Questions for tomorrow's presser, pls consider!
1/ Vic CMO said y'day we might be the only nation using n95 masks on COVID wards. Considering it's widely known that Singapore, S.Korea, HK etc adopted this practice in MARCH, is it concerning that our top med officer isn't aware?
2/ How's the trial of isolating 'contacts of contacts' progressing in Kilmore progressing? Do you have plans to roll it out elsewhere? Are you considering significant $ incentives to encourage people to comply, as it might be difficult to convince contacts of contacts to isolate?
3/ Workplaces: Looking for infections in hi-risk settings is critical when we open. Gov announced asymptomatic testing of 95 such businesses 2 weeks ago.
But atm, owners can only ask 25% of workforce to be tested per month. How can we increase this? Can new antigen tests help?
4/ Hospitals: At box hill, where we have another outbreak, staff who've worked on a COVID ward can work a consecutive shift on a non-covid ward, when they might be incubating and transmitting the infection. Why aren't we co-horting staff so they only work on covid wards? &
If not possible, have you considered a buffer period of 2 weeks during which they can't work on non-covid wards?
Or even a 5 days buffer by which point 50% of infections would become apparent?

If THAT is impractical, simply a day 5 & 11 test after ending shifts on covid wards!
5/ There is growing recognition for the role of aerosol transmission, and it seems Vic government recognized this when they announced VENTILATION studies in Victorian hospitals a month ago. What have you heard about the results? When can we expect to hear findings?
6/ What is the origin of the hospital outbreak, a patient or staff member working on the COVID ward?
If answer is 'unknown' or staff: then how can the CMO yesterday on ABC radio dismiss the relevance of fit-testing of masks worn by staff on COVID wards? abc.net.au/radio/melbourn…
7/ @DanielAndrewsMP said recently he is not aware of what is happening in fed run aged care in Victoria as it's a fed/regulator's responsibility. However the aged care taskforce is a collaboration. What further measures would you like to see from feds to safeguard Victorians?
@bridgerollo @Raf_Epstein @sumeyyailanbey @andrew_lund @BlakeJohnson I hope you consider these questions. Thank you for your work, very grateful.
I do apologise, one of these is a bit of a 'gotcha' question. But the concern behind it is that top level officers are being misleading, or ignorant regarding infection prevention and control. I'd love for our cho/deputy cho, who are doing a great job, to set record straight.

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More from @drvyom

13 Oct
Stunning claim today by senior Vic health official today "We have the strongest PPE guidance...in the world.. one of the only, if not the only place I'm aware of where people are wearing them (N95 masks)... in our COVID wards".
But then: (1/n) abc.net.au/radio/melbourn…
These are the guidelines from Singapore General Hospital, laid out for the world to learn from in MARCH. (2/n)
ncbi.nlm.nih.gov/pmc/articles/P…
These are guidelines for Tan Tock Seng Hospital (3/n)
Read 11 tweets
13 Oct
What's the initial source of the Box Hill outbreak? Was it a patient, or a staff member who was previously working on a COVID ward? Do we know?
(This is relevant as staff's masks were not fit tested when working on the COVID ward. Nor were they 'co-horted') #covidvic #springst
@healthcare_19 @NeelaJan @an_leavy any news about origin? cmo dismissed that fit testing would've made a difference as he said outbreak was on general ward. but that assumes infection didn't originate from HCW who had been working on covid ward prior.
If the origins are uncertain then how can the Chief medical Officer state that fit testing of masks is irrelevant to the box hill outbreak, as he did this morning on abc radio???
Read 4 tweets
12 Oct
The tail is not stubborn. Its our reluctance to upgrade our #TestTraceIsolate and Infection prevention/Control in high risk settings that is holding us back.
How do we upgrade?
Testing - be far more flexible with our criteria for testing in outbreaks, ESPECIALLY with CASUAL contacts. And for both close/casual contacts we need to consider testing on day 5 as we know home based quarantine is flawed. Once lockdowns are over, tata.
Testing (more) - every casual contact/anyone who stepped foot on a ward during a hospital/aged care based outbreak should be tested on day 5, not people who spent more than 29 min there. Somehow this got through to Vic gov after days of questioning.
Read 11 tweets
12 Oct
Even @DanielAndrewsMP, not medically trained, sees the issue in a testing criteria of min. 30 min exposure in hospital outbreaks. The equivalent of dropping a Tim tam on the floor and saying “10 second rule lol” Why’d it take tweets/ journos asking to get this changed? #covidvic
DHHS is TOO RIGID with their approach. You don’t need to test every casual contact at a high exposure site. But you SHOULD test if
> there have been positive cases at that site who were casual contacts (Chadstone)
> indoor setting, small no. of ppl
> aged/healthcare
#covidvic
This is totally impractical with 700 cases a day. And yet a no-brainer with 6-15 cases a day.
Read 6 tweets
11 Oct
Fed gov caused the aged care disaster but I don’t ask for leadership changes in the middle of a pandemic.
Most docs, esp me, were v angry at Jenny Mikakos’ Multiple insults to the profession. No chorus of ‘resign’. We know the bigger problem is systems not people. Plus...
Those claiming I’m biased towards labor, ok let’s accept that.
But before you start waaawaahing, good luck trying to find another Doctor who has levelled more critiques of the Victorian approach.
What a weird for a true Laborite to do right? Daily, multiple critiques of the approach, since March.
Read 5 tweets
11 Oct
Let's exaggerate: Imagine each of the 9 location had 2000 people exposed as casual contacts.
Imagine we asked them to get tested, & 100% *actually* turn up on the SAME day.
That's 18K tests.
We were testing 30K/day recently.
Not saying we must test all, but can test *much* more
This is why those 30 minute limits on hospital outbreaks (which was insane) don't make sense.
This is why it *not* testing all the customers of the butcher in the infectious periods (1000 ppl max) when there was evidence of 2xCASUAL contact transmission doesn't make sense.
'proportionality' was not a great excuse in and of itself for either of these 2 examples.
Which is why, despite citing 'proportionality' a few days ago to justify the 30 min limit (maybe it was deputy?), CHO made the right call and asked for it to be changed today.
Read 4 tweets

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