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Matters of public importance COVID-19


 'As probably one of the few members with training in infectious diseases epidemiology I find that I am actually less certain about most of this than just about everybody else in this chamber.'

 I would like to thank the member for Malvern for raising this matter of public importance, and I certainly endorse the comment that this house thanks all Victorians for the sacrifices they have made to contribute to bringing this pandemic under control. I also share the concern expressed about many of the other issues in this motion but without the same rhetorical extremes. When we are tempted to criticise the government or the public service we first need to ask if we would have done any better. As probably one of the few members with training in infectious diseases epidemiology I find that I am actually less certain about most of this than just about everybody else in this chamber.

I caution against certainty at this time. No party went to the last election with a costed policy on managing a respiratory virus pandemic. Most of our knowledge about this virus and about this pandemic was learned this year. So, rather than obsessing over who to blame, I think the most important use of our time is to find what lessons we can draw from the mistakes that have clearly been made so that if we learn them well we do not repeat them.

On the government side I think that people will judge a government less harshly when it is open and clearly making painful decisions for the public good, but not if it is secretive. The government needs to be more open than usual at this time with Victorians. Oppositions and non-government MPs need to change too. We must accept that people do not want shrill politics; they want information. But shrieking ‘Resign!’ at the first sign of uncertainty or inconsistency does not help and indeed undermines confidence in us all, particularly when there is little evidence that you would have done any better.

The first wave of infections in March and April gave us time to prepare for what followed. The initial failures in the management of hotel quarantine and in the Cedar Meats outbreak were doubtless significant failures, but focusing alone on these two events may also be blinding us to more important lessons that lie elsewhere. The most important lesson I think we need to learn now is the answer to: why did the current second wave take off after it had escaped hotel quarantine, and why couldn’t we stop it until we had stage 4 restrictions, masks and a state of disaster?

Last week I was called by a person recovering from COVID who told me that his first call from contact tracers was 14 days after his symptoms began. I think there is little doubt that Victoria’s contact-tracing system at the start of this crisis barely existed at all. It had to be built from scratch. People had to be recruited and trained. We had just a handful of contact tracers at the beginning of the year specialised in contact tracing sexually transmitted diseases and tuberculosis. Was there sufficient expertise in the department to build up the system to the size it is now? Probably not. The evidence suggests that through July, when this wave of infection was taking off, we were still building the contact-tracing plane while we were flying it. It probably was not working very well.

Part of the answer may lie in the fact that the Victorian health department is one of the most dysfunctionally organised in the nation, despite the excellent staff who are in many ways the ones who are holding the system together. This may go back to the gutting of the department of health by the Kennett government, the setting up of hospitals as separate entities and the burying of the chief health officer some distance away from the chief medical officer in the organisational hierarchy. The fragmentation of the health system is different from other states and territories, and I am quoting Professor Lindsay Grayson here, an infectious disease specialist:

… where there is an overarching health structure and clear lines of authority, a central source of guidelines and standards, and central oversight.

We have inherited a complex health system, a fragmented health system, that is not fit for the purpose of managing a pandemic; and also, for reasons beyond the control of the state health minister, it is fragmented in other ways between state and federal management and public and private systems. So we should not be peddling the illusion that we can fix these entrenched problems with a political scalp or two. We also need to be able to work better together and across jurisdictions. We have seen a national cabinet, but I think it is clear now that we needed, and still need, a national centre for disease control to help work across the many different parts of our health system. A well-functioning disease control system would have coordinated this and would have pooled expertise from multiple states to help Victoria in its hour of need.

I want to turn now to what happened in North Melbourne and Flemington public housing. It is a sad truth that the most heavy-handed, authoritarian responses are disproportionately applied to those with little voice and power to fight back. People in public housing deserve the same dignity and respect as every other member of the community. People should never again be locked up without access to food or medicine. For this reason the Greens called for an independent inquiry into how the hard lockdown of Flemington and North Melbourne public housing towers was managed. We were relieved that the Victorian Ombudsman has announced that there will be such an inquiry. We earnestly await its findings and we will push for their implementation.

I would like to move now to another concern raised by the member for Malvern: the large numbers of infections amongst healthcare workers. I have been contacted by many health workers who feel that the state government has failed in its duty to keep them safe. In Victoria over 3200 healthcare workers have now tested positive to coronavirus. In Victoria the odds of a health worker becoming infected are at least four and by some calculations closer to 30 times higher than those faced by the rest of us. Hospitals and other countries have achieved a zero rate or low rates of infection in staff, often after hastily making changes due to the same problems suffered here in Victoria. We need to try and emulate their success.

So one of those issues that has been frequently raised is the adequacy of PPE, personal protective equipment, and specifically the type of masks used to prevent respiratory aerosol infection. The state government has done well to obtain millions of masks and gloves when global demand was very high, but our hospitals are now churning through millions of masks each week—800 000 of the more expensive disposal N95 respirators go in the bin every week plus a much larger number of gloves, surgical masks and gowns.

Miners and others working in hazardous air are given high-quality reusable elastomeric respirators. They fit better, they filter aerosols better than disposable N95 masks, they do not need to be replaced—so they are secure against supply shocks—and they do not add to the mountains of waste being collected daily from public hospitals. They and the recently developed ventilation hoods developed by engineers at Melbourne University are worth investigating and, in my opinion, investing in to reduce the problems posed by a high consumption of disposable PPE.

Fit testing is something that health workers have been calling for months. I am pleased to see that it is being trialled at last in one hospital, but it is disappointing that it was actively discouraged by hospitals when staff tried to arrange it privately. The fact that I have been hearing about these problems for a couple of months suggests that the government has some serious lessons to learn in this department.

Finally, given that so many health workers have been infected and it is very difficult to prevent when a health worker gets within coughing range of a patient, I want anyone looking after me, if I go to hospital, not to have to worry about their safety, not to have to worry if they can afford time off work. At any given time now we have got hundreds of hospital staff off work either because they are infected or because they are isolating because they have been exposed. So just as we did with firefighters, I believe that we should legislate or otherwise guarantee presumptive rights to workers compensation for any monetary loss for time off work for infected staff.

There are many other lessons that we can learn from this pandemic. I do not have time to go into them now, but health messaging in culturally and linguistically diverse communities is, I think, one area where we have—and it is easy to say this with hindsight—failed and we have a lot to learn. Also, something that the Premier has pointed out is the problem with insecure work and people’s ability to take sick leave.

That said, I support the member for Malvern in raising most of these concerns, and I conclude where I began: by thanking Victorians for the sacrifices that they have made in working to control the pandemic, and I particularly thank those in the electorate of Brunswick.

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Dr Tim Read
Greens MP for Brunswick
4 September 2020
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