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Hello and welcome to The Stand with Amy Dunfee.


The stand is proudly supported by Tasco at Tesco, our exclusive house for over 65 family carers and extremely medically vulnerable customers are every weekday, Monday to Friday, up to nine a.m.. Health care and emergency services have priority access at all other times now, more than ever, every little helps. Now our own troubles with the coronavirus are beginning to wear people down. There's a lot of confusion. There isn't much leadership. And the figures are getting worse by the day.


Yesterday, four hundred and fifty people were infected. There are more people in hospital now, more people in intensive care units. And the fatalities are low at the moment. But we think from all the experts we've talked to understand that the deaths are sure to follow people. When they look around the world, they think immediately of places where it's been handled well. New Zealand is one Taiwan, South Korea. And, uh, looking at the figures for Australia, it's quite sobering in an Irish context or indeed in a British context.


And Australia is a country of 25 million people, and they've had so far a hundred and eighty eight deaths. We in Ireland have had eighteen hundred, just over eighteen hundred. And that's remarkable. Also, the number of infections in Australia, 27000 now here it's 36000. So it's a pleasure to welcome to the stand. Now, an Irishman who's working in Queensland, in Australia now. Conroy is a consultant in public health medicine in Queensland, and he's responsible for dealing with outbreaks of various kinds.


And while we're very grateful to you for joining us, and I wonder if you could explain to us the system in Australia the way it's important to isolate perhaps Queensland from New South Wales and so on. Is it one rule for all or is it each state responsible for dealing with this their own way? Yeah, thanks for having me on. Yeah, I mean, there's a bit in all of that to try to unpack. And in Australia, the states all have their own state governments, their own state health systems and their own state borders.


So they're broadly responsible for their own management of their own covid strategy, although it's been fairly uniform through. I also have to say and then, you know, on a federal level, they're responsible for things like national border controls. But we've, you know, we've done pretty well. And Queensland here, actually, which would have a population pretty much the size of Ireland. And we've had a thousand and fifteen hundred cases and six deaths. And that's been pretty successful by any measure.


And I suppose it's incredible by our measure.


I mean, six deaths, same population as Ireland and six deaths is remarkable.


Yeah, I haven't dealt with a corvids death in my region and we've dealt with lots of cases and outbreaks in the whole lot. We had a first wave just like everyone else. I suppose the difference is how you how you manage it. And it's been pretty well publicized that what we do in Australia, similarly to New Zealand, did was we we implemented pretty early, fairly aggressive set of measures. And probably the main one at controlling this was what we call mandatory hotel quarantine.


So anybody arriving into the country has to go into quarantine for 14 days. And that's the reason you're in quarantine, is to make sure you don't have covid. You know, you get tested a couple of times when you're there, you get medical checkups. And, you know, if you do have covered, it usually gets picked up and you stay in isolation for a little bit longer. But the rationale behind that is really important. And I think to a public health perspective, it doesn't get talked about enough.


The reason that's worked so well is it allowed people like me in the public health units to deal with the cases that we had or that were already in the country. So it's a bit like, you know, if you're if your bathroom gets flooded, the first thing you want to do is turn off the top. We turned off the top of new cases coming in and not allowed, you know, allowed our teams to sort of say, right, OK, let's go out and find these cases in our regions.


And these cases, as you well know, they there are spider's web of transmission chains. There are sideways, forwards, backwards. And, you know, they're fairly complex to get you to get your head around and why you're trying to do that while you're introducing new cases into the country and they're setting up silent transmission chains is really very difficult. So this this system allowed us to take our first wave and to really crush that curve. And when the when the cases were down to very small levels, we went super aggressive.


Yes. If there was a case we weren't tolerating with the following over ninety five percent of their contacts we were accepting, will you follow up on one hundred percent of their contacts? You hunt them down and make sure they're not sick. And so it was pretty aggressive. But I would say the the the if mandatory hotel quarantine piece has been really important to them, what else has happened is most of the states have watched the other states. Yes.


And they've sort of said, right. Queensland, we're doing pretty well right now. Victoria, New South Wales, both had leaks from their hotel quarantine system unfair. And also it was a new system. No one had ever done anything like this. You know, this was a brand new system. There were problems early on and it failed in Victoria, failed in New South Wales to an extent. And there were cases. But people we were very quick in Queensland.


We just shut off our borders and said, right, you can't come in from Victoria. You can't come in from New South Wales unless you're doing it, unless you're doing something that's essential for the functioning of the state. If you're delivering food or if you're an essential doctor or a nurse or something like that, you know. So we took very, very aggressive measures very early on and clearly rigorously enforced.


For example, we have the thing at the airport where you get a form and you sign it and you get a test. But only 30 percent of the people who went through that process bothered to answer their mobile phone. But much, much more important than this is what really will be interesting to our listeners, the pressures that came. We got it down in June, late June, early July. There were single finger infections on some days, maybe 10 days or 12 and very few deaths.


And immediately the pressure came on from businesses, particularly in the hospitality area, restaurants and. Hubs, but other businesses as well, travel, for example, and the pressure came on to relax the lockdown, which had allowed us to get to where we were. So we seem to have done the exact opposite. But there were people here and Jerry Kaleen from UTC is one of them. Thomas Ryan, who's a young scientist at Trinity College, was another.


Now is the opportunity, they argued, to really crush this to counter argument from business and commercial interests. And it's understandable, of course, was now is the time to open up. Was that a fatal mistake we made?


Well, I mean, it depends which are I don't draw you into the politics of it, but in terms of the principle of fighting infectious diseases, which you've been doing for a very long time around the world, was that an important decision and the wrong one?


Well, you see, I don't think the decision was the one to make at that time. I don't think the time is when you say we have 12 cases today in Dublin. Let's now go on, try and get rid of this thing. That's not the time to do the time. That's the way to do this, if you're going to do it, is to have a strategy where that's you're going to do because if you had back in March or April or whenever you had those very low numbers, if you had said right where we've got very low case numbers now, that's really hammer the cases that we know about.


The problem is your borders are still open. And we saw a case in Iceland recently or two tourists came in and they that they led to a cluster of a hundred cases. Yes. And what would have ultimately happened is that a snowdrift of of cases would have come from from outside. And gradually they would pick up momentum and you would probably have got some form of another wave. I think what should have happened before that if you are going to go down this deep suppression or elimination route, was that somebody should have should have gone to sort of the border control option.


Now, I think I think it's really important in saying that I'm I'm an expat. I'm living in Australia. It's it's enough for me to tell Irish society to shut their borders and expose what it's for me to say is from a technical perspective and I've heard Gerry talking about this, as you said, I'm a big fan of his and I'm very well. And I think you've got to look at this as though it's part of a broad strategy. And if at that stage the borders have been shot, I would totally agree.


You have absolutely no interest in what you have to accept. You talk about the businesses that all these people have very legitimate concerns. To my mind, an elimination or a super national strategy is a medical and economic, legal and a societal issue. So what I would always say to people and I have always said to people in Ireland, when you suppress this virus and the way that we have its life gets pretty good. Yes. You know, I can go to shows.


I can go to restaurants here. I'm not slammed with cases. You know what? I can do 90 percent of what I do before I travel overseas. And that's that's not really an option for most people in the world at the moment. But there are economic costs. There are legal issues on their medical issues. So what needs to happen is we need to consider this as an option. And I don't see that that's happened. I don't see there's been a proper economic analysis of what's the cost of trying to suppress this thing versus what's the cost of not doing this?


What are the legal issues with the two jurisdictions on the island, that kind of thing? Yes.


And is it fair to say now that the public health versus prosperity argument is a false dichotomy? Because if you get the virus down to where you've got it down to that, if you go the extra mile and really get even more rigorous when it's, you know, the infection and single figures, that's the quickest way to reopen your economy.


Yeah, and I, I find it a little bit amusing in certain countries where public health and economics are on different sides of the divide and they're the worst enemies, we're very poorly over here in Australia. Yes, there are certain sectors which have suffered greatly, you know, your airlines and that kind of thing. And they need government support and, you know, really, really difficult for them. And there has to be innovative ways to support those industries.


But as you say, the I'm not an economist, but broadly speaking, for the public health literature, we see that the countries that are doing best economically, I use the word best in the context of a poor global economy because of the countries who are coping with it best are the countries with the lowest number of cases like us and. Yeah, New Zealand and Taiwan and Japan, people like that, so I think as well, yes, absolutely.


So I think you're right that the road to prosperity is opening up like we've done here, where we're open for business. Our domestic tourism is booming. You can get a hotel room where I live this week because it's school holidays. You know, it's really busy.


Now, let me ask you another question that's very relevant, it seems to me. Do you have the population density in Queensland that we do, for example, in Dublin or that they do in London or other big cities? So in terms of the the problem we face you face, are we comparing apples with apples or apples and oranges in terms of population density?


You're always going to compare apples and oranges to an extent when you try and look at one country as an utter sort of and no deviation template that never works for you. But having said that, we're not too dissimilar. If you look at Queensland, we have a big city, Brisbane, population of 10 million people, not not too far off Dublin with some other big population centres like the Sunshine Coast, the Gold Coast. And then we have lots of regional towns in the same way that you do in Ireland.


So I would think I mean, there are some very remote areas in Australia, but, you know, they they haven't been particularly afflicted with covid. And it's been the cities under the areas of big population density. And we have lots of them here in Australia. So I don't think that's the I don't think that's a great difference. I would have to say.


So when you look at your own state of Queensland, you're clear that it was an aggressive and rigorously enforced regime that explains the success.


Yeah, I think it was. I think a lot of people would regard our border controls. Even the WHL, with the time, regarded our border controls as excessive. But you know that that aggressive ability to hunt down these cases and forward trace them a backward trace them and sideways trace them came about because we have an extraordinarily well resourced public health unit system in Australia, which Ireland doesn't have. You know, I mean, you're comparing the the Queensland Health system to the Irish health system.


And there are two very different beasts. And we've essentially been resourced to look, nothing's ever perfect within the public health system, but we've been very well resourced and very well supported by colleagues in Ireland and probably can't say the same thing. So we were able to mount this aggressive public health response in Ireland. They have absolutely world class public health doctors, nurses, epidemiologists, you name it. But they're pretty hamstrung, I would say, by sort of by the resources they're given to do the job.


Now, the key one of the key measures is and the resolution of this is clearly testing and tracing. We have not in any way are anywhere near in Ireland. What we need in terms of testing and tracing. I just saw on television last night that it can take up to six days as someone gets tested with symptoms. The result comes maybe two days later and then the contacts are found maybe six or seven days later, by which time, presumably so many people have been infected.


So that's a core problem. Did you have that problem and beat it or did you never have it in the first place?


Well, we, um, we ramped up our testing capacity very early on by using and the private sector and by using the university sector, because in Ireland you've got these really talented medical scientists to do all the testing. But, you know, they don't just multiply overnight. Some people get told that we need more of them. You know, these guys are highly trained, master's degrees. The whole you don't just pull them out of thin air. So, yeah, we have the same problems, but we use the private sector.


We use the university sector. And, you know, we we scaled up. But I suppose, you know, you're seeing the you're seeing the downside of that now. And I think actually it's testing that worry is one of the things that worries me most about Ireland, because the way I would look at this is that to get tested Ireland, you have to have these very specific set of criteria, which is actually pretty good to try to pick people who don't fit those criteria and get them tested.


But nonetheless, the criteria are very specific. You must have this symptom, most of the symptom or you must have this. And I also look at that and I go, you know, I've managed cases over here and I wouldn't have even qualified for a test tonight. So, you know, and that's because they don't have enough capacity to test. What we do is we test anyone. We say if you have the slightest thing, could be any form of head cold respiratory symptom, a slightly a slightly blocked left left nostril.


We want to we want you getting tested right, because we've all of us managed lots and lots of cold cases who that like that. And it's no surprise because covid has a spectrum all the way from people who die back to people who are asymptomatic and everything in between. So this idea that we're only testing a particular group and I think actually, to be fair to the guys in Ireland, they have picked the best yield out of what they could get.


The symptoms they've picked are the most reliable symptoms. But nonetheless, you're definitely missing him. Very hard to quantify, but you're definitely missing a reasonable amount of people who just wouldn't qualify for a test. And then there's this other that maybe can't be fixed because testing capacity just I don't know why it hasn't been dealt with eight months into a pandemic, but there it is. But my other big concern around testing is the amount of steps you have to go through.


Know, yes, you can have one of these specific symptoms you're going to ring. Your GP has to decide. You can have a test GP arrange the testing. People are testing for you. You know, they tell you you have to be here at a specific time. And we hope it will just be because we have learnt over the years in public health that diseases like overcover is no exception. They try you in vulnerable populations, your immigrant homeless population, all the really vulnerable groups.


And sometimes they don't have a GP. They can't because of a chaotic lifestyle. Things, you know, they may not be able to get to a testing centre at a specific time. They may not have the money for the bus. You know, and what we've done is essentially in most towns around Australia, we've settled pretty simple, you know, Komaki with two nurses and some swabs and so. Yeah, yeah, yeah. County Council, can you walk in the swab of your nose?


You've got an SMS a day or two later and I don't know why that's not happening. I presume it's a resourcing issue and the more difficult you make it for people to get tested, the more you miss people from vulnerable populations and vulnerable populations are worth something like covid explodes.


And that's something that needs to be really careful of now in the parts of Australia, New South Wales, I think, and Victoria, where there has been more of a problem. Can you tell us why and how the problem was dealt with? Yeah, look, it was mostly an issue of am I suppose you have these mandatory hotel quarantine regimes that we have and what that results in, it's a whole load of people with covid or at risk of Colvert being in the one building.


And that building becomes somewhere you have to be really careful of because it's usually in a big hotels or in city centres with lots of people around. So and what happens in Melbourne essentially, was that the and the infection control procedures were not followed as strictly as they should have. So some of some of some Kovács Leto's, if you will, spread around Melbourne and spread into New South Wales. But that was a really interesting and test of the system of foreclosures, because we always said reasonably close that the international borders was because if you do get another wave, then you're just dealing with that wave and you're not bringing in new cases.


Look how quickly Melbourne have got things under control. They went up to 800 cases one day and today there were 15. We've had single figures over the over the last week. And that's because they're not dealing with other transmissions coming in from overseas. They've got their own public health units only have to deal what's in Melbourne. And the public health units are very good at that, if that makes sense.


In terms of the national conversation now in Australia, was the consensus arrived that between people in public health like yourself and the broader community where people are concerned for their jobs and for their businesses, was a consensus arrived at or did each state go their own way or both? Yeah, a bit of both.


I mean, each state has that has their ability to to go their own way. And actually, all our response is, broadly speaking, tend to be to be pretty similar. And there at the beginning, there was a lot of consensus from people like me that the public health teams, we had a very data driven approach. Initially, we looked at the global picture and we sort of said, right, where are cases coming from? They're all coming from.


They're all coming from overseas. So we felt all the information to the politicians, look, please shut the borders. You know, we don't know how long it's going to be for, but that's your data driven approach. It's simple. You look at where your case is coming from. OK, how do we keep close the borders? None of us like doing that. None of us want to do that. But that's where it is now. The word difficulties at the time, of course, as you would expect, that there were there were major concerns from sort of business lobby groups and there were lots of people who were concerned about this.


But I would have to say, while there's still a little bit of that, generally speaking, people have seen the benefits of of having society open up. And I think they look at situations like Europe where you just oscillate between these lockdowns. I mean, how a business can ever function in an environment where you just don't know when the next sort of city wide restrictions are going to take place to be that, it's a very difficult situation for any business to be in.


So I think we have a degree of predictability which business people know of predictability, and that's what we can offer.


And it's not as if Australians don't think a point is, you know, something that be said about that.


And the other thing is that they've conquered or for the moment and they have conquered the coronavirus problem. And the political leadership, I think is Morrison is the prime minister of Australia. He doesn't mess around, does he? It's strong, forceful, forthright, and don't mess with me. Leadership.


Yeah, I mean, at the beginning has said it certainly did at the start some great jokes that don't close the borders, but the medical advice was close the border. So he did it. And I think that's that it's that sort of combination of somebody who took you know, I'm completely apolitical. But to be fair, there were very brave political decisions made early on when people absolutely lambasted Australia for shutting off borders because, you know, diplomatic issues, the whole lot was it was difficult, but they did it now where they've also and I think and maybe it's the difference between Australia and Ireland was and they listened to the medics.


I speak to my colleagues. I was working in an Irish public health unit until December. So still talking to colleagues all the time. And they really don't feel they have any input into decision making at any level other than the very local managing individual cases.


And yet politicians will say that they are following the science. Yeah, I hear this all the time, but the guys at home are saying, well, we. We're not getting asked about it, right? Ireland has probably 60 public health doctors and these guys I mean, I'm not just saying it because I'm friends with a lot of these guys are world class. Yes. They're in demand all over the world and they're highly thought of. It enables people like me to get jobs over here because people are just so enthusiastic about hiring Irish public health doctors.


But I really feel that they're not being listened to the front and center. Like, if I could give you an example, I would I would put it to you. I may be wrong, but I don't think that most people think that, you know, management of Colvard is happening at a national level or is happening in Rolnick Glenn's office five Roanne am. I suspect a lot of people don't realize that there are eight regional public health units in Ireland and with very small numbers of public health doctors, public health nurses, surveillance scientists, people like that, who when when there's a cluster, when those of these are likely to jump in and slam it down.


And these guys are world class. And I think we're just not hearing a lot from them. And when we do hear from them, it's gold. You know, the last couple of days there's been press conferences where they've described these clusters to try and give an example of a web of how people can spread this disease. And, you know, these have come from the public health doctors, the public health nurses, that kind of stuff is going to and I think they need to be listened to.


They're the experts and they need to be put in, you know, to talk to the public, because one of the things public health doctors without nurses are experts in is a message. We're very used to it, you know, so and you know, but actually, the interesting thing to go back to the political point is that now and the prime minister in Australia is less enthusiastic about, er, restrictive measures on the state premiers who are sort of saying, no, no, we like things the way we are.


We're not quite ready to open up just yet. So that's been an interesting development for them. You know, that'll evolve over time. But that's just been a slight change in the last month or two, which has strong leadership to listen to. The medics was the key.


OK, thank you very much now for talking to us from beautiful Queensland. And we're extremely grateful to you and we wish you well in your work out there. And thank you very much for joining us. You're very welcome. Any time.


And we may welcome it because things are looking bad here. Now, Conroy is a consultant in Public Health Medicine in Queensland. And we're extremely grateful to him, to all of you for listening and of course, to our sponsors, Tesco. That's all we have time for now. We'll talk to you soon. The stand is proudly supported by Tesco at Tesco, our exclusive ours for over sixty fives. Family carers and extremely medically vulnerable customers are every weekday, Monday to Friday, up to nine a.m..


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