more_vert
IN A submission to the Parliament of Victoria’s Inquiry into the Victorian Government’s Response to the COVID-19 pandemic, Associate Professor Julian Rait, President of the Australian Medical Association (AMA) (Victoria), recommended that “a Royal Commission be called into Victoria’s response to the COVID-19 pandemic”.
The submission describes 11 “missteps” by the Victorian Government, including the mismanagement of the hotel quarantine system (which is now subject to a judicial inquiry).
The submission was dated 31 July 2020, at the peak of Victoria’s second wave, with 629 new cases of coronavirus reported in the 24 hours to 30 July, and a 7-day average to 31 July of 436 new cases per day. At 9 September, the 7-day average was 70 new cases in Victoria per day.
Several of the “missteps” can be refuted.
Gatherings
In his submission to the Inquiry, Associate Professor Rait said that the Victorian Government created a public perception of “tolerance of large demonstrations”, such as the Black Lives Matter rally. The Victorian Government, police, and the Chief Health Officer urged people to stay at home and to avoid attending rallies. There was a clear message to the Victorian community that the restrictions were essential (here and here). There is no evidence that this message fostered public complacency about the restrictions on gatherings.
Aged care facilities
Associate Professor Rait’s submission takes the Victorian Government to task for the St Basil’s Aged Care Home tragedy, saying: “Siloed decision-making within the Victorian Government … put individuals at risk such as the decision to furlough all St Basil’s staff without ensuring a plan for care for residents, leaving their basic needs unmet”.
As at 9 September, there had been 208 cases of COVID-19 linked to St Basil’s (residents, staff, and close contacts). As at 20 August, 31 St Basil’s’ residents had died from COVID-19.
Accountability for the St Basil’s debacle cannot be attributed exclusively to the Victorian Government.
Premier Daniel Andrews defended the decision to quarantine the staff, in order to contain the COVID-19 outbreak. There were reports of subsequent deficiencies in residents’ care. However, the actions of the Victorian Department of Health and Human Services (DHHS) will have saved lives by reducing the potential transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from staff to residents.
St Basil’s is a private facility. It is under the jurisdiction of the Australian Government. As such, the Australian Government shares some accountability for the St Basil’s debacle. The Australian Government’s aged care regulator took 4 days to notify the federal Department of Health about the COVID-19 outbreak. The replacement surge workforce was implemented by the Australian Government Department of Health.
The Royal Commission into Aged Care has criticised the Australian Government for failing to develop a COVID-19 plan for the aged care sector.
Questions have been raised about St Basil’s preparedness for a COVID-19 outbreak, and about its strategies for preventing COVID-19 in staff and residents. These issues are the responsibility of St Basil’s management. They are not the responsibility of the Victorian Government.
Further, on 24 August, the Victorian Aged Care Response Centre (VACRC), a joint initiative of the state and federal governments, launched a web-based incident management system (the Victorian Health Services Coordination Hub) to track and monitor COVID-19 cases, outbreaks, and personal protective equipment supplies in the aged care sector. This was an appropriate, but late response to the COVID-19 aged care crisis in Victoria. Would there have been fewer deaths, and less distress for residents, if the VACRC had been implemented at the earliest opportunity in the crisis?
There have been no outbreaks of COVID-19 in aged care facilities run by the Victorian Government.
Communication with the community
I agree with Associate Professor Rait that communication with culturally and linguistically diverse groups has been suboptimal. There were mixed messages on isolation after testing, and on exercise for people with a confirmed diagnosis of COVID-19.
Some asymptomatic people who were associated with workplace outbreaks or community outbreaks, but not defined as close contacts, were told at testing services that they did not need to isolate after testing pending their SARS-CoV-2 test result.
Some asymptomatic contacts, and some symptomatic people were also told by the testing service that they did not need to isolate pending their results.
Some people who had COVID-19, and some people who were contacts, were permitted to exercise outdoors, therefore breaching isolation and quarantine respectively.
The mixed messages seemed to reflect a perfect storm of misunderstanding and misinformation, promulgated by a combination of inconsistent facts and advice from news media, social media, health care services, and the DHHS.
These problems, undoubtedly, should not have occurred. These problems have been corrected, as indicated in the information currently provided in the coronavirus section of the DHHS website.
Contact tracing
Although not mentioned in Associate Professor Rait’s submission to the Inquiry, it is clear that the contact tracing system used by the DHHS will require a review. The number of new cases of COVID-19 in Victoria per day rapidly increased from 73 on 1 July to 685 on 4 August. The total number of cases, and the rate of increase in daily new cases exceeded the capacity of the DHHS system to provide effective contact tracing.
A contact tracing system will inevitably be capacity-limited. An effective contact tracing system will need to maximise the number of cases (total and rate of increase) that can be managed.
There are no easy answers here. A review published in The Lancet earlier this month concluded that “large-scale manual contact tracing is therefore still key in most contexts”. The value of automated contact-tracing tools, such as the COVIDSafe app, has yet to be proven. This review estimates that for contact-tracing apps, population uptake of 56–95% is required to control COVID-19. Another review published in The Lancet examined the impact of testing delays and tracing delays on the R0 (reproduction number). Not surprisingly, this review concluded that onward transmission of infection from an index case is reduced with fewer delays in both testing and tracing.
Although not examined or discussed in these reviews, perhaps a significant flaw in any contact tracing system is the human factor; for example:
- people:
- not getting tested;
- delaying getting tested;
- not responding to contact attempts by DHHS (ignoring phone calls and text messages);
- not isolating after testing;
- not isolating after a positive SARS-CoV-2 test;
- not recalling close contacts;
- declining to identify close contacts.
- contacts:
- not responding to tracing (ignoring phone calls and text messages);
- not quarantining.
Perhaps a decentralised community-based model will work more effectively; for example, the door-knocking system for following up index cases and contacts implemented in the UK (and in Victoria now).
An effective contact tracing system requires the cooperation of the community in which it is being implemented. Education by DHHS about the public’s roles and responsibilities in contact tracing will support the public’s “buy in” to an effective system.
Social distancing and wearing masks should be considered as preventive approaches for testing and contact tracing; fewer cases, fewer contacts.
Singapore has developed a decentralised community-based model that includes an app (Trace Together), and a highly evolved system of protocols and integrated multidisciplinary roles involving activity mapping, analytics, surveillance, and door-to-door inquiries. This video explains Singapore’s contact tracing system.
The contact tracing models in Taiwan and Iceland have been praised for their cooperative strategies in response to the pandemic.
Evaluation is awaited for the systems in the UK, Singapore, Taiwan and Iceland.
Communication between government and GPs
In his submission, Associate Professor Rait said that:
“General practitioners need a much stronger two-way dialogue with the state government so that model development, enactment, collaboration and feedback can be improved … Indeed, there has been a lack of a two-way dialogue and strong relationship between the state government and general practitioners – and a lack of support from the state government over many years … AMA Victoria believes there needs to be a genuine, long-term culture shift in DHHS’s to improve its engagement with stakeholders. In a pandemic, we see that disconnect and stress play out very clearly, whereby GPs are ignored or excluded from our disaster preparedness.”
I disagree. The relationship and communication between government and general practice has been fit for purpose, but, of course, this could be improved.
General practice has been well supported through the pandemic by the Australian Government, the Victorian Government, the Australian College of Rural and Remote Medicine, the Royal Australian College of General Practitioners, and the Primary Health Networks. Australian Government initiatives include telehealth, GP-led respiratory clinics, and the provision of personal protective equipment for general practices. Information and updates have been provided by newsletters, notifications and webinars. The information is available, not always in a “spoon-fed” format, but GPs are expected to know how to find the information that they require.
Although the Australian Government and the Victorian Government have generally provided appropriate and timely information, two-way communication, undeniably has been deficient. GPs do not have clear communication systems to contact the government for questions, advice and comments. Dedicated phone lines (hotlines), dedicated email addresses, and designated departmental GP liaison officers could help to overcome some of these problems.
I refute the contention that general practice has not been involved in planning and implementing the response to the pandemic. The role of primary care in the pandemic is well described in this article published in the MJA.
General practice has been integral to the pandemic response, providing care for people with COVID-19 (85% of whom are managed in the community), and for people with other acute problems, chronic disease, and preventive activity needs. General practice has an ongoing role in managing people with COVID-19-related mental illness, COVID-19-related social problems, and long (or post-acute) COVID-19.
Notification of COVID-19 to DHHS
GPs (and all doctors) have always been required to notify urgent infectious diseases to the Victorian DHHS, by phone, 24/7. Online notification for COVID-19 has now been introduced, and this provides an additional option. This is an example of a response by DHHS which has improved the relationship and communication between DHHS and GPs.
The role of the Chief Health Officer in Victoria
It has been revealed at the Parliamentary Inquiry into hotel quarantine that Professor Sutton, Chief Health Officer, was excluded from the role of State Controller by the DHHS Secretary, contrary to the state’s pandemic plan, and contrary to Professor Sutton’s wishes. The State Controller has overall responsibility for emergency response operations.
There have been suggestions that the Victorian Government has not adequately sought public health advice and expertise in its response to the pandemic.
Professor Sutton has said that he first learned about problems in hotel quarantine when he read reports of them in newspapers.
Summary
In his submission to the Inquiry, Associate Professor Rait described “missteps” by the Victorian Government.
I partly agree with him.
There is evidence that some mistakes have been made in regard to COVID-19 outbreaks in aged care facilities; communication; contact tracing; and governance. Consequently, there have been some adverse events and adverse outcomes. In many instances, culpability is shared with the Australian Government or with other agencies. The “missteps” must be considered in the context of the pandemic, with many issues and challenges that could not have been anticipated in pandemic planning.
The Victorian Government has taken steps to correct any missteps that are its responsibility.
The Victorian Government did not promote tolerance of large gatherings.
In my opinion, the Victorian Government’s response to the pandemic has perhaps been “good, but could do even better”.
Internal analysis will be enough to identify issues and determine timely solutions, for the ongoing response to this pandemic, and for planning the response to the next pandemic.
An inquiry with the powers and the expense of a Royal Commission is not required.
Dr Andrew Baird is a GP at the Elwood Family Clinic in Victoria. He is a tutor in professional practice for medical students at the University of Melbourne.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Loading ...
Regarding Victoria’s second wave of COVID-19 and aged care facility residents, how do we apportion responsibility between the Victorian government and the Australian government for the number of cases and the number of deaths?
The Victorian government accepts responsibility for SARS-CoV-2’s presence in the community.
What about the Australian government?
Excluding Victorian Public Sector Residential Aged Care Facilities, Aged Care Facilities in Victoria are regulated by the Australian government.
The non-Public Sector Aged Care Facilities were deficient in their preparation for preventing outbreaks, and deficient in their response and management when outbreaks occurred.
Lessons learned from Newmarch House had not been implemented.
The Victorian Aged Care Resource Centre was not set up until 25 July.
The Royal Commission into Aged Care Quality and Safety has criticised the Australian government for its COVID Response Plan. There was no plan specifically for aged care.
Today (29 September), Department of Health Secretary (and former CMO) Professor Brendan Murphy, in his response to the Senate COVID-19 Inquiry, said,
“If the public health response had been more prompt we might have avoided some of the scale of the outbreaks in Victoria”
“But largely with the benefit of hindsight and in responding with a response centre … we may have been able to prevent some of some of the spread”
“Some deaths could have been avoidable, potentially yes, if we’d set up [the commonwealth intervention] earlier but we weren’t in a position to know that the need was there until the time we did.”
Professor Murphy admitted that he was aware of the increasing community transmission in Victoria by 18 June.
I believe that the Australian government must take some responsibility here.
Hi Max,
Thank you very much for your comments.
Are you conceding the last word to me?
Thank you for being the first commenter.
You referred to an episode of MASH. Great drama series. No, I haven’t seen the episode with Hawkeye insisting on having the last word. Well done, Hawkeye. I’ll look out for this episode.
I referred to the examples of incidents causing deaths in response to Tony’s comment:
‘2019-2020 bushfire season leading to 173 deaths leads to Royal Commission
COVID pandemic 2020 781 deaths and still counting’
Tony’s comment seemed to imply that a high number of deaths —> Royal Commission.
I was merely trying to point out the fallacy of this implication. The number of deaths does not per se indicate the necessity for a Royal Commission.
The judicial inquiry into the HQ program has now concluded and we await the final report on 6 November.
The initial findings have indicated that there have been failings in the development, operation, management, and governance of the HQ program, but that no one person or one system is responsible for the second wave and its sequelae. Changes in the DHHS and in other government departments will be implemented to correct these mistakes, so that errors do not occur with future outbreaks in this pandemic, and in future pandemics.
A Royal Commission into the Victorian Government’s response to the pandemic is not necessary.
I will concede, however, that a Royal Commission would not be wrong: Just that it would be a waste of time and money, and of no value.
Andrew re
“If the Australian Government knew that the best way to enforce the program was to use Police backed by the ADF – and not private security contractors – then why didn’t the Australian Government stipulate that all States use Police and ADF?”
Every other state managed to and only Victoria did not and no-one can remember why, who or how that decision was made. The question is not “why didn’t they stipulate” but “why didn’t the Andrews government take up the offer of help and allow the Police to abrogate their role (which of course gave them more time to handcuff and pepper spray protesters)”
“International travel is not the responsibility of the States. ”
Agreed but the second they land in a capital city they are the States responsibility.
“The States had only two days to get the program up and running.” and only Victoria royally cocked it up
My original question still stands, do you stand by your claim that the Andrews government has done a good job? Obviously one ministers career being over would suggest not.
In Australia, in 2019, there were 900 deaths from influenza – but no Royal Commission.
Plausibly due to a failure in government management and oversight?
In Australia, in 2019, there were 1,195 deaths from road trauma – but no Royal Commission.
Plausibly due to a failure in government management and oversight?
In Australia, in 2018, there were 3,046 deaths from suicide (2019 data not available)
Plausibly due to a failure in government management and oversight?
There were 173 deaths due to extraordinary events of the bushfire.
Plausibly due to a failure in government management and oversight? Well actually, seems there could be a possible case to answer based on a deficiency in policy and implementation.
There were 768 deaths in Victoria due to the event of the bungled hotel quarantine.
Plausibly due to a failure in government management and oversight? I am hoping that can be seen as rhetorical.
Bring on the Royal Commission.
BTW Andrew, given your digression into earlier TV shows, did you ever see the episode of MASH where Hawkeye always insists on having the last word?
Hi Tony,
Thank you for your comments and your opinions.
The Royal Commission into National Natural Disaster Arrangements (‘The Bushfires Royal Commission’) was established by the Australian Government to examine preparedness, response, and recovery in relation to natural disasters. Its remit does not include examining the Victorian Government’s response to the bushfires.
This article challenges the AMA (Victoria)’s call for a Royal Commission into the Victorian Government’s response to the pandemic.
I have argued that such a Royal Commission is not necessary.
The AMA (Victoria) has not called for a Royal Commission into the more general issue of managing a pandemic. The AMA (Victoria)’s call is about the Victorian Government.
The Judicial Inquiry into the HQ program has already identified mistakes in communication, management, and governance by bureaucrats, by the Victorian DHHS, and by the Health Minister. These mistakes can be corrected, and solutions implemented. It’s not necessary for a Royal Commission to revisit this. Further recommendations may be presented in the final report which is due in November 2020.
I propose that it is a little disingenuous to suggest that ‘every senior politician and bureaucrat gave exactly the same answers at the Inquiry invoking the Sergeant Schultz Defence’. The video streams that I watched and the transcripts that I read are not consistent with this. Yes, the answer was ‘don’t know’ on many occasions. This is a judicial inquiry under oath, and we have to accept those responses as correct. It’s up to Justice Coate to work it all out.
(For those who are puzzled, Sergeant Schultz was an affable and inept character in the American 1960s’ sitcom, ‘Hogan’s Heroes’, which was set in a German prisoner of war camp in World War II. Sergeant Schultz’s catchphrase was ‘I know nothing’ – essentially denying knowledge of knowledge. Another fictional character who was famous for the catchphrase ‘I know nothing’ was Manuel in Fawlty Towers, but I’m digressing.)
Number of deaths is not a good indicator for instituting a Royal Commission.
In Australia, in 2019, there were 900 deaths from influenza – but no Royal Commission.
In Australia, in 2019, there were 1,195 deaths from road trauma – but no Royal Commission.
In Australia, in 2018, there were 3,046 deaths from suicide (2019 data not available) – but no Royal Commission. (Eight months ago, the Prime Minister Scott Morrison announced a permanent national commissioner to investigate suicides among Defence Force personnel and veterans – but not a Royal Commission).
2019-2020 bushfire season leading to 173 deaths leads to Royal Commission
COVID pandemic 2020 781 deaths and still counting. Yet every senior politician and bureaucrat gave exactly the same answers at the Inquiry invoking the Sergeant Schultz Defence.
A Royal Commission is mandatory
My shortest comment so far. Two points of information.
1. The inquiry into hotel quarantine in Victoria is an independent judicial inquiry
2. Witnesses give evidence under oath.
Here’s a photo of Lisa Neville taking an oath on the bible at the inquiry.
https://www.theage.com.au/politics/victoria/ministers-claim-they-were-in-the-dark-as-hotel-quarantine-program-went-wrong-20200923-p55yk2.html
The hotel quarantine program is an Australian Government initiative, announced on 26 March, and introduced on 28 March. If the Australian Government knew that the best way to enforce the program was to use Police backed by the ADF – and not private security contractors – then why didn’t the Australian Government stipulate that all States use Police and ADF?
International travel is not the responsibility of the States.
The States had only two days to get the program up and running.
Why isn’t the Australian Government appearing at the Inquiry?
Lyn, fair enough question re political affiliation and it would be even more so if instead of responding to article in the comments section, I was given the format to write my opinion as an editorial of this august publication.
To answer your question. I have never belonged to any political party. I have donated a small amount of money to my local Labour members reelection fund in Queensland, in thanks for her help with a school enrollment issue. I am on excellent personal terms with my local Green councillor who I allowed to distribute election materials from my surgery.
Not that its relevant, but I have voted for LNP more often than not and in the senate last time voted for the Pirate Party.
Who do you support politically Lyn? After all its only fair to ask.
Lyn in response to your claims that other governments wouldn’t do it better, I simply point to every other Australian state whom has done so. Both Labour and LNP. It’s the incompetence and mismanagement I am angry and shocked at, not the banner on the letterhead. Its the capricious and illogical application of the current rules I continue to be upset at and the avoidance of Parlimentary scrutiny I am suspicious of.
During acute care Lyn, when the “swiss cheese” holes line up and the patient suffers an adverse event (including death) there is an independent enquiry (Coronial or Medical Board). The injured party then gets redress and those who made the errors (even with good intent) may get remedial retraining and supervision, limited sanction or financial penalty. If the individual is unhappy with the outcome of the independent enquiry they have the right to challenge it and the poor or inadequate care they got via the courts.
All I am calling for is the equivalent of an independent enquiry, in this case a Royal Commission.
Andrew you are mistaken in stating that Judge Coate is presiding over a Judicial Inquiry.
A Judicial Inquiry like a Royal Commission requires witnesses to give evidence under oath and has the power to subpoena documents. This inquiry does not have those powers and hence this explains why Mikakos, Neville, Pakula, Crisp, Ashton, Peake etc can’t remember anything and why the minutes of the crucial meetings have not been presented.
The loss of 700 lives, the destruction of thousands of businesses, the loss of hundreds of thousands of jobs, the complete abrogation of democracy and the greatest catastrophic failure of governance in Australia’s history mandate a Royal Commission
A Royal Commission is necessary for the greatest catastrophic failure in governance in Australia’s History that has cost hundreds of lives.
The current Inquiry does not require witnesses to give evidence under oath and does not have the power to subpoena documents.
This is the reason why no one has been able to provide any answers to the key questions.
In Yes Minister, Sir Humphrey advised the Prime Minister never to have an inquiry unless you know the outcome which is exactly what the premier has done.
Democracy doesn’t exist in Victoria.
If you follow the Hotel Quarantine Inquiry the need for a Royal Commission is evident. The problem with this inquiry is that evidence is not given under oath and as a result the new paradigm in Victoria for ministerial responsibility is to use the Sergeant Schultz defence and pass the buck to the next person.
No doubt we will see the same from the Premier tomorrow who manipulated his appearance at the the tribunal from Wednesday to Friday afternoon which is a traditional time for politicians to hide and limit bad press. Furthermore his announcements on Sunday ensure that whatever he says on Friday will be nowhere to be seen by Monday.
If Dr Saul Geffen is asking a question, a valid question, for Andrew Baird to declare any political affiliations, then it is only fair that he is willing to answer the same question himself (wrt to LNP affiliation).
I live in Victoria & have been directly affected by the lockdown. My husband’s restaurant business has gravely suffered, and so too have my children.
I am a frontline health worker working in acute care, & I can appreciate how mistakes happen in time critical situations, especially when you are unlucky enough that the holes in the Swiss cheese “line up”.
I am not looking for any particular individual to take the blame, because I think most people involved acted with good intent in a time pressured & novel situation.
What I would like to see is the “system” improved ASAP to prevent this happening again.
I am grateful that my children are alive & in good health.
I also consider myself fortunate that I have not contracted COVID on the frontline despite inadequate PPE guidelines propagated by the Feds & filtered down to the states.
I do not think the events or the outcome would have been any different or any better under a Liberal state government.
In order to improve the situation & adequately fight this virus, we must UNITE & learn…together.
Re: Saul, September 23, 2020 at 9:41 pm
Hi Saul,
I will attempt to respond to your questions and comments, but I concede that I am unlikely to persuade you that a Royal Commission into the Victorian Government’s response to the pandemic is not necessary.
There are 6 million Victorians. I suggest that you have been conservative in your estimate that thousands of Victorians are suffering. I don’t know of any formal surveys about the effects on the population. To date, there have been 771 deaths due to COVID-19, and there have been a total of 20,100 cases of COVID-19. Clearly, the stressors associated with the pandemic and with the response to the pandemic will have led to people suffering psychological distress, social problems, mental illness, and financial stress. There have been devastating adverse effects on the economy and on businesses.
As you have written, this ‘scale’ of ‘suffering and deaths’ has been avoided in the other Australian States and also in the Territories. It has also been avoided in New Zealand. However, consider an international perspective, and compare Victoria’s second wave with the situations in the USA, the UK, and Europe.
I agree. Hotel quarantine has been a debacle, and I referred to the ‘mismanagement’ in my article. However, this is being addressed appropriately with a judicial inquiry. We await the outcome of the inquiry. This will identify the mistakes, and it will enable the Government and its Departments to implement appropriate changes: no further action required, no Royal Commission required.
The high numbers of cases of COVID-19 exceeded the capacity of the Victorian DHHS’s contact tracing system. As I suggested in my article, contact tracing systems are inevitably capacity-limited, and inherently flawed due to the vagaries of human behaviour. I saw a lovely infographic which illustrated this (although it’s based on the UK – hardly the ideal model). There is no ‘gold standard’ for contact tracing, despite the Prime Minister’s liberal use of this term to praise the NSW contact tracing system. One wonders how the NSW system would cope with daily case numbers of 500 over several days? Let’s hope that this is only ever tested in modelling, not reality.
The Victorian DHHS has already implemented appropriate changes to improve its contact tracing system – using a decentralised model, and CRM software to support contact tracing. A Royal Commission is not required.
One probably shouldn’t use the term ‘apparatchik’ to describe the bureaucrats, but I agree, the bureaucrats have demonstrated that there were mismanagement and miscommunication in their administration of the hotel quarantine program. However, this is being addressed, and a Royal Commission will not add anything here.
Lies about federal support? Misunderstanding, perhaps, but no evidence has yet been presented that there were lies. However, misunderstandings are problems, and these need to be addressed. Again, a Royal Commission is not required.
Overall, in the context of the challenges presented by SARS-CoV-2, and with a global perspective, yes, the Victorian Government’s response has been ‘good, can do better’.
No, I have never been a member of ALP. I have no associations with the Victorian Government. I have no associations with politicians of any colour. I am a member of the AMA, but I am not involved in medical politics.
Yes, there have been mistakes, and these need to be addressed and corrected. Changes need to be implemented now, ‘on the run’ as it were. We can’t wait for a formal Royal Commission to present a report months, maybe years hence. This pandemic isn’t going anywhere fast, so the Government needs to know what it needs to do differently, and it needs to know this know. This is being achieved by internal review, root cause analysis, and change management. It is also being assisted by the HQP judicial review. A Royal Commission would be expensive, slow, and redundant. A Royal Commission into the Victorian Government’s response to the pandemic is not necessary.
Andrew thanks for your concern. My personal injury and inconvenience pales in comparison to what many thousands of Victorians are suffering. Suffering and deaths on a scale that has been avoided by every other Australian state.
What would be the harm in a formal judicial review (ie a RC) of the entire response. The lack of contact tracing, the slowness to recognise the issues, the lies about lack of federal support? The absolute shambles of apparatchiks during the current review pointing the finger at each other saying “it was her idea”/ “no it was his idea””no i cant remember whose idea it was” “it was a good idea it just didn’t work”.
In your own words you now admit the quarantine management was a “debacle”. Still think they have done a good job?
Last question Andrew, have you ever been an ALP member or are you in some other way associated with the current Victorian government you so vehemently seek to shield from enquiry?
Re: Saul, September 22, 2020 at 12:38 pm
Hi Saul,
I am very sorry to read about your personal experience of the pandemic. The situation with your son must be devastating, and it’s horrendous that your friend’s business is now broke.
We will await the outcomes of the Inquiry into hotel quarantine. Based on what has been reported so far, it seems that there were several mistakes in governance and communication involving several individuals, and it seems that the mistakes ‘lined up’ to result ultimately in the ‘leakage’ of the virus from hotel quarantine into the community, leading to the second wave and its sequelae. The sequelae of the second wave include deaths, hospitalisations, large numbers of cases, and the lockdown, and the adverse consequences of the lockdown on social wellbeing, mental wellbeing, and the economy.
I note your comments about resignation and election. Maybe. But there’s no place for a Royal Commission.
Re: Maryanne, September 22, 2020 at 10:29 am
Thank you very much for your comments. As I have indicated above, we will await the outcomes of the inquiry into hotel quarantine (it’s not a Royal Commission).
I agree, the Premier is accountable for any mistakes, although he might not be responsible for the mistakes.
I do not know if there have been any formal surveys to assess Victorians’ opinions about the Victorian Government’s response to the pandemic, but I get the impression from the news media that you are correct in writing that the majority support Daniel Andrews.
The ‘draconian’ measures are a necessary response to the second wave. Victoria’s second wave has been controlled. This is in contrast to the second waves that have occurred in Europe, and the second wave that is about to occur in the UK.
I agree. Mistakes have been made. As indicated above, the judicial Parliamentary inquiry is addressing the hotel quarantine debacle. Mistakes have already been identified, and solutions have been implemented accordingly. The full report is awaited. A Royal Commission will not add anything to the findings and outcomes of this inquiry.
There is no place for a Royal Commission into the Victorian Government’s response to the pandemic.
Dear Andrew, to stay on topic (unlike many posters here who rabbit on about HCQ or hide behind anonymity). I need to declare my bias. My son has missed substantual schooling opportunities as he is an elite ballet program in Melbourne and the school is closed to face to face teaching. I have not been able to see him and he has not been able to join his family at holidays or long weekends. My close friend has a pub in Essendon that is now broke. If the Victorian Government had effectively governed (Like the NSW/ SA/ QLD/ Tasmanian and NZ governments did) we wouldn’t be having this debate.
If Andrews and his ministers did the honorable thing and resigned and called an election. We wouldn’t be having this debate. Then I would agree no RC would be needed. Til then……
Why do we need yet another Royal Commission? Early in the pandemic it was evident that the infection was being brought into Australia by returned travellers. All state governments had to do was establish and maintain an efficient system of quarantine of the returned travellers. Only the state of Victoria failed in this crucial task, because the politics of giving jobs to individuals from the Labour party voter base took precedence over best practice. This alone was responsible for the second wave in Victoria and the reason why the whole of Melbourne is now being quarantined from the rest of Victoria and the country. Daniel Andrews, DHHS bureaucrats, health officers, police and others have continued to deflect questions from the media and the royal commission and spread blame regarding the use of private security contractors over ADF to guard return travellers. As the Premier of Victoria Daniel Andrews is accountable for the position Victoria finds itself in. It is my impression that the current draconian measures are his attempt at remedying his government’s monumental error. Given that the constitution of Australia does not permit the Federal Government to open up interstate borders that have been closed by individual states, Victoria has no other option to stay the current course of severe lockdown measures. Unbelievably the majority in Victoria believe that Daniel Andrews is doing a marvellous job!
Re: Saul, September 21, 2020 at 10:20 am
Thank you very much for your comments.
I stand by my comment.
None of the other States or Territories have had to manage a second wave. Let’s hope that they don’t have to manage a second wave to prove the efficacy of their response or otherwise.
The hotel quarantine debacle is subject to a judicial inquiry. The Victorian Government will learn from the findings of this inquiry, and appropriate changes can be implemented.
The second wave exceeded the Victorian DHHS’s capacity for contact tracing. It’s not known if the systems in other States and Territories would have been more effective or not. These have not been modelled or tested. The gold standard for contact tracing has not been defined, despite the Prime Minister’s use of this term.
The Victorian Government, police, and Chief Health Officer presented a clear message to the community that the restrictions that applied were essential. The protesters disregarded this message.
Daniel Andrews made the decision to impose a curfew to support the enforcement the restrictions. He did not state that this decision was on medical advice (or against medical advice). Professor Brett Sutton subsequently stated that he had been consulted about a curfew, but that he had not suggested it, or been involved in the decision. He stated that if involved in the decision making process, he would ‘probably’ have introduced a curfew.
A Royal Commission is not necessary to achieve the objectives of analysis of mistakes, and implementation of necessary changes to systems, plans, and operations.
A Royal Commission will be expensive and slow. The pandemic is ongoing. Changes need to be developed and implemented now to ensure an optimal ongoing response to the pandemic. It will be too late to wait for the report from a Royal Commission. Appropriate changes have already been implemented in quarantining and contact tracing.
A Royal Commission should not be contingent on a certain number of deaths due to COVID-19 or on a certain number of cases of COVID-19. Any decision about a Royal Commission should be based on overall outcomes of the pandemic response, not specifically on deaths or cases.
A Royal Commission has a place where analysis and change are not possible with internal review. A Royal Commission into the Victorian Government’s response to the pandemic is not necessary.
I have presented arguments that support my contention that a Royal Commission into the Victorian Government’s response to the pandemic is unnecessary.
I accept that others do not support these arguments, and that they have arguments which support the call for a Royal Commission. I accept that others have different opinions.
This pandemic is not over yet……the 1918 flu pandemic lasted almost 3 years. So bare in mind that many comments (& decisions) may not age well….across the board.
If you think a Royal Commission is the panacea, just look at Aged Care & all of the costly past Royal Commissions that achieved little except for lining pockets of the legal fraternity.
I personally think Andrew Baird presents some valid & reasonable arguments, including the “Swiss Cheese Model”.
If >3400 Health care workers can contract COVID, mostly at work, with recommended PPE & knowledge of infection control, then it comes at no surprise that this disease could escape quarantine.
Thank-you Andrew Baird. You are a person of clear thinking & reason, aiming to get the best outcome for healthcare.
“ In my opinion, the Victorian Government’s response to the pandemic has perhaps been “good, but could do even better”.
Dr Baird do you think that comment has aged well?
The Victorian Government response has failed. Abysmally. At the cost of literally hundreds of lives and massive economic and social costs.
Every other jurisdiction in the country has done better. For longer. Other governments of both sides of politics managed. They didn’t run quarantine as a social engineering tool. They involved police and ADF. They had a decent contact tracing departments. They didn’t pretend that a curfew was based on medical advice. They were more proactive at preventing BLM meetings.
Why on earth would you try and prevent an enquiry?
How many deaths would make one worthwhile?
Re: Max, September 18, 2020 at 11:15 am
Hi Max,
Thanks for your comments.
I am yet to see any arguments here to indicate that a Royal Commission is necessary.
Mistakes have been made by the Victorian DHHS and by the Victorian Government in the response to the pandemic.
Even with planning based on experience with previous pandemics, mistakes were inevitable in a new, evolving, and dynamic situation.
My argument is merely that these mistakes are better addressed by internal review rather than by a Royal Commission.
Internal review can call on external experts for input and advice, if this is necessary. Internal review can lead to timely changes in planning and operations.
What’s the harm of a Royal Commission? Principally cost and delay. There’s the potential for attention to be diverted from the key issues if a Royal Commission’s scope widens to include issues which are not directly related to the Victorian Government. There’s also the potential for reputational damage.
A Royal Commission is expensive. The argument that Governments are already spending billions in response to the pandemic, so another $50-100 million or so doesn’t matter, is a non-sequitur. If there’s high spending, it’s incumbent on Governments to avoid unnecessary expenditure.
A Royal Commission takes time to set up and time to report. With internal review, it’s possible to get timely action on changes that are necessary. As the pandemic is ongoing, changes need to be implemented now, and ‘on the run’, not at some time in the future.
Through MDOs, medical practitioners will be familiar with Reason’s ‘Swiss cheese model’ in the context of medical mishaps.
Even if the votes here disagreed with the call for a Royal Commission, I would not be using the poll to support my argument.
(Poll results so far:
Agree with call for Royal Commission: 45
Disagree with call for Royal Commission: 34)
Andrew,
With respect, you do seem to be inordinately invested in the desire to avoid a Royal Commission. Why?
Apart from parsimony, what is the harm?
And your Swiss Cheese Model looks a shaky metaphor: as anyone who has tried to get hole-punched pages back into a ring binder will attest, holes that are actually meant to line up are hard to get lined up. The probability of random holes in layers of Swiss cheese all aligning to allow catastrophe through must be exceedingly unlikely.
Rather than nobody being to blame as suggest, it seems far more likely that there is a systemic defect, and it ought to be brought out into the sunlight.
So no; dismissive as you seem keen to be, let’s bring on the Royal Commission.
The votes recorded here agree.
Re: Peter McLaren.
Hi Peter, thank you for your comments.
The topic of a national agency for disease control is beyond the scope of the article.
Australia does have a national agency for disease control: The Communicable Disease Network Australia (CDNA). The CDNA is in the Department of Health. Australia also has the Emergency Response Plan for Communicable Disease Incidents of National Significance (CDPLAN), and the Australian Health Protection Principal Committee (AHPPC). Perhaps the role and function of CDNA and AHPPC need to be reviewed and ‘beefed up’?
It’s interesting – and very worrying – that the Centers for Disease Control and Prevention (CDC), which is a federal agency under the US Department of Health and Human Services (DHHS), has been undermined by the US Government during the pandemic. For example, today, Trump publicly criticised Robert Redfield, Director of CDC, for claiming that a vaccine won’t be ready until the middle of next year at the earliest; Trump says that USA will have one ready in three weeks.
One of the real problems not alluded to is our lack of a national Centre for Disease Control, unlike most other developed countries. Not only would it serve to remove some of the ‘politics’ from the discussion and coordinate a national approach, it would also act as a repository of knowledge for the management of future pandemics.
At today’s inquiry into hotel quarantine, Dr Annaliese van Diemen, Deputy CHO, said, ‘Everybody has responsibility in some way, shape or form. I’m not trying to blame anybody’.
Dr van Diemen said, ‘A large number of small actions or decisions undertaken by a large number of people was behind the outbreaks in the hotels in Victoria. I don’t believe that any one individual is responsible for what occurred’.
This looks like an example of the Swiss Cheese Model of a critical incident.
There are many layers of defence (cheese slices) between a risky situation and a critical incident.
There are flaws in the defences (holes in the cheese).
None of the flaws on their own could have caused the adverse outcome (the critical incident).
Any one of the defences could have blocked the critical incident from occurring.
Unfortunately, not by intention, all of the holes in the cheese lined up, so no defences, and to keep the metaphor going, SARS-CoV-2 sails through the holes from a hotel room and into the community.
So no one person to blame. No one protocol to blame. No one system to blame. It’s a combination of factors all lining up in a particular – and unpredictable – way.
Root cause analysis. Internal review. ‘Holes’ identified. ‘Patches’ proposed. Solutions implemented. No need for a Royal Commission here. Move along, please.
Re: Anonymous, September 15, 2020 at 6:42 pm
Thank you for posting a copy of this letter.
Dr Ron Ehrlich (drronehrlich.com) is not a medical practitioner. He is a dentist. Dr Brighthope is not registered with AHPRA as a health practitioner in any health profession.
In USA, there are two registered randomised trials of hydroxychloroquine combined with Vitamin C versus standard of care for mild COVID-19, and for prophylaxis of COVID-19. There are no conclusions from these trials.
There are no current registered trials of Vitamin D in either the prophylaxis or treatment of COVID-19.
(Davis J, et al, ‘Clinical trials for the prevention and treatment of COVID-19: current state of play’. MJA (213) No 2, 20 July 2020, 86-93)
In summary, the authors of the article note that there are many candidate drugs in pre-clinical and early phase development, and that these form a pipeline for future large clinical trials if current therapies prove ineffective or unsafe.
Absence of evidence is not evidence of absence of effect, but a pandemic is not the time to be tinkering around without evidence.
I agree with your comments about promoting a healthy lifestyle. It’s stock-in-trade for GPs to promote a healthy lifestyle to their patients and to their communities, and this is evidence based: no smoking, no more than 10 units of alcohol per week, at least 30 minutes per day of moderate intensity exercise, rest/relaxation, social connectedness, and a well-balanced, varied diet.
Re: Anonymous, September 16, 2020 at 1:43 pm
I do not see how this incident relates to the call for a Royal Commission into the Victorian Government’s response to the pandemic. It’s not my place to support or to condemn the action taken by police in the arrest of a person who allegedly encouraged Victorians to take part in lockdown protest gatherings. The issue is an incident related to the enforcement of lockdown restrictions. Ms Buhler can deny the charges and she can make a complaint against the police. A bad situation for Ms Buhler, and not good PR for the police. However, not a reason for a Royal Commission.
Hi Cate,
Thank you very much for informing us that comments are moderated. I am sorry, I was aware of this, and I should have indicated this in my post about anonymous comments.
I declare a bias.
I have family members who live in the UK and the USA. I am in contact with them on most days. COVID-19 and its repercussions are inevitably the main topics of conversation. I follow the UK news and the USA news in reputable publications. My family members are okay. They are not in ‘hotspots’. They are anxious and stressed.
I perceive the Victorian Government’s response to the pandemic in the context of my understanding of government responses to the pandemic in these countries. The Victorian Government is doing well in comparison to the governments in the UK and in the USA, where there have been deficiencies in strategy, organisation, systems, and leadership in response to the pandemic. Indeed, in the USA, there have been 50 different responses, one for each State, with an overarching national response characterised by Presidential input, misinformation, incompetence, negligence, ignorance, and chaos. These problems have not been seen in Victoria.
The Victorian response to the pandemic is not perfect, and has not been perfect. For a new and dynamic phenomenon, such as the SARS-CoV-2 pandemic, a ‘perfect’ response seems unrealistic.
I do believe that in assessing and analysing the Victorian response to the pandemic, it’s appropriate to consider the international perspective. In terms of cases and deaths, the COVID-19 situation in Victoria is orders of magnitude better than the situation in the USA, the UK, India, South American countries, European countries, and so on.
In July, the WHO launched the Independent Panel for Pandemic Preparedness and Response (IPPR) to evaluate the world’s response to the COVID-19 pandemic, co-chaired by Helen Clark, former NZ PM, and Ellen Johnson Sirleaf, former President of Liberia.
Boris Johnson has committed to a deferred independent public inquiry into the UK’s response to the pandemic. But not immediately. An article published in the BMJ in May recommended that the inquiry meet 5 criteria: ‘It must be quick, broad, ambitious, able to command widespread public and stakeholder support, and focus on the most important weaknesses to date’. https://www.bmj.com/content/369/bmj.m2052
There are no plans for a formal full-scale inquiry into the USA Government’s response to the pandemic.
Health Minister Chris Hipkins has committed to launching a review into NZ’s response to the pandemic, prompted by the recent outbreak in Auckland. There has been no commitment to a starting date for this. The NZ Government has by all accounts ‘done well’ in its response to the pandemic. A review of the response seems appropriate – not an Inquiry or a Commission.
One might ask Zoe Buhler from Ballarat whether in the current environment she might in retrospect have been better to post on Facebook anonymously.
Such a question would have seemed fanciful only a few months back, and ought still to be.
From the editor: Just as an FYI … while anyone can comment, anonymously or otherwise, every comment is moderated. Defamatory comments don’t get through. Advertising doesn’t get through. Conspiracy theories don’t get through. Where possible we check references provided in comments, and if the sources are credible they get through.
20 comments so far (07:30, 16 September).
Name provided – 13 (me – 8, others – 5)
Anonymous – 7
Insight+ enables anyone to post a comment. Commenters are required to enter their name and an email address. The name can be hidden, so that the comment will be posted anonymously. The name can be an alias. Insight+ does not check or validate names or email addresses.
There’s a place, of course, for anonymous comments in online discussions. Commenters may wish to protect their privacy and not disclose their identity if their comment relates to personal issues such as their health.
For a contentious topic such as this, I believe that anonymity is a potential barrier to debate. The source of a comment is significant. Who wrote it? Are they a medical practitioner, or another healthcare professional, or someone who works or has experience in another area? What experience and/or qualifications do they have to comment on this topic? Are they affiliated to a professional organisation or a political organisation?
Anonymous comments may be the white noise of online discussion: distracting, difficult to interpret, and significance not clear.
Ever since Dan Andrews and his health minister smirked about throwing Dr Higgins under the bus in the early days of the Pandemic, I have observed an ongoing arrogance of his government. Just an observation, for what it is worth.
Dr Baird I do not share your support of the Premier. There has been an egregious failure of risk management that is unparalleled in Australian history. The two elements of risk are likelihood and consequence. Given the situation re transmission overseas , the likelihood of returning travellers being infected was high, hence the need for hotel quarantine to prevent community transmission. The consequences of community transmission were seen in Italy and New York i.e. catastrophic. With a high likelihood and a potentially catastrophic outcome the risk of poorly managed hotel quarantine was extreme. With such a risk, competent managers devote every available resource to manage and contain that risk. In NSW and QLD, Police and the ADF were brought in. In Victoria, poorly trained, poorly equipped and poorly supervised security guards were used. The priorities of the Government were laid bare by reports that they received diversity training but none in infection control. I would love to see the risk assessment, but I suspect they have thrown out the fag packet it was written on. The tragedy that has befallen Victoria and it’s beleaguered citizens was foreseeable and preventable. In my mind it was negligence and I suspect a Court will be called upon to determine if this was the case. I find the (in)actions of the Premier and his Government inexcusable.
Re: Andrew Baird says:
September 14, 2020 at 12:54 pm
Re: Anonymous, September 14, 2020 at 11:49 am
Andrew, you asked for the medical letters of advice to ministers, CMO, PM etc from doctors of our community. These doctors and their organisations preceded the 13 senior doctors who all begged to be included in the discussion for the management of COVID. If any of there accountable people we elected had included and would act on these evidence based advice there will be less cases and less deaths and especially support for our frontline doctors. One question for the Royal Commission would be why were these doctors dismissed? Amongst several, here is one such letter to minister Greg Hunt which were also sent to Brenden Murphy CMO.
Hon. Greg Hunt
Minister for Health
PO Box 6022 House of Representatives Parliament House Canberra ACT 2600
Australia
12 May, 2020
Dear Minister Hunt,
Re: Complementary treatments for COVID19, acute respiratory disease and sepsis.
Firstly we would like to congratulate you, your team and the country-wide health system that has managed to respond so incredibly effectively to the threat of this pandemic and undertaken enormous preparatory work to both avert and prepare for a variety of scenarios. We applaud your efforts and would like to throw our support and collegial resources into the effort.
We write to draw your attention to a low cost, low-risk treatment path for infectious respiratory diseases like COVID19 in advance of the 2020 influenza season which will this year be conducted in an unprecedented high-risk environment. We believe some simple, inexpensive measures could be put in place to reduce the morbidity and mortality associated with both COVID and influenza – the cost of which would not need to be borne entirely by the health system.
In short, we would like to be:
included in discussions regarding the possibilities of non-pharmaceutical, generally recognised as safe treatments for respiratory disease in both preventative strategies for high risk groups and in treatment options at early onset and in clinical care; these treatments involve the use of recognised complementary medicines already listed and registered on the ARTG
given the opportunity to make the case for research into the efficacy of a number of treatments used in integrative medicine that we believe could be helpful immediately in both the treatment of COVID19 and in the treatment of influenza and sepsis both for efficacy, low toxicity and side-effect profile and cost-effectiveness; and
patients allowed to be administered IV Vitamin C in clinical care on request by appropriately trained and experienced practitioners
We’re aware of your practice of taking advice from a broad range of sources but to the best of our knowledge, these do not include those practising in integrative and nutritional medicine. In this particular scenario, we believe we have a unique and useful perspective to offer and would like to work collegially to provide some options for broad public health messaging, preparedness and treatment options for severe cases. We all share a concern for relative risk and public health.
Much of our population, by reason of poor diet, underlying chronic disease and stress, are deficient in optimal levels of certain nutrients that would allow their immune system to function optimally. This situation is not unique to Australia and has perhaps been the basis for a number of international clinical trials looking at the efficacy of supplemental vitamin D and high dose vitamin C in the prevention and treatment of acute respiratory distress syndrome (ARDS) and in the treatment of respiratory disease generally. The results of these studies have been broadly positive and are attached.
The TGA has made recent reference to the use of IV vitamin C in overseas trials in the treatment of COVID19 and while we would agree that there are as yet “no published peer-reviewed studies in the medical literature to support the usage of this vitamin for COVID-19”, nor is there published peer-reviewed data for the use of hydroxychloroquine for the treatment of COVID-19 , azithromycin or any other treatment currently being used in clinical settings for this cohort of patients- hence the immense research effort into existing pharmaceuticals the development of an effective and safe vaccine. As with each of the other off-label treatments, limited, non-randomised studies are being used to inform treatment options as they emerge and we would argue, IV Vitamin C is no different.
In fact it is both biologically plausible and low in risk and cost.
We believe this is a truly positive and in the words of the Prime Minister, a “Team Australia” moment.
It is a moment for “all shoulders to the wheel”, and empowering the immune systems is an opportunity we can all embrace.
We would be extremely keen to add our collective experiences in administering complementary treatments into the broader thinking about effective therapeutic probabilities in COVID patient management.
We have a cumulative experience of treating thousands of hours and hundreds of patients with intravenous vitamin C
Vitamin D is also effective in the prevention of acute viral respiratory infections with a systematic review of 25 randomized controlled trials (11,321 participants aged 0-95 years) of Vitamin D supplementation demonstrating a 12% reduction in participants experiencing at least one acute respiratory tract infection (OR 0.88, 95% CI 0.81-0.96). Number needed to treat (NNT) with Vitamin D to prevent one acute respiratory tract infection was 33, comparable with the NNT to prevent one influenza-like illness in adults with parenteral inactivated influenza vaccine (of 40 in adults and 28 in children). The benefit was greater in those receiving daily or weekly vitamin D without additional large bolus doses. Protective effects were greatest in those with severe deficiency (<25mmol/L baseline levels) with only 4 people needing to take supplements to prevent one acute respiratory tract infection19. In many of these studies, the results prove that vitamin D prevents respiratory infections even at very low dose supplementation. A Cochrane review also found that Vitamin D supplementation reduces the risk of severe asthma exacerbations which are often precipitated by viral upper respiratory tract infections, further evidence of benefits in respiratory tract infections20.
Former Centre for Disease Control (CDC) Chief Tom Frieden MD has gone on record advising that Vitamin D may strengthen the immune system and may help prevent infection with COVID-19. He states that: ‘Vitamin D supplementation reduces the risk of respiratory infection, regulates cytokine production and can limit the risk of other viruses such as influenza. A respiratory infection can result in cytokine storms – a vicious cycle in which our inflammatory cells damage organs throughout the body – which increase mortality for those with COVID-19. Adequate Vitamin D may potentially provide some modest protection for vulnerable populations’ 21.
These are just a few of the basic elemental supports we could suggest. There is a pharmacopeia of options available that could be prioritised and explored but unless this is done collaboratively, with established research centres that feed into government decision making processes, they would likely be wasted effort. We believe it would be beneficial for some of our team to sit down with selected researchers and clinicians to consider which existing evidence is sufficient to inform current clinical practice and recommendations, and whether any general advice could be issued to GPs and the general public on the basis of the existing evidence base that may help to lessen the impact on the system as we come into winter.
I would like to acknowledge that this document has been drafted in consultation with our Founding President of the College, Prof. Ian Brighthope.
Your advice as to the best way to proceed would be most welcome.
Yours in health,
Dr Ron Ehrlich B.D.S, FACNEM, FASLM
President Australasian College of Nutritional & Environmental Medicine (ACNEM)
cc. Prof Brendan Murphy, Chief Medical Officer
References
1. Hemila H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev 2013; 1: CD000980.
2. Carr AC, Maggini S. Vitamin C and Immune Function. Nutrients 2017; 9(11): 1211. https://doi.org/10.3390/nu9111211
3. Peng ZY. Vitamin C infusion for the treatment of severe 2019-nCoV Infected pneumonia. ClinicalTrials.gov, US National Institutes of Health. Available at: https://clinicaltrials.gov/ct2/show/NCT04264533
4. Chen N, Zhou M, Dong X et al. Novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet Adv 2020; 29 https://doi.org/10.1016/S0140-6736(20)30211-7
5. Wang T, Du Z, Zhu F et al. Comorbidities and multi-organ injuries in the treatment of COVID-19. The Lancet. 11 March 2020. https://doi.org/10.1016/S0140-6736(20)30558-4
6. Cheng RZ, Shi H, Yanagisawa A et al. Early large dose intravenous Vitamin C is the treatment of choice for 2019-nCov pneumonia. Orthomolecular Medicine News Service, 16 Feb 2020. Available at: http://orthomolecular.org/resources/omns/v16n11.shtml#Ref13 [accessed 18 March 2020]
7. Nabzdyk CS, Bittner EA. Vitamin C in the critically ill- indications and controversies. World J Crit Care Med 2018; 7(5): 52-61.
8. Furuya A, Uozaki M, Yamasaki H et al. Antiviral effects of ascorbic and dehydroascorbic acids in vitro. Int J Mol Med 2008; 22: 541–545.
9. Patel V, Dial K, Wu J et al. Dietary antioxidants significantly attenuate hyperoxia-induced acute inflammatory lung injury by enhancing macrophage function via reducing the accumulation of airwar HMGB1. Int J Mol Sci 2020; 21(3). pii: E977
10. Fowler I, Kim C, Lepler L et al. Intravenous vitamin C as adjunctive therapy for enterovirus/ rhinovirus induced acute respiratory distress syndrome. World J Crit Care Med 2017; 6(1): 85-90.
11. Gonzales MJ, Berdiel MJ, Duconge J et al. High dose Vitamin C and influenza: a case report. J Orthomolecular Medicine 2018; 33(3): 1-3.
12. Marik PE, Khangoora V, Rivera R et al. Hydrocortisone, Vitamin C, and thiamine for the treatment of severe septic shock. Chest 2017; 151(6): 1229-1238.
13. Zabet MH, Mohammadi M, Ramezani M, Khalili H. Effect of high-dose Ascorbic acid on vassopressor’s requirement in septic shock. J Res Pharm Pract 2016; 5(2): 95-100.
14. Hemila H, Chalker E. Vitamin C can shorten the length of stay in the ICU: a meta-analysis. Nutrients 2019; 11(4). Pii: E708.
15. Prier M, Carr AC, Baillie N. No reported renal stones with intravenous Vitamin C administration: a prospective case series study. Antioxidants 2018; 7: 68. DOI: 10.3390/antiox7050068
16. Quinn J, Berber B, Fouche R et al. Effect of High-Dose Vitamin C Infusion in a Glucose-6-Phosphate Dehydrogenase-Deficient Patient. Case Reports in Medicine 2017; Article ID 5202606. Available at: https://doi.org/10.1155/2017/5202606 [accessed 18 March 2020]
17. Saul AW. Shanghai Government officially recommends Vitamin C for COVID-19. Orthomolecular.org. 3 March 2020. Available at: http://orthomolecular.org/resources/omns/v16n16.shtml [accessed 18 March 2020]
18. Matthay MA, Aldrich JM, Gotts JE. Treatment for severe acute respiratory distress syndrome from COVD-19. Lancet Respiratory Med 2020. Published online March 20, 2020. https://doi.org/10.1016/S2213-2600(20)30127-2
19. Martineau AR, Carmago CA, Hooper R. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017; 356: i6583.
20. Martineau AR, Cates CJ, Urashima M, et al. Vitamin D for the management of asthma. Cochrane Database Syst Rev 2016;356:CD011511.
21. Frieden T. Former CDC Chief Dr Tom Frieden: Corona virus infection risk may be reduced by Vitamin D. Fox News. Available at : https://www.foxnews.com/opinion/former-cdc-chief-tom-frieden-coronavirus-risk-may-be-reduced-with-vitamin-d [accessed 24 March 2020]
Re: Anonymous, September 15, 2020 at 9:30 am
We have a difference of opinion. Unfortunately, neither of us has facts to support our opinions and points of view.
I believe that the Premier’s analysis of events changes appropriately in response to a dynamic situation.
I believe that the Premier takes guidance from his Ministers, from the Victorian CHO, from the Australian CMO, and from the PM.
I do agree that there have been mistakes in management – most obviously in respect of the quarantine debacle. However, the quarantine debacle is already subject to a Parliamentary inquiry.
A Royal Commission is not required.
I agree with you that there must be accountability and responsibility, and I believe that the Premier has taken this on board.
The Premier has claimed both responsibility and accountability.
In July, the Premier told ABC: “I’m the leader of the state, I’m the leader of the government and I’m ultimately responsible for what goes on in this pandemic response and in all things.”
At the press conference on 6 August (471 new cases of COVID-19 that day), the Premier said, “I am accountable because of the job I have. I’m accountable for any mistakes, and all mistakes, that are made. I have never shirked that responsibility. I’ve never moved so much as an inch away from that responsibility. That is the role that I have. I will own those errors. I will be accountable for those errors. Mistakes have been made. I’m determined to get those answers.”
The Premier didn’t win on strategic communication. During the second wave in general, and in his responses to the media inquisition about the quarantine debacle, he clearly lost the accountability narrative to the media.
Re: Anonymous, September 15, 2020 at 12:46 pm
No need to apologise for ‘harping on’ about BLM. You are adding emphasis to your point of view.
I do not have any evidence to support my contention that the Victorian Government’s messages prior to the Black Lives Matter rally in Melbourne on 6 June did not foster complacency in the public about the restrictions. My contention is based on my interpretation that the messages did not foster complacency thus.
Similarly, you have not presented any evidence to support your contention that the Victorian Government’s messages prior to the Black Lives Matter rally in Melbourne on 6 June did foster complacency in the public about the restrictions.
Same situation: different interpretation.
Attempting to fine and to arrest up to 10,000 demonstrators is otherwise called a riot, and this would be inconsistent with civil order and with social distancing.
The approach that was taken was one of harm minimisation. Not ideal, of course.
I could gainsay each of your four points, but I don’t think this would be helpful, as your points are based on opinion, not fact, and my rebuttals would also be based on opinion, not fact. Ergo, unfortunately, stalemate.
To describe the Premier’s conduct as ‘the most egregious double-standard in public life in memory’ is possibly hyperbolic.
As you would expect, I find the reference to Milo Yiannopoulos in this context both inappropriate and distasteful.
Sorry if I appear to be harping on the issue of the BLM Andrew, but your (and the Premier’s) responses seem inadequate.
“Daniel Andrews stated that it was ‘simply not feasible’ to fine or arrest demonstrators in view of the large numbers that were expected to attend the rally”.
There are a limited number of possible differential diagnoses from this statement, all of which are unpalatable:
1. If you are big enough, ugly enough or aggressive enough, we’ll just let you break the law: i.e. mob rule is OK in our state. We only police the soft targets
2. We say that we want you not to congregate, but we don’t really think it’s that important (which would rather contradict your assertion that there were no suggestions before the rally that ‘fostered public complacency about the restrictions on gatherings’).
3. We say that we want you not to congregate, but we also need to pitch to our base and because we tacitly agree with the BLM cause, we won’t stand in its way
4. We could have invoiced the organisers for provision of police services to prevent violence (which would have shut them down very rapidly), like we did for Milo Yiannopoulos, but he is a right-wing agitator and not on our side, whereas the BLM marchers are left-wing agitators and on our side, so we waved them through.
To be kind, I would say that many in the community received message #2.
But there are a great many others for whom #1,3 and 4 are reason enough to dismiss the Premier and his edicts and his harping, for what remains the most egregious double-standard in public life in memory.
Daniel Andrews has demonstrated negligence, there have been preventable deaths – this needs to be acknowledged & addressed.
The premier Dan Andrews has demonstrated and communicated recurrently that he is not accountable or responsible. His analysis of events changes frequently. He does not appear to be capable of guidance, he takes his own?? There have been multiple transgressions in his management of the COVID response.
A Royal Commission is required.
There needs to be accountability and responsibility taken for blatant failure.
There needs to be learning.
Hi Alan, thank you for your comments.
A Royal Commission into the Australian Government’s response to the pandemic is beyond the scope of this article. A non-inquisitorial Royal Commission into pandemic management is beyond the scope of this article.
An inquisitorial Royal Commission into the Victorian Government’s response to the pandemic is not ‘contraindicated’. It’s neither necessary nor appropriate. Problems in the Victorian Government’s response can be effectively addressed and resolved by internal review. There is already evidence that the Victorian Government (and other State Governments, and the Australian Government) are learning ‘on the run’, implementing changes in pandemic management promptly in response to review and feedback.
There are maybe some political agendas in the calls for a Royal Commission into the Victorian Government’s response to the pandemic. To quote John Howard in 2014, ‘Royal Commissions should not be used for narrow targeted political purposes’.
I note Max’s comments.
The Federal and State Governments have spent billions of dollars in providing support for workers, businesses, the economy, health services, mental health, etc., however, this does not necessarily imply a licence to spend ‘a relatively small sum of money’ on an initiative that may be unnecessary and of poor value – such as a Royal Commission in to the Victorian Government’s response to the pandemic.
I apologise if I appear to be an apologist for the Andrews’ government.
Hi Rod,
Thank you very much for raising these important points. The AMA (Victoria) submission did not include any references to Mr Andrews’s responses to questioning at the press conferences. The submission predated the imposition of the curfew in Melbourne.
On 30 June, Mr Andrews announced that genomic sequencing had linked a large group of cases in the second wave of infections to quarantine breaches at The Stamford Plaza and at Rydges on Swanston. This was on the same day that the government got the information.
The curfew was Mr Andrews’s decision. It was introduced as an aid to the enforcement of restrictions under the State of Disaster. Professor Sutton has not expressed explicit disapproval of the curfew. Indeed, when asked whether he would have introduced it had the decision been his, Professor Sutton said: “ I’m not sure. I haven’t reflected on it. I think it has been useful. If I put my mind to it, probably.”
The curfew supports the fundamental principle of the Stage 4 restrictions: ‘Stay at home’. The principle of ‘Stay at home’ is backed by medical evidence and medical endorsement.
The curfew – now reduced from 9 hours to 8 hours (2100-0500) – only restricts people from shopping and exercising during these hours. Work, medical care, and caregiving are permitted. The curfew means that people are restricted to 0500-2100 for shopping and exercise. This will be difficult for some (eg shift-workers) but manageable for most. In practice, shopping is only possible between 0600-2030 (opening hours of supermarkets etc).
I don’t think Mr Andrews has overstepped the mark here.
Some degrees of concealment, obfuscation, and media management are stock-in-trade for politicians, and I do not have the impression that Mr Andrews has overstepped the mark here. He has a higher profile than other politicians due to his position as Premier and due to his participation in daily press conferences. In Victoria, we see much more of Mr Andrews than we see of other politicians.
I support the comments made by Andrew. I have been concerned for a while that Julian Rait has been making many negative comments about the performance of the Andrew’s government in relation to COVID19.
We have never been through anything like this before (except the Spanish flu when the internet did not exist).
We already have a judicial review of the government’s major stumble in quarantine control.
I do support Julian’s advocacy of doctor’s welfare and availability of PPE . There has however not been sufficient support from Vic AMA for the difficult and good decisions the government has made in getting our numbers down.
Maybe those wishing for a royal commission need to look elsewhere where governments are afraid to make these tough decisions. France had 10,000 new cases today.
I am glad to see that our federal AMA president,Omar Khorshid has been supportive in the decision to have stage 4 restrictions in Victoria.
These are very challenging times and as we are all imperfect ( some docs struggle with this) some mistakes will inevitably happen.
I see little gain in point scoring at a RC
A royal commission is needed to point out the fundamental lack of talent and intelligence and leadership in the Victorian ALP and their subservient and obsequious Public Service.
All Victorians are suffering because of government and public service incompetence.
Re: Anonymous, September 14, 2020 at 12:31 pm
Police fined three of the organisers of Melbourne’s Black Lives Matter protest $1,652 each for breaching coronavirus restrictions. There were no arrests at the rally.
Three days before the rally, Assistant Commissioner Cornelius stated that protesters would not be fined. Commenting on this, Daniel Andrews stated that it was ‘simply not feasible’ to fine or arrest demonstrators in view of the large numbers that were expected to attend the rally. Assistant Commissioner Cornelius also said he would ‘prefer the protest be postponed until it was safe for large gatherings to occur’.
I stand by my assertion that there is no evidence that the Victorian Government’s messages before the rally fostered public complacency about the restrictions on gatherings.
I don’t follow the link between this rally and community outrage, civil disobedience, and the subsequent incidents as you have described.
Interesting stuff, but I couldn’t find where the contraindication to a Royal Commission was established. Many lives have been lost, many others have been severely impacted, and countless more thoroughly inconvenienced. Business has been trashed, especially, but not limited to the State of Victoria.
It makes no sense to me not to spend the resources necessary to ensure that we have learned everything we can about our response to this pandemic, in order to perform better next time. Because, inevitably, there will be a next time, the odds are about 1% of that being next year.
My only suggested correction is that the Royal Commission should be one of the Federal Government .It should look into the Australian Response, including the federal response and each of the States and territories (including but not limited to Victoria), and should look at the things we have done well as well as those we have done poorly.
Andrew , in other circumstances perhaps a RC would not be justified however the Andrews government does not seem do accountability well.
Witness Dans ducking and weaving at the daily presser. First he couldn’t comment on matters before the judicial review until the judge declared there was no legal basis for not doing so , then the genomic smoking gun of the quarantine fiasco which for some reason the government knew long ago but couldn’t release (can’t remember the excuse for this concealment) then who made the decision regarding the unprecedented Melbourne curfew? “not sure but I agree with it and take responsibility for it” (I paraphrase the Premier) and so it goes.
This is a virtuoso performance by Mr Andrews but to what end? One could argue from the little we know already that concealment , obfuscation and media management are the real priorities of the Andrews government here.
Bring on the RC , the truth openly discovered and widely reported is the disinfectant needed. If there is nothing to see then we will see nothing.
Re: Anonymous, September 14, 2020 at 1:38 pm
Thank you very much for your kind comments about the article.
I support a pragmatic approach to addressing the problems that have undeniably occurred in the Victorian Government’s response to the pandemic. Internal review, root cause analysis, and expert advice will enable the Victorian Government and DHHS to develop timely action plans to improve performance and outcomes in the ongoing response to the pandemic.
I think it’s incumbent on those who are calling for a Royal Commission into the Victorian Government’s response to the pandemic to demonstrate why this is necessary. As an appropriately thorough and complex process, a Royal Commission inquiry takes time to gather evidence and to report its findings. How long? Not known, but surely longer than it takes for an internal review. It’s preferable to get improvements implemented at the earliest opportunity rather than waiting for the final report from a Royal Commission. There are no reasons to believe that the coercive powers of a Royal Commission are required here.
The authors of the ‘Doctors’ Open Letter to Daniel Andrews’ comprise a respiratory physician, a gastroenterologist, a public health physician, a retired and eminent academic general practitioner, an anaesthetist, two psychiatrists, and six surgeons. They are male. There are no frontline COVID-19 doctors. There are no trainees. There are no medical students (yes, I believe medical students should have a voice in the pandemic response – they’re going to be dealing with this pandemic for many years to come …).
The authors do not claim to represent the medical profession in Victoria; indeed, they cannot represent the medical profession in Victoria. Although I disagree with the authors, I respect them, I respect their opinions, and I respect their rights to express those opinions.
Thank-you Andrew Baird for a well considered article with insightful suggestions on where & how the system needs improving.
Let’s save the time & tax payers’ money spent on a Royal Commission & use it to improve the system ASAP.
And with respect to a number of doctors in Victoria writing a letter to Dan Andrews….just 13 out of greater than 30,000 doctors In Victoria…. puts this in perspective.
(Most of these doctors work predominantly in private practice, many semi- retired, and I stand to be corrected, not one of them working on the frontline with skin in the game).
Re: Anonymous, September 14, 2020 at 11:49 am
Thank you very much for your comments.
I read ‘A Doctors’ Open Letter to Daniel Andrews’. This was co-signed by 13 medical practitioners, including Professor John Murtagh. I wrote a response to the ‘Open Letter’, which I sent to ‘Quadrant’ and to Professor Murtagh. I have not received any replies. The Open Letter was published in ‘Quadrant’, https://quadrant.org.au/opinion/qed/2020/09/a-doctors-open-letter-to-daniel-andrews/
My article above is about the Victorian Government’s response to the pandemic.
It is not about the Australian Government’s response to the pandemic.
Premier Daniel Andrews does not take advice from the National COVID-19 Commission (NCC) Advisory Board. This Board provides advice on business and economic issues to the Prime Minister via the Department of the Prime Minister and Cabinet. The NCC Advisory Board does not have a role in providing health advice, and as such, it’s not unreasonable that it’s bereft of medical input on its Board of Directors.
You refer to ‘letters of medical advice’. Where can we see copies of the ‘Letters of medical advice (that) have been written from several groups of doctors to the government which have been unacknowledged and dismissed’ ?
When you refer to CMO, do you mean the Victorian CHO (Chief Health Officer), that is, Professor Brett Sutton?
Daniel Andrews is in daily consultation with Professor Brett Sutton (I can’t reference this, but I will attempt to find a reference to confirm this).
Andrew, you would like to bat this one away early by addressing it at the outset, but you have done so dismissively:
“The Victorian Government, police, and the Chief Health Officer urged people to stay at home and to avoid attending rallies”; yet also announced ahead of the rally that they would not be fining or arresting anyone who attended, and applied a desultory fine to an organiser.
It was this action, above all others, and irrespective of how many cases arose from the rally, that has since signalled the grotesque double-standard that the Andrews’ government has applied, and which has driven community outrage and civil disobedience. It keeps being cited: its effect cannot be under-estimated.
A march of 10000 mixed protesters and anarchists is waved through: a pregnant mother posting on Facebook being arrested, or a woman with the correct papers being dragged from her car by four police officers are dismissed with the fatuous comment that the ‘optics are bad’. Well done Sherlock.
The Victorian government needs to be held to account. No number of state-sponsored inquiries will be enough, and it would be better for an over-arching decision than for individual cases to have to be contested through years of court litigation.
We need a Royal Commission.
Re: Anonymous, September 14, 2020 at 10:44 am
Thank you very much for your comments.
My qualifications are MA MBChB DRANZCOG DA FRACGP FACRRM. I’m a metropolitan non-procedural GP with a background in rural medicine. I have been working in general practice for 30 years. I have been involved in medical education for 20 years. I do not have training, skills, or expertise in Public Health, or Cardiology, or Ophthalmology (Associate Professor Rait’s specialty).
Public Health is within the domain of general practice; GPs do quite a bit of it from day to day.
But no, GPs cannot claim to be experts in Public Health. I am certainly not an expert in Public Health. However, I do believe that I am qualified to at least comment on this topic as a GP who has seen quite a bit over 30 years in the trade.
I absolutely agree that there is a regrettable dearth of public health education in medicine, and that Public Health as a career is not afforded the high status that it needs and deserves. Maybe the pandemic phenomenon will raise the profile – and status – of Public Health Medicine for our current trainees and students?
Andrew, I usually take the back seat but I do need to rise up and say you are missing the point about “communication between government and doctors” – the government and government operated agencies are taking decisions about public health into their own hands without consulting doctors including the 13 senior doctors one of whom is Professor John Murtagh a revered GP and known as father of General Practice; nor advice from several craft groups, leave alone the CMO. I don’t like the way Brett Sutton is being treated either. Doctors’ are not pawns or serfs in this operation but need to be consulted by the government as critical thinkers with combined millennia of years of experience and wisdom. AND doctors are advocates for patients, their families, communities AND are also advocates for our nation’s public health. Letters of medical advice have been written from several groups of doctors to the government which have been unacknowledged and dismissed. Why?
If Daniel Andrews is not consulting the CMO, doctors nor senior doctors then who is he taking public health advice from? As far as I can see there is not one doctor on the NCC.
The elite panel of corporates advising Dan Andrews: National COVID-19 Commission (Advisory Board) Commissioners and Key Staff ( https://www.pmc.gov.au/ncc/who-we-are) are:
– Chairman Neville Power (Chairman of Perth Airport, the Foundation for the WA Museum and the Royal Flying Doctors Federation Board and is the Deputy Chairman of Strike Energy Ltd.)
– Deputy Chair David Thodey is a business leader focused on innovation, technology and telecommunication
– Jane Halton AO PSM FAICD FIPPA is a member of the board of the ANZ, Clayton Utz, Crown Resorts, the Australian Strategic Policy Institute, and the US Institute of Health Metrics and Evaluation.
– Paul Little AO (transport and logistics),
– Catherine Tanna (energy retailing),
– Samantha Hogg (transport, infrastructure, energy),
– Mike Hirst (banking)
– Paul Howes (KPMG)
– Secretaries of the Department of the Prime Minister and Cabinet Philip Gaetjens, the Department of Home Affairs, Mike Pezzullo, and The Treasury, Dr Steven Kennedy.
The pandemic is supposed to go for another 12-18 months and the government’s lack of inclusion, non transparency and alienation of doctors input should be a concern to all about where it may be taking us. It is time to think even more critically now.
I agree with the comments in the above article.
I think it is quite important for anybody making comments in a particular speciality, in this case public health, to be asked to include their qualifications to make such remarks. I am trained in communicable disease epidemiology and have experience of public health practice and teaching, about which I think I am able to comment, but recognise that I am completely unqualified to comment on – say – cardiology, although I have some grasp of the area. So many people seem to believe that epidemiology and public health is an automatic part of medicine in general, and of course a few classes are included in undergraduate training, but recognition of it as a speciality os sorely lacking, and overall this contributes to its downgrading as a speciality.
It is undoubtedly true that we will learn a great deal from the evidence gathered and the ensuing conclusions of the Royal Commission.
That a Royal Commission might cost a few million dollars is no longer relevant: we no longer even blink for any number that doesn’t have a billion attached to it.
One can expect apologists for the Andrew’s government to be opposed.