What will living with COVID look like?

ISOBEL DEANE (PODCAST HOST)

Welcome. This is the Sydney Ideas podcast, bringing your talks and conversations featuring the best and brightest minds at the University of Sydney and beyond.

FENELLA KERNEBONE

Welcome to Sydney Ideas. This is the University of Sydney's public talks programme.

My name is Fenella Kernebone and I'm the head of programming for Sydney Ideas and thank you so much for joining us. Before we begin proceedings, I would firstly like to acknowledge and pay my respects to the traditional custodians of the lands on which we all meet, where we work, and, of course, where we share ideas.

And that is wherever you happen to be joining us online today. In particular, I pay my respects and acknowledge the Gadigal people of the Eora nation. It's on their ancestral lands that the University of Sydney is built.

And as we share our knowledge and our teaching and our learning, also our research practices within the university; m ay we also pay respects to the knowledge embedded forever, within the Aboriginal custodianship of country.

So today, we are hearing from a range of experts to consider what the roadmap to reopening is going to look like. It's drawing on the work of the Open Society Common Purpose taskforce that's hosted here at the University of Sydney.

To kick off today's conversation though, it is now my pleasure to welcome Mark Rigotti, who is the chair of the Open Society Common Purpose Task Force.

He is a partner and a senior advisor at Herbert Smith Freehills, where he is the immediate past CEO. Mark is going to say a couple of words of introduction, and then welcome our first guests. So thank you, Mark, over to you.

MARK RIGOTTI

Thank you very much Fenella and good evening everyone. It's great to be joining you. I am the Chair of the Open Society Common Purpose Task Force, which is an independent task force that was established in late 2020 in response to the COVID pandemic, to unpack how the pandemic is not only an enormous health challenge, but also a societal one.

Members come from a broad range of sectors and include the CEOs of the Law Council of Australia, PwC Australia, Settlement Services International, Sydney Symphony Orchestra and many academics from the University of Sydney.

Our report, A roadmap to reopening, was released earlier in this year in May, and it explored how Australia can reengage with the world in the era of COVID-19 and also how Australia can strengthen its societal foundations as it does so. It offers a psychological runway as we build a path to reopening. All links are on the Sydney Ideas website.

Monday this week saw the end of the lockdown in Sydney where I'm located; a lockdown that lasted more than 100 days, schools have been shut, businesses closed.

But with the easing of restrictions this week, particularly for those that are vaccinated, we hope that today's conversation will help each of us individually better understand what reopening means and what the next phase of the pandemic will bring both from a health and a political perspective.

Dr Luara Ferracioli is our moderator for today. She'll begin with a conversation featuring Dr Nick Coatsworth and Professor Marc Stears. Following this she'll moderate a panel with epidemiologists Professor Catherine Bennett, paediatrician and epidemiologist Professor Fiona Russell, and child and youth mental health expert, Professor Adam Guastella from the Brain and Mind Centre.

Thank you, and please welcome Dr Luara.

LUARA FERRACIOLI

Thank you Mark for introduction and good evening everyone. I'm Dr Luara Ferracioli, Senior Lecturer in Political Philosophy here at the University of Sydney. It's a real pleasure to be part of this event.

So today we're going to ask what will living with COVID look like? Now that we are reopening our state and starting this journey of living with the virus circulating in our community?

I would now like to welcome my first two guests, Dr Nick Coatsworth was one of Australia's Deputy Chief Medical Officers. He is an infectious disease physician, a respiratory physician, a practitioner of disaster humanitarian medicine, and an expert on high level health administration. He's also the Executive Director of the Medical Services Group at Canberra Health Services.

And Professor Marc Stears, a political theorist. He's the director of Sydney Policy Lab. Prior to this, he was a professor of Political Theory at the University of Oxford and he also worked as a chief speechwriter to the British Labour Party, under the leadership of Ed Miliband.

Welcome Nick and Marc.

Nick to you first, we have a very good sense of the freedoms and they will go to the vaccinated, and expectations are placed on the citizenry for the near future.

But I think many people are not so confident about the risks involved in this next phase. So let's start with children. What are the risks to children, the reopening be too risky for them?

NICK COATSWORTH

I think the first thing to say Luara, is that we can understand how concerning this must be for our community, because we've gone from an essential position of zero COVID, which effectively became a zero tolerance for COVID cases.

And in some parts of the country, it still is, to a situation where we are going to have this respiratory virus in our communities, and certainly for the three states that are affected New South Wales, the ACT and Victoria, that is the case now. It is important that we recognise where the risks are significant and where the risks are not so significant.

I think kids are a good place to start and there are people on this Sydney Ideas episode who are more qualified than me to talk about COVID-19 and kids. But if I can give you my perspective, and that is that we know from the Australian experience and the international experience, that COVID-19 is overwhelmingly a mild disease in under 12-year-old children.

To detect a positive vaccine effect is going to be extraordinarily difficult, because the disease is so mild already, and so the next big debates around whether we should be closing schools or just closing classes, or closing year groups or not closing anything at all with single cases of COVID-19 – these are where the debates are going to be.

And there's going to be a strong debate about whether under 12's should be vaccinated but we need to frame debates with the correct risk interpretation and certainly that's something that maybe we haven't been so good at doing.

We've overplayed a lot of risks where they haven't been as significant and children is certainly one of those. So I wanted to comfort everybody who's got kids like I do under 12 – that my view is that it is safe for us to open up and have those children back at school.

LUARA FERRACIOLI
Great. And how about the impact on the health system? Do you think for example, the health system here in New South Wales is ready for this next phase?

NICK COATSWORTH

By contrast, this is where we do have to be very careful and I think every jurisdiction realises that. From what I've seen, though, I wanted to let people know that I've worked on COVID wards, and in the past month, I've seen a different disease to the one that's in 2020.

Well, how can that be? And you keep telling us, Nick that the Delta variant is no different in terms of disease severity, etc, etc. And it's not. So what's changed?

What's changed is that in hospitals, we are much more comfortable in dealing with COVID-19. We're much more confident with our procedures. What's changed is that aside from people who are vaccinated who are in a much, much better position, this is now largely a disease, a severe disease of the unvaccinated

Of course, vaccinated people can still get COVID-19. But we have a range of other treatments as well. We have a new monoclonal antibody; this is a drug called sotrovimab, that if you give it within the first five days of symptoms to an unvaccinated individual, has a significant reduction in the incidence of ICU admission, intensive care admission or death.

And we've rolled out that to 70 patients here in the ACT, and only one of those has gone on to be hospitalised afterwards. So that's great news. So just wanted to emphasise that whilst we have to look at the capacity issues with our health system, that's the most important thing.

And the most important way to assess that is not by looking at the daily cases, they are now being decoupled from hospitalisations and intensive care admissions.

Both those things are going to be the important measures going forward and fortunately, as we know, in New South Wales, those curves have now started to come down again.

LUARA FERRACIOLI

And when it comes to looking forward, which country or countries do you think we should be emulating here in New South Wales? Now we were the envy of the world last year. But now which country do you think we should be looking at?

NICK COATSWORTH

Look, I still thinking a lot of ways Australia's out in front, maybe we're not like out in front like Ian Thorpe used to be in the 1,500 metres of the Olympics, but we're still out in front.

And we need to acknowledge that the community's done an amazing job I think. You got to get lessons from all around the world and temper those lessons and analogies with the fact that we are different, a different society and even within Australian communities, COVID is behaving differently.

Depending on which of your communities is infected, what's the density of your population? How many of your people can spend time outside? There's so many factors Luara.

And one of the things that frustrates me a lot is that when you see people comparing, and particularly people who paint a more gloom and doom scenario; trying to compare Australia with with countries where there are manifestly different policies, and manifestly different outcomes of COVID-19.

And one of the big ones at the moment is people will point you towards the effect of COVID-19 in children and horrible numbers that are seeming to appear in the United States, but pointing to states where vaccination rates amongst the adult population are extraordinarily low.

But using that analogy to justify certain policies amongst our children in Australia, and so just make that cautious point that it's very important to, you know, compare where it's necessary, beware of the power of analogy, question it and ultimately collect our own data.

LUARA FERRACIOLI

Right. So let's bring Marc to the discussion. Marc. Let's move to, let's tease out the connection between public health and politics.

Do you think that we're seeing a more exacerbated or different form of political polarisation as a result of COVID? And what effect do you think this polarisation around public health has had or will have on the health of our democracy?

MARC STEARS

Yeah, thank you so much, Luara. Thanks for being here, and it's great to be in a discussion with Nick and thanks to Nick for all of his work during the pandemic.

I mean, I think the brute truth here is that the pandemic has been politicised and polarised right from the start. And we've heard an awful lot, of course, about following the science when most politicians most of the time sadly, have done what they always do, which is that they've followed the focus groups or they've followed the electoral polling, you know, the primary instinct of most elected politicians still, not just here in Australia, but around the world, is to get re-elected, and to stay in front of their opposition parties.

And the pandemic has been no different from that, you know, there have been heroic policy successes, both here in Australia and elsewhere. But they have been tempered always by the fact that people, you know, politicians do politics that's deep in their DNA.

And you know, that, as I say, it's been there right from the start, I think you see an intensity to it now, because politicians are all trying to work out, what's the likely position, we're going to have in two months, three months, four months time.

I mean, they they all think of this, as you know, if not the full end game of the pandemic, then definitely a wholly different stage. And they're not quite sure what the public is looking for, what kinds of reassurances the public needs, and what's going to get them ahead.

And I think, you know, to come to your question of polarisation, I mean, it's an open question, I think about whether what we'll get is a new consensus, you know behind opening up and the kinds of policies that we've seen here, the new premier in New South Wales adopt, or whether we will see a sort of deep divide emerge between those people who are happy to open up, and those people who are much more anxious and would prefer to stay locked down.

You know, my personal instinct at the moment, is that the opinion polling here in Australia is pretty strong for opening up. And we're seeing some of the, you know, the previous advocates of lockdown move to a position which is more comfortable with opening.

So at the moment, you know, the politicians like Dominic Perrottet, have an advantage, I think, electorally. But you know, definitely all to play for and the politics could well take, you know, many twists and turns before we fully get out of the pandemic yet.

NICK COATSWORTH

Yeah, I might just add something there, Luara, which is that we can't underestimate the politics of science here.

And I think that a lot of time, science and scientists has been framed as somehow above this and able to provide a completely objective evidence.

And I think what we've actually seen is the positioning of certain scientists or infectious disease positions, or physicians or advocates behind certain political positions, and so we can't escape critique as the medical profession, and the scientific community for contributing to that polarisation in the debate.

And I think the the way out of that, though, is to capture something that Marc just said, which is there that fear is a powerful emotion.

And fear was used by a lot of people, myself included, and it was very scary in 2020. So to try and pivot the community away from that sort of fear response to the optimistic response is actually a really, really hard thing to do.

But I think all of us in the scientific community have a responsibility to do that. And particularly when we have, those of us have overestimated effects on a fairly consistent basis. It's important to take that back and explain.

Well, probably first acknowledge when people have been, when you've been wrong, that's a really important thing to do. And I'm not sure that we're entirely good at it as the scientific community,

LUARA FERRACIOLI

Let's stay on this topic, because as you mentioned, there has been, you know, alarmist rhetoric from some parties. And in a way, you can see why the media would amplify those voices.

And maybe those voices made more sense last year. And now it's time time for them to reassess some of their positions. But how do we now move to discussions that are more nuanced and balanced around things like we just mentioned with children or that, you know, the risks associated with, say, the AstraZeneca vaccine or the risks of contracting COVID when we're no longer in lockdown?

So basically how do we move away from these more alarmist rhetoric around COVID, that has become so prominent in Australia, and now, it's not letting us move at the right speed? Or at least not let everyone be at the right mindset for this next phase?

NICK COATSWORTH

We were both so keen to jump in there you go first, Marc.

MARC STEARS

It's a crucial question. I mean, my instinct, first of all, is that one of the reasons there's been such a sort of frenzied debate around COVID, in all the ways that you just described is because it's the only thing we've been allowed to debate for the last 18 to 19 months.

I mean, if you think about how the political news cycle usually works, a topic or an issue, we'll have three days most as the headline story, and then you move on to the next debate. So we're talking about education one minute, and the economy the next minute, and some local issue the next minute, and then a foreign policy issue the next.

Whereas we've all been consumed with COVID. And journalists, therefore, you know, and politicians, and as Nick was saying, you know, health experts all try and make this as exciting as they possibly can. And often, the doom and the gloom is the way that they get that media attention.

My instinct from looking elsewhere around the world is you get a more measured COVID debate, when it finds itself situated in other debates.

You know, so it's very important that we begin to think about mental health, unemployment, you know, sort of the nature of our economy. It's great to see people talking about environment and climate change issues, again, not turning away from COVID and pretending the pandemic doesn't exist, no one's suggesting that we pretend it's not there.

But situating it within a broader package of concerns that we all actually have as citizens of society today. So my encouragement for politicians of the journalists and for medics at the moment, is to try to place COVID in a broader context than we've been able to do during the pandemic up until this point.

NICK COATSWORTH

I think one of the issues from my perspective is that there's there's been this false dichotomy created between health which is represented by as fewer COVID cases as possible, I would hasten to add that is not health.

And the economy on the other side by which you have to make these binary decisions that if you open up, you're suddenly going to have 1000s of cases and I am noting, that with deep respect some of the comments that are coming in on on the chat at the moment, one of them in particular has referenced the number of deaths in New South Wales and attributing those to Liberal National Party policy.

Now, can I just clarify very clearly that we will not reach the number of COVID deaths in 2021 as we had influenza deaths in in 2017, which was 1126. But no one's turning around and blaming the liberal National Party for the 2017 flu pandemic.

And, you know, this is something that I have personally suffered, the only political party I've been a member of has been the ALP. I was the former president of a major multinational charity, Doctors Without Borders in Australia.

I'm not from the right side of politics. And yet, I think one of the distortions of this and you have to put the responsibility here on members of what we would call the progressive left in this society, some many of whom would fit into that category, people listening today, but have falsely dichotomised that and then what's happened is those voices that Marc thinks we should have parity that I think should have parity, the voices of teachers, the voices of mental health experts, the voices of human rights experts. I mean, what is the definition of human rights within a public health emergency?

These are the debates that we didn't have, that are important to now have and try and get ourselves away from that false dichotomy. There's no one in Australia who is looking for a Boris Johnson type, open up straightaway approach. Everything you see at the moment is measured and cautious and with the capacity of the health system in mind.

LUARA FERRACIOLI

All right, well, let's wrap up our discussion that has been so interesting, but looking forward, not so much the short term but perhaps 10, 20, 30 years from now.

Are we better prepared for future pandemics? Both In terms of the policy settings we have, but also in terms of the politics around. What do you think have you learned important lessons?

NICK COATSWORTH

Yeah, and look, indisputably the answer is yes, we and again, I refer to Ian Thorpe, we might not be that far ahead as we were in 2020. But I still think we're world leaders in this and we have learned a lot.

And I think one of the one of the key learnings I think, is that when we, when we do this, again, we need to have a very significant focus on the balance between public health and liberal democratic rights.

And in particular, we need to understand that when we make a particular policy setting, any policy setting is going to involve some winners, some losers, some overreach, but that we have to be very attuned as policymakers and public health leaders, that when we have situations where people can't visit funerals, or the story today or yesterday of the six year old with cerebral palsy, who's in a quarantine Hotel in New South Wales waiting to get to Queensland, that is a signal that our policy settings have over overreached.

And we need to be more adept and adaptable at pulling those back. And the problem is when you over regulate, you create so much burden of regulation that you have no flexibility to deal with the cases that matter like that one.

MARC STEARS

Yeah. And I think Nick's can put his finger on it's incredibly important points there. I mean, the only one I would add, is that we need to remember that pandemics are global by definition.

And, you know, this pandemic hit at exactly the wrong point in global politics when you had Donald Trump as the president of the United States, Boris Johnson as the Prime Minister of the UK, both reckless, but most importantly, nationalistic and narrowly focused on their own concerns.

And as a result, we didn't have a really proper internationalised response to what is fundamentally an international issue. And, you know, if I'm taking one learning from Australia, you know, we closed the borders, and in a way that worked it kept case numbers much lower than they would have been otherwise. But another way it didn't work, which it made us think that we could somehow deal with this issue ourselves, you know , our little homey Island separated off from the world could somehow beat the pandemic and we can't.

So next time we go into a situation like this, I hope that we'll have global leaders who are able to take a more globalised perspective. And that we'll all remember our international obligations, as well as our duties to our fellow citizens.

LUARA FERRACIOLI

Thank you so much, Nick, and Marc, it's been great to discuss these important issues with you and to our audience who have joined us today.

Thank you for joining this event. It's great to have your company. For more information about our speakers tonight and to access some of the resources, all the links on the Sydney Ideas website which we'll add to the chat now.

And now the second half of our event. A panel examining what we must do better in this next phase with three health experts to share their insights. First Professor Catherine Bennett, she's the Deakin’s Chair in epidemiology within the Deakin’s Institute for Health Transformation. She's a leading researcher and teacher in public health with a specific interest in infectious disease epidemiology and community transmission.

Also joining us today Professor Fiona Russell is a paediatrician epidemiologist and translation researcher. She's director of the Child and Adolescent Health PhD programme in the department of paediatrics at the University of Melbourne and is a member of the WHO Collaborating Centre for child and neonatal health researcher training and group leader for the Asia Pacific health research at the Murdoch Children's Research Institution.

Last but not least, Professor Adam Guastella is the Michael Crouch Chair in Child and Youth Mental Health. His position is based both at the University of Sydney and at the Sydney Children's Hospital at Westmead and the Brain and Mind Centre here at the University of Sydney. Welcome Catherine, Fiona and Adam.

CATHERINE BENNETT

Thanks for having us.

FIONA RUSSELL

Thanks, Luara.

LUARA FERRACIOLI

Catherine to you first. I think you have calmed many people's nerves this week with a great piece at the Sydney Morning Herald, where you put forward what I would describe as a moderately optimistic view of what life will look like for us.

But the critics might say, we're opening up too early. You know, we've read many of us have read statements such as sacrificing the vulnerable at the altar of freedom. What's your response to those criticisms?

CATHERINE BENNETT

I think it is interesting that there was a national plan set, and as we got closer to those benchmarks, particularly the vaccination benchmarks, people became more spooked by it, you know, looking at some of the things we're learning, we're actually a bit more worrying about Delta, for example, and the ability for the vaccines to to reduce transmission, for example.

But other things are actually good news, and often the good news didn't kind of make it into those conversations. So we learned from the National Centre for Immunisation Research that actually children weren't so good at sharing it, particularly amongst children, even if they were infected.

And so it was about trying to balance all the information coming in, and looking at where we stood on the plan. And I think that's, that's exactly why you have a plan so that you put the best information together, you actually update it if you need to. But at the same time, we knew there was, in fact, I think was the Victorian premier described it as a corridor, you kind of have to go through, or a gateway to get to the next part. And it was, by definition, going to include some uncertainty.

And I guess I would have thought of all the things we've learned, we've learned uncertainty, we've learned how to live with that, actually, for this last period, but this step really highlights how polarised the community has become.

And I think Nick talked about this earlier around, the scientists also becoming quite polarised in some areas. And I think if anything, if I describe my own time, over this 18 months, it's been about trying to sit with the data, which is usually in the middle, it's not extreme about opening up, now we've got to, can't just put cost of health against everything else.

But equally, it's not about staying locked down forever, it's trying to find that nuance. To try and learn what we can from our own data and to navigate this in a safe way. And now that's all we still can do.

That's the only way you bring people in from both sides. The people who are frustrated need to see us progressing towards something more normalised. But also, we have to do this in a way that acknowledges the anxiety that now sits with a large part of the community.

So I think encouraging these conversations in the middle ground, addressing people's fears, talking about what it's going to look like. But importantly, I think what I've tried to put in, in my vision statements as an epidemiologist about these next few months, it's also saying we're not going to have surprises, we'll be able to see how it's working.

And we're not committing to something that we can't adapt as we go, in fact, we should adapt as we go. And that it's not what we planned six months ago, could be terribly wrong, and we're all going to suffer for it. It's basically saying we're now learning from each other as we go.

And we use this week's information to form next week's decisions if we need to moderate it. And hopefully, that reassures people that we're not over committing to freedom. But at the same time, where we're doing this in an evidence based way, and you have to pull away from those polarised views and focus on the job at hand, because there's so much going on in this space at the moment.

LUARA FERRACIOLI

Fiona, can I bring it to the discussion? What do you think? Should we be feeling moderately optimistic? Do you have a different view on this?

FIONA RUSSELL

Look, I think we should be absolutely moderately optimistic with you know, otherwise, there's no point. I think I you know, we've been through so much and, um, you know, Victoria's got the world now of lockdown.

And do we really want to live like this forever? I don't think so. So I think we, you know, we can look towards, you know, I work in global health.

That's my area of work what I've been doing for two decades. So I always see what's going on in other countries. And I track them. And because we're, you know, as Nick has said, we're sort of maybe we're kind of ahead, but for the long haul, perhaps to some degree, and we can look at other countries and what's been going on in them that are kind of ahead and experiencing things ahead of us.

And so when it comes to schools, we can have a lot of confidence about things going ahead.

And being confident that, you know, we will certainly see lots of infections, there will be lots of outbreaks. But the kids by and large are going to be absolutely fine. We knew that last year, in fact, I mean, we knew that we had to keep proving it.

We absolutely knew that last year, except the alternative viewpoints, you know, got the media and schools were shot and it should never it should have never actually happened. I mean, initially we thought, well, we have to protect the children. We thought it was like flu.

And so we had to protect and close everything up and do it to you know, to protect the children from getting sick to the illness. But it became very clear very early on that the children were were spared of the worst worst of it.

However, we kept the kids you know, the schools closed in Victoria. And the reason for that was because it was thought that they were going to be infecting their grandparents, who were at that time at risk of the most severe disease and severe outcomes.

And so it was the children's rights and their learning opportunities, their mental health, their whole childhood was being put on hold to protect their grandparents and older people with comorbidities.

However, we knew we knew very early on from about August at least, that that wasn't actually the case that schools were contributing very little.

And we did the Victorian analysis of all the data that showed that with testing, tracing isolation, you could contain these things. And by and large, it's what's happening in the community that was you know, spilling over into the schools. By and large, we, you know, we we put together a plan, but you know, that was just sort of shelved, and nothing happened.

And so, unfortunately, then Delta came along, of course, and it's changed everything enormously. So again, we had to have a look and see, okay, what's happening with the children.

And again, we've got pretty good data now to show that it's not more severe. I mean, certainly, it's more common. It's more transmissible, that data that Catherine had mentioned from Sydney, we knew that last year, and when we knew that it was teachers, teacher to child, and very uncommon, you know, from child to child. And that's why outbreaks do occur.

And we expect them to happen when we open up. But again, we need to really learn from this experience going forward. So when children do go back, and they will mostly get infected, by and large, we have got mitigation measures in place to do as much as we can to prevent that and prevent children potentially taking it home.

But that's why it's so important that parents and teachers get vaccinated. So you know, the adults don't get sick. But by and large, it's a very mild infection in children and very uncommon, particularly for the primary schoolers who aren't vaccinated, to end up in any strife.

LUARA FERRACIOLI

So, I think many parents have received information similar to what you just said, and thought, okay, I'm going to calm my nerves and think about all the things that my children are missing out and send them to school.

But I think there's still some parents who, you know, despite having very healthy children are very nervous about sending their children to school.

And it's almost like we need politicians, and not only also our public health experts, but maybe experts in other areas, and not only mental health experts, but also philosophers and other people to point out, the children are missing out on the goods of childhood.

But it's not just about learning. When you get home, yes, you can learn. But when you go to school, you get to learn in a carefree way, you get to learn the civic virtues that will be so important later on. You get to have a bit of a normal life.

And you know, childhood is very short. It's only, you know, 10 years. So, do you think we need more leadership for our politicians who just say, enough is enough, children have so much costs on them. It's now time to really try and give their childhood back?

FIONA RUSSELL

Yes, look, you're absolutely right, Luara, it's been, you know, I can really understand the anxiety amongst parents, it's certainly completely understandable.

And it's new territory, it's new territory for everybody. We haven't experienced anything like this before we've been locked up, while Delta's out in community and all of a sudden, we're going to be let loose, and we'll be seeing lots of infections and our children will get coughs and colds and, and commonly will end up in hospital, although that will happen, but will be very uncommon.

So it's a new area for us, but we have to again, you know, look to see what's happened overseas. So Denmark, for example, probably one of the most successful countries that managed COVID.

They started their plan back in about February and so they opened up you know, the few grades and primary school in February when there was only 4% of people vaccinated. And the following month, they opened up all the classes and and they continued that you know, the whole year so they haven't closed them again, except for for for some holidays and things so and they've been doing absolutely fine and now they're one of the best.

The kids are back at school now. They're not wearing any masks. There's no social distancing. In fact, there's virtually no restrictions and so we can look forward to that, I would hope next year and so those you know, it takes a you know, really takes a village to raise a child and so the school is such an important part of a child's life and it's been very challenging for parents, particularly those in Victoria to manage,

you know, all the uncertainty for COVID, their businesses, their life, their work and then to be homeschooling as well and, to see the deterioration in their children which is, you know, which has just been devastating in fact, in terms of the mental health impacts and the loss of social skills and the skills of what children need, they need face to face to be able to learn and develop.

So yes, it's I think it's, parents will make those decisions, I hope, based on you know, what's best for their child, you know, in terms of the risk of infection, but how so important it is to get back and play and have some fun face to face and be a child.

LUARA FERRACIOLI

Adam, can I bring you here because you're doing a lot of reporting working to space by presenting the webinar series, Keeping the Kids in Mind, what do you think are the more serious mental health impacts that we need to attend to in this next phase of the pandemic, especially for young people?

ADAM GUASTELLA

I think the, to understand where we're going, we've got to understand where we're coming from, and the impact of lockdowns on mental health.

And the indirect impact of lockdowns on mental health has not been evenly distributed across the population. You know, there are some populations of children, whether they're from vulnerable backgrounds with neurodiverse needs or different communities with less financial supports, or with different housing arrangements, that have not had the same experiences of lockdown as others.

And their access to healthcare to mental health care, to other supports, has not been there and so this accumulation of impact has had a negative impact on many of those children and families. And so, in terms of moving out of lockdown, we need to make sure that we have the supports in place or to build those supports that haven't been there for the communities that need it and to prioritise those community's integration.

I mean, everyone is going to have anxiety. And that's normal given particularly what Nick's talked about in terms of the messaging that's come from COVID, as well as the changes in the loss of jobs and financial success for many families.

But this transition has to be built on hope, and a sense of control. And we will see families move into that space, and we predict succeed. And as people succeed, and as people see others succeed, the anxiety will reduce.

But it's also true, that these mental health effects that have occurred will not just quickly disappear for some families. Some of those things will experience extended mental health effects that will need support.

And I was interested to see the child and mental health wellbeing strategy released just yesterday, which we had some involvement in, and the critical need for integrated supports for families is going to be crucial during this time.

LUARA FERRACIOLI

So this strategy, is I take it a very important first step, is there anything missing? Is there anything else that politicians really need to attend to at this stage?

ADAM GUASTELLA

Well, you know, there's lots of things recommended in that strategy, which I completely agree with, and there needs to be investment behind it to provide support.

Things like access to care, increased training for health care professionals to provide services to the community, increased access, and schools during this time has become a community hub for the community.

So there will need to be increased support, particularly for schools, and I note the Victorian announcements regarding increased supports for counsellors, but we need those sorts of responses nationally.

LUARA FERRACIOLI

Great, well, let's move to a final question before we take the questions from our audience. Let's go back to you, Catherine, other countries are opening up or have already opened up fully, how practically and desirable is it for Australia to stay close to non citizens and just bring back citizens who are abroad?

And also how practical and desirable it is for states like Queensland and Western Australia to stay closed?

CATHERINE BENNETT

Yeah, I think it's interesting that we're in different places now. Even within Australia, it's um, you know, some of us were talking last year already about, actually many of the people associated with this webinar, about the need to have those big conversations about how we open up how we bring back things into balance.

But no one was really ready for it was really quite interesting. And one of the questions that kept stopping that conversation was, how many deaths are we willing to tolerate? And then it got too hard and people walked away from the conversation.

And I'd always thought that was a conversation that was happening in other parts of the world. It didn't typically happen here. When we have a disease, you're, you're trying to decide how much you can invest to reduce the impact of that disease.

You're not living in this belief that you can live without the disease with all these other extreme measures in place. So the the truth in New South Wales and Victoria ACT, and of course, New Zealand is that the virus is here.

And once Delta is embedded in the community, it's not going away. So it is about bringing it under control. And I just want to echo Adam's words, you know, we have to move to hope and control away from fear and uncertainty.

And that's definitely been my mantra for some time now and try to build that sense of the vaccines as part of that control. But our international border was an important part of the control initially. But I've felt that that's completely shifted as well.

And again, as Nick said earlier on some of the decisions being made, including those around the border about people coming to Australia and not being allowed to sit with their parents as they died, because there was some state rule about something and this was a fully vaccinated person willing to, you know, hire their own jet, and do all those things very safely.

We'd lost sight of what we were on about here, we'd apply these rules to the letter in a way that became inhumane. Now we're in a situation where arguably, someone fully vaccinated, coming on shore coming home, out of those 10s of 1000s of people still stuck overseas, there isn't an argument in Melbourne, and in New South Wales to keep those people held back.

We use home quarantine all the time, for people who actually have the virus in the community, when we have these big outbreaks, let alone their primary contacts.

The risk in someone from overseas is less than half a percent of them being positive. And in fact, only a very small percentage of cases were in fully vaccinated return travellers. So we must do that we must do that. Now.

That's just you know, a no brainer. Looking ahead, I think we've we've still got a lot of work to do with those people looking to come to Australia for good reason. Particularly, you know, I declare my bias that university students wishing to come back and be part of our vibrant University education programmes.

But also workers and all of others, we're now dealing with the issues around not having the expertise we need for some of our industries. So I think it's right to do it in steps. But at the end of the day, it's a levy, you know, the wall is in the middle. And whether that's overseas, and we say, well, we might still have some high risk countries, you might screen people in a different way, we might still want to quarantine people for a while if they're not vaccinated, or if they're carrying a variant that we're not sure about. It's on the concern list.

But equally, we have to then look at our internal borders, and the more New South Wales and Victoria, ACT become externally focused as we open up our international borders, you know, we can't lose sight of that conversation and the decisions that have to be made internally, because they've been too many families separated for too long.

And I'm hoping that, again, as others have said, as they watch what's happening in New South Wales, and Victoria, as they learn about the fact you can live with the virus and be in control, that that will actually motivate them.

At the moment, we're in the pool. We're swimming with the virus, we're trying to bring it under control as we get our vaccine levels up to that safe level that protects our ICU and hospitals and our people. The other states are kind of learning to swim standing beside an empty swimming pool. But they can look at us, you know, we will watch the Olympics, we will get motivated, we all think we can swim really well at the end of it.

But you know, at the end of the day, they are learning from us. And this experience in the East Coast is going to benefit the whole country. And hopefully that's going to be not just about, you know what they need to have in place for vaccination levels and the way they're going to tailor their contact tracing to suit the new world that we're learning about from New South Wales and Victoria.

All of those things will shift they can learn that. But hopefully it's that psychological approach to the virus that we start to normalise it, we start to put it in the suite of important infectious diseases we have to manage, but not ones that every member of the community has to manage every day.

LUARA FERRACIOLI

Right, this has been so great. Let's now move to the questions from our audience. So let's have a look at the top questions that have received the most attention.

So would Australia have been better off with a national strategy? Do we need to have a national strategy? Do we really need to be more forceful?

When it comes to bringing the other states to join in a way that's more meaningful in that we're all in the same swimming pool? To use your your analogy Catherine.

NICK COATSWORTH

Luara can I just make a quick comment on that? Very quick because I know we'll all have a view. I think we did start with a national approach.

I think the Australian Health Protection Principle Committee and the states, when there was a uniform wave across the country in March 2020, we actually did have that. I think the only way we could get that back in a future pandemic is for, this might even get me in trouble.

But for first ministers and health ministers to actually allow their Chief Health Officers to speak at the table of the AHPPC freely and frankly, and then take that advice back as consensus of advice of the AHPPC, the Australian Health Protection Principle Committee, which I can tell you fractured around about July of 2020, in terms of that consistency of advice, so the AHPPC needs to be strengthened again, make the AHPPC Great Again, that's what I would say.

LUARA FERRACIOLI

Fiona, Adam, and Catherine, any thoughts on this work?

CATHERINE BENNETT

Just to add to what Nick said, I actually think from a public health perspective, that consistency is everything.

And we're saying what we're doing is evidence based, and yet we're doing different things. And then that questions, that whole business of, of how the evidence is driving those decisions.

And that's incredibly important for public health, confidence. And no matter which way you look at this, from a public health perspective, it's the behaviours of the individuals, whether they get tested, whether they do isolate, whether they wear their mask, all of those things are what matters most.

And so you lose control of that if you start to create this sort of a debate nationally, that was exacerbated by some of the commentators as well, I think.

That then confuses this whole issue about what's evidence-based. So I absolutely think you should put all your best brains together.

And there's a lot of talk about having something like not a CDC, per se, but actually having an independent group of people, independent of government, that that can support the states, the CHO's, everybody and you just can then bring that together virtually quite quickly in a crisis. So what's the AHPPC, you know, on steroids? That's not a good analogy.

But you know, and I agree, I think, you know, working off that model, is the way to go and it will matter, right the way through to how people even perceive that we know what we're doing, and that they should buy into it, it'll make everything much more effective.

LUARA FERRACIOLI

Let's move to the second question in our list, because I really love that question. Do we think that COVID has permanently changed our society for better or worse? And how can we adapt to that? Has there been any permanent change that will become very salient to us as we move to the next phase? Any of you, Adam, Catherine?

CATHERINE BENNETT

Well, I'll just go quickly first, as an infectious disease epidemiologist, you kind of want everyone to just not go to work, if they have symptoms, all those little things that actually will make a difference to everyone's life.

And I think a lot of us have got used to not having a cold for at least one winter season and what's possible. So I do think there's been an awareness of infectious diseases that we'd forgotten about.

And we've built society now, particularly in Australia, in the big cities. That's the microbe heaven. And I think we've also learned that that has its weaknesses as well, whether you're in a public housing tower, or a quite an affluent tower, that has shared facilities, you know, all those things, we've actually created some challenges for ourselves.

So I think it has given us pause to really rethink how we live safely, particularly in the face of infectious diseases. And I do think some of that will carry forward.

I think we've changed in so many ways. It's academics, the whole research community. politicisation of all of this, you know, and the weaponisation actually, of epidemiology a lot of the time, some of these things are good, some of these are bad, but I actually think all perturbation is good if you learn from it, and move ahead, taking advantage of the things that actually maybe we plan on to but we could do better.

FIONA RUSSELL

Yeah, I'd like to just say something because I, you know, I'm normally a optimistic person. But I'm afraid in this regard. I think I'm quite pessimistic.

Last year, I was, you know, because again, my whole career is in global health. I was just so pleased for the first time ever, that people were interested in anything else apart from, you know, beyond our borders, and the health of people beyond our borders.

And I found that just such a important aspect to, you know, for us, as Australians to understand what's going on in the rest of the world. However, this year, and with 2021, and particularly now, our little microcosm has narrowed down again.

I think we've become very narrowed vision, and we can't look out to see you know, everybody else is doing this. You know, it's okay. You know, I know we have to be brave and it's anxious and we feel stressed and anxious about it. But other people are doing this too.

And we're doing this carefully and measured and things. So I think in that regard, the other thing that I have found also very disappointing is that we know as in all infectious diseases, it's a disease by and large of inequity, we've known that it is very visible.

You know, last year we were all outbreaks it was in the in Victoria was in the LGA's that are in the same this year. And it's been, you know, we had a vaccine this year, and so, so disappointing to see that our coverage in those areas was so low, you know, and Victoria, which is the number one hotspot of COVID, in Australia, had the second lowest coverage for our Indigenous population.

And so, and then the Northern Territory, I just saw a YouTube video of the North Northern Territory health minister almost in tears, saying how there's so much misinformation for the Indigenous communities, and that's why they're not getting vaccinated.

You know, the communications plan has been so poor, and the amount of effort. If getting off up on a Dyess is the way to inform what's going on, then it's a gross failure. So we have not been able to engage with our diverse community, and the inequity within that community, we know where the infections occur, and that's where all the resources have to go to.

And that hasn't happened. And so I found I found that very disappointing that we haven't learned from that. And even though it's shone, a blazing spotlight on this, it's been ignored,

LUARA FERRACIOLI

Almost time to bring our last speaker to join us. But Ada, I think we have a very good question for you here, which is for those that are still feeling hopeless, anxious and unsure about the future, what would you say to them?

ADAM GUASTELLA

Well, look, I mean, I just echo what was said over and over again, it's totally normal to feel anxious in the current circumstances. You know, never in the entire time that I've been a clinical psychologist have I said that 'you don't need to worry about that.'

And they've gone 'thank you very much I'm out of here'. We need to understand what they're anxious about. And then to put strategies in place to deal with the things that give them concern, and also to give them control, and also for kids and for families.

So, you know, I think there's no point dismissing the fear. But there is a point to start thinking about, what are the strategies that give you hope, give your family strategies to succeed in the future.

And if you can't develop those, look to others for support, just to go back to Fiona's comments, I do have some hope. There's been a lot of talk about community. And there's been a lot of talk about looking after each other. And I really hope that rhetoric isn't just rhetoric long term.

But actually, as a community, we take the lessons, we've never had a pandemic like this, while I've been alive, our society has been challenged in a way like it's never been challenged, like this, that I've been aware of.

And so there are lots of learnings we can take from this and one of one of those things is that we do need to come together as a community to have the support services that look after each other in place, so that if this does happen, again, we can buffer those negative effects.

We know that communities and countries that have very good support services, whether it's health services, mental health services, they experience much lower rates of mental health problems than communities that did not we can take we can take from that and make sure those services are in place more effectively in the future.

LUARA FERRACIOLI

Thank you to our speakers, Catherine Bennett, Fiona Russell and Adam Guastella, for joining us tonight and sharing your insights. My name is Luara Ferracioli and it's been a pleasure to moderate tonight's conversation.

Before we say goodbye, let me hand over to Professor Tim Soutphommasane, the Director of Cultural Strategy at the University of Sydney, and Professor of Practice, both in sociology and political theory within the School of Social Political Sciences for final words. Over to you, Tim.

TIM SOUTPHOMMASANE

Thank you, Luara, and what a conversation we've had this evening and I want to begin by thanking Luara for guiding the conversation so deftly, and so wonderfully, and to our amazing all-star cast of speakers to Nick, Marc, Catherine, Fiona, Adam, a big thank you and thank you to all of you in the audience tonight as well, both on zoom and also on LinkedIn for the questions that you've sent through.

We've covered so much ground tonight, including the politics of COVID, the politics of science, human rights, mental health, the wellbeing of children, I can go on. And there were so many important insights but a fewreally struck me as I was listening to the contributions.

So one is that it's very clear that the world we're in right now in 2021 is a very different one, to the one that we were in during 2020. And we're obviously in a transition from being in a COVID zero world in Australia, to having to live with COVID.

And the pandemic will become, as some of our speakers have said, really a pandemic of the unvaccinated. Also really clear, too, that the polarisation we've had in our public debate, the past 18 months may have prevented us from learning some of the right lessons from experiences overseas, it's important that we do reflect on what other countries have got right.

And finally, while it's understandable, there is fear and anxiety out in the community, at the moment, we've got to move to a mindset of hope, and control and neutralise the virus.

Well, this conversation tonight, friends has been an extension of some of the work that we've done on the Open Society Common Purpose Task Force, and we set ourselves and that task force has a number of tasks, one of which was to create a psychological runway for Australia to reopen our society and re engage with the world to have a more proportionate public conversation about COVID and its risks and burdens.

And also to broaden public understanding of the issue to ensure that we appreciate this is not just a public health crisis but presents a broader societal challenge to our community. Make no mistake, there's an enormous task for us to rebuild right now.

And it will require a great deal of hope, ambition, guided by science and balancing the risks, but I hope that you get from the event tonight from our speakers, a model of how this can be done. So once again, thank you to Luara and to our speakers and on behalf of all of our panellists in Sydney Ideas.

Thank you to you for joining us and we hope to see you again at the University of Sydney for another conversation with Sydney Ideas.

ISOBEL DEANE (PODCAST HOST)

Thanks for listening to the Sydney Ideas podcast. For more links, resources or the transcript, head to the Sydney Ideas website or subscribe to Sydney Ideas using your favourite podcast app.

Audio transcript

Mental health and support

Professor Catherine Bennett, epidemiologist, Deakin University

Dr Nick Coatsworth, infectious disease physician, ANU

Dr Luara Ferracioli, Senior Lecturer in Political Philosophy, The University of Sydney

Professor Adam Guastella, Michael Crouch Chair in Child and Youth Mental Health, University of Sydney

Professor Fiona Russell, paediatrician and epidemiologist, The University of Melbourne

Mark Rigotti, Senior Adviser at Herbert Smith Freehills

Professor Tim Soutphommasane, political theorist, The University of Sydney

Professor Marc Stears, Director of Sydney Policy Lab, The University of Sydney

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