 Okay, Peter. I'm going to start the credits now. Okay. My name is Peter Murphy from the Sydney Politics and the Pub Committee. This session was organised by Kathy Vogan, who is managing the technical support tonight. Our regular Tuesday evening program is on this coming Tuesday at 6pm sharp, also online. Now, I acknowledge the traditional custodians of the land on which we are tonight, wherever we are, including the Gadigal people of the Eora Nation on whose land I am residing. Their lands were taken, never ceded. Our topic tonight is ending quarantine, mental health of citizens and health workers. Now, Sydney has ended the curfew in those local government areas of concern and will end its lockdown when a 70% vaccination rate has been reached. But they say they will maintain other health measures after that. A careful balance must be struck between freeing Sydney's stir-crazy citizens, rebooting businesses, and keeping the COVID outbreak under control with health services and health workers already under pressure and ICU space filling up now. Our speakers tonight are Dr Arthur Chesterfield Evans, a medical practitioner, epidemiologist, a former surgeon, and a former NSW Upper House MP for the Australian Democrats. And Professor Ian Hickey, co-director, health and policy at Sydney University's Brain and Mind Centre. We are going live to the general public through the Politics in the Pub and the Consortium News websites. You can send questions and comments anytime by using the chat function in the YouTube channels there. We may also have a small audience with the speakers and the tech team in the Zoom room, maybe not. But if they are here, they would be able to put their questions live. Our speakers will each present for up to 20 minutes each, and then we would have the Q&A and aim to finish at 7.15pm or when the questions run out. So now I'd like to ask you to welcome Dr Arthur Chesterfield Evans, our first speaker. Please go ahead, Arthur. Hi, sorry about that. Phone just ringled. Should turn it off. Yeah, my background was in surgery, and then I went into occupational medicine. So I've done some epidemiology post-grad and some... and written some papers, but I wouldn't call myself an epidemiologist as such. I'm a GP. I'm not at the front line with COVID, but I am in general practice, and I do keep in touch with what's going on. I did quite a lot of intensive care years ago, and interestingly, they're all writing enough refortune to go back. So there's a horrendous shortage of people in intensive care, and it's getting worse. As far as mental health is concerned, I set up the mental health inquiry in 2000. The New South Wales Mental Health Inquiry, so I was part of that, and of course I was pushing to get it set up, and I think that had a reasonable effect, although it did just show how inadequate the services were. And each mental health inquiry, which happened about every decade, said the same things that, you know, it wasn't good and it isn't good. It's very hard to get patients in the hospital now, as it always has been, and mental health is a very neglected area. I do think, though, that if you want to do preventive mental health, you give people jobs, and you pay them when they're injured, and you give them physical treatments, and you give them hope, and you give them housing, and you treat them with respect. So the idea that simply letting them come out of their houses and roam free into a COVID epidemic will somehow help their mental health, I think is the last refuge of a scoundrel, quite honestly. I just think that the sudden interest in mental health from the corporate sector, who have never shown any interest in it before, is just them trying to get the place unlocked. That's my perspective on it. And I guess the other thing I do know a bit about politics, having been in Parliament for nearly nine years. So I suppose I'm trying to give a perspective of all four areas, GP, epidemiology, politics, and mental health, and I've certainly deferred to Ian on the mental health side at least. I think we have to look at the health system as a whole, and I think that is really a big problem that this is exacerbating, and it's being covered up by huge amounts of money being thrown at it. If we look at the Australian situation, we have a huge imbalance in finance between the states and the federal. The federal government gets all the money, and the states deliver the vast bulk of the services. The federal government is actually not capable of delivering those services. Centrelink is a pretty bad example of how inefficient they are. But that's why they have to call in the Army, because they really don't have any troops, so to speak. They don't have anybody on the ground. It relies on the states, and they have basically balanced their budgets by squeezing the states. So the states are always trying to deliver services and having a very poor. Now, this is particularly the case in the health area where federal and state both have some areas. And basically, if you were trying to run a health system, you'd better have a monopoly, because then you can direct your resources optimally. A market's probably not the thing to have in the sense that it's not really a commodity that people want to buy. If they can avoid buying it, they will. They don't want to get sick. And it needs universal health insurance so that we all pay the same and we get what we need, not what we can afford. So it doesn't become how deep your pocket is. It's how sick you are. So I must have been a great believer in universal free health insurance, and that's being progressively undermined towards an American model. If you look at the main driver of health policy in Australia, it's not how to run a good health system. It's how to shift the costs to somebody else. Now, there's really five players in this. There's the federal health department. There's the state health department. There's the private health insurance. There's Medicare, which is effectively federal, and there's the patient. So each one of them is trying to get, I guess you could call Medicare and the federal government the same thing, but they are each trying to shift the costs onto some other aspect. They don't care what the total cost is as long as they can shift the cost to someone else. So this is very inefficient because they're happy to take inefficiency as long as they're not paying. And this has resulted in things like, well, the general demarcation is that hospitals are state and what happens out of hospitals is federal. Although that's not quite true either because hospitals in the home are growing and that's because the state is trying to minimize the number of people in hospital by subsidizing nurses to run around and discharge people quicker, more quickly, to get them out of hospital. So there's a hospital in the home thing, which is now becoming keeping COVID patients at home in order to save money. And that's now a really growing area, which is still state. So when the federal government unlocks, when the problem goes to the health system, it will be borne by the states largely. And I don't know how much that's in Morrison's thinking, but the problems won't really be his. If you look at just simple examples, they used to have outpatients if you went to the emergency department, went to outpatients. They abolished those, although they were very cost-effective and they were good for training, they registered most of the work. But when they closed them, the patients had to go to the specialist rooms, which is much more expensive, but the federal government, the private health insurers and the patients paid for that, the state did. So it was a cost shift. When you go to emergency department, they give you two tablets and say, here's a script for the chemist and they save the cost of the rest of that script. But of course, your efficiency is you have to go to the chemist to get another script that it all has to be dispensed again and the total cost is much higher. So we have this cost shifting and the federal government for its sake has run Medicare down. Medicare was set up paying 85% of the AMA fee. It now pays 46%. So the GPs have taken a 50% pay cut over the last 30 years really in real terms. And that of course means the poor people can't afford that the doctors tend not to do Medicare. The patients go to emergency department and the cost of an emergency department visits about $190. The cost of a GP visit at AMA rates is $84. The cost of Medicare rates is $46. And if the GP isn't accredited, it's $21, right? So the costs are being pushed to someone else. So the whole health system is about pushing the costs to somebody else. Now this means when the stress happens, there isn't capacity. These states have run down the hospitals to the maximum extent and there's blocks for ambulances long before COVID. They had no hospital to go to. They were diverted. So now there's a COVID problem. And the government is, the state government has wrapped up hospital in home to try and keep people there. And they have quite elaborate protocols now to have quite elaborate protocols for how long people stayed at home. And the hospital in the home people, of course, are no longer discharged. They're no longer discharged as many patients to the hospitals in the home. Hospital in the home staff are being used on phones and they have a protocol to phone people. Some of them are testing them at home, swabbing them. And some of them are ringing them every day and saying, how are you going, how are you going and watching for the red flags you might call. So if they've got an algorithm, we should bring them up and then they're classified by their risk of hospitalization, the ROH. And their vaccination status, social factors, like health literacy, whether they live alone, whether they've got a lot of kids, risk of violence and abuse. The double vaccinated, if they're double vaccinated, they're low risk, regardless, no risk. And their mental health and they're provided with a pulse oximeter, which measures your oxygen and basically in COVID, you can get bad lung disease and your oxygen can fall without you realizing and people can get very sick. And then, of course, once your oxygen starts to fall, you can get very sick very, very quickly. And then, of course, you call an ambulance. And at the moment, the ambulance system is totally overloaded. And there was an article in the Saturday paper yesterday about that. So the system is really at breaking point. The federal government is throwing a lot of money at it. And they're putting normal patients, if you put them that way, into private hospitals. Patients who are not COVID are going into private hospitals, highly subsidized. The federal government subsidized private hospitals early in the pandemic when they expected lots of cases. They were basically emptied and paid to stay empty in case we needed them. So the government at a federal level is throwing a lot of money at the problem, basically, so that you can't see the fundamental problems within the health system and the increasing privatization of everything and the running down of Medicare. Really serious health problems that are being swept under the carpet, I believe by sort of what I'm saying, random grants might be a way of putting it in terms of the federal government's policy. The key point about the lockdown is, and I think this is probably the message that's the take home from this talk as a whole, is that vaccination really can't cut it alone. And there's a graph which I want to show you. And just a second, I'll see if I can do this. I can't share. I've done something wrong here. How do I show you this graph? Is the green button at the bottom of this? Arthur, I will do it for you. Thank you. I'll press the button and I'll press the green button and it doesn't come up. Can you put it up, Cathy? Yes, I can. Thank you, Cathy. Let's see. I'll get it. I thought I'd just opened it. I understood conceptually. It's just when you have to do it, it's not quite the same. No. It's your first time. So no worries. Just one second and I'll find it myself. Right. I've got it. Now I'm going to switch. I'll put the graph up and I'll just keep talking. Yes, all right, dear. Where is preview? There it is. Okay. Share. Is that the one you're talking about? That's the one I'm talking about. Yeah. Okay. Now this is a graph of what will happen to the numbers of Delta patients. They're the R number that you see at the top there. Delta variant is a type of COVID which is more infectious than the previous ones. It's a general property of viruses that the more virulent one, that is to say the one that gets from one patient to the next fastest will out complete the viruses that gets the next patient more slowly. So the Delta variant is more infectious. Right. More virulent. That R number is the number of patients that come from each patient. So if one patient produces six other cases, that's an R number of six. Now, if nobody comes in contact with anybody, right, the maximum lockdown, if you look at the blue line down there, the R number is 1.2. So each person infects 1.2 people. That's with only public health measures. In other words, you keep people getting anywhere near anybody else as much as you can. And not many will get next to anybody so that the people don't get sick. If you then add vaccines, which means that they transmit it less and carry it, they have less cases, this muddy car key one goes down there. The R number gets less than one. Once the R number is less than one, the total number of cases will decline. Once the number is above one, each case will infect more than one other case. And so the number of cases will slowly rise. And the size of the R number is how steep the rise is. And you can see it always gets more and more steep because it's a geometric progression. Two becomes four, becomes eight, becomes 16. Each time it doubles, it doubles bigger. So that is with public health measures. Now, if you have vaccines only, in other words, you let people breathe on each other, which is what boils down to, even with 80% of the total population vaccinated, if the vaccine is 60% efficient at making people not get sick, the graph goes up like that. And if you see the difference in vaccines only compared to public health measures, if you've got 80%, 85% of the total population vaccinated, you've effectively got 15% of them not vaccinated, right? And 15% is quite enough to transmit to people. So if someone goes out there, 15% of the people he or she meets will be able to be infected. And some of the others will be infected as well, although they won't get sick. You get a massive increase. The R number goes up to 2.9. If you've only got 64% of the population vaccinated, the R number becomes 3.7. So you have a very rapid right. So the people who think the vaccines can replace public health measures should look at this graph and see that it is an absurd proposition. You need public health measures and vaccines. And of course, you'll see these two graphs. One's at 64% vaccinated. The other one's 85%. They still go up very steeply because there's still a lot of people not vaccinated. Now, if we look at Australia's vaccination rate. Is there another graph that you want shown, Arthur? There's some numbers. I'm trying to find the right here. Here we are. Oh dear. I can't show it. Kathy hasn't got this one. I just talked about Australia's vaccination rate. It doesn't matter. Basically, Australia's vaccination rate is 93 doses per 100 people according to WHO. In other words, we've had 93 doses for each 100 people, which means on average, we've got less than one dose per person. 71% of the over 16s have had one dose. But that's only 57% of the whole population. You can't ignore the under 16s because they're great little spreaders. If the kids go off to school, a lot of them will get infected because they'll be socially probably more in contact with each other than at the average workplace. And they'll bring it home. If you've ever had a kid and the kid's gone to daycare, the minute the kid goes to daycare, the parents get every cold in the whole country because the little kid gets it from the other kids and brings it home. And of course, it's an intimate relationship you have with your kids. So if you've got an isolated home, but your kid goes to school, you have a wonderful conduit for the virus. So that when you say 71% or 70% of the other 16s are vaccinated, you've effectively got 30% not vaccinated. And then you've got 57% of the population as a whole not vaccinated with the kids spreading it. So it's very irresponsible. It's been 43% of the population have had no vaccine. Now, if it's just, it's simply not enough people. We've got 46% of the over 16s vaccinated, 46%, which is 37% of the population have had two doses, which means 63% have either had no dose or one dose. Now, that is not enough protection, quite simple. And if you go back to the previous graph, the idea that a vaccine can replace public health measures is absurd. And even with very high vaccination rates, you'll still get a big climb. And I think we have to go a bit longer. And of course, the thing stopping vaccination really is, the thing that's stopping is locking down is the government has abolished job keeper and job seeker at a realistic level. And the people who are most affected are the essential workers who of course often live paycheck to paycheck and haven't got any money. So effectively it's the government's unwillingness to subsidize it for a bit longer. And they want to open it, which saves them subsidizing and supposedly helps the budget. The cost of treating somebody is horrendous. The cost in intensive care of a person is extremely expensive, not to mention that they may die. Even if you look at the cost, it's extraordinary. And the labor intensiveness. And I mean, you have a 10% long COVID rate. So if somebody gets sick with COVID, 10% of them will have ongoing problems with their lungs and sometimes with their memory, with depression. The idea of simply saying, oh, well, we've got enough intensive care beds. We've got to open up sooner or later. We should wait until the vaccination rate is absolutely as high as we can. We should wait until the kids are vaccinated too. And I don't think that's impossible. If we can vaccinate a million people a week in New South Wales, it would take four or five weeks to get all the people who are willing to be vaccinated vaccinated. My own view is it should be compulsory. When I worked in New Zealand, I was going to work in Dunedin Hospital. And they said, have you had all your vaccines? And I said, I think so. Where's your certificates? Where's your record? 30 years ago, 30 years ago and maybe you can't. And they said no, well, if you better have them all. I said, well, no, they've had no job basically and that was regarded as 100% normal. And this idea that it's your civil right to be infectious is absurd, I think. And someone said, oh, you don't have to wear a seatbelt if you don't want it but it's an invasion of your private space? Well, that argument was had in the 1960s. And in 1970, Victoria was the first jurisdiction in the world to make seatbelts compulsory. It's all been accepted. The fascists haven't marched any faster because seatbelts are compulsory. So the idea that it's the thin end of a wedge, I think, is a nonsense argument. Yes, it does involve some personal risk, but the risk, the right to infect somebody is much less important than the right not to be infected. We had this argument of passive smoking, but this is much, much worse than passive smoking in that it's not transient. It's a permanent long-term infection that may kill the next person. And of course, the masks reduce the spread of small particles of liquid by about 85%. So the masks mostly help people who are infected not spread it to other people. The spread back the other way is only reduced about 15%. If it's in the air, it won't stop it coming in as well as it stops it going out because the droplets all end up inside the mask. So masks are very important also and must be ignored, but staying at home and staying distance is very important. So this rush to open things is very worrying. I think, yeah, if you look at the political situation, I think it's the big end of town telling the government what to do. And I think it's an extremely foolish thing and will end up in a disaster. I think we'll overdo the capacity of the health system or basically an unwillingness to hold on a bit longer. Okay. Thank you very much, Arthur. I've got a lot to think about there. And it's a really direct bit of information that people have to deal with. Can I now ask Professor Ian Hickey to switch on your microphone, Ian? And we'll hear your views. Yeah. And thanks for the opportunity. Normally, I'd be coming to you from the lands of the Gadigal people of the Oran Nation from my office at Sydney University. At the moment, like everybody else, I'm locked down. And it has become kind of interesting that mental health has suddenly appeared as the reason, the health reason to justify rapid removal of restrictions. As I wrote in the Sydney Morning Herald two weekends ago, the sudden interest in mental health is welcome, but the weaponization of mental health for mental health for political reasons is not welcome. And I think we need to look at what has happened over the course of the pandemic in terms of mental health and where we are now. So back at the start of the pandemic, myself and my colleagues at Sydney University, we're involved in a lot of modeling of the potential impacts of the pandemic on mental health and on suicide and suicidal behaviors. When you think about mental health, there are two main pillars on which our mental health and well-being individually and collectively stand. One is personal autonomy, being able to go about your business and an income, being good health, make choices about your life. But the other is social cohesion, the extent to which we can act collectively in our common interests. The pandemic represented a major threat to both of those, a major threat to job loss, to unemployment, to social disruption, to economic hardship, as well as being suddenly disconnect with each other, face the most threats, most things that we're really scared of. We huddle together and we respond collectively, certainly most acute stresses, bushfires, overwhelming events, disasters, people often come together and behave cohesively. However, the pandemic therefore represented a significant threat and you can model the virus as Arthur was just showing you in terms of his R numbers. You can actually model the mental health impacts. You can model the likely outcome in terms of suicidal behaviors, presentations to hospitals, deaths, etc. And that's exactly what we did. More importantly, you can make recommendations to government as Arthur was just showing for the virus, what you can actually do. So we're emphasizing at the start that things that really mattered were what turned out to be called job keeper, increasing the amount of job seeker, supporting housing, particularly the most vulnerable, supporting not foreclosing on mortgages, providing the social safety net to really work. It's interesting during the early phase of the pandemic, social inequity in Australia went down for the fastest rate that it ever had done in 30 years. We actually did stuff that we said it wasn't possible, put homeless people in hotels, kept people to their jobs, didn't allow people just to become unemployed but to participate at least for the start. Our recommendations to government based on that modelling is that job keeper in particular should have been continued not just beyond the September 2020 deadline as it was and not just beyond the April 2021 deadline but should have been continued throughout and should have continued right through to 2022 at least, even if modified in this exact form. Keeping people connected to their workplace is critical to social connection as well as the income support that flows. Other areas in terms of education support for young people and other areas were not so effectively supported and certainly support for casual workers, support for people who were not Australian citizens, support for women without assets and often in casual jobs often from non-English speaking backgrounds was largely absent from those government programs. So while government did some things that were useful it actually avoided doing other things which would have been quite useful too. One of the things about the mental health modelling that we predicted is that the impacts would not be short term. They were never just due to lockdown. They're complex in the social, the economic ways which I was just starting to describe and they have their biggest impacts on young people, those with less assets, those with less opportunity. So these kind of threats, these kind of social difficulties that we faced exacerbate the inequities that we already have and they hurt most those who are most vulnerable in the first place. The truth is in 2020, beyond the JobKeeper JobCigar issues from a specific mental health point of view government didn't do very much. It was waiting for the productivity commission report. It was waiting for the Victorian royal commission. We and others lobbied hard to include things in the initial response in the 2020 budget in October and the subsequent budgets to actually do a lot. In reality only the Victorian government under Dan Andrews which has committed $3.8 billion to mental health following this royal commission is anywhere near the size and scale of what's actually required at least at a state level to get the process going. The Commonwealth has talked about $2.3 billion over the next four years of mental health depending on an agreement that's currently negotiating with the states. So over the 18 months since the pandemic started if you ask what governments have actually done for mental health in terms of the economic bit JobKeeper JobCigar supports for the first six months and then JobKeeper for 12 months very important. Beyond that not much just awareness campaigns and hold each other's hands and sing Kumbaya and hope it all goes well. You know we all pull together but in fact do we all pull together not really as we've just seen in the Delta Australian experiences in Sydney those in Southwestern Sydney they've had completely different experiences so those who are already more vulnerable those who are already doing things tough those living in much more difficult circumstances many of those essential workers Arthur was just discussing have actually had to go and actually continue to work continue to earn a wage continue to live in ways that the society has not been very sensitive to and then they've had challenged about whether they're really behaving as Australians are they really pulling together. You know I've spoken to a lot of people from Muslim backgrounds from non-English speaking backgrounds who've felt really harshly that they have been blamed for the exacerbation of the situation in recent times when in fact as people recall the outbreak occurred in Eastern Sydney wasn't contained but has had its maximum impact on people's lives and deaths and disruption in Western and Southwestern Sydney and like many many other health issues it's hit hardest those with least resources with least assets and exacerbated the health inequalities so suddenly about three or four weeks ago in New South Wales and elsewhere around the country up pops the cheap psychiatrist up pops the we've got to end all this for the mental health consequences we've been going on about the mental health consequence rate in months nobody's really been listening but suddenly it's at the top of the agenda that it's the reason we've got to end all this and end it in a big hurry for the mental health consequences and for the kids who are being affected the kids are being affected disruption to school disruption to education disruption to social development the wider for all of us disruption is really important I'm the first to say that but there's also then what are the risks associated with rapid de-escalation of the public health measures and when you look at who I'm intrigued in the public messaging I've written also in The Herald about the extent to which white Anglo-Saxon males dominate the message sending the police sending the defence forces sending people in uniform to tell you what to do and often the language of our chief officers I need you and if it goes wrong it's your fault and that finger blaming often at people in southwestern Sydney if you don't stay home you're going to send the police and the ADF and the curfew and helicopters over the top because that's the problem as distinct from what you really need is communities to act collectively and together to understand the cultural and other differences that actually exist and the struggle that really exists for multi-generational families living in very different circumstances from many other people including myself who live in much more privileged circumstances and then who's really at risk if you rapidly remove the restrictions that we actually have in place before the vaccines arrive now before the vaccines arrive of course if we'd all been vaccinated much more quickly we'd be in a different set of issues long before but clearly the vaccine supply remember that wasn't a race it was a major problem but also who's had access to the vaccines even if they had arrived the apartment that I normally reside in in Sydney is right in the middle of the Alexander Waterloo the Waterloo Towers that have been shown on the news in the last 24 hours how it is that those groups of people have not had access to vaccines up to this point some of the most vulnerable people that's decided clearly at most risk you may or may not know that people with mental health along with particularly severe mental illness psychosis and severe depression if they catch COVID they're much more likely to be hospitalized and much more likely to die so when we talk about who's really at risk many of those people with pre-existing mental illness already have other issues I love this idea of underlying health conditions 41% of the population at least has underwhelmed under underlying health conditions and if you die you're one of those people who die but oh you had an underlying health condition somehow it doesn't matter so much of course those people with underlying health conditions are not only not only likely to be older they're likely to be poorer they're likely to have other comal conditions they're likely to have mental health problems and substance abuse conditions so we've entered into this weird discussion about the value of life depending on whether you have an underlying health condition or not now of course those who don't who tend to be younger who tend to be wealthier who tend to live in better suburbs in a particular way perhaps are more anxious to get back to their jobs their lives their unrestricted travel as they would like without much consideration of what might be the impact on everyone else who is going to get sick who is going to get overwhelmed who is going to die who needs to use the hospitals in southwestern and western Sydney that are much more under pressure than those on the northern beaches or in eastern Sydney or in the regional areas at the moment so there is a lot going on that's very hard to explain as to why mental health should get dragged out if you're interested actually in the mental health of people what you're interested in is the fastest possible but effective health solution to get our society back to where it was we're lucky in Australia to some degree that we've avoided the health disaster that did happen in Europe and the UK and in North America and particularly an interesting look at the UK and North America societies that have lost their fundamental social cohesion that couldn't respond and of course in the Trump years in the United States a complete disaster and still can't effectively respond to the Delta variant but who has been most affected by that which groups of the population have suffered the most in those particular kind of areas we have as I say been lucky to avoid that but in terms of the social and economic effects of the pandemic we see in Australia that as predicted the effects have mainly been on those who actually have not been so effectively supported by government who had less assets who were in casual work who were younger who were often from migrant backgrounds non-english speaking et cetera on an ongoing basis so at this point if you're really interested in the mental health of where we all go yes we've got to find a way to effectively but slowly and responsibly gradually remove restrictions in an effective way that does not put those who are more vulnerable at greater risk and allows that to happen clearly sitting behind that are two aspects one's access to vaccines and the proactive nature of that the government chose very much to go down an unusual path for vaccination very strong reliance on private providers through aged care on GPs and only partial providers on state-based hubs this is contrary to all of our previous work in national vaccination work but if you go through the states to start with and then require the states to make contact with those more vulnerable populations the more vulnerable populations guess what get vaccinated much more quickly we wouldn't be suddenly staring at the towers the housing towers in Waterloo and Alexandria tonight and wondering how it is that those people weren't further up the queue you wouldn't be wondering why in southwestern city the vaccination rates in non-English speaking communities nothing would be de-emphasized all the issues that Arthur discussed about access to health care if you use a private model or even the general practice model that we have favor those with higher health literacy with higher economic capability with better access to health care they've been prioritized so there are many examples where unfortunately the way that Australia's approached many of the key issues associated with the pandemic have only exacerbated those various health inequalities and social inequalities that exist beforehand and from a mental health point of view even more importantly they remain the issues so any notion that we have to rush to end quarantine to save people's mental health it's a nonsense it has been a nonsense from the start in any sense that everyone individually can take care of their mental health the famous thing that has become an Australian kind of another awareness campaign which is kind of nicely in ordinary times are you okay should have this year been are we okay and the answer would have been actually we're not okay we're really struggling all of us have actually struggled because we're disrupted to some degree and distressed and somewhat disorientated by the pandemic but collectively if you look at how we've responded as a nation we're not okay at all there's a national disintegration state against state Eastern Sydney versus Western Sydney Anglo-Saxon older English entitled versus non-English speaking migrant sort of backgrounds those are essential workers versus those in careers and those in their professions in various ways and now a pretty clear division of a fierce economic drive I had the pleasure of doing a podcast this week minding your mind which I'd like to advertise to all of you minding your mind which I do with James O'Occity we're talking about Ross Gittens the economist this week this notion that the economy is a holy grail that we all must worship actually the economy exists for us not the other way around we don't work for the economy the economy needs to work for us and when people are asked to trade off the economy versus their health or dying guess what they tend to choose staying alive and worry about the economy a bit later on and what you're seeing of course is play out in Western Australia and in Queensland and South Australia and Tasmania that's a large part of the country actually where they have the situation still relatively under control and the ACT fighting ferociously even though it's locked man locked in New South Wales to keep the Delta variant under control long enough for quarantine for vaccination rates to go up so they don't necessarily have the same degree of infection and hospitalization and death as New South Wales and Victoria now face guess what the population chooses that the population doesn't worship the economy it wants to stay safe if it can up to a point over a reasonable period no one in those states thinks that's forever it's not La La Land it's not forever everyone knows that eventually the nature of the virus and the pleasure of being on a Academy of Social Sciences a webinar recently with Peter Doherty the Nobel Prize winner he said look the Delta variants going to end up being like chicken pox okay it's a very infectious virus it spreads that's not really the question the question is have you got the situation under control have you actually dealt with the most vulnerable are those who are most at risk seriously protected by vaccination and then by continuing public health measures as appropriate sadly and I think we've seen this play out this last weekend I for the life of me can't figure out why those in the housing estates why those who are most at risk weren't prioritized a lot earlier why those with chronic mental health problems weren't prioritized a lot earlier why the state systems weren't reaching out to those people not relying them to come to hubs not to get themselves online if you can work it out and get yourself to home bush and figure it out and whether you really were prioritized or not that the most disadvantage way people would somehow find their way through that system to vaccination or we're in the circumstances where socialization is easy where it's not easy in those particular situations so I think what we've seen again is that great Australian laziness what could possibly go wrong and what we've seen is what can possibly go wrong when you don't proactively act cohesively and you don't reach out to those who are most at risk because when they're at risk guess what we're all at risk the notion that you can activate act individually and protect yourself or your family or those you don't wish to know because they live in a different part of the city or they come from a different cultural background or they suffer from mental illness or they're poor or they're disadvantaged guess what when they're unwell we're all unwell and from a mental health point of view I think that's my overarching message too is that actually I was asked at the stand of the pandemic did I think Australia's social fabric was intact that we would act collectively and a rather kind of you know trying not to be too miserable about it I said look I think so you know we kind of like mateship we kind of pull together we didn't do well in natural disasters we're generally fairly skeptical central government we're generally kind of cohesive but I think at this far in you've got to ask yourself have we actually done that well and I think actually the answer is not as well as we would have liked and if at this point we somehow use the excuse of mental health problems to justify putting many many more people at risk that need to be at risk and particularly that we put at risk some of the most disadvantaged members of our society then I think we really will have failed there's clearly a large push from that it's attributed to the business community it's attributed to certain forms of economics but that kind of economics worshiping that economic God it's a false God as Ross Giddens says the economy exists to serve us not the other way around our mental health and well-being is us and we need an economy to support it but actually we need to protect it so I think the issue is at the moment actually the safe and clear way to go is not to read into the Doherty Report anything you like the Doherty Report actually is quite conservative you get into the detail it's not an excuse 70% isn't 70% it's 56% as everybody knows there's a lot to be done with kids people aren't going to rush out and put their kids at risk and not put others at risk but more importantly not not more important than that but equally important in that is there's a whole lot of vulnerable people at risk whose voices are largely absent from much of this public discussion and I think events like the one we're participating in this evening need to continue to say that really matters and their mental health and well-being is our mental health and well-being and we all need to take responsibility for that thanks thank you very much Ian that was really brilliant I think and I I think it's a big challenge as we're all going to go into this next five weeks the pressure will really be on both ways I think so we'll go to the Q&A the first question I got was to Arthur I think with custom-built facilities historically speaking people were able to recover together and socialize together and hang on sorry Arthur what do you think about custom-built quarantine and hospitals for this COVID pandemic considering Australia does have a history of building such from the 1830s to deal with the many pandemics we have had in fact facilities in New South Wales, Queensland, Victoria and WA still exist have been fully restored included accommodation and on our tourist attractions could they be used in your opinion so over to you Arthur sorry I wasn't unmuted yeah well the manly quarantine stations lovely historically and it has three levels you know we're a steerage class middle class and upper class but the facilities are you know 150 years old or whatever it is I think to simply say to people well you know go for a team might be might be a little primitive but at a serious level I think the idea that we simply took big hotels and threw money at them and said you know you'd be with killed two birds with one stone we've made the rich people happy we've kept the hotels open and that's very good they're not designed for quarantine because the air flow is not isolated there's not HEPA filters between rooms just to make sure that the air is got all the particulates out which is what you really need I mean you're much better to have a tent city where all the tents are further apart than you are to have a hotel in the center of town really I mean there's no reason why we we've ignored infectious diseases for a very long time because they haven't been such a huge problem and I mean I know I mean I've worked for a lifetime in in medicine and I've never really had to worry about serious isolation you know there was the odd the odd ward which had an infected person or the odd person who needed reverse nursing where they had no immune system and we were going to infect them but that's been it's been a very small part of the hospital system for a very long time but a quarantine station needs to be built as a purpose-built thing with isolated isolated air pockets really and not too much contact between individuals then all the people at quarantine are not the same if they come off the same plane doesn't mean they're all infected and they can all just socialize some of them are infected and some are not even on the ship some are infected and some are not then you don't want to have the quarantine station infecting the lot saying right oh you can all wander around and infect each other and then you'd all stay until the last one gets over it that's not what you do you have to isolate them by the groups that they were in which are infected or not infected and keep them for the incubation period I think it's a disgrace that the government hasn't done that in all this time and all those people are stuck overseas and it's typical of the government now they're getting the private sector to fill it in 18 months later I mean it just says the way the government does everything now it's all for profit and we don't do anything if we could possibly avoid it and I think it's an indictment particularly of neoliberal governments lately but this one in particular thanks Arthur I don't know if you want to make a comment on that Ian but I've got another question here which brings out some of the other issues I think this is from somebody on the consortium news audience Ivor Mekton why don't we act on the data out of India that showed the success of Ivor Mekton treatment and then the increase of hospitalizations after the government banned it in favor of vaccines so we're dealing here with the controversy so who would like to sort of have a go at this problem that we are having in the whole debate you want to have a go Ian I actually leave that one to you Arthur but I'm happy to say I read I know look I'm a person who reads this stuff regularly and I take quite a lot of interest in what others have to say I'm afraid to say I think that person's information is not accurate want to go there yeah and I think it's a raised interesting thing misinformation about drug treatments about all sorts of things at the moment is right what fascinates me is the extent to which people believe it like you know running off to believe things I mean I understand the distrust in government generally speaking as a sort of a side to all of this what I have thought is unhelpful during this particular period just to make the politicization of mental health the politicization of our chief health officers of health officials of health advice I think it's also been very problematic well we don't have in Australia is actually things like the national institutes of health I mean Dr Fauci in the United States the national institutes of health national institutes of health is actually separate from government not a government it's not a government he's government paid official but his governance is separate what we found is chief health officer standing up next to premiers and things all the prime ministers all the time and sometimes a bit hard to tell because you know it confuses the public if their health advice from one chief health officer is completely different to another it's fine to open up it's fine not to open up it's fine to have this vaccine it's not fine to have that vaccine you know that creates real problems and I think that creates the environment of furthering the distrust that already exists in the wider world obviously there's something that's been fanned hugely out of the separatist politics of the United States and elsewhere in the world to distrust reasonable medical advice the reasonable medical advice about ivermectin at the moment is forget it the reasonable advice about vaccines we're lucky and I'm just people I think a bit forgetful if you go back a little more than a year it was a great and I'm I sat through academy of science meetings academy of other meetings there was a great deal of anxiety about whether we would have any effective vaccine you know most vaccines fail on the way to production the fact that we have actually a number of different vaccines all of which are effective they are different in their side effect profiles no vaccines ever been invented that didn't have side effects in a particular way in particular way they've been closely supervised the overwhelming benefits to us all a vaccination which is what public health and vaccinations all about it is just back protecting all of us in a particular way you know it's kind of interesting so the distrust of reasonable medical information and the promotion of nonsense and really harmful medical misinformation is really difficult really I think reflects rather sadly on the world that we do live in I think one of the things we're going to have to think about in Australia is how do you rekindle trust in actually good medical advice and I think actually we need to see a movement towards greater independence of the medical advice from the machinery of government the machinery of politics so that people are more trusting again of the medical advice which is advice it's not the decisions from the political decisions that people make as the elected representatives of us all okay thanks it's another question to both speakers are we to assume that this recent concern with mental health as an urgent priority is coming from the government that is starving people especially those who have low income and can't work from home to starve them back into the workplace is that is that a reasonable read I don't think it's aimed at particular people I think it's part of a basically ideological debate where you know people have worshiped the God of the economy whatever that is versus this idea of you know thinking and then other really interesting ideas that set of set behind it do you remember we couldn't afford it the debt do you remember the debt you know it suddenly last year forget the debt I was again very lucky this week doing a webinar with the governor of the reserve bank debt is just not a problem Australia is a very functional economy longer term the issues the reason you have what we have is when you have a crisis you need a government to spend money on the stuff that matters health care supporting jobs supporting it while we do everything we can to ride out that crisis so don't think it's actually sort of you know something you need to be paranoid about it's not aimed at a particular group it's ideological basically you know and behind that there are certainly businesses and let's face it there are lots of businesses that have been really severely effective you're in hospitality you're in tourism you're in a number of other creative arts and other industries this has been a disaster so there are lots of small businesses and other businesses and lots of bigger businesses in the airline industry and others who are in danger of collapsing you know so clearly clearly they all have an interest in the economy opening as soon as possible to get back to where they were of course there are others I mean I'm part of the higher education industry which no one seems to care about and in fact you know up to 40,000 jobs have been lost in higher education during this particular period government doesn't really like that I had a fascinating moment sharing with you I actually filled out the forms last year for JobKeeper on the basis that we in the university sector should because massive loss of overseas students and I have a nice secure job but we were all facing the situation I only be told by government you're not really a worker university academics forget it you know what useful work did you ever do you know you don't wear a high busy vest or a hard hat you know you're in trouble you know so the ideology of these things has run through many aspects of the pandemic and I think not to our national benefit in particular ways so I think the issue at the moment is the and anyone who's looked at the economics of this the better the health outcome the better the economic outcome if you screw the health outcome if you mess up the health outcome the worse the economic outcome so the tricky thing for governments and I wish we had a more sophisticated debate in Australia a more serious national if the national cabinet was actually a national cabinet a serious national consensus of course we need at some points to move to less restrictive environments but how do we do that in the safest way that puts the least number and particularly the least number of vulnerable people at risk as we go forward thank you very much Ian what about your comment on that question Arthur Oh I agree with Ian I mean that that's exactly right it's ridiculous ideology that you can run the economy and it doesn't matter what the health system does when you've got thousands of people dying at vast costs it's frankly absurd and very callous and the idea as Ian said we know last year we couldn't have any debt at all then we've got the biggest debt we've ever had in history and then we say oh now it's too big again you know we have to cut it back again so we and it's very much ideological I think you know that we mustn't have debt because you know it's bad to be in debt you you we basically have to keep the country running and if we keep the people at home who who have to stay there and I you know the the the way they've destroyed the higher education sector is vandalism beyond belief really but it's it's again part of this and the only thing that matters is money knowledge doesn't matter you know you can always get a cheap academic because there's so many of people educated so you know we don't care that ever you know as long as the education system makes a buck we don't really need it no much more than that you know I mean it's a it's an arrogance of management I think it came from the idea that the only thing matters is whether you can manage something to make money and if everything else is of trivial importance and if you can make money you know everything so you don't need experts you just get one in you know put out a tender get in and make you know it's this lack of respect for knowledge and and the idea that the money is the only thing that matters will not cut it if you make the wrong policy decisions in health particularly and this is the one we're talking about now if you make the wrong policy decisions a lot of people die if you think that's going to help the economy then you really don't understand things and I think the hubris of the Morrison government that thinks if you put out enough press releases today that they've forgotten the one yesterday the day before and you keep this stuff going eventually people forget because you've repeated it so much well that might be you might be able to influence perceptions but if a lot of people start dying who didn't have to you can put out as many press releases you like the people will be very angry and and quite justified and that's I'm afraid where we go okay thanks Arthur maybe I can bring it back to the the real situation we're facing in Sydney and New South Wales so now it's September 19 come October 25 the government seems to be saying we will be lifting the lockdowns we will have you know masks we will have some limits on numbers meeting but basically that's it so can you see any prospect of that basic decision being adjusted change for the better in terms of the problems you've you've both talked about rising numbers of cases in hospitals people's fear fear even of going out is there is there a scope that you see in our processes in New South Wales for that yes because you see it already so you know I was talking to colleagues on in Northern Rivers just earlier last week within a day Lizmore was shut down again you know so I think the what's it what's going to happen here is you're going to have the big kind of you know weave somehow set you all free to save the economy and save the business and get the kiddies back to school and then you're going to see actually region by region place by place it's not nearly as simple as that and depending what's happening around infection rates I mean my parents aren't going to simply rush their kids back to school either you know unvaccinated kids in particular ways particularly teenagers you know so yes schools might be open but how many kids are there you know like so I think and then and then of course it'd be the summer holidays three weeks later and you know the kids will be out of school actually again so I've opened the schools but the kids won't be at school I mean if you're serious you'd probably cancel the school holidays but it's a bit like canceling Christmas really you know it's not going to happen in a particular way I mean that's not really what's going on so I think you know we live in a weird kind of world of press releases of media cycles what's going on seriously behind that is the extent to which the public health systems are actually working are coping are supporting particular communities or not what happens in the hospitalization rates we haven't mentioned this evening but you know the immunization rates vaccination rates amongst indigenous people remain incredibly low they're incredibly vulnerable communities you know they're going to be decisions made that say oh look it's open but the little bits are shut or we haven't done that oh you know so I think you're we're going to see is the hoopla out of New South Wales now the national government that you know we're living with COVID it's all fine we rescued the economy jobs are back you know it's out of recession but actually from place to place and I think what would be interesting is compare the rhetoric in New South Wales and Victoria because in truth probably pretty similar things will be happening about trying to manage the gradual reduction in areas in the other states one of the problems is actually encouraging people to get vaccinated before they have significant delta outbreaks or exposures in those states but they've obviously still got some time on their hand so they will use border restrictions much more ferocious I think Mark McGowan's made that pretty clear in the end stage of palisade made that pretty clear works pretty well people want to stay alive you know it causes disruption you bet but you know no one wants to get really really sick and you know COVID isn't just the flu you know if you're unvaccinated you've got other health issues or whatever else it's really seriously dangerous so so weighing up those kind of issues is going to be and then the impacts on the health systems Arthur's talking about we don't have a lot of capacity in the health system we saw this last year the underinvestment in public health in Victoria really harmed Victoria the bits that aren't there when you can't see them you know they're not emergency rooms obviously but you know the public health infrastructure was seriously degraded in Victoria and it cost them a lot there's very little capacity in the in the in the health system a particular mental health system in any of our states and territories so we can't cope with too much more pressure than we ordinarily have and a whole lot of other bits of the health system have been cancelled or put on hold or suspended in particular ways so they're all sorts of impacts I think if you can if you can wade through the nonsense higher level rhetoric I think what's going to be more important is what is actually going on in different communities at different kind of periods and the real issue which I'm wish the government would pick up isn't 70% or whatever it's getting to much higher rates we're all much safer you know when 90% of the entire population is vaccinated including the kids and also it's 90% of everybody not 90% of the northern beaches or 90% of you know the wealthier areas or 90% of those with high socioeconomic risk or 90% of those who don't have underlying health conditions it's actually when it's 90% of all of us then you're in a different kind of situation of reducing transmission and in that sense living with COVID like we live with other really serious illnesses that we've been able to vaccinate against plus it was I thought quite quickly emphasised with the appropriate other public health measures when there's an outbreak and monitoring that very closely I think the danger is of course the danger is everyone else interprets the government rhetoric to mean your beauty it's all off and just resumes their normal life in a particular way and other government messaging which has been really unhelpful that a lot of the dangers which are indoors with poor ventilation in certain situations which are much more dangerous than on a beach or in a park or in other kind of areas you know gets confused in a particular way and then you get really serious outbreaks again in disadvantaged areas and workers in certain kinds of environment with people less autonomy and less kind of choices so what worries me is who's going to be most hurt by a fairly less a fair approach to this whole problem okay thank you Ian Arthur have you got some comment there no I agree with Ian I mean I think the government's hairy chested approach you know we're going to open up and this is our timetable and business needs certainty so they can timetable things and we're not going to vary from our path because you need certainty I mean this is just hairy chested nonsense and as Ian said they're going to have to eat away at the edges to try and stop this thing and if they don't I think frankly it's going to get disaster and all the submarines in the world won't distract from the problem we're going to have okay we're coming up to five minutes to go I've got a questions come through on my phone from Stephen in the Blue Mountains so he's saying are we he's asking are we at this point able to think about the next pandemic what have we learned really from this experience of these 18 months or 20 months that you know we shouldn't repeat and and what should we repeat for the next one and I guess we have to realize that you know we've seen Delta what about we see some other variant that's really difficult to manage you know 12 months from now well this is where the great Australian what could possibly go wrong problem arises again just to mention the webinar was on with the Academy of Social Sciences last week everyone across that field and this included economics sociology health was saying we've got to stop and reflect on what's gone wrong with this one but the chance that anyone in politics is going to stop and reflect with us got wrong with this one is nil you know we're going to run into a federal election fixed at all fine I mean as you said I mean we're not out of the COVID situation the way low vaccination rates in the situation in much of the developing world it's highly likely that other variants will develop and when they tend to vary proportion will tend to be more infectious than the previous one and if they win guess what we'll be back in the same problem again and whether or not the vaccines are as effective against new variants will be a huge problem again so I worry that one of the issues is the great Australian kind of oh well it's Christmas or whatever you know it was a bad year but let's move on we won't reflect on what have been the governmental failures the machine government failures perhaps more important most importantly though the social failure you know what are we you know what have we not learned about the society that we live in that we need to do differently I think the heroes of this pandemic and so written in or quoted in today's papers have been the non-government organizations the community organizations the local action people who've actually done really sensible things locally have learned a lot what we haven't been able to combine that with his sensible machinery of government particularly at the state and federal level in particular ways so that we do actually act more cohesively more in a more responsive way we of course we have the luxury of geography being an isolated island at this end of the earth we tend to get to see what happens first elsewhere but we haven't necessarily learned about ourselves along the way and to pick up at this point the hubris is unbelievable best in the world and what have we been we've been in front of the queue best in the world aren't we lucky you know boy we've made a few dodgy decisions along the way and errors I mean and to be fair to governments who wouldn't have made some errors along the way but really preparedness we you know we don't learn we were we had to had pandemic sort of scenarios before we hadn't done them for about a decade we weren't really prepared we hadn't really had the machinery of government in place so the questions are really serious one will we learn because there will be either in the short or longer term repeating situations like this they've been predicted and we've had with SARS previously we've had other particular types of things that have come close previously and in the global world in which we live I mean the idea the arrogance of the Europeans that the Chinese virus wouldn't get to Europe and the arrogance of the North Americans I happen to be in North America when Trump was going on about the China virus don't worry about the China virus there was only 15 cases at the time it'll die out you know like the arrogance of those particularly developed countries that somehow they'd be fine and wouldn't have to worry about the rest and be able to contain health the miracles of modern medicine would extinguish this bushfire really quickly you know I think unfortunately the world went to sleep and found the bushfire in the morning and burned the place down you know I think we need to learn it's a really serious question whether we have either the right leaders or the right mechanisms to learn what we need to learn thank you I think we'll go to the last question to Arthur is natural immunity from having caught the virus better or more durable than induced immunity from a vaccine well interestingly there's been a paper on this which says that the vaccine does better than than a previous infection which is counter-intuitive really you would expect the natural immunity to be to be better and they're saying that even if you've been infected you should still get vaccinated so that was an interesting point and I think probably people need to know that okay maybe there's time for one more this is from George is there any effort underway to collaborate with the Russian researchers who are developing a vaccine which actually blocks the transmission of the virus that's a very technical question I don't know if you've got it but my understanding is that the the Russians haven't made their data available and so the western medical assessment system if you want to put it that way hasn't really had anything to work with and is therefore poo-pooed it I mean you could be more paranoid and say it's all political but I think the lack of data I think if the data were available on both that and the Chinese viruses I think there would be people willing to look at it and obviously they'd have to apply in terms of getting approved by the relevant authorities but the lack of literature on it in the western press what can you say I mean if you believe in transparency in order to make decisions you have to say well you know if we have any data we can't say anything okay I can't say transparency matters for all of this so much there is actually work going on about all sorts of ways of interfering with the transmission of the virus things you can squirt up your nose things might apply and a number of the number of the vaccines already clearly interfere with the transmission of the virus to a degree so it's a huge amount of research going on worldwide but half as last point transparency matters to us all okay thank you very much I think we'll leave it there it's been a really good discussion and your presentations were very very helpful I think to our audience so thank you very much Professor Ian Hickey and Dr Arthur Chesterfield Evans we can't the applause but I'm applauding and I'll just remind everybody that the politics in the pub is on again this Tuesday night at six o'clock and the topic's quite different it's called energy moving to renewables another giant topic for our society and the the speaker is David Shoebridge MLC for the Greens in New South Wales so you're all welcome to come back for that thank you very much to Ian and Arthur and Kathy the whole team here thank you very much thanks