediatricians.

Dr WOODRUFF - That’s why I thought it might be someone else at the table who could answer that question. Thanks Dr Veitch.

Mr ROCKLIFF - Perhaps Professor Lawler could?

Prof LAWLER - Through you, minister, I would think, Dr Woodruff, that it’s probably worth noting that we do capture clinical and operational activity within the public health system, which is predominantly to do with presentations with disease states rather than incidents within the community.

As Dr Veitch has highlighted, there is a lot of information and data collected on specific notifiable disease of which neither of those currently stands as a notifiable disease. I think what Dr Veitch describes about gathering and understanding from local paediatricians, it is important to note that a lot of provision of such care is also occurring within the private sector which we don't necessarily capture under our report arrangements. We do code for presentations within the public sector and health activity on that basis, which is, as you would appreciate, different from incidents within the community.

Dr WOODRUFF - Just to clarify, it seems that in the state and nationally we don't collect data on the incidents of diabetes. I thought we might have done that. That's a concern.

Do we collect information on RSV and streptococcus A? Has there been an increase in the incidences of those since the start of the pandemic?

Dr VEITCH - Yes, Dr Woodruff, there has been an increase in the incidents of both those diseases, but that's because they only became notifiable diseases last year. So, we don't have a solid time series, but we have a sense of the usual incidents and prevalence of RSV through our laboratory-based surveillance. It hasn't seen to be unusual in the last couple of years. RSV did continue to circulate in Tasmania even when, for example, influenza didn’t in 2020 and 2021.

Dr WOODRUFF - My final question, probably for Dr Veitch. There is research evidence that the coronavirus can increase miscarriages, stillbirths and premature births. At least, there is suggestive evidence of that. Do we have any data we collect in Tasmania, albeit it would be a small number, on miscarriages, stillbirths and premature births? And do we have that information pre-COVID 19 and by year since COVID 19. Are we collecting that information?

Dr VEITCH - Again, I would probably have to ask what's available in the hospital system. We do have a Council of Obstetric and Paediatric Morbidity and Mortality, which is a longstanding system. I can't here and now remember the particular details that are included in that report. But that will be the first thing to turn to, and that's publicly available.

Mr ROCKLIFF - We could ask the chief nurse, Ms Douce, to come up.

Dr WOODRUFF - That would be really helpful. Thank you.

Mr ROCKLIFF - Perhaps you would just like to repeat your question.

Dr WOODRUFF - Hello, Ms Douce. My question was in relation to miscarriages, stillbirths and premature births, with suggestive evidence at the moment that the coronavirus can increase the risk of those events. Do we collect data on those miscarriages, stillbirths and premature births? And if so, is there a time series, say, of the last five years in Tasmania?

Ms DOUCE - The perinatal database that we use in Tasmania is Obstetrics Tas. For all pregnancies coming into our system and, indeed, any maternity service or private service within the state, that data is captured.

In terms of miscarriages less than 20 weeks, I'm not 100 per cent sure that we capture that, but certainly anything over 20 weeks is captured, particularly the period of gestation in terms of premature birth and stillbirth are absolutely captured through that database.

Dr WOODRUFF - Can you provide that information for the last four years, please? Probably five years.

Ms DOUCE - That would actually be captured through the council of perinatal, maternal and morbidity committee report, and that's reported annually. I think that the most recent report would be 2021.

Dr WOODRUFF - Can I put that on notice to get that information from that report?

Mr ROCKLIFF - Yes, I believe it's publicly available but, of course, if you would like to put it on notice.

Dr WOODRUFF - Thank you, I appreciate that.