Latest / Uncomfortable Conversations with Josh Szeps / "Will We Ever Re-Open?" with Prof. Mary-Louise McLaws

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"Will We Ever Re-Open?" with Prof. Mary-Louise McLaws · Uncomfortable Conversations with Josh Szeps

• 0:00
  Get a humans. The pandemic has not been kind to rational conversation. It has not been kind to
• 0:07
  consensus building. The past, oh what is it, 12 months, 14 months, 16 months has been a whirlwind
• 0:19
  of competing interpretations, rival scientific ideas, and ultimately a kind of a war of
• 0:28
  attrition in which both sides hunker down on the battlefield in their trenches. Certain that
• 0:36
  either lockdowns make no sense or lockdowns are essential and we should be doing more of them
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  that vaccines are the solution to the pandemic or vaccines are an overrated conspiracy
• 0:51
  to turn us all into obedient sheeple. This has not been a great time to, I suppose, fulfill the
• 1:00
  expectation that a great disaster might bring us together. Do you remember at the beginning of
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  the pandemic there was a sense that maybe this is the thing that is finally going to let us
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  sloth off our divisiveness, our superstitions, our irrationalities, our tribalisms, our
• 1:16
  parochialism, our nationalism, and as we enter this great global challenge we will come together.
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  Did we? Perhaps not. But perhaps the wake of the pandemic, perhaps the recovery from the pandemic,
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  perhaps the next chapter is a time when we can come together, say enough is enough.
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  We will not be cowered from having the conversations that we want to have on the terms that we
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  want to have them. We will not be cowered from believing in science and reason and we will state
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  things clearly and plainly and I will respect you as a person. But respecting you as a person means
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  that I won't always respect your stupid ideas. I will respect you enough to stand up to the stupid
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  ideas. I will respect you enough to have the kind of frank conversation that perhaps we need to have
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  if we're both grownups. This is a place for those conversations, conversations that are respectful,
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  conversations that are thoughtful, conversations that are informative and sometimes more often
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  than not. Yes, a little uncomfortable.
• 2:29
  Welcome to the show. I have been trying to get this guest for so long,
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  low these many years or weeks or days really. This is a guest so important at a global,
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  influential level that we've had to continually reschedule because she keeps having to stay up
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  until four in the morning on at World Health Organization meetings, which are not necessarily
• 2:54
  timed ideally for Australia. But because she is a VIP of global stature, she has to spend her
• 3:02
  nights at the World Health Organization virtually and then cancelling on poor old Mr. Zeppes.
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  But we got up and what better time to have this conversation about the future of life under the
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  pandemic? Mary Louise McClause is a professor of epidemiology from 2005 to 2007. She was the World
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  Health Organization's advisor to China and Malaysia. So, those are thing or two about that. She reviewed
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  the SARS outbreak in Beijing and among healthcare workers in Hong Kong. And she reviewed the pandemic
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  influence of guidelines of Australia on behalf of the Australian government, the guidelines for
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  healthcare workers in a pandemic. So, the vast 12 months have been very busy for her. This is the
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  what her entire life has essentially been leading up to. She is a member of the World Health Organization
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  as well as it's like I could read off a whole list of the Health Emergencies Program experts
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  advisory panel for infection prevention and control preparedness readiness and response to
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  COVID-19 and a member of the New South Wales Clinical Excellence Commission COVID infection
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  prevention and control task force. Her expertise is hospital infection and infectious disease control
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  and she's an epidemiologist professor at the University of New South Wales, which is located
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  in Sydney. She's one of Australia's leading experts on coronavirus and one of the worlds
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  really. And I'm so glad that I was able to speak to Mary Louise right now. It is currently
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  Friday the 28th of May last night, Thursday the 27th, Victoria, the second most populous
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  state in Australia and the home to Melbourne. Entered a seven-day lockdown. There was a breach of
• 4:47
  the hotel quarantine system for inbound travelers from abroad. And so Melbourne has yet again
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  gone into a lockdown. You may remember that last year Melbourne had one of the most severe
• 5:00
  lockdowns anywhere in the world, four months of exhausting harrowing lockdown. New South Wales,
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  the most popular state with Sydney is located, has taken a lighter touch towards lockdowns and has
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  relied more on testing and contact tracing and localized lockdowns in suburbs where they've been
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  outbreaks rather than the more heavy-handed blanket lockdown that Victoria has undertaken.
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  So I want to understand first whether or not lockdowns work and the extent to which they work
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  and whether they're alternatives. But more importantly, what's going to happen once the international
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  border is open and we get rid of the quarantine hotels? Are we just going to keep locking down when
• 5:45
  unvaccinated people come into the country? Is there a realistic expectation that at some point
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  we're going to be leading normal pre-COVID lives and also have an open international
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  border? Or is that fantasy? There was a big hoo-ha a few weeks ago when the boss of Virgin
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  Australia, the airline, said quite bluntly that we have to start thinking and having a
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  serious honest conversation with ourselves about what level of death really we're willing to
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  tolerate from coronavirus, because if, unless we want to be a hermit kingdom forever, at some point,
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  this policy of keeping out all foreigners and making every returning Australian stay under
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  police guard in the hotel prison for 14 days, that is not going to be sustainable.
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  And given the variants and the mutants and the inadequacies of the vaccine and the existence
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  of anti-vaxxers and of people with compromised immune systems and so on, is it realistic
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  to imagine that there will be a day when Australia has zero COVID deaths and also an open border
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  and also no real physical distancing, which is sort of the status quo in Sydney and much of Australia
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  right now, because there's no endemic community coronavirus spreading around.
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  And the Virgin boss was saying that's unrealistic, we have to accept that at some point
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  coronavirus is going to slip in, it's going to become endemic and people will die.
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  Well, unleashed the hounds of hell on her. Everyone said that that was incredibly
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  tactless. She had to backtrack it and apologize, but a little part of me respected her hootspa
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  for being able to articulate what nobody else is willing to admit, that the status quo is not
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  sustainable and we shouldn't want it to be. But I don't want to be a broadcaster who just waves
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  his arms about and goes, well, you know, we should just have to get over ourselves and we need to
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  open up and like, I'm not an epidemiologist, I don't know what I'm talking about, I don't know how
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  to balance the risks with what might be a prudent approach. So I wanted to talk to Mary Louise
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  because she does know those things. Having just had this conversation that you're about to hear,
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  I can honestly say I am more hopeful about the future than I have been in 12 months.
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  I hope you will be too. After you hear this conversation between me and the one and only,
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  WHO, approved, sleep deprived, professor, Mary Louise McPherson.
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  Can you, can we just start by establishing how useful we know lockdowns?
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  There is no preparation. They have to be used well while people are in lockdown so that
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  contact traces have sufficient time to order the priority of who, which contact needs to be
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  set at the top of the list and then ring them up, develop a report and trust and then go through
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  a very long and detailed questionnaire helping the contact remember all sorts of details
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  about what could have placed a limit risk and also what how they may inadvertently, of course,
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  other people risk. But don't forget that good contact tracing means that when a case is found,
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  100% of them should be identified and contacted within 24 hours of that diagnosis.
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  In Australia, it's relatively easy. Everybody has a mobile phone practically and they know
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  after having a test that they're going to be contacted. And then, of course, if they don't answer
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  the phone, they are also supposed to be at home after being tested. That's the general rule.
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  You get tested, you stay at home. The government pays a small amount to cover the cost of you
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  not going to work. So that if you don't answer the phone, the police go around and knock on your door
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  to see if you're okay and to try to then match you up with your contact traces so they can start
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  that really important interview. And then once they've found from the case all the contacts
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  on average a person between 20 and 39 and in Australia and in fact most of the world,
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  they carry the majority of the burden for cases and because of the nature of their age and their
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  sociability and their work life and they often have to have multiple jobs within this global
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  economic downturn, they have at least 10 contacts a day. So a contact racer is constantly working
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  behind time to find their each contact and to ascertain who their other secondary cases are
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  to stop further spread because we know that about 16% of people will always be asymptomatic,
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  never ever have a symptom and they can still cause infection and then we know that about from day
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  three or four after exposure most people become or 50% of people start to become infectious
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  and that kind of relates to about day two or three before symptoms and then on symptoms you become
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  very infectious, your viral load is high and then it usually takes an average person two days to get
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  tested after symptoms before that penny drops that oh I might be sick. So you've then got another
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  two days of potential spread so the portal contact racer is constantly working behind time and that's
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  why you need a circuit breaker for lockdown. So if the lockdown is just a pause button to allow the
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  contact racers to do their work and try to ring fence the disease without it getting ahead of them
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  as they're trying to play catch up does that mean that a lockdown would not be particularly useful
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  in the absence of contact tracing? It would still be useful but you'd have to extend that lockdown.
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  So sometimes a quick shot lockdown with a few unusual cases helps because if you don't start
• 12:50
  finding evidence of coronavirus in the wastewater areas where you've never seen them before
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  because don't forget you excrete this virus for a very long time. So it's very helpful if you've
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  never seen the virus in certain ways warden. And just to clarify for people who might not know what
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  you're talking about we are testing the sewage. Correct. And is that commonplace all over the
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  world or is that an Australian thing? Are they testing all the sewage plants in the states and the
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  UK? They should be. I mean sewage testing has been used to trace or fault pathogens for many years.
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  I've been doing sewage testing for four pathogens of interest and antibiotic use since 2017.
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  So it's not something new and certainly America has had wastewater testing for all sorts of
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  things before. So I'd be surprised if America isn't using it certainly Europeans. I know
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  Israel is so I'd be surprised if they weren't using it. And it's not very helpful when you find
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  COVID constantly in a wastewater treatment plant before it gets treated because people excrete it
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  for a very long time. But it's very helpful to tell you maybe where you're starting to see it.
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  You haven't seen it before and then that tells you that somebody's acquired it. And in Australia
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  the acquisition is mostly from a leak from a quarantine hotel because we don't have
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  circulating virus. So that will tell you either that those people from quarantine who've
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  gone back home and some of them may have been positive and we'll know which ones they were
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  where that which postcode said gone to and where we should expect to see it. But if we're seeing
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  it in postcode where we don't expect people from quarantine to go home to who have been positive
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  then that's when the authorities start to think that maybe they should call for testing.
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  But back to your question about does it work without contact tracing?
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  Well contact tracing is used across the world and America certainly use contact tracing.
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  They certainly have performance indications that are very similar to ours. That a case should be
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  identified contacted by the contact tracing program within 24 hours and being identified
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  through a test. And their contact, their primary contact should also be contacted within 24,
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  48 hours. So the US do use contact tracing. I mean they have held a very prestigious
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  position in the world as being the best, you know, epidemiologist in the world. And so this
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  wouldn't be anything new to them. But certainly the idea of putting a pause on spread helps as well,
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  but it wouldn't be for a rapid three day period. That's where it's more like putting a circuit
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  breaker. What you have to do is have people in lockdown for at least twice in average incubation
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  period. Mostly the best approach is twice the maximum incubation period where you would want
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  zero cases if you're going for elimination. In, for example, Ebola, for example, on Moose,
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  or if you're not tolerant of circulating virus, which Australia isn't. So see that's the very
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  big different Josh between Australia and America. Is that Australia doesn't tolerate circulating
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  virus? So their approach is elimination. And that's where the Australian population
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  accept lockdown very readily. That's that brings us to I suppose the main reason why I want to
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  talk to you now because as Victoria, into us another lockdown, there's been a lot of argue
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  dodging over the past few weeks. I've noticed it become part of the national conversation with
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  people beginning to think about what happens in the longer term. The remarks by the
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  Virgin Australia boss that at some point there will be coronavirus circulating here and some
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  people will die and she was pilloried for saying that and the Prime Minister has emphasized that
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  he's not going to do anything that would endanger Australians and we won't reopen the international
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  border until it's safe to do so, which got a lot of people scratching their heads and going,
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  what does safe mean when you think about the ambient background level of deaths from flu and
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  other pathogens prior to coronavirus? Are we willing to tolerate those a few thousand deaths a year
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  for example, the way that we do with flu after we're all vaccinated? How do you get your head around
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  the way that we ought to think about the longer term? Well, first of all, I'm happy that's about
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  the Virgin boss was shamed because it's outside our culture. So you've got to really understand
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  the culture of the country that you're dealing with and in Australia we don't tolerate this idea
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  of a acceptable death rate. We just don't. Now the reason that flu people die from the flu in
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  Australia is because we haven't quite made it at the same level of unacceptable
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  suffering as COVID because Australians have really gone on board with the idea of our
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  place in space as global citizens. We do know that people over 60 have a really a pretty high level
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  of take of the vaccine at 75 percent. People would in health, public health would like it much
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  higher than that. The reason that those under 60 don't get vaccinated is because the GPs
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  often don't see younger people as often as they see the 60 and over. So it's much easier for
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  GPs to tell those who are 65 and over each time they come to get their prescription
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  really filled for, you know, the hypertension or their hypercholesterol linear,
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  even for their cholesterol or their pain relief, you know, with the anti-inflammatories for their
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  arthritis. If you then use that opportunity to say it's now time to get vaccinated.
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  And if we could see the younger group, we probably see very little suffering of influenza
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  in Australia. I mean, where one of the best vaccinated in the world for the zero to five
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  year olds and that includes some flu vaccine of the young kids as well, we're up to 95 percent
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  for childhood vaccinations because we make it easy and we have a lot of resources.
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  Right, but I mean, I suppose that the question is when you said we that there are cultural
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  differences here and that we don't tolerate an acceptable death rate, isn't the argument
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  against that that we actually do, but we do it tacitly and we don't like to talk about it,
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  if you know, if there was no flu in Australia and it only existed abroad, would we close the
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  borders in perpetuity to keep it out and if not, then where hypocrites? Well, there's a lot of
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  underreporting of COVID and we just have to see what's happening with countries like India where
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  they just can't keep up with the case numbers, but like death numbers, Brazil can't either,
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  that what we think we're dealing with for deaths in due to COVID is underestimated.
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  Certainly the death due to flu needs to be witnessed and responded. Australia bought 14 million
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  doses of flu vaccine last year and they're all used. If they bought more, they'd probably be used
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  as well. You have to wake up the population and it's the journalists who wake them up with the
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  health of the GPs, the general practitioners that get Australian's loads of aces. The Australian's
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  are very cooperative as a nation for a public impact. So, for example, with the gums. So when we had
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  our a very large massacre in Tasmania, our authorities said, we're going to take the gums away
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  and Australian to ensure when we started to see that seatbelt wearing was not used very well
• 22:19
  by passengers. They said, well, we'll find the driver and all of a sudden all the passengers quickly
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  learn to use their seatbelts and nobody complained about that, you know, finding out the driver.
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  They accepted it. We're very ready to accept public health innovations like we
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  don't advertise smoking or figure it to kept behind a closed cupboard and we tolerate that.
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  We get public health quite well. We just haven't got behind flu, but I predict that after COVID,
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  the flu uptake vaccine will be very, very high. I was a part of getting the public to come for
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  free influenza vaccines. We get three cities all on one day and the uptake was very good,
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  but we need to get the general practitioner, the physician, family physician on the side.
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  I'll be getting back to COVID and our response to COVID. The difference between us and America
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  and the UK, I think, the crucial difference was our authorities toyed or flirted with the idea
• 23:47
  of herd immunity from a natural infection and the public through the media
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  dismissed it as cruel and then the authorities then responded with clothing at the border,
• 24:04
  hotel quarantine, development under supervision and basically restrictions on a sliding scale
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  of risk where the UK were flirted with the idea of herd immunity and then the numbers
• 24:24
  went up so far that it was too late for them to try to do elimination of circulating virus.
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  I don't think that there are very many Australians who would swap out Australia's fate thus far
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  for that of the UK or the US and many Australians are rightly proud of Australia's response in
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  having been so aggressive so quickly and being able to eliminate it. The question now though,
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  I suppose my fear to put it bluntly is that we're not doing a good job of transitioning
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  psychologically to what the next phase might be in the longer term because you just mentioned all
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  the other variants that are circulating, the horrifying situation in India, who knows what's
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  going to happen in Pakistan and Bangladesh and the whole continent of Africa. I mean, I see this
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  sequence of train wrecks coming and at the same time, I see friends in the US and Europe
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  who are vaccinated and feel like life is gradually just starting to begin to get back to normal
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  and all of the reasons that we were given for the aggressive approach here in Australia initially
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  had to do with stopping a runaway pandemic, making sure that the hospitals don't get overwhelmed,
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  making sure that the vulnerable are protected and all of that's laudable but whether or not that
• 25:46
  should still be the case in 2026 is the question and if not, how do we get from here to there
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  and at some point aren't we're going to have to accept that all of the variants and everything
• 25:57
  that's going on in the developing world is going to mean that some of it will slip through,
• 26:00
  like I don't see if maybe help me understand this but I don't see a future in which you can have
• 26:06
  both open international borders and a return to, I suppose, or a continuation of the kind of
• 26:13
  life that we enjoy currently in cities like Sydney and no coronavirus deaths. The Venn diagram just
• 26:20
  doesn't overlap does it? Well, I'm a little more optimistic than you are at the World Health
• 26:28
  Organization a couple of nights ago we had the world's best vaccinologist provide us with evidence
• 26:38
  about how well all of the vaccines are responding to the variants of concerns, some are responding
• 26:46
  better than others, how to predict whether or not a vaccine recipient is in fact protected because
• 26:56
  the term vaccine efficacy pertains to the level that the vaccine will prevent whatever the
• 27:03
  primary outcome was and the primary outcome initially for most of them was prevention of death,
• 27:10
  prevention of severe disease, and hospitalization and at the moment it would appear that all
• 27:20
  commonly used vaccines protect against the variant and concern for all of those things.
• 27:28
  What is challenging is the variants of concern having breakthroughs with infection
• 27:36
  but at the moment it doesn't seem as if we will die regardless of which vaccine we will have
• 27:45
  and that's great news. Right, but all I mean is that even if you have a maximum uptake of
• 27:50
  vaccination in Australia then there's going to be some cohort of the population who doesn't get
• 27:56
  vaccinated, some cohort of the population whose immune systems aren't strong enough to be able to
• 28:01
  react to the vaccine and provide full protection and some cohort of people who are vaccinated but still
• 28:06
  vulnerable to at least passing along the disease to people who I don't know might be elderly or
• 28:12
  otherwise immune compromised. Would it be realistic to expect that no one's going to die of coronavirus
• 28:19
  that they will come up point at which no one will die of coronavirus even if it is still circulating
• 28:23
  in countries abroad and people don't have to quarantine when they come here?
• 28:27
  I think the biggest risk of death will be in those who refuse to get vaccinated or can't get
• 28:35
  vaccinated but the reason that we talk about herd immunity is because it acts like a fence
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  and it's and yet that vaccine efficacy that results in a proportion of recipients not ever developing
• 28:53
  a level of protection represents the whole in the fence and when you get a virus that circulates
• 29:02
  in a human being they come across the fence and if that level of uptake is high and I believe it
• 29:09
  should be about 83.5 percent or around about 85 percent. I love your accuracy. About 83.5 percent.
• 29:17
  Yes, they based on Pfizer and AstraZeneca vaccine efficacy and based on an assumption of the
• 29:28
  R naught being fairly high if it doesn't happen and that takes account of variants.
• 29:37
  Then the majority of the time that escaped virus through somebody coming into Australia will hit
• 29:48
  the wall of an immune person. In occasion we will get through the whole fence and that will be
• 29:57
  through somebody that didn't elicit an immune response or didn't get vaccinated and yes it will
• 30:04
  that person will then get infected and they will then attempt to spread it but will the virus
• 30:11
  will attempt to spread it and that virus will come across another wall and most of the time that
• 30:17
  wall will be immune. Now a colleague of mine from the University of New South Wales his name is
• 30:27
  Professor Miles Davenport. They have a really exciting presentation at WHR the other night too
• 30:35
  to all of us who are there listening intently and he talked about the level that we need
• 30:42
  that to protect us using a convalescent level of antibodies if you know when people have a normal
• 30:50
  sorry a natural infection and for protecting against death or severe infection it's very low
• 31:01
  so that was really good news. It basically said have the have the vaccine and you'll be protected
• 31:07
  from severe infection and death so that's great news. It's not great news for those who refuse to
• 31:15
  be vaccinated or who can't get vaccinated. But sorry Professor just to just to clarify we're talking
• 31:23
  about about severe illness and death but we're not talking about the infectiousness or the contagiousness
• 31:32
  yes well that by default what happens in phase three trial is that we get their primary outcome of
• 31:40
  success for death severity and hospitalization but they often don't test for symptomatic
• 31:51
  or asymptomatic infection because it's time consuming and it's expensive and so what happens when
• 31:58
  they do phase four or roll out in the real world we actually see that the vaccines do better than we
• 32:05
  ever expected. So if you have a look at the Pfizer response in Israel the Pfizer was even before
• 32:18
  the war where you know people during the war kept inside their response levels were very very high
• 32:27
  so it's not just protecting against severe disease or death it's protecting against infection
• 32:35
  so if you have a look at the US they've done brilliantly well as well so they started rolling out
• 32:41
  on the 23rd of December and they had on that day about 234,000 cases it's mind boggling
• 32:50
  they then went up to a peak of about 378,000 cases on January 8 and just the other day they were
• 33:01
  down to 19 and a half thousand cases. So that is yeah that is a splendid result. So wait let me
• 33:08
  let me let me just sorry I just want just in case people missed that they were at over 300,000 new
• 33:12
  cases a day and they're now less than 20,000 new cases a day so it's it's less than 10% it's
• 33:19
  more than like a 92, 193% reduction on what they were at the January peak. It's brilliant so yeah
• 33:27
  and then the UK which uses AstraZeneca and Australia is using AstraZeneca in the over 50s
• 33:34
  they've had so they started on December 13 they had about 18 and a half thousand cases on that day
• 33:44
  again January 8 they had a peak around about 68,000 cases and a couple of days ago they had
• 33:54
  about 2,700 cases so you know it works so 68,000 cases down to fewer than 3,000 cases in the UK the
• 34:07
  the reason I just want to I want to get the listeners head around why I might sound like I'm being
• 34:13
  for snickety or a pedantic about this question it's it's only in contract I'm only establishing this
• 34:21
  in contrast to the what seems to be the expectation of the prime minister and I think the expectation
• 34:26
  of many Australians that there's going to be some reasonably easy or predictable way to maintain
• 34:34
  elimination that I think most people are still at least certainly a month ago most Australians were
• 34:40
  laboring under the impression that we get vaccinated things get better in the rest of the world the
• 34:47
  international board is open and then life is basically what it what it was prior to COVID and nobody
• 34:53
  dies and so when I say what about you know even if the vaccines make us 100% protected against
• 35:02
  getting very sick or dying if they don't give us 100% protection against infecting somebody else
• 35:08
  and if there's still some cohort of people I mean let's assume that we don't get to perfect herd
• 35:13
  immunity and there's still some cohort of people in Australia who are anti-vaxxers or whose immune
• 35:18
  systems aren't up to scratch then if I re into the country from visiting main laws in the United
• 35:25
  States even if I'm vaccinated there is a I mean prior to the coronavirus over 100,000 people
• 35:30
  are entering Australia every single day if even if it's 99% effective the vaccine which it's not
• 35:36
  1% of 100,000 people a day is still quite a lot of people who could be infecting other people
• 35:41
  and even if you know 83.5% of Australians are vaccinated there's still some cohort of people
• 35:47
  where it can bounce around now I'm not saying this is a price that isn't worth paying I'm saying
• 35:50
  it probably is a price worth paying but the price exists doesn't it? There is a price but I'll
• 35:58
  just remind you in Australia 98% of deaths were in the 60 and over in the 70 and over it was
• 36:06
  94% of all our deaths so 4% were from the 60 to 69 year olds but the 70 and over 94% of all deaths
• 36:16
  so if the deaths in those in a younger than 60 is rare in Australia our health services were not
• 36:26
  overloaded and fortunately most Australians got what I would turn non-hospitalized COVID because I
• 36:36
  think by calling it mild is disrespectful to those people who didn't feel it was mild at the time
• 36:43
  and they you know they were at home and they were suffering badly but and this is a disease
• 36:50
  inflammatory disease and we do now have much better knowledge about what does work and what
• 36:59
  doesn't work with with treatments that we're still very fit on the ground when it comes to
• 37:04
  treatments and there's still a lot of accessibility to our polyvalent antibodies or one of
• 37:14
  the clonal antibodies is still not a lot of those around and it's still expensive so yes we
• 37:22
  we may get people who get sick but if we can vaccinate to the 88% all of our elderly are vaccinated
• 37:31
  though I believe but it's not yet the case that we should make all frontline workers have the
• 37:39
  vaccine on a mandatory basis if they don't want to get vaccinated then the authorities need to
• 37:45
  find them another job because if you think it's your right not to get vaccinated but you're looking
• 37:51
  after very very vulnerable people it's not your right to potentially be the conduit between
• 37:59
  the person coming in from overseas and then giving you the virus and then you give it to the
• 38:03
  vulnerable that's not on that's not a human right that's just obliterance so um but that but
• 38:11
  the so my parents my parents are in their 70s they hear if I go and visit my in-laws in the states
• 38:17
  and I'm vaccinated and I come back in let's project this into the future and there's no hotel
• 38:21
  quarantine and I go and visit my parents there is some non-zero chance that I could have picked it
• 38:29
  on the plane and I could be carrying it even if I'm vaccinated they're vaccinated but let's suppose
• 38:37
  that there's some non-zero chance that they might be able to carry it and as they go about their
• 38:41
  lives visiting their other over 70-year-old friends at some point there's a non-zero chance that
• 38:46
  they're going to bump into someone who they could infect who could get sick from it well is that not
• 38:52
  what am I misunderstanding yet okay well let me just make you feel a little better son
• 38:57
  at your age you'll probably get Pfizer there's a five percent chance that it may not work in you
• 39:05
  but that was based on people of all age groups not just on your age group so in fact the vaccine
• 39:12
  efficacy in your age group may be even better then let me remind you that we had a presentation
• 39:21
  by Pfizer of work done in Qatar and the vaccine one dose plus 21 days or two doses plus seven days
• 39:32
  was enormously effective against the B1351 the one in in sorry in South Africa and then the B117
• 39:43
  so it is highly effective and if you do catch it there's some science around the fact that you'll
• 39:54
  catch it at a lower viral load so you you'll maybe one of the less than five percent that may
• 40:02
  catch it your parents will have had two two AstraZeneca's they have a greater risk or not
• 40:10
  elasticity a good response it's highly likely that the Oxford trial of the Nixon match
• 40:19
  will in the 600 they've looked at so far it's been very successful and that your parents will be
• 40:26
  offered a booster of Pfizer or you know the donor on one of those which then really kick start
• 40:34
  your immune response so the probability of lining up your parents who may be unprotected in
• 40:44
  yourself having a low viral load may be true but what I think we should be doing at the border
• 40:51
  which we're not doing now is using 15 minute rapid antigen tests to identify that you're coming
• 40:59
  back in you've got your vaccine passport that says you've had two doses and it's still within
• 41:08
  a period of time that you should have good circulating antibodies or T cell response
• 41:14
  you then arrive and you have a rapid antigen test if it tests positive you'll be should be tested
• 41:20
  with a confirmatory PCR test and in the meantime you may be put into some sort of isolation to
• 41:27
  ensure that that was a real positive result if it's a negative you go home and how long does
• 41:33
  that take Professor the PCR? Well the rapid antigen test takes 15 minutes while you're waiting for your
• 41:40
  bags the PCR test is a saliva one that was developed up on the by the Dodie Institute in Australia
• 41:48
  that takes four hours that would be very annoying but there are also rapid antibody tests so if you've
• 41:56
  got a vaccine passport plus high antibodies it's unlikely that you're carrying it but you could
• 42:04
  just do a rapid antigen test. And what's the false positive rate of the rapid antigen test like
• 42:09
  how many people would have to be waiting around in the in the in the temporary quarantine?
• 42:13
  Yeah yeah so it does have a false positive result level and but mind you the PCR test
• 42:22
  negative level as well none of them are perfect but the rapid antigen tests in Australia most of them
• 42:29
  that have been TGA approved have a level that actually have 99 to 100 percent so if you enable
• 42:35
  negative you truly are negative and you go home or you go home and you're told Josh can you please
• 42:42
  take this take home test and open up your WhatsApp and when you're at home on the third day
• 42:49
  test yourself and if you're negative then you're most likely negative. So a colleague of mine from
• 42:55
  the Australian technology I thought sorry I think they call technology Australia he prefer
• 43:03
  a model that says you stay in isolation for five days and I think that we could be doing some
• 43:10
  research that says we'll do a test at the airport we'll do a test we'll give you a take on test
• 43:16
  and and let you stay down for three days we'll do some people for five days and see how well that
• 43:24
  goes but I think that the more we're learning about the vaccines the more optimistic I am
• 43:34
  is that we're going to be in a good place. That's very reassuring my so let's talk about the public
• 43:43
  relations I suppose component of it because you're speaking as an epidemiologist which makes sense
• 43:48
  I think about the cultural and political imperatives that politicians feel and the way that they
• 43:57
  have to I suppose pander to the to particular factions who live in particular electorates that
• 44:03
  are important to politicians rather than necessarily to what a pure platonic reason driven policy
• 44:10
  might look like and I still worry that the expectation that this is going to resolve itself
• 44:20
  with no downsides and all upsides is something that people are still holding on to. You're making
• 44:25
  me hopeful but I guess let me put it this simply it will this bluntly do you believe that we can
• 44:31
  open up for example in calendar year 2022 in such a way that there will be zero deaths
• 44:40
  from coronavirus in Australia sustainably. Well Josh may I give you some caveats I think that
• 44:51
  the next time we get the elderly who acquire COVID we need to take them to hospital I think what we
• 44:59
  did by making them stay at a residential age care facility and expect that that shared home
• 45:06
  environment that's not built as a property hospital would work and wouldn't then have the virus
• 45:13
  travel through a residential home with unrealistic and cruel so I think that anyone that's
• 45:22
  positive that's elderly should be immediately missing to a hospital that can cope with an infectious
• 45:29
  agent and I believe that when we open up we need to be science driven we need to get away from the
• 45:37
  idea that we can't use rapid antigen test the reason I believe we're not using them in Australia
• 45:43
  is because they're not on the Medicare rebate system so in Australia every time you have a
• 45:50
  PCR test and you're not front-line and it takes a normal work hour of about 24 hours per turn
• 45:59
  around they get a reimbursed $100 or they're about where rapid antigen testing cost about an
• 46:10
  American dollar $5 versus an Australian $100. Once we get rapid antigen tests on the reimbursement
• 46:21
  system you'll have border protection which at the moment is a state-based system and they don't
• 46:28
  want to spend any extra money because the rapid antigen test is not on that reimbursement once we
• 46:34
  get that on the reimbursement level then we'll start to use more science around this
• 46:40
  an Australian company provides America with take home tests when I asked the TGA why we aren't
• 46:47
  doing that I was told quite surprisingly that it's because they don't want Australians to have the
• 46:56
  burden of being told they're positive at home with a kid because at the moment they're already
• 47:04
  told at home because they get a phone call they just not performing the test themselves and
• 47:11
  yes they turn up for a test with an expectation of stealing themselves for a positive result
• 47:18
  that's right and what does it tell us about the esteem in which the therapeutic goods
• 47:23
  administration holds us as citizens if it doesn't think that we're capable of finding out about
• 47:30
  our own health results I think that that explanation was actually made up made up I think
• 47:42
  it was made up because I then did reply and this was a public meeting actually in Parliament
• 47:49
  and I did say you know Australian teenagers and adult women have been performing pregnancy
• 47:56
  tests at home for a long time now and sometimes they're not always happy with the news
• 48:03
  so I'm sorry I I think that there was another element that we weren't being told
• 48:10
  well I mean the rules never make the rules never make sense on this sorry sorry but there's a
• 48:14
  I do remember I went for I had a bunch of tests of STD tests just to routine ones and the the
• 48:23
  clinic said this was this was many years ago the clinic said look if if it's if it's no problem
• 48:31
  then we'll give you a call but if it's a positive result with something of something serious
• 48:36
  then we'll give you a call to make an appointment to come back in and be delivered to the news in
• 48:40
  person and I was like well then if you just if you call me and tell me that I need to come in
• 48:44
  then I'm going to think that I've got HIV or something like just tell me I'd rather know over
• 48:48
  the phone if you like don't don't sugarcoat it if I think I'm gonna tweak when you say we can't
• 48:54
  tell you what we need to discuss you're gonna have to be here in person yeah so I do think the
• 48:59
  medical profession hasn't kept up with the maturity of the community so you know we give a result
• 49:06
  that say you don't have bowel cancer when you do a take home test and everybody over 50 in
• 49:13
  Australia has given a take home test unless of course they've had a diagnosis and then of course
• 49:18
  they have a more invasive procedure every three to five years but it's you know and then if you
• 49:28
  do the testing correctly you get a record a letter that says that didn't work out doing again but
• 49:35
  I do think that we need to start giving full respect to the community about the fact that they're
• 49:42
  growing up and they can you know they can cope with this so and how would you get it so just to
• 49:47
  clarify the jargon in case people didn't understand the last little bit the TGA is the therapeutic
• 49:51
  goods administration which is the government body that decides whether or not the medicare the
• 49:55
  universal socialized health care system that Australia has is going to reimburse a particular
• 49:59
  drug or test or procedure or whatever how do you get the rapid antigen test onto the onto the TGA
• 50:06
  like freebie list so that places actually want to do it well that's going to be very difficult Josh
• 50:12
  because the pathology practices are not going to be very happy with this because a lot of these
• 50:21
  PCRs could should be augmented with rapid antigen test for example the current
• 50:31
  cluster outbreak in Melbourne have Victorians lined up around the corner for five hours or more
• 50:38
  or sitting in their car for many hours and Australians are unbelievably remarkable when they're
• 50:44
  asked to do something they turn up in droids and then they're told of the we've run out of swabs
• 50:51
  or the census closing now what they could be doing is augmenting this with what level of
• 51:00
  risk you think you have and if you take it slow you get you get a rapid antigen test and sure
• 51:08
  you'll get some false positives and then you have a major variant yield swab that can back up with
• 51:15
  this test better regardless of what test you have in Australia you're asked to then go home and
• 51:20
  isolate so the pathologists are going to have to cope with the fact that the medicare bill cannot
• 51:30
  cope with this for too much longer the amount of testing that we've done in Australia is
• 51:38
  is very high and all you have to do is multiply that by a hundred dollars and you'll see we're
• 51:45
  in the we're in the billions and the other issue is I mean our prime minister started using the
• 51:54
  term rapid antigen test and gave the impression to myself and other scientists that this was a
• 52:02
  possibility it's just that because states and territories would have to cope with the cost
• 52:11
  they're not going to embrace it until it gets onto that medicare bill and there's a there's a
• 52:17
  attention between the doctors pathologists and and the and the group that decide what should be
• 52:28
  rebated so you mentioned states and territories the states and Australia's a federation like the
• 52:35
  United States so all of the provision of services is conducted at a state level by state governments
• 52:40
  healthcare and so on in policing and the federal government handles the the big stuff like
• 52:44
  defense and so on so the border you would imagine is the federal government's responsibility
• 52:49
  the international border that is and who comes into the country but once the person comes into
• 52:54
  the country once and no non Australians are allowed in at the moment but Australian citizens
• 53:00
  and permanent residents with the exception of the the weird work about India recently are generally
• 53:05
  allowed back in but they're funneled into quarantine hotels and kept under police guard for a
• 53:10
  couple of weeks and those quarantine hotels are run not by the federal government who's setting
• 53:14
  those rules but by the state governments who are the ones that run healthcare and police and so on
• 53:20
  which are the relevant entities that that have to run the quarantine now some of the state governments
• 53:25
  would really like to open up in a fairly bullish way not immediately but in the medium term in
• 53:33
  particular the most popular state new South Wales West Sydney is the premier is like a US governor
• 53:38
  is is quite adept at so far that touch wood managing outbreaks through contact tracing through
• 53:47
  localized lockdowns but Sydney hasn't had a full Melbourne style you know widespread you can't
• 53:54
  leave your house style lockdown since the early days of the pandemic back last may a year ago
• 53:59
  Mary Louise what do you think is going to come of the tension that exists between state governments
• 54:06
  that want to get their economies going and feel confident enough that they can probably keep on top
• 54:11
  of minor outbreaks using good contact tracing and mass testing and isolated quarantine versus
• 54:18
  the federal government which seems I mean no federal government in Australia ever loses an election
• 54:22
  on the basis of of tub thumping about the border and making sure that Australians feel safe from
• 54:28
  threats abroad and locking up refugees on desert islands to ensure that none of them ever make it
• 54:33
  to Australia the Australians are fixated on this idea of us being a an island that we can decontaminate
• 54:38
  from the rest of the world be that other impoverished people or viral pathogens how do you see it
• 54:44
  playing out if if we increasingly get a divergent priority at a state level versus a federal level
• 54:51
  and what should happen to allowing people to travel once again well I think the Australian community
• 54:58
  are a very powerful in their voicing of their displeasure with their leaders.
• 55:09
  Australians are very very peaceful and the way they voice their displeasure is through
• 55:17
  journalists and through their local member and all you have to do is go to your local member
• 55:25
  and express this concern and the local member who wants to keep their job will respond.
• 55:31
  Well the tension that we often have is when we have a lot of states that have the don't actually
• 55:41
  and areas within states that don't have independent representatives the member is usually a first
• 55:50
  and foremost loyal to the party and then loyal to the people secondary but if they think they're
• 55:58
  not going to get voted back in again they'll certainly agitate the party for a change just the way
• 56:05
  we did for stopping our authorities from closing with herd immunity and that changed very rapidly
• 56:14
  and it was awesome thanks to the journalists for helping with that so how do I see this playing out
• 56:23
  as an epidemiologist and this is a wish list that's probably never going to happen I think that
• 56:30
  federation such as Australia should because we have a very small population now you know 25
• 56:37
  minutes we should when a pandemic is called or it's actually a public health emergency of international
• 56:45
  concern that's when member countries are legally obliged to start preparing and responding not
• 56:50
  when a pandemic is called that's actually just a call that is administratively important for WHO
• 56:59
  but when a seat is called that's when we should become a collective in our approach and not
• 57:08
  statewide in our approach to have national best practice that is agreed upon by all the states
• 57:15
  and territories within a quiet room where they can get very cranky with each other but it should be
• 57:22
  a one a one approach a whole of government whole of population approach rather than Western Australia
• 57:32
  wanting to close their borders at you know in one case we need to bring in science so that there's
• 57:39
  no closing of internal borders so that we can test people so that they have a human right to see
• 57:46
  their family and and travel for for work so we need much more science even though we are very science
• 57:53
  driven just as you say though professor that Australia has cultural differences that set it apart
• 57:59
  from other countries and the Australians are much less tolerant of a cavalier attitude towards
• 58:04
  life and death and are in many ways more obedient than their counterparts in other anglophone
• 58:10
  countries that there are those differences between states as well and you know West Australians
• 58:17
  they do not want any coronavirus in West Australia that is that is just a blanket fact overwhelming
• 58:24
  majorities whereas I think in Sydney there is a recognition that you know Sydney side is a proud
• 58:30
  of being a big global city they feel like they're connected to Asia they feel like they're
• 58:34
  internationalists and globalists who can hop on a plane and go to Los Angeles or London whenever
• 58:38
  they want to there is that elite in Sydney and in Melbourne as well I don't exclude that and
• 58:45
  if you are if you're requiring a consensus within Australia about the international border then
• 58:52
  aren't you sort of giving the most jittery premier or the most jittery state a terrorist veto over
• 59:00
  everybody else because they're never they're never going to see the world with the same cavalier
• 59:05
  attitude that Gladys Bayerigickley and the New South Wales Premier does I mean in some ways I'd
• 59:09
  almost rather the New South Wales and Victoria you figure out a plan of opening up to the rest of
• 59:15
  the world and if the rest of Australia wants to cut off New South Wales and Victoria from Australia
• 59:20
  I'd rather be able to visit my in-laws in New Hampshire than go on a holiday in Ningaloo Reef
• 59:26
  well don't forget you're talking to an epidemiologist and we aren't economists
• 59:34
  and you know we are criticized for not being economists but that's not our job our job is to give
• 59:44
  evidence and analysis on on how to protect people from an outbreak and then up to the politicians
• 59:51
  to then decide and then it's up to the voters to then because it's a democracy to then say
• 1:00:00
  you're right or you're wrong so I do see New South Wales being cavalier because they want to
• 1:00:10
  get voted back in they they want the economy to run but that's from an epidemiologist perspective
• 1:00:18
  so you know when I see Western Australia want to put up the border I think to myself I understand
• 1:00:25
  that you want to protect people that's great from outbreak management perspective that's great
• 1:00:30
  but let's use science so that we don't have to close borders and this is where I get frustrated with
• 1:00:36
  the idea of why aren't we using rapid-adjudging testing that yes it has its problems but my goodness
• 1:00:43
  it would allow I mean for example we close we're closing our borders to Victoria people are coming
• 1:00:50
  home but they could be bringing the virus with them to tell them to go home is one thing but they
• 1:00:56
  could go home and then decide the fridge is empty and they need to go shopping or they can't
• 1:01:01
  afford because not everybody is privileged they can't afford to then order in food from one
• 1:01:09
  of the big grocery stores because they charge for that some people live hand-to-mouth every day
• 1:01:15
  from every wage and and if they are told stay home and they can't you know they've got to go out
• 1:01:23
  and they may not have friends and family to deliver food to the front doorstep so one way around
• 1:01:30
  that is you science embrace science that could prevent this sort of difference in response
• 1:01:40
  we don't even have an agreement for a traffic light system so at the beginning of the second
• 1:01:48
  wave last year I of course thought data so I was looking at the data and I could see that there
• 1:01:55
  was going to be a big problem in Melbourne because there were the occasional case in two different
• 1:02:03
  hotels quarantine systems and then I saw a large increase in case numbers in our multicultural
• 1:02:12
  community why because they obviously have some relationship with a security guard who got
• 1:02:19
  infected from their manager we still don't know how the manager got infected but probably because
• 1:02:26
  in those early stages they weren't wearing face shields and face masks continuously
• 1:02:32
  and then it gets into a multicultural community that live in overcrowded conditions
• 1:02:38
  because they're trying to save money to build a good life so where was a traffic light system
• 1:02:47
  that said when the case numbers every day goes up and in Australia I'm talking about straining
• 1:02:54
  traffic light system I worked up that if the case numbers got over five it will go into dangerous
• 1:03:03
  times and then I did some simple calculations and sadly I was right every time that it was going
• 1:03:11
  to then escalate and we don't have a traffic light system across Australia for zones and we could
• 1:03:20
  have this system that they agree upon that if it's this amount of cases like the last one the one
• 1:03:27
  that's happening now in Melbourne they have one case coming from the quarantine hotel they then
• 1:03:35
  caused inadvertently four cases then they caused 10 and that was you know twice the amount in 24
• 1:03:43
  hours at that stage that was a red light for my traffic light system and they should have had a three
• 1:03:50
  day lockdown to give the quarantine so to contact traces time so a national system
• 1:03:57
  and so if I just I'm not across the timing of of how it did play out at what stage did the
• 1:04:03
  the the the the lockdown of the whole state come into effect it came in on Thursday night but
• 1:04:08
  yes but where was that in relation to your recommendation of the red light should have gone off
• 1:04:13
  at 10 10 infected cases the red light should have gone off on the 26th so today's the 28th
• 1:04:23
  right should have happened on what so there should have been a three day lockdown on Wednesday
• 1:04:26
  instead of a seven day lockdown from Thursday night yeah because I mean exponential growth
• 1:04:31
  happens so fast doesn't that the only need that the 30 hours between the recognition of the 10th
• 1:04:36
  case and the implementation of the lockdown you can you can have people who don't know that
• 1:04:41
  they're infected infecting a lot of other people in the space of 36 hours yeah exactly so
• 1:04:48
  now I've got a statistician at my university at University of South Wales who ran a very much
• 1:04:55
  more sophisticated model and he said oh your simple system works very well when you're only
• 1:05:02
  given a certain amount of data and that's what we need on rapid data making it obvious to the public
• 1:05:09
  I believe in full transparency it is a democracy and to keep that democracy you've got to keep
• 1:05:16
  transparency out and that that traffic light system alters or you know flickers between
• 1:05:22
  you know green amber and red and then the public know what's going on it's it hasn't been tested
• 1:05:30
  in a in a large community like America but certainly it's worked sadly every time in Australia
• 1:05:38
  so we really do need to become more federal based when we have a system we have a pandemic because
• 1:05:49
  just because where you choose to live doesn't mean you don't get best practice national best
• 1:05:55
  practice and that's what we need national best practice across all of our country and that's what
• 1:06:02
  I think America needs as well you don't choose to live in your region because of who runs it
• 1:06:08
  you choose often for many reasons a job you like the climate you grew up there that doesn't
• 1:06:16
  mean to say that you move because you happen to like the the state premier you don't do that or
• 1:06:24
  you don't happen to like the mayor you just move because of all the other things that make life
• 1:06:33
  enjoyable and then if you don't like the representative you try to vote them out so instead of
• 1:06:40
  relying on the best practice in your area you need to know that you're being given national
• 1:06:48
  best practice and this plays out really loudly in our quarantine system so we have best practice
• 1:06:57
  in Howard Springs which is up in the Northern Territory which is run by a group of people by
• 1:07:04
  called Osmath who are experts in their kind of quasi um a military and it's led by a man called
• 1:07:13
  Ian Norton and of course the doctor in Doe in hospital who responded to the body body and they
• 1:07:22
  have best practice they've never had a problem not one tiny breach because they
• 1:07:30
  short up all the holes in that wall and when you do outbreak management you don't just have
• 1:07:36
  one system of prevention you do what like the Americans call bundling so they bundle
• 1:07:42
  systems in a hospital to get best public um sorry patient safety so and it's based on
• 1:07:50
  that where you don't know perfect evidence you've bundled or what you think works well
• 1:07:57
  meaning that you and you bring in redundant systems so that if one fails the other will pick it up
• 1:08:02
  if that fails another will be there to pick it up there's there is no breach that will get through
• 1:08:06
  all of the the layers of the safe exactly and you don't just rely on testing on date two and day 10
• 1:08:14
  or 11 which we've been doing and then if somebody feels unwell and gets tested between those two
• 1:08:20
  that dates they then and they're found to be positive they then get moved to a meeting hotel
• 1:08:26
  and they start their quarantine all over again now that's just crazy we should be testing more
• 1:08:31
  often so that people aren't left in quarantine for so long we need to test our staff every day
• 1:08:41
  that's only just happened over the last few months and yet how much brings we're doing that
• 1:08:47
  from the get go so we we do need to have best practice and how it springs well best practice they
• 1:08:57
  have a single story a hut and they have natural airflow because quarantine hotels were never built
• 1:09:08
  as proxy hospital they can't match the 10 air changes per hour per person for an average size
• 1:09:15
  ward in a hotel system where you might get two people in a room a couple or a family who are
• 1:09:23
  exhaling particles before they know they're positive and then they're spread and I've been
• 1:09:30
  agitating since last year that the quarantine system needed to be perfect built and 24 breaches later
• 1:09:39
  we still don't have them and I've estimated that since our lockdown on the 20th of March 2020
• 1:09:46
  from the rest of the world and we put in place a secure quarantine hotel system that
• 1:09:54
  just over 22,000 cases have been directly related to breaches in quarantine
• 1:10:03
  and I know that I'm mindful of your time now and I don't want to keep you but just on the question
• 1:10:07
  of the the red light orange light green light system where you would have nationally standard
• 1:10:12
  ideas triggers that would say all right we're going to go into a three day lockdown because you know
• 1:10:16
  we've hit five more than five cases a day for example doesn't that depend on how good the the
• 1:10:21
  contact tracing is and isn't it an indictment of the Victorian government that the I mean I was
• 1:10:28
  thinking I was saying to a friend this morning if only something had happened a 10 months ago
• 1:10:33
  that might have given the Victorian government a kick in the pants and thought wow we really need
• 1:10:37
  to make sure that contact tracing is diamond standard top notch higher whoever we need to hire bring
• 1:10:42
  them in from overseas if we need to hire redundant people who've been laid off by quantists I don't
• 1:10:46
  care what it costs we're going to make contact tracing so good that we can get on top of anything
• 1:10:50
  throw all the money in the world at it if only something had happened back then like the four
• 1:10:54
  months lockdown that they endured one of the longest and most most harrowing lockdowns anywhere in
• 1:11:00
  the world and still they don't believe that their contact tracing is good enough to ensure that they
• 1:11:05
  can get on top of a small as you say what it was three people initially rate of infection
• 1:11:13
  would the traffic light system have to be different depending on each state's capability to get on
• 1:11:17
  top of tracing cases well my traffic light system works that you don't wait until you get to the
• 1:11:24
  red you go orange and then you go three day lockdown but three days the sitting contact
• 1:11:35
  tracing might do more in three days than the mobile ones might well first of all let me just remind you
• 1:11:41
  that to do a good traffic light system you respond before you get into the red so when you're in the
• 1:11:50
  orange and the on which of the data was that we had four which was the 25th so four cases plus
• 1:12:00
  the one from the South Australian quarantine hotel that would have been an orange going into an
• 1:12:07
  orange system of five it was then starting to go something seriously wrong and everything should
• 1:12:16
  everybody should have been asked to start wearing masks and stop going to the football and then
• 1:12:23
  they were just talking about maybe they'll reduce the lines for people going into the football to
• 1:12:29
  fewer they weren't really realizing how serious this was right so it's still sort of being made up as
• 1:12:37
  it goes along so instead of having a Thursday night seven day lockdown you're staying on Tuesday
• 1:12:42
  there are a bunch of things that you could have done that are short of a lockdown that could have
• 1:12:46
  helped get on top of it yeah and we could make this a national system right so that so that the rest
• 1:12:52
  of the country isn't isn't having to cope and the professor I'm going to let you go because I feel
• 1:12:57
  guilty yeah I just just lastly I want to clarify I see if I can summarise this okay and if you give
• 1:13:02
  it this the Josh steps Mary Louise McClure's sign signature of approval my takeaway is bring in
• 1:13:09
  rapid antigen tests on a widespread basis require everyone who works with elderly and sick people to
• 1:13:15
  be vaccinated improve the quarantine hotel so they're all operating like the Howard Springs
• 1:13:21
  Northern Territory facility is test returning travelers more often using a greater variety of
• 1:13:28
  tests and that way you can probably get rid of the quarantine hotels as as something that everybody has
• 1:13:33
  to go into and what allow vaccinated travelers to who have rapid antigen tests at the airport
• 1:13:42
  to spend three days at home or something like what's the what's the next step it suppose we're
• 1:13:46
  talking about let's think of January 2022 right let's say we're celebrating on New Year's Eve
• 1:13:50
  kissing under the mistletoe what is what is a feasible expectation for those Australians who are
• 1:13:56
  still languishing with friends and family abroad and wondering when they're going to be able to
• 1:13:59
  see them well I think that should be that they've had put up one of those who want to come to
• 1:14:06
  Australia and it should be a double vaccine within and their vaccine has to be timely they
• 1:14:14
  you know can't be more than a year old or he has to be fairly recent and an antigen tester at PCR
• 1:14:24
  test we require three days before they hop on the plane a lot can happen in three days so if you're
• 1:14:30
  going to require that you need a rapid antigen test at the airport and then you get home you're given
• 1:14:37
  a kit to take home even an electronic wristband to make sure you don't leave your premises at home
• 1:14:45
  for three to five days and you tested twice you do your own tests at home twice during that stage
• 1:14:52
  you take your band off you give it back and you're free to go around the community
• 1:15:00
  and of course it does rely on being vaccinated so those who aren't vaccinated you may have to
• 1:15:09
  stay at home for longer yes or you may have to still be in a quarantine hotel no correct yes
• 1:15:15
  fast a good one always a good one thank you professor great to talk to you
• 1:15:22
  it's a pleasure and stay well and get vaccinated