SA chief public health officer Dr Nicola Spurrier answers your coronavirus questions

Why is SA blitzing testing, is your test something to fear and what are your survival chances on a ventilator? SA’s chief public health officer answered these questions and more. VIDEO & TRANSCRIPT

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South Australia’s chief public health officer Professor Nicola Spurrier joined us online at advertiser.com.au again on Friday for a live Q&A session covering some of your most pressing coronavirus questions.

You can read the full transcript of the session below or replay the video above to see Dr Spurrier and senior journalist Andrew Hough discuss everything from SA’s testing blitz to household hygiene.

Andrew Hough: We are going to start with a question from Claire, who wants to know about the new testing regime that was announced on Wednesday. Why has it been introduced, how long will it last and can you please also explain things like where can you get tested if you need an GP referral and things like that.

Professor Nicola Spurrier: Yep, sure. So, the reason for introducing this testing is because of course we’ve got quite low cases in South Australia at the moment of COVID-19, and this is fantastic so it’s a really good position to be in.

But I think as we’re learning more about COVID-19, we’re also learning that you can have this disease but have quite mild symptoms, but you can still transmit that to other people.

And we’re in a very good position with our pathology testing because SA Pathology has been able to provide so much in terms of testing facilities, but also we feel more confident about the supply of the reagent.

So we’ve been talking for some time about opening up that testing criteria. It had been very narrow to start with, particularly focusing on international visitors and also interstate travellers but of course we have fewer and fewer people coming internationally now. So it was really the time to say to anybody in South Australia we would like to have you tested.

Actually I’ve just been on a teleconference this morning with the staff from SA Pathology and they have had an amazing, an overwhelming response from South Australians, because I was thinking people might not want to come and have a test done because it can be slightly uncomfortable, but actually we’ve had a huge response yesterday. I’m sorry I’m putting my glasses on and off – I’ve tried to get you in focus Andrew. I think I need my glasses more often than not now.

In terms of where to go, we do have on our website all of the COVID clinics, and we made sure that these are also in regional and rural areas, but I am aware one of our SA Pathology staff, when they were going past the COVID Clinic at the Royal Adelaide yesterday, there was quite a long wait time. But when we checked at Flinders, it was a much shorter wait time so what I’m quite keen to do is actually put some real time data up on the website so that people can check and see what the wait time is.

So we haven’t got that just at the moment but we’ve got our media and comms staff working on that so that you’ll be able to actually work out when it would be a bit of a quieter time.

Of course we do want to have people presenting if they’ve got a fever or some respiratory symptoms. It’s not just about having no symptoms at all but certainly if you’ve got a cold, even if it’s something you wouldn’t normally go to your doctor to see them about, we would like to have you tested.

Andrew Hough: Well that leads me to my next question from Brian, Dr Spurrier. He says that he’s had a cold for three weeks but he seems to have recovered now. Is he eligible for that testing?

Dr Spurrier: Yes, Brian. As long as you’ve just recovered. I think we would still like to have you tested.

I forgot to actually answer the previous question in terms of do you need to see your GP?

So all of our COVID clinics where you actually go to the clinic and you walk in, we do an assessment. So, in essence, you don’t need to go and see your GP because you’ll get your health assessment there. If the nurse or the doctor involved thinks actually maybe there’s another cause of your fever, of course we don’t want to be not picking up other health concerns, then they’ll sort that out.

The drive through clinics, you do need to have a referral form, the SA Pathology form from your GP, but many GPS are happy to be able to do that over the phone. So if you’re going to go into the driving in you are still need to get a referral form from your GP

Andrew Hough: No problem. This one is next from BB. I hear the tests are really uncomfortable. Should I be worried?

Dr Spurrier: No. So I had a staff member this week, who had to have a test done, and she said to me, “well, it was just a little bit uncomfortable but it was very quick”.

I also want to let you know, I’ve had a test done as well.

So you have a swab that goes to the back of your throat, and maybe it makes you feel like gagging a little bit, and then that put the same swab to the back of your nose. Now that is uncomfortable but it’s very, very quick.

It’s the sort of thing that’s a little momentary discomfort is not as bad as having a blood test at all.

Please don’t shy away because you think the test is going to hurt.

Also the people doing the testing they’re really experienced. I’ve been doing lots of them and it’s quick. It’s not somebody fumbling around not knowing what they’re doing.

Andrew Hough: Sure, no problem. The next question is from Maggie. I’ve looked at getting an online test done. Are they as accurate as those done via SA Pathology in the clinics, and should I pay money for an online test?

Dr Spurrier: Oh, please don’t do any online testing. I actually didn’t know that that was available, but presumably somebody set up a way of sending a swab back and then testing it.

I would absolutely not recommend that in our lab. We have a set of controls we’re always calibrating it and we’re checking against the Victorian lab, which is our controlled laboratory.

Come and have yours for free, done in an SA Pathology site where you know it’s going to be done properly and you’ll get an accurate result.

Andrew Hough: We have had a lot of questions coming through live on Facebook as we go, Dr Spurrier, because obviously a lot of people are very interested in what you have to say, I want to just mention that some of the clinics that you previously said were very busy. Is SA Health looking to extend any of the hours that the clinics are open?

Dr Spurrier: Yeah, we’ll definitely look at that as well. We will see how things were yesterday in terms of the wait time and the number of people that have come through, and we will definitely be looking at that. There’s a lot of flexibility with their SA Pathology, for example, we’ve just had all of the people at the Adelaide Airport tested, and they were very flexible.

If the airport had wanted it we could have set up a testing clinic down at the airport.

So we’ll have a look at the numbers, we don’t want people to have to wait long periods of time.

And I think having information about the wait time at the various clinics will also be helpful.

One other thing that Tom Dodd said to me was the drive through clinics, when they first started, they only had one line of cars for example, but they have actually increased that and they now have two lines of cars so that really sped up their processes. And people might find that that drive through is a good option.

It means that you have to ring through to your GP, and maybe see your GP or at least talk to them, but it is a quick way of doing it.

Andrew Hough: No problem. I am going to do a final question on this topic, Dr Spurrier. This is from Marie and she was wondering if there’s any different strains of coronavirus and are the tests that are currently available, able to identify all of those different strains?

Dr Spurrier: So first up the initial test doing a PCR just as a negative and positive but you are right there’s can be genetic differences in the coronavirus.

It’s called genomic testing, and we would use that more extended testing when we’re trying to make links between different clusters and between different people.

So we’ve got the capacity to do that, but we wouldn’t be doing that on the large number of individual tests so it would only be if we had a positive and we had no clinical way of making a link between people that we might go down that track.

Andrew Hough: Okay, no problem. This leads to a next question from John. After the new testing regime is completed in a fortnight, what is our endgame? What is the government and SA Health strategy, and when can we expect to see restrictions eased, if so what will first be relaxed?

Dr Spurrier: Now that is a very big question, John – a million dollar question.

I’ll just go back to the testing regime. What we’ll probably do after the two weeks is continue to have more open criteria for testing in South Australia.

It’ll depend a little bit on the results, but it may well indicate that we don’t have very much transmission at all in our community, and therefore we would be just asking anybody to be tested.

Just to remind people that even when we first started testing for COVID-19 anybody that had a respiratory infection and went to their GP and had a test done that the GP thought they needed to have done, we were also running COVID-19 from that very early day.

That’s why our testing is so much higher than some of the other states. As an example.

Now going back to this more complicated question, what that is in game.

So if I had been asked that question, maybe three or four weeks ago, I would have been thinking we need to continue suppressing this virus, and this in disease, as much as possible, because we still had quite high numbers.

You can also see when you have even a couple of people are positive how quickly it can get out of control, as demonstrated at the moment in Tasmania.

So I think very clearly, we want to continue suppressing this in South Australia.

I think in the last week or so, when we’ve seen such low numbers, and also thinking about what our results will be in two week’s time, it will give us an indication of people’s behaviour in the amount of transmission in the two weeks prior, you know, two weeks behind.

But we’ll also have the results from this more extensive testing.

We might be in much better position to say we could possibly even eliminate this virus in South Australia.

Now I can’t, I don’t have a crystal ball, and it’s really just looking at the information that we have on a day-to-day basis.

It certainly will want to be continue to suppress things because even when you have a small amount of disease, as I said, it can really get away with you.

That being said, we’re very aware in health and across government, and you are aware as a community, the impact of these restrictions on everybody’s life, and we need to be very careful at looking at any negative, all those negative impacts that are impacting or affecting people, and that includes not just not being able to go down to your local pub, but it’s also about the people that run those cafes in those venues and the impact of not having a job.

I absolutely feel for people who have, you know, been unemployed through this whole pandemic. But then you’ve also got the issue of people’s mental health and being in isolation, not being able to contact others, and I know when I was looking at some of the media there was a, an editorial looking at what people really miss, and people are really missing hugs so people, you know, we as human beings need to have that physical contact and that connection with other people.

But then the other thing that I’m very mindful as a health professional is, I know our hospitals are quiet, I know that our GPS are not very busy at the moment, and it does worry me that people who have got health problems are not coming to get those health problems dealt with because they’re concerned that maybe they’ll catch the virus so we’re very mindful about looking at any of that sort of data as well.

It’s a bit of a sort of long winded answer but you’ve got to take all of this into consideration when you’re making decisions about when to lift.

The first thing people know I’ve said this before I’m very keen to have schools open. So that’s one thing that I’ll be sticking by we haven’t closed our schools in South Australia.

The other thing that I’m very mindful of is the elective surgery, because again, it sounds like when you say it’s elective, then it doesn’t have to happen, but also when you go and look at the sorts of conditions and people on those waiting lists quite clearly there are people that with very significant health problems and we need to be getting back on to working through the elective surgery.

The real thing that has held us up with that is the lack of a really good supply of masks in South Australia so that once we’ve got that, then we’ll be more reassuring about getting through some of those medical procedures

Andrew Hough: A follow up from myself about the masks. Dr Spurrier, do you have an update about the issue that we reported on yesterday with the masks and the ICU staff at the Royal Adelaide Hospital?

Dr Spurrier: Yes, so we’ve had some very good communication back and forth to the Commonwealth about that. One of the issues with these types of P2 masks or N95 masks is that they are manufactured for a range of purposes so it’s not just, they’re not just protective for bacteria and viruses, but they’re also used, as people know, in the bushfires for protecting against smoke and also in industrial settings.

So because they’re not actually a therapeutic goods, that’s why TGA or Therapeutic Goods Administration, don’t generally make a recommendation on them because it’s not a therapeutic good for them to do that.

So we’ve just we’ve had some reassuring emails from the chief medical officer and from the TGA that they are fit for purpose, and then our infectious disease staff have been looking at it as well, in terms of whether or not people need to be also wearing a full face shield just, just as an additional precaution.

They are absolutely fine for viruses and bacteria with droplets. It was an issue about a large splash, the sort of thing that might occur in surgery in a surgical operation where you might be getting a blood splash, but in general in an ICU setting that’s not an issue.

We are also lucky we’ve got some really good set ups for one of our universities to do some independent testing, and that was done yesterday and I’ve seen a preliminary report so I think we’ll be fine on those masks coming through from the Commonwealth.

I feel really reassured about it and I haven’t had a chance to go and speak to our clinicians this morning, but we will be working to speak to our clinicians to make sure that they’re okay with it as well.

The other positive just to say to people in South Australia we were very lucky. We’ve got some great companies in South Australia and Detmold have been very keen to manufacture masks here in SA, and we’ve been waiting for a number of machines that are manufactured in China to come to South Australia. And I’m hoping that we’ll have some very good news in the next couple of weeks about those machines arriving here and we can do our own manufacturing we will all feel really happy when that happens.

Andrew Hough: Fantastic. And just as a follow up to the suppressing of the virus, Dr Spurrier, I have a question from Andy. He wants to know, do you support the so-called issue of herd immunity, in which the virus is effectively allowed to go through the community? Do you think that’ll be introduced in South Australia, and if so will you rule that out?

Dr Spurrier: I don’t think that that’s the way to go, and I don’t think that we’d be supporting that either in South Australia or in Australia.

That’s one of the strategies that Sweden has put in place and the strategy that the UK had started off with.

It’s this theoretical ability if you’ve got enough people who are infected with a virus and they develop immunity, that you would be able to protect the whole community.

This virus is very transmissible so it’s very easily transmitted and we might need to have at least 80% of people immune. The first thing is we don’t know how much immunity you get from having the infection.

We don’t know about it because it’s a novel virus, and it’s a coronavirus and as people know that’s the same sort of virus that causes a common cold and quite clearly you can get a cold at the beginning of winter and then you can sometime later you get another cold it might be a different strain, but, you know, we’re really not sure about the level of immunity.

We also know that in countries such as Italy where you’ve had a huge amount of people getting very sick, and really overwhelming the hospital systems.

Even in those countries where they’ve had many deaths and it’s just been so tragic that it hasn’t actually been a large number of people as a percentage of the population who have had the infection, although of course we don’t know there might be some people with mild symptoms that haven’t been tested so the number might be underestimated.

Even those countries where they’ve had that sort of controlled transmission approach, we’re not overly confident, we really don’t know whether it’s providing herd immunity or not.

Sweden is the is the case in point at the moment, who’s had this more sort of controlled way of transmitting the virus, I haven’t got the number of deaths that they have had as an update but it certainly, I don’t think would be palatable to many Australians.

I think we’re really in a very, very lucky place. We have been able to really get control of this through having our borders closed early so we were much earlier in this pandemic than other countries when they went into total lockdown.

Now we just have to take it slowly. Take a deep breath. I know it’s awful having the restrictions and we’ll be looking at what we can lighten up over the coming weeks and months, but I think people really do need to be patient and, let’s put some science around this let’s get some really good heads together.

It’s certainly not going to be my ultimate decision, it’s going to be a lot of people talking and working this through together, including people in the community as well. Which is it’s always good to see that people are thinking about these things themselves.

Andrew Hough: Dr Spurrier we’re very lucky to have you with your very reassuring tone and your comments. We’re getting a lot of feedback from our readers about what an amazing job you and your team are doing so I just want to say thank you for all your hard work.

Angus asks if there are any updates for the Barossa region lockdown? Will it be lifted when school returns after the holidays?

Dr Spurrier: That’s a really good question. So, we haven’t had any cases from the Barossa since the 31st of March.

So on Wednesday that was exactly 14 days time, so that’s the 14 days incubation period.

Usually however we would like to see two reproduction cycles of the virus so that would be theoretically 28 days, which would be Wednesday, I think I was going to look this up, but I think it’s the first week of school going back.

So we will need to make a decision about whether we leave in a couple of days or whether we say look we’re fairly close, let’s just have the Barossa schools going back.

I don’t think they will be closed for very much longer. Of course, I’ve got my fingers crossed, and if you could all do the same, that we don’t have any more cases in that area.

Andrew Hough: Excellent. So we have a question from Jay, which I think you’ve alluded to already but it would be good just to get your clear thoughts on this Dr Spurrier. Do you believe that state boundaries, whether closing the state boundary were really the most appropriate way to contain the virus?

Dr Spurrier: Yes. So another excellent question.

So we’re not all the same in the different states we’re all on a slightly different stage and one of the reasons for South Australia is that we don’t have as many international arrivals as Victoria and New South Wales and also Queensland, but the other reason we’re in a different situation in South Australia is that we have been testing at much higher rates.

That gives us a level of confidence that we don’t have the level of community transmission that some of the other states might have, because if you don’t test you don’t know.

I know that that the ABC have, as I’ve been mentioned to you before Andrew, they actually have a very nice data section that they update every day and it’s very well explained. People can have a look at that and can see what the testing looks like from state to state.

But the other way of getting a bit of a handle on that is looking at the number of people we have in intensive care in our hospitals, compared to our number of cases, and that’s that that is also publicly available on that website and what it shows is that South Australia we have a relatively small number of people that need to be in hospital, and in ICU compared to our total number of cases, compared to particularly Victoria.

Now, to me, that means that we’ve actually got a better handle on our cases where ascertaining we’re being able to detect their cases because we’ve got about the right ratio of what you would expect.

So, the interstate borders, I know it’s very challenging because many people have family and friends that live interstate and it’s also really impacted that health service because it means that if we have doctors that want to be travelling in between states we’re still having to quarantine those doctors. But certainly at the moment, I’m much more comfortable keeping that those borders the way they are, until I can feel more confident that we’ve got approximately the same amount of community transmission, as the other states.

At least we haven’t done a hard shutdown of our state borders. We do certainly allow people to come in, but we do ask them to have the quarantine and it’s not a hotel quarantine at least it’s in a resident residential facility.

I know it’s a pain in the neck, my daughter’s come from Canberra she’s a student from ANU, she’s come back to Adelaide, and I think she went a bit stir crazy during that quarantine period. I know it’s not right. But I do think it is that additional protection we can have in South Australia.

Andrew Hough: That leads me to my next question. This is from someone who calls themselves Confused. Hi, thank you for all your hard work, firstly, but they’re confused about schools. When the public is being told all the evidence shows schools are safe and they’re not transmitters. They want to know why do we then stop them from for example children seeing their grandparents, their families, and why should they keep them to themselves in the holidays and not catch up with their friends as well?

Dr Spurrier: Yes. So the issue about schools, from my perspective is relatively clear.

When you look at the evidence from overseas, and also, more recently and probably more importantly, our evidence in South Australia and in the other states, children, whilst they can get the infection, they have quite mild infection, and they can transmit it between each other certainly.

What we do know, from again, the data that’s coming from South Australia and interstate is the majority of cases that we’ve seen in school, the children have caught it in their family. Usually from international or interstate travel or being a close contact of a case, they haven’t picked it up in school.

Again, when teachers have it, that’s exactly what’s happened before as well.

I think we’ve had about 10 teachers and about 10 students who have had COVID-19 in our state.

There’s only been one, if one case of transmission it was from a teacher to a student just in a normal classroom setting.

So we haven’t seen the sorts of transmission that people are aware of, a lot of this is based on what we know with influences so when there’s been influenza pandemics actually closing schools, particular schools where there is more of a problem has been helpful.

But this doesn’t seem to be the case with COVID-19. Now, also looking at South Australia we have never had the level of community transmission because we got in early in this pandemic and we closed the borders.

So again, that’s also very reassuring It was one of the reasons why I wanted to do this bit of a COVID blitz on the testing in these two weeks, so that when school is about to go back I can feel really confident that we don’t have that high level of transmission.

And then to the question of why wouldn’t we let children see grandparents. Being grandparents where you’re in a more vulnerable age groups so we know that from the age of 60 up if you get COVID-19 you really can be in a bad way, and particularly with co-morbidities such as if you’ve got, you know, heart disease or diabetes or other respiratory illnesses which are more common as you get older.

So it’s just really a bit of common sense around having the children see the grandparents. If you can have the kids, the grandchildren see your grandparents, but not all the hugs and kisses that often kids want to do.

Now, I know because I’m a paediatrician but also a mother that kids are not always great in terms of their hygiene.

However, what I will say is kids are really smart, and they can be taught things, and they really catch on quickly, and so on. There’s been a lot that education department’s done working with children, working with teachers to really improve the hygiene and the social distancing that’s possible in schools.

So there’s a huge amount that we can actually do to make schools as safe as possible and that’s some of the things that AAHPC have been providing guidance on and I’ve been working closely with our education department on.

At the end of the day, education is an absolute right of every child and there are many parents that do try their best to teach their children at school but if learning at home was the best way to teach kids we’d all be learning at home, we wouldn’t have schools, absolutely schools are the best place for kids to get an education.

I think my youngest is 12, and I haven’t kept him out of school and I’m absolutely looking forward to getting him back to school, going into next term.

Andrew Hough: I don’t know if you can see my question Dr Spurrier, but that was definitely my next question I was going to ask.

Dr Spurrier: Definitely. He needs to get off the PlayStation and his iPad and actually do something useful.

Andrew Hough: I bet you are looking forward to that more than he is.

I have a question from Timon. Do you have any idea when children’s, as in under 18, sport may recommence? They say for the kids that would be a massive high and huge mental health icebreaker even just training, starting at a community club level. Do you have any ideas, Dr Spurrier, of when those restrictions may well be eased?

Dr Spurrier: I can’t give you an absolute time but these are the sorts of things that we’ll be going through in terms of looking at the restrictions, taking into account the level of disease that we’ve got in our community.

Again, I can look at my own personal experience – my son’s absolutely mad about basketball, and he’s desperate to go back to training, you know you can only do so much in your own backyard with the hoop and the basket and going down to the local basketball court.

Some of the things that we’d be looking at and considering is whether it’s contact sport or not and so the amount of, you know, body fluid contact that you might have.

That’s the reason why we haven’t closed down tennis or golf in our state. Other states have done that, but we’ve been okay with people out.

If you want to go out on an oval and kick the soccer ball around, and you’ve got a group less than 10 then we’re okay with that in SA.

It’s a good question. We will be looking at all of those things and taking into account what impact it has had on young people as well.

Andrew Hough: No problem Dr Spurrier, thank you. Alan asks, can I, or should I, visit my 83-year-old mother, who lives alone?

Dr Spurrier: Allan, what I’d be saying is have a think about your risk profile.

If you’re a frontline health care worker who might be coming across people with COVID-19, then you might want to avoid that.

If, however, you don’t feel that you’ve been into any risk category, so obviously, you won’t have had any international travel and probably no interstate travel, there would be no reason that you couldn’t go and visit your mother.

It’s probably also, you know, it’s a sort of thing that’ll cheer her up, and you may also be able to help her out with shopping and other sorts of things.

So whilst we have said to people when you’re older and, you know, it’s important to think about reducing the number of contacts with people, I think if you’re able to reduce the number of contacts that you have with other people in your community, then you’re lowering your risk and therefore you’re less likely to be risking your mum's health as well.

Andrew Hough: And that then leads to another question Dr Spurrier. In terms of visiting aged care facilities, are those restrictions likely going to be in place for longer than say the other restrictions and social distancing that we’ve got in place?

Dr Spurrier: We certainly know that things can be quite dire when we get a case of COVID-19 in an aged care facility and there was the Dorothy Henderson example from New South Wales, which was one of the early cases in an aged care facility and there have been a number of deaths unfortunately associated with that, even though that facility was run very well and they did all of the cleaning and all of the social distancing and suchlike that they needed to do.

On the other hand, the guidance from AHPPC allowed a certain number of visitors to go into aged care facilities. I have been told anecdotally that some of the aged care facilities have even reduced the visitors, more than what has been recommended.

That’s one of the things that we’re wanting to work through with aged care because it’s so important that elderly people do have visitors from their family.

So the guidance and the guidance that AHPPC put forward, has been put in a direction or a law in South Australia so people can get online and look for that particular law, and it does explain the number of visitors who are allowed and the age of those visitors and it was all to do with reducing the risk but not completely stopping visitors to age care.

Andrew Hough: I have a question from John, Dr Spurrier. In terms of the Adelaide Airport cluster, is your advice still that the airport can stay open, and do you have an update on the Qantas cluster?

Dr Spurrier: Yes, so we’re happy that the airport stays open, Qantas has had good risk mitigation strategies and sort of business continuity, and it is important that we still get planes into Adelaide because we need critical freight, particularly from my perspective, medical freight, but of course there’s other things that we need to get into SA.

We have tested just about all of the 750 Qantas workers, and we were getting those results through and we’re working through with Qantas so we’ve been happy with the results. I just don’t have the numbers for you today to give you an update until later this afternoon.

We’re very comfortable with the way Qantas has worked with it and we’re also very comfortable with the level of cleaning.

It was a fairly extreme measure to take that large number of people out of the workforce, but we were just getting this trickle of cases through and we really needed to get on top of that.

Andrew Hough: Julie asks does low suds washing powder effectively kill off coronavirus?

Dr Spurrier: I don’t know the answer to that one. I’m sorry.

What I do know is that I was is the virus can be pretty quickly killed, and if you’re using a standard washing cycle, I wouldn’t think it would make any difference what sort of washing powder that you use.

In fact, if you have a high suds, I know that my front loader doesn’t like too much washing powder and doesn’t like it if there’s too many bubbles.

I think you’re probably doing fine with however you’re using, you know, the sort of washing machine you’re using.

More important is really around the hand washing and hygiene and thinking about spreading germs that have come from somebody else’s saliva or from their nose.

I’m always watching people to see if they put their hands up by their face, men stroking their beards, you know people itching their noses.

That’s what concerns me a lot more.

Andrew Hough: My hands have been down here Dr Spurrier, trust me.

Craig asks, countries across the world are wearing face masks when out public. Is it mandatory for us or is it something you would look at to introduce the use of face masks here in South Australia?

Dr Spurrier: I think if there was a huge amount of COVID-19 in our community that might be something we’d need to look at but it’s certainly not something we need to be doing now and it certainly hasn’t been something that we’ve needed to do in the past.

The thing with the face mask is it’s really, it’s protecting, stopping the person that has the infection spreading the infection. So at the moment if you do have a cold and you go and get a sample taken at one of our COVID clinics, we might be asking you to put a mask on, to go home with it until you get the test result back.

So it’s more about the person that we think either has the disease, or maybe developing the disease we want them to wear a face mask.

But out in public it’s much better to do that social distancing of keeping one and a half meters away from other people and reducing contact with people as much as possible.

That is a lot more effective.

The other thing with a face mask is not all face masks are the same, so they provide a different level of protection.

If you wear a face mask for a prolonged period of time I can get wet because you’re breathing and you get that condensation.

Then if you put your face up and adjust the mask and then you tap something you’re just passing the infection on. So we really feel that it’s not necessary for people to wear.

I do see people out in the street wearing face masks and I absolutely appreciate that there are different cultural, you know, practices, and I know that in some Asian countries wearing a face mask is a sign of hygiene and is a very well recognised, it’s something that’s quite accepted. So I’ve absolutely no problems with people wearing those masks if they want to.

But as a general thing as you know we haven’t been pushing that in terms of a public health intervention.

Andrew Hough: Dr Spurrier, a question I forgot to ask earlier when it comes to the restrictions, business restrictions.

Is it something that you’re looking at you’re talking about the impact on the economy and unemployment and things like that? Is part of your thinking, or SA Health’s, thinking about lifting restrictions on where businesses can open for example, hairdressers, pubs, clubs, etc. What your current view on that?

Dr Spurrier: Yeah, so that’s definitely all of the things that we’re looking at, but and we really need to do it with some good planning.

Some of the things that we would be wanting to look at is, if we know that this virus is transmitted more when large groups of adults are congregating, and there are certain activities that, and in certain businesses where social distancing is not the norm, I mean you don’t go to a nightclub to social distance really do you?

So there are certain things like that that we’d be saying actually the public health risk is too high, but then we also need to look at the economic impact and there’ll be some businesses where there’s been much more of an economic impact and an impact on their employees and other businesses.

So you what I’m keen to do is work very closely with the businesses and industries in South Australia to have a look at that side of things, and then to weigh that up against the public health impacts.

I can’t give you exact times and time frames.

I suppose the other thing when you’re thinking about these restrictions that I probably should have mentioned was, and it’s an important thing to consider is, when we put these restrictions in we did it really quickly and the reason we did it very quickly was we knew we didn’t have much time to stop this virus because once it gets in and takes hold it just takes off like wildfire. Like you’ve seen in Italy and now in the UK.

Many people in Australia will have relatives in those countries and will have heard how devastating it’s been.

So we put all these restrictions in bang like that, over a couple of weeks. And that was because of this time frame.

That means we don’t really know which one was most effective. We’ve now got the luxury of time.

I know it’s a pain in the neck all the all of the restrictions and it’s even worse than a pain in the neck for people who’ve lost their jobs, but we’ve now got a bit of luxury of time to be able to plan this and do this in a much more controlled way.

So, I would be recommending that we look at one thing that we lift and then we give it a couple of weeks and then we look at something else that we lift, and give it a couple of weeks so we’re not just going, Oh look, it looks good. Let’s just stop it all and see how we go.

Because once the disease gets in again, we don’t know whether we’ll be able to so successfully stop it as we’ve had, as we’ve been lucky to do previously.

So we’re trying to get ourselves in a good place. We’ve worked on our hospitals and our ICU beds. We’re working on having a really good contact tracing team and using some IT and digital support to improve those sorts of processes. We’ve got fantastic testing in South Australia. So we’re getting ourselves in a good place, but if I could just ask the public of South Australia to be really patient that we really need to do this in a very controlled way because if we do it too quickly we could undo all of the good work that we’ve already done here. Does that make sense?

Andrew Hough: Oh it makes perfect sense to me and I am sure very good sense to our readers. As I said before Dr Spurrier, the way you explain things in a very easy to understand way is actually quite remarkable so we all are very grateful for that.

Dr Spurrier: Thank you.

Andrew Hough: Karen, asked if a person has to go on a ventilator, what are their chances of survival?

Dr Spurrier: That is, again, a very good question.

So obviously when you’ve got yourself to ICU you’re not in a good way. So you’re really having difficulties, and obviously once you are then ventilated it means that you’re going to need support for your breathing.

When you look at overseas data, the survival rate in intensive care may only be about 50%. But you need to take that into account the types of care that are provided in some of the international ICUs.

But the other thing is how quickly are people actually getting into an ICU.

So one of the things that the model has pointed out to us some months ago at the beginning of COVID-19 when we were looking at the international scene was there’s often a bottleneck for people to be recognised to be deteriorating enough to get into ICU.

So one of the things having our Royal Adelaide as specifically a COVID-19 hospital is we’ve been able to set in place some really good processes so that there’s a streamline of going from the standard ward into intensive care.

So we might be admitting patients into our intensive care that maybe you’re not quite as unwell as people that are going into intensive care in another country.

The other thing is, when you were starting to learn more about this disease, there’s the impact of the virus itself on the body, but the body has an immune reaction, and for whatever reason with this virus at about a week, seven to nine days into the infection, some people seem to get an overwhelming immune response that is not helpful at getting rid of the virus but is actually very unhelpful in terms of the health of your body.

So we are seeing people in intensive care where they’re starting to have liver problems with their liver and problems with their kidneys and those organs going into failure.

So you can continue to ventilate the person but you have ended up with such damage to other organs in the body.

It’s not a really easy question to answer. But what I’ve thought would be useful, perhaps thinking through as I’m answering this, is getting some numbers on how many people we’ve had to ICU in South Australia, and what the mortality has been.

So I can follow up after we’ve done this question and answer with getting those numbers

Andrew Hough: That would be very helpful. Thank you, Dr Spurrier. Do you have an update on any patients in the ICU, as well as the staff that are now in quarantine together with the nurse that has contracted COVID-19?

Dr Spurrier: I’m so sorry it’s too early in the morning. I get our report around lunchtime, and we include the number of patients in ICU, so I don’t have that this morning but we’ll definitely have that for people this afternoon.

Andrew Hough: And how are the ICU staff?

Dr Spurrier: They are doing pretty well. They are a really amazing group of people. Bec who did the media with me earlier this week from intensive care at the Royal Adelaide, her words was that they feel privileged to be able to be looking after people with this disease.

I mean what a remarkable thing to say, you know, the rest of us looking in probably think ‘oh my God, we wouldn’t want to do that we wouldn’t want to put ourselves at risk’, but this is a really special group of people and so they really support each other and it’s pretty tiring. We know that as well.

I suppose one of the things that that does keep people going or some other little random acts of kindness, and I was sent an email from the Lyell McEwin Hospital from one of the senior consultants in the ED department, and they realised that their junior medical staff were getting really stressed out about the whole situation and then put together these care packages.

These fantastic little packages, including toilet rolls and packets of potato chips and this is the sort of things that they thought their junior staff would like. And I just thought, you know, that’s a fantastic way of supporting people at the front line at all levels.

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Andrew Hough: Paul asked Dr Spurrier what is your understanding of the accuracy of testing down in South Australia? Do you have a percentage or an understanding of any false positives or false negatives?

Dr Spurrier: Yeah, so I was talking to Tom Dodd earlier this week and he said to me, I think there have been two or one possibly two false positives, out of all the tests that they’ve done. This is an incredibly accurate test, and those two that were queried, you know, positives one saying they’re a false positive is the lab are very vigilant at seeing something slightly, you know, not quite right when they’re doing the testing and they’ll retest it.

And we’ve also seen one if not two samples to the reference laboratory in Victoria, so I’m,very, very confident about the testing here.

Andrew Hough: As part of that testing, Gayle asks do you propose to screen for antibodies, so we know who has had COVID, and do you have any further evidence or research in that you can catch COVID-19 twice?

Dr Spurrier: I can’t answer that second question about whether you can catch it twice, I keep looking at the international literature on that. There are countries where they’ve had the disease for longer and they’ve had more cases and we’ll be needing to look at that data, I think, to get the answer to that.

Going back to the question of can we test antibodies we certainly can test them. We haven’t got ourselves entirely set up in South Australia to do that but some of the other states such as New South Wales can do that testing, and we’ll be looking at having that more streamlined here in the future.

In fact, we have got that there’s a particular need for us to be doing that. Trying to link some particular cases at the moment, and we’ve asked New South Wales if we can do that serological testing and so we can do it if we need to.

People might also be aware that there were some that were there are some point of care tests which means that you can do it very quickly that were based on serology.

The accuracy of those was so low that we were very concerned in South Australia that these would be taken up and be used inappropriately and give people a false sense of reassurance that they have either had the disease or they haven’t had the disease.

So we actually have a regulation in South Australia banning their use. We were still able to use those if we needed to in a public health sense, more or less, or if SA Pathology thought they’d improved enough.

But as you can see people can be quite entrepreneurial, things can turn up and be suggested as being useful. But in this case, we didn’t feel that that would be helpful at all for people.

Andrew Hough: What is the current turnaround time for testing, Dr Spurrier?

Dr Spurrier: So yesterday, I’m very accurate on this, it was 16 hours and I think it was either 16 hours and 16 minutes or 16 hours and six minutes, it was something like that.

So I had that from the lab this morning, so that’s a very quick turnaround.

That’s from when the laboratory gets it till they get the result. So the other thing to take into account if you are living in the country, it does take a little bit longer to get the specimen into the lab to get a process.

Then of course we need to have somebody get the result back to the patient so there’ll be a little bit of extra time added on either of those ends depending on the situation.

There’s one other thing that will be useful to mention, we are very aware of, particularly when somebody is waiting for a result and that just keeping themselves isolated until they get that result is quite a harrowing time for people but it’s stressful.

It can take a little while for the clinician to actually get on the phone and give that person a call back. So we’re setting up an automated SMS, a way of doing that using some very nice technology that’s been developed in South Australia from one of our local companies, and we’re hoping to have that in place on Monday, so that when you you’ll get your results back much more quickly once the results are spat out from the lab.

Andrew Hough: We have generic question regarding vaccines, Dr Spurrier. Elizabeth was wondering on hearing the SAHMRI and Murdoch Institute, a trial which SA Health is helping fund a BCG vaccine used in tuberculosis, does that mean that people who are essentially aged over 60 that have had that BCG vaccine, does that mean that they are immune from catching COVID-19, and do you have any information regarding any official vaccine trials in South Australia that may well lead to a vaccine?

Dr Spurrier: So in terms of the BCG vaccine that was exactly the question I asked Steve Wessling at SAHMRI in terms of this trial because I’m not quite in that age group but I’ve had a BCG. I’ve still got the scar on my arm and I wondered whether that did provide protection or whether you’d have to have it more recently.

There’s not really a good answer to that question, it seems like the when you have a BCG vaccine it improves your whole response of immunity to other infections, but I think we really don’t know enough about how long ago you had the vaccine so it may be that you need to have it more recently, to be providing an infection and that sort of scenario.

I think we need to be looking at everything that could potentially be helpful in this space and so we were very keen in SA to get health care workers as part of that trial.

We know that BCG vaccines don’t have any major side effects so it seemed like a really good option for us to be involved with that research.

What was the second part of that question in terms of general vaccines?

Andrew Hough: Is there any work in South Australia that you are aware of into developing a vaccine?

Dr Spurrier: I haven’t had any direct communication with researchers in South Australia but we were really well placed in Australia with his very good vaccinology research.

I am a very positive person.

I think we just have to go forward and try and look at all possibilities in terms of vaccines.

On the other hand to be more, you know, maybe more realistic, other sorts of coronaviruses have really struggled to find vaccines and to be able to develop vaccines.

We know from even things like the current common cold which is also a coronavirus, you know, we don’t tend to develop much immunity to it.

But, you know, I don’t think that that shouldn’t stop us being positive and thinking that we’ve got a lot of really smart people in Australia working on this at the moment.

We’ve also got our CSL laboratory looking at making sure if there is a vaccine that we can start producing it very quickly so not only do you need the vaccine you need to have it tested and then you’ve got to be able to scale up the production of it.

Andrew Hough: Dr Spurrier, I know that you have to leave shortly so we’re going to have just a couple more questions.

The first thing is from Jane is as we move into the next stage, we have a risk of a so-called second wave of virus. Will people in high-risk groups still need to have self-isolate until a vaccine is created and on the market?

Dr Spurrier: I think we will have a bit more of an idea in the next month or so, where we are at.

We’ve certainly had the sort of flush through of our international visitors now, and we don’t now have that as an issue. I have already talked spoken about interstate that I still got some concerns from some of those eastern seaboard states.

We may also be having some international arrivals in South Australia, because we’ve got repatriation flights coming to all parts of Australia and that will include South Australia and it’s likely we’re actually working on some plans and protocols today because our information is that we’re likely to have some international arrivals early next week. So we might start to see some cases. When that happens, but if we’re following our protocols to have people in quarantine and we can now do some more testing and that sort of thing.

I feel quite confident we’ll be able to kind of keep that ring fence.

I think I’d be able to answer that more confidently after we’ve had this two-week blitz and we’re opening up the testing a bit more broadly. I think, you know, and for people that are in high-risk groups, I think I would still be very careful about how many contacts you’re coming into and really keep up the hygiene as much as you possibly can.

Andrew Hough: Dr Spurrier, our readers would like to ask a personal question of yourself, how you personally holding up? You have a particularly tough job at the moment. How do you cut out the so called white noise of the, how do we say this politely, the armchair critics that may think that they know better than yourself and your team.

Dr Spurrier: I’m holding up pretty well actually, thank you.

I’ve got an excellent team in the department, and it’s also such a rewarding work to do. So you know I’ve trained in medicine, I’ve worked as a paediatrician, but I very early on decided I wanted to do public health, and that’s when it’s a medical specialty when you’re treating, not an individual patient but you’re actually treating the whole of the population, and you use things like data to work out what’s wrong with the population and then you put in place some measures to treat it.

Why I feel really inspired during public health is what you’re doing is stopping people getting sick in the first place. Most of us don’t like to get sick and it’s almost always better to have a prevention rather than a cure.

So, just being able to work in a space that I find personally really inspiring is keeping me going.

Then, of course, I’ve got a great team here in SA Health I’ve also got a fantastic family, and I’ve got three children, and they’re always quite amusing actually and, and I thought, and it’s always good to have a bit of a laugh as well, it’s another way of keeping yourself going.

My daughter, who’s 20, she was telling me last night she’d found a meme that had been made of me and she thought I would be quite cross about it, but I got a laugh, and it was on a website that was a Kath and Kim website, so I wasn’t I wasn’t compared to Kath or Kim, but you might remember Prue? And I thought that was fantastic.

So I think if you could have a bit of a laugh at yourself and that’s something that keeps me going as well.

The other thing is I’m a really keen trail runner, and I go for a run every morning with the dog. It’s always dark, I’ve got my head torch on and that turns off all that white noise and chatter and I always solve problems when I’m running.

I’ve noticed how many people are out being physically active. I’m hoping that you’re also enjoying that that sense of peace and that sense of reflection that you get when you’re physically active, particularly out in nature. I never liked going to do so much better out in the wide world.

The last thing that I’m just thinking of that’s kept me going I mentioned one of those things before was that little act of kindness that I saw at the Lyell McEwen, and they called it COVID kindness, and that there’s just little things that you see around the place. I was driving in today and there was a childcare centre where the kids have drawn these most beautiful rainbows and they were are all stuck along the fence and you know those things really lift your heart, don’t they?

My mother was telling me about a bear hunt that was happening in her neighbourhood and she had to take a teddy bear out of her letterbox and then write a note and then go and put it in somebody else’s letterbox, so the way that the communities are connecting. I find those sorts of things really inspiring that sort of thing that keeps me going.

Andrew Hough: Final question – Dr Spurrier, I know you have to go, but I believe congratulations are in order and that you are now a professor. Can you say how that has come about?

Dr Spurrier: I used to work at Flinders University before I had the job in the department so I had the title of Associate Professor, because of the work that I’ve done there so I’ve got a research background and I used to run the medical student program up at Flinders in paediatrics for a long period of time, and I’ve just, it’s something that I enjoy doing.

I still have medical students who come and help me in my clinic when I’m doing a paediatric clinic at Flinders, unfortunately I’ve had to give that up because of the enormous workload at the moment.

But anyway, I also enjoy doing research and I still have some research publications. I’ve managed to get one research publication with a student this year, which was quite nice.

So anyway Flinders University contacted me and they said, we’d like to promote you to full professor, which I think is marvellous. One thing, it makes it easier than saying associate professor or make it easier for my staff when they do the signature block on any letters, so plus my mum was really proud.

Andrew Hough: That's fantastic. Congratulations Dr Spurrier.

Finally, is there anything else that we missed or that you’d like to say to our readers. In closing?

Dr Spurrier: I would just like to say a big thank you again to everybody in South Australia, we are doing so well in this state, just keep it up.

It makes me sad when I look out at Rundle Mall and there’s no one there but I know it’s because you’re all doing all of the right things.

It’s tough. We’ve got to go on with this for longer, but really a big thank you.

Also I get nice messages and nice emails sent to me and I really appreciate it. So thank you everybody.

Andrew Hough: Dr Spurrier, thank you very much for joining us and your valuable time.

It’s been very insightful again, and I hope that for our readers it has been a help.

Dr Spurrier: Pleasure, Andrew. Thanks.