Emergence Plan Transcript, AMA (WA) November 21 | AMA (WA)


Dr Mark Duncan-Smith | AMA (WA)

Emergence Plan Transcript, AMA (WA) November 21

Monday November 22, 2021


Mark Duncan-Smith

AMA (WA) has created an emergence plan on the back of feedback that we’ve had from people in the community, especially rural and remote doctors saying that they’re concerned regarding the resources and the planning effectively to transfer very, very sick patients to the city.

Also, last month, the education minister, when questioned about what schools were doing to prepare for COVID, replied that they were going to be cleaning the surfaces a little bit more often. This greatly concerned us with respect to the irrefutable evidence that COVID is airborne, ventilation spread and accordingly, we created this document.

What the AMA (WA) wants to see with the exposure of WA to COVID is basically a slow burn, and not a tidal wave of cases.

When we reduce restrictions sometime early next year. We back the Government’s conservative approach of 90 per cent vaccination, and have put forward a proposal for a stepped gradual reduction in restrictions, first of all, for those who are fully vaccinated who wish to travel for meeting up with family and for reunions, followed by a month later with free travel for people are fully vaccinated for holidays, for example.

We propose that a date should not be set for unvaccinated people to travel, and that should be revisited when we do reach 90 per cent vaccination, and the Government should look at what’s going on then with respect to the amount of COVID in our community and the danger that that proposes.

We have been alerted by country doctors that there does not seem to be a coherent plan to transfer critically ill patients who may be ventilated with COVID and as Bunbury is the only country centre with an intensive care unit and the ability to prolong ventilate a patient, then this would lead to an increased death rate in country patients compared to city patients potentially if there wasn’t a coherent and adequate plan.

We also wanted the Government to be aware that in January, early January, 350 new doctors will be starting work for the first time. They have no training. They have no PPE. They have no fit testing for N95. They have no training in the systems or protocols to deal with COVID.

These 350 doctors need time to be able to get all of that done so that they have a safer working environment and are able to take care of the public more carefully and more accurately.

We’ve also pointed out in the paper the potential to use the first two weeks in February for the vaccination of the 5-11-year-olds, on the assumption that the vaccine is both ATAGI and TGA approved.

The vaccine is already being injected in United States of America and Canada, to 5-11-year-olds and the vaccine has gone through the regulatory approval for that age group in those two countries. We anticipate that the TGA will approve it in early next year and we would like to see, again, an adequate plan to deal with the vaccination of the 5-11-year-olds.

A five-year-old in Victoria unfortunately and tragically died this week from COVID, and people need to be aware that although the death rate is low in children, there is a high or significant incidence of long COVID in children. In Australia it’s reported it being potentially around the 2 to 3 per cent mark, but the NHS, which has a much greater experience with long COVID in the paediatric group reports 7.4 per cent of children get long COVID.

Now put that in perspective. That’s potentially 35,000 cases of long COVID in children if they’re not vaccinated. We just need to keep this in mind.

Again, what we want the Government to do is to achieve an outcome that is a slow burn and not a tidal wave with COVID cases so that our medical system is not overrun.

Now, open it up to any questions.


Hi Mark, in the Premier’s presser earlier on today when asked about the plan for country people, he pretty much said the plan was to encourage them all to get vaccinated and then they wouldn’t need to go to hospitals in the first place if that sort of happens. Is that good enough and does that fill you with confidence?

Mark Duncan-Smith

No, it doesn’t. What we need to have is a plan for what’s going to happen when these patients become critically ill.

We currently have a outbreak in Katherine that is not far from Kununurra. There is travel with remote groups between those areas, and we could easily see an outbreak in Kununurra in the next few days.

So no, that doesn’t fill me with confidence. I would like to see a plan that sees what will happen with those sick patients. The capacity of RFDS to transfer these patients for a COVID ventilated patient reduces the capacity of the system because of all the precautions that have to be taken with COVID. I would like to see a plan where the military, for example, has been briefed on this, and potentially able to assist in WA.

WA is a very special situation; we have extreme distances but the COVID doesn’t care about that.  COVID can strike someone down, requiring ventilation and intensive care unit care from Kununurra, for example, and that needs to be properly taken into account.

There needs to be a plan for the elevation, and increased capacity of ability to transfer these patients. Otherwise, country patients will die at a higher rate than city patients when COVID hits.


It seems like a pretty grim reality of what would happen. Can you just talk us through a bit more about those country doctors’ concerns and what they are predicting will happen on the ground there if nothing is done?

Mark Duncan-Smith

The concern is that if a patient crashes with COVID, from a respiratory point of view, it needs to be ventilated, then they need to be tubed and ventilated, typically very quickly.

Now, if they do that in an emergency department in Broome Hospital for example and there isn’t an adequate number of ventilators there, they don’t have the ability to ventilate those patients for prolonged periods of time and what will happen is that capacity of holding the patients there could easily be overcome and that would mean the next patient that comes in may not get ventilated at all, with obvious grim outcomes.

So what we want to do and what we are hearing from them is they haven’t, they’re on the ground, they’re preparing for this. They have not been informed of a proper plan.

They don’t have any details of a proper plan, and I should make the note that even if there is a proper plan, but we don’t think there is, then the fact that they don’t know about it means it’s useless anyway.


Do you think we’ve got a health system in crisis? Are we bracing for breaking point here?

Mark Duncan-Smith

Well, we already know that most intensive care units in Perth are in bed state black most of the time.

That means that the ICU beds are already fully occupied with strokes, heart attacks, trauma, brain tumours. Now these problems don’t go away just because COVID comes knocking on our door.

So, we need to look at this and understand that COVID is coming. And yes, the Premiers message is correct, we have to get everyone vaccinated, that’s the way we protect our loved ones and ourselves and the medical system, but the reality is that it is knocking on our door, we are about to bring reduced restrictions and therefore potentially invite COVID in.

Well, not unfortunately invite it in – COVID will get into the community, and when that occurs, we need to have a plan to transfer these sick patients, especially from the country and we need to have a plan of how to escalate that if the resources and abilities of RFDS, for example, are overcome.


Mark, Jess Page from 7 here, apologies if you’ve already covered this. I’ve jumped on late, but which regions are you most concerned about, and would it be accurate to say that those regions where health resources are more scarce, are the same ones where vaccination rates are scarily low: the Wheat belt and the Pilbara.

Mark Duncan-Smith

Well, it’s not just that, it’s even it’s worse, I think for the Gascoyne and the Kimberley because these are places that require air transport For, if a patient is ventilated, and you can’t stick a patient in an ambulance and drive them from Kununurra to Perth, it it’s just not going to have a good outcome.

So the biggest areas that we’re worried about really are the far northwest. We’re worried about the resourcing, we’re worried about the preparation. We’re worried about, for example, Kununurra emergency department that is really old sort of stock of facility and can’t separate necessarily COVID from non-COVID and as soon as we get one case of COVID in there, really the whole hospital is going to be considered a COVID hospital.


And Mark thinking of that anti-vax cohort that keep expressing concerns about putting foreign substances into their bodies, can you run through for us, as well as the ventilators, the obvious one everyone keeps talking about, but also, what are some of the drugs that would be pumped into a COVID patient to keep them alive when they present to hospital?

Mark Duncan-Smith

Look with a patient that is sick with COVID, then potentially their oxygen is obviously potentially going to be given.

Yes, there are new antivirals that can come be used. There are monoclonal antibodies that can be used. And like I would say this to the people that don’t like vaccines or a pro-disease out there, if you get sick with COVID don’t rest on your laurels.

Don’t stay at home and die, come to the hospitals, come to see the doctors and nurses you’ve been abusing and giving death threats to We are still going to take care of you, so please don’t stay at home. Seek help.


Is there a concern about, I suppose what I’d call the trust deficit with WA’s political and health system at the moment. Is public confidence in both those systems lacking and is that a concern?

Mark Duncan-Smith

Look, we’re aware that the Government is trying to get ready for this, but we did this because we saw holes in the planning.

We especially were concerned about the schools, were especially concerned about rural and remote.

And we really just wanted to provide a framework to assist the Government in their preparation, and to try to maximise the preparation and minimise the disease and death.


Can there be confidence that the vaccination drive’s not misusing private information?

Mark Duncan-Smith

Look, as far as a conspiracy goes, there’s a thing in science called Occam’s Razor, and that is that the simplest solution to a problem is typically the solution.

Now, if you give the option that there is a conspiracy between big Pharma, governments, doctors, healthcare professionals, scientists and that millions of people around the world have not really died, as opposed to the quite simple fact that there’s a virus coming that’s going to potentially kill people, well then, the people that are pro-disease need to understand is that Occam’s Razor says there is a virus and it’s coming.


Is it possible for these rural hospitals to help get ventilators there? What can we do? What’s the plan look like from now on? Or is it just too late?

Mark Duncan-Smith

No, I don’t think it’s too late. I think it’s a case that for example, we need to look at the capacity of RFDS to transfer ventilated patients.

There will be a capacity for them, and the Government should be looking at other options such as the military and already be talking to them about potentially asking them for assistance in the case that RFDS gets overrun.

These are the sorts of conversations we want to see happening now, and not when we get the COVID outbreak.


Is there a timeline of when you’d like the Government to release plans for hospital rural hospitals, for schools and things like that?

Mark Duncan-Smith

Well, essentially that sort of work should be done now, and the plans should be put across all the schools across Western Australia and to the hospitals across WA.

We want to see planning that results in systems that can then be followed to reduce the effects of disease and death.

So we’d like to see this happening yesterday, but we certainly want to work with the Government to get as good as system up and running and ready as we can in the time available.


Do you have a prediction on how many deaths in rural communities there could be if this COVID just ravages these communities?

Mark Duncan-Smith

Well, I don’t have access to the modelling, I would assume that the Government does have modelling on those sorts of figures.

I would be estimating that at the moment if we had a significant outbreak in rural and remote Northwest WA in the Aboriginal communities, that the death rate would be in the hundreds.

But again, I don’t have modelling, that’s just my estimate.

All right, any other questions?


Thanks, Mark.

Mark Duncan-Smith

Now, the only other thing I’d say is that we also called for a domestic COVID passport to be introduced approximately a month before the opening up or reduced restrictions and that is to get people who are unvaccinated used to the fact that there’s going to be social restrictions when we actually do get reduced travel restrictions.

Now this has already been foreshadowed by the Government, but we would like to see that introduced approximately a month before we reduce travel restrictions, so that those that are unvaccinated are used to the fact that they have, they won’t be able to do many things.


Well, although under the current plan, if we do reach 90per cent, the only things they won’t be able to do or go to the over-1000 capacity event.

So unlike QLD and others, they’ll still be able to go to coffee shops, the pub, so it’s a pretty small level of restrictions, isn’t it? Would you like more?

Mark Duncan-Smith

Well, I think what we need to do is see the Government look at this and see what they think is necessary.

And of course, this is a moving field. If we do get a serious outbreak of COVID, then it would be a case that people that were vax, were not vaccinated may be restricted from going to pubs, clubs and other events.