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Health – COVID-19

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Monday, 23 November 2020

Tags: COVID-19, Health

Dr WOODRUFF - Minister, I want to shift the questioning to talk about our COVID 19 response . COVID-19 has been hugely disruptive everywhere in the world and in Tasmania. Despite our having responded and weathered the situation well, there is still an outstanding level of risk - especially now our borders have opened and we are more exposed than we have been previously. Our understanding is the hotel quarantine that would be used for repatriation flights or mercy flights would use state and federal government employees such as police and defence force staff for security, rather than private security companies. Can you confirm that is true, and tell me whether there will be any staff at the repatriation hotel quarantine facilities who are contracted or employed by private companies? If that is the case, what plans are there to make sure that the risk to the community is minimised?

Ms COURTNEY - Thank you for that important question. We know we have many Australians who are overseas and who want to be able to return home. As a country, it is important for us to ensure we are looking at ways to bring Australians back home. I believe there is a broad community support for this, because people find themselves in very trying circumstances. We also know there is a risk associated with it. We have seen that in other states. A large body of work has been undertaken through federal mechanisms to look at best practice to make sure we are doing things safely.

The quarantine hotels for international visitors are managed through the State Control Centre - SCC. They are managed by Communities Tasmania, and questions about staffing and security are better directed to the appropriate minister. Health provides advice and support about interacting with these quarantine hotels. A lot of work has already been done through Public Health as well as through the THS, to have the right models. We have also engaged with the federal government to ensure we have the right model and the resourcing to support that model. I am happy to ask the department to talk more broadly about what Health is doing, noting there are still further steps required . However, procurement of security is not a matter for the Department of Health. The secretary will provide more information about that.

Ms MORGAN-WICKS - Through the minister, the Department of Health is responsible for the clinical model of care provided for hotel quarantine and particularly in relation to the pending international or mercy flight arrivals. The clinical model of care is currently being discussed with the Commonwealth Department of Health. The Commonwealth Department of Health has an overarching role in supervision, assistance and support to the states and territories regarding the clinical model of care implemented for hotel quarantine and what happens if a guest develops COVID-19, or has any other medical condition while in quarantine in a state Government-provided facility. If the Chair is in agreement, I will ask Dr Tony Lawler to speak to the development of our clinical model of care.

PROF LAWLER - Thank you. As you highlighted, we have a quarantine system in place because we recognise there is a risk. From the beginning of the pandemic we have managed hotel quarantine in conjunction with Communities Tasmania in all aspects, including providing advice on infection prevention control, providing advice on utilisation of PPE and also the management of guests, or residents, as they become patients. We have had instances where we have had to transfer individuals from quarantine hotel to hospital and that has been undertaken in line with strict Ambulance Tasmania protocols and has been tested and shown to be effective. As we move towards the next stage, which is the acceptance of international arrivals, both through repatriation of Australian citizens and through the seasonal worker scheme, we are working closely with the Commonwealth Government, around their advice and also their requirements for supporting this work.

The clinical model of care has been developed, through discussion with infectious disease infection prevention control expertise and also with the leadership of relevant clinical staff within the Royal Hobart Hospital. The international arrivals will be in the south and it hinges on a number of things, including the separate cohorting of Pacific Labour Scheme versus repatriated Australian citizens, and also the appropriate separation and cohorting of any of those who are identified as COVID-19-positive or diagnosed as COVID-19-positive.

There are close linkages with the Royal Hobart Hospital to provide care for those who have medical need, whether it is through their COVID -19 infection or recognising that those coming under the seasonal worker scheme - and also those who have spent an amount of time outside Australia - will likely have significant comorbidities. It needs to be close to and closely linked operationally with the Royal Hobart Hospital. As the secretary highlighted, various issues around how care within the quarantine hotels can be escalated, and what are the appropriate mechanisms of infection prevention control or education are all being worked out. We expect them to be resolved pretty soon.

Dr WOODRUFF - Thank you. Minister, you'd be aware that the South Australian and Victorian outbreaks were linked to quarantine breakdowns. They were also linked to casualised workforces which have increased in the community, as people working in sensitive facilities like security are also forced to work elsewhere to make ends meet. Would you consider, as the Minister for Health, accepting that Communities Tasmania has overarching responsibility for managing security, but would you also accept the risk is there, with a casualised workforce? Would you move to make an arrangement where, if someone such as a cleaner or someone else working on the site has a second job, you would compensate that person so they did not work in the second job and stayed committed to working in hotel quarantine to minimise risk to the community?

Ms COURTNEY - Thank you for the question. We have learned from other jurisdictions about the management of hotels and management of the workforce. I am afraid I cannot comment on a portfolio I do not manage. I suggest you take those questions to the relevant portfolio minister for the Department of Communities. Employment structures for quarantine hotels for overseas arrivals or even the ones we have stood up for interstate people coming from medium risk zones and requiring quarantining in a hotel are best directed to the minister responsible.

Dr WOODRUFF - I was talking about the health risk. Do you accept the health risk of the casualised workforce and as Health minister, are you going to make sure the health risk is clearly identified to the responsible department and that that is plugged. The casualisation of the workforce is a health risk, which has been identified in two states, and was the reason for two major outbreaks and for Victoria going into a second lockdown. So, as Minister for Health, are you going to consider recommendations unplugging that risk?

Ms COURTNEY - As the Health minister, when we are looking at standing up mechanisms for international arrivals to potentially land here in Tasmania and quarantine for a period of time, I want to ensure we have the most appropriate standards across all parts of the care. Some areas my department is not responsible for; however, I am confident that other departments seek advice from Public Health.

I also know that a lot of work has been done federally; indeed, we have the Halton review which we participated in. We welcomed the visit to Tasmania to go through not just the health part of our preparedness and our response, but also through different areas. Through the work Jane Halton has done, has come a number of learnings. We have also seen that in jurisdictions and preliminary findings are coming out of the work in Victoria as well, so all of these things are being incorporated and learned from.

I am not going to comment on the model that Communities has stood up. What I can comment on is that from a Health perspective, we are ensuring that our systems are as robust as possible and I am confident that other parts of government that I am not responsible for will be taking on board all the learnings from the various reviews that have been done.


Dr WOODRUFF - Minister, through you possibly, to the Director of Public Health. I am interested to understand where our state stands, given - I think the Premier said earlier last week - 11 000 people have travelled to Tasmania only in a couple of weeks, now that our borders are opened. There is a huge number of people moving between states and the potential for movement of the virus, which is still active in a number of states. Could you please outline to us where we are in Tasmania with PPE; the resources in hospitals for staff to be able to deal with tourists and the possibility of an outbreak; and for the real prospect of repatriated Tasmanians returning here, many of whom I understand may be sick, which is why they are desperate to come back to Australia and may come to hospital, and potentially will be at higher risk than other people?

Ms COURTNEY - I will be very pleased to answer that. A number of questions are contained there, Dr Woodruff. While I respond to other parts of your question, I will ask the secretary to provide a detailed update on PPE. She can do that towards the end.

Loosening the restrictions on our borders has been undertaken the entire time on the advice by Public Health. The ultimate decision is enacted through the State Controller. I will have Dr Veitch talk to the risk profile.

We have done a lot of work at our borders to ensure that we have the right processes. Indeed, before people even come to Tasmania we have a risk base standing for different jurisdictions: low, medium, high. That is based on the advice of Public Health. The circumstances and the rules around when people come to Tasmania are different, depending on the different levels. The website has a lot of detail for people before they come and, depending on the risk level of the jurisdiction, how they need to engage with either the Tassie travel app or the Good2Go app. The website provides advice provided on how that can happen.

Everyone who arrives in Tasmania receives a health screening and DPIPWE have done a really good job in standing up those processes through Biosecurity, with Public Health advice.

Regarding the travel we are seeing between jurisdictions, we have done that in a way that is safe and based on the circumstances of those jurisdictions. As we've seen in the last week and a half with South Australia, when those circumstances and the risk level is changing in jurisdictions I will act very swiftly - not only on travellers who are due to arrive, but indeed people who are already here in Tasmania. It is something we keep abreast of and the Director of Public Health also does through his regular contact with his AHPPC colleagues.

You also asked about people returning who might be unwell. As part of the planning for the quarantine hotels for international arrivals, I outlined earlier today that the management of those sits within Communities Tasmania. However, if people need to interact with our health system we need to have robust protocols in place, because of the risk. Earlier, Dr Lawler outlined some of those protocols around transport. There is a range of other protocols to ensure high risk patients who might need care are cared for in an appropriate way. I'm sure Dr Lawler can expand on that.

Given the breadth of your question, I will ask Dr Veitch to talk about the risk from travellers and jurisdictions, and then I will get the secretary to run through the PPE component as well.

Dr VEITCH - Thank you, minister. The minister has covered it in broad detail. She has mentioned we have a risk framework for assessing risk that a person coming from another state may pose to the Australian population, should they come here. It's a very conservative risk framework. It really admits very little risk at all. It is principally based on the number of unexplained cases that have occurred in a jurisdiction in the last 28 days. What we have said as our starting point is that if fewer than five unexplained cases have occurred in a jurisdiction in the last 28 days, then that is low risk. In fact, most of the places we've been dealing with have had none, one or two cases of unexplained infection in the last 28 days. We're dealing with risk at the bottom end of low risk.

We have higher risk categories - a medium risk category which talks of having between five and nine unexplained cases in the jurisdiction in the last 28 days; and a high-risk category where there have been 10 or more cases of unexplained transmission in the last 28 days. Once you get to that 10 or more cases of unexplained transmission in the last 28 days, you are dealing with quite widespread transmission to have that many unexplained or mystery cases in your jurisdiction in the last month.

That is just a starting point. We have to bring a lot of other considerations into play, and in some circumstances the other considerations may be even more important than that raw number. That situation played out last week. The other considerations are not so much the unexplained cases but the explained cases; even cases that are occurring that are linked to each other, we don't want ignore them. They propose a risk also. We take them into account. We look at the trend of the cases. We look at the control efforts in place in the jurisdiction. We look at the testing that has been done in the jurisdiction.

To give you an idea of our thinking about South Australia last week, we knew as the week passed that they had between about 15 and up to just over 20 cases, all very tightly linked to each other. South Australia was in a situation where there were no mystery cases. We all knew where they had all come from, but what we didn't know is whether the places these people had been to when they were infectious could have posed a greater risk. In this case we look beyond that simple one-dimensional metric and say there could be a risk here from South Australia, despite there being no unexplained cases. That was the reason to our approach to requiring quarantine for people from South Australia.

It is a multi-dimensional risk assessment strategy. It is not tied into a hard and fast metric. It also uses some other quantitative and qualitative considerations, and that is how we determine what category we will put a state into. Once we have done that, we look to - in the case of high risk - having the highest level of requirement, which is mandatory hotel quarantine. In the medium risk category, we will typically have people either going into home quarantine or hotel quarantine if they don't have the option of an acceptable place at home. In the low risk category we don't require people to be quarantined but to behave the way that everyone in Tasmania does - get tested when you get sick - so we don't have a high level of requirement.

As we move through this pandemic we are looking to whether we can be a bit more targeted, so we can look at a local government area or even attendance at a particular setting as being the trigger for requiring quarantine. It is quite difficult to confidently confine risk sometimes to those smaller settings.

CHAIR - Let the secretary answer the PPE section and then we will come to Labor.

Ms MORGAN-WICKS - With global demand for PPE at unprecedented levels during the pandemic it has been a key priority area for the Health Emergency Coordination Centre. We have established the PPE State Emergency Medical Stockpile, which is a separate stockpile from usual PPE stocks that we maintain for the THS. It has targets of at least six months of supply, based on our peak COVID-19 PPE usage which we measured and modelled off the north west outbreak PPE usage. As at 16 November 2020 the Department of Health held the following PPE in stock - •

surgical masks - 8.24 million; that is beyond our target in terms of the SEMS; •

gowns - 2.07 million; and we have an additional 14 500 on order above normal supply; •

eye protection and goggles - 1.28 million; •

gloves - 21.41 million; with another 2 million on order above normal supply; •

hand sanitiser - 66 106 litres; •

face shields 168 069; and probably most importantly - •

our P2 or N95 respirators. Those have probably been the most talked about item of PPE throughout the pandemic. We currently hold 427 995 respirators, which is close to 80 per cent of our SEMS target. Our initial target was to reach 544 000. We have 3.33 million on order above normal supply.

I will explain, because they are large numbers they are trying to work out in terms of the modelling. By the end of November, we are predicting we will hold 243 days' worth of N95 respirators. That was based on our existing peak COVID-19 demand. By the end of May, we should reach a total of 3.356 million. This takes into account usage that is estimated during that time, which would then mean we have had 1240 days' worth of N95 supply. We are getting regular drops of the N95 respirators, each month.

Dr WOODRUFF - When is that going to be?

Ms MORGAN-WICKS - We are getting regular drops through each month, so we have estimated drops for November, December, January through to May 2021. However, for example, if you wanted to look at close to a years' worth of supply, that will be by the end of January. That is over and above our current THS normal stock.

Dr WOODRUFF - Sounds comfortable.


Dr WOODRUFF - Minister, the report released in April, on the cluster in the North West Hospital, recommends considering the underlying drivers of staff presenting to work while they are unwell with respiratory illnesses and implementing strategies to minimise that. It also recommended reducing the movement of staff between facilities.

The Royal Flying Doctors Association of Tasmania provided a submission to that inquiry. They raised concerns that staff movement between facilities contributed to the outbreak and was partly caused by 'low paid casual carers who have little option but to work across multiple sites'. They were also concerned about sick leave.

Does your recommendation include reviewing staffing and pay structures to make sure that workers are given a reasonable rate of pay and sick leave ,so they can take time off when needed?

Ms COURTNEY - Thank you for that question. All 17 recommendations of the report you refer to, the North West Interim Report, are now complete. Work continues in the department, to ensure those completed recommendations are embedded. They were important recommendations, and ensuring that they could be used across a system is critical.

With regard to staffing, we have provided, through the THS, mechanisms to support staff to be able to take leave. One of the most important learnings from the North West, is ensuring that staff felt supported to not turn up to work when they are unwell, so they can be tested.

We have mechanisms for our testing clinics to identify healthcare workers, so we can prioritise those tests to get them back as quickly as possible.

I will get the secretary to outline the leave issue, and how the mechanisms worked earlier in the year, and also the mechanisms we now have for staff to access leave.

It is important to ensure that presenteeism does not impact our system with regards to COVID 19, and it is something we take very seriously.

I do commend the health workers I have spoken to. Everyone is taking this very seriously. I know people are very aware of their symptoms. I think the whole community has a much higher level of awareness around the importance of being well, and not assuming that something is hay fever, for example. I will ask the secretary to speak about the leave provided to staff so they can comply with that.

Dr WOODRUFF - Casualisation versus contract - which would solve the problem?

Ms MORGAN-WICKS - Through the minister, I ask the CMO to discuss presenteeism. He made recommendations in the interim report about presenteeism and can advise on what the Tasmania Health Service Emergency Operation Centre - THS EOC - has actually done with health screening to try to stop staff at the front door should they still be presenting with symptoms of COVID 19.

Prof. LAWLER - The issue of presenteeism is challenging. Individuals are driven in some instances to attend work with symptoms, but there are also other instances where, with the best will in the world, the individuals don't recognise their symptoms are actually presenting risk to others.

We have instituted and consistently apply screening tools in our hospitals through THS EOC, an emergency operations centre that sits under the ECC, which I have the pleasure of chairing.

We have a visitor and staff screening tool that is applied consistently when individuals attend the hospital. It is presented in some places, particularly for visitors, as a paper tool, but for staff as an app. There is the capacity to scan a QR code on arrival, fill in some questions around recent travel, contact with individuals who have been unwell, are you yourself unwell, or are you awaiting the results of a COVID-19 test, and those issues are then flagged with a screening individual who is also there to answer questions.

That has enabled us to have comfort that we are screening both staff and visitors for symptoms It encourages them not only to consider and reflect on whether they should be attending work, but also to have a more vigilant approach to those they have been in contact with, or in fact whether they have had symptoms themselves.

It is a method of screening to provide a mental cue as well as a process lock for individuals turning up with symptoms to the workplace.

Dr WOODRUFF - Well, minister, could I ask a follow-up to that?

Ms COURTNEY - I will ask the secretary to complete that answer.

Ms MORGAN-WICKS - In relation to leave, I looked at our sick leave rates again and they are actually declining. We have a COVID-19 special leave provision, which has been available to staff if they need to get a COVID-19 test, and while they are await the test results.

Staff in the north-west outbreak who were required quarantine were paid all the standard normal time as per their contractual arrangements.

Dr WOODRUFF - Minister, the question our rural doctors raised, though, is about casualisation. What Professor Lawler has described is a perfect model, but it can fall down in the real world, where people may be disinclined to be entirely as honest as they might need to be if they need to take the shift simply in order to pay their rent.

This comes from a casualised workforce. Rural doctors proposed transitioning away from that, particularly in the regional hospitals. Is there a consideration of moving away from casualisation of this important workforce?

Ms COURTNEY - We have made lots of steps in recent years, and indeed through this Budget, to ensure we are recruiting more permanent staff across our entire system.

I note this is not only an issue across THS; it is also across private hospitals, in aged care, and other vulnerable settings.

It's something we continue to look at. I'll speak to one example and then perhaps Kath, the secretary, might expand. Through our different escalation protocols, and our different facilities, we have mechanisms in place to ensure we only have staff working in specific areas as a facility escalates.

There'll be mechanisms from the escalations protocols that are right for that location, to ensure we're doing everything we can to prevent infection and the spread of COVID-19. In some facilities I've seen, when things have escalated, staff are working in one department rather than across two departments as they may usually have done.

The annual report shows there has been an increase of more than 600 permanent FTEs across our Health services. We are making significant inroads. We need to ensure our system has robust protocols, as outlined by Professor Lawler, to ensure we minimise the risk wherever we can.

Dr WOODRUFF - That is a commitment to continue that then, is it?

Ms COURTNEY - We've clearly demonstrated that this year.

Ms O'BYRNE - I am absolutely here for the call. I think we're comfortable with Dr Veitch though unless you have further questions. I'm not sure if Rosalie has more questions.

My question goes to the nature of the budgets -

Ms COURTNEY - Is that the committee's decision?

Dr WOODRUFF - I have a lot of other questions. I have things that I want to ask of Dr Veitch but there simply isn't time, given the other questions.

Ms COURTNEY - That's fine, Dr Veitch is here for the next period of time. It was a consensus that he wasn't needed again but, no, that's fine.

Dr VEITCH - I'm here, I'm not running away.