Have NSW and Queensland learnt their lessons from Victoria? - ABC News

Tegan Taylor: Hello, this is Coronacast, a podcast all about the coronavirus. I'm health reporter Tegan Taylor.
Norman Swan: And I'm physician and journalist Dr Norman Swan. It's Tuesday, 25 August.
Tegan Taylor: So Norman, we've been talking a lot about Victoria on this podcast and with good reason because that's where the majority of Australia's new cases are coming. But there is also spread happening in New South Wales and Queensland. And some of the questions that we are getting are about basically whether these states have learned some lessons and are making some changes to their approach based on what's happening in Victoria.
Norman Swan: Well, you're a Queenslander, why don't you tell us what's happening up there?
Tegan Taylor: So, it is interesting, the health authorities up here have been quite open about the fact that they are nervous, they are worried to see some community transmission happening here, it's linked to a juvenile detention centre, and we know that prison outbreaks are problematic because you've got people in close quarters. But they are definitely making some changes to the sorts of restrictions they've brought in based on what's happened in Victoria.
So, nothing has really changed in terms of businesses but the number of people that you can have visiting a household or private gatherings outside your house, that has been what is restricted, and that's based on the Victorian experience that some of those clusters that happened early on were really linked to large family networks rather than transmissions happening at businesses.
Norman Swan: Yes, and offices, although there was one outbreak in a lawyer's office in north-west Melbourne from memory, that's right. So this is domestic, it's at family weddings, family events, funerals and so on, people are hugging, close together, and the opportunity for aerosol spread early on.
Tegan Taylor: And, on that, one of the other things that has been mentioned much earlier in this Queensland outbreak that happened in Victoria is that they are advising people to wear masks now. If you are in a public place, in a crowded place, they are advising that you wear a mask, and that's not something that we heard until quite a long time into the Victorian outbreak.
Norman Swan: That's right, and thankfully they are deviating from the national advice of this which has been a bit reserved. It's just an extra layer of protection, even if there's not much virus around. You just don't know where it is.
Tegan Taylor: What about where you are, Norman, in New South Wales?
Norman Swan: In New South Wales they seem to be getting the unknowns down to a low number, which is the statistic that worries everybody, it's why Victoria went into stage 4 lockdown is they just had far too many people where they didn't know where they were getting the virus from. So New South Wales is running along in reasonable shape. The problem is there is still virus around. And whilst we report day by day on the numbers and the number of unknown sources, this can change on a day-to-day basis. You've really got to look at the running average of what has happened in terms of the trend. But the trend is small numbers and increasingly knowing where the virus is coming from.
Tegan Taylor: Obviously we all would prefer to have zero spread whatsoever, but New South Wales seems to have maintained a low level that has been more or less consistent. Is that maybe a different way of living with the virus long-term?
Norman Swan: I'm not sure that that's what their aim is. They've said in the past that they are not aiming for zero spread, but there is enough anxiety around even at low levels that you can't quite relax. But if they couldn't get it down to zero spread, and I assume that they are trying incredibly hard to do so, then you probably could live with this, but you are living with the situation where they are probably going to have to do mandate masks rather than just ask people to wear masks, and have quite strict social distancing so that there is minimal chance of virus being spread around, so if there is virus it tends not to get spread. But there will always be the risk of a blowout.
Tegan Taylor: So we might talk about Victoria just a little bit because we've got a question from Olea. You've said, Norman, a few times that Victoria isn't being transparent. And when Olea has been watching the pressers every day they are saying that they do feel like there's a lot of transparency there. So what are you referring to when you say that?
Norman Swan: It's digging down and being completely open, for example, about the hospital spread. And we tend to find out that late, we tend to find out…we don't really know how it is being transmitted, we've been misled I think about how it has been transmitted because the minister at one point said only 10% or 15% are being caught in hospitals. It's clearly not the case, most are probably being caught in hospitals, possibly not from patients, maybe in the tearoom and other places where they could be passing it on, but we haven't sorted that out.
What we don't know, at least I'm not aware of knowing, is whether patients have caught it from healthcare workers. One hopes that hasn't happened but we haven't heard that statistic either. And why we should know about this is really the two areas that seem to be the problem…yes, there's still some problem with food storage facilities and so on, outbreaks stemming from them, and those are always at risk. But largely we have aged care residents, we have healthcare workers in both aged care and in hospitals, and if you subtract them from the total, there aren't many cases left in Victoria from community spread. So Victoria is doing really well.
But they've got to be upfront about their hospital problem so that we can all share in that, and that means when we go in as a patient we are just careful, or we know that there is no patient spread and it's healthcare worker to healthcare worker because people are arriving late at hospital with serious conditions which need major interventions, and they need to be sure that the hospitals are safe. And I think it creates doubt if they are not being entirely open, perhaps for political reasons.
So I think those are the reasons why they've just got to be straight and tell us what the statistics are and how they are dealing with it. Because if they really get on top of the hospital situation, get on top of aged care, they are pretty close to solving the problem in Victoria really.
Tegan Taylor: And we've got a question from Sue about people who are immunocompromised. So we were talking the other day about potential vaccines and whether it's safe for people who are immunocompromised to receive a vaccine that's based on a live virus. And Sue is just wanting clarification on whether the vaccines being developed are classed as live vaccines.
Norman Swan: The Oxford vaccine is a live vaccine, it's a chimpanzee virus. It's been used extensively over many years in trials of malaria vaccine and in children, Ebola, MERS and others, it's a tested vaccine technology. I'm not aware what the evidence is in immunocompromised people. It has certainly been used in environments where there is lots of HIV/AIDS, in Africa for example.
The University of Queensland vaccine is not a live virus, it's a traditional vaccine in some ways where you've got an adjuvant which stimulates the immune system, to which they attach a bit of synthesised DNA, recombinant DNA made in vats, so it's a part of the DNA of the spike protein, and then that stimulates an immune response directly, so it doesn't require a virus.
And the mRNA vaccine produced by Moderna and some other companies around the world, it's not a virus either. So there is a Chinese adenovirus, and I think the Russian vaccine is an adenovirus too, so there are a few live virus vaccines around, but not all of them.
Tegan Taylor: While we're talking about vaccines and specifically the Oxford vaccine, you've got some interesting news to share about what is going to take to actually get that vaccine around the world if it does prove safe and effective.
Norman Swan: Well, last night on 7.30 we covered the manufacture of this. So it's still not known how you would manufacture this at scale. They know how to manufacture small quantities but they haven't quite worked out how to manufacture it at scale. They will solve that problem but it hasn't been solved yet. They've got some time because the results of the trial won't be in until October or towards the end of this year of the phase 3 study.
And the other issue is that once a vaccine has been manufactured, it's got to be kept cold. It's called the cold chain. So from the point of manufacture to the GP surgery or a bush clinic in sub-Saharan Africa, it's got to be kept cold. Now, usually for most of vaccines it's between 2 and 8 degrees. In other words, roughly the temperature of a fridge, but very accurately kept, and they have all sorts of technologies for making sure that the vaccine hasn't had a period outside the cold chain. At the moment it looks as though the Oxford vaccine needs to be stored at -70.
Tegan Taylor: What!
Norman Swan: Yes, so liquid nitrogen kind of temperatures. And that really changes the transportability of the vaccine. It's likely that they will solve that problem but that's what it looks like at the moment. What I'm illustrating here is not to make people utterly depressed that nothing is going to happen, but there's more to a vaccine than just constructing one, getting an immune response, making sure it's safe, it's got to be able to be manufactured in huge amounts, it's got to get into glass vials, you've got to be able to produce them, the rubber stoppers, the needles, and it's got to get to where it needs to be without having warmed up, even at 2 to 8 degrees.
So there's just a lot of complexity here with most vaccines, you've just got to be careful. And it makes an announcement such as President Trump's…well, it's not an announcement, it's a report, in hearings that it has been intimated that the Trump administration is tempted to fast-track approval for the Oxford vaccine before the phase 3 trial results are in, to be a bit bold and perhaps maybe even a bit reckless.
Tegan Taylor: Speaking of Trump and fast-tracking things, over the weekend they've issued emergency authorisation for doctors to treat COVID-19 using blood plasma from people who have recovered from the disease.
Norman Swan: Yes, it's called convalescent serum and only a few days ago the Food and Drug Administration in the United States was saying there wasn't enough evidence to recommend that outside a clinical trial, and the Trump administration has quoted one study which comes from Minnesota and the Mayo Clinic, and this is an uncontrolled study, so no placebo, it has not been peer reviewed. The variation, how it was treated, some people got it early, some people got late. The dose wasn't clear, it seemed to be concentrated antibody. A highly problematic study, you would not approve it on that basis.
And the problem here is that is only limited supplies of this, and there are still clinical trials going on, and you want clinical trials to continue so that you know that it is safe and effective. It could be an effective treatment for people seriously ill with COVID-19, but we won't know if they can't supply the serum to people who need it in a randomised controlled trial, and there is a randomised controlled trial going on in Australia as well.
Tegan Taylor: Well, that's all we've got time for on Coronacast today. But if you like us, why not tell a friend and leave us a review on Apple Podcasts if you can.
Norman Swan: And if you want to ask a question, go to abc.net.au/coronavirus, go to 'Ask Us Your Questions' and fill in the form and mention Coronacast. And leave a comment if you like. We'll see you tomorrow.
Tegan Taylor: See you then.

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2020-08-24 18:01:00Z
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