Friday 29th of March 2024

the government had no proper infection control plan for COVID19 related problems with the oldies...

scoom

Prime Minister Scott Morrison copped a punch from the Royal Commission into Aged Care Quality and Safety this week.


Counsel assisting Peter Rosen QC charged the government had no real infection control plan for COVID-19 related problems, all of which were foreseeable, charging there was complacency and hubris at a federal level stemming from a sense of self-congratulation.

Through the week the Morrison’s government fought back.

The usually invisible and largely ineffective Aged Care Minister, Tasmanian Senator Richard Colbeck, was sent out but minutes later no one could remember a thing he had said.

The government then offered up Professor Brendan Murphy, head of the Commonwealth Health Department and, for the first half-year of the pandemic, the federal chief medical officer.

Murphy tried to defend the government’s actions and outline just how “plan prepared” they were.

The royal commission gave him a quick lesson in who was running the show and his message was lost in his ham-fisted attempt to lecture the inquiry.

With this PR debris gaining its own community transmission, Morrison emerged from what had been almost a week of isolation, braving the late winter chill of his office courtyard and saying sorry for those times when the hard work of himself and everyone else fell short.

It was an attempt to call a halt to the blame game.

It’s a favourite media and political sport which had been revved up on a daily basis, particularly in respect to what Dan Andrews and his Victorian Labor Government had and hadn’t done in the last six weeks as the virus raged out of control in his state.

The fact Morrison’s media surrogates and some of his ministers and backbenchers have been feeding this “blame Dan” argument was ignored as Morrison said everyone was doing their best.

And if, on days things didn’t go well and there were tragic consequences, well the Prime Minister was sorry.

It was suggesting a complexity of effort and problem-solving that others were not affording Andrews – regardless of any respective faults in managing quarantine in Melbourne, or Commonwealth oversight of aged care at any stage.

The clear distinction is that Andrews’ detailed answers are required for roles, responsibilities and outcomes, while for the Commonwealth it’s more a case of “we’re all in this together and doing our best”.

Morrison’s reluctance to step up amid the criticism of how his government was handling aged care during the pandemic is typical of his thin skin – and also a refusal to accept blame or acknowledge wrongdoing.

We’ve seen it throughout the year, from his stubborn attitude about the summer’s fire disasters (“I don’t hold a hose, mate”) through his initial opposition to shutting down parts of the economy and school restrictions, and when he was missing in action on the day Victoria imposed the strictest lockdown experienced so far.

Morrison basks in the praise he’s been given during the pandemic for having learned from the glaring mistakes he made during the bushfires.

The man who couldn’t be told anything and didn’t hold a fire hose now begins most news conferences with lists of achievements; either the vast range of economic interventions to support many of those individuals and businesses hit by the virus fallout or the multi-faceted health and emergency response.

It’s not only a boast but also an attempt to inoculate himself from criticism. He also wants people to know he is the “can do” leader who sees a problem, sizes it up and sets out to fix it.

It is what the public wants and Morrison knows repetition is a large part of convincing people.

He does deserve praise for having learned the lessons of the bushfires – if he hadn’t he would be in the leadership doghouse with his international colleagues Donald Trump and Boris Johnson.

However, he hasn’t taken all of his failings on board and addressed them. Far from it.

He is still stubborn, especially when it comes to accepting criticism – he likes to answer such charges with a broad, shared-with-everyone acknowledgment of shortcomings.

He never admits to a detailed, specific complaint of failure of any kind.

Morrison also likes to enlist others – within his government or from the broader bureaucracy or community – to back up his rebuttal of criticism.

Using Brendan Murphy as a kind of bureaucratic human shield didn’t work and has damaged what was a strong public profile for the former chief medical adviser.

 

Read more:

https://thenewdaily.com.au/news/national/2020/08/15/dennis-atkins-morrison-shrinks/

 

disembarking the covid princess cockup...

Despite the disaster that was about to unfold as hundreds of passengers disembarked the Ruby Princess on March 19, an inquiry has found the two departments in charge of coordinating human biosecurity were not communicating.

 

Key points:
  • The inquiry found a NSW Expert Health Panel made "serious mistakes" in deeming coronavirus among passengers a "low risk"
  • It also discovered there was "silence" between the two main agencies ahead of the ship's arrival in Sydney
  • Commissioner Bret Walker SC labelled the disconnectedness "disturbing"

 

In fact, the only direct communication between NSW Health and the Commonwealth department that morning was a handful of text messages to say there was "no concern" over the "low risk" of reported illness among passengers.

Within hours, about 2,600 passengers would disembark, with some heading home interstate and others overseas, continuing the spread of the virus at home and abroad.

The inquiry into the Ruby Princess cruise ship delivered late yesterday identified "inexcusable" and "inexplicable" mistakes by NSW Health.

It linked 28 COVID-19-related deaths to the cruise ship, including 20 people in Australia and eight in the United States. 

The findings outline the shared responsibilities of failings across multiple departments and levels of government.

While it found NSW Health panel made "serious mistakes" in the way it deemed COVID-19 among passengers a "low risk", it also discovered there was "silence" between the two main agencies in the days leading up to ship's arrival in Sydney.

Commissioner Bret Walker SC labelled it "disturbing", prompting recommendations for sweeping changes for better communication and clear chains of responsibility between agencies.

 

Read more:

https://www.abc.net.au/news/2020-08-15/ruby-princess-inquiry-how-did-it-happen-coronavirus/12560722

fair call...

As Victoria grapples with coronavirus outbreaks in multiple aged care facilities, Labor Party figures have sought to blame the Federal Government for the unfolding disaster.

Arguing the Coalition was slow to respond to the looming threat, former opposition leader Bill Shorten told the ABC.

"People in aged care, we know they're more vulnerable. But only now it seems the Federal Government is waking up and saying it's going to do more. It's a federal responsibility, aged care." 

Mr Shorten repeated his claim the next day in an article for the Herald Sun, writing that: "The Prime Minister wants to delegate the tough decisions of the pandemic to the various state premiers.

"In some cases, this is appropriate. But aged care is a federal responsibility, and one that has been neglected for years."

So, is the Federal Government responsible for aged care?

RMIT ABC Fact Check investigates.

The verdict

Mr Shorten's claim is a fair call.

Individual aged care facilities are legally responsible for the safety of their residents, but the Federal Government is responsible for the aged care system as a whole.

The Government's primary role is to fund and regulate facilities to ensure they adhere to agreed safety standards. These standards include preventing infectious disease outbreaks.

Mr Shorten spoke of the preparedness of the system for COVID-19.

Aged care facilities are also subject to the public health laws of their host state or territory, so state governments retain some responsibility for residents.

However, a state's involvement only comes after an outbreak takes hold. Under powers not specific to aged care, it can, if necessary, take over facilities.

In preparation for COVID-19, both levels of government agreed on their roles and responsibilities for helping residential care facilities respond to outbreaks.

These largely reflected existing legislative arrangements, but they made clear the Federal Government would, in addition to its regulatory role, manage the supply of personal protective equipment and help address staff shortages. State governments were tasked with, among other things, testing, contact tracing and working with hospitals to free up hospital beds.

 

Read more:

https://www.abc.net.au/news/2020-08-15/fact-check-is-aged-care-a-federal-government-responsibility/12553808

who will decide if further action is required?...

NSW premier Gladys Berejiklian’s unreserved apology for the Ruby Princess debacle is a welcome response to the final report by the special commission headed by Bret Walker, but it does not end the matter.

Firstly, as NSW Police Commissioner Mick Fuller said, there is a criminal investigation underway, having received 1200 submissions.

Secondly, the Greens are pushing for a federal inquiry that could call the officials from the Department of Agriculture who were blocked by the federal government from appearing at the Walker commission. Greens leader Adam Bandt said that such an inquiry “may be the only way to get federal officials to face questioning on the Morrison government’s role through this crisis”. Ahead of the release of the commission’s report last Friday, the federal agriculture minister, David Littleproud, declined to rule out a national inquiry, saying, “If there’s further action required then of course the federal government will undertake further action.” Lastly, Walker himself flagged that there were two areas that the commission was unable to investigate: union concerns about the welfare of the crew after the Ruby Princess left Circular Quay, and the way passengers were treated in the aftermath of the disembarkation. A federal inquiry could look at both issues.  

Journalist Malcolm Knox observed almost every hour of the Ruby Princessinquiry, and wrote, in a masterful essay for The Monthly, that the disembarkation was the result of “a convergence of bad organisation, bad systems design, bad communication, a legacy of bureaucratic rigidity, and a set of guidelines that was, in Walker’s words, ‘doomed to inadequacy’ – not to mention plain bad luck”. This was borne out by Walker’s own finding that NSW public health officials did adequately attempt to protect the public against COVID-19 on cruise ships, “however, and it is a big however, their attempts sadly miscarried in this event”.

Describing the disembarkation as a “sorry episode”, Walker seemed loath to pass adverse judgement on officials – and he went right out of his way to exonerate the NSW health minister, Brad Hazzard, and did not even see the need to call Hazzard as a witness. He would have done so, Walker wrote, “if questions of substance had arisen about the law, the organisation of the department, its resourcing (including recruitment of appropriately expert officers), or the like. Nothing of those kinds did arise.” How remarkable. 

Walker found it was “crystal clear” that the Australian Border Force had no relevant responsibility, given its lack of medical or epidemiological expertise, and “neither the ABF nor any ABF officers played any part in the mishap”. Not so plain was the position of officials in the federal agriculture department who, Walker wrote, had ultimate responsibility for the disembarkation decision under the Biosecurity Act – although they would exercise this responsibility based on the advice of the NSW health department, under an agreed division of functions.

As constitutional law expert Cheryl Saunders tweeted after the ABC’s Insiders canvassed this issue: “To correct misapprehensions, following #insiders. Quarantine is a shared power. Commonwealth law prevails if there is inconsistency.” There was no inconsistency here – although Walker wrote that the Commonwealth’s refusal to allow its summonsed officials to appear was the one “fly in the ointment” of the commission. Most likely, the Commonwealth did itself a disservice. 

For now, it seems the political fallout from the Ruby Princess may be contained. But the fallout from Victoria’s hotel quarantine failures could be more damaging, with the ABC’s Four Corners revealing that the Australian Medical Association warned Victoria’s health department about infection-control dangers in quarantine hotels more than a month before workers started contracting COVID-19, and with Jennifer Coate’s inquiry hearing evidence that security guards in Melbourne’s quarantine hotels were told there was no need to wear personal protective equipment when taking guests out for fresh air or delivering UberEats orders to rooms.

Premier Daniel Andrews confirmed a decline in new cases overnight, but 25 deaths – the highest tally to date – of which 22 were in aged-care facilities. When COVID-19 is brought under control, the failures in aged care during this pandemic may overshadow every other issue

 

Read more:

https://www.themonthly.com.au/today/paddy-manning/2020/17/2020/1597643984/unreserved-apology

 

 

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protocols weren’t followed on and off the ship...

Federal agriculture officials did not speak to the doctor on board the Ruby Princess cruise ship before passengers disembarked in Sydney.

Department of Agriculture, Water and the Environment secretary Andrew Metcalfe admitted to a Senate inquiry on Tuesday that protocols weren’t followed on the ship.

The vessel has been linked to 28 coronavirus deaths and hundreds of cases, with a NSW inquiry into its Sydney disembarkment laying most of the blame on state health authorities.

But Mr Metcalfe says the process for completing a traveller illness checklist was not followed by federal agriculture officials.

“I now understand that the local application of the protocols at the Port of Sydney, in relation to cruise ships, was for my officers not to administer TICs but to consult with medical officers on the ships to get notified of any health issues,” he said.

“I am advised that on this particular occasion our officer only relied on the NSW medical assessment.”

Mr Metcalfe stressed his department’s main focus was on plant and animal biosecurity risks but said it had a role in the human biosecurity framework.

It remains unclear who gave oral advice for passengers to disembark about 6.30am on March 19, about an hour before Agriculture spoke to NSW Health.

Australian Border Force was absolved of any part in the debacle through the NSW inquiry.

NSW Premier Gladys Berejiklian has apologised over the saga and promised to implement all recommendations from the inquiry.

Social Services Minister Anne Ruston will also appear before the Senate inquiry along with officials from departments she is responsible for.

Defence officials will also face questioning.

 

Read more:

https://thenewdaily.com.au/news/2020/08/18/ruby-princess-senate-inquiry/

 

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an emergency-ish...

This week marks six months since Prime Minister Scott Morrison moved ahead of the World Health Organisation, and most other countries, to declare the coronavirus a pandemic.

At the time, Australia believed the WHO was moving too slowly. Mr Morrison wanted to show he was ahead of the game and ready to deal with this rapidly spreading virus.

On that day in late February, there were already 22 confirmed COVID-19 cases in Australia, mostly people who had come directly from Wuhan.

As he made the pandemic declaration, Morrison announced he was also initiating the Coronavirus Emergency Response Plan, a 56-page document he held proudly aloft and described as “very comprehensive”.

The idea was to instil confidence in a nervous community. It was still OK to go to the footy or eat at the local Chinese restaurant, the Prime Minister assured us. The government had a plan

Forewarned but not forearmed

It’s easy with the benefit of hindsight to poke holes in the document for the problems it failed to foresee in this pandemic, but it certainly didn’t miss one major area of risk: aged care.

In the “high severity” scenario, the plan warns aged care facilities would be “stretched to capacity”. It spoke specifically of the need for “surge staffing” and gave an assurance that “planning will consider what is needed to protect the most vulnerable members of our communities… such as the aged care sector”.

Most importantly, page 17 of the document made it clear that while the states and territories would be responsible for public health and hospitals, “the Australian Government will be responsible for residential aged care facilities”.

The government’s own “Emergency Response Plan” couldn’t have been clearer about where responsibility lay for this vulnerable sector as the pandemic arrived.

The PM and responsibility

Six months on, more than 260 elderly Australians in residential aged care have sadly lost their lives to COVID-19. There is no doubt many of these deaths would not have occurred without the widespread community transmission in Victoria, yet the Prime Minister has struggled to accept even a share of the responsibility.

He’s said sorry for “the days where expectations are not met”, but that’s as far as the concessions go. The ABC’s Michael Rowland put it to him directly on Wednesday that aged care “is a federal responsibility”. In response, Morrison would only accept that “we regulate aged care”.

On Friday, the Aged Care Minister went further. During an excruciating appearance before a Senate committee in which he couldn’t recall the number of COVID deaths in aged care, nor the number of active cases, Richard Colbeck eventually conceded that “in some circumstances we haven’t got it right and we apologise for that”.

And that brings us to state borders

As Colbeck gave his evidence on Friday, federal and state leaders were grappling with a problem the “Emergency Response Plan” definitely didn’t foresee six months ago: state border closures.

The actions of some premiers and chief ministers to completely wall-off their jurisdictions has frustrated the federal government and business community from the get-go. Families separated by distance have also felt the pain.

Nevertheless, the border closures have been wildly popular and the Prime Minister has long since retreated from any battle to force a re-opening. The limits to his authority on this have been well and truly exposed.

Morrison has, however, maintained pressure for at least some transparency around these state decisions and on Friday he scored a win. The leaders agreed their combined panel of top medicos, the AHPPC, will decide when to declare a particular region has become a coronavirus “hot spot”.

This should in theory mean independent experts now making these contentious decisions and might at least put some pressure on the premiers to justify any decisions denying entry to those from a “COVID-free” region.

There have been some heart-breaking cases over the past week of parents being unable to cross a border to access cancer treatment for a young child, or others unable to see a dying loved one.

Farmers in areas with no coronavirus, have been unable to move stock, feed and equipment. The premiers had to give some ground.

Six months into this pandemic, some of the basics on border crossings and aged care preparedness are still being worked out.

Given we may be living with this virus for at least another six months before a vaccine hopefully comes along, it’s better late than never.

-ABC

 

and it does not work well for the oldies...

In a hypothetical alternative universe where we already have a vaccine against Covid-19, world leaders will have a choice about how to deliver it to the population. The most vulnerable people, along with the nurses, doctors and care workers who look after them, are likely to be protected first.

If only it were that straightforward. The most vulnerable age group, the elderly, are particularly tricky to vaccinate.

“We have very few vaccines designed for older populations,” says Shayan Sharif, a professor of vaccinology at the University of Guelph, Canada. “More often than not in the last century, most vaccines have targeted childhood diseases.”

Shingles is one exception, usually given to patients in their 70s, and there are one or two other vaccines for diseases like meningitis or human papillomavirus developed for young adults. But otherwise immunology is skewed in favour of children.

“We have a tremendous amount of knowledge about childhood diseases,” says Sharif. “When it comes to young adults, middle age and old age, we don’t have a lot of experience.”

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To understand why older people are harder to vaccinate, we have to look at the differences in their immune system. Many infectious diseases are more severe in older adults than younger adultsOlder people have more risk factors – a lifetime of exposure to carcinogens or other infectious diseases will increase the risk of future disease from new infections. But they also undergo something called immunosenescence – ageing of the immune system.

Just like many other parts of the body, our immune system shows signs of our ageing. Some of the immune cells lose their function. The immune system is a very complex network of cell types that interact with each other. If something, somewhere within the system is not working, it interrupts the delicate balance of the immune response.

How does the aging immune system work?

When you are infected by a pathogen, the first layer of the immune system, the innate immune response, starts attacking the pathogen at the site of infection. For respiratory diseases, that could be the lungs, trachea or nose. White blood cells, or macrophages, attack the pathogen, swallowing it up before destroying it.

As those macrophages break apart the pathogen inside themselves, they present bits and pieces of it to another type of immune cell known as T cells. These serve as the “memory” of the immune system. T cells cannot see the pathogen by themselves and need certain macrophages, called antigen presenting cells, to show them the pathogen. That activates the next layer, the adaptive immune system.


There are several types of T cells. Killer T cells, or cytotoxins, attack our own bodies’ cells in order to eliminate those already infected by the pathogen, reducing its proliferation. Helper T cells provide assistance to B cells, another part of the adaptive immune system.

B cells can see the pathogen on their own but for optimum function they need helper T cells. B cells produce antibodies. But to produce the most effective antibodies, they need this complex interaction with T cells.

The goal of a vaccination is to stimulate our immune systems to produce effective antibodies before we are exposed to the pathogen. Much has been made in the news of antibody tests as a way of proving who has had Covid-19. However, not all antibodies work, not everyone who has been infected with Sars-Cov-2 – the virus that causes Covid-19 – has antibodies and some antibodies have a limited lifespan. (Read more about whether we can be immune to Covid-19.)

The issue for vaccinologists is that the delicate balance between all of these cells in elderly people becomes disrupted. So, what happens in an older person’s immune system?

“Basically all of those cell types are impaired in their function,” says Birgit Weinberger, from the University of Innsbruck, who studies immunosenescence and vaccinations of the elderly. “They produce a different set of cytokines [proteins that aid communication between immune cells]. I think the important issue one has to keep in mind is that none of those cell types act on their own.”

 

Read more;

https://www.bbc.com/future/article/20201013-why-older-people-are-harder-to-vaccinate

 

 

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