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Subjects: Swine flu, Professor Chris O'Brien

NICOLA ROXON: Thank you for coming this morning. There's not a great deal of changes. I wanted to
give you the opportunity to give you a quick update and answer any questions that people might have
about the latest in dealing with swine flu.

The publicly confirmed cases this morning have now risen to 878. That's 74 in New South Wales; 752
in Victoria; 31 in Queensland; seven in South Australia; two in Western Australia; five in
Tasmania; four in the ACT; and three in the Northern Territory.

As you can see, and as we have anticipated in the past week, those numbers are continuing to
increase, particularly in Victoria.

Seven schools are currently closed; 10 are reopening today. Four of those schools are in Victoria;
two in Queensland; and one in the Northern Territory.

Of course, I need to emphasise that under the modified sustain phase that Victoria has now moved on
to, schools won't necessarily be closed according to the past practices. In fact it's more likely
that the only ones that would be closed would be special schools or child care centres - and
they'll be managed on a case-by-case basis, depending on the numbers and the particular risk in
that cohort.

There are 19,273 cases internationally; 117 deaths; 66 countries that are now covered. Australia is
representing about 2.6 per cent of the cases that have been reported to the World Health

As I've said, these recent surge in cases was not unexpected, given the behaviour of the disease
that we've seen in other countries.

We believe that Australia's response has been proportionate and measured. Obviously we are going to
be in a transition period for a number of days or weeks while we see this uneven distribution of
the disease across the country. We do however expect that it will be advancing in all jurisdictions
in a fairly short time frame.

I do want to continue to emphasise that there are no travel restrictions that are being put in
place within Australia; and there certainly is no advice or health advice that has been provided
that people should defer their travel within the country.

There are measures that continue in all jurisdictions outside Victoria to particularly target our
schools, where we know that this disease can spread quickly. And further work is being done.

The decision made by the Health Protection Committee that if school aged children had travelled to
areas of high prevalence they should be asked, on a voluntary basis, not to attend school for seven
days. That will obviously move over time, as the disease spreads. We know at the moment the highest
prevalence is in the north and west of Melbourne; not actually extending into regional Victoria,
and not yet across the rest of Melbourne in any large numbers.

So we will continue to have advice and take advice from the health professionals on any changes to
the prevalence rates.

And I think that's really the main issues.

We are having an increased number of requests that are being made - calls upon the national
stockpile. Those requests are being considered by the Chief Medical Officer as they come in; in
particular the inventory that we have; the paediatric Tamiflu and of course the masks and gowns,
etcetera, that have been requested by some jurisdictions; they have already been provided to a
number of those jurisdictions.

The requests have been fairly modest, and I think that's all going smoothly to date. We do expect
that there will be a change as the numbers increase into other jurisdictions.

So I'm happy to answer questions.

QUESTION: Any indication there's a sort of easing off at all? Or are the numbers still sort of on
an upward trajectory?

NICOLA ROXON: they're on an upward trajectory. They're not doubling or tripling as we had seen at
the start of the week.

We do expect that if this takes hold in other schools, where the disease spreads quickly, that
we'll see those numbers increase. It's really not possible to have a crystal ball.

What we feel comfortable about is we know that this disease to date has been exhibiting as a fairly
mild one. I think the latest report from Victoria was there's only been a total of six people
hospitalised; all who are doing well.

But, it does highlight the need for vigilance, but also highlight that there is no cause for alarm,
and that the public should continue to go about their ordinary business. And that we are now moving
to a phase where we will be trying to particularly target those who are most at risk, and of course
continue with our efforts to delay the spread of the disease while the vaccine is being worked upon
and tested by CSL and other manufacturers around the world who are trying to create a vaccine.

QUESTION: Is there an estimate of how this will progress as we move into the seasonal flu season,
if you like?

NICOLA ROXON: the most difficult problem that will be faced is that the symptoms are very similar.
We know to date that there is a risk of swine flu turning into a more serious respiratory problem,
which is not so common for seasonal flu.

The important change when Victoria moved to modified sustain is the agreement of all the states and
territories to move to sentinel testing, which is essentially random sampling of people who
experience flu-like symptoms.

So, it gives us the tools to monitor how much of the flu in the coming weeks is seasonal flu; how
much is actually this H1N1 strain. And we will have to simply keep monitoring that over the coming

The health experts do say this is a time to be cautious; where the combination of the flus might
turn it into something much less virulent or something more virulent; and we need to keep an eye on
it because of that.

The other jurisdictions that have so far had large numbers of cases are all going out of their flu
season, so we do know that there might be some changes in Australia that we have to be alert to.

QUESTION: Minister, it's been reported that Australia's got the highest caseload outside of the
Americas of people diagnosed with the flu. Given the rest of the world had a, a one month head
start of people getting infected, and we had quarantine measures in place originally; why has it
sort of galloped away?

NICOLA ROXON: I think that one of the things we've got to remember is we have one of the best
systems in the world to be able to test this disease.

We don't have the same systems in every other country around the world, or indeed, even in the
region. So I think having those protections in place early; being on alert; identifying the first
cases; doing that ring-fencing as I think Jim Bishop describes it, of families, so that we have
followed its spread; means that we have actually tested and counted those contacts very closely.

Now that is actually a compliment to Victoria's health system, and I don't think should be turned
on its head to indicate that there is some other reason that it's spread. This is just an, highly
infectious disease which is going to spread across the world, let alone across our country.

I think we're probably better at counting than some others. And that's why these figures will
continue to go up.

But don't forget, I mean Mexico - obviously, where the first deaths were recorded - has 5,000
cases. The US has over 10,000 cases. They are not doing their testing in all jurisdictions at the
same level. So it's quite difficult to accurately know the number when we have some countries that
are moving to, the same as we ultimately will, that sentinel testing, random through the community,
rather than the tracing of each case as it spreads.

QUESTION: Is there any, any sort of, obviously as we're getting into the seasonal flu, has that had
any impact though in the spread of it compared to sort of...

NICOLA ROXON: I met last night - at an unrelated function - with a number of people who've been
working with the World Health Organisation on these issues, and certainly when you move into the
full summer season, that does have some impact on the killing off, and reducing the spread of the

I'm not a medical expert, I wouldn't like to predict why that has changed here, or what will happen
in the future, but I think from previous answers that you've had from Professor Bishop, he's made
it quite clear that there are some different risks for us, because we'll have the two types of flu
circulating at the same time, and of course it transmits easily in cold weather, and people are
generally more likely to have seasonal flu that may turn into something else, and we'll have to

One of the things that the health experts are very keen to follow from here, is whether there will
be any combination, as I understand it, there's often a bit of a fight for dominance if you like,
of which strain will win out, and it can be the weaker strain that wins out, and that will be good
news obviously, for the country, if it means that there's some combination which is of even less
virulence, but we simply don't know the answer to that yet.

QUESTION: Does it appear that it's less deadly, if you like, or less risk to health in Australia at
least, from this type of influenza, compared to normal, seasonal influenza? I mean, given the
number of cases we've got at the moment, regular, seasonal influenza would normally have killed one
or two people.

NICOLA ROXON: Look, I think it's still hard for us to tell, we hope the way it's exhibited in
Australia, and the care, the great care that has been put into identifying the cases, and treating
families, means we'll be able to reduce the severity of the disease.

The thing that is difficult, which we have indicated from the start, is the hard edge of the
disease, which still seems across the world to be a different group of people to those that are
normally most vulnerable to seasonal flu.

We know that the deaths that occur from seasonal flu are usually amongst the elderly, often amongst
residential care and that does not seem to be the group of people that will be particularly
vulnerable to this disease, which means our monitoring needs to be different, we need to be paying
attention to a group of people that we wouldn't otherwise regard as being particularly at risk from
seasonal flu, and I think that's the real emphasis now, on us trying to - still try to contain the
disease, but move our focus to those groups that we think are most at risk. And we need to do that
while we still tackle our normal seasonal flu load at the same time.

QUESTION: Professor Bishop likens fighting swine flu to running a marathon, whereabouts do you
think we're at?

NICOLA ROXON: These diseases can last for many months, they can in fact also come back again in a
following flu season. The reason there has been so much focus on this around the world is because
it was a new strain of flu, that we hadn't seen previously, and I would have thought we're not at
the halfway point, given that we still don't have an extensive spread in Australia.

We are only part way, but closer to having a vaccine, and we still are prepared to put all of our
efforts into containing the disease as much as possible.

So the reason it's a marathon is we will potentially have this disease with us not just through
this flu season, but a risk of it again in the following year. We will of course by that time have
a large proportion of the community vaccinated, and the risks will be different.

QUESTION: Minister, do you see any merit to the idea of deliberately exposing people to the mild
flu, so they develop an immunity to it, such as swine flu parties?

NICOLA ROXON: No, that's not something that I would be providing advice to do. Certainly there is
healthy debate about once you've ascertained if the disease is going to be relatively mild, the
point at which you allow that to take its course within the community.

There is an inevitability about that, but we are in the phase where we are trying to slow and
contain the disease, that's why we're taking the fairly strict approach we're taking in our

I don't think having events aimed at spreading the disease is a good idea, but of course, when
we're further down the track, and more confidently able to say that it's always going to be a mild
disease, then of course there'll be less concern more broadly in the community.

I just don't think we are at that point yet, and people need to remember that the novel nature of
the disease does mean we're dealing with a different beast, we hope, and it appears that it's a
mild one, but we still can't confidently say it won't change into the future.

QUESTION: Just quickly, I may have missed this, but John Brumby has lashed out at some other states
on their restrictions on returning children and others, are those precautions a good thing?

NICOLA ROXON: The public health advice that has been given is for the states that don't have the
same prevalence yet, as we're seeing in the northern and western suburbs of Melbourne, that they
should take efforts to try to reduce the spread of the disease into their school environments.

This is a voluntary process, it's about other jurisdictions saying to parents, if you have school
age children, if you've been in an area of high prevalence, if you've been involved in activities
that kids are often involved in, you need to consider whether out of a precautionary step, you'll
keep your children out of school.

QUESTION: Do you think the Premier's being a bit sensitive?

NICOLA ROXON: I can understand that the Premier wants the message to be very clear that there are
no travel restrictions for adults, or indeed for children, that there are precautionary measures
that are being put in place as voluntary restrictions in other states, and I think this is
difficult in a Federation, but we need to be honest about the fact, if you have jurisdictions that
still have less than a handful of cases, of course they will do what they can, within the realms of
having a proportionate response, they will do what they can, to make sure they can slow the spread
of the disease.

At the same time, I think Premier Brumby's doing absolutely the right thing, to be out there
reassuring people that there is no concern coming to Victoria, that there is no reason for people
to defer or delay their travel, and that some sensible precautions will be a proportionate response
to this.

There is an inevitability which I think all of the jurisdictions understand, that we will
eventually in Australia, move to modified sustain for the whole country, and we have of course some
tensions that are going to exist, while we have jurisdictions on a different level.

That's just a reality, I think it's, you know, a sensible one, which is designed to acknowledge the
different spread of the disease at this point in time, but it won't be in place for that long, as
we see the disease take its course throughout the rest of the country.

QUESTION: Just on another matter, do you have anything about Chris O'Brien?

NICOLA ROXON: Yes. I understand that the Prime Minister is actually going to make a statement later
today about Chris O'Brien. Obviously this is very sad news, particularly sad news for his family,
for very many families of patients that he treated over a distinguished career.

But he has done a remarkable amount of work in his lifetime and really been able to persuade not
just governments, but I think health professionals and others, of the need to work differently in
providing cancer care.

He will leave a very lasting tribute for having fundamentally changed the way we can provide
effective and compassionate care to cancer patients. And whilst that probably won't be much solace
to his family today, I think it is something that the rest of the country can be very grateful for.