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Senate Select Committee on COVID-19
23/04/2020
Australian Government's response to the COVID-19 pandemic

EDWARDS, Ms Caroline, Acting Secretary, Department of Health

MURPHY, Professor Brendan, Chief Medical Officer, Department of Health

Committee met at 10:00

CHAIR ( Senator Gallagher ): Today marks the beginning of the public hearings into the Australian government's response to the COVID-19 pandemic. Over the past five months every Australian's life has dramatically changed. As of this morning, 74 Australians have lost their lives to the virus, hundreds have been critically ill, and thousands have been infected across every state and territory. To protect lives, significant restrictions have been placed on every member of our community. The economic impact of the health response has been devastating for millions of Australians and is still unfolding. The government's and Reserve Bank's economic response to the pandemic and its effects has to date totalled more than $300 billion. It is against this background that the committee will begin its work.

This committee is a key vehicle to provide accountability, transparency and scrutiny of the Australian government's response to the pandemic for the Australian people. Over the next 18 months we will work tirelessly to shine a light on every aspect of the national response. This is not your typical Senate committee. We will demand a lot of witnesses in terms of a cooperative approach that is based on working together in the national interest to ensure all aspects of our response are the best they can be. Political grandstanding will be kept to a minimum; major political points can be made by members in other places. Public hearings will be held virtually, with senators and witnesses joining in by video link or telephone. We will be conducting our work with the assistance of various technologies. We are hopeful that this will be seamless, but there may be teething problems, so apologies for that upfront if we do encounter those.

It's expected that in the first months of our work the focus will be on the government departments and agencies and their areas of responsibilities in relation to the COVID-19 response. Considering the significant challenges facing the nation and the high level of public interest in the matters we are inquiring into, the committee expects that ministers and public servants at the table will be in a position to answer the questions put to them by committee members. The committee expects witnesses to be absolutely frank with it and to provide as much information as possible. This is what the Australian people would expect of their government and of their Public Service. Taking questions on notice will not be encouraged, but if they are taken on notice then the committee expects the answers to be provided within five working days. To facilitate this approach, witnesses will be provided with a list of topics that will be covered in the hearing to allow witnesses to prepare. This is a public hearing, and a Hansard transcript of the proceedings is being made. The hearing is also being broadcast via the Australian Parliament House website.

Before the committee starts taking evidence, I remind all witnesses that in giving evidence to the committee they are protected by parliamentary privilege. It is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to the committee, and such action may be treated by the Senate as a contempt. It is also a contempt to give false or misleading evidence to a committee.

The committee generally prefers evidence to be given in public, but, under the Senate's resolutions, witnesses do have the right to request to be heard in private session. If a witness objects to answering a question, the witness should state the ground upon which the objection is taken and the committee will determine whether it will insist on an answer, having regard to the ground on which it is claimed. If the committee determines to insist on an answer, a witness may request that the answer be given in camera. Such a request may, of course, be also made at any other time.

I now welcome Professor Brendan Murphy, Chief Medical Officer, and Ms Caroline Edwards, Acting Secretary of the Department of Health. I understand that information on parliamentary privilege and the protection of witnesses and evidence has been provided to you.

I remind senators that the Senate has resolved that an officer of a department of the Commonwealth or a state shall not be asked to give opinions on matters of policy and shall be given reasonable opportunity to refer questions asked of an officer to superior officers or to a minister. This resolution prohibits only questions asking for opinions on matters of policy and does not preclude questions asking for explanations of policy or factual questions about when and how policies were adopted. Officers of the department are also reminded that any claim that it would be contrary to the public interest to answer a question must be made by a minister and should be accompanied by a statement setting out the basis for the claim.

Professor Murphy and Ms Edwards, on behalf of the committee I'll begin by thanking you and your colleagues for your hard work leading the public health response to COVID-19 over the past five months. I also thank you for your agreement to appear this morning at relatively short notice for the first hearing of the select committee. The committee felt it was important to begin an inquiry into a pandemic by first hearing from those responsible for coordinating the health response.

Professor Murphy, you wrote to me, as chair of this inquiry, on 21 April 2020 confirming your attendance before the Senate select committee today and outlining the time you were prepared to appear and the terms on which future invitations should be made. The committee will use best endeavours to meet those terms. I would, however, make the following point: the committee has a direct and ongoing interest in the way you perform your role as Chief Medical Officer in response to the COVID-19 pandemic and, on that basis, you should consider your cooperation with the committee as central to and not separate from your pandemic related commitments. Whilst the secretariat will endeavour to work with you to schedule future appearances, I note the power conferred on the committee to call both for persons and for documents in the discharge of its functions.

Professor Murphy or Ms Edwards, would you like to make an opening statement? Actually, I know you will be; we've had it emailed to us! Could I just get agreement from the committee that the opening statement be tabled? There are nods all round. Thank you. I will now hand over to Ms Edwards and Professor Murphy.

Ms Edwards : I have a very brief opening statement, which has been tabled. Thank you for the invitation to address the committee in relation to the Department of Health's involvement in responding to the COVID-19 pandemic. The department has worked and continues to work closely with other agencies across the Australian Public Service and state and territory governments on developing and implementing a comprehensive and coordinated response package.

On 20 January 2020 Australia's National Incident Room was activated in response to the COVID-19 outbreak. Shortly after this the department commenced providing advice to the public on COVID-19, including fact sheets via its website. In response to the events unfolding both nationally and internationally, on 30 January the Australian Health Protection Principal Committee—AHPPC—commenced daily meetings. This longstanding committee, chaired by Professor Murphy and including all chief health officers in every state and territory, provides advice directly to governments and has been essential in determining our response measures.

At the same time, an unprecedented health response began rollout from late February, following activation of the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19). On 11 March the government announced a $2.4 billion first phase health package. The package included investment across primary care, aged care, hospitals, research and the National Medical Stockpile. The investment also enabled communication activities aimed at providing practical and up-to-date advice to the public and the health sector.

Subsequent measures have included: over $1 billion in funding to support the mental health of Australians, bolster domestic violence services, further expand telehealth and ensure access to emergency food and essentials for vulnerable people, and secure additional stocks of personal protective equipment and other medical supplies and equipment; an additional $444.6 million in support for the aged-care sector; a $1.3 billion guarantee to private hospitals to secure 30,000 hospital beds and 105,000 nurses and other staff.

The department has worked collectively with governments and the broader health and medical sector to support a rapid response to the virus. The initiatives the department is implementing, when combined with broader measures such as social distancing, border restrictions and strong messaging on good hygiene, have meant Australia is well placed to manage the virus.

CHAIR: Thank you. Professor Murphy, do you have an opening statement?

Prof. Murphy : Nothing in addition, other than to say that, obviously, I'm very pleased to help work with the committee, and, as always, will be frank and fearless in my responses. I'm very happy to assist. I think we're pretty proud of the way we've responded and obviously very happy to be open to scrutiny.

CHAIR: Thank you, both. I'm going to start the questions. We have an agreed call list to facilitate the call around members of the committee. We'll be proceeding with 15-minute allocations. In your opening statement, Ms Edwards, you said the Australian National Incident Room was activated on 20 January. Professor Murphy, can you inform the committee of when and how you first became aware of the coronavirus outbreak in Wuhan and the surrounding province?

Prof. Murphy : Certainly, Senator. We first heard notification through the WHO on New Year's Day, on 1 January, that there was a cluster of pneumonia of unknown aetiology in Wuhan, in China. We watched that over the first week. I think in the second week of January the advice coming out of China was that there had been no more cases for a week and that there was no evidence of human-to-human transmission. At that stage it was thought to be what we call a zoonotic infection—an infection that seems to spread from an animal to a human but not spread widely amongst humans. That was the advice coming out of China. But around 19 and 20 January that all changed. There was clear evidence coming from China that there was significant human-to-human transmission, which was game-changing. If you've got a virus which doesn't spread from human to human, it's very easy to contain. Once you've got human-to-human transmission, it becomes a significant risk. That's when we activated our NIR and we started our essentially daily meetings of the Australian Health Protection Principal Committee, which is our national committee comprising all the chief health officers—a range of expert advice. We set up a working group with what we call our Communicable Diseases Network, and we started discussing with our international counterparts. From about 19 or 20 January we were in an active response mode. We declared this a listed human disease under our Biosecurity Act a few days later—one of the first countries to do that—because we recognised the pandemic potential of the virus.

CHAIR: Thank you. Between 1 and 19 or 20 January, you say you were in more a watching mode.

Prof. Murphy : Correct.

CHAIR: Could you elaborate a bit on what that means?

Prof. Murphy : We were getting data out of the WHO, from our counterparts in other countries and from the CDC. We were trying to get intelligence. All of the data coming out of China suggested that there had been this cluster of cases. There were about 43 cases, and then they said there had been no new cases for a week and all cases had come from animals. It was a very different position once it was acknowledged and recognised internationally that there was human-to-human transmission of a significant degree.

CHAIR: And on 19 or 20 January you moved to a more formal mode, which we can come back to. Between 1 and 19 January, was any formal escalation occurring across Health and, indeed, out to the states and territories?

Prof. Murphy : There were discussions through our Communicable Diseases Network around the intelligence and the information we had. You need to recognise, Senators, that there are quite often small outbreaks of zoonotic infections. We've seen these with avian flu; we've seen them with other things. These happen every couple of years and we obviously watch and wait. We knew that we were well prepared for a pandemic because we've had longstanding pandemic preparedness plans based around flu pandemics. So we were just watching and waiting to see whether this developed and whether we needed to activate our well-established and existing plans.

CHAIR: So, in response to the notice on 1 January—I think you said that came from the WHO—

Prof. Murphy : Correct.

CHAIR: Did you take any specific actions as Chief Medical Officer in response to that report?

Prof. Murphy : I took action. I was on leave at the time. I came back in the second week of January. I had a briefing, and the briefing at that stage was, as I said, that there'd been a report of a cluster of cases and that the Chinese authorities were assuring that there wasn't human-to-human transmission, there were no new cases and there had been none for a week. So at that stage we decided to keep pursuing our intelligence sources and watch. There was nothing to suggest at that stage that we were at a high risk of pandemic, but we were watching closely.

CHAIR: Could you indicate the point you provided briefings to the health minister and/or the Prime Minister about some of these events that you were watching?

Prof. Murphy : I'd have to go back and check. I think I informally briefed the health minister during that period, when we were watching and waiting, and described that we were waiting to see whether there was any evidence of human transmission. I don't think we briefed the Prime Minister. I don't think that, internationally, the level of concern was particularly high until about that time, on 19 and 20 January, when human-to-human transmission was clearly demonstrated.

CHAIR: Can you recall when you initiated briefings more formally to the government?

Prof. Murphy : On 19 January, we—

CHAIR: It was on the 19th?

Prof. Murphy : Yes. Once that new information was in, we moved to a very different mode.

CHAIR: And that was a briefing to the government to alert them to the information you had and that you were establishing the Australian National Incident Room?

Prof. Murphy : Well, activating. The Incident Room is well established. It's activated on many occasions. It was already active for the bushfires, but we set up a whole range of new teams and moved it into a much more focused operation in terms of this pandemic.

CHAIR: When were you first asked to brief the cabinet?

Prof. Murphy : Let me just have a look. I think I briefed the National Security Committee of cabinet that weekend. I'd have to go back and check that. I'd better take it on notice. We certainly raised the travel advisory, because we'd made recommendations through cabinet around 22 to 23 January. I don't have a record here of when I formally first briefed cabinet. Most of my briefings have actually been to the National Security Committee of cabinet. I've briefed the full cabinet on three or four occasions, but I've probably briefed the National Security Committee of cabinet two or three times a week since that pandemic situation evolved in late January.

CHAIR: I might hand over at this point to Senator Watt. Senator Watt, are you happy to take the call for the next seven minutes?

Senator WATT: Sure. Professor Murphy, thanks for joining us today. You might remember that at the most recent estimates I asked you a few questions about PPE, personal protective equipment. I just want to follow up on some of that. Just briefly on the National Medical Stockpile that the government has, what was already in the stockpile in December-January that is now helping us to respond to this outbreak?

Prof. Murphy : Thanks, Senator. The stockpile has a range of items. In December-January we had about 10 million P2 masks. I've got some notes on that.

Ms Edwards : Just while Professor Murphy is looking, I will say that traditionally the stockpile has held a more limited range of products than we're now considering: two different types of masks—the P2/N95 masks that Professor Murphy referred to, as well as surgical masks. In addition to that, it really focuses on particular medicines. Those were the things that were stocked in it at the time.

Senator WATT: So it doesn't tend to include things like gowns and things like that as well?

Prof. Murphy : Generally not. Regarding most of the personal protective equipment, we had 15.6 million P2/N95 respirators and nine million surgical masks; a range of other devices such as thermometers; a lot of antiviral drugs—one of the main purposes of the stockpile is to provide antiviral drugs, because pandemic influenza is one of the biggest risks in terms of stockpile—a range of antibiotics; a range of chemical, biological, radiological and nuclear antidotes; and immunoglobulin products. Masks have always been considered the major risk in terms of stockpiling. That's what most countries have done. We have small amounts, generally, of other things. Masks aren't made on site in Australia to any great extent; gloves and a number of other things are. So, in terms of personal protective equipment, it was mainly masks—and, as I said, about 25 million. Some of those were distributed during the bushfires in response to the bushfire smoke. But, once it was pretty obvious that something was going to happen with this pandemic, we stopped any further distribution of masks for bushfire and smoke response.

Senator WATT: On those figures that you have given me, the numbers, what was the date that those figures were in place?

Prof. Murphy : That was before the bushfire distribution. So that would have been late December, early January.

Senator WATT: And then the bushfire distribution took some of those out?

Prof. Murphy : About 3.5 million of the P2 masks were distributed in the bushfires.

Senator WATT: But nothing else from the stockpile?

Prof. Murphy : No.

Senator WATT: Once you became aware of the outbreak, what measures did the government take in January and early February to secure additional supplies for the stockpile? We saw that happening with other countries. What did Australia do?

Prof. Murphy : We've been working tirelessly from late January in a procurement process—and Ms Edwards can probably talk more on this, because she's been involved in that—both in the Department of Health and the department of industry, and we've invested billions of dollars. We, like every other country, have been scouring the world. We've made some very significant purchases and we have been able to supply essential PPE right throughout this outbreak, and, at times, there have been distributions that are just in time. We've set up a task force in the Department of Health and a task force in the department of industry and there has been a very significant investment. I think it's important to point out that Australia, unlike the US and other countries, has not run out of PPE at any stage in this pandemic. One of the challenges has been that one of the biggest production sites for PPE in the world is the city of Wuhan—and that was locked down. It's been a challenge, but we've managed it. I don't know if Ms Edwards wants to say anything more about the nearly 100 people working on PPE procurement over the last few months.

Senator WATT: In the interests of time, I might just leave it at that. That's probably as much as I need on that point—and I think we've got the secretary for a bit longer today, if we want to come back to that point. Professor Murphy, as I was saying, I asked you about this in estimates in March. I have had a look back at the transcript. I asked you whether we had enough masks and other protective equipment, and you said, 'For some scenarios, yes, and for some scenarios, probably not'; that, in 'some of the model scenarios' our 'stock would be insufficient'; and that, 'for a worst-case scenario, it would be much better to have more PPE'. In retrospect, are you satisfied that we had and have enough?

Prof. Murphy : At that time, when we weren't sure of what course the pandemic would take and we hadn't achieved the literally hundreds of millions of masks that we have in the last several weeks, we were in a more precarious position then. Fortunately, because of our public health measures, we haven't had a large or uncontrolled outbreak. But that was always a potential, and there were scenarios where, at that time, we wouldn't have had enough PPE. We are now in a much better public health position and our PPE situation is much better. So I am a lot more confident at the moment.

Senator WATT: Roughly when was it that we got to the point where we did have enough PPE? You're saying that, at the outset, depending how it went, there was a risk that we wouldn't have enough. How long did it take until we did?

Prof. Murphy : It's always a balance between the outbreak and the PPE stock. At that time, at estimates, we weren't sure how the outbreak would go in Australia. We're more confident now about our public health measures and control. But at no stage have we ever been in a position where I have felt that any safety has been compromised by a lack of PPE. But, back then at estimates when we were talking, if we had had a very big outbreak soon after that time, we may have been in a position where the PPE stock might not have been sufficient—but we have never reached that situation. Now, because our public health measures are strong and our PPE stock is much, much better, I'm in a very much more confident position.

Senator WATT: Have there have been any instances where you have advised the government to acquire certain PPE and that advice has not been acted on?

Prof. Murphy : I haven't been directly involved in the PPE procurement process; there's a large task force. Essentially, the message from government—and Ms Edwards can talk to this later—has been, 'Spend what you need to make Australia safe.' Obviously, there have been lots of people offering PPE. We want to make sure that PPE, particularly masks, are of high quality. There have been some people making fairly outrageous price demands, and we have certainly been paying premium prices. The message from government all the way through has been, 'Do what you need to do to make us safe.'

Ms Edwards : Senator, I should point out the delegation to buy PPE rests with me and with the CMO. I think initially it was done by the CMO, but, due to his busy schedule, I have been doing it as of late. We've been making the decisions internally on the basis of those delegations for what we need.

Senator WATT: Thank you.

CHAIR: Senator Paterson?

Senator PATERSON: Thank you very much, Chair. I'll start my questions with Professor Murphy, because I believe his time is more limited today, and, Ms Edwards, I might return to you later. I just want to flag at the outset—I know departments have been invited to make submissions to the committee—that one thing that would be helpful, either in the Department of Health's submission or the PM&C submission, from a whole-of-government point of view, is a time line of decisions made by the federal government. That will allow the committee to ask appropriate follow-up questions about those decisions.

Prof. Murphy : We're very happy to provide that. We can provide a more detailed time line of actions and decisions, if you like. We can provide a comprehensive time line of how it's all evolved.

CHAIR: Thank you.

Senator PATERSON: That would be excellent; thank you. Professor Murphy, thank you very much for your time today and for your leadership throughout this crisis. One of the challenges for this committee is that we have to be both backward looking, because we're a scrutiny committee of decisions made by government, and also forward looking, because our constituents certainly expect us to help them get a better picture about what their weeks and months are going to be like, to the extent that we can. So, with the constraints of time, I want to ask a few questions about the road in and a few questions about the road out. Firstly, on the road in, in your view, what were the key, most important, decisions that the government made? The reason that I ask that is that, if we can identify the most successful interventions we have made, that will give us some picture of how we're heading as we look, hopefully, to relax those restrictions in the future.

Prof. Murphy : In terms of government decisions, I'd have to say that government decisions, both federal and state, have at all times been advised by the consolidated national advice from the AHPPC. I've been pleased and impressed by the way every government has taken the medical advice and responded to it. In terms of government decisions, the most important early decisions were related to border measures. They were difficult decisions. We made a decision initially to not allow any flights from Wuhan without very careful health screening. Then they stopped and we put in border measures stopping all flights from China. We put in measures stopping people coming from Iran and the Republic of Korea. We then started some very enhanced border measures and progressively hyped up our recommendations to DFAT to increase the travel advisories. We have now really closed our borders.

It's really important to note that two-thirds of the cases of COVID-19 in Australia have been in returning travellers. Border controls, including the most recent and most restrictive border measure, which is to formally quarantine in hotels every returned traveller, have been quite challenging for government, but I think they have been one of the biggest reasons for our success.

Other important decisions have been to invest very substantially in testing. The reason that we are not in the position of the UK or the US is that we were well prepared. We had our Public Health Laboratory Network, our AHPPC—all of our national federated structures. We got going with our Public Health Laboratory Network to develop in-house testing before there was any commercial testing. We tested widely. We have one of the highest testing rates in the world. We got on top of all those early cases out of China in late January and February. We identified them, quarantined them and isolated them; in other countries, they spread. So, getting on top of the testing and tracing and isolation and really upskilling the public health units in each of the states and territories has put us in a position where we have at no stage had widespread, undetected community transmission like those other countries have had.

Of course, when we had some community transmission, particularly in Sydney and in Melbourne, the very difficult decisions were made in March to introduce progressive social-distancing measures. Despite our very strong testing and contact tracing and isolation measures, once you have community transmission where you don't have an identified contact you have to control that by reducing human contact. So, as the epidemiology evolved and the national cabinet was formed, we had a nationally consistent approach—we don't like the term 'lockdown' that some countries and some commentators have gone for—to introducing a progressive range of social-distancing measures to reduce that community transmission, and that has certainly been what we've seen. So there are three sets of measures: the huge investment in the public health response; border measures, really strong border measures—some of the strongest in the world; and the measures around social distancing.

Senator PATERSON: Thank you. On those border measures, they were, as you say, among the earliest in the world and the strongest in the world; in fact, we moved ahead of the recommendations of the World Health Organization on those matters. But, I guess, indirectly, the World Health Organization made criticism of measures such as those. Why is it that Australia moved ahead of the World Health Organization and other countries?

Prof. Murphy : We had a huge amount of traffic from China. We had a very, very large number of flights; I think there were 160-plus flights a week from China. China was clearly, in that early phase, the epicentre. It wasn't just Hubei province; it was spreading rapidly in other provinces of China. We knew that the greatest risk to uncontrolled transmission was in imported cases. As an island, we were in a position of perhaps doing border measures more effectively than other countries, so the unanimous health advice of the Health Protection Principal Committee was that we should do that. I conveyed that to the Minister for Health and the Prime Minister, I recall, on a Saturday morning, and those measures were introduced that night. We had an urgent convening of the National Security Committee. I think, in retrospect, our colleagues in the UK and the US regret that they didn't do the same.

Senator PATERSON: Australia's obviously one of the leading countries in the world in terms of health results. There are only a few other countries that can boast the results that we've got. To what extent are you evaluating those countries? Of particular interest to me is Taiwan's success in combating the virus, because they appear to have done so with less-stringent restrictions than even Australia has. Are you studying their response, and why do you think they've been successful?

Prof. Murphy : That's a good question, Senator. As I said, our strength has been our public health response plus our border measures plus social distancing. Taiwan certainly have introduced strong border measures, and they have a very strong public health response—very, very aggressive contact tracing and isolation. That is what we, at the request of the national cabinet, are now looking at, in terms of whether we can reduce some of our distancing measures by enhancing, even further, our public health response. That means testing like you've never tested before. We've got one of the best testing rates in the world but we want to do even better, because the risk, if you remove any social distancing, is that you can get a community outbreak. We've already seen, in north-west Tasmania, a small community outbreak related to healthcare workers. That has needed to be controlled—very excellently controlled, I should say—by Tasmania's Department of Health. So Taiwan, I think, is a good example of very strong public health measures. Singapore is interesting; they had a very similar approach to us but they've now had a second wave, in their migrant worker population. We have to be very, very aware that, whilst we've only had seven cases over the last 24 hours—we're in a wonderful position—there is a permanent risk of further waves. This is a highly infectious virus and it can take off fairly quickly, so we are certainly watching those like-minded countries.

Senator PATERSON: Thank you. Turning quickly, in my remaining time, to the road out: of particular interest to the media today, I noticed, is the issue of schools. That's been an ongoing debate. You've been very clear throughout this that the AHPPC's advice hasn't changed—that it is safe for schools to remain open with appropriate measures in place. I just want to drill down a bit into why that's the case. As a starting point: of the roughly 6½ thousand cases in Australia, how many of those are children?

Prof. Murphy : The proportion of children is very small—under 10, I think. It's only a handful. There are some more in the teenager group. I haven't got the exact numbers with me; I can provide that for you. But, generally, internationally, for those under 19 it's about 2.4 per cent. That's the figure from across the world. What we've seen in Australia is that there are hardly any cases under 10 and a small number of cases in teenagers. Most of those children and teenagers have been family contacts. New South Wales Health have done some very good work looking at cases that have occurred in schools, and they have found, really, no evidence of student-to-student transmission in schools. There have been some instances of student-to-teacher and teacher-to-teacher transmission. It's very interesting: completely unlike influenza, this virus doesn't seem to infect children as much. There is still uncertainty about whether they may have asymptomatic infection; if they do, they don't seem to be transmitting it in schools. So we don't think the school environment is a high risk for transmission from children to children. We have had concerns about adults and vulnerable teachers—older teachers, teachers with chronic disease—and adult-to-adult transmission in the school environment, so the measures that we've recommended have been around that. The advice from the AHPPC, which includes all of the state and territory chief health officers, has been very consistent on that basis.

Senator PATERSON: Thank you. Could you, on notice, provide the number of children who have been infected, any confirmed cases of children-to-children infection and any confirmed cases of children-to-adult infection?

Prof. Murphy : Yes.

Senator PATERSON: I think that would help build a picture about why it is safe and why your very clear and consistent advice has been for schools to open with appropriate measures in place. Chair, I think I'm probably getting quite close to my 15 minutes, if you have any advice on that.

CHAIR: You are very close.

Senator PATERSON: I have just one final question, then. Professor Murphy, to what extent has our understanding of the seriousness of the virus changed over time? I'd be very interested in your advice on the CFR and IFR measures of the seriousness of the virus, based on the data we've had. For example, in the very early stages we only had the data from Wuhan, and now we have much better Australian data and data from elsewhere in the world. Has your picture of the seriousness of the virus changed in that time?

Prof. Murphy : Not materially. My view is that the case fatality rate is around one per cent. There are lots of countries with much higher fatality rates, and our view, increasingly, is that that's because they're not ascertaining cases. Countries like us that have tested widely and have good ascertainment—the Republic of Korea is a good example; Germany's a bit closer, but they've probably missed some cases too. We think that, if you're capturing widely, we are seeing about a one-per-cent case fatality rate. Consistently, 80 per cent of cases across the world are mild. One of the challenges has been that some are so mild. In Italy and America, you probably had thousands of people infected, particularly if it was a flu season in the winter, and people just didn't know that this was COVID-19 circulating around.

We've only seen a relatively small number of people who've required hospitalisation and intensive care treatment. Most people have been perfectly able to manage. That's one of the reasons why it's so infectious—so many people have mild disease and will continue to go to work or continue to circulate in the community but unfortunately that small group, mainly of elderly people and those with chronic disease, can get a very serious follow-on pneumonia and die.

Senator PATERSON: I have just one final follow-up question on that. There are some commentators who suggest there is likely to be widespread asymptomatic infection in the community that we haven't picked up yet because we haven't done sufficiently widespread testing. How likely do you think that is in Australia?

Prof. Murphy : Very unlikely. We have been doing sentinel testing across a range of GP practices for weeks. We have been testing every unusual pneumonia case that comes into a hospital and not found any. We're now testing in most jurisdictions. At the moment, we're testing every single person who has acute respiratory illness. South Australia has been testing very widely from early on. All the other jurisdictions are now doing it. I think we would have found evidence of this. Clearly there is probably some, but I don't think there is widespread community transition in Australia at this stage.

Senator DI NATALE: Thank you. I just want to go back to some of the questions that Senator Watt asked about the Medical Stockpile. You talked about—

CHAIR: We're having some issues with your volume.

Senator DI NATALE: Okay. Did you want to go to somebody else and I'll get on the teleconference line?

CHAIR: I'll go to Senator Keneally and then go back to you if you can join us by teleconference, because you are breaking up now.

Senator KENEALLY: Thank you, Professor Murphy and department officials, for being here today. I'd like to ask some questions relating to the Ruby Princess. In doing so, I know the focus of today's hearing is on the responsibilities of the CMO and the Department of Health, and in future we will be, as a committee, coming back to the issue of border closures and the Ruby Princess, and I look forward, Professor Murphy, to you joining us at future hearings on that topic. But today is a good opportunity to ask a few scene-setting questions. For clarification, Professor Murphy, under the Biosecurity Act 2015 you are Director of Human Biosecurity—is that correct?

Prof. Murphy : Correct.

Senator KENEALLY: On 6 March the Department of Health issued a fact sheet called 'Information for the cruise industry COVID-19'. I can circulate a copy of that if it's necessary. It refers to the requirements under the Biosecurity Act for cruise ships to report, through the Maritime Arrivals Reporting System, or MARS, any passengers who show signs of illness. There've been media reports that the Ruby Princess reported, through MARS, 158 ill passengers, including 17 with high fevers. Are you able to confirm those numbers?

Prof. Murphy : The way the health assessment at the borders is done—whilst I am Director of Human Biosecurity, the human biosecurity clearance process is devolved to the state and territory public health units because they are the public health response. So the public health clearance process is done by the department of agriculture biosecurity officers in conjunction with the human biosecurity officers of the state and territory public health units. They are the people who look at those documents and provide the health clearance. New South Wales Health was the responsible delegated health authority for making the decisions around the Ruby Princess, so I haven't personally been given a copy or been shown the MARS report. Obviously this is subject to, as you know, a judicial inquiry in New South Wales.

Senator KENEALLY: A commissioned inquiry, that's right. Let me press on with a couple of other questions, then, because I do want to get to this issue about the role of the biosecurity officers. What is the relationship of those department of agriculture biosecurity officers to you in your role as Director of Human Biosecurity?

Prof. Murphy : I appoint the chief human biosecurity officers in each state and territory, and they recommend a range of other human biosecurity officers. They are medically qualified people. The department of agriculture biosecurity officers have an initial screening role. They administer travel-with-illness checks and they do the initial screening process. If they have any concerns about health issues on an aeroplane or a ship, they then consult with the state and territory public health officers who are delegated human biosecurity officers. So I convene the group of chief human biosecurity officers. We develop polices. We do exercises. I'm ultimately responsible for their appointment, but they work in the state public health units. Because public health is a federated structure in Australia, it's devolved to the states and territories. The Commonwealth doesn't have any on-the-ground public health officials. We work in a federated partnership.

Senator KENEALLY: Thank you. That's helpful. That 6 March Department of Health COVID-19 cruise ship fat sheet says:

If an ill traveller is reported through MARS, a biosecurity officer will liaise with the vessel to screen for COVID-19 …

Can you tell us how many biosecurity officers actually met the Ruby Princess when it docked in Sydney on 17 March and if they conducted any screening for COVID-19.

Prof. Murphy : No, I can't. As I said, that was a response from New South Wales Health in their devolved role as human biosecurity officers. Obviously they've made comments about that and they're waiting for the outcome of the inquiry. There are issues about what they were told from the ship and what information they acted on, but I have not been directly involved in that response. That will be the subject of an inquiry.

Senator KENEALLY: On 15 March the Prime Minister announced that all people entering Australia will be required to self-isolate. Did biosecurity officers or any other federal officials direct the 2,700 passengers disembarking the Ruby Princess on 19 March to self-isolate?

Prof. Murphy : Again, that would have been an instruction of the Border Force and biosecurity officers and New South Wales Health officials. That was a requirement for everybody coming off an incoming aeroplane or vessel. Again, I wasn't there on the ground. I don't know what directions were given to those passengers, but I would assume that that one was given.

Senator KENEALLY: Okay. That same federal Department of Health cruise fact sheet also says that disembarking passengers with no signs or symptoms of COVID-19 must 'wear a surgical mask' when travelling domestically in Australia on aeroplanes, taxis or public transport to reach their home destination. Do you know if they were directed to wear a mask or if any masks were provided to the 2,700 passengers as they disembarked?

Prof. Murphy : I don't know that, no.

Senator KENEALLY: On 15 March the Prime Minister banned foreign flagged cruise ships from arriving in Australia and he announced an explicit exemption for some of the foreign flagged cruise ships carrying Australians on board. On 18 March the federal Minister for Health made a determination under the Biosecurity Act that gave effect to that announcement. Can you confirm that you gave advice to the Minister for Health regarding that directive?

Prof. Murphy : I did.

Senator KENEALLY: Are you able to table for the committee the written advice that you provided?

Prof. Murphy : We could take that on notice. There's a letter that I wrote to the minister that I'm sure we can table.

Senator KENEALLY: I don't know if you're able to confirm this, but did Secretary Pezzullo, from Home Affairs, also provide advice?

Prof. Murphy : I can't confirm that.

Ms Edwards : Yes, he did.

Prof. Murphy : Did he?

Senator KENEALLY: Okay, thank you. Was it joint advice or was it separately provided?

Ms Edwards : It was two separate people's advice as part of collating the evidence for the minister to consider.

Senator KENEALLY: On that 15 March announcement from the Prime Minister, when he said he would ban cruise ships: he did say that, in relation to those cruise ships that would be allowed to return, there would be 'bespoke arrangements that we put in place directly under the command of the Australian Border Force'. Did those bespoke arrangements change any of your responsibilities as the Director of Human Biosecurity under the Biosecurity Act?

Prof. Murphy : No specific changes to my responsibility, but clearly the intention was an enhanced health response by the state and territory public health officials who are working as human biosecurity officers. I think there have been a number of other cruise ships that have been very well processed under those enhanced arrangements, and obviously the circumstances around the Ruby Princess are being examined elsewhere.

Senator KENEALLY: What is your understanding of what those bespoke arrangements under the command of Australian Border Force are—that is, do you have any understanding of what powers Australian Border Force assumed in taking command of the arrival of cruise ships?

Prof. Murphy : I think the powers were already in existence. I think the intention was that there would be enhanced health screening in partnership with the state and territory public health officials. The powers to refuse or grant permission to disembark aeroplanes or ships are already there. They've always been there and they've always been able to be exercised, even before this pandemic; but clearly the enhanced border measures that we've put in place progressively, not just for cruise ships but for planes, are around significantly enhanced screening and significantly enhanced information, and that applies to aeroplanes and to ships.

Senator KENEALLY: And your understanding from what the Prime Minister said on 15 March is that that was directly under the command of the Australian Border Force?

Prof. Murphy : Border Force work in strong partnership with the biosecurity officers in the department of agriculture but they are, as I've already said, very closely related to the state and territory public health officials as human biosecurity officers on the human health risk assessment. But Border Force certainly have had the lead role in implementing our enhanced border measures, both for aeroplanes and in ports.

Senator KENEALLY: The determination to ban cruise ships that was issued by the Minister for Health on 18 March does make provisions, at section 5(b), that vessels that had started to return to Australia before midnight on 15 March 2020 would be allowed to arrive. Were you aware at the time that you advised the Minister for Health on the determination that the Ruby Princess was one of the ships that would be carved out and be permitted to return?

Ms Edwards : I don't have the correction in front of me but I think it's characterised as they were exempted from the prohibition, as opposed to being allowed to arrive.

Senator KENEALLY: Sure.

Prof. Murphy : There were lots of cruise ships. I was first made aware of the Ruby Princess after disembarkation had occurred, so I wasn't aware of it. And I must say that New South Wales Health—it had only been to New Zealand and back, and New Zealand was not seen as a high-risk country. I think everyone was quite surprised at the fact that there turned out to have been a significant COVID outbreak on that ship. On first principles it wouldn't normally have been seen to be a particularly high-risk vessel.

Senator KENEALLY: We certainly did know, though, that cruise ships presented a particularly significant risk. We'd had the Diamond Princesa month earlier—

Prof. Murphy : Exactly.

Senator KENEALLY: where people were actually quarantined before they were allowed back into Australia. That's why I'm trying to understand the picture of who knew what about the content and the health of the people on board.

In terms of the human health reports that come through the MARS system, in a media conference on 25 March the ABF commissioner said that the ABF can access those human health reports. Can the Department of Health access them? Can you access them? Who has access to them?

Prof. Murphy : I'm sure I could, because they're under a delegated authority. But, as I said, this delegation of that human health assessment is done through New South Wales Health and their human biosecurity officers. We could access them, I'm sure. I'm sure Border Force would provide them to us. As I said, this is the subject of a very extensive inquiry in New South Wales, and I think it would be useful to await the result of that fairly intensive inquiry.

Senator KENEALLY: And I respect that, Professor Murphy. However, it's well demonstrated that an inquiry in another jurisdiction does not preclude the Senate from asking questions in Senate hearings or estimates.

So when did the federal government first receive a human health report from the Ruby Princess? There've been conflicting reports in the media as to when reports were received on the human health of the passengers on board. Is it possible to tell us what dates those human health reports were received and how many there were?

Prof. Murphy : I'm sorry, I'm not quite sure what you mean—a report after the ship had disembarked, or were you talking about the reports that were provided before entry?

Senator KENEALLY: Before entry.

Prof. Murphy : Again, I don't have that information to hand and, again, it would not normally have come to the federal government; it would have come to the local public health units, the human biosecurity officers in New South Wales Health and the local Border Force.

Senator KENEALLY: But don't the MARS reports go to the department of agriculture?

Prof. Murphy : They do, yes, and I haven't—

Senator KENEALLY: That's what I'm trying to understand—at what point did the department of agriculture first get a MARS report?

Prof. Murphy : Sure. We can find out when those reports came to the department of agriculture. We can take that on notice.

Senator KENEALLY: I'll put some questions on notice in relation to that. I'm aware that I only have a few moments left. I'll also put on notice—or, if you can, update the committee here today—a request for the most up-to-date figures on the Ruby Princess in terms of how many cases are directly linked to it, how many deaths have occurred and how many cases of community transmission have occurred as a result of the Ruby Princess, and the same for the other cruise ships that arrived after the determination was put in place.

Prof. Murphy : We can certainly do that. I should make the point, though, that most of the cases on the Ruby Princess would have happened whether or not it had disembarked. Those cases were contracted on the ship. The public health concern that you're rightly raising is that if a disembarkation had been into a more structured quarantine process there may have been less community transmission as a result of that, but the vast majority of those cases did contract the virus on the ship and were managed, obviously, when they got off the ship. New South Wales Health were very proactive once they realised there were cases on the ship. Every single passenger around the country was contacted. But we can certainly provide all that information for you.

Senator KENEALLY: Just to finalise this, Professor Murphy: you've mentioned New South Wales Health a number of times; are you trying to assert that the Commonwealth has no responsibility here when it comes to a ship arriving at our borders?

Prof. Murphy : Not at all. Border Force and Agriculture have very strong local operational responsibility. The Commonwealth Department of Health and I, as the Director of Human Biosecurity, have overall policy responsibility. We work very closely with the human biosecurity officers in the states and territories, but the operational decisions are very much delegated to the state and territory human biosecurity officers. But we certainly have responsibility; I'm not in any way denying that.

Senator KENEALLY: Thank you.

CHAIR: I'll now hand over to Senator Di Natale, who's joining us by phone.

Senator DI NATALE: I want to go back to the issue of PPE. Professor Murphy, Senator Watt raised the issue of masks with you, but I want to talk about other personal protective equipment, specifically gloves, masks and face shields. I just want to get an estimate from you about the quantities of those within the National Medical Stockpile.

Prof. Murphy : We have not traditionally kept PPE to any great extent. We have very small holdings of those things, just to enable a very early response. The reason for that is—and this is internationally pretty much the practice—that masks, particularly in a flu pandemic, which is what we have always been preparing for, were seen to be the highest-risk item, and that's why we focused on providing what we saw to be a pretty good supply of masks. We haven't normally provided a lot of those other things. Many of them are manufactured locally. We haven't really seen a significant glove shortage through this outbreak. It is true that at times gowns have been hard to come by. But all of our experience through this pandemic is that our focus on masks was the right one, because that has been the single most difficult part of PPE to acquire. Obviously, when we're reviewing the stockpile at the other end of this, we might look and see whether more strategic holdings of those other PPE could be required. But the evidence of what the problem has been is very much related to masks.

Senator DI NATALE: But, Professor Murphy, having spoken to many of my colleagues in ICU, as well as a number of other stakeholders, they have cited that the lack of gowns has been a very significant problem for them. The issue of gowns and face shields has meant—obviously there's been great success in terms of reducing community transmission. But, should there have been more community transmission, they were concerned—this is the information that's been communicated to me—that, while we've been focused on ventilators in intensive care, we didn't have some of the most basic equipment, like gowns and face shields and so on.

Prof. Murphy : I don't think we've ever been in a position where we've run out of those, Senator. We have been procuring a lot of other PPE arrangements on the basis that we might have had a bigger surge, as you're identifying. So we have been procuring gowns, we have been procuring gloves, we have been procuring hand sanitisers and face shields. But we have not been in a position, that I'm aware of, where there have been critical shortages. There have been concerns at times; we've gone low. Gowns, more recently, have been a concern, but we've got some supplies of gowns coming in. Again, as I said, when we're at the other end of this, we will look at whether more strategic holdings of those items in the future might be necessary.

Senator DI NATALE: Moving on, I might just ask: on notice, can you tell me what, in terms of numbers, we have of those other—I know you've got questions around masks, but gloves, gowns and shields. If you can just provide on notice the numbers in the medical stockpile.

Ms Edwards : I might just give some background to that. We'll provide on notice what we can. As Professor Murphy says, we haven't traditionally held any gloves, gowns or goggles in the stockpile. At the beginning of the process, there were none of those items. You are obviously very aware that the role of the national stockpile is limited. It's to provide assistance to states and territories, especially for public hospitals, in times of a particular health event. We have dramatically expanded our activities under PPE, including in relation to the stockpile, over the last few months, including procuring those additional items, some of which are arriving and some of which are scheduled to arrive. What we've been doing is trying to ensure appropriate supply of that over the next six-plus months.

In addition to that—that's only one of the things we've been doing—we've been working very carefully with states and territories to help their orders, to ensure that any international deliveries can come into Australia to work with the difficulties with the supply chains internationally. We've also been working with the department of industry to increase the capacity of local producers of masks but also other types of PPE—

Senator DI NATALE: Sorry to be rude, but I've got very limited time. I suppose I'm very—

Ms Edwards : One additional thing to mention very quickly is we're also making sure we're getting a clearing house and we can match up states and territories or other people who need PPE with people who can provide them. I just don't want you to go with the idea that it's simply into the stockpile and out. There are all sorts of mechanisms.

Senator DI NATALE: Understood. Again, given we were talking about preparation for an influenza pandemic, where ventilators still would have been an important issue, it's not much use having ventilators if we don't have ICU staff with gowns to staff them. I'm sure we'll learn a lot, as Professor Murphy said, on the other end, but it does seem more than passing strange to me that we didn't have any gowns in the medical stockpile. I will move on.

You spoke about the issue of, in terms of our success—let me say from the outset that obviously you have done very well, Professor Murphy and your team, and I do want to acknowledge that from the outset. You spoke about the effectiveness of various strategies: border closures, testing and tracing, boosting our public health capacity and, more recently, social distancing. Just in terms of what comes next, it seems to me that, based on the measures you have taken, the tools that are open to us are to relax some of the social distancing measures and to relax some of the border closure measures. Would it be fair to say the last thing you're looking at is changes to border controls?

Prof. Murphy : Absolutely, Senator. The international situation at the moment is such that any relaxation of border measures would be very risky. We recommended to the national cabinet only a few days ago that we continue the very restrictive bans on Australians leaving the country, unless there are exceptional circumstances, or anyone except Australian citizens coming back, and then only when they're formally quarantined. They are extraordinary measures, but the international spread of this virus is huge, including to some countries where we know they're not ascertaining cases very well, including in our region.

Senator DI NATALE: So would you expect that, when it comes to international travel, we're talking about a period of at least three months? Are you prepared to put a time frame on that?

Prof. Murphy : I think it's very hard to put a time frame on anything at the moment. I think we are thinking in a planning framework of three to four months in terms of our next steps. We're looking at, potentially, whether we can relax some distancing with very strong compensation by even stronger public health measures. But I wouldn't be envisaging any material changes to border measures in that three- to four-month period; I would agree.

Senator DI NATALE: In terms of social distancing, you mentioned schools. What would you expect would be the next candidates? Understanding that you haven't made final decisions on this, what would be the next candidates for changes to social distancing?

Prof. Murphy : The AHPPC and all the state and territory health officials and all the experts advising me—about 30 of them—all believe that schools are a safe environment to open. They can be made safer for teachers by excluding those teachers who are vulnerable, and teachers and adults practising social distancing and practising good hygiene. So we are encouraging schools to reopen. The Northern Territory has not closed at all. South Australia has kept pretty good school attendance. WA is planning to reopen. We are hopeful that progressively there will be a reopening of schools, and certainly the national cabinet is supporting that. We understand the anxieties of some parents and some teachers, and we understand that some states are taking it more slowly than others. The two measures we have encouraged through the national cabinet recently have been schools reopening in a progressive way and a gentle recommencement of elective surgery.

In about three weeks time the national cabinet will be seeking further advice from AHPPC, and that advice will be whether we are in a position where we have the world's best public health response system so that we are screening broadly across the country, we can pick any new outbreak very quickly, and we have the response capacity in our state and territory public health units to very quickly isolate, quarantine and control an outbreak, as has been done so well in Tasmania. If that's the case, the national cabinet will look at some cautious measures to consider a first stage of relaxation. They're not pre-empting any of those decisions. There is great concern that if we relax too much too quickly we could get a second wave, as has been seen in Singapore. So the national cabinet has asked us to come back with a very comprehensive set of advice, and they'll be looking at that in about three weeks time.

Senator DI NATALE: Have you got any sense about what those next measures might look like? Are we talking about gatherings or again allowing people to gather in small groups? Would that be next?

Prof. Murphy : Without pre-empting the decisions of the national cabinet, that is the sort of thing. We certainly would not be contemplating large-scale gatherings, but certainly some relaxation of the size of small groups is possible. There are a range of measures they have asked us to consider: things like community sport and some retail measures. All of those things will be in the mix, but we have to weigh up the public health risk versus the benefit to society and the economy. It is a challenging situation now. We've done so well. As I've said before, there is nowhere else I'd prefer to be than in Australia at the moment. We've got to keep the public with us, and the public have been fantastic. But we've got to make sure that our measures are sustainable, because there will be some sorts of measures that are going to be needed for quite a long time.

Senator DI NATALE: I'm just going back to that question of border closures. You're saying that it's a fairly safe bet that any resumption of international travel is at least four months away?

Prof. Murphy : I wouldn't want to make a clear prediction. I'm just saying I cannot in the foreseeable future see the international risk to be such that we would have a material change in the border measures. The national cabinet and the Prime Minister have asked us to review them on a regular basis, and we will obviously review the situation, but not at the moment, with the international scene. There could be examples where maybe you could relax things. New Zealand has suggested that Australia and New Zealand should relax their measures. We could consider that. All of those sorts of things are quite speculative at the moment.

Senator DI NATALE: So you wouldn't envisage some change where people are allowed to travel again but with there being a strict enforcement of quarantine on their return?

Prof. Murphy : That is a possible measure. If the epidemiology changed in some countries, that could easily be a measure. But again one of the challenges with this virus, in the absence of a vaccine, is that no-one in the world has a very clear path about the future. We have relatively good short-term planning frameworks and we're going to reassess things as we go. If a good vaccine candidate appears in the next few months, that could change our strategy completely.

Senator DI NATALE: Going back to the question of preparedness—and we did discuss that—obviously, there will be many lessons learnt. But one of the things we have now learnt is that you said, in terms of pandemic planning, the last sort of drill occurred well over a decade ago. Is there any reason that we—

Prof. Murphy : That's completely untrue, Senator.

Senator DI NATALE: Sorry, I'm just referring to reports—

Prof. Murphy : We do regular planning exercises. In fact, senators may be pleased to learn that we did an exercise in May last year on a pandemic in a cruise ship coming into Sydney. That was an exercise with New South Wales Health. We do two or three exercises a year with our state and territory colleagues, sometimes with the World Health Organization, often with many other countries. Those exercises you were talking about that were done a decade ago were very massive exercises, done before we really even had a pandemic plan. We have a very well established pandemic preparedness framework, which is why we were one of the first countries in the world to have a COVID response plan signed off and launched. We had it done within weeks of the first identification of a problem. So we do exercises all the time.

Senator DI NATALE: Thank you for highlighting that. Given that one of those drills we'd done was with regards to a cruise ship, how did we get the Ruby Princess so wrong?

Prof. Murphy : I would prefer to await the outcome of that judicial inquiry. As New South Wales Health and others have said, there were some decisions made that, in retrospect, everyone regrets. It's not clear what information was provided to whom by whom, and I would much prefer to wait and see the outcome of that inquiry. But, clearly, there were mistakes made. I think that everybody was doing their best in a very tricky and tense time. That was probably the peak of the outbreak, with lots of cases coming in from all sorts of places. I think let's not blame anyone but wait and see what the outcome of that inquiry is.

CHAIR: Senator Di Natale, I'm going to have to hand over to Senator Lambie now and give her the call.

Senator DI NATALE: Thank you.

Senator LAMBIE: Tasmanians feel that we're at the epicentre of the crisis right now, especially those of us on the north-west coast. Could you give us some sort of assessment of how Tasmania went from being ahead of the curve against COVID-19, by closing our borders early, to getting a spike in cases on the north-west coast? And, quite frankly, many of us do not believe it comes down to a dinner party.

Prof. Murphy : Nor do I. As you know, that assertion that was made in what I thought was a closed session of a New Zealand parliamentary committee was immediately retracted when the facts were pointed out. I think what happened in north-west Tasmania is a very good example of just how infectious this virus is. Tasmania's Department of Health have been investigating it, obviously, and I haven't seen the final report, but it seems likely that healthcare workers picked up the virus from a Ruby Princess passenger who was being cared for. Again, I'm not going to comment on how it was spread from a healthcare worker to another worker—whether it was in the workplace or in the tea room or whatever. I don't know and it's not my role to speculate on how it happened. But it just shows that, once you have someone who is infected who may not know they're infected, they can spread it to a lot of other people before anyone knows. Once the Tasmanian health department discovered there were infections, and they immediately tested and screened a lot of people, it had spread.

It's a very precautionary tale that shows how quickly this virus can spread. Because it doesn't make most people—most fit, young people—sick, they can continue to go to work and continue to interact with their fellow workers without knowing that they're infectious. So it's really just an example of how rapidly an outbreak can occur. And it was bad luck. I think the Tasmanian health department has responded in an exemplary fashion. They decided it had spread so far they needed to close down the two hospitals and quarantine a lot of staff, and they have brought it under very good control. It's a very good example to the rest of the country of something that could happen anywhere. It's no fault of anybody in Tasmania that it happened there, and they've responded very well.

Senator LAMBIE: We also had a problem down here with the PPE right from the beginning, and the stories that are going around are quite devastating, I'll be honest with you. What this crisis exposes is that Australia has problems with the supply chain for PPE, pharmaceuticals and medical equipment. Instead of being able to ramp up production, had we been making it on home soil, we had to compete with other countries to buy it all from China. Do you know if anything about this is going to be rectified in the future? Has anyone started discussions on this?

Prof. Murphy : I don't think we have had a significant shortage of pharmaceuticals. We've been following that very closely through this pandemic. It was obviously a concern for us because a lot of base pharmaceutical products are made in China. The TGA has been monitoring that very closely, and we have not had, as far as I'm aware, a critical shortage. The PPE issue was a perfect storm of PPE, because most of the biggest production is in Hubei province of China, and China was the centre of this. America has been making cloth masks out of handkerchiefs; we have never been in that position. Whilst a lot of healthcare workers have been anxious about the low stock, we've been able to replenish that stock. I'm not aware of anyone exposed to risk by not having—

Senator LAMBIE: I note—

Prof. Murphy : Can I just finish, Senator. On the issue of local production, I think the Commonwealth government and some of the state governments do accept that it is important for us to improve our local production, and they've invested in significant upscaling of mask production at a number of sites in Australia. So that's been a big part of our response. We agree that we should become more self-sufficient in this area.

Senator LAMBIE: I note—and I'm sure everybody else on the panel has heard about this too—that our carers out there still do not have PPE gear. Is there a reason? Are they not special at all, these carers? They're going from one place to another. While you may be able to contain this virus now, if these viruses get worse in the future, you're going to have carers going from one house to another without PPE gear.

Prof. Murphy : In the disability sector we've been looking at that area. We have not, at this stage, recommended in the epidemiology that there should be widespread wearing of masks outside of people—obviously, when people have respiratory illnesses, they should be wearing masks. We're working with the disability sector, which has been a bit concerned about that issue. What I'm saying is that any person who's looking after anyone with an acute respiratory illness who might have COVID-19, or anyone looking after a COVID-19 patient, as far as I'm aware, has been provided with adequate PPE.

Ms Edwards : In relation to PPE for aged-care workers and disability workers, we moved some time ago now to expand the potential use of masks and other equipment held in the national stockpile. In the event of any outbreak, particularly in an aged-care home, they are immediately provided with PPE to ensure that the care of those residents and the whole facility can be covered by adequate PPE. That's one of the real success stories so far and one of our main concerns. We have actually maintained relatively few—and tragic where they've happened—outbreaks.

In north-west Tasmania in particular, the result was absolutely exemplary. There was a worker who tested positive in a particular aged-care facility. We worked with the Tasmanian government, the provider and others to react very quickly. As a result, there was only one resident who tested positive, and all other workers and residents tested negative because we moved in using PPE appropriately to provide it where it's needed, working with the Tasmanian government and the provider. It's absolutely a major risk that we're very aware of. We're committed to providing appropriate equipment in Tasmania and everywhere, which is why we've been working with states and territories to have equipment in the national stockpile. We need to use it where it's needed in accordance with the medical advice, as opposed to releasing it for purposes which aren't going to assist carers or the people who are being cared for.

CHAIR: Senator Lambie, this will be your last question.

Senator LAMBIE: What indicators will you look at to determine whether it's safe to wind back some of the social distancing measures? What will be the trigger for you to decide that it's safe to loosen some of those restrictions?

Prof. Murphy : A very important question, Senator. Thank you for that. We are developing a range of measures for the national cabinet at the moment. Clearly, in the epidemiology, the number of cases, that we're seeing, the most important measure is the number of what we call community transmission cases, cases that have appeared where they're not clearly known to be a contact of another case. If the cases you're finding are all people that are known contacts—they've been in isolation—you're much more relaxed. If you've got cases that are appearing in the community that aren't a known contact, they're the ones that worry us. That was why we introduced distancing. We're only seeing a tiny handful of those at the moment—a couple of cases a day. That will be a very important measure. The other measure we will need to convince the national cabinet of is that we have sufficient testing across the country so that we know that we're sampling, everywhere in the country, everyone with acute respiratory illness and some people who are even asymptomatic, so that we can be assured that we're prepared. It's basically the case epidemiology and our public health preparedness. Those are the two measures that we'll be looking at.

Senator LAMBIE: Thank you.

Senator PATRICK: Professor, firstly, thank you very much for the good job that has been done. I know it has been done under difficult circumstances. I want to explore an area where, in my view, we haven't done as well as we could have. In your opening statement, or in response to questions from Senator Gallagher, you talked about two-thirds of cases being returning people, so not endemic, and you said that one of the biggest reasons for our success was the closing of borders. We first placed travel restrictions only on 24 January. That lasted for a day, because the president of China actually stopped all flights from Wuhan. The first real measure of any effect was on 1 February, where we basically banned people from China arriving. The next measure was on 29 February, basically a month later, where we targeted Iran. Can you make some comments in relation to this? In that respect, we had outbreaks in Europe and the United States, yet we didn't really act quickly in that regard.

Prof. Murphy : It's a very interesting question, border measures. As I think was alluded to before, the WHO has never supported them. The UK and other like-mindeds, like Canada, never introduced any border measures. A lot of other countries feel that it isn't a proportionate measure. We were quite brave in taking the measures we took. We took the measures that we thought were related to the risk at the time. It wasn't initially practical or possible to close off the borders completely. I think it's really, really important to note that the vast majority of those two-thirds of cases that have come into Australia are returning Australian citizens. We cannot stop Australian citizens from coming home. It's not constitutional or legal in any way. It was not possible to quarantine in a formal hotel way until the travel volumes dropped recently and the risk was higher.

We certainly took measures to stop foreign nationals coming from those countries where we were seeing a high risk of importation. When we saw cases coming from China, we stopped China. We stopped Iran because Iran clearly was the biggest hotspot at that time, and we had a lot of cases from Iran coming in. We took those measures—again, very contested measures in the international scene. Then we have moved more aggressively because the outbreaks have occurred across—you couldn't then pick off country by country. We then moved to totally banning all foreign nationals from coming. We are still getting imported cases coming in because we can't stop our citizens returning. It's a fallacy to think that you can close the borders and stop cases coming when most of them are your own citizens. What we have to do is try to mitigate them coming back with the virus. Now what we have done is stop them from leaving, so they won't come back. We're not letting anyone go on holiday overseas and potentially bring the virus back.

Senator PATRICK: You said they were difficult decisions, in your response to closing borders. Did the difficulty come from the fact that the WHO opposed the measures, or were there difficulties in terms of our own ministers, mindful of the economic effect, putting pressure to stop or not put bans in place?

Prof. Murphy : As I said, the National Security Committee of cabinet have, on every occasion that we've come to them with a recommendation around border measures, taken appropriate measures on our recommendation. It has always been matched by AHPPC advice. On occasions I've been very seriously questioned about the proportionality and whether the economic impact and the impact on our supply chain—one of the challenges we have now is ensuring our international supply chain of things like PPE and testing kits. That's why the government has had to support the airlines to keep some flights going. Even though those decisions were very difficult for government, they have stuck with the health advice of the AHPPC on every occasion.

Senator PATRICK: Has any modelling been done to look at early closure versus later closure? In the end, we got to the point where we closed all of our borders. One could argue that, had we done that more quickly, we would have had fewer cases in the country. In my case, it was the result of a wedding that took place in New South Wales, through another senator. That's how these things spread. Prior to these events, were early closure and late closure ever modelled—and, indeed, the economic modelling associated with those options? That clearly had a part to play in decision-making.

Prof. Murphy : There was no specific modelling on that. The decisions were taken on the epidemiology at the time and the perceived risk at the time. It's very hard to model a future risk.

Senator PATRICK: For example, we've done pandemic planning. We know that things like social distancing, closing borders, shutting down commercial activities and so forth are measures that work. However, it seems that the Treasurer was caught offside in February when he said that he had no idea of what the economic cost would be. That implies that Treasury was never given any of those measures to then model and work out what the impact would be—noting that the government is looking at this in a two-pronged way, one on a health front and one on an economic front.

Prof. Murphy : We've been working with Treasury really closely across this whole pandemic. I would point out that in pandemic influenza, as you say, we've done huge planning and modelling for that. Again, internationally, most people don't favour border closures as part of pandemic influenza. They see it as something that is a delaying tactic, which has more negative consequences. That's the reason for the WHO's position. We took a very different position because of the nature of this virus and the nature of its epidemiology. Our decision was the right one in retrospect. We were probably one of the most forward leaning countries in the world in border measures. I know you'd like us to have done more earlier, but we did more than most other countries in the world.

CHAIR: Senator Patrick, I have to hand the call to Senator Davey now. We'll come back to you at the second slot. Senator Davey.

Senator DAVEY: Thank you very much. Thank you, Mr Murphy, for coming in and giving us your time and for the work you, and your whole team, have been doing since January. I'm sure we all appreciate it. I want to quickly go back to Senator Keneally's line of questioning on the Ruby Princess. I note that she put on notice that she'd liked some information about all cruise ships that were arriving around the same time. Just following on from that, and to be more specific, because I note the MV Artania arrived in Western Australia around the same time and the handling of those two ships was entirely different, can you explain where the differences lay? Were there any differences in the way the federal government agencies handled those ships? Why were those ships treated so differently? Why were the outcomes so different?

Prof. Murphy : I was obviously involved in providing advice to WA Health in respect of the Artania. They certainly had some issues early on. We provided some Commonwealth government assistance, at their request, with an AUSMAT, which is an Australian medical assistance team, to help them plan. Every case is different. The Artania was of a different size. Most of the passengers were not Australian citizens—many of them were German—and they were able to fly them home, get them onto a charter flight, and then they were dealing with the crew. I think early on they were very concerned about the Artania. I think the response that we helped to assist them with was good, but I think the circumstances were very different. I'm not sure that I want to draw any more conclusions from that.

Senator DAVEY: I appreciate that. While we're on different circumstances, there have been some issues with the way the different states are handling certain aspects based on the advice they're all getting. Specifically, I can go and play a round of golf here in New South Wales, but if I drive down the road to Victoria I can't. I can go fishing and fencing in New South Wales, but I can't do the same in Victoria. What is the advice of the AHPPC when it comes to outdoor activities such as fishing, hunting, golf—those sorts of things?

Prof. Murphy : There has been no specific health advice. Our advice was that we strongly supported the restriction of outdoor gatherings. We supported the 'no more than two person rule' as a strong public health measure, and we thought it should definitely be regulated by the 10 people or fewer in public health regulations. The national cabinet has been very collaborative and consistent with that. It's true that, at the margins, some of the states and territories are responsible for implementing their regulations, and there are some marginal differences. Essentially, we have had a very consistent social distancing message, which is: stay at home unless you have to go to work, if you can't work from home; have to go to school, if you can't work from school; have go to the shops for essential goods; have to go to the doctor; or have to go outside for personal exercise.

AHPPC has not made specific advice on whether two people playing golf is safe or otherwise. I think the Victorian government has taken the view that allowing some of those external leisure activities is inconsistent with the stay-at-home measure—other states haven't. They're differences at the margin. The national message has been pretty consistent: to avoid gatherings, to keep apart from each other, to practise good hand hygiene, to try to not travel around the country and to stay home. So, sure, there's been a little bit of marginal difference and confusion, but I think we should cut the states and territories some slack. They've done a fantastic job at implementing what is essentially a national, consistent position.

Senator DAVEY: I want to move quickly to the ICU bed capacity in Australia. I that understand pre COVID-19 we had ICU bed capacity of around 2,000 across the nation—

Prof. Murphy : A bit more than that—

Senator DAVEY: We've managed to move that up to 7,000—is that correct?

Prof. Murphy : We have probably closer to 2,400 ICU beds that at this moment are able to be used. Fortunately, the peak we've had was only 90 people in ICU and only, I think, about 50 ventilated with COVID-19, and that's dropping now, which is wonderful. We worked with the Intensive Care Society and we looked at the capacity to expand our existing ICU to around 7,000 beds—you're right. That is essentially a three-times increase on our current capacity. That would mean taking over operating room recovery areas; taking over some wards; buying additional ventilators, which we've pretty much purchased now. We could go higher, but we calculated that if we went to three times that would stretch our workforce to the absolute limit. We just wouldn't have enough nurses to be able to operate those ventilators or enough doctors to be able to care for those people. So we have worked on what is a practical, sustainable plan in a worst-case scenario. Then we have fed that back with our modelling to make absolutely sure that our public health measures meant that we got nowhere near that. We have no intention of going near 7,000, but we are prepared if this outbreak, in a second wave, gets out of control and we end up in our worst-case position. But I would be extremely disappointed if we got to such a position. We're planned. We're prepared. We have bought the ventilators. We've planned where the beds can expand. But we haven't actually set up those ICUs yet. It's a planning framework.

Senator DAVEY: Thanks. I note in regional areas we have been pretty good at containing the outbreak, so it's minimised in regional areas. However, there is still a lot of concern in the regions that if there were an outbreak—or, to use the terminology, a 'hotspot'—regional areas wouldn't be as well prepared. How quickly can we ramp up ICU access in regional areas?

Prof. Murphy : There's much less capacity to ramp up in regional areas. I haven't got the numbers with me now. But our plan does envisage probably less than doubling ICU capacity in regional areas. We recognise in our plan that if we had people with severe respiratory COVID-19 in a regional area we would have to largely medevac them to major centres. That's probably in their interests anyway if they need some of the really complex care and the experimental drugs. Part of the federal government's plan has been to put aside a fair bit of money for enhanced retrieval. We're working with all the state and territory retrieval agents, the Flying Doctor Service and others, so that we are prepared so that, if we did have severe cases in a regional area that exceeded the ICU capacity, we would be bringing them back.

If you look at what happened when we brought the people back from the Diamond Princess to Howard Springs in the Northern Territory, we had all of the cases that got COVID-19—because Territory Health were not prepared to look after a large number—flown back to their state of origin within 12 hours. We've got a very good retrieval system, and that's a very important part. The other thing for the regional areas is to make sure we've got the respiratory clinics and the testing, and that's been progressively rolled out. We've got a number of regional COVID-19 testing clinics. We're now significantly expanding the testing capacity in the private sector. The final comment I'd make about regional areas is: we've been doing everything we can to stop people from the city travelling to the bush and bringing the virus with them. That is less of a problem now that the case numbers are so low, but that was a big focus early on.

Senator DAVEY: Yes, it certainly was, and it was certainly felt in the regions. Easter was probably the quietest I've ever seen it in my home town, but we appreciate everyone staying home. In the examples that we've had, where we've had hotspots in the regions such as the Barossa and north-west Tasmania, was there any requirement for emergency evacuation and did the process work?

Prof. Murphy : Not that I'm aware of. As I said before, we're only talking about the less than five per cent of people who get really severe disease; a few more than that need the hospital, because they're frail. But for most people, when there's an outbreak, it's like they've got a cold or a flu, and they can generally be isolated in their own homes and looked after. So I'm not aware of any major evacuation. I probably wouldn't necessarily be aware of them, because the state and territory health departments would run them. I'm not aware of a major issue where anyone in a regional centre has had their care compromised by lack of local resources.

Senator DAVEY: I note that we've got different flattenings across the states and that some states and territories have very few recent cases. Do you think it is advisable for some states to start easing restrictions before others, or would you be averse to that?

Prof. Murphy : As I said before, there are some differences between the states. Some states went harder than the baseline recommendations of the national cabinet. Some of them have already started to look at some of those beyond the nationally consistent—for example, WA put a restriction on takeaway liquor, because they thought that that might be a problem, but they've now reversed that. South Australia didn't ever enforce the two-person ban, so they've been more relaxed. I think at the margins, where they've gone harder—I think Victoria allows you to take your fishing boat out now; it didn't initially. So I think some of those things which I said are marginal are being relaxed. I would be concerned if there were major changes in one state, short of a national cabinet decision. We are a federation, and it has been absolutely wonderful to see how the national cabinet has worked across all governments, all parties, in a consistent way to introduce what is largely a consistent national approach, with something at the margins.

Senator DAVEY: I have one more question. I note the NRL are still talking about restarting soon. In Australia, we are a sporting nation. Community sport in the regions is the backbone of a lot of our communities. There are a lot of netball and football teams waiting to know when restrictions may ease on their activities. Any indication?

Prof. Murphy : That will be in the mix for national cabinet discussion in three weeks time. I personally feel that community sport is a really important thing, and there are ways to make it safer, but national cabinet will have to weigh up the public health risks versus the clear benefits of re-establishing community sport. That will be something that will be in the mix for consideration.

Senator DAVEY: Thank you very much.

CHAIR: I acknowledge the time; we're 15 minutes behind time. I'm just going to quickly go back to Senator Watt for one question before relieving Professor Murphy.

Senator WATT: I have a follow-up to the question from Senator Davey about the NRL. Speaking as a Queenslander, there's obviously intense interest in when that's going to get up and running again. You may have seen that yesterday some representatives of the NRL said that they had government approval to resume on 28 May. Is that correct, to your knowledge? Has the federal government been involved in giving that advice? I haven't been able to find any confirmation of which government has provided this approval, so I'm just interested to understand that.

Prof. Murphy : At a public health level, the responsibility would largely lie with the states involved, because they are the ones who've imposed the public health regulations. I would be hopeful that decisions around starting codes would have national cabinet approval, because there's more than one sporting code. The federal government and the Minister for Youth and Sport's office are obviously in ongoing discussions with the NRL. There hasn't been a formal process of seeking approval from the Australian Health Protection Principal Committee, to my knowledge. We haven't been asked for formal advice at this stage.

Ms Edwards : Can I just add: obviously, we would expect to be consulted, and we think we would be on any decision, but there hasn't been a direct approach to the Department of Health at the moment. Also, there would have to be involvement by the federal government in relation to the Warriors, given that they're located in New Zealand. As I understand it, there hasn't yet been a formal approach about that either. It would probably go to Border Force rather than us.

Senator WATT: So, to your knowledge, there has not been government approval provided for the NRL to resume on 28 May at this point?

Ms Edwards : We're not clear, other than in relation to the Warriors, that there is a clear process. Otherwise, as Professor Murphy says, we expect and hope that it would go to national cabinet. At this stage we haven't had a formal approach, in any event. We might not.

Senator WATT: Okay. Thanks.

CHAIR: Professor Murphy, just before you leave: will you be appearing at the New South Wales commission of inquiry?

Prof. Murphy : I don't believe so. I haven't been—

CHAIR: You haven't been called as yet?

Prof. Murphy : I haven't been called, no.

CHAIR: Thank you. On behalf of the committee, I thank you for giving evidence today and remind you to respond to questions taken on notice within five working days.

Proceedings suspended from 11:46 to 11:53

CHAIR: We are running 15 minutes behind time, so Ms Edwards has kindly agreed to allow us to catch up that time during this hearing. So we will run perhaps 10 minutes over.

Senator WATT: Ms Edwards, I have a series of questions about the tracing app. My understanding is that your department, the Department of Health, is the lead agency in developing and rolling out this app.

Ms Edwards : Correct.

Senator WATT: Is it correct that the Digital Transformation Authority is doing the build?

Ms Edwards : We are working closely with the DTA.

Senator WATT: Who does what? I suppose that is my first question. The DTA is doing the build. Your department is leading the rollout?

Ms Edwards : We are the overall policy lead, because it's a Health-led initiative in all ways, and the DTA are involved in providing technical advice and engaging in the coding work. But the policy work is all happening through Health, and our IT area is intimately involved with the DTA also, but the actual coding is being done by them.

Senator WATT: And it's the Attorney-General's Department that is responsible for managing the privacy and security concerns? Is that correct?

Ms Edwards : The Attorney-General's Department has responsibility for privacy, but we obviously are working very closely on the privacy issues directly. But we're taking a lot of advice from the Attorney-General's Department.

Senator WATT: I've seen some comments from the Minister for Government Services, Minister Robert, who has said that the government will be introducing legislation to govern the use of this app. Is that correct?

Ms Edwards : It's a matter for the government, but there are all sorts of options being considered about how to ensure it meets the specifications of the policy.

Senator WATT: So no formal decision has been made at this point to introduce legislation to govern the use of the app?

Ms Edwards : Not that I'm aware of. Options are being considered.

Senator WATT: So there are a number of options, and that's one of them—to introduce legislation?

Ms Edwards : Legislation is clearly one option to be introduced, but I don't have any further information.

Senator WATT: What are the other options if you don't go down the legislative path?

Ms Edwards : There are policy constraints and government decisions. There are arrangements with third parties—in particular, states and territories—about how they might use any data in terms of their health response. There's also potentially activity under the biosecurity declaration, and there may be other options of which I'm not aware.

Senator WATT: So if you didn't have legislation, one option is some kind of contractual relationship with the states and territories? Is that right?

Ms Edwards : There might be options. There might be alternatives. But we are having to engage with the states and territories. If you want me to talk to you about the design of the app, you'll understand why that's a key element.

Senator WATT: Yes, sure. So, to your knowledge, there's been no decision made for the government to introduce legislation in the next sitting week, in May?

Ms Edwards : Not to my knowledge.

Senator WATT: My recollection is that Minister Robert has made comments saying that the government will introduce legislation. How important is it for any legislation, if that's the path the government decides on, to be introduced quickly? If there's any delay in that, does that potentially delay the rollout of the app?

Ms Edwards : I'm not sure that I can comment more on the content of hypothetical legislation, about which I'm not aware that there's been a decision, or on what impact it might have. But I can tell you that there are various options being considered for how the app design is bolstered or put in place and finally settled. As I said, if I can go through the design attributes, you'll see what's being proposed, and then you'll be able to consider what options there might be.

Senator WATT: Yes, sure. Could you do that briefly? I know I've only got a limited amount of time.

Ms Edwards : I can totally do it briefly. Very briefly, firstly, the purpose of the app will be solely to assist in the public health response and, in particular, the contact-tracing processes that the states and territories already do. You would know, as we've talked about already, that they contact and interview a person who's been diagnosed, using all sorts of investigative attempts and so on, to try and find out who might have been in contact—who was in the supermarket, who is in their family and so on. It's to assist that purpose and that purpose only. It'll be completely voluntary. There'll be no geolocation data stored. The only thing that will happen is that encrypted data will be stored on a person's phone. So, if you download the app and I download the app and we're 1.5 metres away from each other for 15 minutes or more, an encrypted, unique identifier from my phone will swap with your you unique identifier, and they will sit in our phones. If they never need to be used, they'll sit there until we delete the app and not go anywhere at all. When you first download the app, the only thing that's shared is your name, age range and postcode. That goes back to a national store, and that's how you get allocated your unique identifier.

Senator WATT: Thank you for that. I'll come back in a moment to what you just told us. On this point about legislation or whatever other mechanism is put in place, my understanding is that the intention of any legislation or other alternative is particularly around the privacy constraints, which is obviously something of great concern to the public. Is there any potential that this app will be rolled out before those privacy issues are dealt with via either legislation or any of the other alternatives that you've talked about?

Ms Edwards : The app, when rolled out—whenever that may be—will deal with all of the privacy concerns through the processes of a privacy impact assessment and so on, and through commitments that there'll be no geolocational data; there'll be no access to the data other than by public health officials, and that includes the Commonwealth and so on; it'll be encrypted at all times other than when it's provided to those public health authorities; and it'll not be used for any purpose—not for enforcement, not for compliance, not for a passport type approach, which has been floated by some commentators—other than public health. The government would be considering options to ensure that that very clear policy outcome that we are designing for is entrenched, and there are various options for that.

Senator WATT: And those options, you've said, may involve legislation but may not—there might be other options chosen. Will the app be rolled out before whatever option is chosen is implemented, or will the roll-out time be held up until that option, whatever it might be, is implemented?

Ms Edwards : We're a little bit in hypothetical territory, but can I say that my understanding is this is a Health led initiative. Those privacy and other issues will be dealt with before the app is launched, and the options for ensuring they're dealt with are being explored.

Senator WATT: The concern people have got is to make sure that whatever option is chosen around privacy is in place before this app is rolled out, and you're saying that will occur.

Ms Edwards : It's absolutely our concern also. Our aim here is to maximise the uptake to make people feel comfortable to download the app with the absolute assurance that it'll not be used for any purpose other than to ensure that we can contact and trace people who may have been in contact and hence be a part of that fundamental response. We have set the parameters. They've been very clear with me what they are, as I've outlined, and the options to make sure that is the case are being explored currently.

Senator WATT: What can you tell us about the privacy impact assessment? Will that be published once it's completed?

Ms Edwards : I expect privacy impact information will be published, yes.

Senator WATT: Are you working to any particular time frame for the rollout of this app?

Ms Edwards : That's a matter for government—exactly what the time frame is. We're working on it very hard and very quickly so it'll be ready, depending on when other interdependencies are there.

Senator WATT: So the government hasn't made a decision at this point on an estimated roll-out date?

Ms Edwards : I haven't been informed of exactly how and when. We're making sure it's ready, but there are options for how things will be entrenched. There's a communication piece. There's the coding that the DTA are doing. There are cybersecuity issues and there's the policy work. All of that's being done very quickly, but I couldn't help you any further on the exact timing.

Senator WATT: One of the things I've heard various ministers say is that this information won't be held by any federal agency; it'll be passed on to the relevant state and territory authorities. What privacy rules, if you like, will be put around the use of that information by state agencies? The concern, of course, is about what's going to be done to constrain the states once it leaves the federal government.

Ms Edwards : The data, if needed, will flow from your phone to a national store in encrypted form. We won't have any access to it, and it will be able to be accessed by a state official. As I mentioned earlier, we'll have arrangements—whether an agreement or an MOU or something—with the states which absolutely limits the people with access to it to using it only for the purpose of tracing people who may have been in contact with someone with the virus, in order to do what is an already entrenched and very standard practice of contact tracing.

I think, whatever option is chosen, we'll definitely be having agreements with the states—and we've been talking to them about that to make sure that that's the sole purpose and the only access to that data. It'll be very limited data. The access that the official will have will really only be the phone number of a person who has been collected as having been in contact with a person with a COVID-19 diagnosis, to be able to contact those people. Really, what we're trying to do here is give them the contact details of the people who are with you in the queue at the supermarket so you don't have to go back to the CCTV footage to try and figure out who they were or put out an alert. What we're trying to do here is take a very manual process fundamental to our public health response and add to it fast and effective additional contact for that purpose only.

Senator WATT: Earlier, you were giving us a quick run-down on how this will work. One of the things that I've read is that it will actually work only if there's what's being termed a digital handshake, where both people involved need to have the app open for it to work. Is that the case?

Ms Edwards : I think this is an issue that was raised—I think I heard it mentioned on the radio this morning. It's a complex situation. Bluetooth needs to be enabled, that's true. When you download it, you'll get a prompt to say: have you turned bluetooth on? Once bluetooth's on, the effectiveness of bluetooth, as you'll know from when you use it in your car, is slightly better or slightly worse, depending on how far away you are from the device and what else you've got running—if you're running Spotify and so on. This was a problem, apparently, in the Singapore app. Since that app was downloaded, and ours is different, there have been improvements both in the way the app would run and, we understand, in its working with Apple and Google. It's not perfect, but it is good, and Apple and Google are also working on making improvements over time. So, yes, we think it'll work. We think the accuracy and effectiveness of the signal will improve over time as the operating systems upgrade, but it's not the case that it won't work in the way that has been identified. We've moved beyond that, and I'm assured the bluetooth technology will work. Obviously, if it's not 100 per cent, we'll take 99 or 95 per cent of contacts in the first instance. And, as it improves, it'll improve greatly.

Senator WATT: Let's say it's you and me standing in a queue at the supermarket and one of us is infected; it won't require both of us to have the app on in order for the other to find out that you're infected or for information to be transmitted?

Ms Edwards : Both of us will have to have bluetooth on, and if you have the app on and in front it'll be a quicker, straighter signal, but it will still work in all circumstances. As I say, we're working to improve it over time.

Senator WATT: Why was it that the government selected the Singapore TraceTogether app as the model for the app?

Ms Edwards : I don't think the Singapore TraceTogether app is the model. Singapore provided openly its code and we've drawn upon that code in developing our own app, which is Australian based, with our own improvements and so on. I'm not a techie app-y person, but I understand we've drawn on the code and used it but we've added and changed it so that it's unique for our circumstances.

Senator WATT: There have been multiple reports saying that it's based on the Singaporean model. Are you saying that's not correct?

Ms Edwards : It's been an important contributor.

Senator WATT: You'd be aware of concerns about the operation of Singapore's app. It seems to work well on Android devices but not as well on iPhones. How are we addressing that in the Australian app? Does that go to what you just told us about improvements being made?

Ms Edwards : That's what I was talking about before. It works slightly differently on Android devices compared to iPhones. Our app at the moment is apparently better on Androids than iPhones, but both of them are working and improving and working better than some of those problems that were experienced in Singapore.

Senator WATT: You'd be aware that Google and Apple are also developing their own solution and that several countries have gone down that path. Why are we not doing that?

Ms Edwards : We've gone down the path of taking the source code, working with Apple and Google, to make an app which meets our circumstances and which is entirely limited to providing the data, through a national store, in encrypted form back to state health officials—not to other people, not in any other way. We've developed it to suit those circumstances to meet the privacy needs and health needs of Australia.

Senator WATT: The only other thing I just wanted to cover was the take-up rate that's required for this to work. We've seen the health minister, Mr Hunt, say that the government's goal is 40 per cent take-up of this app. Is there any science behind that 40 per cent? What's the modelling or rationale behind 40 per cent being the critical number?

Ms Edwards : I think 40 per cent would be a great take-up. We'd like 90 per cent or more, but I think what we're actually working on is that people taking it up will help, and the more who do take it up the better. We haven't got a particular number in mind. I'll be happy if 20 per cent do. I'll be happier if 40 per cent do. I'll be even happier if 80 per cent do, because it'll give more data to our health officials.

Senator WATT: But why was 40 per cent chosen as the goal?

Ms Edwards : You'd have to ask Mr Hunt about that.

Senator WATT: So that was his decision?

Ms Edwards : I'm aware of the comment, but I haven't discussed with it him.

CHAIR: Senator Watt, we might need to leave it there and go to Senator Di Natale, who is sharing his allocated time with Senator Siewert. Senator Di Natale, I understand you're on the phone.

Senator DI NATALE: Yes, I'm also watching, but I've got some audio problems. I want to follow on with the same line of questioning as Senator Watt. In relation to the 40 per cent take-up rate, there's no evidence that that's a number that's necessary for this to be successful?

Ms Edwards : I'm not aware of the basis for that number. Obviously the bigger the take-up, the bigger the impact. Particularly with such low infection rates in Australia, most people who download this app will never, ever have a use for it, which is great. As I said, I'd love 40 per cent—that seems a good target to start for. If it's 90 per cent, 80 per cent, all the better. If a lower number take it up, it's still going to be a useful tool for our state and territory health officials.

Senator DI NATALE: So you're saying that there is no critical threshold beyond which this thing becomes ineffective?

Ms Edwards : I'm saying that we want to implement it because any assistance will be better than no assistance, and the greater the amount of contacts being gathered in this way, the greater it will help the states and territories. So I'm saying there's no base level under which I would think the app wouldn't be useful. It will be useful at any level and it will increase in usefulness as it gets greater uptake. But we want to encourage all Australians who have a smartphone to download the app and use it, and we'll provide all the assurances we possibly can. It's been designed in as limited a way as it possibly can be to have a public health impact.

Senator DI NATALE: Some members of the government have indicated that they're going to link the easing of restrictions with the take-up of the app. Has the department considered that the restrictions that are currently in place will be dependent on how many people take up the app?

Ms Edwards : I'm not privy to any such discussions. We're trying to make sure that we bolster the public health response. I think Professor Murphy and others have been really clear that the things we really need in place are good testing and excellent contact tracing, so what we're focusing on is making sure this can be a tool to make the contact tracing better. We'll be in a better position. And how effective our contact tracing is and how effective our testing is will no doubt be taken into account by national cabinet in considering the next step for restrictions. But I'm not aware of, and am certainly not privy to, any discussions about a direct link.

Senator DI NATALE: Again, just to be crystal clear, you don't believe that the cabinet will be drawing any link between the take-up of this app and—

Ms Edwards : Just to be crystal clear, I'm not involved in any such discussions. I'm not part of the national cabinet deliberations.

Senator DI NATALE: But you're providing advice to government and you haven't given any indication to government that there needs to be a certain percentage of people taking up this app before there's a consideration of easing restrictions?

Ms Edwards : No, the Department of Health hasn't. Obviously the national cabinet will be considering the restrictions. But, to be clear, the Department of Health doesn't feed directly into the national cabinet. The CMO, through the AHPPC, does, and we work very much in partnership. But the Department of Health has been very clearly tasked with developing an app which will augment the contact tracing process, and that's what we're doing.

Senator DI NATALE: In terms of how long the app is in place, obviously there are only a few pathways out of where we're at. One is with a vaccine, and that may be at least a year and possibly longer away, if at all. How long does the app stay in place?

Ms Edwards : The app's facility to download stays in place for as long as the pandemic will be assisted by having that functionality. I should say that, at the end of the process, if you delete the app off your phone, all of the data that's stored in there, if you've never needed to send it to a health official, is deleted, along with your app. At the end of the day, we remove any access for a public health official to any of the data that has moved through. In the meantime, it continues to be a tool that people can download and use.

Senator DI NATALE: At this stage it's not time limited; you're assuming that this continues to be operational until such time as you declare the pandemic is over. Is that correct?

Ms Edwards : I think we are looking at having it as a useful tool while the pandemic is here, but, like every one of our measures, they're being reviewed regularly and they're all time limited. I'm certainly not able to say how long we predict the pandemic will go for, but we'll certainly review it after some time. At the moment it's there for as long, and only so long, as it's useful to augment the public health response.

Senator DI NATALE: I have a couple of other quick questions before my time runs out. Has the department provided any advice to the government or to any of the other existing channels about people in detention, specifically people held in immigration detention facilities?

Ms Edwards : I'm not aware of any, but I'm not aware of all of the discussions that happen through the medical processes. I'm not aware of the department providing any advice, no.

Senator DI NATALE: Does the department have concerns that people held in immigration detention are obviously at significantly higher risk, and what steps are being taken to mitigate those risks?

Ms Edwards : We're concerned about every Australian and every person in Australia who may be at risk of the disease. We want to reduce those risks. But you'd have to direct questions about immigration detention to the Department of Home Affairs.

Senator DI NATALE: I have a question on the alcohol and other drugs sector. I understand some dedicated funding for mental health has already been allocated, but as far as I can tell there hasn't been any dedicated funding to the alcohol and other drugs sector. Obviously we've seen reports about increased alcohol consumption, we've seen evidence of people turning to other drugs during the pandemic, and there's been some anecdotal evidence of an increase in demand for services from some of the alcohol and other drugs service providers. Again, is there any specific attention being given to that sector and is there any dedicated funding for public health campaigns and so on, either for people currently in treatment or for people who may develop a problem with substance abuse? Has there been any consideration given to dedicated funding in support of some of those public health campaigns?

Ms Edwards : I'll have to take on notice exactly where it's up to, because I'm not up with the latest, but we've certainly been looking at that in particular. We also share concerns about potential increases in drug and alcohol use, and potential misuse, and we're looking actively at the issue. Can I take on notice exactly where we've got to on it and come back to you?

Senator DI NATALE: Thank you.

CHAIR: Thank you very much, Ms Edwards. I will now hand to Senator Siewert, who's been very patient.

Senator SIEWERT: Ms Edwards, I'd like to follow up some of the issues around aged care, particularly remote aged care. I note there was an issue around access to PPE and the process of waiting to see if there was an indication of COVID before PPE could be accessed as it is in metropolitan areas. In remote communities that is obviously really difficult. Can you outline how that issue is now being handled?

Ms Edwards : As I was mentioning before, I think to Senator Lambie, we do allow access to PPE from the National Medical Stockpile, even though it wouldn't normally be used in this way for aged-care facilities where there's an outbreak, and that's equally in remote or regional areas as it is in the cities. To date we haven't had a circumstance like that, although perhaps north-west Tasmania, given the low numbers of flights, could be seen as reasonably remote. We're just making sure we have arrangements to get things to people quickly. In relation to north-west Tasmania, we came to an arrangement with Aspen where they used their existing PPE and then we topped it up. If there were an outbreak, say, in the Northern Territory, we have been working very closely with the Northern Territory government. We had a request for release of PPE there—not for aged care in particular—and we managed to deliver that within I think 24-hours, certainly not much more than that. So we'll make sure it gets to where it needs to go using the transport that we can access.

Senator SIEWERT: Wouldn't it make sense for some of those more remote communities—out to Papunya, for example, or any of those places, and in the north of WA—now that you're building up the stockpile of PPE, to make sure they've got more on hand? Surely we want to make sure that we're acting instantaneously if there is an outbreak, and any delay in those communities could have a significant impact.

Ms Edwards : It might make sense to do that. I might have a think about exactly where and how we might do that, bearing in mind we have got a much better position on PPE, but it's still really the most efficient way to keep it centrally and then send it quickly to where it's needed when it's needed, to make sure it's right. You'd be aware that PPE doesn't last forever, either—it does eventually degrade—so it's not as though we can park it places and leave it there forever. We are constantly getting it in and getting it out. But we're open to any ideas about how we make sure we're readier in remote than we are already, although so far it has been a good situation. But, really, the mechanisms for getting PPE to people have so far not been an issue once we've dispatched it, and we'll look at all mechanisms to make sure it gets to where it's needed. Now, I'd hate to have PPE in Papunya when it's needed at Ngukurr, because it's a much more difficult task to get it from Papunya to Ngukurr than it is to get it from the stockpile to Ngukurr.

Senator SIEWERT: I was using that as an example of making sure we've got it out there, more readily accessible than perhaps it is now. In terms of its use, I will also ask about access to supplies. How involved is the Department of Health in ensuring that supply lines are being kept open to remote and regional—but particularly remote—communities? I'm still getting a lot of feedback about lack of access—to food supplies, for example—in stores in remote communities.

Ms Edwards : Yes. We've been involved in the work with supermarkets and so on, as part of the whole-of-government collaboration. That's really being led out of the Department of Home Affairs, so you might want to raise it with them. They've had a very effective process to make sure that stores and supply lines continue. By and large, supply lines for things like food and other essentials have been reasonably robust. There was a lot of that buying beyond what people needed, which caused the issues, rather than any problem with supply lines. I'm happy to raise with them checking what the remote supply lines are, but I haven't seen any issues. You might want to take it up with them when they're here.

Senator SIEWERT: Could you raise it? I've had direct feedback from communities and I've also spoken to a number of people who are reporting lack of access to groceries and also very high—even higher than normal—prices in remote communities. Is work being done on price gouging in these situations?

Ms Edwards : As always, if you provide the information through the minister's office, we're very happy to follow up with the National Indigenous Australians Agency and with Home Affairs.

Senator SIEWERT: I will follow up on the specific issues. But I am asking in general: is that being followed up—

Ms Edwards : Yes.

Senator SIEWERT: across remote communities, in terms of price gouging?

Ms Edwards : I understand those issues are being dealt with, but they're being dealt with by the Department of Home Affairs, so I'm not across the detail of that.

Senator SIEWERT: I'll follow up with them. Can you outline very briefly how the interdepartmental processes are working on that particular issue?

Ms Edwards : I really think you should address those to the Department of Home Affairs. They have a large amount of work that is being done on it, of which we're only one bit, and I'm not intimately involved in it myself.

Senator SIEWERT: What I meant was: are you on that committee?

Ms Edwards : The Department of Health is on every committee at the moment, I feel. I'm not intimately involved in that issue, but I could take on notice how we're involved in that issue.

Senator SIEWERT: If you could take that on notice, that'd be great. As you articulated earlier, you have committed quite a lot of resources to mental health services. I'd like an update on whether you are monitoring the effectiveness of that spending and what the take-up of those services has been.

Ms Edwards : Can I take that on notice? I don't know if I have a level of detail now. We are, of course, monitoring very closely what's happening with the demand for and the supply of our services. We can take it on notice. That was for mental health services? You cut out for a moment.

Senator SIEWERT: That was for mental health services, yes.

Ms Edwards : I'll take it on notice.

Senator SIEWERT: That'd be appreciated. I'm after a level of detail on the uptake and the effectiveness and whether you're monitoring the effectiveness of the services to make sure that you're meeting need, particularly in regard to the telehealth mental health services. Does that make sense?

Ms Edwards : Yes, it does. Because it's such a new measure, we'll come back to you about how much effort we've put in thus far in order to have results, but we certainly are very interested in making sure what the take-up is and are monitoring that closely now. We can provide figures, and we will be interested to know what impact it has had. Obviously, one of the lessons learned when this is all over is how we've gone with delivering all these extra services very quickly in a normal way.

Senator SIEWERT: Yes, exactly. Perhaps you could outline the detail of what processes for monitoring you have in place—I appreciate there won't be much actual response yet from that monitoring. I'm going to run out of time, which is why I'm trying to move quickly, so I apologise. Are you considering other measures to be put in place to support people as we come out of the lockdown and to look at the potential longer term mental health issues that result from this whole crisis situation?

Ms Edwards : We certainly will do that. We're still at the point of implementing measures at the moment. As you can imagine, it has been a very busy time, but we are already planning for what happens next and where we go to at the end of those specific measures. We're just getting to that now, but, obviously, we're interested in what happens next. We're all a little bit cautious about moving too far ahead. We've got these fantastic figures at the moment, but, really, the whole department is on standby to respond if it were to get worse again, and I'm very keen to keep us all in that mode for a little while longer at least. But we're very aware that over time we'll have to be thinking about what next. If the numbers hold and we really can show we have flattened the curve as dramatically as it appears at the moment, then, of course, coming out of the measures, we'll need to work on how we do that appropriately and the lessons learned and, also, what comes next.

CHAIR: I'm going to have to move on—my apologies. Ms Edwards, are you aware of whether the Department of Health is being called before the New South Wales commission of inquiry?

Ms Edwards : No, I don't think we have been.

CHAIR: Following up on Senator Siewert's point, are you able to provide the committee with a list of the various committees and task forces and what arrangements have been established across government where you are a member of those committees? Can you provide that information to us?

Ms Edwards : Absolutely. From where we sit, we can obviously provide you with information about all the arrangements within Health that we've put in place to respond.

CHAIR: That would be very useful.

Ms Edwards : We may also talk to other agencies to see if there's some way of providing that more holistically for you, rather than our slice of the pie. We'll take on notice what arrangements we're involved with.

CHAIR: That would be very useful. Throughout the crisis, as it has rolled out, there have been references from health officials about herd immunity, containment strategies, suppression and elimination. What is the strategy? Which one of those terms would accurately reflect the government's strategy in relation to COVID-19?

Ms Edwards : I would prefer to refer you to the statement the Prime Minister and the national cabinet have made, because those are decisions made by the national cabinet. Also, Professor Murphy probably could have helped.

CHAIR: Yes. We ran out of time with him.

Ms Edwards : I'm obviously listening—we're working very closely—but it would be much more preferable for the committee to hear from the authority of source on that, which is effectively dealing with the epidemiology issue.

CHAIR: I think the latest statement from the national cabinet has it as 'suppression/elimination', as though those are similar strategies, and I think there has been quite a bit of discussion about the fact that they probably aren't. So which one is it?

Ms Edwards : We're certainly trying to reduce the number of infections, particularly through community transmission, to as low as can possibly be expected. I think the expression is 'to eliminate it as a public health issue'. Now, whether that equates to suppression or to elimination or to both is something you should take up with the epidemiologists.

CHAIR: That suggests that there isn't an overarching federal government position on what the strategy is.

Ms Edwards : It's a position you should ask the Prime Minister and the national cabinet about—or the advice given to it through the medical area of our department, led by Professor Murphy. I couldn't comment on behalf of the government.

CHAIR: But the government hasn't issued a direction to Health to say: we are approaching it from this strategy. That hasn't occurred.

Ms Edwards : No. We're hearing the public statements made very frequently by the Prime Minister after national cabinet meetings, and we're certainly trying to flatten the curve as much as possible and reduce infections.

CHAIR: We might follow that up in another hearing.

Senator KENEALLY: I'd like to pick up on some of the questions asked earlier around schools, to see if we can tease it out a bit more. Could you succinctly provide to us what the federal government's advice to parents is regarding sending their children to school?

Ms Edwards : Very similarly to the suppression/elimination question, the advice of the federal government is what comes out of the national cabinet, which is supported by advice from the AHPPC. But the Department of Health is not directly providing that advice. I'm aware of the advice that comes out of the national cabinet and I'm aware of the advice of the ACT government in relation to my own children at school, but I couldn't speak from the point of view of the Department of Health to give an authoritative answer on it.

Senator KENEALLY: Sorry—isn't the Department of Health running a public health campaign right now regarding coronavirus?

Ms Edwards : Yes, it is. I can take on notice—

Senator KENEALLY: What is the advice of that campaign regarding parents sending their children to school? What is that campaign advising parents?

Ms Edwards : I'll have to take on notice what any of our advisory materials might have been, but my understanding is that states and territories are providing advice about what should happen in schools in their jurisdictions. I'm not aware, and, if there is something the department is aware of, I'll take it on notice. But these are decisions of national cabinet on the advice of the AHPPC—which, for these purposes, operates separately from the Department of Health—having regard to the advice of the department of education and all of the advice of the states and territories, and then the national cabinet makes its decisions.

Senator KENEALLY: I would like to put on notice what the federal Department of Health's public health campaign is advising parents in regard to sending their children to school. Some of the questions I have are probably better directed to the CMO, but we can see what you are able to answer for us. Bearing in mind what the CMO told us earlier about what we know and don't know about children and the virus, is there any advice as to whether it's safe to send children to school if it's not possible for them to maintain the 1.5 metre social distance at their school?

Ms Edwards : It's definitely a question for the CMO, and I think it's one that the AHPPC have been considering, so it would be, when they've finished that advice, publicly available.

Senator KENEALLY: So you're not aware that that advice is actually publicly available?

Ms Edwards : I'm not aware.

Senator KENEALLY: The CMO mentioned that he had concerns about the wellbeing of teachers and acknowledged that that was an issue that needed to be considered. Is there any advice available to schools as to how they can manage risk for teachers or assess risk for individual teachers?

Ms Edwards : There is advice that goes to the AHPPC, to the national cabinet. If it isn't published when it's concluded, you'd have to address that to them or to the CMO, who advises the national cabinet on these issues.

Senator KENEALLY: Again, does the public education campaign from the Department of Health contain any messaging?

Ms Edwards : Not that I'm aware of, but I'll take it on notice with the other question.

Senator KENEALLY: Thank you. I would've liked to ask the CMO this but I will ask you. To the extent that we know about the capacity of children to spread the virus, they themselves may not be falling ill from the virus; they seem to have a very low rate of actually being ill. But, as to their capacity to spread the virus, do we have any sense of whether they are able to spread it, even if they're asymptomatic?

Ms Edwards : I think the CMO made comments about this situation earlier, and I would refer to those, but obviously medical advice about how and when the virus spreads is a matter for the CMO and the AHPPC.

Senator PATERSON: Sorry to jump in, but I think you took on notice some questions from me about child-to-child transmission and child-to-adult transmission, so that might assist.

Senator KENEALLY: Yes, it does. Thank you, Senator Paterson. I just thought we'd see if we had any actual advice within the federal Department of Health. But I think you're right. We'll look forward to those answers from the CMO.

Can the federal Department of Health give us any sense of what advice has been provided for children in an early childhood setting, and again for teachers and educators in an early childhood setting? Is there any particular public advice being provided to parents there?

Ms Edwards : Again, I understand it's an issue that has been considered by the AHPPC in advice provided to national cabinet. I'm reasonably confident there is public stuff about that, too, in the AHPPC advice. I don't want to be difficult, Senator, but I'm not in the medical stream of the department.

Senator KENEALLY: I understand.

Ms Edwards : There are plenty of things we are doing on the other side, if you're interested in—

Senator KENEALLY: And I get that. I do. Particularly, I'm interested in the intersection between whatever public health campaign is being run by the Department of Health and what advice it might be providing on this issue of schools. I might leave it there, Chair, and pursue some of this with the CMO next time we have him back.

Senator PATERSON: There are just two issues that I want to pursue before offering the call to my coalition colleague Senator Davey. Ms Edwards, thank you for your answers to Senator Watt and Senator Di Natale about the app, and particularly about the privacy protections in there. They are very understandable questions that I think a lot of Australians have and want to be reassured about. If and when they are reassured about it, I'm hopeful they will download it in big numbers. One thing, though, we haven't really covered today is the purpose of the app. So could you outline for us the rationale and what the app can assist us to do?

Ms Edwards : There's solely one purpose of the app, and that's to collect information about close contacts of people who've been in contact with somebody who's diagnosed with COVID, so that state and territory health officials can include that information in the work they already do to find, track down, advise and work with people who may have been close contacts. That's a fundamental part of stopping the spread of the virus: to make sure we find anybody who may have been in contact and ensure they self-isolate, get the treatment they need, get tested and so on. They already do that. It's absolutely a major thing that's happening now, and all states and territories have dramatically ramped up their capacity to do this, but at the moment it's a very manual process. If I'm diagnosed with the virus, I'd be able to tell them about the family that I've been with; I might also be telling them about some people that I've been to when I've been in the office on those days when I'm not working from home. But also I'd be saying, 'I went to Woolworths and I think I was more than 1.5 metres away in the queue, but I'm not sure and I don't know who those people were.' As the system currently works, state and territory governments can look at CCTV footage to try and figure out who people are, potentially. They do all sorts of very fantastic investigative work. They also put out alerts: 'Were you in Woolworths at Dickson on this date?' What the app will allow us to do is to really add to that process so that, if I was in the line only a metre away from somebody for 15 minutes—a long line—we will, in an encrypted form, have swapped unique identifiers. Once I'm diagnosed with COVID, I put a code into my phone, and all of those unique identifiers that I've swapped go into a central repository, which can be accessed—again, only by a public health official. The public health official will then be able to pull up a whole stack of phone numbers—which is the first time it's de-encrypted into phone numbers—and be able to call up: 'Senator Paterson, I think you might've been in contact with somebody; we need to talk to you about it and make sure that you've got the health needs you need, plus be tested or isolated as appropriate.' The key thing is: that's the only purpose of the app, and we've designed the functionality very carefully so only the functions required to do that purpose are included and no others.

Senator PATERSON: So obviously what you're saying there is that one of the advantages is: in the current manual processes, I'm being interviewed by a contact tracer; I won't know the names, let alone the phone numbers, of people that I've had incidental contact with in the community—as you say, in a line at the supermarket, but also perhaps on public transport. There's no way I could provide that information. And this app will allow that. I'm also interested, though: does it make any difference to the time taken to complete this contact tracing, and is that of assistance? For example, how long does a manual process take right now?

Ms Edwards : I'm not an expert in the manual process, but it can take a long time, as can a lot of those processes. The interview can take a long time. The person who is infected might be very sick and not able to do the interview as quickly as possible. As I say, if it's in a supermarket and so on, you'd have to go to other sorts of mechanisms. So having the phone numbers will be of enormous assistance. If there's a large take-up of the app, then that will, in some ways, replace a lot of the work that has to be done, because you can go straight to the phone numbers. It won't entirely replace it. We rely on these very skilled people already to do these fantastic investigations that they do. But it certainly has the scope to greatly assist—I think the term 'to industrialise' has been used—our contact tracing process, and we think that's an absolutely fundamental part of our health response, which is why we've been working on the app.

Senator PATERSON: So would it be fair to say that the current manual process can take, on average, a couple of days to complete, after a positive diagnosis?

Ms Edwards : It can take longer than that, I would think, and it would be incomplete—that's the other concern. And perhaps it'll be incomplete whatever we do—I mean, when we're in our community, and out and about. But this will certainly be an enormous tool to help. So it's really just to make that process better.

Senator PATERSON: Compared to the kind of process that goes for a number of days, a technological process with an app could be instantaneous.

Ms Edwards : For those people for whom you've had a digital handshake, yes.

Senator PATERSON: I share the concerns that many people have about privacy protections, and I'm reassured in part by the answers you've given about the robust protections that must be put in place to assure that. Moving on to the second issue, you and Professor Murphy answered some questions about the increase in ICU bed capacity asked earlier by my colleague Senator Davey. Just to drill down a bit more specifically on that, what about the increase in ventilator storage and capacity? I know that's slightly distinct from ICU capacity generally.

Ms Edwards : There are a few things that have been happening in relation to ventilators. First, a lot of work has been done by the states and territories, both through the AHPPC and with CEOs of health departments, which I'm involved in, to make sure we know exactly what's out there in current ICU and also what's out there not in current ICU, like some anaesthetic machines that can be added in with minor changes, and also things like finding out what ventilators there might be in the community for all sorts of reasons. We've even gone so far as to talk to the Veterinary Association about whether there are any human ventilators there which could be appropriately cleaned and used. That's one side of the process. In addition to that, we have been aggressively procuring ventilators. We've been doing that in two ways. One has been to go to overseas locations but also, very importantly, locations in Australia to use local production. That's both using an existing world-class production facility in Australia and also investing in local industry to get up rapid work to create a ventilator here in Australia. We have contracted with a party, a consortium, in order to do that. We're doing that work very closely with the department of industry, who are also working with other industries to upscale our ability to produce PPE and other items. The ventilator work is a key one, and we're really happy that we now have on order, we think, sufficient ventilators to enable us to meet that 7½ thousand aim and a bit more. We're being cautious.

Senator PATERSON: Just to put that in direct number terms, where have we gone from, how many did we have and how many do we to expect to have?

Ms Edwards : I think Professor Murphy said we had something like 2,400 ventilators in ICU rooms at the moment. We've found through various mechanisms about 2,000 more, and then the balance we're buying. I say 'and a few more' because we've been very cautious. Obviously, the scenes we've all seen on TV and so on in other countries are just beyond—the other thing about ventilators is that we're working very closely with states and territories about how we make this a national resource. We've expanded the national stockpile, at least notionally, to say it can have ventilators in it so that we can make sure that they get to where they're needed when they're needed, and all states and territories have been very cooperative in that work.

Senator PATERSON: One final question from me. We've gone from roughly 2½ thousand ventilators and are aiming for 7½ thousand plus some, as you said. How many ventilators are currently in use for COVID-19 patients?

Ms Edwards : I think Professor Murphy mentioned the number before, but it was less than 50. I think it was 50.

Senator PATERSON: So there's a fair bit of spare capacity to go.

Ms Edwards : We're very pleased to be in this position.

Senator PATERSON: Thank you; that's enough from me. If there are any questions from Senator Davey, I'll defer to her.

CHAIR: Senator Davey, you're not coming through now. Are you unmuted? Okay, we might go to Senator Lambie, if that's okay, and I'll come back to you, Senator Davey, once we've assisted you to find out where your volume has gone.

Senator LAMBIE: Even if Australia manages to completely eradicate all new cases of coronavirus transmission in the community, would we have to keep the borders closed to international visitors until there's a vaccine? Is there any plan?

Ms Edwards : Professor Murphy engaged with this question in response to someone else's questions earlier. To paraphrase what he said—it's not my area of expertise—the prevalence of the disease outside Australia and many places in the world means that this will be a very difficult issue, about people coming to Australia, for some time. That's one, of course, that will be decided in discussion with the national cabinet and by the federal government on the advice of Professor Murphy and all of the members of the AHPPC. I would also mention that, even if we got to a position where there were zero infections notified anywhere in Australia, the key to that is making sure we are actually picking up any that might be there still or that come into the country in some other way. That's why we keep talking about having comprehensive testing and contact tracing. I was just talking to Senator Paterson about that—so making sure that we test widely anybody who has respiratory systems of the type within the protocols that are set, for example, and also we do some sentinel testing, which I've now learned means basically doing some effectively random testing around the country so that we aren't getting to a position where there's a community transmission of the disease of which we're not aware, which appears to have been what may have happened in some places overseas. At the same time, it's that process of making sure that when we do find a case we rapidly track down anybody who might have been in contact with that person so that we can identify and contain the outbreak before it gets out of control.

Senator LAMBIE: If we don't manage to eradicate the virus from the country while we wait for a vaccine and there are other spikes, whether or not it's in a rural and regional area like the north-west coast, is it going to be the status quo that they will just go straight into lockdown if there's an outbreak in those communities? Is that going to be a standard procedure from here on, or will it be up to states to make up their own rules?

Ms Edwards : I don't think there's anything standard about what's happened with this pandemic so far. As Professor Murphy said, we're not keen on the term 'lockdown'. It will certainly be standard practice that if there is an outbreak anywhere in the country it will be quickly responded to with testing, contact tracing and also social distancing and isolation to the appropriate extent required, and also, as in north-west Tasmania, immediate action to safeguard those in the community who are most vulnerable. Whether that looks exactly like it did in north-west Tasmania, which has been a very successful action by the Tasmanian government with us and others, is a matter that will depend on our learning more and on the nature of the outbreak.

Senator LAMBIE: That's pretty much because we're in lockdown. That's what's happened. That's why we are asking. Obviously, if it's going to work it will have to be an example that we'll need to see across the country if it gets worse.

This virus will disrupt our lives and the economy until we can control the virus, but we've been told it could take 18 months until we get a vaccine. Do you know why the government came out saying this crisis would only last six months? Was it based on the medical advice coming from the department? Is the reality that we could be living with disruptions to our lives and work until 2021?

Ms Edwards : To go back to the vaccine issue, the development of the vaccine could take 12 to 18 months, if ever. I think that's been the statement that's been made throughout. There's no guarantee there'll be a vaccine then or at any time, so we're working hard to make sure we've got measures to control the virus in Australia in any event. The Prime Minister has talked about six months on various occasions. I think he's generally talked about 'at least' six months, and most of the measures we've put in place have been for a period of six months. I'm sure the Prime Minister has previously also said—and I'm only listening to him the same way as you, Senator—it could be longer. We are looking all the time at everything we're doing, how it's working and what impact it's having as, no doubt, the national cabinet is and all states and territories are. Most of our measures are for six months, and as we get closer to the end of that six months circumstances will be considered to see what happens next.

Senator LAMBIE: We've had a lack when it comes to mental health counselling and drug and alcohol counselling. We have counsellors out there who could have been helping in the rural and regional areas even before this virus started. Do you know whether the health minister is now considering giving those counsellors or their patients a Medicare rebate or get them to telehealth? They're counsellors. We use counsellors in headspace and other things like that for our kids, but we can't seem to pay counsellors without them being a psychologist or psychiatrist and give them a Medicare rebate for their patients while in this crisis. Has anyone considered giving those counsellors a Medicare rebate for their patients so we can have them in the system and so we can actually see more? I'm not sure if you're aware, but right now even veterans are waiting six to eight weeks, and this was before the virus. So we've got a problem out there.

Ms Edwards : Access to telehealth for allied and GP access for mental health services was increased on 13 March and then increased again very broadly on 30 March. So when you talk—

Senator LAMBIE: But that's not to counsellors, is it? Is that to counsellors?

Ms Edwards : I'll take on notice the exact scope of the measure, but it certainly applies to a range of allied health people who do psychological drug treatment. It's not restricted to doctors. I'll take on notice for you exactly who can have access to it, but there's very broad telehealth available for mental health services now.

Senator LAMBIE: I'm very aware of that, but it still doesn't include the counsellors, and right now we're going to need all hands on deck when it comes to mental health and drug and alcohol issues, there's no doubt about that.

CHAIR: Senator Lambie, last question.

Senator LAMBIE: Thanks, Chair. I want to quickly go back to the National Medical Stockpile. Do you include the Australian Defence Force's stockpile in your National Medical Stockpile? Or is their stockpile separate?

Ms Edwards : They have separate stores, but we work closely with them and make sure we know what each another is doing if needed. But they have separate supplies for their needs.

Senator LAMBIE: Do they have enough? Who's doing their accountability over that side for the men and women who are serving?

Ms Edwards : We'd have to take that up with the Department of Defence. I have certainly talked to them about PPE, and I'm not aware of any issue with supply.

CHAIR: Senator Lambie, we might be able to take that up with the Department of Defence as well. I'll try going to you again, Senator Davey.

Senator DAVEY: Can you hear me this time?

CHAIR: Yes, we can hear you.

Senator DAVEY: Great. I just want to go back to the issue of vaccines and our research capacity in this area. I note that an Australian lab was one of the first in the world to map the virus. Can you outline for us what we're doing in research in Australia not only for vaccines but also further research into the virus or similar viruses, and what capacity we have to be part of that global network of researchers in disease prevention?

Ms Edwards : We are already part of the global research work, but in this research specifically we moved quite early on research in relation to COVID-19. I can provide on notice detail of exactly what. In summary, there has been a bit more than $36 million released from the Medical Research Future Fund so far. That's for vaccine development through $3.35 million to the University of Queensland in partnership with the Queensland government and Ramsay Health Care, $2 million for a competitive grant opportunity also in relation to vaccines and $13.6 million still to be earmarked for vaccine development. We are really keen to make sure we invest in the places with the absolutely best prospects of moving forward on a vaccine.

We're also investing in antivirals—obviously a good treatment for COVID in its serious form is another aim that would help us to manage the issue—and that includes $8 million for a competitive grant opportunity to identify and develop antivirals. We're also looking at work with the Walter and Eliza Hall project assessing the effectiveness of hydroxychloroquine, although that's not in place as yet.

We've got $5 million for clinical trials to support better treatment and management of COVID patients with severe acute respiratory distress, and, further, an investment in diagnostics. So that's $2.6 million for the Peter Doherty Institute of Immunity and Infection to increase our ability for widespread testing; $1 million to the University of Sydney for a project using artificial intelligence to support frontline health workers, using CT scans to diagnose more quickly the severest of patients; and $1.5 million in public health for living guidelines on the clinical management of patients.

In addition to that investment out of the MRFF, the government has also announced $2 million to the Australian Partnership for Preparedness Research on Infectious Disease Emergencies through the NHMRC; and also significant funding for the CSIRO, including $220 million to upgrade the Australian Centre for Disease Preparedness and $10 million to further support vaccine development work through that mechanism.

Senator DAVEY: I note that this morning or overnight there were announcements in Britain, I think, and in some other nations that they've actually moved to clinical trials of certain vaccines. Are there any clinical trials currently approved or occurring or pending in Australia for either antiviral treatment or vaccinations?

Ms Edwards : I'm not aware of any currently underway, but I'll take that on notice. I'm not sure I will be able to answer the pending part, because obviously the clinical trial will follow identification of a candidate molecule—I think that's what they call it—but we're certainly very much in the forefront of the work. Frankly, I don't care which country comes up with it first; let's find a vaccine so that we can help everybody.

Senator DAVEY: Thank you. I have nothing further.

Senator PATRICK: Ms Edwards, I've got three lines of questioning and 7½ minutes, so just keep that in mind if you wouldn't mind. In relation to the application, is it reasonable to presume that the data on that application would only be prevented from being obtained by way of warrant or subpoena if legislation was put in place?

Ms Edwards : That would be a mechanism to do that, yes. There may be other mechanisms that would also prevent it being disclosed in this way, such as under the biosecurity declaration.

Senator PATRICK: Okay, so another concern might be admissibility in a court and things like that. So the department's alive to that issue?

Ms Edwards : Yes.

Senator PATRICK: Okay. If there was legislation, I presume we would have a sunset clause of some sort?

Ms Edwards : I'm not aware of exactly what is proposed or might be proposed, but every other measure we've done in relation to COVID has had an ending, so I would imagine on that basis it would too. But I'm not aware of the proposal.

Senator PATRICK: Okay; thank you. You heard me asking the CMO about Treasury modelling. I know you're not Treasury, but obviously Health would have looked at this in terms of pandemic planning, social isolation, commercial closures and border closures. Are you aware of Treasury, at any time prior to the COVID outbreak, modelling those effects such that they could be informed about their aspects of decision-making in a place like the national cabinet or the forums?

Ms Edwards : I'm not aware of what Treasury might have done prior to the pandemic, Senator.

Senator PATRICK: Okay, but you will have—

Ms Edwards : They may well have been involved in the pandemic planning—bearing in mind I turned up as the acting secretary on 24 February.

Senator PATRICK: Okay. The other questions I have relate to opening up again. In watching the way in which we have sought to restrict the emissions of the virus, each state has, in some circumstances, done something slightly different, recognising that each circumstance is different. I presume, in opening up, we will see perhaps opening up in places like South Australia and Western Australia first and then Melbourne and Sydney. Is that the approach that will be adopted?

Ms Edwards : Those are really matters for national cabinet, but Professor Murphy did note before that, in his view, he'd be very cautious about advising for very disparate approaches in different places. That is his current opinion. But the specifics of how and when restrictions are lifted, assuming we do maintain the excellent position we're in at the moment, will be a matter of very careful medical advice to the AHPPC and then considered by national cabinet.

Senator PATRICK: In terms of opening back up, noting that New Zealand has a similar sort of circumstance to us—that is, a well-controlled outbreak—is there going to be an Anzac approach to this? Has the department been talking to New Zealand about the prospects of opening up, perhaps with New Zealand involved as well as the states in Australia?

Ms Edwards : I'm sure there have been very frequent discussions with New Zealand, but I haven't been privy to any of them.

Senator PATRICK: Okay. In the international circumstance, and Senator Lambie talked a little bit about this, we're seeing latencies across each of the different continents. There was stuff in The New York Times about how it might spread in Africa. Is the department looking at this in terms of a time frame for Australia and New Zealand, and perhaps then looking at China, which seems to have things relatively well under control, versus some of the other jurisdictions?

Ms Edwards : The international evidence in the transmission of the disease is being taken into account to a very high degree in the advice that is being provided by AHPPC and others, so it's an important factor, but the department itself hasn't got anything to add on that issue.

Senator PATRICK: So it's not the department that interacts with other agencies, such as the World Health Organization and/or other health departments in other jurisdictions?

Ms Edwards : We do interact with the World Health Organization and other jurisdictions all the time. On this issue of the spread of the epidemiology, it is really led by Professor Murphy, through the AHPPC. We leave the doctors to deal with those things.

Senator PATRICK: The Chief Medical Officer indicated that a biosecurity declaration was made around 24 January. Is there a declaration in place in relation to an endemic transfer of this disease? That goes to the real question I want to get to: will there be some formal declaration made that we are no longer in those circumstances?

Ms Edwards : I think the answer to that is yes. I'd have to take on notice exactly when it was made and what the process would be for reversing it. I think I referred to it in my opening statement as the activation of the health sector emergency response plan. So there will be a point, hopefully sooner rather than later, at which that emergency response will no longer be in force. I can take the process on notice.

Senator PATRICK: Is that a legislative declaration or is that a policy declaration?

Ms Edwards : Can I take that on notice. I think it's under the health regulations and pandemic plan that Professor Murphy is responsible for. I wouldn't want to have an imprecise answer for you.

Senator PATRICK: The question ultimately goes to whether a declaration that this is over will be made at the end, and how that would happen. Thank you very much.

CHAIR: I've got a couple of questions, in closing. Ms Edwards, going back to my earlier question about the overarching strategy, are you aware of whether the federal government had a firm strategy of elimination, suppression or containment in place that they advised agencies of at any point during this?

Ms Edwards : In relation to the suppression, elimination—

CHAIR: Yes, the overarching strategy. Did the federal government ever have their own overarching strategy, and, if so, what was it?

Ms Edwards : The federal government advice from the very beginning—certainly for as long as I have been involved in the issue—has been absolutely based on the medical advice. We have gone for the medical advice as the core documents. That strategy has evolved over time, necessarily—because, with what was happening at the beginning, there were a lot of unknowns; there still are, and it's evolving as we go. When decisions are made on the basis of medical advice, there are great efforts to make sure those decisions are communicated throughout all agencies, and there are a lot of mechanisms by which we are in contact across the whole of Australian government agencies very frequently, and we're all working under the same proposal. If you're asking, 'Was there a plan set sometime in January that we're abiding to,' circumstances have changed dramatically and it's being constantly reviewed. The main overarching factor I've observed, and it has very much been the case, is that it's been entirely led by the medical and health advice.

CHAIR: In terms of going to national cabinet, did the federal government go to national cabinet with an overarching strategy position? I note the national cabinet has subsequently put out a view on that, which is suppression/elimination. Are you aware if the Commonwealth led and took a particular position on what it should be, noting that, in those few short months, there's been mention of herd immunity, containment, suppression and elimination? You're saying that it may have moved through all of those over the last five months?

Ms Edwards : I'm not aware of herd immunity ever having been something talked about by the federal government; it may be the case, but I am certainly not aware of that. We have been talking about what are the possible strategies—suppression, eradication, elimination—and the extent to which those are different. I would make the point that the national cabinet does not include the Minister for Health, and the Department of Health doesn't feed up into it. So you'd probably want to direct your questions about the national cabinet, how it works and what's being directed there to the department of the Prime Minister. The national cabinet is only the Prime Minister and the first ministers of each jurisdiction, plus the CMO.

CHAIR: But the CMO is not an independent statutory position. He exists as a deputy secretary, I think, in the Department of Health.

Ms Edwards : He's the CMO and the deputy secretary, although, since the beginning of this pandemic, his deputy secretary functions have been moved elsewhere. So he's operating solely as the CMO. That's why I'm here, for example. There is an independent and direct route from the AHPPC to the national cabinet. We obviously work closely with them, but we are not part of the national cabinet. Questions about how the national cabinet runs, what goes to it and so on should be directed to first ministers.

CHAIR: Sure. I'm just trying to understand how it works internally. So Health is leading the response to the pandemic, the health response to the pandemic—

Ms Edwards : The health response.

CHAIR: but the Chief Medical Officer acts independently and, potentially, without any line of sight from you as acting secretary of Health?

Ms Edwards : We work incredibly collaboratively—it's very much a team approach—and he's intimately involved in the health response, which the department is responsible for, but he also has direct responsibilities, because the AHPPC advice goes directly to the national cabinet. It does not come back through Health.

CHAIR: So you don't see the advice from the AHPPC before it goes to the national cabinet?

Ms Edwards : It does not come through health ministers, no.

CHAIR: Not even through health ministers. He does not provide that information to you. He's not an independent officer, as I understand it.

Ms Edwards : We work very closely on it because the National Incident Room, which reports to the CMO, is part of the department. So I'm aware of a lot of things going on, but they do not formally come through us and we're not party to them. The process is run by the Department of the Prime Minister and Cabinet and the first minister departments of all the states and territories, as it should be. They're the leaders of the nation.

CHAIR: From your point of view as the acting secretary of the Department of Health, you are not aware that the federal government has had an overarching strategy in the terms described in the national cabinet framework?

Ms Edwards : I think the government has had an overarching strategy from very early on. All the actions that have been taken have been based on health advice. I said that I wasn't aware whether suppression, elimination, eradication and so on were at the heart of that either at the beginning or at any other time, and I said it wasn't set at the beginning in order to guide where we were going, because it depends on what's happening. There's no question we've been working under a clear strategy across the whole of government, of which we're a major part but not the only part, from the beginning.

CHAIR: But that strategy can't be summed up as containment, suppression or elimination?

Ms Edwards : No. It's complex. It takes lots of elements. It can't be summed up simply at all.

CHAIR: Ms Edwards, we might leave it there. We look forward to having you back throughout the committee's inquiry. I remind you that questions taken on notice need to be responded to within five working days, but the committee acknowledges your workload as well. If you need longer, just engage with us. I thank senators for attending today. Overall it has been a successful hearing, with the use of technology. I also acknowledge the committee secretariat and DPS for their efforts to get all of this shipshape for today's hearings. Thank you very much.

Committee adjourned at 13:08