Four Corners

30 March 2020

Pandemic

SCOTT MORRISON, PRIME MINISTER OF AUSTRALIA:

We're a strong nation, we're a strong people and in the months ahead we're going to find out just how strong we are. The health battle is the main battle that we face. The health battle is the battle that all Australians are enlisted in as we fight this virus.

SEAN NICHOLLS, REPORTER:

Australia, like much of the world. Is now on a war footing, for the fight against Coronavirus.

NORMAN SWAN, HOST, RN Health Report:

I think it's reasonable to draw an analogy here with wartime. If you're a general commanding a brigade or whatever, you plan for a battle and how many casualties you're prepared to accept. And that's what this is about.

SEAN NICHOLS, REPORTER:

Cities, towns and suburbs are in virtual lockdown, while health workers around the county prepare for an onslaught.

PROF. SHARON LEWIN, Director, Doherty Institute:

Every person, every infected person infects two others, so you can imagine how quickly that will grow.

PROF. KIRSTY BUISING, Director, Victoria Infectious Diseases Service, Royal Melb. Hospital:

For the staff, people on my team, the people here at the hospital, this is going to be one of the toughest years of our lives.

SEAN NICHOLLS, REPORTER:

But were Australian authorities too slow to act? And did we waste precious time tackling the pandemic?

REPORTER:

What kind of screening was there of passengers like you arriving from the United States?

BONETA-MARIE MABO:

Oh there was no screening. Nothing, nothing at all.

DR ANDREW MILLER, President, Australian Medical Association WA:

It's an incredibly inefficient system and we're not surprised that the response has been to have mixed messages, conflicting messages from different levels of government, lots of committee meetings, lots of teleconferences, additional layers of bureaucracy imposed, people unable to decide who it is that's going to make a particular decision.

SEAN NICHOLLS, REPORTER:

Tonight on Four Corners, the story of how the viral outbreak in China grew into a global pandemic. We investigate how COVID 19 arrived in Australia, how it spread and whether Australia is winning the fight to contain it.

The coronavirus outbreak began in the city of Wuhan, China, in late 2019.

Within weeks it was out of control ... and about to be unleashed on the rest of the world.

DR ANDREW MILLER, President, Australian Medical Association WA:

I felt sick in the pit of my stomach, because I'd been following this, uh, since the start of January. And I remember seeing a tweet that came through about 27 cases of an unusual pneumonia that had been found in Wuhan, associated with a fish market there, and there was some reference to maybe SARS. And since that time I was following it, and what's chilling to me now is that that was 12 weeks ago, and in that time, the world's been turned upside down as a result.

SEAN NICHOLLS, REPORTER: On January 13, in Thailand, a Chinese tourist from Wuhan became the first confirmed case outside of China.

PROF. DALE FISHER, Chair, WHO Global Outbreak Alert and Response Network:

This is a highly transmissible disease. It's novel. So there's no immunity in anyone in the world. It's got a reasonably high death toll and is happening when the world is at its most connected ever. Whether there's ships, planes, millions of people traveling everywhere. It started in Wuhan. So people traveling out of Wuhan and Hubei province were exporting it. But then as soon as it went to other cities around the world, epicentres of disease spread occurred and then people from those cities became the exporters of the virus.

SEAN NICHOLLS, REPORTER: Within days, a second case outside China was detected, this time in Japan.

The man in his 30s had also recently been to Wuhan.

PROF. SHARON LEWIN, Director, Doherty Institute:

Around mid-January, there were three case reports, two from Thailand, one from Japan and at that time there was a calculation or modelling done of how many flights go in and out of Wuhan to have accounted for three cases outside. And that, that modelling said there must have been at least 1,700 cases in Wuhan and at the time, the reports were that there were 40 cases in Wuhan. So, there was already a lot more human to human spread that may not have even been, people had been aware of. So, um, there had already been a lot of travel outside of Wuhan, probably with people with relatively mild symptoms or even asymptomatic, all over the world by that stage.

NORMAN SWAN, HOST, RN Health Report:

Inevitably we were going to get our first case, inevitably it had to be from China. But still, China was hiding things and it was hard to know what was going on. And I don't think we did too badly, but we could have known, and we should have known, that it was going to take off quickly around the world and the demand for testing kits and other things was going to be huge.

SEAN NICHOLLS, REPORTER: From its origins in China, over the next two weeks cases of coronavirus were diagnosed in 20 countries.

PROF. SHARON LEWIN, Director, Doherty Institute:

Well, I've always, always thought we would see cases in Australia because of the high travel between China and Australia, large amounts of tourism, lots of Chinese students here. Um, there was no reason why, um, we were going to be protected.

SEAN NICHOLLS, REPORTER: Coronavirus arrived in Australia on board China Southern Airlines flight 321 from Guangzhou which flew into Melbourne on January 19.

Five days later, a 58-year-old passenger from that flight went to Monash medical centre on the advice of a GP.

He complained of having a fever, cough and shortness of breath.

RHONDA STUART, Head of Infection Protection, Monash Medical Centre:

We were warned about him coming because there were actually, the family were quite well aware of what was going on in Wuhan. He was a person that lived in Wuhan and came across to visit his relatives, so they were really well aware of what was going on in their home country. And he was well prepared. He actually phoned ahead, came to the emergency department wearing a mask, advised us that he thought he might have the virus, so all the streamlines that were put into place to manage him started from the day he turned up at the door.

SEAN NICHOLLS, REPORTER: Monash staff took him straight to emergency.

RHONDA STUART, Head of Infection Protection, Monash Medical Centre:

So, as soon as he came to the emergency department, a mask was put on him and he was streamlining to a room, in a single room, negative pressure chatted to about his illness. With staff were wearing the full PPE, the personal protective equipment and then we undertook the testing, which was the- the test in the back of the nose and that's a Pharyngeal test, and he was actually admitted into the ward because we thought that he needed to be observed in case he did deteriorate.

SEAN NICHOLLS, REPORTER: The next day, the test came back positive for the virus.

Rhonda Stuart immediately called the health department.

RHONDA STUART, Head of Infection Protection, Monash Medical Centre:

So, there's lots of messaging going around and of course, there was an escalation process within our health services as well. I think the reaction to the first call about our first case was okay, here we go. We've got this first case. We're just going to deal with it now.

SEAN NICHOLLS, REPORTER: The same day three more people were diagnosed in Sydney ... all had flown in from Wuhan.

NORMAN SWAN, HOST, RN Health Report:

January 25th was less than a month after the first cases in China. China was going pear shaped, but we hadn't had much information out of it, they kept it hidden, so it was really just beginning. There wasn't a lot of time to prepare, a lot of ignorance, lack of knowledge about the virus.

SEAN NICHOLLS, REPORTER: Two days later, a 21-year-old woman from Wuhan studying at the University of NSW tested positive.

The same week, on the Queensland Gold Coast, a tour group flew in from Wuhan.

A man and woman from the tour group tested positive for coronavirus and were taken to a Gold Coast hospital.

PROF. DALE FISHER, Chair, WHO Global Outbreak Alert and Response Network:

All those early cases from China were travellers from Wuhan and Hubei province. The very vast majority and that's why one of the very earliest restrictions was to limit travel from there. In fact, China was very fast to limit movement out of Wuhan and Hubei. Because they could see that that was really the source of the spread.

SEAN NICHOLLS, REPORTER: With infections outside China surging, the World Health Organisation declared a global emergency.

TEDROS GHEBRANIOUS: We must all act together to limit further spread. The vast majority of cases outside china have a travel history to Wuhan or contact with someone with the travel history to Wuhan.

SEAN NICHOLLS, REPORTER: In late January, after Australian scientists isolated the virus, a team at the CSIRO's Animal Health Laboratory began growing it in their lab.

But the experts warned it could take 18 months to develop a vaccine.

Meanwhile, epidemiologists began preparing for the worst-case scenario.

PROF. RAINA MacINTYRE Head, Kirby Institute's Biosecurity Program, UNSW

In a worst-case scenario, maybe 50% of our population might get infected. So you work out the numbers then in terms of how many people are going to die and then how many people are going to need hospital. We know that about 20% of everyone who gets infected gets seriously ill and needs a hospital bed and some of them need an intensive care bed. According to the modelling we've done for other serious infections, you will rapidly run out of the capacity to treat people and to provide high levels of intensive care if we've got 20 to 50% of the Australian population infected.

SEAN NICHOLLS, REPORTER: In the United States, the Trump administration announced a ban on all foreigners travelling from China.

Officials were at pains to play down the danger.

Alex M. Aza II, U.S. Health and human services secretary: I want to stress. The risk of infection for Americans remains low. And with these and our previous actions we are working to keep the risk low.

SEAN NICHOLLS, REPORTER: The next day, Australia imposed its own China travel ban.

SCOTT MORRISON: To substantially reduce the volume of travellers coming from mainland China they recommend additional border measures implemented, deny entry to Australia for people who have left or transited through mainland China from the 1st of February today.

REPORTER: In hindsight, did Australia act quickly and decisively enough?

PROF. BRENDAN MURPHY, Chief Medical Officer:

I think what we did was put in border measures fairly quickly. We started screening flights from Wuhan, and then China locked down the whole of Hubei Province. We had 15 cases who came out of Wuhan from before they locked down. We were very keen to protect our borders, and we did that. We've had one of the most rigorous border restrictions where we introduced travel bans from all of mainland China

PROF. SHARON LEWIN, Director, Doherty Institute:

By that stage, there had already been a lot of travel, enormous amounts of travel, to all parts of the world, and that's how it got around. I mean, you know, you just need one case. We know that the reproductive ratio for this virus is what we call something called the as zero, the number of people that each person infects, and on average, it's 2.2, 2.6. Every person, every infected person will infect two others, so you can imagine how quickly that will grow.

NORMAN SWAN, HOST, RN Health Report:

The travel ban with China was actually one of the best things that we've done, and it was done pretty promptly. And the mathematical modelling suggests that we would have had almost double the number of cases in Australia had we not done that.

SEAN NICHOLLS, REPORTER: In Singapore the rising number of global infections prompted swift government action.

PROF. DALE FISHER, Chair, National Infection Prevention & Control committee, Singapore:

We isolate them, we do take them out of society until they're clear through to negative throat swabs. Contacts are aggressively sought after, and this is done through interviews, through checking CCTV, things like this. And if you are at close contact, you're put in quarantine and that is strongly enforced.

BILL BOWTELL Strategic Health Policy Consultant, UNSW

Singapore was one of a number of countries adjacent to China who had a folk memory of SARS and MERS, the eruption of those problems. And I think the government of Singapore, the people of Singapore, all the institutions understood very quickly what they might have to do in relation to the emergence of the coronavirus. So, they had a plan ready to go, well thought through, well-resourced, everybody knew what to do. There was clarity and simplicity of structure and they responded extremely well.

SEAN NICHOLLS, REPORTER: In February 21, Italy recorded its first death from coronavirus.

The same day a cluster of 15 cases was confirmed in the northern region of Lombardy.

NORMAN SWAN, HOST, RN Health Report:

What went wrong in Italy is that they were asleep at the wheel and the infection was spreading when they knew that they should have been at risk and be alert to the process. And they started getting cases and they thought it was the flu and they just responded too late. And by the time they responded and it was too late. If you're not doing testing and you don't know what's going on, it's spreading through the community and there's a lot of people with it and that what you've got now doesn't tell you what's going to happen in two weeks time because you don't know the speed at which it's increasing.

SEAN NICHOLLS, REPORTER: In Iran the virus was also spreading undetected.

PROF. SHARON LEWIN, Director, Doherty Institute:

The next country that was hit was actually Iran and that was very worrying because Iran first reported deaths. And on average it takes about three weeks to die with coronavirus so if they're reporting deaths there must've been at last three weeks of circulation in the community.

SEAN NICHOLLS, REPORTER: On February 23, Iranian-born beautician Roya Ovisi flew home from Tehran into Queensland's Gold Coast, unwittingly bringing COVID 19 with her.

She went to a Gold Coast hospital to be tested ... the next day the result came back positive.

ROYA OVISI:

I burst into tears because I was so shocked. Then, they told me, "We will send an ambulance for you right now." So they'll come to take you to the hospital. I was so upset that I rang my son and I said it in tears that I have contracted Corona. Well, my son tried to calm me down. But, nevertheless I was upset as I had been in contact with people. I had looked after my clients.

SEAN NICHOLLS, REPORTER: After 19 days in hospital, Roya Ovisi had recovered and returned to her gold coast home.

ROYA OVISI:

I, myself, in fact was a witness to it in Iran. They hid it from Iranian people for about one and a half or two months. And they didn't tell people, that this disease actually exists in Iran and many people were sick. Many had lost their lives.

JOHN DALEY, Chief Executive, Grattan Institute:

So far I think we have been very slow to close our borders, so although we work relatively quick off the mark in terms of constraining travel from Wuhan where the epidemic originated, we were pretty slow to close our borders to traffic from anywhere else at a point that it was obvious that many other countries in the world had a significant number of cases on, of the virus and therefore, and indeed this is exactly what turned out, a lot of people got off planes in Australia allegedly went into self-isolation, in practise wound up infecting plenty of other people in Australia and now we have a significant number of cases in the community, which means that we have got no chance of tracking and tracing them all. So we should have closed the borders much earlier than we did.

PROF. BRENDAN MURPHY, Chief Medical Officer:

The border measures thing is a very debated area. The World Health Organization has never supported travel restrictions at all. We took the view, and we have not done much in the past, we took the view that the risk of this was so high that we put in travel restrictions more extensive than just about any country in the world.

SEAN NICHOLLS, REPORTER: On February 27 in Australia, Scott Morrison announced the government was bracing for an escalation.

SCOTT MORRISON: Based on the expert Medical advice we have received there is every indication the world will soon enter a pandemic phase of the coronavirus and as a result we have agreed today and initiated the implementation of the 'coronavirus emergency response plan'.

SEAN NICHOLLS, REPORTER: Despite the growing emergency, Australians were assured there was no need for drastic measures.

SCOTT MORRISON: there is no need for us to be moving to have mass gatherings of people stop. You can still go to the cricket and football and play with your friends down the street. You can go to the concert and go out for a Chinese meal. You can do all of these things because Australia has acted quickly.

BILL BOWTELL Strategic Health Policy Consultant, UNSW

The comments made at that time by the prime minister, the minister of health, the chief medical officer, were not, to me, logical and not conveying really a sense of urgency or commitment to look very closely at what was being done in comparable countries. So in my view, something was very wrong.

NORMAN SWAN, HOST, RN Health Report:

I think the messaging and the planning at that point in Australia was in a mess. I believe that what's been happening until recently is public relations Valium. Politicians, leaders, medical officers have been trying to just not panic people. "It's going to be okay. Trust us, it's fine.

DR ANDREW MILLER, President, Australian Medical Association WA:

Part of the mixed messaging was the, the problem that the way that our media and politics works is that everyone comments on everything pretty much. And they're just in that cycle of dealing with things, with putting the spin on it that suits the particular person who's delivering the message. And they have a lot of media advisors who are telling them what to say. That's not the way to deal with a health crisis.

SEAN NICHOLLS, REPORTER: Two days later the first case of community transmission of the virus was confirmed.

PROF. DALE FISHER, Chair, WHO Global Outbreak Alert and Response Network:

This is really where you can't shut down the chains of transmission. You can't identify them. You've really lost control in that setting and that's where we're seeing countries shut down because they simply say "We can't find everybody, can you all please just stay in your houses. Come to us if you're very sick but otherwise just stop all contact with people". It's stopping transmission by stopping all of human contact, basically.

SEAN NICHOLLS, REPORTER: On March 1, in a Perth hospital, the first Australian died from the coronavirus.

He had been aboard the cruise ship Diamond Princess where there was an outbreak of the disease.

PROF. SHARON LEWIN, Director, Doherty Institute:

I was watching what was happening in the Diamond Princess very closely. Uh, quite horrified. All these people, 3000 if I remember, trapped on a ship. And seeing the infection spreading was very alarming because it was very worrying that something was going on there allowing that level of spread. And I remember the image of the man that unfortunately died, holidaying in some-somewhere in Asia and, very tragic, of course, to read about that.

NEWS READER: A 95 year old who was based at an aged care facility in Macquarie Park in Sydney. She has become the second person to die in relation to the coronavirus outbreak.

SEAN NICHOLLS, REPORTER: Despite the risk, huge public events were still talking place.

Including a Super Rugby game and the T20 women's World Cup final - attended by

86,000 people at the Melbourne Cricket Ground.

At least one spectator had coronavirus.

NORMAN SWAN, HOST, RN Health Report:

We had football games, basketball games going with tens of thousands of people turning up. Two reasons why that was mad, completely mad and stupid. One is even though there's not much COVID-19 in the community, you're increasing your risk of getting it the larger the number of people you come in contact with. The second reason is contact tracing is what hundreds of hardworking professionals are doing at the moment. You can't do it when you catch it at a football match and you can't do it when you're a gathering of 500 people outside.

TEDROS GHEBRANIOUS: WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction. We have therefore made the assessment that Covid19 can be characterised as a pandemic.

Even after the outbreak was declared a pandemic planning continued for the Formula One Grand Prix to be attended by hundreds of thousands of fans in Melbourne.

LEWIS HAMILTON: "I am really very, very surprised that we are here. I think in motorsport it's great that we have racing but I think it's really shocking that we are all sitting in this room."

DR ANDREW MILLER, President, Australian Medical Association WA:

The continuation of mass gatherings and things like the Grand Prix, the football festivals and so on, was a huge source of frustration to doctors who were living in the future and staying in very close contact with what was happening now in Europe. We understood the logarithmic exponential nature of how the cases take off and that we needed to buy as much time as we could to save as many lives as we could.

SEAN NICHOLLS, REPORTER: Just before the race began, spectators were told they would be locked out of the venue.

A few hours later, organisers pulled the pin on the whole event.

MAN: The AGPC has been advised by Formula One that the Australian Grand Prix has been cancelled. The Australian Formula One has been cancelled.

BILL BOWTELL Strategic Health Policy Consultant, UNSW

Even by then the NBA in America, the baseball, the soccer, all those huge, great sports had announced their seasons were finished. But here in Australia the pressure was so great that despite the Americans who are not known for not loving a buck took the right decision and stopped these things. It should have been abundantly clear to the administrators, to the government that that was the right thing to do.

REPORTER:

Should all of those massive events been called off earlier?

BRENDAN MURPHY, Chief Medical Officer:

I think in hindsight you might have said that, but things were moving so rapidly that week. At that time the risk of transmission in a large crowd was very low because we didn't have very many cases, but we were watching the rise in cases and we were watching what was happening in Europe and the US.

SEAN NICHOLLS, REPORTER: On March 13, Scott Morrison announced announced the formation of a national crisis cabinet and restrictions on public gatherings.

SCOTT MORRISON: Based on the advice we have received today about the increasing cases of community transmission it has been recommended to us that we move to a position by Monday where we will be advising against organised non-essential gatherings of persons of 500 people or greater from Monday.

SEAN NICHOLLS, REPORTER: The announcement didn't change Scott Morrison's plans for the weekend.

SCOTT MORRISON: Well I still plan to go to football on Saturday because this is an arrangement we're putting in place from next week as a precaution this is an early stage action that we are undertaking to make sure we get ahead of this.

SEAN NICHOLLS, REPORTER:

What were you thinking when you heard those words come out of the prime minister's mouth?

BRENDAN MURPHY, Chief Medical Officer:

That's a matter for him. It's not for me to comment on the Prime Minister's decision making, but I don't think it was an unreasonable thing to still go to the football that weekend. We had not recommended people stop going to gatherings the weekend before that proposed Monday restriction.

DR ANDREW MILLER, President, Australian Medical Association WA:

Because doctors live in the future with this disease and we're anticipating where it's going, the concept that, that football was even on at that point, the concept that the Grand Prix was going to go ahead with teams being brought here from Italy, doctors were contacting me saying, "The world has gone mad. We don't know whether the prime minister's completely disconnected from reality. Has, has his advisors not told him what's happening?" Presumably, part of this is about trying to keep civil order and calm. But what doctors understand, probably better than anyone, is you can't dodge the truth.

SEAN NICHOLLS, REPORTER: Within hours, Scott Morrison announced he wouldn't be going to the football after all.

NEWSREADER: And for more on that breaking development regarding the Home Affairs Minister Andrew Probyn joins us from parliament house, Andrew what do we know and will this diagnosis have any impact on members of cabinet?

SEAN NICHOLLS, REPORTER: We know that Peter Dutton woke up this morning with a sore throat felt unwell got the test done it came back positive and he's been put in isolation in in a Brisbane hospital

SEAN NICHOLLS, REPORTER: Last week the Home Affairs Minister was rubbing shoulders with the US Attorney General William Barr and the US President's daughter Ivanka Trump in Washington.

Australian travellers Debbie Kilroy and Boneta-Marie Mabo were also on their way home from a trip to the United States.

BONETA-MARIE MABO:

Probably flying out of the States is when I started to feel quite ill. I just had a sore throat and I put it down to, like, maybe the cabin, and just being in a confined space and sometimes I do get a little bit of a dry, like, throat when I'm flying.

DEBBIE KILROY:

When we landed on Saturday morning, you know, I still had a- headaches, body aches, I was congested, sore throat, still nauseous, and so when we got off the plane and went through customs, there was a table with some information, put, some pages, which I picked up and had a read of. And then I was just getting more worried as we were waiting for our luggage, that we decided that we would go directly home, get my car and go to the hospital to get tested, because we were unwell.

SEAN NICHOLLS, REPORTER:

What kind of screening was there of passengers like you, arriving from the United States?

DEBBIE KILROY:

Oh, there was no screening. Nothing, nothing at all.

BONETA-MARIE MABO:

Absolutely nothing.

SEAN NICHOLLS, REPORTER: Despite meeting the criteria in the testing guide lines the two women were turned away from the first hospital they tried.

BONETA-MARIE MABO:

We told them exactly what our- what we- what had happened, that we'd been in contact, that we had symptoms, we'd just got off of our international flight. And they literally turned us away and said, "We don't do testing on the weekend. Come- you'll have to go home and isolate and come back on Monday."

SEAN NICHOLLS, REPORTER: They eventually found a hospital willing to test them and were sent home to wait for the results.

DEBBIE KILROY:

Then they rang on Sunday. Sort of early afternoon, on Boneta-Marie's phone and told her that she was positive and no one was ringing me, so she handed the phone to me and I asked, and they went, "Oh. Oh yeah, you were positive too. Sorry we hadn't rung you."

JOHN DALEY, Chief Executive, Grattan Institute:

It is not good enough to simply tell passengers as they come to Australia, "You should go home and self-isolate." There's a chance they're going to infect the taxi driver on their way, uh, and there is a very good chance that many of them will not in fact do it. Or that they'll say, "Oh, look it doesn't matter if I just quickly go to the shops," or, "Look it doesn't matter if I just like have a cup of coffee if I kind of wash my hands first." And anecdotally a lot, at least there have been many people who have treated self-isolation in that way, and not surprisingly they have wound up infecting others. Those people don't realise they're infected, they infect more people and rapidly the growth of the epidemic happens. If you are serious about a quarantine what you do is you say to people literally as they get off the plane "You are going to be living in the following hotel room for the next 14 days. "

TEDROS GHEBRANIOUS: In the past week we have seen a rapid escalation of cases of COVID 19. The most effective way to prevent infections and save lives is breaking he chains of transmission. And to do that, you must test and isolate. We have a simple message for all countries: test, test, test.

PROF. DALE FISHER, Chair, WHO Global Outbreak Alert and Response Network:

Testing is so important because this is community spread and it's very difficult to distinguish from other conditions. So, if you don't have the opportunity to test, you're not going to identify individuals, which means you're not going to get the opportunity to isolate, which means you can't contact trace and you can't quarantine the contacts. So, testing is the foundation of breaking transmission chains.

SEAN NICHOLLS, REPORTER: But Australia was already running short of test kits.

In a letter to the nation's GPs, the Chief Medical Officer wrote that the supply of test kits and swabs was 'deteriorating rapidly, with kits no longer being available in some regions of the country'.

And that only patients who met strict guidelines should be tested.

DR ANDREW MILLER, President, Australian Medical Association WA:

It's been very concerning and surprising to doctors that we haven't followed the standard process in a pandemic which is test as many people as you can as often as you can. Contact trace as far as you can. Shut it down, isolate it as much as you can because we haven't had testing capability because we've run out of reagents, we've run out of test kits. This is something that left us flatfooted, clumsy, and slow to respond, and limited our options for what the doctors can advise that we do at the earliest most important stages of a pandemic.

SEAN NICHOLLS, REPORTER: Across Australia, doctors have been inundated with patients asking to be tested for coronavirus.

In Western Sydney, local GP Jamal Rifi started offering a drive-through service.

DR JAMAL RIFI: How are you today? Can I have a look at your forms? So you don't have a fever cough or sore throat?

WOMAN: No.

DR JAMAL RIFI: Ok, well you're definitely in a very low risk. But let's come in, we'll do the assessment, we'll examine you and we'll see how you go.

The strict criteria and scarcity of equipment means he has been unable to do many tests.

WOMAN: And then I saw the sign and thought, oh well I'd better call in, just in case.

DR JAMAL RIFI: We all know if we are to discover anyone who is a potential carrier of the virus we need to do test, test and test. But unfortunately these guidelines are very restrictive. And it may actually allow us as doctors to miss some cases. We don't want to miss these cases, but we are forced to. That will mean there are people out there carrying the virus we don't know about them and we can't trace, we can't treat, we can't isolate. We have to rely on the goodwill of the people.

SEAN NICHOLLS, REPORTER: The decision to not test more people from the beginning of the epidemic in Australia confounded leading epidemiologist Professor Raina MacIntyre.

Professor MacIntyre has been self-isolating in her Sydney home to avoid catching the virus.

PROF. RAINA MacINTYRE Head, Kirby Institute's Biosecurity Program, UNSW

In Australia we have testing criteria, so you can only get a test if you have been in contact with someone who's had COVID, or if you've returned from overseas travel, or if you're a healthcare worker, or if you're in hospital with a severe and unknown pneumonia. So that means that anyone who doesn't meet those criteria can't get tested. So that is a restricted testing strategy, and it's, you know, driven by the fact that there has been a shortage of test kits. But it means that you're unable to identify the extent of- of the disease in the community.

SEAN NICHOLLS, REPORTER: On March 19, Italy overtook China as the country with the highest death toll, with 3,450 dead.

That figure has since more than tripled.

People keep describing this as flu, it's worse than that?

DOCTOR: No. It's a totally another thing, it's more like pneumonia, more pneumonia than flu. It's very severe pneumonia so it's a massive stress for every health system.

PROF. RAINA MacINTYRE Head, Kirby Institute's Biosecurity Program, UNSW

Italy had a problem because they followed the same testing approach, a restricted testing approach, they were too slow off the mark.

SEAN NICHOLLS, REPORTER: Less than eight weeks after the first case was diagnosed, the number of infections in Australia was quadrupling every week.

NORMAN SWAN, HOST, RN Health Report:

As we speak, we are 12 to 20 days behind Italy, the numbers are going up almost vertically in new South Wales, Victoria is not far behind us, and even Singapore is losing control. So once it starts doubling its significant numbers, it just runs away from you. So we're going straight up. So if you're going straight up and you're doubling every three or four or five days, it's year seven maths. We are going to be where Italy was. Something's got to change that curve. If something doesn't change that curve, that's where we're going to be. Simple as that.

SEAN NICHOLLS, REPORTER: From March 20 the government banned all foreigners from coming to Australia.

That didn't stop many passengers on the ruby princess cruise ship disembarking in Sydney, bringing the virus with them.

SEAN NICHOLLS, REPORTER: Despite the alarming projections many were still ignoring the warnings. In Sydney, police moved into clear beaches.

The Prime Minister decided it was time to take more severe action.

SCOTT MORRISON: That in enclosed spaces for gatherings in the following facilities to be closed as of midday tomorrow. Registered and licensed clubs, licensed premises in hotels and pubs. Entertainment venues and cinemas, casinos, and nightclubs, restaurants and cafes will be restricted to take away only.

Despite the governments of NSW and Victoria pushing to close schools, Scott Morrison insisted they should stay open.

SCOTT MORRISON: Children should go to school tomorrow. There's no change to the medical expert advice.

BRENDAN MURPHY, CMO: We reaffirmed our position that the risk to children of Coronavirus is extremely low. We've had hardly any cases in primary school children, and the international experience is that it is a very, very low risk of symptomatic infection.

The two biggest states broke ranks.

DANIEL ANDREWS, Premier of VIC: We have taken the decision and the chief health officer of Victoria is completely comfortable and supportive of this to bring forward the school holidays and to spend these precious days without kids at school to plan for remote flexible distance learning.

GLADYS BEREJIKLIAN, Premier of NSW: In relation to schools I want to stress that schools in NSW from tomorrow will remain open. The health advice has not changed. However, for practical reasons in NSW we will be encouraging parents to keep their children at home to ensure there is one single unit of teaching.

NORMAN SWAN, HOST, RN Health Report:

I've sympathy with the school's decision because it's a difficult one to make. It will have major impact, but the reality is that young people spread this disease, 30 per cent of infections. And the modelling suggests that if you really want to control this, you've got to close schools and universities.

PROF. RAINA MacINTYRE Head, Kirby Institute's Biosecurity Program, UNSW

There probably is substantial undetected transmission going on in children and young people. When we look at the data from South Korea who did do extensive testing, more than any other country, they saw an enormous amount of cases, the highest amount of positives, actually in the age group 20 to 29 years, but they did see cases in children as well. There have also been a number of studies now published that children don't necessarily get mild disease, some children have actually died and some have had very severe disease requiring intensive care.

PROF. BRENDAN MURPHY, Chief Medical Officer:

The Koreans did a lot of testing. They didn't find, as far as I'm aware, any evidence of super-transmission, but I would agree. We don't know. She might be right, but there is no current evidence that children might be super-transmitters. So what we were saying is that, sure, schools need to make adjustments with proper hygiene practices, avoid large assemblies, but there was no really strong evidence that this was exposing the community to transmission. And parents could make their own choice.

SEAN NICHOLLS, REPORTER: Last week, as infection numbers in Australia sharply escalated, the pressure on the nation's health system continued to intensify.

At Royal Melbourne Hospital, people queued for tests at the new fever clinic.

Staff looked after a steady stream of patients.

NURSE: pop that on your finger for me. Any contact with a confirmed case of Coronavirus?

WOMAN: No

NURSE: I'll take your temperature. Just on your forehead. What are your symptoms?

WOMAN: coughing shortness of breath, headaches, fever.

NURSE: for how long?

WOMAN: The fever and shortness of breath as been for about a week now

SEAN NICHOLLS, REPORTER: After weeks of criticism, on March 25 the strict criteria for who can be tested was relaxed.

PROF. KIRSTY BUISING, Director, Victoria Infectious Diseases Service, Royal Melb. Hospital:

The expansion of criteria certainly does put increased pressure on hospitals. So the requirement to screen more people is obviously stretching resources. It's stretching our staff resources. My colleagues in the screening clinic are working extraordinarily hard. But they're doing that I guess to help as a community for us to identify and manage cases to try to limit the transmission in the community.

KIRSTY BUISING: So Grace, how many COVID-19 patients do we have at the moment?

NURSE: So we have two at the moment. One confirmed and one query.

KIRSTY BUISING: Ok. And are they well?

NURSE: Yeah the confirmed case is quite well. And the query confirmed is still a bit unwell at the moment.

Dr Kirsty Buising and her colleagues are expecting an onslaught.

PROF. KIRSTY BUISING, Director, Victoria Infectious Diseases Service, Royal Melb. Hospital:

In order to manage larger numbers of patients simultaneously, we're having to think about physical spaces in the hospital that we might use for clinical care that might otherwise have not been occupied. We're trying to make sure that those spaces are appropriate and safe. We're getting the equipment we need in those locations and we're recruiting staff to help care for those patients.

JOHN DALEY, Chief Executive, Grattan Institute:

A number of academics in Australia have estimated that we will run out of critical care pa-, capacity when we have about 45,000 infections in Australia. That's reasonably consistent with the estimates that have been done by Imperial College in London. When you hit that number at 45,000, assuming nothing changes and even if you do a lot of things within the next few weeks you're still going to be well short of the number of people who will be infected in due course if this virus runs its course.

SCOTT MORRISON: By no later than midnight tomorrow, that is 11:59pm Saturday states and territories will be quarantining all arrivals through our airports, in hotels and other accommodation facilities for the two weeks of their mandatory self-isolation before they are able to return to their home.

SEAN NICHOLLS, REPORTER: In Australia - as in much of the world - there's no end in sight in the battle to control the spread of this coronavirus.

SCOTT MORRISON: Tonight, the National Cabinet met to consider a series of issues and they related principally firstly to the issue of public gatherings. Now, you'll be aware of the arrangements that are already in place, that gatherings are currently restricted to 10 persons, except for members of your household. That advice has now been strengthened to say that it should be reduced to two persons in public spaces and other areas of gathering. In addition, in public areas, public playgrounds, outside gyms and skate parks will be closed as from tomorrow

NORMAN SWAN, HOST, RN Health Report:

I think it's reasonable to draw an analogy here with wartime. If you're a general commanding a brigade or whatever, you plan for a battle and how many casualties you're prepared to accept. Already in Britain it looks like the Somme and I'm not overstating it. The stories you're getting out of hospitals in Britain where consultant physicians, consultant surgeons are on heart-lung bypass because of coronavirus where they're running out of PPE and they're wearing loose masks and aprons instead of PPE, and they're being sent into battle by their bosses. It's just like World War One. And that's what it could be like here.

SEAN NICHOLLS, REPORTER: As the number of infections and deaths continues to rise, there is now growing concern about how those on the front lines can cope.

PROF. RAINA MacINTYRE Head, Kirby Institute's Biosecurity Program, UNSW

We're going to have healthcare workers facing the brunt of this in the health system, and they're going to be forced to work either without PPE, or with inadequate PPE. They're going to be infected, they're going to die. Like they are in Italy and like they're getting infected in the United States. It would take a generation to replace healthcare workers, they're not like, you know, drugs and vaccines that we can just crank up the production and get some more. We can't afford to take a soft approach or a gently gently approach because we have to ensure that our healthcare workers are not in that situation as they are in Italy or Spain. In Spain doctors are weeping, because they have to take the ventilator out of patients to give it to other people who are younger, you know, because those patients are too old and they're getting infected. They're treating their own colleagues. They're seeing their own colleagues dying, we really should be doing everything we can to make sure we don't get to that point.

PROF. SHARON LEWIN, Director, Doherty Institute:

There are multiple scenarios, but the two main scenarios in my head are that our measures that we can introduce right now are able to control and flatten the curve, so we don't see a sudden upswing in infections and significant numbers of people in our hospitals and significant deaths. One outcome is that we really do flatten the curve and I do think it's possible, because we've seen other countries do it. And the other outcome, which I am dreading to see, is that we'll see something like Italy or the U.S., where we see a very dramatic increase and our health system overwhelmed. And we definitely don't want to be seeing that. But it's possible.