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Acid Reflux causes and Treatment

COVID 19 Press Conference – Monday 2 March 2020

COVID 19 Press Conference – Monday 2 March 2020

We’re going to start this morning by
talking about the flu and flu vaccinations and when we’ve dealt with
that then we will deal with coronavirus and after that we’ll take whatever
questions anybody wants to ask on any topic. I am delighted to be here with Dr
Chant but also more delighted to be
here with Ellie and Rose and Carrie Ann. Would you guys like to come out here
please you might if you’re out here with me you maybe look a bit better I’d be
afraid all right well look obviously we’re approaching the the flu season and
the government here in NSW have been working very hard to determine
how we can improve safety for the community particularly because of
obviously other factors that are occurring at the moment in this
particular incoming flu season and so today I can announce that the government
will be permitting pharmacists across this state no matter where they are to
be able to provide the vaccinations and actually give the vaccinations for
people under the age of 16 until today until we made this announcement the
vaccinations would be given by pharmacists for flu down to the age 16
so we had determined that we should go further and make it vaccinations down to
young children at the age of 10 but of course vaccinations are very very
important flu vaccinations are very important particularly for vulnerable
groups and they can still be done through your general practitioner and
should be done particularly this year I would just advise the community and
remind the community that particularly those who are over the age of 65 those
who are under 5 pregnant women people who perhaps have a other respiratory
issues such as asthma should certainly be having the vaccine but my
recommendation is Health Minister I’m sure dr. chant
supports this is that this season particularly everybody should be
ensuring that they get out have a flu shot there’s no doubt about
it but because of the compounding factors this particular season we’re
going to see a converging period where the flu season will come upon us and at
the same time we’re expecting of course the way things are moving at the moment
for the corona virus to also be extending its its reach can I say that
the flu vaccine of course whilst it’s extremely important it’s also very very
important for the flu and for other of the corona virus as well the people just
exercise the usual caution that they should take and I dr. chan if you could
pass over if you’ve got it you’ve got the notice remind folks that the most
important thing you can actually do is either use a hand wash or simply use
soap and water constantly be washing your hands in the next few months would
help us all we have a major major issue for us all at the moment but it’s
manageable it is manageable and every person in our community has a role if
you’ve been out in a public place or if you’ve been somewhere that you might
have touched some other you know publicly available banisters or doors or
been in trains wash your hands so we got to do soap and water is going to make a
huge difference to how we actually approach both the flu season and the
corona viruses now we have these two gorgeous young ladies Rosie and Ellie
and their wonderful mum Carrie Anne and I’m gonna ask Carrie Ann just to tell us
a little bit about what happened when Rosie didn’t do so well when she didn’t
have a flu shot she was under fire at the time she’s now
a very big girl she’s now ten but when she was four they had a very difficult
time Karen you okay to come up and explain with the girls and girls you
stick with your mum if you just look there’s any spot out there and just talk
and explain what happened and the girls just before their fourth
birthday Ellie got sick with flu we didn’t know it was flu we just thought
it was a bad cold a couple of days later her sister came down with the same very
high fevers very fatigued not eating not drinking very upset tummy
cough progressed into a worse cough six days into the illness Ellie turned a
corner we expected Rosie to turn a corner a
couple of days later that didn’t happen she deteriorated until one day I noticed
that her eyes were closing she was struggling to breathe took her to
emergency at the wrong North Shore they put her on oxygen
they said that her lungs were almost 100% consolidated and within 48 hours
she was intubated and moved by ambulance to Sydney kids hospital she was
intubated for ten days she was in ICU for two weeks we were absolutely
delighted that she pulled through because we were told several times that
she might not live and she had extreme reactions to the medication because she
was intubated for so long so it took us three months to wean her off the
medication and it took us six months to recover fully she’d lost a quarter of
her body weight she couldn’t walk and she’s now shorter than her sister her
immune system was was impacted for some time but we’re really grateful that
she’s alive because of the fantastic support that we had from the doctors and
nurses at Sydney kids hospital when I kept asking why us why us how did this
happen because they were very healthy before it happened the doctors kept
asking me if I’d had the children vaccinated I didn’t know that you could
get vaccines for children and I would have hands-down preferred a vaccination
than been sitting in ICU hospital wondering if she was going to pull
through that hour that day that week so I made a promise to the doctors that I
would get them vaccinated every year which they don’t like but they have it
done and our whole family is vaccinated and that’s why we’re here
it’s really important to us so they look exactly the same
rosy and early but one actually obviously le had it as well and le
recovered basically by itself but Rosie ended up with the worst end of the for
the flu virus and Rosie what are you reckon about orally which what do you
reckon everybody should make sure they go and have a sick if they do catch
pretty good so thank you very much what do you reckon le yeah so wash your hands
and a flu vaccine the best ambassadors for the residents of New South Wales
thank you so much ladies I really appreciate you help thanks very much
Kevin thank you you can just take it you fantastic ten
years old I amazing please don’t run against me too soon all right now so
that’s the the issue of the flu vaccine and we’ll deal with that if there are
any questions in due course but will now deal with coronavirus obviously the
situation remains unfolding world that’s don’t you agree tell me when you’re ready you’re okay
thanks very much obviously the situation remains
unfolding worldwide and indeed here in Australia Australia so far though is
doing a lot better than most other countries and we are hoping that we can
continue to do a lot better particularly with the help of the
community and taking the appropriate steps to protect themselves as that
today in New South Wales we have six confirmed cases of the covert 19 in the
corona virus novel coronavirus and we have another just over 80 that are
currently being reviewed tested and that’s a rolling number it varies I said
yesterday it was about 300 but there’s been tests that have shown that the bulk
of those people all those people actually have been cleared and of course
there’s 80 odd remaining the the two additional ones everybody’s aware of the
original for folks who had the novel coronavirus kravid 19 and everywhere I
think is aware at this point that those people recovered three of them quicker
than the fourth but nevertheless in the end the fourth one recovered and they’re
all out of hospital the other two who have come in just in more recent days
are both from both travelled from Iran one of them came in on the 22nd of
February there was a 40 year old male and he started to get symptoms a couple
of days after he arrived and tests couple days after that confirmed that he
had the carbon 19 virus we also have a 50 year old one who came in on the 23rd
of February and again a similar similar situation except that she started to
feel some of the symptoms almost immediately upon arrival so she was
tested as well and has been confirmed and both of those
are now in hospital in regard to the First Gentleman the 40 year old we have
two of his close contacts that are in quarantine and another six I think that
are actually in isolation two are in hospital while we did further tests the
other six are in self-isolation the 50 year old lady came in though on a cata
flight on the 23rd of February arrived at 6:50 p.m. at Sydney Airport
it was flight 908 I in flight 908 Kat our cue our 908 and we are currently
making investigations as to precisely the location that she was occupied in
occupying in the plane and we’re also looking at trying to ensure that we
reach out through the border force details and we can access to to contact
the various people who are sitting in her immediate vicinity and I’ll ask dr.
Chen in a moment to expand on how many rows we’re looking at there but my
message is the Health Minister is that anybody on that flight QR 908 that
arrived on the 23rd of February at 6:50 p.m. into Sydney Airport should be very
aware that there was somebody on their flight who had the corona virus and if
they do have any of the symptoms then that we will come very familiar with
flu-like symptoms effectively then you should get along to your doctor if you
have any doubts any thoughts that it might be the crown of iris please ring
ahead to your GP or ring head to your local emergency department so they’re
aware and contact the appropriate steps just to keep everybody safe but of
course is trained in health system and particularly New South Wales health
demand entire health system here in this country is doing an extraordinary job to
look after people and we would anticipate that if you do come forward
you’ll be extremely well looked after can I ask dr. chan to expand on any
aspects of that and then we’ll take some questions on that can I just say at the
moment whilst there are other as I said just over
eighty Bank being still tested there’s no case that we’re aware of beyond the
six that I’ve just referred to but of course it is a an unfolding situation
again I’d say to the community New South Wales health the Commonwealth Health
Department all of the state and territory health departments can only do
so much but we’re confident that provided we
have a partnership with the community will we’ll get through this
appropriately and so I’m just asking again for people to realise the
importance of using hand wash and also there’s if you haven’t got hand wash use
soap and water and use it frequently and do the basics if you’re sneezing or
coughing cough into your elbow don’t cough into your hand and then touch
other things and and just make sure that if you’ve got a temperature a cough or
any other spiritual issues you do get along as I’ve described to be assessed
by a general practitioner or by the emergency department of your hospital
now I’m going to ask dr. chant who at this stage is very tired having been
dealing with us now for quite some weeks but I’m going to ask her to make any
further comments to add to anything I might have important them or both of us
take questions dr. Chen Thank You minister just in reference to your
question about the plane so we are reaching out directly to the airline as
also is through the NAT of the usual way in which we get the border cards through
border force and through the National incident room but we have released
details of the plane and as me as minister said if anyone on that plane
develops any symptoms they should contact their health provider
immediately in addition we will be asking those close contacts of the case
and that’s in in relation to a couple of rows in before and after where the
patient was sitting to actually self isolate themselves for 14 days and we
will be reaching out as soon as we’ve got contact details but we have released
this information as soon as it became available I would also like to say that
we will be announcing and as you can have seen throughout this event we’ve
we’ve announced the cases as soon as we hear about them within a couple of hours
of getting a positive test and making contact and
and ascertaining some key information relevant to the media so there will be
always times where we have patients that are under investigation but we are
committed to publicly releasing the details of confirmed cases very promptly
so I thank you for your assistance so those those patients are reasonably well
our experience in New South Wales has been our cases have been in the milder
spectrum these are obviously in younger people and obviously we know that from
our experience internationally and even on in Australia that people with
underlying illnesses and particularly the elderly have a more challenging
course with this virus then perhaps younger theatre people so so that yes
there are hospitalized but they’re not requiring intensive care and their
condition is stable look I’ll just have to check but we had no further test
results last night so I’ll let you know if there’s any new positives but there
are known new positives we do runs twice a day so they’re sometimes repeat
samples and you know that we continue to monitor them you can imagine that we’re
taking a very cautious approach often people might have a runny nose but if it
gets worse we’ll rescreen them so you should be assured we’re taking a
cautious approach in finding any cases the two contacts there were they were a
household contact it was just more about the disposition of a family a family
group it’s often easier to keep them together and for that support as well as
diagnostic testing access at Westmead because the labs just on their facility
as well you release yesterday yeah so the simple
sort of symptoms we look at we were having a very low threshold for testing
anyone because we do know that the spectrum of disease is can be anywhere
from very mild to the very severe so anyone with a fever runny nose headache
sore throat even just a mild a sore throat we have been if there have been a
contact of a case we’ve been screening them to preclude translate that they
have the novel coronavirus so we’re taking a very precautionary approach to
symptoms in any context so at the moment we don’t know the details of the of the
wedge the patient person was sitting she hasn’t got she did not retain a boarding
card we’re going into the airline and is also as well the National incident room
for those seating but we have put out publicly the QR 908 including amplifying
that through social media we are getting on to that first thing this morning but
we did release those details last last night and encourage people to be
watchful of symptoms and there is quite a lot of when we are doing contact
tracing on planes etc we know that the media is a very effective way of getting
that information out in our subsequent contact tracing exercises on the plane now the international community is
learning all the time and we I think there are a number of learnings from the
Japanese cruise ship public health official from Australia was actually
deployed to Japan and there were also officials from CDC and other
international communicable disease control agencies we’ve shared some of
that information and in terms of our response to cruise ships will be
incorporating those learnings in our response we would do it differently in
light of those learnings so we would not be quarantine everyone on the cruise
ship we would also be very clear about some of the issues around the crew and
the crews interaction with the patients also we know that this virus can be
spread by contact with surfaces particularly it doesn’t live for a long
time on surfaces but it does live there and as MIT that’s why minister saying
wash your hands make sure you think so some of those learnings we have
reflected upon and it’s been actually great how the international community
and our communicable disease experts have been sharing that intelligence in
real-time so we can actually revise and reflect upon our own planning for those
scenarios look we are obviously monitoring
critical supplies very closely in our health care system we are have got a
centralized procurement agency called health care and we have centralized
procurement and then resupply for all our health facilities through that
mechanism our CAS are monitoring that and we have secured supplies of masks
obviously in a time of competing demand and high international demand for masks
we must keep our health care workers protected they are at the frontline and
they’re the nature of their exposure to clients in giving patients and giving
giving care is much closer and prolonged so it is they are a priority for us to
protect so we we have asked all our hospitals to undertake planning for
acute respiratory clinics and that’s in the knowledge that you won’t be able to
discriminate between potentially impatience with influenza or other a
spiritual virus and covert 19 we’ve asked all of our hospital emergency
departments to plan for those I think it’s important to also in embrace our
learnings from the past where one-size-fits-all doesn’t work
we know that the spread of the virus or the spread of even the flu season can
impact in different areas of the state at different times and so we envisage
that these clinics may be open and operational for certain times and not in
others for very small in in in rural areas there might be different models
that are done with general practice combined models so we’re very much
wanting local planning we’ve set out the parameters around what our expectations
about these respiratory clinics but we’re also open to exploring lots of
different models to basically ensure that we have improved access for people
with respiratory clinics through their spiritual clinics to really release some
of the burden on our emergency departments who we know will be quite
stressed um certainly all hospital so what we’ve
said is all emergency departments have to have plans for these acute
respiratory clinks but can I just suggest that in our response its the
emergency departments will be supported by the whole of the whole of the
hospital infrastructure so for instance we may be actually diverting some other
groups of patients away from the emergency department the whole purpose
of these clinics is at a time of very high demand where access to general
practice may be quite challenging it’s important that we have effective
pathways for people presenting with respiratory illness but we’ve also got
to manage our heart cases our oncology cases all the rest and so there might
also be streamlined pathways for some of those patients particularly where we
might not want them coming through an emergency department and being in
contact with others with infectious diseases the strategy of also moving
patients to a respiratory clinic pathway is also to reduce some of the infectious
disease burden within an emergency department but but we also know the
learnings that patients can present with chest pain and they can still have
covert 19 or or influenza so it’s really very important that we have really upped
our infection control in our emergency department settings and I’m actually
very pleased in the management in the way our emergency departments managed
our latest two confirmed cases it was pleasing that they had been recognized
at triage placed into a single room and health care workers weren’t exposed so
that gives me confidence that the messages and that planning has been done
in the health system treat illnesses we know that you can
contract flu and coded so what’s what steps are being put in place to ensure
that people with flu and mingling with well the reality is is we we won’t be
able to distinguish just by looking at a patient but what will happen is that
people will be given masks and we will have to maintain infection control we
can’t assume everyone that’s coming to the respiratory clinic has has covered
some of them will have flu some of them will have RSV so so in setting up the
respiratory clinic you have to be very careful about infection control again
putting masks on patients keeping space physical spacing having lots of
hand-washing and so there are some of the considerations that have to be put
in place when we put in these enhanced pathways but there are very important
strategy but similarly is phoning and using health direct other ways of
getting support from general practice in terms of telephone consultations some of
these strategies are being explored currently in how we can make sure that
basically our real health resources are for those that need that face-to-face
assessment and for those that need reassurance or a light touch
intervention that can be delivered over a telephone or through other technology
that we employ those techniques know so it’s basically the whole purpose
of these clinics is to meet an excess demand for IDI so it’s one strategy when
you’re IDI is swamped with a large number of patients presenting with
respiratory illness like fever cough it’s around how do you plan to manage
that group of patients but really the task is how do we keep that IDI
functioning so all the people that need emergency care are cared for and so this
is one strategy but the hospitals will put in a range of other strategies to
make sure that we have strict pathways that
cardiac the pathways for oncology you know our pregnant women and all of those
patient groups that will be attending emergency departments so whilst that we
have a focus on our respiratory clinics as one strategy it really is a more
comprehensive strategy of how we’re going to manage our emergency
departments at a time of increased stress
I want to start off by saying that the Australian healthcare system is one that
I’m immensely proud of and it is a strong robust system and at times of
crisis or at times when we are challenged we actually pull together and
so at the moment our districts are planning for a significantly increased
level of emergency department presentations at a time that might hit
when we’ve also got significant flu activity in the community sorry so we’re
planning for that as well as planning for our critical care resources in terms
of how we would scale our critical care as well as our general hospital bed base
we can deal with it it’ll be tough and as a minister said it’s about
partnership with the community so we’re going to call on the community not to be
attending emergency departments if they can seek care in alternate ways that
doesn’t compromise their health we also want to balance that with a message we
don’t want people to be stoic and avoid care so we have to balance those two
messages but those simple messages around hygiene messages and when we’re
also is giving the public health advice about isolation or social distancing all
those measures when we’re talking about those in public we just call upon the
community to heed those and act wisely because what we are trying to do is
dampen down any transmission in the community so that our health systems can
cope with all people presenting not only the people that are presenting with the
acute respiratory illness be it flu or covert 19 but also the other health
elements because of you going to the treasurer to
ask for more money for health we had a cow AG health ministers meeting
on Friday and I made the point during that Co AG meeting to the federal
government that we have obviously a budget which is designed for a normal
ears health if there is such a thing because there’s always something that
pops up in health as I’ve discovered the last three years and I have put the
federal government on notice that it may be that we in fact all states and
territories agreed but we may need more money to be able to deal with it but at
this point we are looking to manage it the reason why I made that point was
that it may become necessary if if it does escalate to have some of our
services diverted Adam f ed out of our public hospitals into private hospital
so we may be moving some of our patients into the private system and paying the
private system which means that our budget will be going there we might need
some additional money look those the federal government
acknowledged that that may become a case and as dr. chauncey said the health
system in this country is amazing and every state and territory Minister last
Friday with their Minister Hunt had a very open discussion and I think he was
very pleased to see just what every state and territory was doing but it may
become it may become necessary to get some more money from the federal
government to address some of those issues we don’t know that’s the bottom line we
don’t know what we do know is that we expect more and probably a lot more and
so the message that I have been trying to get out as the State Health Minister
is if you don’t need to come to an emergency department if you have an
ailment that is not requiring an emergency for heaven’s sake don’t come
go and see your GP you know as Doctor chances we don’t want people to not have
their health issues addressed but we have in this country a fantastic primary
health care system some countries don’t have it we have a primary health care
system and that’s our general practitioners so from the state
ministers point of view we are saying – to all of our constituents all of our
residents in our states and territories if you don’t think you’ve got something
that’s major and it’s not an emergency then don’t go to the emergency
department go to your GP and let the GP look after it because that’s that’s why
we have general practitioners mikono can I say one of the issues for us is in the
last seven years I mean seven years ago our emergency departments across this
state we’re coping with two million people here in seven years it’s
escalated to three million people as has been said today there’s already an
enormous pressure on our emergency departments and our hospital system this
partnership going forward is about a whole lot of factors that the community
can help with you can wash your hands you can use those appropriate cleansing
agents and do it frequently but you can also think about not going to the
hospital because right now a whole lot of people who use our emergency
departments really are not in any man’s language and emergency so go to your GP
if you know that that would be the appropriate place to go having said that
if you’re really sick go to an emergency department bring a hit and go to your GP
if you think you might have the symptoms of coronavirus wring ahead and make sure
that your GP or yiridi emergency department to know so they can take the
appropriate steps look the preparation is what the phase
that we’re at the moment we have where we’re behaving in New South Wales as our
all states and territories as if this is already a pandemic but it hasn’t been
declared yet as a pandemic but why the World Health Organization but our system
is doing really well it just making sure we prepared the precautionary principle
is applying extremely well and if we need to move into that depending on the
location around the state we’ll do it dr. chant feels enthusiastic wait a
minute sorry I just might clarify that we actually have set up a few models flu
clinics so you probably be aware that there was a flu clinic at Royal Prince
Alfred hospital and that was some set up particularly because we were screening
large numbers of returning travelers from China and so that was the where we
were taking them for their screening and assessment I know that Westmead has got
a clinic and assessment center and similarly North Shore has set it up at
particular time so again the importance is that it’s not a one size fits all if
there isn’t demand it’s sometimes not appropriate to have a separate clinic
man by a separate team that is sitting there not you’re not working very hard
when you’ve got another group that are working very hard in your emergency
departments so again we’ve we’re very much being pragmatic about the
flexibility of these clinics and they need to be able to be stood up and
responsive to the local demands in the way that’s locally dictated what works
for them well are you gonna wrap this up but can I stay finally as the health all
right in the community can you confirm reports
that we’ve received I think you as you would know that it is
important that we understand our supply of masks it is essential that we have
appropriate personal protective equipment to protect our health workers
and one of the prudent strategies is to make sure we control where the masks are
centralized them so we know where the volumes and we also monitor ordering
patterns because clearly there are some behaviors that play out such as I think
what all of us would do is the temptation to stock pile or hoard and
we’re just trying to manage the supply chain and make sure that those that we
have a good understanding of those masks but there is no shortage in our system
but we are encouraging prudent use and prudent ordering so that we can actually
manage the supply chain I look I can’t come in on the operations
at a particular Hospital but obviously you can imagine that these these
products are there has been a significant price rise in the community
for these products these are valuable as I said the actions we’ve had taken is to
centralized procurement monitor usage advise that there needs to be more
security around the products just so that we really understand what supply
we’ve got to inform our projections and our ordering patterns but you know
generally healthcare staff are very responsible and I want to indicate that
our commitment is to actually ensure healthcare workers remain protected and
have access to the appropriate protective equipment know um can I just
say finally I’d have to say I think that Australia if you’re if you’re a citizen
of any nation in the world being a citizen here in Australia is a pretty
good time to be a citizen here in Australia we have the best health system
we have all the appropriate steps in place and it’s about as good as it gets
for anybody here in this country and just by way of further notice last night
I happily ate in a Chinese restaurant I don’t have a mask and I do wash my hands
frequently and I suggest that we can all do that thank you very much

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