TRANSCRIPT OF PROCEEDINGS · 5/5/2020 · TRANSCRIPT OF PROCEEDINGS O/N H-1193679 MR B. WALKER SC,...

.RUBY PRINCESS INQUIRY 5.5.20R4 P-278

©Commonwealth of Australia

AUSCRIPT AUSTRALASIA PTY LIMITED

ACN 110 028 825

T: 1800 AUSCRIPT (1800 287 274)

E: [email protected]

W: www.auscript.com.au

TRANSCRIPT OF PROCEEDINGS

O/N H-1193679

MR B. WALKER SC, Commissioner

IN THE MATTER OF A SPECIAL COMMISSION OF INQUIRY

INTO THE RUBY PRINCESS

SYDNEY

9.31 AM, TUESDAY, 5 MAY 2020

Continued from 1.5.20

DAY 4

MR R. BEASLEY SC appears with MR N. KIRBY as counsel assisting the

Commission

MR D. McLURE SC appears with MR G. O’MAHONEY for Princess Cruise Lines

Ltd and Carnival plc t/a Carnival Australia

MS G. FURNESS SC appears with MS K. LINDEMAN for the Health Administration

Corporation

MS J. FRANCIS appears for the Commissioner of Police



COMMISSIONER: Good morning. This is the first public hearing of the Special

Commission of Inquiry into the Ruby Princess. The order of events this morning

will include an opening address by senior counsel assisting Mr Beasley. As Mr

Beasley will make clear, but as I wish to emphasise, the opening statement contains

no conclusions about any matter still under investigation. It will, however, I hope, 5

assist in a public understanding of the proceedings of the Commission to date and

into the future, so far as the more important avenues of inquiry are concerned.

I need to emphasise that the Commission has invited submissions generally. No one

should feel inhibited as to what they wish to put in a submission by reason of 10

anything that Mr Beasley says or does not say. So long as submissions are fairly

understood, a reasonable response to the terms of reference to which I have to

respond, those submissions will be both received and carefully considered. Before

we go any further, apart from appearances already announced at the previous

hearing, are there any further appearances this morning? 15

MS J. FRANCIS: Yes, Commissioner. My name is Francis, F-r-a-n-c-i-s, initial J.,

and I seek leave to appear on behalf of the Commissioner of Police.

COMMISSIONER: The Commissioner of Police has leave to be represented and I 20

thank you for your attendance. Mr Beasley.

MR BEASLEY: Commissioner, on 31 December last year, the World Health

Organisation was informed of cases of pneumonia of unknown aetiology that had

been detected in Wuhan City in China. This followed warnings given by Dr Li 25

Wenliang, an ophthalmologist at Wuhan Central Hospital, who had seen several

patients with symptoms consistent with a SARS type virus and who then cautioned

colleagues to wear protective clothing when seeing patients.

By 3 January this year, 44 people with this new disease had been reported to the 30

WHO, but no causal agent had yet been identified. That changed on 7 January, when

a new type of coronavirus was isolated as the cause. Chinese authorities soon shared

its genetic sequence to enable the development of diagnostic test kits and the virus

was given a shorthand name, SARS-CoV-2. The disease caused by that virus is

known as COVID-19. 35

It may be that the outbreak of this novel coronavirus is related to a leap of the virus

from an animal to a human. It may be that the outbreak originated from the exposure

of a person to an animal from a seafood market in Wuhan. The science is that, like

MERS and SARS, the COVID-19 virus is closely related to bat coronavirus. 40

Fortunately, these are not a matter that this Special Commission of Inquiry is

required to determine.

Coronaviruses are neither new nor uncommon. They are known to cause respiratory

infections. Some infections, like the common cold, cause relatively mild symptoms. 45

Other coronaviruses, such as that causing SARS, severe acute respiratory syndrome,



a virus genetically similar to the COVID-19 virus, and MERS, Middle East

Respiratory Syndrome, caused severe illness.

It is directly related to an understanding of this inquiry’s terms of reference to note

that the COVID-19 virus can cause severe illness. Its early symptoms are similar to 5

those associated with the common cold and influenza, sore throat or a fever, fatigue,

a cough, difficulty breathing. Statistically, it appears that perhaps 80 per cent of

people who contract COVID-19 have mild symptoms before recovery. I say

“perhaps” because I acknowledge that this virus and its long-term effect on humans

is obviously limited. 10

Dwelling again on statistics for a moment, 15 per cent of people have severe

infections and five per cent require care in a hospital intensive care unit or

equivalent. COVID-19, as we tragically know, can also lead to death. In the most

severe case, and this is a summary and not exclusive of other critical complications, 15

sufficient lung cells are destroyed, prompting a strong immune response. Air sacs in

the lungs become inflamed and filled with fluid and the patient is unable to uptake

sufficient oxygen.

There are matters related to the age of people who contract the virus and whether 20

they have any underlying health issues of a variety of seriousness, but they don’t

need to be explored as the main focus of this inquiry or further today. COVID-19 is

transmissible from person to person and readily so. This occurs through inhaling or

ingesting respiratory droplets expelled when an infected person either coughs or

sneezes. Those droplets also land on surfaces and, coming into contact with those 25

surfaces, can also lead to transmission. Surfaces include someone else’s hand as an

example, not just objects.

People are most likely to shed the virus to other people when they are symptomatic,

but asymptomatic spread has been detected. Although by no means at a level of 30

absolute certainty, the incubation period for the virus appears to be in the range of

two to 14 days, that is, if a person is infected, they are highly likely to experience

symptoms within 14 days. Contrary to some wild claims, there is no currently no

cure for COVID-19 nor is there a vaccine. There might be a vaccine at some time in

the future, which might take many months or many years. We don’t have to 35

determine that either.

By 30 January this year, it is likely that over 12,000 people have contracted COVID-

19 in China with nearly 1500 severe cases and 170 deaths. The virus had also by this

time spread to at least 18 countries. As a result, the WHO determined that COVID-40

19 outbreak was a “public health emergency of international concern”, that is, it was

an “extraordinary event which is determined to constitute a public health risk to other

states through the international spread of disease and to potentially require a

coordinated international response”, that it was “serious, sudden, unusual and

unexpected”, and that it carried implications for public health beyond the affected 45

states’ national border and “required immediate international action”.



By 11 March, there were at least 118,000 cases of COVID-19 in 114 countries with

more than 4200 people being recorded as having died from the disease. Partly as a

result of what the WHO described on that day as “the alarming levels of spread and

severity of the disease”, it made the assessment that it could be described as a

pandemic, that is, a “infectious disease outbreak that is spread on a global scale”. 5

COVID-19 thus became the first coronavirus to have caused a pandemic.

As of today, more than three and a half million people around the world have tested

positive to the disease and over a quarter of a million people have died. Prior to the

disease being declared a pandemic, it had been detected on cruise ships. Given the 10

transmissibility of the disease, that could have surprised no one. There are now

millions of people each year who enjoy holidays or at least take part in journeys on

cruise ships. These ships are very large; they have the capacity to carry thousands

of passengers and crew.

15

On these cruises, in close proximity to each other, people eat together, drink together,

dance together and watch entertainment together. Outbreaks of gastroenteritis and

influenza are not uncommon. One such large cruise ship is the Diamond Princess.

Like its sister ship the Ruby Princess, it has a capacity to take about 2700 passengers

and 1100 crew. As a result of a former passenger of this ship testing positive for 20

COVID-19 in late January this year, testing was undertaken of passengers on the

ship, who were exhibiting flu-like illness symptoms while it was in Japanese waters.

Ten of those people tested positive for COVID-19 on 4 February. That day, the ship

was quarantined in the port of Yokohama, that is, passengers and crew were not 25

permitted to leave the vessel. Two weeks after quarantine was imposed, over 500

passengers and crew had tested positive for COVID-19, including over 200 said to be

asymptomatic. By the time passengers were permitted to leave the Diamond

Princess, more than 700 people on board has tested positive for COVID-19.

30

Passengers on the cruise ship the Grand Princess also tested positive to COVID-19 in

early March. One of those passengers, a resident of California, had been on the

cruise ship between 11 and 21 February when it sailed down the Mexican coast. As

a result of further positive tests from this cruise, passengers on board the ship as of 4

March were ordered into quarantine in their rooms by the United States Centre for 35

Disease Control.

The ship, which was off the coast of California, was ordered by the Californian

government to stay there. The National Guard airlifted test kits to the shift by

helicopter. Of those passengers and crew tested on 6 March, 21 returned positive 40

tests for COVID-19. There was some debate about whether passengers would be

allowed to leave the ship. On 9 March, the passengers disembarked at the port of

Oakland and all were put into compulsory quarantine.

That brings me to the Ruby Princess; it docked in Sydney in the early hours of the 45

morning of 19 March, having cut short a cruise to New Zealand which had begun on

the 8th of March in Sydney. About 2700 passengers were allowed to disembark later



that morning. 13 of those passengers and crew had been swabbed for COVID-19,

but the test results were not available at the time that the passengers were allowed to

disembark the ship. This included swabs from two passengers who required

ambulance transport from the ship to the Royal Princess Albert Hospital. They had

been diagnosed with “febrile acute respiratory disease” by the ship’s doctor amongst 5

other medical issues I will come to. They had been tested for influenza, but that

result had been negative. Both passengers later tested positive for COVID-19, with

that result confirmed on 20 March.

Since the time the passengers of the Ruby Princess disembarked from the ship on the 10

morning of the 19th of March, hundreds have been tested positive for COVID-19, as

have hundreds of crew. Others, particularly from countries other than Australia like

the UK and the US, believed they contracted COVID-19 but were not able to be

tested. Some people have become extremely unwell; some have died. Some people

in the community, it seems likely, have become infected by COVID-19 as a result of 15

contact with someone who contracted the disease while on the Ruby Princess. I am

not going to be specific about numbers because I cannot be. The numbers are still

evolving and this inquiry is not yet being provided with precise information; it has

sought it, and no doubt more precise information will soon be at hand.

20

One matter I can raise, however, regarding community transmission from the Ruby

Princess concerns an outbreak of COVID-19 at the Northwest Regional Hospital in

Tasmania, the first cases of which were detected on the 3rd of April. As at 21 April,

114 people have contracted the disease in this outbreak: 73 members of the hospital

staff, 22 patients and 19 others. In an interim report published on 29 April 2020, the 25

Tasmanian Department of Health has found that the likely original source of this

spread of the disease is one or both of two inpatients to the hospital who acquired the

disease while on the Ruby Princess cruise that returned to Sydney on the 19th of

March.

30

There is another reason for me to resist the temptation to state things as matters of

fact in this opening statement. This is an inquiry and it is ongoing. Not all the facts

are yet known; to the extent they are, not every issue related to them is as clear as it

could be. By the end of the inquiry, that position will have changed. There are some

other matters of importance to raise about the nature of this inquiry before I briefly 35

mention what we do know for certain and what evidence will be taken at these

upcoming public hearings.

This is a special Commission of inquiry; it is not a trial. There is no case theory as

such. As Commissioner, you have been asked to determine facts and make 40

recommendations. You will not be determining legal rights. The most important

aspect of what you do, Commissioner, is unlikely to be attributing blame to any

person or any group of people, if there is blame to be attributed, for the decision to

allow passengers to disembark from the Ruby Princess on 19 March. It will, first, be

more important to determine that the facts are: who knew what and when? Who 45

passed on information and to whom? Who made the crucial decisions and why?



The next most important responsibility given to you is the request for you to make

recommendations. Protocols and policies were in place that are relevant to the

manner in which the ship was treated. Decision-making processes were also

involved, some recorded in writing and some partly not. You have been asked to

make findings and facts about recommendations about these policies, protocols and 5

the decision-making process generally. Of course, as a function of making findings

of fact, you will identify who had responsibility, and for what, to what happened with

the Ruby Princess from the time it re-entered Australian waters on 18 March until the

time passengers left the ship on the morning of the 19th of March and in relation to

the tracing of the spread of the disease amongst passengers and members of the 10

community after that.

There are some matters of fact that are already known and I will summarise them

briefly. The Ruby Princess left Sydney for a cruise to New Zealand on 24 February.

Prior to this, the New South Wales Department of Health was developing and 15

implementing what it described as an enhanced screening process for identifying and

managing risk of COVID-19 in cruise ships entering New South Wales ports. By 19

February, New South Wales Health had published a draft document titled Cruise

Ship COVID-19 Assessment Procedures for Ports First Entry into Australia.

20

This document was circulated to other states in the Commonwealth with the hope of

it forming the basis for a national response. The 19 February draft assessment

procedure noted that some existing measures under the Commonwealth Biosecurity

Act were already in place for the notification of diseases on cruise ships. This

included the requirement of ships to submit a Human Health Report under the 25

maritime arrivals reporting system in the period between 96 to 12 hours before an

estimated time of arrival.

The Human Health Report forms required by the Commonwealth Department of

Agriculture, Water and Environment require a cruise ship to answer details such as 30

the number of ill people on board the ship, the number with a temperature over 38

degrees and the number with persistent coughing and difficulty breathing with “no

apparent cause”. Whether this form, which was updated on 14 February to require

details of whether the ship or people on it had visited China within the previous 14

days, could be improved in any way falls within your terms of reference. 35

The enhanced measures brought in by New South Wales Health on 19 February

included requiring ships to ask passengers and crew by ship announcement if they

were experiencing “respiratory symptoms or fever” and for them to be assessed at

the ship’s medical centre free of charge. Passengers and crew with respiratory 40

symptoms or fever were required to be isolated in their cabins. Ships were also

required to inform New South Wales Health:

…where a respiratory outbreak of greater than one per cent of people on board

the ship was identified. 45



Evidence will be called as to what is meant by the term “respiratory outbreak”. You

will have to not only make a finding about that, but also what should have been

meant by the term “respiratory outbreak” as well as the reason for and utility of the

one per cent criterion. I say this because a “respiratory outbreak of at least one per

cent of people on board” was an important criterion for whether a ship was assessed 5

as high-risk, medium-risk or low-risk under the enhanced measures developed by

New South Wales Health.

Where a ship is designated medium or high-risk, a New South Wales Health

assessment team boards the ship prior to passenger disembarkation. Under a high-10

risk scenario, passengers are not to leave the ship until the results of COVID-19

testing are available and clearance is given by the Chief Human Biosecurity Officer.

It seems that under a medium-risk scenario, passengers assessed as well were

allowed to leave the ship prior to any COVID-19 testing results becoming available.

That protocol is again something you are required to examine and make 15

recommendations on. Under a low-risk scenario, all passengers are free to

disembark the ship regardless of any symptoms they might be suffering from.

New South Wales Health continued to develop these enhanced measures. On 22

February, Dr Kerry Chant, the Chief Health Officer of New South Wales, published 20

a letter to the cruise ship industry that advised representatives from that industry that

New South Wales Health had adopted enhanced measures to assess the risk of

COVID-19 in cruise ships entering New South Wales ports. Attached to this letter

was a document outlining additional requirements. Amongst many procedures

required to identify and manage cases of respiratory infection on board, it was now a 25

requirement of the ship to provide New South Wales Health with a copy of:

…a full acute diseases log at least 24 hours before the ship is due to arrive at a

New South Wales port.

30

Some of these ARD logs for the Ruby Princess have already been discussed in

evidence and will soon be tendered and subsequently placed on the inquiry website.

These logs contain details of passengers and crew with what is termed “acute

respiratory disease”, their temperature, whether they had an “influenza-like illness”,

whether they have been tested for influenza and the results of that test, when they 35

reported to the ship’s medical centre, when they first became symptomatic and

commentary as to whether their symptoms are worsening or resolving.

Ships were also required by New South Wales Health to notify it of swabs taken for

testing of COVID-19 and how to treat those swabs in relation to refrigeration, 40

labelling and the like. The enhanced measures also contain a number of

requirements of New South Wales Health if, following a risk assessment, it

determines that a New South Wales Health assessment team will board a ship upon

arrival at port. These enhanced measures were again updated by New South Wales

Health on 9 March, and again they are a matter upon which you will receive 45

evidence, including expert evidence, and make findings and recommendations about.



On 6 March, the Commonwealth Department of Health published a National

Protocol for Managing Novel Coronavirus Disease Risk from Cruise Ships. The

Department of Agriculture, Water and Environment, the Department of Home

Affairs, the Chief Human Biosecurity Officers and the Cruise Lines International

Association were amongst those consulted in the development of this protocol. It’s 5

described as a “border operations protocol”. In this protocol, amongst the criteria

that each public health unit was advised to use to inform their risk management

strategy were the following:

Whether the number of cases presenting with influenza-like illness exceeds that 10

expected for a specific itinerary or season, ie, potential outbreak.

which was defined as equal to or greater than one per cent of passengers and crew

and “where point-of-care testing for influenza is available and the number of cases

presenting with ILI testing negative for influenza exceeds that which is expected”. 15

There are a couple of matters of significance for this inquiry about these terms. The

Commonwealth Protocol uses the language “influenza-like illness” for the one per

cent analysis. The New South Wales Health Enhanced Measures Protocol uses the

term “respiratory outbreak”. The Commonwealth Protocol draws attention to an un-20

particularised number of negative flu tests. The New South Wales Health Protocol

raises as relevant whether the “outbreak is not explained by positive influenza test”.

Whether there is a difference in this language will have to be examined in the

evidence. If so, what is the difference? Why is there a difference and what are the

consequences of that? The inquiry will ultimately have to make findings and 25

possibly recommendations about this.

Returning specifically to the Ruby Princess and what we know for certain at the

moment, on 6 March, New South Wales Health emailed the ship’s doctor requesting,

amongst other things, provisions of the ship’s acute respiratory diseases log by 9 am 30

on 7 March. The ship was not due into Sydney until the morning of 8 March. On 8

March, at about 8 am, the doctor sent the acute respiratory diseases log to New South

Wales Health. She also advised that after the ship had made an announcement at 5

pm on 7 March for people to report any respiratory symptoms or fever, the log

number had increased from 30 to 170. 35

At some time on 7 March, an assessment team of four medical professionals

conducted a risk assessment for the Ruby Princess and assessed it as medium risk.

The full details as to the decision-making process that resulted in a medium risk

assessment is not yet in evidence. We do know, however, that the percentage of 40

people identified on board as having a “influenza-like illness” was less than one per

cent, but two passengers had been identified as having recently been in Singapore,

then identified as a country with an elevated risk profile.

As the Ruby Princess was assessed as medium risk, after it docked on 8 March and 45

before disembarkation, a New South Wales Health Assessment Team, consisting of

doctors and other health professionals, boarded the ship. Prior to this, a pilot from



New South Wales (Port Authority) had boarded the ship to safely guard it into the

harbour. There will be some evidence about what he was told about the state of

health of those on board the ship and whether he was misinformed and whether there

was some innocent misunderstanding. The evidence will also be called from the

operations manager of the New South Wales (Port Authority) as to her attempts to 5

obtain clarity and information from other agencies about health concerns on cruise

ships from this point on, continuing until after the Ruby Princess returned to Sydney

on 19 March.

As to the New South Wales Health Assessment Team that boarded the Ruby Princess 10

on 8 March, it would appear that they may have been expecting to assess something

like 170 people with relevant symptoms. Instead, assembled inside one of the ship’s

restaurants were over 360 passengers and crew, who had identified themselves as

suffering from respiratory disease symptoms of some kind. I’m not suggesting

there’s anything sinister in this. The ship had made an announcement and it may be 15

that not all these people had previously attended the ship’s medical centre.

As a result of the assessments made on this morning, nine swabs were taken for

COVID-19 testing. All returned negative results. Prior to those test results

becoming available, passengers that had not reported symptoms and those that had 20

been cleared by the Assessment Team were free to leave the ship. The Ruby

Princess left Sydney again on the evening of 8 March, travelled to New Zealand,

stopped at various ports of New Zealand, before returning to Sydney in the early

hours of 19 March.

25

Before I briefly mention what happened of relevance during this cruise that we know

until the time of disembarkation of passengers, some matters of relevance happened

off the ship from the time it left until shortly after it docked that should be briefly

mentioned.

30

On 13 March, the Prime Minister, Mr Morrison, announced the formation of a

national cabinet to assist in providing a national response to COVID-19. Restrictions

on gatherings of more than 500 people outdoors and 100 people indoors were put in

place from 16 March. On 15 March, the Prime Minister announced that any person

arriving back in Australia from overseas would be required to self-isolate for 14 35

days. With only four exceptions, international cruise ships were banned from

entering Australian ports.

Mr Morrison stated that for the excepted cruise ships, which included the Ruby

Princess, “Some bespoke arrangements that we put in place directly under the 40

command of Australian Border Force to ensure that the relevant protections are put

in place.” What those words meant in practical terms will be inquired into. On 16

March, the New South Wales Minister for Health, Mr Hazzard, made an order under

the New South Wales Public Health Act directing persons who arrive back in the

state from overseas to self-isolate for 14 days. Similar directions were made in all 45

states and territories. On 18 March, the day before the Ruby Princess arrived back in

Sydney, the Governor-General declared the existence of a “Human bio-security



emergency” enabling the Commonwealth Minister for Health, Mr Hunt, to make a

determination under that Act prohibiting operators of international cruise ships from

entering an Australian port.

An exemption which applied to the Ruby Princess that for this reason, cut short its 5

cruise to New Zealand was for ships that had set sail for an Australian port before the

end of 15 March. On 19 March, the day the Ruby Princess arrived back in Sydney,

the Prime Minister announced that Australia was closing its borders to all non-

citizens and non-residents with effect from 9 pm on Friday, 20 March. Mr Hunt

subsequently made a determination to this effect under the Biosecurity Act. Back on 10

the Ruby Princess, on 14 March, the ship docked in Wellington. Five swabs from

passengers with relevant symptoms were tested onshore for COVID-19; all returned

negative.

The next day, 15 March, the ship docked in Napier. Passengers were allowed 15

onshore. There are reports – and it will be necessary of course to establish this by

evidence – of an outbreak of COVID-19 in that city said to be related to the ship. On

the same day, the ship’s senior doctor, Dr von Watzdorf, who has given evidence

already to this inquiry via an unreliable video link to the ship while it was at Kembla

emailed New South Wales Health and expressed the view that: 20

It seems we are in the early phases of an influenza A outbreak on board.

All febrile patients, which would appear to be a reference to those with a temperature

of 38 degrees, had tested positive to influenza A, except for one. However, that 25

passenger was one of the ..... that tested negative for COVID-19 in Wellington. On

17 March at 4 pm, New South Wales Health emailed the ship’s senior doctor and

requested the acute respiratory disease log by 9 am on 18 March. New South Wales

Health again asked for passengers and crew with “influenza-like illness” to be

isolated and for an announcement to be made that anyone with “respiratory 30

symptoms or fever” present to the medical centre for treatment free of charge.

Instructions were given should an onboard assessment be required. At about 9.30 am

the following morning, that is 18 March, both the ship’s senior doctor and a Sydney-

based port agent separately sent the acute respiratory disease log to New South 35

Wales Health. This log was part of the material given to the New South Wales

Health Assessment Panel who had given the responsibility of determining whether

the ship should be characterised as low, medium or high risk. At least by 4.40 pm on

18 March, but probably earlier, that panel had assessed the ship as low-risk, meaning

that when it docked on 19 March at the overseas passenger terminal at Circular 40

Quay, no one from New South Wales Health would board the ship and at least as a

matter of health assessment from New South Wales Health, the passengers would be

free to disembark.

What deliberations the New South Wales Health Assessment Panel had and for how 45

long and what criteria they based their assessment on will be the subject of evidence.

Some known factors are matters of importance however, even though there is limited



evidence about the panel’s determination or the basis for it. One, the ship’s acute

respiratory disease log was sent to New South Wales Health 18 hours before the ship

docked in Sydney and over 20 hours before passengers left the ship. The logs sent at

9.30 am on 18 March was not up to date for acute respiratory disease or influenza-

like illness at the time the ship docked. 5

There is significance to that. A pre-arrival assessment form was completed by

someone within New South Wales Health based on the 18 March log. That indicated

104 of 3795 people on board presented to the ship’s medical centre with acute

respiratory disease. That’s 2.7 per cent. The figure, at the time of the ship’s arrival 10

was to a significant degree, higher. The number of passengers and crew who had

presented with “influenza-like illness” was 26 of 3795 or 0.94 per cent. That is,

obviously, very close to the 1 per cent criterion that may have been used for the

assessment to change from a low-risk to a medium or high-risk determination.

15

In other words, if it was 38 people, not 36, the 1 per cent level is reached. By 19

March when the ship actually docked, the 1 per cent level had been reached,

although that data was not before the Health Assessment Panel when their

determination was made. Two, the pre-arrival risk assessment form also noted that

48 people on the ship had been tested for influenza A, but only half, 24, had tested 20

positive for that disease. Whether that is significant is something you will have to

determine. Three, the pre-arrival risk assessment form also noted that two

passengers required medical disembarkation. Both had “febrile upper respiratory

tract infection” and both had tested negative for influenza and both had been

swabbed for COVID-19. 25

At about 7 pm on the evening of 18 March, the cruise line’s port agent, Ms Bibi

Tokovic, called New South Wales Ambulance to book ambulance transfers for these

two passengers to take them to the Royal Prince Albert Hospital at 3 am the next

morning. That is, the morning of 19 March. That call is recorded and there is no 30

doubt as to what was said. I will read part of it onto the record when we begin

evidence. It also seems that the information given by the ship’s agent to New South

Wales Ambulance was accurate. The agent said both passengers had febrile acute

respiratory disease, they had both tested negative to flu, they had been swabbed for

COVID-19 but with no results yet available, they had other health concerns and that 35

precautions should be taken by ambulance officers.

Very unfortunately, one of these passengers died of COVID-19 about 48 hours later.

The mention of COVID-19 swabs and symptoms consistent with that disease caused

both concern and confusion to a New South Wales Ambulance supervisor that night. 40

His concern mainly related to whether the ship would be allowed to berth in Sydney

and hence, whether there would be passengers to take from Circular Quay by

ambulance the next morning. He contacted the Royal Prince Alfred and was told

they had no record of passengers coming to it from the ship.

45

He contacted the New South Wales Port Authority. That contact, through no fault of

his, led to more confusion and uncertainty. That confusion is such that even listening



to tapes of the calls where they exist does not make what happened easy to follow.

Given this, it would not be wise for me to attempt to summarise these calls now. It is

better that the evidence simply be called. Only these matters need be said for now.

The New South Wales Port Authority, following its own protocols, emailed the ship

seeking information about the health of passengers and crew. This was primarily to 5

assess the risk of putting its pilot on the ship.

The police were contacted but had been provided with no information. At one point

in the morning, the Ruby Princess’s booking to berth in Sydney was cancelled by the

Port Authority, primarily, it seems, because of a concern that one or more passengers 10

had actually been positively diagnosed with COVID-19. The booking was later

reinstated. While no one on board had been positively diagnosed with COVID-19 at

the time, all details as to the cancellation of the booking and its reinstatement are not

yet clear but will be the subject of evidence. At some stage, a call was made from a

person who said they were from Home Affairs to the New South Wales Port 15

Authority’s duty harbourmaster.

The details of that call and its purpose are not yet clear. Later, a person who

identified themselves as being from Australian Border Force also called the duty

harbourmaster. The details of that call are not yet clear, but it appears that turning 20

the ship around and sending it back to sea was discussed. Shortly after, the same

ABF officer rang the harbourmaster again and may have said that the ship could now

proceed. There was also a call from the ship’s doctor to New South Wales Ports.

She confirmed that the two passengers requiring ambulances needed assistance

because of a heart issue and a femoral nerve issue. The ship’s doctor stated that both 25

had febrile acute respiratory disease but stressed that this was not the reason for the

medical disembarkations.

At least one representative from Carnival Australia spoke with people from New

South Wales Port Authority that night concerning the passengers requiring 30

ambulances other than the Carnival port agent who originally booked the

ambulances. This call seems to have been made when there was some doubt as to

the ship being allowed to dock in Sydney. What was said in that conversation will be

the subject of evidence. The only thing that is currently clear about all of this,

Commissioner, is that you will need to give clarification as to who had constitutional, 35

legislative and delegated authority to do what in the decision making process and

make findings concerning the lines of communication, what the lines of

communication and cooperation were and whether they could be subject to any

improvement.

40

The Ruby Princess docked at 2.29 am on 19 March. Officers from Australian Border

Force and personnel from the Department of Agriculture, Water and for Environment

boarded the ship. Passengers were allowed to leave the ship later that morning. It

does not appear that the world’s best physical distancing practice was in place during

their disembarkation or when they collected their luggage; perhaps the opposite. It 45

also appears that few, if any, passengers were required to go through passport

control. Passengers left the terminal by car, taxi, Uber, train and bus. That morning,



13 swabs were taken from the ship for COVID-19 testing. Later, three tested

positive for the disease.

One of those tests was from a passenger who was not on the acute respiratory

diseases log by the ship’s doctor – sent by the ship’s doctor to New South Wales 5

Health at 9.30 am the day before. When that was discovered, New South Wales

health contacted the ship’s doctor who on 20 March provided an updated log

revealing many more passengers who had identified as having attended the medical

centre with both acute respiratory disease and influenza-like illness. Commissioner,

your terms of reference require you to examine the knowledge, decisions and actions 10

of the crew of the Ruby Princess and that of its operator.

You will no doubt make findings about those matters. You are also required to

examine protocols of government for assessing and responding to COVID-19 risk on

cruise ships entering New South Wales. They require you to make findings about 15

those protocols and to make recommendations. The terms of reference require you

to make findings of fact about all communications between relevant agencies

concerning the disembarkation of passengers from the Ruby Princess on 8 and 19

March and crucially, to the assessment of risk made by the New South Wales Health

Assessment Panel. That includes the criteria for the risk assessment, the information 20

it was based on, and the decision-making process. You will need to determine

whether these things could be improved, whether different decisions should have

been made, and if so, what. Recommendations will no doubt flow from those

findings of fact, some of all of which are likely to be based on expert assistance

provided to you and expert evidence called during the inquiry’s hearings. 25

Your findings of fact will, where appropriate, need to be made, to the extent it is

possible, without the use of hindsight. No doubt, however, your recommendations

will take full advantage of that hindsight. As to the decision to allow people to

disembark from the Ruby Princess on the morning of 19 March, only two matters are 30

probably completely clear. There was a risk to passengers and crew had they been

made to remain onboard the ship. There was another risk to the community in

allowing passengers to leave the ship before the COVID swabs had been tested.

There was a risk even if no COVID swabs had been taken.

35

No doubt you would consider the risk of leaving people onboard the ship until the

COVID testing had been done and what steps should have best been taken then. As

to the risk of people being allowed to immediately leave the ship, that risk,

unfortunately, appears to have materialised. I refer there to at least the outbreak in

northwest Tasmania I mentioned earlier. As to hearings, evidence will be called 40

from passengers of the ship on its 24 February and 8 March cruises. All passengers

and any other persons able to give evidence or information relevant to your terms of

reference are invited to lodge submissions via the inquiry website by the end of this

month. Advertisements have been made concerning this.

45

There will be hearings focusing on expert evidence and expert decision-making. The

hearings this week involve evidence from employees of New South Wales



Ambulance, the Port Authority, Carnival Australia, and New South Wales Health,

although not members of the Health Assessment Panel at this stage. One thing to

note about the hearings of this Special Commission, work only commenced on 21

April, but you are required to report to government by 14 August. Hearings took

place on 22 and 23 April in circumstances of urgency because the ship had been 5

delayed from leaving Australia the weekend before, but was going to leave on 24

April.

Very little documentary material or other evidence was available to the inquiry when

those hearings took place. Witnesses were only summoned on 21 April. Advertising 10

those hearings was not a priority for any sane person, which includes everyone

working for your inquiry. The hearings were livestreamed, albeit with a very poor

link to the ship. The transcript of those hearings is able to be accessed from the

inquiry website and read by anyone interested. These hearings have been the subject

of wide notification. Wherever possible, that will continue. Because of your 15

reporting deadline, hearings including these are taking place where possible in

circumstances where not all of your summonses seeking documents have yet been

responded to.

The hearings this week do not require more documents, but further hearings cannot 20

be said until summonses for documents have been responded to, which is happening

now. If it please the Commission.

COMMISSIONER: Thank you, Mr Beasley.

25

MR BEASLEY: What I intend to do now, Commissioner, is read onto the transcript

some material from a taped conversation seeking ambulance disembarkation from

the two people that required it when they left the ship in the early hours of the

morning of the 19th of March. I also want to make some tenders of documents. I

think we have a manila folder. What I’m going to tender firstly, and sorry, following 30

this tender and following reading the extract from the ambulance call, Kelly-Anne

Ressler is here to give evidence. I’m tendering, I’ll just read this out, first of all an

email from Laura-Jayne Quinn of New South Wales Health to the Ruby’s senior

doctor which was sent on Tuesday 17 March 2020 at 4.01 pm. That should be

Exhibit 1. Do you have a list, Commissioner? 35

COMMISSIONER: I do.

MR BEASLEY: Yes.

40

COMMISSIONER: Rather than read the list, it can be published. Can I inquire,

does the list include by way of annexure or in any other way the ARD log?

MR BEASLEY: I don’t think it does yet, because we are redacting the names - - -

45

COMMISSIONER: Thank you.



MR BEASLEY: - - - of people to keep their health details private.

COMMISSIONER: No. You anticipate me. So the proposed redaction is of name,

address and contact details. Is that right?

5

MR BEASLEY: I think there’s only name on it. I don’t know that addresses are on

the document. My memory of it, without having it in front of me, is that it has only

got names and nationality.

MS FURNESS: Contact details too, Commissioner. 10

COMMISSIONER: Yes. Contact details. I think - - -

MR BEASLEY: Yes.

15

COMMISSIONER: - - - there’s a whole lot of emails.

MR BEASLEY: All of that’s – anything identifying a person is being redacted.

What’s being left is things like when they went – when - - -

20

COMMISSIONER: Certainly.

MR BEASLEY: - - - a passenger went to the medical centre - - -

COMMISSIONER: Certainly. 25

MR BEASLEY: - - - what they had wrong with them, et cetera.

COMMISSIONER: Thank you. I need to make this clear on the record, then. The

redaction, that is the obscuring on copies to be published on this Commission’s 30

website and in its records, of the acute respiratory disease log or logs from the ship,

have been redacted simply to recognise, I hope appropriately, the privacy interest of

passengers concerning their health history. There is nothing else that explains why

that information will not be published. Because the identification of individuals,

particularly given subsequent history, is absolutely critical to an understanding by 35

this Commission of the events in question, I need to make it clear on the record that

the Commission’s staff, and indeed, it will turn out, some legal representatives of

persons permitted to appear in this Commission, will have access to some of that

identifying information.

40

I don’t want anyone to think that this Commission proceeds in the dark, as it were,

concerning the identity of passengers in relation to their relevant health. We know

all the details. The only reason we’re not publishing it, as I say, concerns questions

of privacy. I don’t think there’s anything more I need to say about that, Mr Beasley.

45



MR BEASLEY: I don’t think there is. Rather than read out each of the Exhibits 1

to 15, perhaps what I’ll just do is simply tender the documents that are on the exhibit

list, which can be circulated to any - - -

COMMISSIONER: Thank you. 5

MR BEASLEY: - - - interested party, any legal representatives or any interested

party.

COMMISSIONER: Thank you. That - - - 10

MR BEASLEY: So you’ve already been given Exhibits 1 to 15. I will be tendering

the logs you’ve referred to. There’s the log sent at 9.39 am from the Ruby Princess

at 9.39 am on 18 March. I’ll be tendering that. I’ll be tendering the log that was sent

after everyone got offboard on the 20th of March. I’m not sure whether there are any 15

acute – there may be an acute respiratory disease log for the ship’s journey from 24

March to 8 – sorry, 24 February to 8 March. If that becomes available, I’ll probably

tender that too and we’ll adopt the same process.


MR BEASLEY: Can I just say, I had a discussion, Commissioner, with Ms Furness

for – senior counsel for New South Wales Health regarding the names of the two

passengers that were taken off the ship by – with the assistance of ambulance, and

we’ve decided that their names will not be subject to redaction. They’ve been 25

mentioned multiple times, including in the media, so there seems little point for that.

COMMISSIONER: Thank you. Very well, then. So where I read passenger names

redacted, for example, for Exhibit 3 in this proposed exhibit list, that’s to be

understood as meaning passenger names and other identifying details - - - 30

MR BEASLEY: Yes.

COMMISSIONER: - - - including contact.

35

MR BEASLEY: Yes.

COMMISSIONER: Thank you. Well, I mark all of those documents as exhibits

accordingly or for identification as well, and that procedure will be followed, that is,

a list compendiously to update the records, including those available on the 40

Commission’s website from time to time. Thank you.

MR BEASLEY: Thank you, Commissioner. Just before Ms Ressler gives her

evidence, I want to read onto the record some extracts of a transcript of a recording

made by New South Wales Ambulance of a call from Carnival’s agent, port agent, 45

which was made at about 7 pm on 18 March to a New South Wales Ambulance

officer called Ashley, A-s-h-l-e-y, Nguyen, N-g-u-y-e-n. This call identifies the



person from the ship’s port agent as Bibi. We know that is Bibi Tokovic. Because

she’s referred to as Bibi in the transcript, that’s how I will refer to her without

intending any disrespect.

This call was taped and so we’ve checked that the transcript is an accurate record of 5

what’s recorded on the audio. The crucial parts of this call, which is a call from the

woman who identified herself as Bibi seeking two ambulances to attend the ship at 3

am on 19 March, are, first of all, the woman identified as Bibi says this concerning

the passengers:

10

Basically, they’re infectious. They’ve got an upper respiratory tract that also

require cardiology consult.

Bibi then goes on to say:

15

So that’s one of them and the second one is the same. They’re infectious.

They’ve got upper respiratory tracts and they have severe lower back pain, and

I can’t read the words.

There’s then some discussion about picking up the passengers at 3 am at the overseas 20

passenger terminal. The person identified as Bibi notes this:

We’ve been requested by New South Wales to take them to the Royal Prince

Alfred.

25

Bibi again says:

So it says –

Pausing there, presumably, she is reading from something: 30

…febrile upper respiratory tract infection, signs of rate-related cardio

ischemia.

The ambulance officer asked: 35

So is he infectious?

Bibi responds:

40

So the doctor has told me they’ve been tested for coronavirus so precautions

need to be taken, so possibly.

There’s discussion about where the ambulance people will meet the passengers that

were required to be taken to the RPA. There’s a further discussion about the 45

diagnosis of the passengers, where Bibi repeats concerning a female passenger:

.RUBY PRINCESS INQUIRY 5.5.20R4 P-295 K. RESSLER XN

©Commonwealth of Australia MR BEASLEY

So she’s got febrile upper respiratory tract infections.

And:

There’s severe lower back pain with signs of a femoral nerve radiculopathy. 5

Bibi then again says later:

Yeah. They’ve been tested – she’s been swabbed for coronavirus. Influenza

test, negative. She needs assessment in the emergency department with 10

imaging and a specialist.

There is then a phone call, which seems to be a clarifying phone call from someone

more senior at New South Wales Ambulance called Naomi Mannion, M-a-n-n-i-o-n,

who calls Bibi back, who has left her phone number. Bibi informs Naomi Mannion 15

that both of the passengers needed a stretcher. She then says this:

Yeah. They’ve got no – they’re not on oxygen.

She then says – this is Bibi: 20

And just to make sure that, you know, they could potentially be infectious, so let

the Ambulance Service know.

And then there’s a discussion that the ambulance officers will be wearing protective 25

gear. They’re the only matters I want to read onto the record from those phone

conversations, Commissioner. Ultimately, at a convenient time, either or both the

audio recordings will be tendered and the transcript tendered.


MR BEASLEY: I think we now have Ms Ressler here, your Honour, to give

evidence.

COMMISSIONER: Yes, please. 35

<KELLY-ANNE RESSLER, AFFIRMED [10.31 am]

40

<EXAMINATION BY MR BEASLEY

MR BEASLEY: Thank you, Ms Ressler. Ms Ressler, I’m Richard Beasley, one of

the counsel assisting the inquiry. Your full name is Kelly-Anne Ressler. 45

MS RESSLER: Yes.



MR BEASLEY: And you are currently a senior epidemiologist in the public health

unit in the south-eastern Sydney local health district?

MS RESSLER: That’s correct.

5

MR BEASLEY: And you’ve worked in that public health unit since 2004?

MS RESSLER: I’ve worked in the public health unit since 1998.

MR BEASLEY: All right. And since 2004, you’ve been - - - 10

MS RESSLER: The epidemiologist.

MR BEASLEY: And since the last two years, the senior epidemiologist.

15

MS RESSLER: About a year or two. Yes.

MR BEASLEY: Thank you. And you’ve provided this Commission with a

statement of – dated 1 May 2020?

20

MS RESSLER: Yes.

MR BEASLEY: And with the exception of paragraph 102, where we are to add in

the word “and”, in paragraph 102(2), after the word “arrival” and before the word

“should”, it’s true to the best of your knowledge and belief? 25

MS RESSLER: It is.

MR BEASLEY: And it comes with 20 annexures?

30


MR BEASLEY: I will tender that statement with the annexures, Commissioner.

MS FURNESS: Commissioner, might I ..... the tender. 35

COMMISSIONER: Yes.

MS FURNESS: There are a number of annexures which contain logs and various

other pieces of information about patients. 40

COMMISSIONER: Yes.

MR BEASLEY: Subject to redactions notified to me by Ms Furness, I will tender it.

45

COMMISSIONER: I’ve got to make sure that Mr Beasley’s anticipation is

accurate. Is that the first matter you want to raise?



MS FURNESS: There are two matters. One is in relation to the names of various

patients.

COMMISSIONER: Yes.

5

MS FURNESS: There may well be some email addresses and the like that are not

public email addresses, as it were, or those that shouldn’t be public for some reason.

COMMISSIONER: Then I will make this direction, so that the regime for redaction

of passengers’ names for reasons of health privacy remains effective and coherent, 10

that there will be no publication of any contents – the contents of the statement of Ms

Ressler with its annexures until after I’m satisfied that the Commission staff, with

appropriate liaison with those representing New South Wales Health, are satisfied

that there will be no disclosure of that kind of detail.

15

MR BEASLEY: It can simply be an MFI.

COMMISSIONER: And I make it clear that that is a regime I wish to be observed

- - -

20

MR BEASLEY: Understood.

COMMISSIONER: - - - hereafter as well.

MR BEASLEY: For the time being, it can be MFI 3. 25

MFI #3 STATEMENT OF KELLY-ANNE RESSLER WITH ANNEXURES

DATED 01/05/2020

30

COMMISSIONER: No. I’m content to mark it as an exhibit now.

MR BEASLEY: All right.

35

COMMISSIONER: But it simply won’t be published until - - -

MR BEASLEY: Of course.

COMMISSIONER: - - - that redaction is effected. 40

MR BEASLEY: Yes.

COMMISSIONER: All right. Ms Furness, is there anything else?

45

MS FURNESS: There isn’t at this stage, Commissioner, but might I reserve the

right to perhaps just discuss with Mr Beasley at the outset any further matters that



might be the subject of redaction and, to the extent that that’s problematic, make a

submission to you, Commissioner?

COMMISSIONER: Yes. I would encourage that by way of discussion out of

session, if possible. The composite document is Exhibit 16; is that correct? 5

MR BEASLEY: It is, yes. So my understanding is, then, that in particular the

annexures will not be published on the website until such time as Ms Furness has

spoken to me and discussed any concerns she has about any part of them.

10

COMMISSIONER: Now, Exhibit 16 is the same as the document marked for

identification 3 on the 1st of May?

MR BEASLEY: It is.

15

COMMISSIONER: Thank you. Namely, the statement of Kelly-Anne Ressler of

the 1st of May 2020 with its annexures.

EXHIBIT #16 STATEMENT OF KELLY-ANNE RESSLER WITH 20

ANNEXURES DATED 01/05/2020


25

MR BEASLEY: Thank you. Ms Ressler, you describe yourself as a non-medical

epidemiologist; can you explain what you mean by that?

MS RESSLER: My qualifications include an undergraduate degree in science and a

Master of Public Health. I am not a medical doctor, so I am unable to give any 30

clinical advice or assess any patients.

MR BEASLEY: Because we’re in a public hearing, why don’t you explain what a

non-medical epidemiologist is, though?

35

MS RESSLER: So my role as a non-medical epidemiologist at the Public Health

Unit is to undertake disease surveillance, to respond to outbreaks of infections, to

provide advice for research and studies undertaken by the Public Health Unit. Yes,

that would be - - -

40

MR BEASLEY: And one of the things you have been involved in, I think since

2004, is what you have described in your statement as the cruise ship program.

MS RESSLER: Yes, that’s correct.

45



MR BEASLEY: Can you explain to the Commissioner what the Cruise Ship

Program is? Before you do, I want you to tell the Commissioner what the Cruise

Program was before anyone had heard of COVID-19; what did it involve?

MS RESSLER: Okay. Sure. So our Public Health Unit has two programs that we 5

undertake for cruise ships arriving in Sydney. One part is the Cruise Ship Health

Surveillance Program, which I coordinate; the other one is the Vessel Inspection

Program, which is coordinated by our environmental health team. So as part of my

Cruise Ship Health Surveillance Program, we review all the Human Health Reports

for cruise ships before they enter into Sydney. 10

MR BEASLEY: Just pause there. Human Health Report: you’re talking about a –

that’s a Commonwealth Government document, correct?

MS RESSLER: Correct. 15

MR BEASLEY: Under the Maritime Arrivals Reporting System?

MS RESSLER: Yes, that’s as it is now and since 2017. Before 2017, we had a

process whereby ships would copy us in on those emails. 20

MR BEASLEY: Yes.

MS RESSLER: And even prior to that, we had our own Human Health Report that

was a voluntary program with the major ships arriving in Sydney, that they would 25

send us human health information.

MR BEASLEY: When you say “we”, you’re talking about New South Wales

Health, correct?

30

MS RESSLER: I’m talking about the South Eastern Sydney Local Health District

Public Health Unit.

MR BEASLEY: All right. Yes.

35

MS RESSLER: Yes.

MR BEASLEY: Which is part of New South Wales Health, I think.

MS RESSLER: True. 40

MR BEASLEY: All right. And - - -

COMMISSIONER: Can I just understand. So it’s since, you say, 2017 the

surveillance of cruise ship human health has been effected by copying you into the 45

Commonwealth Department of - - -



MR BEASLEY: Agriculture, Water and Environment.

COMMISSIONER: - - - Agriculture, Water and Environment, as it’s been variously

named, form called a Human Health Report, supplied by means of what’s called the

Maritime Arrivals Reporting System; is that correct? 5

MS RESSLER: Yes. That’s correct. The Maritime Arrivals Reporting System

started in 2017 and was an online platform, and our unit were given access to log into

that system to review the Human Health Reports.

10

COMMISSIONER: And did you understand or has it been your understanding that

from that time in 2017, that information was required by reason of Commonwealth

authority to be supplied to Commonwealth authority and thereafter by arrangement

made available to a State authority, namely, you?

15

MS RESSLER: It was different in each jurisdiction and - - -

COMMISSIONER: Just in New South Wales will do.

MS RESSLER: In New South Wales, yes. 20

COMMISSIONER: Thank you. And the Commonwealth authority, as you have

understood it from that time in 2017, was it the Department of Agriculture, etcetera?

MS RESSLER: Yes. 25

COMMISSIONER: Or was it the Department of Health, was it the Department of

Home Affairs or was it any other department?

MS RESSLER: It was the Department of Agriculture. 30

COMMISSIONER: Agriculture. Thank you.

MR BEASLEY: In February this year, New South Wales Health established what

I’ll call an Expert Health Assessment Panel, which was to make risk determinations 35

about cruise ships entering New South Wales ports, primarily for assessing risk in

relation to COVID-19. Can I just ask you, prior to COVID-19 becoming a risk

concern for cruise ships coming into Australian, in particular New South Wales

ports, was there an expert panel in relation to particular diseases before COVID-19,

for example, for gastroenteritis or influenza, or was this a brand new thing for 40

COVID?

MS RESSLER: This was a brand new thing for COVID.

MR BEASLEY: All right. And just to clarify, you yourself weren’t at any time a 45

member of the expert health panel that made – was given the responsibility of



making determinations of either low, medium or high risk for COVID-19 for cruise

ships coming into Australian ports in February and March?


5

MR BEASLEY: But you did provide assistance to that panel?

MS RESSLER: Yes.

MR BEASLEY: And sometimes some suggestions? 10

MS RESSLER: Yes.

MR BEASLEY: Right. And you worked closely with people that are members of

that panel? 15

MS RESSLER: Yes.

MR BEASLEY: All right. You report to Professor Ferson?

20

MS RESSLER: Correct.

MR BEASLEY: And he’s the director of the Public Health Unit that you’re

attached to?

25

MS RESSLER: Yes.

MR BEASLEY: And you work closely with Dr Vicky Sheppeard?

MS RESSLER: Yes. 30

MR BEASLEY: And she’s the deputy director of the Public Health Unit you report

to. And there are other members of the health panel, correct?


MR BEASLEY: I imagine that by sometime in late January and through February

of this year, the spread of COVID-19 throughout the world, but particularly in cruise

ships, given your responsibilities, was something that was probably number 1 on

your radar; would I be right? 40

MS RESSLER: It was definitely a high priority.

MR BEASLEY: All right. And I imagine you were also, amongst other people in

your Public Health Unit, noting the fact that COVID had spread on ships, and you 45

were probably aware of ships like the Diamond Princess, for example, where COVID



had spread throughout the ship and passengers were being quarantined on it,

etcetera?

MS RESSLER: Yes.

5

MR BEASLEY: All right. Having had that concern about COVID-19, can I ask

you, were you involved in the creation of any of the – I’m focusing only on New

South Wales at the moment – any of the protocols or policies that New South Wales

Health established in February of this year about how to manage and assess risk for

COVID on cruise ships? 10

MS RESSLER: I wasn’t involved in the creation of those protocols. I may have

been given a document to comment on.

MR BEASLEY: A draft? 15

MS RESSLER: Yes.

MR BEASLEY: All right. Talking of drafts, can you go to Annexure 1 of your

statement. This is the first draft protocol I want to ask you some questions about. 20

You see it’s entitled Cruise Ship COVID-19 Assessment Procedure for Ports of First

Entry into Australia?

MS RESSLER: Yes.

25

MR BEASLEY: It’s called a draft, 19 February 2020. Do you know anything about

who the authors of this protocol are?

MS RESSLER: No, I don’t.

30

MR BEASLEY: All right. Do you recall being given a copy of this to make any

comments on?

MS RESSLER: Not specifically, but I possibly did.

35

MR BEASLEY: All right. I take it that means you don’t have any notes or anything

that you have tried to look at to assess whether you have got any record of having

made any comments about this draft?

MS RESSLER: I haven’t looked for those notes yet, no. 40

MR BEASLEY: You haven’t?

MS RESSLER: No.

45

MR BEASLEY: All right. We’ll ask you to do that.



MS RESSLER: Okay.

MR BEASLEY: But do you recall reading this document - - -

MS RESSLER: Yes. 5

MR BEASLEY: - - - about the time it came out? Because it – given that it’s not

badged as New South Wales Health, but let’s just assume it is New South Wales

Health. It’s obviously – given your role with cruise ships, it’s obviously a fairly

crucial document for you to be familiar with, correct? 10


MR BEASLEY: All right. I just want to ask you some questions about it.

15

MR McLURE: Commissioner, I’m sorry to interrupt. Could I just make it known

that – I’m not criticising anyone, but we don’t have these documents, so it’s not

really easy for us to follow what’s going on.

COMMISSIONER: I take your point. 20

MR BEASLEY: Well, I’ve got – not only do I not have an objection to Mr McLure

having the documents, he probably should have them.

COMMISSIONER: No, I couldn’t agree more. Is there anything that can be done 25

immediately to supply that deficiency?

SOLICITOR ASSISTING: It’s been sent to the solicitors.

MR BEASLEY: Apparently, it’s – I’m hearing someone whispering behind me that 30

it’s gone to Mr McLure’s solicitors. It hasn’t found its way to him, obviously.

COMMISSIONER: Oh dear.

MR McLURE: Well, I think what that’s a reference to is that it may have been 35

emailed to my solicitor, who of course are not permitted to be here, so that’s not

really solving the problem.

COMMISSIONER: No. I want to solve the problem.

40

MR BEASLEY: I’m happy to break for – well, it’s up to you, Commissioner, but

we could break for five or 10 minutes and a bundle of documents can be given to Mr

McLure.

COMMISSIONER: Well, I’d like that to be done. I think that will be quicker in the 45

long run.



MR BEASLEY: Yes. I mean, the shortest course would be for Mr McLure to be

given a copy of - - -

COMMISSIONER: Yes, quite.

5

MR BEASLEY: - - - the witness’s statement with the annexures.

COMMISSIONER: No, quite.

MR BEASLEY: Because with the exception of one or two other documents, they’re 10

the documents I’m going to be asking the witness about today.

COMMISSIONER: Is Mr McLure the only person deprived at the moment?

MS FRANCIS: No. I also don’t have a copy, Commissioner. 15

COMMISSIONER: So we need at least two. Very well. We’ll break. If I can

make it fairly quick, so 10 minutes by way of an accelerated morning break. So

we’ll resume at five to 11. Thank you.

20

MR BEASLEY: Thank you, Commissioner.

COMMISSIONER: Thanks for raising that, Mr McLure.

25

ADJOURNED [10.47 am]

RESUMED [10.59 am]

30

COMMISSIONER: I appreciate that counsel haven’t had a chance to fully absorb

the material that has just been given, but do you understand you have at least been

given it now?

35

MR McLURE: Yes. I have been given the - - -

COMMISSIONER: Yes.

MR McLURE: - - - MFI 3, Commissioner. So ..... just raise with you - - - 40

COMMISSIONER: MFI 3 is what is now Exhibit 16.

MR McLURE: Thank you.

45

COMMISSIONER: Yes.



MR McLURE: At some stage, could I perhaps raise with you the question of

whether any questions we might wish to put to the witness could be deferred to a

later occasion once we’ve had the opportunity to digest the material

COMMISSIONER: Yes, you may and yes, you can. 5

MR McLURE: Thank you.

COMMISSIONER: I do appreciate that. To the extent that we can avoid the

witness having to return, we all should try to do that, but I appreciate that the 10

procedure has to provide you with the proper opportunity. Yes. Mr Beasley.

MR BEASLEY: Ms Ressler, I was about to ask you some questions about the

document behind Annexure 1 of your statement, and you’ve already clarified that

you did – you weren’t the author of this document, correct? 15


MR BEASLEY: And you don’t recall – you recall reading it, but you don’t recall

making any comments about it to anyone. I think you said you may have, but you 20

can’t recall.

MS RESSLER: I may have. Yes. That’s correct.

MR BEASLEY: Given it’s not your document, please don’t think the questions I’m 25

about to ask you about it are in any way a criticism of you. They’re not necessarily

even a criticism of the document.

MS RESSLER: Okay.

30

MR BEASLEY: We’re just trying to explore whether you’re able to help us

understand it. So that’s the sole purpose of my questions about this document. You

will see that it has – it discusses what are the existing measures that were already in

place under that heading, which include - - -

35

COMMISSIONER: Now, this is the first annexure of what’s now Exhibit 16.

MR BEASLEY: Yes. Annexure 1. Yes. And it discusses the Human Health

Report under the Biosecurity Act that we’ve already discussed.

40

MS RESSLER: Yes.

MR BEASLEY: And it then discusses the enhanced measures and talks about

passengers and crew that have been in high-risk areas and 14 days prior or contact

with a confirmed case of COVID-19 etcetera. And then over the page, it has what I 45

would understand to be some new pre-arrival requirements. Some of those relate to

where the passengers and crew have been, in particular in relation to mainland China,



which was obviously considered at the time a high-risk destination. But if you look

down four – I will call them bullet points even though they’re not quite – it requires

the ship to:

Actively ask passengers and crew if they have respiratory symptoms or fever 5

and ask them to present to the ship’s doctor for assessment, free of charge.

Do you have any understanding of what the Commissioner should take to mean by

the phrase “respiratory symptoms”?

10

MS RESSLER: Respiratory symptoms would include any single or multiple

symptoms of cough, difficulty breathing, runny nose, sore throat, respiratory

symptoms.

MR BEASLEY: Symptoms that are consistent with what could be a common cold 15

- - -

MS RESSLER: Yes.

MR BEASLEY: - - - could be a flu - - - 20

MS RESSLER: Yes.

MR BEASLEY: - - - and symptoms that we know are also associated with COVID-

19? 25

MS RESSLER: Yes. Correct.

MR BEASLEY: But it – there’s a distinction between respiratory symptoms or

fever in that it’s asking the ship to ask passengers and crew if they have one or other 30

of respiratory symptoms without a fever or if they just have a high temperature.

Correct?

MS RESSLER: My understanding is it’s asking for any of those symptoms.

35

MR BEASLEY: Yes.

MS RESSLER: Yes.

COMMISSIONER: So fever without respiratory symptoms is an object of interest 40

under these enhanced procedures, is that right?

MS RESSLER: That’s how it reads - - -

MR BEASLEY: Yes. 45

MS RESSLER: - - - Commissioner, yes.



COMMISSIONER: But is that how you understand it - - -

MS RESSLER: Yes.

COMMISSIONER: - - - as an epidemiologist? 5

MS RESSLER: Yes.


10

MR BEASLEY: And the free of charge to go to the medical centre, do you have an

understanding as to why the request was made for – to attend the ship’s doctor free

of charge? Is that to ensure that people that might have a concern about having to

pay nevertheless, if they’ve got these symptoms, turn up and get themselves assessed

at the medical centre? 15

MS RESSLER: Yes. We were – it was trying to reduce any barriers to people

presenting for assessment.

MR BEASLEY: In other words, reduce the risk of people that were symptomatic 20

deciding, “I’m not going to go to the medical centre because I don’t want to pay for

it and I’ll either not report it or I’ll see my own doctor when I get off the ship”?

MS RESSLER: Yes.

25

MR BEASLEY: Correct?

MS RESSLER: Yes.

MR BEASLEY: All right. It then talks about a pre-arrival respiratory illness 30

screening and asks the ship’s doctor to carry out certain requirements, including

taking swabs to store for COVID-19 testing later, isolating patients. I assume that

isolating patients relating to people that are presenting with respiratory symptoms or

fever. And update details on ships acute respiratory diseases log. Can I ask you

about that in your experience involving cruise ships. The acute respiratory diseases 35

log was something cruise ships had to keep even prior to COVID-19, is that right?

MS RESSLER: Most cruise ships, yes.

MR BEASLEY: When you say “most”, what did New South Wales Health require 40

of cruise ships coming in to Sydney to berth - - -

MS RESSLER: We don’t - - -

MR BEASLEY: - - - in a New South Wales port. 45



MS RESSLER: We don’t require them to keep a respiratory diseases log. It’s a

requirement of the US CDC - - -

MR BEASLEY: CDC.

5

MS RESSLER: Yes. And so most of the ships had them, and I, before COVID,

thought all of the ships had them, but there were a couple of ships that came in since

our enhanced screening and they didn’t keep them.

MR BEASLEY: Does that mean – let’s go back prior to the days of COVID, so up 10

to 31 December 2019 or thereabouts. The US Centre for Disease Control required

cruise ships to keep these acute respiratory disease logs as a matter of law - - -

MS RESSLER: I - - -

15

MR BEASLEY: - - - as you understood it?

MS RESSLER: I don’t know the law. There was an acute respiratory disease log

and an acute gastroenteritis log.

20

MR BEASLEY: All right. For New South Wales in terms of an acute respiratory

diseases log, that was something that you asked for and hoped you got it, but it

wasn’t compulsory?

MS RESSLER: We asked for it and hoped it came in the standard form that we 25

were used to, but it didn’t. And so for – not the Ruby Princess, but another ship, we

provided them with a template to complete for us.

MR BEASLEY: Right. And - - -

30

COMMISSIONER: Is there any significance in the A in ARD that is acute? I see

references to mild respiratory disease - - -

MS RESSLER: Yes.

35

COMMISSIONER: - - - the log is for acute respiratory disease.

MS RESSLER: Yes.

COMMISSIONER: That supposes there will be an assessment by a clinician, is that 40

right?

MS RESSLER: Yes.

COMMISSIONER: And the clinician would be the ship’s doctor, is that right? 45

MS RESSLER: Yes.



COMMISSIONER: In these enhanced procedures, the reference to respiratory

illness, should I understand that as meaning, in your understanding, respiratory

illness, whether it is mild or acute?

MS RESSLER: Yes. Any respiratory symptoms is what we were specifically 5

asking.

COMMISSIONER: No. I’m not asking about respiratory symptoms. I’m asking

about the expression “respiratory illness” which you will see in the document.

10

MS RESSLER: Yes.

COMMISSIONER: Should I understand that as meaning mild and acute?

MS RESSLER: Yes. 15


MR BEASLEY: Just dropping down further, you will see pre-disembarkation that

the ship’s required to inform the jurisdictional health authority – in this case, if it’s a 20

New South Wales port, obviously New South Wales Health – where a:

Respiratory outbreak greater than 1 per cent of people on board is identified

on board.

25

Do – first of all, in terms of your understanding of the phrase “respiratory outbreak”,

consistently with what’s being said above about pre-arrival requirements, is it your

understanding that the phrase “respiratory outbreak” relates to people with both

respiratory symptoms or a fever?

30

MS RESSLER: Yes.

MR BEASLEY: Do you have any understanding of why the criteria of 1 per cent

was used?

35

MS RESSLER: So the respiratory outbreak of greater than one per cent, in my

experience and in my practice and in our cruise ship health surveillance program, we

used one per cent to refer to influenza-like illness.

COMMISSIONER: Could we just stop here. Can I – someone make inquiries 40

please as to – from building management about what’s going on.

MR BEASLEY: Well, it needs to stop, I think.

COMMISSIONER: No. It needs to stop now. I will not have the hearing 45

obstructed, particularly by the same government who’s requiring the hearing to

proceed. I’m really sorry, Ms Ressler.



MS RESSLER: That’s fine. Yes.

COMMISSIONER: It’s not right.

MS RESSLER: Should I continue? 5

COMMISSIONER: Try.

MR BEASLEY: You were just talking about influenza-like illness and - - -

10

MS RESSLER: Yes.

MR BEASLEY: - - - before – which is a new phrase you’ve introduced. It actually

isn’t in this document.

15

MS RESSLER: No.

MR BEASLEY: So just pausing. When we were discussing what’s in this

document, I asked you respiratory outbreak of greater than 1 per cent. Does that – I

suggested to you that must relate to people that have both consistently with what’s in 20

the pre-arrival requirements, people with respiratory symptoms and a fever or people

just with a fever or people just with respiratory symptoms without a fever, and you

agreed with that. You’ve now introduced a term “influenza-like illness”. What do

you mean by “influenza-like illness”?

25

MS RESSLER: Influenza-like illness is a sub-set of acute respiratory illness - - -

MR BEASLEY: Yes.

MS RESSLER: - - - for people who have a fever, plus a respiratory symptom. 30

MR BEASLEY: Just pausing there. When you use the term “fever”, what are you

meaning to convey by that? I know it’s a temperature above normal, but what – is

there anything more specific?

35

MS RESSLER: The Human Health Report requires the fever to be above 38

degrees.

MR BEASLEY: 38 or above or above 38?

40

MS RESSLER: I think it’s 38 or above.

MR BEASLEY: 38 or above. That’s the Human Health Report - - -

MS RESSLER: Yes. 45

MR BEASLEY: - - - the Commonwealth – for - - -



MS RESSLER: That’s right.

MR BEASLEY: - - - MARS. And you just used both the term “influenza-like

illness”, which you say incorporates at least a symptom of fever being 38 or above

- - - 5

MS RESSLER: Yes.

MR BEASLEY: - - - and you use that in the context of the 1 per cent criterion as

well, correct? 10


MR BEASLEY: This document though, what I’ve suggested to you and I thought

you agreed with is using a 1 per cent criteria not in relation to influenza-like illness, 15

but in relation to respiratory outbreak which, seemingly – and of course, again, I

emphasise, you’re not the drafter of the document - - -

MS RESSLER: Yes.

20

MR BEASLEY: - - - but seemingly respiratory outbreak relates back to the earlier

phrase:

Respiratory symptoms or fever

25

Which – tell me if I’m wrong – and I’m obviously reading this as a non-medical

professional, as you’ll appreciate – I would relate to a broader group for the 1 per

cent than just those with influenza-like illness.

MS RESSLER: Yes. There’s an inconsistency in this document with regard to 30

putting a respiratory outbreak with a level of 1 per cent. I don’t have confidence that

we know the level of respiratory illness on board a cruise ship other than I have

confidence in a level of influenza-like illness on board a cruise ship and I have

confidence – and in our program prior to coronavirus - - -

35

MR BEASLEY: Yes.

MS RESSLER: - - - we used a level of 1 per cent to indicate influenza-like illness,

not a respiratory outbreak. During the

40

MR BEASLEY: Yes.

MS RESSLER: - - - risk assessment for COVID, we would provide both of those

figures to the expert panel.

45

MR BEASLEY: Yes.



MS RESSLER: However, we didn’t really understand the significance of the

respiratory illness level, being that we haven’t got that data from prior cruises - - -

MR BEASLEY: Yes.

5

MS RESSLER: - - - and we had made – we had encouraged and the ship had made

announcements with people with any respiratory symptom to come forward. So we

would expect that to be quite a high – well, a higher level than 1 per cent in any

normal population of people.

10

MR BEASLEY: Just pausing there. You’re understanding was that New South

Wales Health in this era of COVID wanted to – the ship to record people and ask

people to come forward to the medical centre if they had respiratory symptoms that

we discussed, cough, runny nose, etcetera, even if they did not have a fever - - -

15

MS RESSLER: Yes.

MR BEASLEY: - - - and hence, wouldn’t fall within the definition of influenza-like

illness.

20


MR BEASLEY: Yes. Now, just backing it back to before COVID in your cruise

ship program, you wanted to know when ships were coming in to Sydney ports,

whether there was an extent of influenza-like illness above 1 per cent because that 25

was significant for you - - -

MS RESSLER: Yes.

MR BEASLEY: - - - as a public health expert? 30

MS RESSLER: Yes.

MR BEASLEY: And why is that significant for influenza-like illness?

35

MS RESSLER: Because that would be a rate at which there’s likely to be an

outbreak on board or there could be an outbreak on board, which is dependent on the

length of the cruise. So we would start making inquiries of any ship that reported

influenza-like illness greater than 1 per cent to see their respiratory log so that we

could have a look at the onset dates of illness, the results of influenza testing, the 40

symptom profile of the passengers who had presented and we could make a

determination if it’s likely that there is an outbreak on board.

MR BEASLEY: Just pausing there, do I take it from that that the use of the word

“outbreak” applies once you have reached that one per cent level, does it? 45

MS RESSLER: No.



MR BEASLEY: No. All right.

MS RESSLER: No.

MR BEASLEY: Well, you explain to me what’s meant – to the Commissioner, at 5

least, what’s meant by outbreak, then.

MS RESSLER: Well, an outbreak is expected – an unexpected increase in the

number of cases onboard the ship. Different cruise ships use different levels to

define their outbreaks. Different body – different health agencies use different 10

outbreak levels, so a cruise ship might – is more likely to use the number of cases in

a defined period of time.

MR BEASLEY: All right. Do I understand this correctly, then, that if there were –

a cruise has been going for seven days and there’s only two out of 3000 people who 15

have reported with ILI, but if the next day 60 do, you still may not have reached the

one per cent, but that is looking like an outbreak?

MS RESSLER: Yes.

20

MR BEASLEY: All right. I’m with you. All right. Thank you.

COMMISSIONER: Can I just ask you, in paragraph 102, sub (2) of your statement,

Exhibit 16, you refer to your unit’s experience since 1998.

25

MS RESSLER: Yes.

COMMISSIONER: None of that was with respect to the SARS coronavirus 2; is

that right?

30


COMMISSIONER: And of course none of it with respect to the disease caused by

COVID-19?

35


COMMISSIONER: And so what you there talk about, a background rate of

influenza-like illnesses being generally about half a per cent of all persons onboard,

that’s a generalised observation since 1998 of a subset of acute respiratory illnesses; 40

is that correct?


COMMISSIONER: And indeed that being a subset of respiratory illnesses, which 45

include mild as well as acute; is that right?



MS RESSLER: Yes.

COMMISSIONER: That - - -

MS RESSLER: Where we had the data for that, yes. 5

COMMISSIONER: Sure. Is it the – was it the unit’s experience that a passenger or

crew member may at first be registered as suffering apparently a mild illness that

later came to be recognised as suffering an acute illness?

10

MS RESSLER: Yes.

COMMISSIONER: So then being categorised as mild was consistent with later

being – suffering an acute disease; is that in your experience?

15

MS RESSLER: Well, in my experience, the acute phases, the onset of the illness

- - -

COMMISSIONER: It would be better if you just answered my question.

20

MS RESSLER: In my - - -

COMMISSIONER: Was it consistent, in your experience, with being categorised as

mild that a person may later come to be categorised as acute?

25

MS RESSLER: Commissioner, I wasn’t assessing these patients and I – we have

one point in time when the logs are received. I don’t really have that information

about their disease progression.

COMMISSIONER: Okay. So in - - - 30

MS RESSLER: But that’s logical, yes.

COMMISSIONER: - - - your professional duties over the period you have told us

about in your statement, did you ever turn your mind to the progression of someone 35

from mild respiratory illness to acute respiratory illness in relation to cruise ship

reports?

MS RESSLER: No, Commissioner.

40

COMMISSIONER: Did you ever wonder whether a person being categorised as

suffering mild respiratory illness meant that they would not develop in the course of

the same voyage an acute respiratory illness?

MS RESSLER: The progression that we would be interested in is somebody who is 45

diagnosed with a mild acute respiratory illness progressing - - -



COMMISSIONER: A mild what, sorry?

MS RESSLER: A mild acute respiratory illness.

COMMISSIONER: What does that mean? 5

MS RESSLER: Just a common cold progressing to an influenza-like illness and

worsening.

COMMISSIONER: So there’s a category, in your experience, that you would call 10

mild acute respiratory illness; is that right?

MS RESSLER: Yes. So they’re all - - -

COMMISSIONER: I have not seen that in any of the documents. 15

MS RESSLER: We don’t usually have an indication of how mild an illness. It’s an

acute respiratory illness, which means that they have one of the symptoms or one or

more of the symptoms of a respiratory illness, and if they have a fever, they’re then

categorised as an influenza-like illness. So there are only the two that, in my 20

experience, we have been interested in.

COMMISSIONER: Now, at what stage did you become aware of the degree of

understood contagiousness of the SARS coronavirus 2?

25

MS RESSLER: Can you please repeat that? At what stage - - -

COMMISSIONER: I take it is stock-standard in your line of business to distinguish

according to degrees of contagiousness of micro-organisms?

30

MS RESSLER: Yes.

COMMISSIONER: Did you ever form a view professionally as to whether it was

understood that the SARS coronavirus 2 was highly contagious?

35

MS RESSLER: I’m not sure if we know how highly contagious it is. It’s certainly

more contagious than influenza. My understanding at the time was that it was

around a reproductive factor of three, so definitely more than contagious than

influenza.

40

COMMISSIONER: Does that make it a matter of public health concern.

MS RESSLER: Of course, yes.

COMMISSIONER: Would you resist calling that highly contagious? 45



MS RESSLER: Measles is highly contagious. I’m not sure it’s as contagious as

measles. Measles is about an 18, from my understanding. Very contagious?

Definitely.

COMMISSIONER: Thank you. Well, now, in your statement, the same 5

subparagraph, 102(2), you talk about experience since 1998 in your unit that with

respect to influenza-like illnesses, up to one per cent would not cause any concern.

You mean to you and your colleagues as public health officers?

MS RESSLER: It wouldn’t trigger a response from us. 10

COMMISSIONER: Well, it actually reads in your statement “would not cause any

concern”; do you see that?

MS RESSLER: Yes. That’s – yes. 15

COMMISSIONER: Is that a phrase you would like to reconsider?

MS RESSLER: Yes.

20

COMMISSIONER: How would you prefer to phrase that more accurately to convey

your opinion?

MS RESSLER: Up to one per cent would be generally an expected level of

influenza-like illness onboard a ship and would not trigger a response from our 25

Public Health Unit.

COMMISSIONER: I thought it was a half a per cent that would be generally

expected.

30

MS RESSLER: Up to one per cent. Background level, we think, is around 0.5 per

cent, up to one per cent. In the 20 years of data that I have, I believe there’s only one

influenza-like illness outbreak included that is less than one per cent, so it can

happen, but it is not part of our response protocols.

35

COMMISSIONER: Well, now, in order to be a cause for concern or a trigger for

response, may I take it that up until the SARS coronavirus 2 came along, you

understood your professional interest was to be aware of an outbreak that could

spread not only onboard but after people disembarked and scattered in the

community; is that right? 40


COMMISSIONER: But with influenza-like illnesses before COVID-19 was

understood to be occurring, how would you know whether there had been 45

community infection with an influenza-like illness where there had been a count, say,

of 0.85 per cent onboard and therefore there was no public health response? How



would you know whether there had been any subsequent contagion in the

community?

MS RESSLER: We wouldn’t, sir. We don’t - - -

5

COMMISSIONER: So you can hardly count that as success, can you, in public

health terms?

MS RESSLER: It is impossible for our program to completely eradicate influenza

from cruise ships or from the community in which we work. We work on trying to 10

minimise outbreaks, respond to outbreaks and prevent onward spread where possible.

COMMISSIONER: So why would you pick 1 per cent, rather than something

smaller or higher?

15

MS RESSLER: So for an individual case of influenza-like illness onboard a ship,

that is the responsibility of the treating doctor to isolate and provide masks or hand

gel or hand hygiene information. My role is to respond to outbreaks that affect the

community, and particularly from cruise ships who arrive and then the passengers

end up in our hospitals. So we are trying to determine an outbreak at which we can – 20

a level at which we can affect that outcome.

COMMISSIONER: But why would you choose 1 per cent?

MS RESSLER: Because our experience is, and we’ve been investigating those 25

cases of fever on board, is that there – it’s not an outbreak under that level. It is an

expected level of transmission in any community.

COMMISSIONER: Do I understand, then, that your unit will have records of what

happens with influenza-like illness traced to a cruise ship where the incidence was 30

less than 1 per cent?

MS RESSLER: We will have records of somebody who has come from a cruise

ship and gone to hospital. Yes.

35

COMMISSIONER: Where the incidence on the ship was less than 1 per cent?

MS RESSLER: Yes.

COMMISSIONER: So – and drawing on those records, your unit is able to say with 40

an appropriate degree of approximation that below 1 per cent incidence reported by

the ship, there is insufficient justification for any public health response at the point

of disembarkation in order to protect the community. Have I understood that

correctly?

45

MS RESSLER: We would do it on a case by case basis, Commissioner.



COMMISSIONER: What does that mean?

MS RESSLER: So if anybody is reported on the Human Health Report as having a

fever, we will request the respiratory logs and we will review them ourselves.

5

COMMISSIONER: Yes.

MS RESSLER: We will also ask for any information about the response that the

ship has taken onboard, and if we have a lack of confidence that the ship is taking a

response onboard that would prevent further transmission, then we would take an 10

action - - -

COMMISSIONER: What sort of action would take?

MS RESSLER: We would often the visit the ship. We would board and we would 15

have a talk to the doctor about influenza vaccination in crew members or isolation

periods or provision of masks or case – active case finding onboard a ship. So we

would offer any sort of public health assistance that we could, and we did that often.

COMMISSIONER: Now, repeating what Mr Beasley has said about this not being 20

your document and this not, therefore, being any criticism of you, I’m intrigued as to

why 1 per cent would have been explicitly adopted for this novel coronavirus. Why

is that?

MS RESSLER: I don’t know, Commissioner. I – I don’t know. 25

COMMISSIONER: Can you remember any discussion with your office or among

your colleagues about that?

MS RESSLER: It is a fairly sensitive measure. It does detect a few cases – fewer 30

cases. One per cent is a low measure. Most outbreaks are much higher than that. So

I – I think it was just chosen based on experience, and I’m actually not sure that –

how it was chosen or why. It wouldn’t have been my selection to put a level of 1 per

cent with a respiratory outbreak. I think that’s too low. But you will - - -

35

COMMISSIONER: You’d better explain that to me, sorry.

MS RESSLER: The number of people who have a cough or a cold or a sore throat

is – it’s a common illness. It’s quite common. I would expect any population of

three and a half thousand people to have quite a number of people who have a – a 40

sore throat or a runny nose. So – and – and we also just don’t have very adequate

data to know how many people on a cruise ship have that. The Ruby Princess in

particular caters for a more elderly clientele. They have worse outcomes. They have

more complications, and they present to the medical centre more often, and in an

environment where we are trying to reduce barriers for people to present and the ship 45

is making constant announcements for anybody with any respiratory symptom to



come forward, I would expect quite a number or quite a percentage on the ship to

come forward or to be identified in that.

COMMISSIONER: See, what did you mean by when you said you would think 1

per cent too low? 5

MS RESSLER: I would – I would expect a – a higher number of people in any

population to have those symptoms, but we don’t know for sure. So the 1 per cent,

for me, we had evidence of influenza-like illness outbreaks occurring somewhere

above that level. 10

COMMISSIONER: I’m – I’m sorry. Are you talking after - - -

MS RESSLER: Pre-COVID.

15

COMMISSIONER: Pre-COVID.

MS RESSLER: Yes.

COMMISSIONER: Okay. 20

MS RESSLER: Unfortunately, this document doesn’t enable us to detect all cases

or even small clusters of COVID. And so - - -

MR BEASLEY: Hasn’t the author of this document, and I know you didn’t draft it, 25

but reading it as a matter of plain English, the author of this document is first of all

telling the ship, “We want to know everyone that’s got respiratory systems or

everyone that’s got fever.”

MS RESSLER: Yes. 30

MR BEASLEY: And then they want to be – New South Wales Health wants to be

informed about respiratory outbreak greater than 1 per cent. Now, tell us if you don’t

know, but one possibility is that the author of this document thought, given it’s

specifically written for COVID-19, that we want to know if there’s more than 1 per 35

cent of people on board with any respiratory symptoms, whether or not they’ve got

fever, rather than using - - -

MS RESSLER: Yes.

40

MR BEASLEY: - - - what I’ll call the old scale of 1 per cent for influenza-like

illness - - -

MS RESSLER: Yes.

45

MR BEASLEY: - - - correct?




MR BEASLEY: And that appears to flow on to – over the page to the risk

assessments, where again, the language of influenza-like illness is not used but the

language of respiratory outbreaks affecting 1 per cent of those onboard is used. 5

MS RESSLER: Mmm.

MR BEASLEY: Which is one of the criteria for a high-risk assessment, and then it

adds, “that is not explained by positive flu tests.” I assume that means that someone 10

with respiratory symptoms that is being tested for flu and the test is negative is more

of a red flag than if they tested positive for flu in relation to COVID-19?


15

MR BEASLEY: Not that you can’t have both. That’s possible?

MS RESSLER: It is.

MR BEASLEY: Yes. 20

COMMISSIONER: That was understood at the time, was it?

MS RESSLER: Yes.

25

COMMISSIONER: Then what is the point of using the expression “explained by

positive influenza tests”?

MS RESSLER: I believe the theory would have been that – that we had another

reason for the illness onboard, which was influenza A, which was a common cause 30

of illness onboard cruise ships.

COMMISSIONER: No. I understand that. But Mr Beasley’s asked you about

coinfection - - -

35

MS RESSLER: Yes.

COMMISSIONER: - - - as a possibility. Coinfection means that having one

doesn’t preclude you from having the other. Correct?

40


COMMISSIONER: So I’m just wondering what this expression means, “an illness

explained by influenza positive testing,” if it is accepted that positive influenza

testing is not inconsistent with suffering the beginning of COVID-19? 45

MR BEASLEY: It may be that the use of - - -



MS RESSLER: It’s - - -

MR BEASLEY: - - - the word explained - - -

MS RESSLER: Yes. 5

MR BEASLEY: - - - is perhaps not the best word for - - -

COMMISSIONER: Well, it may be - - -

10

MR BEASLEY: - - - the circumstances.

COMMISSIONER: - - - a very bad use of the word. This is a screening protocol,

isn’t it?

15

MS RESSLER: Yes.

COMMISSIONER: For public health?

MS RESSLER: Yes. 20

COMMISSIONER: To protect the Australian community?

MS RESSLER: Yes.

25

COMMISSIONER: It strikes me that language of the kind I’m asking you about

now is very poorly chosen.

MS RESSLER: Yes.

30

COMMISSIONER: What do you think about that?

MS RESSLER: I think it was very, very difficult to know how to find cases of

COVID on cruise ships, and I think we – this document could have done it better.

35

COMMISSIONER: Do you know who wrote it?

MS RESSLER: I don’t, Commissioner. I don’t.

COMMISSIONER: There’s been - - - 40

MR BEASLEY: But one thing we - - -

COMMISSIONER: - - - no talk in the office about who wrote this document?

45

MS RESSLER: As far as I aware, it was the Ministry of Health, and I – I don’t

know exactly who.



MR BEASLEY: The New South Wales Ministry of Health, obviously - - -

MS RESSLER: Yes.

MR BEASLEY: - - - you’re talking about there. The Commissioner’s question, I 5

think, “explained by positive influenza tests,” if there’s a – this document is directed

to COVID-19, and knowing that you can have both the flu and COVID-19. A

respiratory outbreak affecting 1 per cent of people onboard where all of those people

have had a flu test and it’s been positive, doesn’t necessarily rule out COVID-19

first, correct? 10

MS RESSLER: Correct,

MR BEASLEY: But it might indicate this is more likely to be flu than COVID-19?

15

MS RESSLER: Exactly. Yes.

MR BEASLEY: Equally, if a number of those people that fall within the category

of respiratory outbreak had been tested for flu and the flu test for some number of

them is negative, that might be a red flag, “This is clearly a different disease and it 20

might be COVID-19”?

MS RESSLER: Yes. It was something that was definitely taken into account, as

was the travel history of the people and depending on the date at which we were

doing it, what the high-risk countries were. So we were asking for a complete 25

respiratory log that had all of that information on it, so that we could provide that to

the expert panel and hope that they could make sense of it in a very complicated and

evolving situation.

MR BEASLEY: Sure. Can I ask you what – it uses the expression “chief human 30

biosecurity officer assessors”. That was replaced, was it, by the New South Wales

Health Assessment Team that would go on board a ship or am I wrong about that?

MS RESSLER: My understanding is that the chief human biosecurity officer was

on the assessment panel. 35

MR BEASLEY: I see. That’s a reference to a New South Wales position, is it?

MS RESSLER: Yes.

40


COMMISSIONER: Is that Professor Tobin?

MS RESSLER: Dr Tobin. Yes. 45



COMMISSIONER: Now, as you understood it at the time, today as well, I assume,

that’s an office under Commonwealth legislation held by a state officer; is that

right?

MS RESSLER: I’m not sure, Commissioner. 5

COMMISSIONER: That’s all right. If I ask you about matters of law - - -

MS RESSLER: Yes.

10

COMMISSIONER: - - - it’s just in order for me to gauge what was made available

to you by way of training and information. Had you been told anything about the

legislative arrangements, the statutory arrangements, under which New South Wales

had a chief human biosecurity officer?

15

MS RESSLER: I was aware of them, yes, over the years.

COMMISSIONER: And did you have an understanding of what role, if any, you

had to play in the legal permission for a ship to disembark passengers?

20

MS RESSLER: I had no role to play in the legal position.

COMMISSIONER: So your understanding was that you had no role?

MS RESSLER: Yes. 25

COMMISSIONER: Yes. Thank you.

MR BEASLEY: For a high-risk assessment, this document suggests that – well, it

states that there won’t be disembarkation of passengers until any COVID-19 testing 30

results are back?

MS RESSLER: Yes.

MR BEASLEY: That means, “Passengers stay on board until we’ve got the results 35

of the swabs,” correct?


MR BEASLEY: And it then talks about moving people to what’s called home 40

quarantine for 14 days; is that something different to – in your understanding, to

isolating at home? Is that - - -

MS RESSLER: It’s the same.

45

MR BEASLEY: It’s the same.



COMMISSIONER: Was it your understanding that that would be a legal

requirement imposed by New South Wales Authority?

MS RESSLER: A legal requirement, not - - -

5

COMMISSIONER: A legal requirement, yes.

MS RESSLER: Not at this stage, no.

COMMISSIONER: All right. Did you have any understanding about - - - 10

MS RESSLER: No, I didn’t.

COMMISSIONER: - - - what legal regime applied with respect to so-called home

quarantine? 15

MS RESSLER: No, I didn’t, no.

COMMISSIONER: Have you ever had training in the statutory arrangements for

self-isolation or quarantine? 20

MS RESSLER: No.

COMMISSIONER: Would it be fair for me to understand that your professional

role, however, would provide an input for those who are responsible for exercising 25

that authority?

MS RESSLER: My professional role is largely restricted to the communication side

of gathering the information and receiving it from the ships.

30

COMMISSIONER: And then inputting that for the decision-making by others?

MS RESSLER: And then providing that to the decision-makers - - -

COMMISSIONER: Yes. Thank you. 35

MS RESSLER: - - - and I would not do anything with legal, anything ever.

COMMISSIONER: The Assessment Team, capital A, capital T, referred to in this

document, what should I understand that comprises? 40

MS RESSLER: Well, that would be myself and anybody else who was working in

putting together the risk assessments.

COMMISSIONER: So not on board, I’m sure? 45



MS RESSLER: I’m sorry. Where do you – where are you looking specifically,

Commissioner?

COMMISSIONER: Well, if you look at risk assessment high risk, there’s a

reference to an assessment team meeting the ship. 5

MS RESSLER: Yes. That is the onboard assessment team. Yes. That is different.

MR BEASLEY: That’s not – that’s not the panel that’s made a determination of

high risk, medium risk, low risk? 10

MS RESSLER: No.

MR BEASLEY: That’s the team that actually goes onboard and assesses passengers

and takes their temperature and - - - 15

MS RESSLER: Yes.

MR BEASLEY: - - - swabs for COVID if necessary and that’s those sort of

decisions? 20

MS RESSLER: Yes.

MR BEASLEY: And you were a member of that team - - -

25

MS RESSLER: I was. Yes.

MR BEASLEY: - - - for the Ruby Princess on the 8th of March, correct?

MS RESSLER: I was. Yes. 30

COMMISSIONER: How is that team constituted?

MS RESSLER: So there were nurses. There was a doctor. There was myself as an

epidemiologist. There were environmental health officers and admin support, and 35

we were working under an incident command system structure where we had the

operations team, who were the medical, the nurses and – and the doctor - - -

MR BEASLEY: Just pausing there, the doctor on the 8th of March was Dr

Sheppeard, correct? 40

MS RESSLER: That’s correct. Yes.

MR BEASLEY: Who – is it coincident she’s also on the expert health panel team,

or because of that she was part of that team that went onboard the ship? 45

MS RESSLER: It’s - - -



MR BEASLEY: Or you don’t know the answer?

MS RESSLER: We don’t have a lot of doctors to choose from. We have three, and

so it’s a coincidence, I guess.

5


MS RESSLER: Yes.

MR BEASLEY: Okay. 10

COMMISSIONER: The positions, if you like, the descriptions that you’ve just

listed for me, in your experience, are they always New South Wales government

employees or contractors?

15

MS RESSLER: Yes.

MR BEASLEY: For medium risk assessment or determination, it’s got – one of the

criteria is the same as for high risk, that is, respiratory outbreak infecting at least 1

per cent on board. Then it’s got a reference to visiting what I imagine is a high-risk 20

country, and then it – the Commissioner was previously asking you a question about

whether you can have mild acute respiratory illness. In this third criteria, it says:

There are other features of concern, such as where one or more cases has

severe respiratory illness. 25

Is there a difference between acute respiratory illness and severe respiratory illness

that you know of?

MS RESSLER: I can’t answer that. 30

MR BEASLEY: You don’t know what - - -

MS RESSLER: It’s outside my - - -

35

MR BEASLEY: - - - you’re not sure - - -

MS RESSLER: - - - expertise. Yes.

MR BEASLEY: - - - what the author means by severe? 40

MS RESSLER: Yes.

MR BEASLEY: All right. Okay.

45

MS RESSLER: That - - -



COMMISSIONER: Insofar as these criteria for risk assessment relate to what I’ll

call clinical history and clinical presentation, that’s for the medically trained and

ancillary nursing people on the team - - -

MS RESSLER: Yes. 5

COMMISSIONER: - - - to consider rather than you?

MS RESSLER: Yes.

10

COMMISSIONER: Have I grasped that correctly?

MS RESSLER: Yes.


MR BEASLEY: For low risk – I’m sorry. I should just draw this to your attention

too. I think there’s a typo in this document. If you look at the very last bullet point

that discusses what happens if there’s a medium risk assessment, and that is first of

all the – the second-last bullet point is: 20

An assessment team will meet the ship.

Then:

25

Prior to the ship disembarking, the assessment team review passengers and

crew who report fever.

Now, the next word is “of” but I think that’s almost certainly “or”, “respiratory

symptoms”. Do you see that? 30

MS RESSLER: Sorry. Which page are you on?

MR BEASLEY: So - - -

35

COMMISSIONER: It’s on the second page.

MR BEASLEY: Second page, medium risk.

MS RESSLER: Yes. 40

MR BEASLEY:

Prior to the ship disembarking, the assessment team will review passengers and

crew who report fever. 45

MS RESSLER: Yes.



MR BEASLEY: Let’s read the next word as or - - -

MS RESSLER: Yes.

MR BEASLEY: - - - “respiratory symptoms.” That is, the team is interested in 5

people, again, whoever has been the author of this document wants to capture people

- - -

MS RESSLER: Yes.

10

MR BEASLEY: - - - (a) who have a fever, and (b) respiratory symptoms, and they

don’t need to have a fever, but I want to see them as well?

MS RESSLER: Yes.

15

MR BEASLEY: Correct. All right.


MR BEASLEY: Commissioner, it’s quarter to 12. I know we had a short break, but 20

we didn’t have a slightly more substantial break. I’m wondering if you want to give

the witness a - - -

COMMISSIONER: Yes.

25

MR BEASLEY: - - - morning tea break?

COMMISSIONER: Yes. I’m content with that. Twelve o’clock.

MR BEASLEY: Twelve o’clock. 30


ADJOURNED [11.44 am] 35

RESUMED [12.01 pm]

40

MR BEASLEY: I’m sorry.

COMMISSIONER: Not at all.

MR BEASLEY: Unlike junior counsel, I wasn’t asleep. I was asking you about the 45

medium risk assessment. I’m going to come back to that because I want to ask you

some questions when we actually put that practice – sorry, that determination in play



on the 8th of March. Just turning the page for low risk assessment, that – the criteria

for that is, first of all, no respiratory outbreak. That would seemingly only make

sense if no respiratory outbreak of one per cent or more is added to the – it seems

like there might be some words missing. And then – or respiratory outbreak that’s

explained by positive influenza test results and no one onboard has visited a country, 5

including Australian COVID-19 testing. So that’s the low risk criteria. Did that

remain the low risk criteria as far as you understood it?

MS RESSLER: Yes.

10

MR BEASLEY: Yes. All right. So the Commissioner can take it, even though this

document is dated the 19th of February, ultimately, at least in terms of – I know

there’s some enhancements made to procedures that New South Wales Health

wanted from ships, etcetera, and some more instructions. In terms of assessing for

high, medium or risk – sorry, high, medium or low risk, that criteria stayed the same 15

for when the Health Assessment Panel had to make determinations on various ships

that came into Sydney to berth during March 2020?

MS RESSLER: Yes.

20

MR BEASLEY: Thank you. All right. Over the page, after the low risk

assessment, there’s a traveller record form. Was that a document that you had

anything to do with preparing? It looks as though it’s an appendix to this document,

so I imagine the answer is no.

25

MS RESSLER: The answer is yes.

MR BEASLEY: The answer is yes?

MS RESSLER: Yes. 30

MR BEASLEY: Thank you for that. So that – was that a – when it says appendix 1,

is that an appendix to this?

MS RESSLER: I believe so, yes. 35

MR BEASLEY: It is, but this is something you were specifically asked to - - -

MS RESSLER: Yes.

40

MR BEASLEY: All right. So - - -

COMMISSIONER: So where is that referred to in the document?

MS RESSLER: I don’t believe it is. Yes, on the first page. 45

COMMISSIONER: On the first page?



MR BEASLEY: First page?

MS RESSLER: The last dot point:

Provide the letter and traveller record form attached. 5

COMMISSIONER: Sorry?

MS RESSLER: The last dot point. Sorry, the second page. Excuse me.

10

COMMISSIONER: Not at all.

MS RESSLER: Second page, the last - - -

MR BEASLEY: Yes, traveller record form. Yes. Thank you for that. 15

COMMISSIONER: “Letter and traveller record form”.

MR BEASLEY: So this is something you were actually specifically asked to

prepare, was it? 20

MS RESSLER: It was based on the assessment form that was used at the airport,

and we modified it within our unit.

COMMISSIONER: What’s the letter? 25

MS RESSLER: The letter is the – the letter is in here. It’s signed by Mark Ferson,

and that letter went - - -

COMMISSIONER: So where is that, sorry? 30

MS RESSLER: I’m not so sure where it is. It is in here.

COMMISSIONER: This is the letter for passengers?

35

MS RESSLER: That’s right, yes.

MR BEASLEY: I don’t know that there’s a letter to passengers here. There’s a

letter from Dr Chant later on to the cruise ship industry, but I think - - -

40

MS RESSLER: It is in here, Mr Beasley.

MR BEASLEY: Is it?

MS RESSLER: Yes. 45



MR BEASLEY: All right. Well, you flick through it until you – is it in your

appendix 1?

MS RESSLER: No, I don’t think it is.

5

MS FURNESS: Can I assist?

COMMISSIONER: Yes.

MS RESSLER: Please. 10

MS FURNESS: Perhaps the witness is thinking of another document rather than the

ones that are annexed to her statement.

MR BEASLEY: Yes. 15

MS FURNESS: I certainly can’t see it and I don’t think it’s here.

MS RESSLER: Okay.

20

MR BEASLEY: The document you’re thinking of was what, a letter to passengers?

MS RESSLER: Yes, it was a letter to passengers to explain the Health team coming

onboard and to ask, I think, anybody who had symptoms - - -

25

MR BEASLEY: This was a letter of an explanation if a New South Wales

assessment team was going to come onboard, what passengers should do?

MS RESSLER: Yes.

30

MR BEASLEY: All right. Similar to instructions given to the ship about making an

announcement about that.

MS RESSLER: Yes.

35

MR BEASLEY: And I think we’ll find some details about that in some emails, I

think. But just going back to this travel record form.

MS RESSLER: Yes.

40

MR BEASLEY: Obviously, it seeks various contact details to keep track of, well,

have been – it’s so you contact people that have been on a ship, firstly.

MS RESSLER: Yes.

45

MR BEASLEY: Details of where they have been, because as I understand it, some

locations were considered riskier for COVID-19 than others.



MS RESSLER: Yes.

MR BEASLEY: So you wanted to know where the ship had been?

MS RESSLER: Where the passengers had been, yes. 5

MR BEASLEY: And then each of those symptoms, cough or fever or runny nose or

shortness of breath, first of all, are symptoms of – they’re symptoms associated with

whether it’s the common cold, or it could be the flu, or know they’re symptoms that

are also associated with COVID in a relatively mild form at first, I suppose. 10

MS RESSLER: Yes.

MR BEASLEY: All right. You wanted to know when the symptoms are first onset

because that may be relevant to shedding a virus, correct, and whether people have 15

been in contact with that person and possibly become infected themselves because of

close contact?

MS RESSLER: It was to assess the onset of their symptoms in relation to their prior

travel history, so if they’d been in one of those countries in the 14 days before their 20

symptom onset.

COMMISSIONER: As at the 19th of March - - -

MR BEASLEY: 19 February or 19 March? 25

COMMISSIONER: As at the 19th of March, the United States of America was still

not on any such list; is that right?

MS RESSLER: On the 19th of March, there were no countries on the list. It was all 30

travel.

COMMISSIONER: All travel. Yes. And it’s 14 days before embarkation?

MS RESSLER: We were looking for anybody who had been in one of those 35

countries 14 days before embarkation and we would assess if they were sick, but if

somebody was sick, we were looking for 14 days before the onset of their illness.

COMMISSIONER: I’m sorry. You corrected me and said that on the 19th of March

it was no longer a list of countries; it was all countries. 40


COMMISSIONER: That is, that the assessment team was interested to know – had

been a place where a passenger was within the period 14 days before embarkation? 45



MS RESSLER: Yes. However, we didn’t apply this on the 19th of March; we

applied this on the 8th of March, when we still had countries concerned.

COMMISSIONER: I’m actually asking about the 19th of March.

5

MS RESSLER: Yes.

COMMISSIONER: Yes.

MS RESSLER: We didn’t use this form on the 19th of March. 10

COMMISSIONER: No. Well, that’s because there was no assessment at all.


15

COMMISSIONER: Yes. But on the 19th of March, as you understood it, if there

had been an onboard assessment, it would have included, in relation to any

individuals, consideration of his or her presence in any other country apart from

Australia within the period 14 days before embarkation; is that correct or not?

20

MS RESSLER: We – by the 19th of March, everybody who was onboard that ship

were counted as a higher risk because they had all travelled internationally.

COMMISSIONER: You have lost me completely. How were they all – who

classified them as high-risk? 25

MS RESSLER: Not high risk, sir. Higher risk.

COMMISSIONER: Sorry. I thought you said “high”.

30

MS RESSLER: Higher.

COMMISSIONER: Higher. Higher than what?

MS RESSLER: Higher than – well, this was the CDNA classification of risk of 35

coronavirus in travellers.

COMMISSIONER: No, no, no. I can only take it one at a time. Higher than what?

MS RESSLER: I’m not sure, sir. 40

COMMISSIONER: What did you mean when you said “higher risk”?

MS RESSLER: The CDNA guidelines provided a higher risk category and by 19

March, anyone with an overseas travel history were counted as higher risk. Hence, 45

they were all required to go into 14 days home isolation.



COMMISSIONER: That was a higher risk - - -

MR BEASLEY: Sorry. Just to help you with – you mentioned the Communicable

Diseases Network of Australia criteria. Are you talking about an epidemiological

criteria that simply had international travel in 14 days - - - 5

MS RESSLER: Yes.

MR BEASLEY: - - - before the onset of illness?

10


MR BEASLEY: That’s what you meant by that.

MS RESSLER: Yes. 15


COMMISSIONER: But I’m actually asking about a different period, 14 days before

embarkation. 20

MS RESSLER: Yes.

COMMISSIONER: Was that - - -

25

MS RESSLER: We were interested in 14 days before embarkation - - -

COMMISSIONER: Yes.

MS RESSLER: - - - particularly, which is why we highlighted or why I highlighted 30

the American people who were on the respiratory log - - -

COMMISSIONER: Yes.

MS RESSLER: - - - because I thought they were unlikely to have international 35

travel 14 days before embarkation. So, yes, we weren’t looking at that.

COMMISSIONER: Yes.

MS RESSLER: But the rules all changed by 19 March. 40

COMMISSIONER: Which rules changed from the protocol that we’ve been asking

you about, tab 1 of Exhibit 16? Which rules have changed from that - - -

MS RESSLER: So we no longer - - - 45

COMMISSIONER: - - - as at 18 or 19 March?



MS RESSLER: Yes. We no longer had the countries of concern. So, previously,

we had been asking for a respiratory log that included any travel in the 14 days

before symptom onset, and we were able to look at those and know if somebody had

been in Singapore or - - -

5

COMMISSIONER: Sure.

MS RESSLER: - - - Thailand, but by - - -

COMMISSIONER: So that had expanded to all foreign - - - 10

MS RESSLER: All countries, and it made it very difficult for us - - -

COMMISSIONER: - - - origins. Yes.

15

MS RESSLER: Yes. It made it very difficult for us to make a determination of risk

at that stage.

COMMISSIONER: Did you raise that with anyone in your office?

20

MS RESSLER: I believe I was comforted by the fact that everybody had to go into

14 days home isolation, so - - -

COMMISSIONER: That’s not what I asked you. Sorry. Did you raise that - - -

25

MS RESSLER: Did I raise it - - -

COMMISSIONER: - - - with anyone in your office?

MS RESSLER: I can’t remember doing so. 30

COMMISSIONER: Well, now, then - - -

MS RESSLER: But at that stage - - -

35

COMMISSIONER: Yes. Sorry. You finish.

MS RESSLER: At that stage, I was glad that the cruises were stopping and I was

glad that everybody had to go into home isolation. We had recognised the risk was

increasing and we were very concerned about it. 40

COMMISSIONER: Now, did you have an understanding of the legal ..... the

obligation to go into home isolation for 14 days?

MS RESSLER: No, I didn’t. I made inquiries on 18 March to try to work that out. 45

COMMISSIONER: And?



MS RESSLER: I was told that it was being enforced by Australian Border Force

and that’s all I knew.

COMMISSIONER: What do you mean “enforced by Australian Border Force”?

I’ve never seen ABF officers out in the community knocking on doors. 5

MS RESSLER: No, no. And I - - -

COMMISSIONER: What did you think you understood by “enforced by ABF”?

10

MS RESSLER: Well, I understood that ABF were going to be advising people to go

into home isolation. I didn’t think they would be enforcing it in the community - - -

COMMISSIONER: No.

15

MS RESSLER: - - - and there is a conversation between myself and seaports

manager in which he says to me, “I don’t know how it’s enforced once they go

home.” We didn’t know.

COMMISSIONER: Did you know whether or not it was under New South Wales 20

legislative authority that the 14-day home isolation or self-quarantine, call it what

you will, was a legal obligation imposed on the disembarking passengers? Did you

know that?

MS RESSLER: No. 25

COMMISSIONER: Was there any talk in the office about whether it was

Commonwealth or State or both?

MS RESSLER: I understood that it was Commonwealth because it was announced 30

by Scott Morrison. So I understood it was Commonwealth and I made a few

questions to Professor Ferson and probably in other communications to try to work

out how it was going to be enforced and what was going to happen. I don’t know

that we got to the bottom of it and I certainly didn’t understand it.

35

COMMISSIONER: Were you, in the period up to and including 19 March, aware of

any exercise of statutory authority by Mr Hazzard, the State Health Minister?

MS RESSLER: No.

40

COMMISSIONER: Was there any talk of that in your office?

MS RESSLER: There could have been. I don’t recall.

COMMISSIONER: Within your office, was it routine for there to be an explanation 45

of the source of authority under which you were acting or for which you were

carrying out your duties?



MS RESSLER: No. I - - -

COMMISSIONER: Were you aware that there was a possible combination of both

Commonwealth and State authority?

5

MS RESSLER: Yes.

COMMISSIONER: And in relation to the possible source of Commonwealth

authority, did your – did the training you received or the information given to you

allow you – lead you to believe what Commonwealth agencies were involved? 10

MS RESSLER: There was an awful lot of information coming through.

COMMISSIONER: From?

15

MS RESSLER: From everywhere. There was - - -

COMMISSIONER: Well, I take it that’s an exaggeration. From where?

MS RESSLER: From everywhere. Okay. Yes. You’re right. 20

COMMISSIONER: That’s all right. From where?

MS RESSLER: From the Ministry of Health, from my director - - -

25

COMMISSIONER: So that’s State.

MS RESSLER: Yes. Mainly from - - -

COMMISSIONER: And your director is State. 30

MS RESSLER: Yes. Mainly from State. Yes. And Sean Tobin would forward me

the Commonwealth information from time to time, but I was not routinely copied

into any of those. I didn’t take it upon myself to clearly understand them. I was

doing my role as I saw my role and I was not only working on the cruise ship 35

program, but I was also heavily involved in case management and contact

management, and it was an extremely busy time and I didn’t really focus on any of

the legalities.

COMMISSIONER: Throughout this protocol, there’s references with respect to the 40

different risk ratings - - -

MS RESSLER: Yes.

COMMISSIONER: - - - to points at which people would be allowed or permitted to 45

disembark. You’re familiar with that idea, aren’t you?



MS RESSLER: Yes.

COMMISSIONER: As at 18 and 19 March, including the previous voyage, 8

March - - -

5

MS RESSLER: Yes.

COMMISSIONER: - - - what was your understanding as to the system under which

people needed permission to disembark or obtain permission to disembark? Who did

you understand was in the position to say “yes” or “no”, “You can get off this ship”? 10

MS RESSLER: The chief human biosecurity officer.

COMMISSIONER: Which you understood to be a State officer?

15

MS RESSLER: Yes.

COMMISSIONER: But you don’t know whether you understood that to be under

Commonwealth authority?

20

MS RESSLER: Well, I understood it to be under State.

COMMISSIONER: Is that because of somebody telling you that?

MS RESSLER: No. Because I’m aware of Dr Tobin’s role and when I’m on board 25

the cruise ships, doing an assessment, I always had that decision made by my

superior.

COMMISSIONER: And because your superior is in the State public service, you

assumed it was under State authority? 30

MS RESSLER: Well - - -

COMMISSIONER: I’m not criticising you for that.

35

MS RESSLER: My superior was in the public health unit and he or she would be in

contact with the State to make that determination. Yes, not the Commonwealth, the

State, as far as I’m aware.


MS FURNESS: Commissioner.

COMMISSIONER: Yes.

45

MS FURNESS: Might I assist in the location of some documents relevant to the

evidence.



COMMISSIONER: Yes. Thank you. Please.

MS FURNESS: Behind tab 17 of Ms Ressler’s statement is the email exchange she

was referring to earlier - - -

5

COMMISSIONER: Yes.

MS FURNESS: - - - and she has written the email to Sean, who is Dr Tobin - - -

COMMISSIONER: Yes. 10

MS FURNESS: - - - who is the chief officer, and Jillian, who is Jillian Hicks from

the Commonwealth Department of Health.


MS FURNESS: And then the responses from Dr Tobin.

COMMISSIONER: Yes.

20

MS FURNESS: That’s the first document. And the second - - -

COMMISSIONER: Yes. No. I’m aware of that document. Yes.

MS FURNESS: And the second document is behind the final version of the Ruby 25

Princess report, and that’s, I think, about appendix 3, which is the letter from Border

Force confirming they’re well.

COMMISSIONER: Yes. Thank you. Apropos that, could you explain to us as at

18 March what position you understood Jillian Hicks to hold? 30

MS RESSLER: She was in the border health section, but I’m not sure of her

position now.

COMMISSIONER: That’s the border health section of the Commonwealth 35

Department of Health, isn’t it?

MS RESSLER: That’s right. Yes.

COMMISSIONER: And then there’s the Commonwealth Department of 40

Agriculture, etcetera - - -

MS RESSLER: Yes.

COMMISSIONER: - - - that looks after – receives the Human Health Report? 45

MS RESSLER: Yes.



COMMISSIONER: And then there’s the Australian Border Force, to which you’ve

already made some reference?

MS RESSLER: Yes.

5

COMMISSIONER: And then there’s Home Affairs and then there’s Immigration as

well?

MS RESSLER: Yes.

10

COMMISSIONER: And that’s before we come back to the state with the Port

Authority and the like. Your training and your office practices did not extend to

making you aware of who was discharging what responsibilities among those various

Commonwealth and state agencies I’ve just named. Is that right?

15



MR BEASLEY: Behind the traveller record form still in appendix 1 of your 20

statement is a blank pre-arrival risk assessment form. Do you have that in front of

you?

MS RESSLER: Yes.

25

MR BEASLEY: Is that a form that you helped put together?

MS RESSLER: Yes.

MR BEASLEY: And at about what time – was that form created at around the time 30

of this 19 March draft protocol, or was it done later?

MS RESSLER: Nineteen February.

MR BEASLEY: Sorry, 19 February. Yes. You’re right. 35

MS RESSLER: It was done around that time.

MR BEASLEY: All right. And did anyone – did you consult with anyone about

what this – what questions this form would ask cruise ships? 40

MS RESSLER: The questions were discussed in the teleconference.

MR BEASLEY: Teleconference with who?

45

MS RESSLER: With the expert panel.



MR BEASLEY: So this was discussed with the doctors that ultimately formed part

of the Health Assessment Panel that made low, medium, and high risk

determinations?

MS RESSLER: Yes. I believe the form was originally developed by somebody in 5

the Ministry, and it was modified as we went depending on the information we

needed to collect and how - - -

MR BEASLEY: Just - - -

10

MS RESSLER: - - - to present it.

MR BEASLEY: Sorry. Just pausing there, you think it was originally developed by

someone in the Ministry – Department of Health?

15

MS RESSLER: Yes. I think so. I’m not sure.

MR BEASLEY: Do you know that person?

MS RESSLER: No. 20

MR BEASLEY: All right. And it was given, what, to you as a draft to work on?

MS RESSLER: It was given to us to use in practice on the early assessments, and

the questions developed as the situation evolved - - - 25

MR BEASLEY: When – when was - - -

MS RESSLER: - - - and it was modified as we went.

30

MR BEASLEY: Sorry. When you say the questions evolved, the form was subject

to change following you having discussions with the health expert health assessment

team?

MS RESSLER: Yes. 35

MR BEASLEY: Which included Professor Ferson, Doctor Tobin, and Dr – is it

Professor Sheppeard, I’m sorry, or Dr Sheppeard?

MS RESSLER: Doctor. 40

MR BEASLEY: Dr Sheppeard, and others that were on that expert panel.

MS RESSLER: Yes.

45

MR BEASLEY: All right. Can I ask you some specific questions about it. I think

we’ve already covered why – there’s some questions, obviously, about where the



ship’s been, number of people onboard, et cetera, whether people have been in

contact with a confirmed case of COVID-19, whether the ship’s been in China, et

cetera. Then there’s a box for has the ship actively asked – sorry, I will go back a

step.

5

Has the ship ensured all passengers with respiratory symptoms are isolated

while on board - - -

MS RESSLER: Yes.

10

MR BEASLEY:

…and provide them with hand rub and mask for onward travel.

Does – when we were looking at the protocol, we had respiratory disease or fever. 15

Now we’ve got respiratory symptoms and fever. Is that – should the Commissioner

take that as a typographical error? Or are you only seeking information about people

who have respiratory symptoms and also have a fever?

MS RESSLER: The shipboard protocols require isolation of people with influenza-20

like illness - - -

MR BEASLEY: I see.

MS RESSLER: - - - so that is respiratory illness and fever. 25

MR BEASLEY: Right.

COMMISSIONER: Sorry, what document are you referring to there?

30

MS RESSLER: These are the shipboard protocols for respiratory illness onboard.

MR BEASLEY: Yes.

COMMISSIONER: So what document is that? 35

MS RESSLER: Well, you would get – I would get them, and I have them – from

Princess Cruises, from Carnival Cruises, from Royal Caribbean. They all have their

own onboard response protocols for respiratory illness.

40

COMMISSIONER: But if I go back to the second page of this Annexure 1.

MR BEASLEY: Yes.

COMMISSIONER: There’s a heading Pre-arrival Requirements that starts: 45

The ship is required to



Do you see that?

MS RESSLER: Yes. Sorry, what page?

COMMISSIONER: It’s the first page of – the second page of text. 5

MS RESSLER: Yes. I see.

COMMISSIONER: It just says:

10

The ship is required to

Do you see that?

MS RESSLER: Mmm. 15

COMMISSIONER: That doesn’t leave room for them to depart from those

requirements by reference to their own templates, does it?

MS RESSLER: No. 20

COMMISSIONER: And if a ship did depart from that they, I take it, would be

corrected?

MS RESSLER: Yes. 25

COMMISSIONER: Did you correct ships in that regard?

MS RESSLER: So does that say “or” or “and fever”?

30

COMMISSIONER: Well, I know what it says.

MR BEASLEY: Yes.

COMMISSIONER: But I don’t think that’s going to affect by question. Did you 35

correct them?

MS RESSLER: I had conversations with ship’s doctors who resisted having to

isolate people with a cough and people with minor respiratory illness.

40

COMMISSIONER: Very well. Could I have a look – could I ask you please, to

look in that first bracket of dot points, at the fifth one – it starts with the word

“ensure” do you see that?

MS RESSLER: Yes. 45



COMMISSIONER: And it’s plain as language can make it that it does not require

fever to accompany respiratory systems or vice versa, doesn’t it?

MS RESSLER: It requires both, yes.

5

COMMISSIONER: It does not require both, does it?

MS RESSLER: No. It doesn’t, it requires respiratory symptoms – or – fever. It

requires all of those people to be in isolation.

10

COMMISSIONER: It actually says “and/or” do you see that?

MS RESSLER: Yes. I do.

COMMISSIONER: So it has cases where there is both and cases where there is one 15

but not the other.


COMMISSIONER: Three categories. That’s plain, isn’t it, to you, as an 20

epidemiologist? Is that correct?

MS RESSLER: Yes. That’s correct.

COMMISSIONER: Did you understand during the period from the 19th of February 25

through to the 19th of March that a ship who resisted that requirement would be in

breach of your protocol?

MS RESSLER: No. I didn’t understand that, at the time.

30

COMMISSIONER: Why not? Isn’t it plain?

MS RESSLER: Because I have worked with ships for a long time and I understand

their internal protocols and I understood that they required people to be isolated for

influenza-like illness and so that is what I was used to. 35

MR BEASLEY: No. I – what the Commissioner is asking, though, is – I think – a

little simpler. What he’s saying is that the protocol clearly requires ships to isolate

passengers that either have a respiratory illness or a fever - - -

40

COMMISSIONER: Or both.

MR BEASLEY: - - - or both.

MS RESSLER: Yes. 45



MR BEASLEY: What I am understanding – am I understanding you correctly in

terms of how you drafted the pre-arrival risk assessment form is that, because of

resistance - - -

MS RESSLER: No. 5

MR BEASLEY: - - - from ship people about isolating people who didn’t have a

fever, you changed the question?

MS RESSLER: Not because of resistance, this - - - 10

MR BEASLEY: All right. Why – why – why – was it modified to include “and

fever” rather than “and/or”?

MS RESSLER: I don’t know. 15


COMMISSIONER: It will reduce, will it not, the class of persons of interest? Is

that right? It will reduce the number of - - - 20

MS RESSLER: Yes.

COMMISSIONER: Yes.

25

MR BEASLEY: When you say you “don’t know” do you recall any discussion at

all with anyone about changing that criteria from “and/or” to “and”?

MS RESSLER: I don’t remember - - -

30

MR BEASLEY: You don’t. All right.

MS RESSLER: - - - any conversation like that.

MR BEASLEY: That’s okay. 35

COMMISSIONER: Well, can you explain that discrepancy?

MS RESSLER: No, I can’t, Commissioner.

40

COMMISSIONER: You’re not, you think, responsible for any part of the text of the

protocol. Is that correct?

MS RESSLER: I don’t think so.

45

COMMISSIONER: All right.



MS RESSLER: I think it might be - - -

COMMISSIONER: But what about the text of the pre-arrival risk assessment form?

Are you responsible for any part of it?

5

MS RESSLER: Probably, yes.

COMMISSIONER: And do you think you’re responsible for that cell in it that

starts:

10

Has the ship ensured

MS RESSLER: I don’t know, Commissioner.

MR BEASLEY: Was this kept on – can I ask you this – the, in its draft forms, 15

before it became final, was this kept on a computer system that you had access to,

that others had access to, that you could make changes and edit?

MS RESSLER: Yes.

20

MR BEASLEY: All right. Who had the capacity to edit the form?

MS RESSLER: Well, anybody who worked in the Public Health Unit did.

MR BEASLEY: Anybody? 25

MS RESSLER: Anybody in the public health unit had access to that form, yes.

MR BEASLEY: Well, who had authority, though, to make changes to it?

30

MS RESSLER: I had authority to make changes. But they were always approved

- - -

MR BEASLEY: Up the line?

35

MS RESSLER: Yes.

MR BEASLEY: So that would go to who? Your Deputy Director or your Director?

MS RESSLER: Yes. 40

MR BEASLEY: All right. So Dr Sheppeard or Professor Ferson?

MS RESSLER: Yes.

45

MR BEASLEY: And there were others that you would circulate a change to? A

proposed change, I’m sorry?



MS RESSLER: Maybe to Laura-Jayne. But - - -

MR BEASLEY: Now - - -

MS RESSLER: Yes, she would have been - - - 5

MR BEASLEY: - - - you’ve just said someone’s Christian name.

MS RESSLER: I’m sorry.

10

MR BEASLEY: You’re talking about Laura-Jayne Quinn?

MS RESSLER: That’s right, yes.

MR BEASLEY: Who is? 15

MS RESSLER: Who is an Environmental Health Officer who was helping me with

the assessments.

MR BEASLEY: Was she someone that helped you in your drafting of this form? 20

Did she have an input into it?

MS RESSLER: I don’t believe so, no.

MR BEASLEY: All right. Can I ask you, if you look down the next cell that you 25

were asked some questions about, it then changes back to:

Respiratory symptoms or fever

So has the ship actively asked passengers and crew, “If they have respiratory 30

symptoms or fever?” And asked them to present to the ship’s doctor for assessment

before arrival. Does the Commissioner take it that regardless of the change to when

people were required to isolate, it was still important from a risk-assessment point of

view to make sure the ship asked people to present to the medical centre that had

respiratory symptoms, whether or not they had a fever, and all those people that did 35

have a fever?

MS RESSLER: Yes.

MR BEASLEY: All right. And why was that? 40

MS RESSLER: Because we wanted people with respiratory symptoms to have a

medical assessment.

MR BEASLEY: All right. But the reason you wanted them to have a medical 45

assessment was?



MS RESSLER: To - - -

MR BEASLEY: In the context of COVID-19 - - -

MS RESSLER: Yes. 5

MR BEASLEY: - - - why?

MS RESSLER: To try – to try – to work out if they could fit the case definition for

requiring a COVID test. 10

MR BEASLEY: All right. Now, I’m just coming - - -

COMMISSIONER: So it’s a screen, a screen being applied at a – with a number of

stages. Is that correct? 15

MS RESSLER: It would be a medical assessment by the ship’s doctor.

COMMISSIONER: Yes. But that would be, then, followed by the possibility of

later steps taken by the Assessment Team from Health - - - 20

MS RESSLER: Yes.

COMMISSIONER: - - - is that correct?

25

MS RESSLER: Yes.

MR BEASLEY: So it’s important - - -

COMMISSIONER: And the screen being applied by the doctor is required to 30

include a recent history of isolation onboard of passengers with either or both

respiratory symptoms or fever. Is that correct?

MS RESSLER: It is, by reading that document, yes.

35

COMMISSIONER: Well, what do you mean by adding that?

MS RESSLER: Because - - -

COMMISSIONER: Do you intend to suggest that this was just words, of no 40

importance?

MS RESSLER: I intend to suggest that ships had their own protocols that they

followed - - -

45

COMMISSIONER: What – what - - -



MS RESSLER: - - - and while a ship is out at sea, I have no jurisdiction over what

they do. This is what we were impressing on them would be in their best interest and

in the best interest of their passengers. But they follow their own protocols and

they’ve been very clear to us over the years that that’s what they do. And their

protocols are generally developed with the United States Center for Disease Control 5

and all I can do is make sure that they are following their own protocols or attempt to

make sure they’re following their own protocols.

COMMISSIONER: Are you sure about that last sentence of your evidence? Are

you sure that’s what you mean? 10

MS RESSLER: In – in – what way, Commissioner?

COMMISSIONER: All you could do is to ensure “they are following their own

protocols” you told me. Actually, you could find out whether they were following 15

Australian protocols, couldn’t you?

MS RESSLER: Yes, I can. Yes.

COMMISSIONER: And if they did not, deal with them accordingly, couldn’t you? 20

MS RESSLER: Yes.

COMMISSIONER: Which might mean that the disembarkation of their passengers

and a quick turnaround for the next set of paying passengers would be impeded; 25

isn’t that right?

MS RESSLER: Yes.

COMMISSIONER: That’s simply incorrect for you to have told me on oath just a 30

minute ago that all you could do was to ensure they complied with their own

protocols, isn’t it?

MS RESSLER: Yes.

35

COMMISSIONER: I’m very - - -

MS RESSLER: I’m sorry.

COMMISSIONER: - - - concerned that you may have tried to mislead me with that 40

answer.

MS RESSLER: It was not my intention, Commissioner.

COMMISSIONER: Very well, then. Can I ask, did you take this protocol, drafted 45

11 am, 19th February 2020, as your marching instructions, if you understand that

expression? Did that tell you how you were to proceed, so far as you were



concerned? Now, you’re hesitating; is that because you don’t know the answer or

you’re unwilling to articulate it?

MS RESSLER: It’s because the words that are written in a protocol are sometimes a

little different to what happens in practice. 5

COMMISSIONER: Isn’t the protocol there precisely in order to shape and control

practice?

MS RESSLER: Yes. And we - - - 10

COMMISSIONER: And if they are different, that means the practice is deficient,

doesn’t it?

MS RESSLER: Yes. 15

COMMISSIONER: Very well, then. Do I gather from the way you have answered

the last few questions that you actually remember that practice was deficient?

MS RESSLER: I remember that practice was extremely challenging, and I don’t 20

- - -

COMMISSIONER: What is challenging, with respect, about insisting to a ship’s

doctor that it doesn’t matter what their practice is or from what other country it may

emanate? In a New South Wales port, they will they have to show compliance with a 25

New South Wales protocol; what’s challenging about that?

MS RESSLER: It’s difficult for me in my role as an epidemiologist in a local Public

Health Unit to insist on the practices of massive cruise ship companies myself. Now

- - - 30

COMMISSIONER: Who else apart from yourself had, as you understand it, the

responsibility for liaising with the ships pre-arrival?

MS RESSLER: The communications that were being sent to the industry from Dr 35

Kerry Chant and from the Commonwealth have the responsibility to impress on them

what is our requirements and - - -

COMMISSIONER: I’m sorry. That is not what I asked. Please answer my

question. 40

MS RESSLER: You asked - - -

COMMISSIONER: Who apart from you had responsibility for liaison pre-arrival

with the ships? 45



MR BEASLEY: I think you’re being asked about your – you had communications

with Dr von Watzdorf, for example.

MS RESSLER: Yes.

5

MR BEASLEY: And that was only you. Primarily, you were the first point of call

with the doctor on the ship.


10

COMMISSIONER: And what I’m trying to find out is what lies behind this image

you have just given us of little old New South Wales and great big cruise companies,

which, if I may so, sounds both unrealistic and offensive. Could you explain

yourself, please?

15

MS RESSLER: I’m not characterising little old New South Wales. I guess it’s

more me and my role and whether or not I personally had the backing to impress on

cruise ships that they needed to put into isolation somebody with a mild cough and

cold, and I - - -

20

COMMISSIONER: Well, now, you have already told us – and this won’t be an

object of my criticising you – you have already told us you had, you think, no

training or instruction at all concerning the sources of authority - - -

MS RESSLER: Yes. 25

COMMISSIONER: - - - that were involved in these dealings with ships; is that still

your evidence?

MS RESSLER: Yes. 30

COMMISSIONER: On the other hand, you did understand that there was a protocol

to guide the way in which these ships were to proceed as they neared Sydney

Harbour, correct?

35


COMMISSIONER: Do you have any recollection of any dealing before the arrival

on the 8th of March or before the arrival on the 19th of March of the Ruby Princess

with anybody onboard that ship, including its doctor, in which the subject of isolation 40

of passengers by reference to respiratory symptoms and fever or respiratory

symptoms or fever was raised?

MS RESSLER: No.

45

COMMISSIONER: So that is other ships and other times apart from that ship on

those two occasions - - -



MS RESSLER: Yes.

COMMISSIONER: - - - that that topic was raised?

MS RESSLER: Yes. 5

COMMISSIONER: Thank you. You agree, I think, with what – something Mr

Beasley has asked you, that as you understood the – I’ll call it the provisional

epidemiology of COVID-19 by the 18th of March, by requiring both respiratory

symptoms for isolation onboard, it would be calculated to reduce the number of 10

passengers isolating on board a cruise ship during the cruise.

MS RESSLER: That would – yes.

COMMISSIONER: Yes. And did it play any part in your thinking that people who 15

go onto a cruise, by and large, don’t do so in order to be alone in their cabin?

MS RESSLER: I’m aware of that, yes.

COMMISSIONER: Did that play a part in your thinking? 20

MS RESSLER: I understand it clearly as a barrier to reporting illness onboard a

cruise ship, yes. It is a reason that people don’t go to the doctor. They don’t want to

be isolated on their holiday.

25

COMMISSIONER: So that’s another factor whereby the number of people in

isolation is – one would calculate that it’ll be fewer than those who, in infection

control terms, should be in isolation.

MS RESSLER: Yes. 30

COMMISSIONER: Is that correct?

MS RESSLER: Yes.

35

COMMISSIONER: And by that last expression, I meant from the point of view of a

desirable outcome onshore in the Australian community; is that right?

MS RESSLER: Yes.

40

COMMISSIONER: While I’m asking questions about the protocol, I wanted to ask

you about a different topic. Am I right in thinking there were fewer people swabbed

for COVID-19 than for influenza on the Ruby Princess in the cruise that finished on

the 19th of March?

45

MS RESSLER: Fewer people swabbed for COVID than influenza, yes.



COMMISSIONER: Yes. Why is that?

MR BEASLEY: Well, I think there weren’t – there was only 25 COVID-19 swabs

onboard, weren’t there, for a start?

5

MS RESSLER: Yes.

MR BEASLEY: So there’s a limitation as to how many swabs the cruise company

had.

10

COMMISSIONER: So it’s a quartermaster, is it, “What stores do you have?”

MS RESSLER: We have - - -

MR BEASLEY: No, they had been provided - - - 15

COMMISSIONER: No, I know ..... is.

MR BEASLEY: Yes.

20

MS RESSLER: No, it’s not a question of their stores. We can test the swab used

for an influenza - - -

COMMISSIONER: You can test that for COVID?

25

MS RESSLER: We can. We – it’s not ideal, but we can do that.

COMMISSIONER: Thank you. Well, why I’m asking the question is this: I have

gathered from my reading, and I’m really asking you for your expert experience, it

appears to have been routine that on these cruises, more people would be tested for 30

influenza than were tested for COVID-19; is that correct?


COMMISSIONER: But I don’t understand how that fits with what the protocol 35

requires under the heading Pre-arrival Respiratory Illness Screening; do you see

that?

MS RESSLER: Yes, I am aware of - - -

40

COMMISSIONER: Where that appears that the routine is that the general category

of respiratory illness that appears to be the result of an assessment by the medical

team after presentation with respiratory symptoms or fever, that all people so

assessed, that is, to have respiratory illness, would have two swabs collected: one for

rapid influenza test and one to store for COVID-19 testing. 45

MS RESSLER: Yes.



COMMISSIONER: Now, you tell me if I’m wrong. I’m only a lawyer. That looks

very plain, clear and unambiguous to me; is that how it strikes you as a public health

epidemiologist?

MS RESSLER: Yes, I - - - 5

COMMISSIONER: Then why would it be the expectation that, routinely, there

were more influenza test swabs than COVID-19 test swabs?

MS RESSLER: I don’t know, Commissioner. I don’t – I don’t know. 10

COMMISSIONER: Well, doing the best you can, first of all, can you recall any

discussion in your office about that apparent discrepancy?

MS RESSLER: No. I can’t. 15

COMMISSIONER: Did any of your superiors ever make any comment to you

concerning the unsatisfactory state of affairs constituted by that discrepancy?

MS RESSLER: Not that I can recall, no. 20

COMMISSIONER: Until now, just – that is now in this hearing, did it ever strike

you as unsatisfactory?

MS RESSLER: Not that in particular. 25

COMMISSIONER: Why not?

MS RESSLER: I would have liked to have done a lot more testing on cruise ships

- - - 30

COMMISSIONER: I’m not talking about a lot more testing. I’m just talking about

the plain requirement to collect two swabs – that means from each of the passengers

or crew present with respiratory illness, doesn’t it?

35

MS RESSLER: Yes.

COMMISSIONER: One for influenza, one for COVID-19, correct?

MS RESSLER: Yes. 40

COMMISSIONER: Because it was understood, wasn’t it, that a person’s state of

infection with COVID-19 might be what is sometimes called occult, that is secret,

correct?

45

MS RESSLER: Yes.



COMMISSIONER: But that such a person sometimes called pre-symptomatic or

asymptomatic might nonetheless be, on the very incomplete and provisional

knowledge to date – that is, to 19 March – might be a source of contagion in the

community.

5

MS RESSLER: Yes.

COMMISSIONER: Is that correct?

MS RESSLER: Yes. 10

COMMISSIONER: Now, I take it as a public health epidemiologist that’s the state

of affairs in which it was thought appropriate that all passengers or crew present with

– perhaps that means presenting with – respiratory illness would have a swab taken

for COVID-19. Am I correct? 15

MS RESSLER: Yes.

COMMISSIONER: Because even if they were dispersed dockside, their test results

could mean the rapid contact tracing, which may save lives in the community. 20

MS RESSLER: Yes. That was the plan.

COMMISSIONER: And although it may be – let me make this clear – a very

difficult and challenging procedure, contact tracing, the policy is a very 25

straightforward and simple one, isn’t it?

MS RESSLER: Yes.

COMMISSIONER: Obtain microbiological information about people whose 30

medical and social history made it sensible, first of all, to take a swab. Is that

correct?

MS RESSLER: Yes.

35

COMMISSIONER: And if the swab was positive, urgently, to take steps with

respect to their possible contagious contact with others, is that right?

MS RESSLER: Yes. That’s right.

40

COMMISSIONER: Indeed, as a blanket precaution, even without any such positive

swab, the 14-day compulsory home isolation was intended to provide some

protection against community contagion, is that right?

MS RESSLER: That’s right. 45



COMMISSIONER: You’ll appreciate, against that background, why – I hope you

will appreciate why it is difficult for me to understand why it would not have struck

you and those in your team and those superior to you in health if that be the case,

then why it would not strike them as unsatisfactory that there were not as many

COVID-19 swabs as there were influenza swabs. 5

MS RESSLER: I agree. It was unsatisfactory.

COMMISSIONER: Has there been, to your knowledge, up to this moment, any step

taken within health to reflect on that unsatisfactory state of affairs? 10

MS RESSLER: Not that I’m aware of.

COMMISSIONER: So here and now, when I’m questioning you, is the most overt

it has ever been raised with you, is that right? 15

MS RESSLER: Yes. That’s right. I – I wasn’t part of the decision making for

developing the testing criteria, and until you raise it with me now I wasn’t aware that

it was so unsatisfactory.

20

COMMISSIONER: Mr Beasley was asking you about this relation of respiratory

symptoms and fever and the various ways and contexts in which the presence of both

or just one or other was an indicator for some epidemiologically informed public

health response. Do you recall those questions?

25

MS RESSLER: Yes.

COMMISSIONER: On the next page of this protocol document under the heading

Risk Assessment, High Risk - - -

30

MS RESSLER: Yes.

COMMISSIONER: - - - and I stress, this is the high-risk case:

The assessment team meets the ship and the next step is the urgent provision of 35

swabs.

Do you see that?

MS RESSLER: Yes. 40

COMMISSIONER:

And that’s from any person suspected with fever or respiratory infection.

45

Do you see that?



MS RESSLER: Yes.

COMMISSIONER: You’re nodding. You do see it.

MS RESSLER: I do see it. Yes. 5

COMMISSIONER: You don’t have any doubt, do you, that that was not a matter

for a cruise company to say, “Actually, we’re only going to have swabs from people

who have both respiratory symptoms and fever.” You would regard that as an absurd

and impertinent - - - 10

MS RESSLER: Yes.

COMMISSIONER: - - - intervention attempted by the cruise company, wouldn’t

you? 15

MS RESSLER: Yes.

COMMISSIONER: Then why would that have not been the same attitude when you

asked to check whether they were isolating before their arrival on the high seas 20

beyond your jurisdiction, as you put it, people who had one or other as well as people

who had both? Why not the same attitude?

MS RESSLER: It should have been the same attitude.

25

COMMISSIONER: It is true, isn’t it, that you’ve always understood that isolation

on board before their arrival in the Australian territorial seas - - -

MS RESSLER: Yes.

30

COMMISSIONER: - - - that that was for the purpose of the later protection of the

Australian community upon their disembarkation?

MS RESSLER: Yes. And to protect other passengers on board.

35

COMMISSIONER: Well, quite. Other passengers may be a vector of contagion for

people in the Australian community.


40

COMMISSIONER: That’s the whole point, isn’t it?

COMMISSIONER: You should take this opportunity to say what you want to say

against this proposition: that what I’ve been asking you about in relation to this

protocol and the purpose this protocol had to protect the Australian community 45

against future contagion doesn’t sound very difficult or complicated in its principles,

correct?



MS RESSLER: Yes.

COMMISSIONER: And yet, seems most imperfectly, not to have been observed, is

that correct?

5

MS RESSLER: Yes.

COMMISSIONER: Is there anything you want to tell me as to why I should not

draw the conclusion that there has been a reprehensible shortcoming in New South

Wales Health in that regard? 10

MS RESSLER: Commissioner, all I can say is that I’m very sorry it turned out the

way it did. It was not our intention. Myself and my colleagues at the public health

unit were working very hard on this. We did what we could and if we could do it

again, it would be very different. 15

MR BEASLEY: When you’re ready - - -

MS RESSLER: Yes.

20

MR BEASLEY: - - - and tell me when you’re ready, I just want to come back to the

pre-arrival risk assessment form to ask you about that box under the box – the cell

dealing with isolation. You tell me when you’re ready.

MS RESSLER: I’m ready. 25

COMMISSIONER: Okay.

MS FURNESS: Commissioner, it is 10 to 1. Might I ask, given the distress of the

witness, that there be an early lunch? 30

COMMISSIONER: You may ask and I will grant it. Yes. Could we resume

though, please, at quarter to 2. Thank you.

35

ADJOURNED [12.52 pm]

RESUMED [1.46 pm]

40

MR BEASLEY: Ms Ressler, before the break, I was asking you some questions

about that pre-arrival risk assessment form.

MS RESSLER: Mmm. 45



MR BEASLEY: And we had discussed the cell dealing with when passengers were

to be isolated. Underneath, there is cell that we briefly discussed about – which

asked this question of the ship:

Has the ship actively asked passengers and crew if they have respiratory 5

symptoms or fever and asked them to go to the ship’s doctor for assessment?

That, obviously, brings in the “or” as in, you are wanting, from this form, people

with respiratory symptoms that don’t necessarily have fever to also go to the doctor

and be assessed, correct? 10


MR BEASLEY: Are you familiar with the, you know what I’m talking about if I

use the expression Communicable Diseases Network Australia? 15

MS RESSLER: Yes.

MR BEASLEY: And I think it’s mentioned briefly in your statement. But I don’t

think the case definition is annexed. Hopefully, in front of you, you have the CDNA 20

COVID-19 Case Definition?


MR BEASLEY: One of the documents? 25

MS RESSLER: Yes.

MR BEASLEY: It says:

30

Current on 19 March.

I want you to assume that that’s, at least, current on 10 March. You will see there

there’s an:

35

Epidemiological criteria

MS RESSLER: Yes.

MR BEASLEY: Which is: 40

International travel 14 days before onset or close contact with a confirmed

case.

Then there’s: 45

Clinical Criteria



Which is broken up in the manner of the 19 February Protocol, if I can put it that way

where the clinical criteria are:

Fever or acute respiratory infection with or without fever.

5

Do you see that?

MS RESSLER: Yes.

MR BEASLEY: Did you have that in mind – and please tell us if you didn’t – did 10

you have that CNDA definition in mind when you posed the question about making

sure passengers and crew report respiratory symptoms or fever to the ship’s doctor?

MS RESSLER: Yes.

15

MR BEASLEY: You did. So you had specifically turned your attention to the

CNDA COVID-19 case definition?

MS RESSLER: Yes.

20


MS RESSLER: The CNDA case definition is the same as we were using in New

South Wales.

25

MR BEASLEY: Right. Okay. And that CNDA case definition for clinical criteria

of:

Fever or acute respiratory infection with or without fever.

30

MS RESSLER: Yes.

MR BEASLEY: Seems to have found its way into that 19 February New South

Wales Protocol, correct?

35

MS RESSLER: Yes.

MR BEASLEY: In terms of assessing low-risk, high-risk, medium-risk, etcetera?

MS RESSLER: Yes. 40

MR BEASLEY: Yes. Okay. Free of charge, I think, we have already discussed.

That was a means of ensuring, as far as possible, that people that had symptoms that

were relevant didn’t not go to the ship’s doctor because they might have to pay some

money, correct? 45




MR BEASLEY: And that would give you greater comfort. The fact that a ship was

not charging people to go to the medical centre for these sorts of symptoms is

something that was factored into the risk assessment was it, in some way?

MS RESSLER: Yes. 5

MR BEASLEY: Yes. All right. But then there’s this division in the next two cells

about, first of all, let’s deal with this one:

Number of passengers and crew who presented to the ship’s clinic with acute 10

respiratory illness this cruise.

MS RESSLER: Yes.

MR BEASLEY: So you want the numbers for those presentations, that I assume, 15

includes where we’re talking about acute respiratory illness, whether or not there’s a

fever, correct?

MS RESSLER: Yes. It includes everybody on the log.

20

MR BEASLEY: All right. But for whatever reason, it’s expressed as a number

rather than also requiring a percentage?

MS RESSLER: Yes.

25

MR BEASLEY: Although it’s easy enough to turn a number into a percentage,

correct?

MS RESSLER: Correct. And we generally gave both.

30

MR BEASLEY: Yes. When you say, “generally gave both” you’re talking about

when the form was actually completed, you would often put a percentage for - - -

MS RESSLER: Yes.

35

MR BEASLEY: - - - that cell, as well as the one underneath, which is specific to

influenza-like illness?


40

MR BEASLEY: What I’m getting to is why that percentage of influenza-like illness

was there, as well? That question about percentage of passengers who had influenza-

like illness was included for what reason over and above wanting to know the

number of passengers that had acute respiratory illness?

45

MS RESSLER: I think, it was just an indicator of severity of illness onboard.



MR BEASLEY: When you say “severity of illness” it would, as I understand it –

tell me if I’m wrong – it would only bring into play those that, apart from having

symptoms of acute respiratory illness, it would just bring into play those that also had

a fever?

5


MR BEASLEY: Yes. Okay. Do you recall any discussion with anyone – first of all

– did you draft those cells, do you recall drafting them?

10

MS RESSLER: I can’t – I can’t – remember.

MR BEASLEY: All right. Do you recall any discussion with anyone about them?

MS RESSLER: No. I don’t. 15

MR BEASLEY: Do I understand your evidence, though, that did you have final

approval for this risk-assessment form? Or was the final approval given to it by

people such as your Director and Deputy Director and people on the actual Health

Assessment Panel? 20

MS RESSLER: That’s correct, yes.

MR BEASLEY: It was them, was it?

25

MS RESSLER: Yes.

MR BEASLEY: All right. Okay. I just want you to turn further. But we’re still in

Annexure 1 of your statement. I think, you will come to a letter from Dr Chant of 22

February 2020 to Cruise Ship Industry Representatives. 30

MS RESSLER: Yes.

MR BEASLEY: Are you familiar with that letter?

35

MS RESSLER: I am.

MR BEASLEY: It wasn’t drafted by you, though?

MS RESSLER: No. 40

MR BEASLEY: No. And that attached an Updated Enhanced COVID Procedures

for Cruise Ships, correct? If you go over to the next page.

MS RESSLER: Yes. 45



MR BEASLEY: And that’s an update, it doesn’t include guidance as to low,

medium, or high-risk determination, but it’s an update on the procedures that New

South Wales Health wants cruise ship staff to comply with, correct?


MR BEASLEY: And also to report?

MS RESSLER: Yes.

10

MR BEASLEY: And you will see there in Procedures to Identify and Manage

Cases of – I should, sorry, I will pause. Before I go on with this document, did you

read it at about the time it came out?

MS RESSLER: Yes. 15

MR BEASLEY: And did you have any role in drafting it?

MS RESSLER: No.

20

MR BEASLEY: All right. Did you – do you recall whether you made any

comments about it before it was finalised or were asked to give any guidance about

it?

MS RESSLER: There was a version that was distributed to the cruise ship industry 25

first and I hadn’t seen that before it went to the cruise ship industry. And after I saw

it, so I had asked them to add in some specifics about the viral transport medium they

needed for he swabs onboard. So that’s the only comment that I have made in regard

to this.

30

MR BEASLEY: All right. And the process for you making a comment on this

form, what was that? Who did you go back to and suggest that there be an addition

to this form or some amendment to it? Was that to - - -

MS RESSLER: That was to my Director - - - 35

MR BEASLEY: Which is - - -

MS RESSLER: - - - or Deputy Director.

40

MR BEASLEY: Right. So Professor Ferson or Dr Sheppeard?


MR BEASLEY: All right. And do you know whether they were involved in 45

drafting this Enhanced COVID-19 Procedures?



MS RESSLER: I don’t. I don’t know if Mark was involved at all. Vicky may have

been, I’m not sure.

MR BEASLEY: Do you know who the author or authors of it were?

5


MR BEASLEY: Okay. Again, you will see where it says:

Procedures to identify and manage cases of respiratory infection 10

It’s talking about actively – cruise ships being required to:

actively identify passengers or crew with respiratory symptoms, cough, sore

throat, fever or difficulty breathing. 15

And asking them to, again:

go to the medical centre free of charge.

20

And in relation to reporting requirements to New South Wales Health, we have as the

first one:

The full acute respiratory disease log.

25

MS RESSLER: Yes.

MR BEASLEY: So that had become a – now a compulsory requirement for cruise

ships coming into Australian waters?

30


MR BEASLEY: New South Wales ports, I should say, correct?

MS RESSLER: That’s right. Yes. 35

MR BEASLEY: All right. And again, we have definition for – there’s down for the

reporting requirements to New South Wales Health, there’s a bullet point that

identifies:

40

• Of any identified respiratory outbreak onboard

With the footnote [1].

MS RESSLER: Yes. 45

MR BEASLEY: And again, we see respiratory outbreak is defined as:



Greater than one per cent of people onboard affected.

Correct?


MR BEASLEY: So again, directing attention to broader respiratory symptoms,

rather than, “influenza-like illness involving a fever” correct?


MR BEASLEY: Okay. Then, over the page, the cruise ship people are advised that:

There will be an assessment conducted by New South Wales Health.

15

MS RESSLER: Yes.

MR BEASLEY: And that will determine whether we’re going to board your ship

and we’ll let you know. And then it’s got details of what is to happen if New South

Wales Health Assessment Team is going to board the ship before people get off. All 20

right. Correct. Then there was an update of that again on the 9th of March 2020,

which you have also annexed behind tab 1 of your statement, Enhanced COVID-19

Procedures for the Cruise Line Industry, Updated 9 March 2020. Did you have any

involvement in the drafting of this 9 March version of the procedures?

25

MS RESSLER: So this is the one that has the information about the swabs.

MR BEASLEY: I see. Yes. So - - -

MS RESSLER: So I made that comment and I could have made another comment. 30

I can’t quite recall now. I had very minor comments about it.

MR BEASLEY: All right. And again there’s a slight change of language again in

this document, where it – sorry. Do you know who drafted – who were the author or

authors of this document? 35


MR BEASLEY: Do you know whether anyone within your Public Health Unit

made any suggestions about it or had any input into it? 40

MS RESSLER: I believe both Mark and Vicky did.

MR BEASLEY: Right. Okay. And when you say you believe, that’s based on

conversations you had with them concerning this enhanced procedures document? 45

MS RESSLER: Yes, and I probably was copied into their comments in an email.



MR BEASLEY: Right. Okay. Do you have those emails still on your system?

MS RESSLER: Yes.

MR BEASLEY: All right. We might seek those in due course because I don’t think 5

we have seen them, Commissioner, yet. Again, this tells cruise ship staff that they

should ensure they do certain things regarding managing cases of respiratory

infection. You see they actively identify passengers and cruise. We’re now using

the language “acute respiratory illness”. Is there anything that the Commissioner

should understand, that you know of, that distinguishes acute respiratory illness from 10

acute respiratory disease?

MS RESSLER: The logs are called an acute respiratory disease log, and that

includes acute respiratory illness and influenza-like illness.

15

MR BEASLEY: I see. All right. So acute respiratory illness may not have a fever.


MR BEASLEY: It may just have the cough. 20

MS RESSLER: Yes.

MR BEASLEY: The sore throat, the difficulty breathing.

25

MS RESSLER: Yes.

MR BEASLEY: If we had fever, we’re in the – provided the fever’s 38 or more,

we’re in the category of influenza-like illness, as far as you understand?

30

MS RESSLER: As far as I understand, yes.

MR BEASLEY: Yes. Okay. All right. And again, it – this updated 9 March

procedure wants staff – clinical staff of the ship to include on the log, details of all

passengers and crew presenting with fever or acute respiratory symptoms, or both. 35

MS RESSLER: Yes.

MR BEASLEY: Three things. All right. And again, that’s consistent with the

CDNA – I’ll make sure I say that correctly, the Communicable Diseases Network of 40

Australia clinical criteria.

COMMISSIONER: Sorry, what was said to be consistent with their clinical

criteria?

45



MR BEASLEY: The fact that the ship is asking – is being asked to ensure that

clinical staff on the ship include, on the log, all passengers and crew with fever or

acute respiratory symptoms, or both.


MR BEASLEY: Given that the clinical criteria for CDNA COVID-19 is fever or

acute respiratory infecting with or without fever, correct?


MR BEASLEY: All right. Thanks.

COMMISSIONER: So just for the record, that’s in your tab – your Annexure 10,

the CDNA document, and it’s page 6 of 27. 15

MR BEASLEY: Yes. I’ve asked the witness to look at a much – at a one-page

document. I’m sorry, you may not have that. That might be causing the confusion,

Commissioner. I’m not sure whether you’ve been provided with – no, you haven’t.

20

COMMISSIONER: Well, I’ve probably seen it, but the one I’ve got in front of me

is the one revised as at the 10th of March 2020, about which Ms Ressler has written

in her statement.

MR BEASLEY: Yes. That’s what I was – the document you’ve just been given is 25

what I was asking her about, which has been the case definition since at least the 10th

of March.

COMMISSIONER: Sorry. I’m looking – you’ve just – I’ve just been given the

national protocol from the Australian Government Department of Health. 30

MR BEASLEY: No, you might – there’s another document you’ve been given, as

well. You might’ve been given three documents.

COMMISSIONER: Yes. And I’ve been given a single sheet, the CDNA definition, 35

current on the 19th of March - - -

MR BEASLEY: That’s the one I’ve been asking the witness about.

COMMISSIONER: Thanks. Do you know what version that is, revision history of 40

the CDNA national guidelines?

MS FURNESS: Well, perhaps I can assist.

MR BEASLEY: Yes. 45

MS FURNESS: The single page was an annexure to the Ruby Princess report.



COMMISSIONER: Yes.

MS FURNESS: And as I understand it, was created for that purpose.

COMMISSIONER: Right. So it’s not in the sequence of versions where version 5

1.18 is the 10th of March, for example.

MS FURNESS: No, Commissioner.

COMMISSIONER: Thanks. 10

MS FURNESS: Behind tab 10 is the version as from the 10th of March.

COMMISSIONER: Yes.

15

MS FURNESS: And there was an amendment on the 13th of March.

COMMISSIONER: Yes.

MS FURNESS: Which is not relevantly applicable. 20

COMMISSIONER: No, no, no. I understand. Yes.

MR BEASLEY: No, I don’t think that’s right. Because if you look behind tab –

well, I might be wrong but behind Annexure 10, we’ve got the sheet that starts 25

“coronavirus disease 2019 COVID-19” with all the boxes, then if you turn five pages

over - - -

COMMISSIONER: That – what follows is version 1.18, isn’t it?

30

MR BEASLEY: Sorry?

MS FURNESS: Yes, 1.18.

COMMISSIONER: That’s recording that version 1.18 is the document that we have 35

as Annexure 10 to this witness’s statement.

MS FURNESS: As at 10th of March.

COMMISSIONER: Which is the 10th of March, yes. 40

MS FURNESS: Yes. There is a further version, 1.19, which is as at the 13th of

March, which is prior to the 19th of March. That is relevantly the same. There was

an amendment as to the definition of contact.

45

MR BEASLEY: Well, relevantly the same is the emphasis – if you go to page 6 of

tab 10.



COMMISSIONER: Yes, that’s what I was looking at.

MR BEASLEY: It’s fever or acute respiratory infection, with or without fever, so

it’s the same.

5

COMMISSIONER: No, no. I understand.

MR BEASLEY: Yes.

COMMISSIONER: I just wanted – there was something I didn’t understand on that 10

same page, 6 of 27 if you could help me, Ms Ressler, you see that they’re defining a

class that they call suspect case.

MS RESSLER: Yes.

15

COMMISSIONER: And that’s of some importance, because being a suspect case

leads to further investigation and management, doesn’t it?

MS RESSLER: Yes.

20

COMMISSIONER: But as I read that, it seems clear that you’re not a suspect case

if although you have the clinical criteria, you don’t have one or other of the

epidemiological criteria.

MS RESSLER: That’s correct. 25

COMMISSIONER: That you’ve got to have - - -

MS RESSLER: Both. One - - -

30

COMMISSIONER: You’ve got to have a criterion from the set of epidemiological

criteria and a criterion from the set of clinical criteria - - -


35

COMMISSIONER: - - - in order to be suspect case.


COMMISSIONER: Now, the second of the epidemiological criteria is close or 40

casual contact, and that itself involves definition, which I’ll pass over at the moment,

in 14 days before illness onset with what’s called a confirmed case of COVID-19;

do you see that?

MS RESSLER: Yes. 45

COMMISSIONER: But that will involve a laboratory result, wasn’t it?



MS RESSLER: Yes.

COMMISSIONER: So this seems to be a definition that sits alongside not operating

the same as the – that precautionary approach taken for assessment of cruise ship

arrivals. That’s not the same, is it? 5

MS RESSLER: No. Not since international travel became a criteria. It was

originally the same.

COMMISSIONER: Well, perhaps we’ll return to that later with documents. Thank 10

you.

MS RESSLER: Okay.

MR BEASLEY: You’d be hard pressed becoming a suspect case if you have to 15

have both the - - -

COMMISSIONER: Well, that – it – it just occurs to me that that doesn’t make

suspect case a particularly useful thing for those, like this witness, charged with

dealing - - - 20

MR BEASLEY: Not if you have to tick the - - -

COMMISSIONER: - - - the arrival of a cruise ship.

25

MR BEASLEY: If you have to tick the epidemiological criteria box and the clinical

box then probably no one on this ship. But anyway.

COMMISSIONER: No. I’m – I’m afraid this might be a silly question, and I

apologise. If I’m travelling in a cruise ship - - - 30

MR BEASLEY: Well - - -

COMMISSIONER: - - - from Napier to Sydney, in a bit of a hurry - - -

35

MR BEASLEY: Yeah, but - - -

COMMISSIONER: - - - in order to meet a cut-off date - - -

MS RESSLER: Yes. 40

MR BEASLEY: That’s true.

COMMISSIONER: - - - am I there and then engaging in international travel for the

purposes of this CDNA definition? 45

MS RESSLER: I believe so.



MR BEASLEY: Yes.


MR BEASLEY: Yes, I suppose - - - 5

COMMISSIONER: So everyone on the ship - - -

MR BEASLEY: Yes.

10

COMMISSIONER: - - - would - - -

MS RESSLER: Yes. Yes.

COMMISSIONER: - - - would - - - 15

MR BEASLEY: International travel. Yes.

COMMISSIONER: - - - satisfy the first of the epidemiological criteria.

20


COMMISSIONER: It’s not only international travel to get on the ship in Sydney?

MS RESSLER: That’s correct. Everyone on the ship had travelled internationally 25

and hence were required to go into 14 days home isolation.

COMMISSIONER: Thanks.

MR BEASLEY: Yes. 30

COMMISSIONER: So that means, then, that everyone on this ship satisfies - - -

MR BEASLEY: It’s the constant ors.

35

COMMISSIONER: - - - the first of the epidemiological criteria so that CDNA as at

the 10th of March and also the 13th of March would then treat as a suspect case

everybody who had and had only a fever?

MS RESSLER: Yes. 40

COMMISSIONER: And everybody who had and had only shortness of breath?

MS RESSLER: Yes.

45

COMMISSIONER: Etc etera etc etera.



MS RESSLER: Yes. That’s correct.


MR BEASLEY: Thank you. I want to ask you some questions about a document I 5

know for certain you’re not the author of. But in front of you, it’s not in your

statement, but slightly prior to New South Wales publishing its 9 March enhanced

code of procedures, the Commonwealth government on the 6th of March put out a

national protocol for managing novel Coronavirus disease risk from cruise ships. Do

you have that in front of you? 10

MS RESSLER: Yes.

MR BEASLEY: Were you consulted at all, or anyone that you know of in your

public health consulted about this protocol? 15

MS RESSLER: I wasn’t. And I don’t know of anyone who was.

MR BEASLEY: Right. Okay. Did you see it at about the time it came out?

20

MS RESSLER: Yes.

MR BEASLEY: Did you discuss it in the office?

MS RESSLER: I can’t recall. 25

MR BEASLEY: With anyone?

MS RESSLER: I can’t recall.

30

MR BEASLEY: All right. It says it was approved by Rhonda Owen, and gives her

title. Do you know who she is?


35

MR BEASLEY: All right. What I wanted to ask you in particular about this

document is that it – commencing on page three has a heading, “Risk assessment”. It

talks about there being no single criterion to dictate any specific action of overall

management. And then it lists a number of individual criteria.

40

MS RESSLER: Mmm.

MR BEASLEY: The itinerary of the vessel, the travel history, over to page 4,

various things like health care capability on the vessel, whether or not health care

consultations are being offered at no cost. And then it uses this language: 45



Whether the number of cases presenting with influenza like illness exceed that

expected for the specific itinerary and season. I.e. potential outbreak which is

defined to be equal or greater than one per cent among passengers or crew

members.

5

Now, first of all, I’d – I – you agree with me that that’s using a different criteria than

New South Health were using when – in relation to acute respiratory disease?

MS RESSLER: Yes.

10

MR BEASLEY: Without fever.

MS RESSLER: Yes.

MR BEASLEY: This is by using influenza like illness for the one per cent criteria. 15

It’s introducing in your understanding the need for there to be a fever of 38 or more,

correct?

MS RESSLER: Yes.

20

MR BEASLEY: All right. You don’t recall discussing that when this document

came out and the contrast between this Commonwealth protocol and the New South

Wales State protocol?

MS RESSLER: No. 25


COMMISSIONER: Now, at the top of page 3, to which your attention’s been

drawn, do you see the statement five lines under the heading, “Protocol,” the port 30

health authorities should be aware of these procedures?

MS RESSLER: Yes, I see that.

COMMISSIONER: When you first read those words, did you understand that that 35

meant you?

MS RESSLER: Yes.

COMMISSIONER: And did you – and you understood that this is emanating from 40

the Australian government, not the New South Wales government?

MS RESSLER: Yes, I understand that.

COMMISSIONER: Did – did you turn your mind to the authority by which these 45

procedures were being made to apply to you?



MS RESSLER: No.

COMMISSIONER: Did – was that ever the subject matter of discussion in the

office?

5

MS RESSLER: Not that I can recall.

COMMISSIONER: Why – why I mentioned it in particular, and this very much

with the benefit of hindsight, Mr Beasley’s draw your attention what may arguably

be differences of real substance - - - 10

MS RESSLER: Yes.

COMMISSIONER: - - - between a State definition of cases that you would manage

– you would manage in a particular way and a Commonwealth definition of cases to 15

be managed for exactly the same purpose.

MS RESSLER: Yes.

COMMISSIONER: And I was – I am interested to know whether you have any 20

recollection of that difference, or any difficulty it may give rise to having been the

subject matter of any discussion in your office? Your workplace?

MS RESSLER: No. No.

25

COMMISSIONER: Are you able to tell us whether as a matter of your recollection

whether you regarded an Australian government document as outranking, as it were,

a New South Wales government document?

MS RESSLER: I was conscious that I worked within a framework of the State 30

health.

COMMISSIONER: Yes.

MS RESSLER: But cruise ships operate in the State – in the framework of a 35

national health. So I’m always – I always try to be aware of the information that

they’re being provided nationally.

COMMISSIONER: Yes.

40

MS RESSLER: Because they don’t go from port to port and change their rules. So

I was aware of this protocol. I was aware of what was communicated to the ship –

cruise ships. I hadn’t previously picked up the respiratory difference in the State

protocol.

45

COMMISSIONER: Now, what Mr Beasley’s drawn to your attention translates to

this, doesn’t it, that the – the one per cent is of a subcategory of the category you



understood to be over one per cent threshold of the – with the State protocol, is that

right?

MS RESSLER: That’s right. That is the one per cent that I was familiar with using.

5

COMMISSIONER: So it means that in a given case, under State criteria it might be

rated medium risk, but at Commonwealth criteria it might be rated low risk?

MS RESSLER: I hadn’t considered that before, Commissioner, but yes.

10

COMMISSIONER: That appears to be what must followed, doesn’t it? Depending

upon the numbers.

MS RESSLER: Yes. But in my mind I was operating based on a one per cent of

ILI. 15

COMMISSIONER: And has that – is that something that you’ve – that you recall as

having obtained for a number of years?

MS RESSLER: Yes. I’ve collected data on influenza like illness on cruise ships for 20

a long time.

COMMISSIONER: And – and so I’m wondering if you can recall why you treated

the one per cent as referring to ILI, that is, with fever, as opposed to the one per cent

with acute respiratory symptoms. Do you recall whether that was because of 25

preferring a Commonwealth to a state version or - - -

MS RESSLER: No.

COMMISSIONER: - - - what? You don’t – you recall that - - - 30

MS RESSLER: No.

COMMISSIONER: - - - it was not so or you don’t recall?

35

MS RESSLER: Yes. Not so. I used the one per cent because we had good data to

back up that one per cent for influenza like illness. We didn’t have good data for a

acute respiratory illness. And that’s how our program had operated for many years

because cruise ships are required to report a fever. They’re not required to report

cases of acute respiratory illness. 40

COMMISSIONER: Sorry, you – now you’ve lost me – I thought that’s what the

ARD log did?

MS RESSLER: Yes. But on the Human Health Report that we had been reviewing 45

for the past number of years, we only had the number of people with fever onboard.



COMMISSIONER: But the Human Health Report is a subset of the information.

That is, it’s not all of the information in the ARD log, is that correct?

MS RESSLER: That’s correct, yes. So when coronavirus started, we started

requesting the whole ARD log so that we could review the patients, review the 5

severity of the illness and review their travel history ourselves rather than relying on

a ship to count them up and put them into a form.

COMMISSIONER: So have I missed – as you now recall it – more data about

respiratory illness was intended to be considered by you and your team when 10

COVID-19 came into your minds, is that right?

MS RESSLER: Yes. Routinely considered by our team.

COMMISSIONER: Yes. And as you understood it, there would be a risk 15

assessment which in New South Wales terms would have high, medium, low, rating,

is that correct?


20

COMMISSIONER: And this one per cent threshold was one of the indicators for

not being low. Is that correct?


25

COMMISSIONER: I may not have properly understood all of your evidence today.

Did you understand, as at the 18th of March, that under the New South Wales

protocol Annexure 1 to your statement, the one per cent did not appear tied to ILI

only but to ILI plus other acute respiratory illness?

30

MS RESSLER: I didn’t realise that at the time, no.

COMMISSIONER: You did not realise that at the time. Thank you. All right. And

again, I apologise if I’ve misunderstood your evidence. Do you, in fact, believe

that’s what the New South Wales Protocol asked for? 35

MS RESSLER: I did think that, yes.

COMMISSIONER: Sorry - - -

40

MS RESSLER: I understood that’s what it was asking for.

COMMISSIONER: What, just ILI?

MS RESSLER: I - - - 45

COMMISSIONER: ILI one per cent?



MS RESSLER: Yes. One per cent referred to ILI. That was my understanding at

the time.

COMMISSIONER: Now, please take your time to answer this, is there anything

you want to draw to my attention in the text of your Annexure 1 of that protocol at 5

the 19th of February? Is there anything in that text where I would understand it as

referring to one per cent ILI as opposed to one per cent respiratory illness?

MS RESSLER: There is not, Commissioner. There is nothing in that protocol, that

I can see now, that I should have assumed that it was only influenza-like illness, 10

when they were asking for a one per cent.

COMMISSIONER: Is there - - -

MR BEASLEY: The text is suggesting the opposite, isn’t it? 15

MS RESSLER: Yes. It is.

MR BEASLEY: You would agree with that? Yes.

20

COMMISSIONER: Is there an earlier iteration of some document of that same kind

which would show a change from one per cent ILI to one per cent the broader

category?

MS RESSLER: Not that I’m aware of. But you might ask the author. 25

COMMISSIONER: Thank you. I probably will. But I’m interested because you’re

the one lumbered with - - -

MS RESSLER: Yes. 30

COMMISSIONER: - - - administering things. And so that I repeat a question, I

have asked in various forms already, can you remember any talk in the office or any

discussion between you and any of your colleagues about this aspect of the

screening? 35

MS RESSLER: Yes. I remember in that – at, maybe, one of our risk assessment

meetings, teleconferences – discussing with Vicky Sheppeard not understanding or

not having confidence in what the ARD per cent meant and so we provided both.

And so - - - 40

COMMISSIONER: Now, the ARD per cent being?

MS RESSLER: Being all respiratory illness, as a percentage of all the people on

board the ship. So we provided both numbers to the panel so that they could 45

consider that.



COMMISSIONER: So ARD plus the subset which is ILI. Is that correct?



MR BEASLEY: Which would show some more severe illness in the subset.

COMMISSIONER: Yes. Thank you. Thanks.

10

MR BEASLEY: When you were talking about the Human Health Form from the –

required by the Commonwealth Government under the Biosecurity Act – you were

referring to, we don’t have it in front of us but no need to look at it, it has a box

saying, “How many ill people have you got onboard?” Correct?

15

MS RESSLER: Yes.

MR BEASLEY: You remember that.

MS RESSLER: Mmm. 20

MR BEASLEY: And who knows what gets put in there.

MS RESSLER: Yes.

25

MR BEASLEY: Then it’s got a separate box, “Who’s got a temperature over 38

degrees?”

MS RESSLER: Yes.

30

MR BEASLEY: And then it’s got a whole lot of questions that don’t seem related

to COVID like, “Have you been sneezed on by a camel?” And things like that?

MS RESSLER: Yes.

35

MR BEASLEY: Things like that, that don’t seem - - -

MS RESSLER: Yes.

MR BEASLEY: - - - related to COVID-19? 40

MS RESSLER: No. They’re standard questions.

MR BEASLEY: Yes.

45

MS RESSLER: Yes.



MR BEASLEY: All right. Okay. Can I ask you to turn to page 7 of this

Commonwealth document? Because again, you’re not the author, but it’s got, at

least to me, some confusing terminology. And it may only be me. But on page 7 it’s

got a heading:

5

Cases of Influenza-like Illness Presenting on Cruise Ships

Then for onboard management, it’s directing ships to:

Actively encourage travellers with respiratory systems to seek immediate

onboard medical assessment. 10

Well, I suppose, if you have ILI, you’ve got respiratory symptoms. You’ve also got

a fever, correct?

MS RESSLER: Yes. 15

MR BEASLEY: Yes. All right. And then it says:

Where point of care testing for influenza is available, two samples should be

corrected. 20

And then goes on about what you should do in relation to SARS-CoV-2 testing or

COVID-19 testing. Then it talks about:

Report of listed human disease COVID-19 suspect case or potential outbreak of 25

respiratory illness, onboard management.

Then it asks the ship’s medical officer to:

Determine whether there is either a suspect case of COVID-19 onboard. 30

I don’t have the document that – I don’t know whether that’s the same as the one

we’ve already looked at for “suspect case”. Then:

An outbreak of ILI onboard with larger than expected numbers of tests are 35

negative for influenza.

And footnote [7] says:

Outbreaks of ILI equal to or greater than one per cent. 40

Now again, that’s consistent with your past experience with the one per cent criteria

linking it back to ILI.

MS RESSLER: Yes. 45



MR BEASLEY: Can you give any assistance to the Commissioner about – from the

point of view of an epidemiologist – about what’s meant by:

Larger than expected numbers of tests are negative

5

MS RESSLER: So from my knowledge, the point of care influenza test has a

sensitivity of 50 to 70 per cent.

MR BEASLEY: What does that mean?

10

MS RESSLER: That means that of 100 people tested, if all of them had the flu,

between 50 to 70 would be positive.

MR BEASLEY: I see.

15

MS RESSLER: And the others would be negative. So if there was - - -

COMMISSIONER: False negatives?

MS RESSLER: Excuse me, sorry? 20

COMMISSIONER: False negative?

MS RESSLER: False negative.

25

COMMISSIONER: That’s right?

MS RESSLER: Yes.

COMMISSIONER: False negative. 30

MS RESSLER: False negative.

MR BEASLEY: So there’s a 30 to 50 per cent range of false negative?

35

MS RESSLER: My understanding, yes.

MR BEASLEY: Right. Okay. So that would mean larger – based on that:

larger than expected numbers of tests are negative for influenza 40

Might involve a figure of 50 per cent or more?

MS RESSLER: Yes.

45

MR BEASLEY: Right. Okay. That’s all I wanted to ask about the Commonwealth

document, Commissioner. I’m not sure if you want to ask any more questions about



that? No. I want to skip over Annexure 2 and go now to your dealings with the

Ruby Princess ship. If you go to your Annexure 3 after the first email, you will see,

an email below it, the first email, being in response to the one I’m drawing your

attention to, that you have sent to the Ruby Senior Doctor on March 6 at 12.58 pm.

And you say: 5

Dear Doctor von Watzdorf and Captain Pomata,

As you know, New South Wales Health has instituted a protocol for Novel

Coronavirus screening. 10

When you used the words, “as you know” was that based on you knew they had been

given information or you, yourself, had had a discussion with, for example, Dr von

Watzdorf about these new protocols?

15

MS RESSLER: That would probably be because they had been through the process

on 24 February, and so I would write that for ships who had already been familiar

with the process.

MR BEASLEY: Right. So because the ship had also docked in Sydney on 24 20

February, it has been subject of the protocols introduced in draft on - - -

MS RESSLER: Yes.

MR BEASLEY: - - - 19 February and then updated from the 22 February letter 25

from Dr Chant, so they know what you’re about to tell them?

MS RESSLER: Yes.

MR BEASLEY: Okay. 30


MR BEASLEY: All right. And then you’ve set out this series of requests for the

provision of information, including – the first one being the full ARD log by 9 am on 35

Saturday, 7 March, and asked for a response to the various other information, yes?

MS RESSLER: Yes.

MR BEASLEY: And Dr von Watzdorf replies to you just before 9 the following 40

day, enclosing the acute respiratory disease log and mentioning that they had 30

individuals on the log at lunchtime yesterday, but after they made the onboard

announcement about asking people to come forward if they had symptoms, which is

something you had asked them to do in your prior email, that number went to 170.

45

MS RESSLER: Yes.



MR BEASLEY: Did that jump in numbers cause you any concern? By concern, I

mean did you – do you remember thinking whether you attributed that simply to the

fact that an announcement had been made or that the ship might be experiencing an

increased number of people suffering acute respiratory disease in the latter part of the

journey? 5

MS RESSLER: I attributed it to there being a lot of passengers on board with illness

who wouldn’t have gone to the medical centre. And we were very aware of

underreporting and under presentation and I attributed it to that.

10

MR BEASLEY: So you – was that one way of saying you attributed some success

to the onboard announcement saying, “please come forward if you’ve got a cough, a

cold - - -

MS RESSLER: Yes. 15

MR BEASLEY: - - - or any other symptom?

MS RESSLER: Yes.

20


COMMISSIONER: In particular, you wouldn’t interpret that as meaning there had

been a process of biological infection – that is, contagion expanding the disease

group from 30 to 170, there had probably been 170 when only 30 had been logged, is 25

that right?


MR BEASLEY: Having received all that information from the ship’s doctor, that’s 30

the material upon which you or someone else fills out the pre-arrival risk assessment

form, correct?

MS RESSLER: Yes.

35

MR BEASLEY: And for this voyage of the ship ending on 8 March – you find that

behind tab 4.


40

COMMISSIONER: That’s your colleague, Laura-Jayne Quinn, who did this, is that

right?

MS RESSLER: Yes.

45

MR BEASLEY: So it – and she completed the form as a means of assisting you, did

she?



MS RESSLER: She did.

MR BEASLEY: All right. So she had the ship’s log and the other information, and

she filled out the pre-arrival assessment form based on that?

5

MS RESSLER: Yes.

MR BEASLEY: And then this gets sent to the expert assessment panel to determine

high-risk, low-risk, medium-risk, etcetera?

10


MR BEASLEY: All right. The circulation of that material, I think you will find

behind tab 6. So this is an email from Dr Sheppeard to Sean Tobin, Bradley

Forssman, Isabele Hess and Leena Gupta. I take it they’re the other members of the 15

expert health panel for this particular cruise of the Ruby Princess. Is that correct?

MS RESSLER: Yes.

MR BEASLEY: All right. And you’re cc’d in. Do you see that? 20

MS RESSLER: Yes.

MR BEASLEY: Why are you cc’d in at this stage?

25

MS RESSLER: I was – probably just so that I could be aware that it had gone out

and a decision might be made soon, or that we would be expected to go into a

teleconference soon.

MR BEASLEY: Yes. As I understand it, without turning up the paragraph from 30

your statement, you took part in a telephone hook-up, did you, when the Health

Assessment Panel actually met and had a discussion?

MS RESSLER: Yes.

35

MR BEASLEY: And if we look at the pre-arrival risk assessment form, something

like 4 per cent of passengers and crew have reported with an acute respiratory illness,

but the percentage with – at least at the time the log is sent – of crew and passengers

with ILI is 0.34 per cent – 0.43 per cent - - -

40

MS RESSLER: Yes.

MR BEASLEY: - - - correct? Which is below that – at least in relation to ILI, that

1 per cent trigger point, correct?

45

MS RESSLER: Yes.



MR BEASLEY: But - - -

COMMISSIONER: Well, it’s also below the .5 rule of thumb to be expected, is that

right?

5


MR BEASLEY: But of course, the 4 per cent figure is not below what appears to be

the 1 per cent criteria in that 19 February - - -

10

MS RESSLER: Yes.

MR BEASLEY: - - - protocol. As I understand it, and it seems relatively clear from

Dr Sheppeard’s email, that what pushed this ship in the panel’s view – and I don’t

want to go over this in detail with you because I know you’re not making the 15

decision, but what pushed the decision to take this from low-risk to medium-risk in

the panel’s view was those two passengers who had been to Singapore - - -

MS RESSLER: Yes.

20

MR BEASLEY: - - - that’s mentioned in the email.

MS RESSLER: Yes.

MR BEASLEY: In relation to this particular determination of low, medium or high, 25

did you make any recommendations or did you just listen in on the phone call?

MS RESSLER: I just listened in.

MR BEASLEY: Didn’t – did you participate in any way that you can recall? 30

MS RESSLER: I could have answered questions that were asked?

MR BEASLEY: Do you have a memory of doing that?

35

MS RESSLER: No. I don’t?

MR BEASLEY: Did you take any notes?

MS RESSLER: No. I don’t think so. 40

MR BEASLEY: It wasn’t your habit to take notes if you were - - -

MS RESSLER: I did take notes. I can’t remember specifically for this, but I do

generally take notes. 45



MR BEASLEY: All right. You – that’s something you can check, whether you

have your notes still for this - - -

MS RESSLER: Yes. Okay.

5

MR BEASLEY: - - - criteria. Okay.

COMMISSIONER: Before you move on, could I just ask you – have I understood

this correctly? What the panel had before them was information that 170 had

presented to the ship’s clinic with acute respiratory illness, ARI? 10

MS RESSLER: Yes.

COMMISSIONER: 18 in number of crew, passengers had influenza-like illness?

15

MS RESSLER: Yes.

COMMISSIONER: Is that 18 a subset of the 170?

MS RESSLER: Yes. 20

COMMISSIONER: Now, the two with the Singapore connection turned out to be

rather important for the panel’s consideration, is that right?


COMMISSIONER: And then there’s 30 in total swabbed for flu, do you see that?


30

COMMISSIONER: And what’s said:

No swabs available for COVID-19 testing.

MS RESSLER: The ship would discard them. 35

COMMISSIONER: But that’s what it says. It’s - - -

MS RESSLER: Yes.

40

COMMISSIONER: The – what did – “swabs available”. Does that mean before

you take the material from the patient or does – is it referring to swabs with patients

material?

MS RESSLER: It is. It’s referring to swabs that the doctor has collected and stored 45

for us.



COMMISSIONER: So there’s – and there’s zero here.


COMMISSIONER: They’re meant to be refrigerated because the testing is onshore, 5

is that correct?


COMMISSIONER: So does that read to you as if this ship had not taken two 10

swabs?

MS RESSLER: Yes.

COMMISSIONER: Furthermore, had not taken even one swab for most of the 15

people in question?


COMMISSIONER: Doesn’t that, on its face, indicate that this is a ship with 20

deficient compliance with the then extant requirement as to swabs?

MS RESSLER: The ships were having a lot of trouble sourcing the correct swabs.

COMMISSIONER: Well, maybe that’s an explanation, but if you could just answer 25

my question first.

MS RESSLER: Yes. I - - -

COMMISSIONER: Do you recall – Mr Beasley was asking about your recollection. 30

I’m just prodding it.

MS RESSLER: Yes.

COMMISSIONER: Do you recall that striking deficiency – I mean, zero where 35

there perhaps should have been 170, 30 when there should have been 170, but do you

recall that being the subject of any discussion among you and your colleagues?

MS RESSLER: Yes. It was a discussion and why I kept pushing for some

information to come from the state level or the Commonwealth to cruise ships about 40

doing this. It was concern.

COMMISSIONER: But you understood that they should – the ship should take the

swabs or not?

45

MS RESSLER: I can’t remember if I understood that they should - - -



COMMISSIONER: Right.

MS RESSLER: - - - or if that would certainly be beneficial.

COMMISSIONER: All right. If you go back a couple of pages, you will see the 5

email from Dr Sheppeard of 7 March at 12.53 pm, do you see that?

MS RESSLER: Yes.

COMMISSIONER: That you – Mr Beasley asked you about, that you were copied 10

in on?


COMMISSIONER: In what I think is the third paragraph, the doctor suggests 15

finding out more information about the two passengers – I will call them the

Singapore connection. Do you see that?

MS RESSLER: Yes.

20

COMMISSIONER: What do you understand in that same sentence when the doctor

says:

Obtain new swabs and test for COVID.

25

That refers only to those two Singapore connected - - -

MS RESSLER: Yes.

COMMISSIONER: But the next sentence is everyone, isn’t it? 30

We will also ask swabs to be obtained from anyone else who presents with ARI

- - -

MS RESSLER: Yes. 35

COMMISSIONER: ..... did you – do you recall, upon reading this, to understand

that to be a reference to swabs for the purpose of COVID-19 testing?

MS RESSLER: Yes. 40

COMMISSIONER: Were swabs obtained from 170 odd-people for COVID-19

testing on that shift?

MR BEASLEY: Just – if you just – to assist you, I think there’s an explanation 45

given by the doctor on the next tab, which might help. So because Dr Sheppeard is

concerned about the two people from Singapore and she has made that request about



swabs, the ship’s doctor has been sent an email asking for that information, and

that’s her response, 7 March at 2.30 pm to various - - -

COMMISSIONER: No. I’ve read that.

5

MR BEASLEY: Yes.

COMMISSIONER: Limited swabs available.

MR BEASLEY: Yes. 10

COMMISSIONER: I will come back to that. But – so first of all, were swabs taken

from 170-odd people for COVID-19 testing?

MS RESSLER: No. So - - - 15

COMMISSIONER: How many were taken?

MS RESSLER: just two, I think.

20

COMMISSIONER: Okay. Do you mean the ship only had two left?

MS RESSLER: So this is on 8 March and she had - - -

COMMISSIONER: It’s on 7 Mach. 25

MS RESSLER: Sorry, 7 March. And she had already seen the 170 people and they

had whatever she had sent them back to their cabins and whatever – however, she

managed those people. So then Dr Sheppeard emailed her, asking for anyone who

presents from now forward to - - - 30

COMMISSIONER: Well, does that mean anybody who presented previously, you

understood was not the subject of - - -

MS RESSLER: The - - - 35

COMMISSIONER: - - - the swab request?

MS RESSLER: The two Singapore people were, yes.

40

COMMISSIONER: No. But not the others?

MS RESSLER: Not the – not that I know of. No.

COMMISSIONER: What would be the medical rationale for that? 45

MS FURNESS: Well, Commissioner - - -



COMMISSIONER: Yes.

MS FURNESS: - - - the witness is not a clinician.

COMMISSIONER: I appreciate that entirely. As an epidemiologist, you 5

understand that testing is done in order to achieve some public health outcome.

MS RESSLER: Yes.

COMMISSIONER: Did you understand what public health outcome would be 10

achieved by not taking swabs from 170, but taking swabs from whoever it was - - -

MS RESSLER: We were - - -

COMMISSIONER: - - - who presented at the clinic after that email? 15

MS RESSLER: We were applying a testing criteria that was looking for positive

travel history, plus respiratory symptoms. So if we were reviewing an ARD log and

we saw someone on there who fit that criteria, we would request that they were – that

they had a swab taken. Dr Sheppeard has asked the doctor on board from that point 20

forward, if any other people present, to swab them in case, when we come on board,

we think they fit that criteria, but we haven’t had the opportunity to review them at

that stage.

COMMISSIONER: So from your last answer, this is a matter that you – on your 25

recollection, it’s Dr Sheppeard who - - -

MS RESSLER: Yes.

COMMISSIONER: Gave further consideration to what happened when Dr von 30

Watzdorf advised of a limited number of swabs, is that right?

MS RESSLER: Yes.


MS RESSLER: She advised that she had a limited number of swabs. My

understanding was there was a process for her to just use the swabs for point of care

influenza testing and store them for us. I’m not sure if that was communicated at this

stage, but we understood that she didn’t have enough swabs and therefore took an 40

extra box with us the next day to leave with her.

MR BEASLEY: Where Dr Sheppeard, in that email, setting out what she is asking,

“Does this sound like a reasonable plan” to the other people in the health expert

panel that the Commissioner’s just been asking you some questions about. She uses 45

the expression, “The ILI rate is low”, that’s the 0.43 per cent we have been

discussing. Do you recall, in the phone hook-up, when a determination was made,



whether there was any discussion by the expert panel about the bigger number of

people who had presented with acute respiratory illness, the 170 people or 4 per cent.

Was there any discussion about that?

MS RESSLER: I can’t remember. 5

MR BEASLEY: All right. And your recollection is primarily the reason for

medium risk was, as we said, based on this concern about the Singapore passengers,

correct?

10

MS RESSLER: Correct, because they had – they fit both the epi criteria and the

clinical criteria for testing.

MR BEASLEY: All right. If you go to tab 9 of your statement, you have included

an email that you send to the ship’s doctor at – on 7 March at 5.42, which is the 15

advice that the panel – health assessment is required, okay?

MS RESSLER: Yes.

MR BEASLEY: So you’re telling the ship’s captain and the doctor that the health 20

panel has recommended an on-board public health assessment and this is what we

want you to do now because of that, correct?

MS RESSLER: Yes.

25

MR BEASLEY: And one of the things, leaving aside announcements about people

who were in Thailand, Indonesia, etcetera, in the second bullet point, as to what is

required:

The medical clinic to ensure that patients seen at the – with fever and/or ARI 30

are also requested to attend for assessment.

See that?

MS RESSLER: Yes. 35

MR BEASLEY: Was that a – something that you decided was needed or was that

on the recommendation of someone on the health panel?

MS RESSLER: This is a standard email that was put together by someone on the 40

panel.

MR BEASLEY: Just pause there. It’s in your name.

MS RESSLER: Yes. 45

MR BEASLEY: But it’s - - -



MS RESSLER: We had templates that Laura-Jayne and I used.

MR BEASLEY: All right. It’s a template that was drafted by whom?

MS RESSLER: Mostly Mark Ferson, I think. 5

MR BEASLEY: All right. What – the reason I’m asking you this is that it appears

as though during the health panel’s deliberations, the ILI rate was considered low

and you have no recollection of a discussion of broader acute respiratory disease, but

at least in relation to this what you say is a template not drafted by you, of concern 10

enough to be assessed is not only people with a fever, but anyone with ARI, even

those that have got ARI without a fever.

MS RESSLER: Yes.

15

MR BEASLEY: So that was an important criteria, at least in terms of an

assessment, once the team’s on-board and looking at the passengers and crew.

MS RESSLER: Yes, because we’d need to check if they’re – if they have the epi

criteria, if they have travelled to a country of concern. 20


COMMISSIONER: Can I just ask you, the medium risk – Mr Beasley’s asked you

questions about the assessment on the 8th. 25

MS RESSLER: Yes.

COMMISSIONER: If you could just go back to the – your Annexure 1, please, the

procedure which is described as draft, 11 am, 19 February 2020. Its second page of 30

text describes in the bold text – the bold lines, the description of a medium risk

assessment; is that right?

MS RESSLER: Yes.

35

COMMISSIONER: Where is it there that I find an explanation for the Ruby

Princess on the 8th of March being assessed medium?

MS RESSLER: Well, it uses the word “and”.

40

COMMISSIONER: I’m sorry, I’m sure it does. I’m so sorry. Where is that?

MS RESSLER: So it’s a respiratory outbreak and however, we were using the

second point:

45

Passengers or crew have visited a country included in the Australian COVID

testing criteria in the 14 days before embarkation.



COMMISSIONER: No, I have read that. I’m just asking you, where do I find –

what’s the language that makes the ship fit that on the 8th of March? Well, you have

put your finger on it. The word is “and”.

MS RESSLER: Yes. 5

COMMISSIONER: So where – how does it fit that?

MS RESSLER: The decisions are made at the discretion of the panel when they

consider everything. 10

COMMISSIONER: I do understand, but that’s not what my question was. How

does it fit that?

MS RESSLER: It doesn’t. 15

COMMISSIONER: Right. Don’t misunderstand me. I’m highly unlikely to report

that these things should have proceeded by cut and dried mechanical box ticking.

MS RESSLER: Yes. Yes. 20

COMMISSIONER: Highly unlikely. But I am interested, nonetheless, to

understand your professional experience as to why this would have been medium

risk, bearing in mind that’s how medium risk was described.

25

MS RESSLER: The risk assessment process was fluctuating and at no stage was it

watertight or completely understandable. It was complex and we – it has nuances in

it and the decisions were up to the expert panel.

MR BEASLEY: Assuming all that, though, I think what you’re being directed to is 30

you only get – if we – I hate to use the expression, “Letter of the law”, but if you

apply the language here literally for medium risk, you only get to medium risk if you

have ticked the first box about respiratory outbreak and at least 1 per cent, correct?

MS RESSLER: Yes, that’s right. 35

MR BEASLEY: And you would only get to 1 per cent criteria for that for the Ruby

Princess on the 8th of March if you were including everyone that had acute

respiratory disease, whether or not they had a fever.

40

MS RESSLER: Yes.


MS RESSLER: Yes. 45



MR BEASLEY: Because if you’re only including the ILI people, you have never

ticked that first box to get to medium risk.


5


COMMISSIONER: Now, the contemporaneous document that we have seen, Dr

Sheppeard’s circular email, doesn’t suggest – I think, doesn’t suggest at all that there

was an inclusion of the remainder of the 170 with ARI but not ILI, so that possibility 10

that Mr Beasley has raised seems to me, A, to be possible, but B, not to have

happened, I think. We’ll ask Dr Sheppeard about it, but - - -

MS RESSLER: Yes.

15

MS FURNESS: : Although Commissioner, might I just point out, obviously this

witness is not the author of this document.

COMMISSIONER: No.

20

MS FURNESS: : But it does say, “While the ILI rate is low, I am concerned”.

COMMISSIONER: Yes.

MS FURNESS: : So there’s recognition in this that the ILI rate was low. 25

MR BEASLEY: Sorry, the - - -

COMMISSIONER: Quite. I agree.

30

MR BEASLEY: You’re talking about the email.

COMMISSIONER: But what I’m saying is that there’s no reference to the ARI rate

being high.

35

MS FURNESS: : No, no.

MS RESSLER: No.

MS FURNESS: : I understand that. 40

COMMISSIONER: That’s my only point. I agree with you entirely. Something

I’m interested in, and I need to get your help on, bearing in mind your place in the

team, is if there’s that – I think you have used the word nuance. If there’s that

nuance and judgment that you understand other people, not yourself, bring to bear, in 45

having assessed the Ruby Princess as medium on the 8th of March, notwithstanding

the circumstances we have been discussing - - -



MS RESSLER: Mmm.

COMMISSIONER: - - - then there’s an obvious question in relation to the 19th of

March, as to why it was rated low risk if you brought the same kind of nuanced

approach to bear. 5

MS RESSLER: I think it is exactly because of the nuanced approach, in that all

passengers were told to go into home isolation, which is what would have happened,

had we known there was a COVID positive from a medium risk assessment. So I

don’t know the decision-making of each of the panel members, and I’d be interested 10

in it, but the reason that I was okay with a low risk assessment, even though we were

all concerned – I was certainly concerned, is because everybody had to go into home

isolation after arriving home.

COMMISSIONER: Yes, quite. 15

MS RESSLER: And that – and all cruises were stopping. There was not a new

population of people getting on board this ship.

COMMISSIONER: You were going into home isolation, and I’ll just ask you to 20

assume, enforced by state legislation.

MS RESSLER: Mmm.

COMMISSIONER: That is, you could be fined if you didn’t observe it, even if the 25

ship was as clean as a whistle. That’s how you understood it.

MS RESSLER: Yes, exactly.


MS RESSLER: Yes.

COMMISSIONER: In other words, going into home isolation was regarded as the

appropriate public health response without any indicators at all of COVID-19, 35

correct?


COMMISSIONER: Thank you. Yes. 40

MR BEASLEY: Yes. We will come to the 19th when we get there. Let’s stick with

the 8th, for the time being. You actually had to board the ship, as part of the

Assessment Team, correct?

45




MR BEASLEY: And the doctor was Dr Sheppeard?

MS RESSLER: Yes.

MR BEASLEY: And there was some nurses with you? 5

MS RESSLER: Yes.

MR BEASLEY: And other people you’ve mentioned in your statement. The

passengers that had responded to the announcement about reporting if you’ve got 10

respiratory symptoms or a fever were placed in a – sorry – they were told to go to a

restaurant onboard the ship, correct?


15

MR BEASLEY: And instead of seeing 170 people, there was over 360 people in

that restaurant?

MS RESSLER: Yes.

20

MR BEASLEY: Was that a surprise to you?

MS RESSLER: Yes.

MR BEASLEY: Did you ask any questions about, “Why there are so many more 25

people than we have been told was on the log?”

MS RESSLER: I remember walking in and saying to somebody, “Are all of these

people here for assessment?” And they said, “Yes.”

30

MR BEASLEY: Was that a conversation you had with the ship’s doctor?

MS RESSLER: No. I think, it was – it was another ship crewmember – I can’t

recall.

35

MR BEASLEY: Did you have any concern about the fact that about 200 more

people than were on the log had reported to this restaurant to be assessed by your

Health Assessment Team?

MS RESSLER: Yes. I had - - - 40

MR BEASLEY: What were those concerns?

MS RESSLER: Underreporting, people don’t present to the ship doctor. So we

only know about, before a ship arrives, the people who have presented to the ship’s 45

doctor. And so there is a large number, obviously, of people who don’t do that but

had self-presented to our assessment clinic. And this was a lot and a lot more than



we had seen on previous ship assessments. But it had happened on other ship

assessments too, where we were expecting less than 10 people and 80 people came.

MR BEASLEY: Sure.

5

MS RESSLER: So - - -

MR BEASLEY: But in relation to this particular day, going on the Ruby Princess

on the 8th of March, that the log that had been sent to the Health Assessment Panel

had advised it that 170 people had presented with acute respiratory disease symptoms 10

and you’re faced – less than 24 hours later – with a room with 366 people saying,

‘We have one or more symptoms of acute respiratory disease.”

MR BEASLEY: Just to clarify that there was 240 of those 360 had symptoms.

15

MR BEASLEY: Yes.

MS RESSLER: So that’s only an increase of 70 over the 120.

MR BEASLEY: What were the other 120? 20

MS RESSLER: The other 120 were people who had a positive travel history but no

symptoms. We screened those people - - -

MR BEASLEY: All right. I see. 25

MS RESSLER: They were asymptomatic.

MR BEASLEY: I see. I see. Okay. So from the log, in terms of acute respiratory

disease, if we ignore the travel history, you – there was an extra 70 people that were 30

symptomatic - - -


MR BEASLEY: - - - that had turned up, that weren’t on the log? 35

MS RESSLER: Yes.

COMMISSIONER: So the travel history is not just New Zealand?

40

MS RESSLER: No. At that stage - - -

COMMISSIONER: Because that would have been the whole ship.

MS RESSLER: Yes. On the 8th of March, the travel history was 10 countries. 45

COMMISSIONER: Okay. So - - -



MS RESSLER: And we had specified travel to any of those 10 countries.


MS RESSLER: Some people did show up who hadn’t been to any of them. But we 5

screened everyone who showed up.

COMMISSIONER: Thanks. Well, you would rather people over-volunteered than

under-volunteered?

10

MS RESSLER: Absolutely.

COMMISSIONER: Yes. Thank you.

MR BEASLEY: Now, those people that were in the room were assessed for 15

symptoms, correct?


MR BEASLEY: Was everyone’s temperature taken? 20

MS RESSLER: Yes.

MR BEASLEY: And if someone’s temperature – was 38 the cut-off in terms of any

further follow-up? 25

MS RESSLER: I think, it was 37.8.

MR BEASLEY: Right. That was a decision, though, by Dr Sheppeard - - -

30

MS RESSLER: By Dr Sheppeard.

MR BEASLEY: - - - not by you?

MS RESSLER: Yes. And she may have even used a different cut-off, I can’t be 35

sure.

MR BEASLEY: Right. Were people that had a temperature of under 37.8 allowed

to leave or told to go?

40

MS RESSLER: People who had a temperature under were provided with

information about preventing respiratory illness. They were given one or two masks,

depending on at what stage we saw them, some alcohol hand gel.

MR BEASLEY: Yes. 45



MS RESSLER: And some information, verbally, about hand hygiene and isolation.

We – although we didn’t think they needed testing for coronavirus – we don’t want

influenza walking through the community, either.

MR BEASLEY: Sure. 5

MS RESSLER: So all of that was done for all the symptomatic people.

MR BEASLEY: Right.

10

MS RESSLER: And then they were allowed to leave, yes.

MR BEASLEY: And the criteria to decide who was swabbed for COVID-19 was

based on what?

15

MS RESSLER: So anybody with a fever was swabbed and anybody with any

respiratory symptom plus a positive travel history was swabbed. But they were

reviewed by the doctor.

MR BEASLEY: Yes. 20

MS RESSLER: And she made that decision.

MR BEASLEY: Yes.

25

MS RESSLER: They were also given a point of care influenza test.

MR BEASLEY: Yes.

MS RESSLER: And if they were positive to that, they may not have been swabbed 30

for COVID.

MR BEASLEY: All right. And does it sound right that, I think, there were nine

people swabbed for COVID?

35


MR BEASLEY: Before those COVID swabs had been tested to find out one way or

the other, the other passengers were allowed to leave the ship?

40

MS RESSLER: Yes.

MR BEASLEY: What was that decision based on? What I am asking you, is if

you’re swabbing passengers and crew for COVID-19 on a medium risk-assessed

ship, why do you let the rest of the passengers off before you have the COVID-19 45

test results for the swabs you’ve taken?



MS RESSLER: Because we don’t have a reason to keep them on. They’ve been

assessed, they didn’t fit any testing criteria, they didn’t fit a suspect case of COVID

- - -

MR BEASLEY: Just – just - - - 5

MS RESSLER: - - - as in screening in the community, they’re allowed to go home.

MR BEASLEY: Well, just pause there for a second. You’ve swabbed people

because they are showing sufficient symptoms that you want to swab them for 10

COVID-19 to find out whether they have the disease or not, correct?

MS RESSLER: Yes.

MR BEASLEY: Let’s assume, for a moment, that one of those tests came back or 15

one or more came back positive.

MS RESSLER: Mmm.

MR BEASLEY: You’ve already let the rest of the passengers go off the ship, right? 20

MS RESSLER: Yes.

MR BEASLEY: Under your procedure - - -

25

MS RESSLER: Yes.

MR BEASLEY: - - - it is a risk, isn’t it, that one of those passengers that had been

allowed off the ship may have been in close proximity to a person that has tested

positive for COVID? 30

MS RESSLER: All of those people would have been counted as close contacts and

all of those people would have been put in 14 days home isolation as we were doing

with every case of COVID that was notified to us.

35

MR BEASLEY: I understand they’re going in home isolation. But if there was a

positive – if there were positive tests – just don’t jump ahead.

MS RESSLER: Okay.

40

MR BEASLEY: We’ll break these questions up. If there was a positive, if one of

these tests or more had have come out positive for COVID and you’ve already let the

rest of the passengers off, at least – there is a risk – that at least some of those

passengers could have been in close proximity to someone that had the disease,

correct? 45




MR BEASLEY: Now, I agree they’re going into home isolation, correct?

MS RESSLER: Not on the 8th of March, they weren’t.

MR BEASLEY: They weren’t? 5

COMMISSIONER: That’s not on the 8th, only on the 19th. Yes.


10

MR BEASLEY: All right. Well, what was the criteria, then, on the 18th of March,

if you’ve tested people for COVID and you haven’t got the test results back, why

were the passengers allowed to leave before that happened?

MS RESSLER: Because they’ve been assessed as not fitting any testing criteria for 15

COVID.

MR BEASLEY: But aren’t they, if - - -

MS RESSLER: If - - - 20

MR BEASLEY: - - - if in my scenario, someone tested positive, there is a risk that

they would be taking COVID into the community, correct?

MS RESSLER: Correct. And that’s the same as every other person in the 25

community at the time.

MR BEASLEY: I’m not sure that that follows. Not every other – everyone else in

the community hasn’t been on the cruise ship, have they?

30

MS RESSLER: No. But if anybody – if anybody presents for testing in a hospital

situation, we don’t isolate their family members on the assumption that they were a

positive COVID and we were applying the same criteria to the cruise ship.

MR BEASLEY: All right. Don’t think I am being critical - - - 35

MS RESSLER: No, I know.

MR BEASLEY: - - - I’m trying to understand - - -

40

MS RESSLER: That was the protocol.

MR BEASLEY: - - - so the rationale, there is a risk that you are letting passengers

off the ship on the 8th of March that they have been in close proximity to someone

with COVID-19 because the test results weren’t back, correct? 45




MR BEASLEY: That’s a risk?

MS RESSLER: Yes.

MR BEASLEY: But that was determined as a risk that was reasonable to take? 5

MS RESSLER: Yes.

MR BEASLEY: And the – were you involved in the thinking or the decision-

making as to why that was considered a risk reasonable to take? 10

MS RESSLER: No. I wasn’t.

MR BEASLEY: Okay. Did anyone explain it to you? Did you have a discussion

with anyone about it? 15

MS RESSLER: No. I didn’t - - -

COMMISSIONER: Could – could I - - -

20

MS RESSLER: - - - I didn’t need someone to explain it to me.


COMMISSIONER: Could I just ask you about the procedure? 25

MS RESSLER: Yes.

COMMISSIONER: Your – your Annexure 1.

30

MS RESSLER: Yes.

COMMISSIONER: If you look at the foot of the page 2 to the top of page 3.

MS RESSLER: Sorry, which? 35

COMMISSIONER: That’s your Annexure 1.

MS RESSLER: Yes.

40

COMMISSIONER: This is a procedure that you understood applied on the 8th of

March?

MS RESSLER: Yes.

45

COMMISSIONER: The foot page 2, top of page 3, there’s the response to a

medium risk assessment. Do you see that?



MS RESSLER: Yes.

COMMISSIONER: Now, this is all where the chief human biosecurity officer –

officer assesses there’s a medium risk that COVID-19 may be circulating on the ship.

Do you see that? 5

MS RESSLER: Yes.

COMMISSIONER: The last of the dot items ..... that is, top of the next page, talks

about the assessment team providing clearance for other passengers and crew who 10

are well to disembark.

MS RESSLER: Yes.

COMMISSIONER: One thing that I was wondering whether you and Mr Beasley 15

might have been at cross-purposes, I have been reading that as meaning this is a

sequence of steps. It starts with the team will meet the ship.

MS RESSLER: Yes.

20

COMMISSIONER: And the last step is that clearance is provided for well

passengers and crew to disembark after there’s been assessment of people - - -


25

COMMISSIONER: - - - who may turn out to be unwell. So there’s a sheeps and

goats exercise. So you’re unwell, you are swabbed and disembarked to isolation.

You are well, you are told to go on your way.

MS RESSLER: No. The people who were - - - 30

COMMISSIONER: On the 8th of March.

MS RESSLER: Yes. On – on the 8th of March, the people who were well who were

un – were – who were swabbed were kept on board in their cabins. And the people 35

who were symptomatic were provided with masks and those people and the people

with no symptoms were allowed to disembark after the assessments had been

completed.

COMMISSIONER: Right. So everyone stayed - - - 40

MR BEASLEY: But before – but before the - - -

COMMISSIONER: - - - on board - - -

45

MR BEASLEY: - - - COVID-19 tests results are back?



MS RESSLER: Yes.

COMMISSIONER: But before any test results are back. Yes.

MS RESSLER: Correct. The only people who were kept on board were the nine 5

people swabbed, and we recommended the ship not allow new passengers on board

because we knew that if there was a positive, all those 2700 people would become

close contacts. But if they allowed new passengers on board the whole lot of new

passengers would also become close contacts and need to go into isolation. So we

recommended the ship delay embarkation until the results were received. 10

COMMISSIONER: Yes.

MR BEASLEY: So the – the risk of allowing people off before the COVID test

results are available on the 8th of March was deemed a risk that was reasonable to 15

take, but the risk of allowing people back on the ship, or new passengers on the 6th –

the 8th of March before the COVID tests were available was deemed not a risk that

should be taken?

MS RESSLER: Yes. The people who had disembarked, if it was positive, had 20

already been exposed. But the people who were waiting to come on board had not.

And we didn’t – if it was negative, we were taking a very prudent approach. We

didn’t want anyone else exposed.

COMMISSIONER: If it was negative. 25

MS RESSLER: If it was positive.


30

MS RESSLER: Yes.

COMMISSIONER: That’s all right.

MS RESSLER: Sorry, did I say it wrong? 35

COMMISSIONER: That’s all right. That’s all right.

MS RESSLER: And that’s also why we had the full contact details of everybody on

board. We made sure we had that so we could rapidly contact those people and put 40

them into isolation.

COMMISSIONER: On the 8th of March, did you have an understanding as to how

much community circulation there was then in Sydney of - - -

45

MS RESSLER: Yes.



COMMISSIONER: - - - COVID-19? So there was a possibility that people about

embark on a cruise already had it.

MS RESSLER: No. On the 8th of March we had very, very small numbers.

5

COMMISSIONER: Thank you. A very small possibility.

MS RESSLER: Yes.


MR BEASLEY: Just on the – the – the risk we’ve been discussing. And I

understand what you say about the reasoning for allowing passengers off before the

COVID test results are available for those passengers that have been swabbed on the

8th of March. But even with contact details of passengers, had one or more of those 15

swabs become positive, then first it’s a pact – a fact that people would have been

allowed off the ship that had been in close contact with people that had tested

positive for COVID. That’s a risk, correct?


MR BEASLEY: And they might catch taxies, catch Ubers, catch trains, catch

flights, even, that was a risk for the people that they came in close contact with

during those travels, correct?

25


MR BEASLEY: Was there any discussion that you remember at all with anyone

about the analysis of those risks that we’ve just discussed?

30

MS RESSLER: No. Not that I’m aware of.

MR BEASLEY: All right. Was there any discussion about – with anyone on the 8th

of March that you had about – were – where swabbing people for COVID, more

people have turned up in this room than expected with symptoms, 70 more than the – 35

is on the log, there might be more people that are just refusing to report acute

respiratory disease because they simply don’t want to?

MS RESSLER: Yes.

40

MR BEASLEY: And what discussions did you have and with who about that?

MS RESSLER: I can’t recall having discussions about that. I knew that that was a

problem and in the earlier stages of the pandemic that was a manageable problem

because we didn’t have large transmission yet. But I was conscious that we could 45

easily miss a case and short of testing everybody and keeping them in isolation in a

hotel, there was – it was a stepped up approach based on the risk at the – on the day.



MR BEASLEY: All right. It – to an extent on the 8th of March, people that have

refused to – that have been – that may have had symptoms and didn’t either go to the

medical centre or didn’t go to the restaurant, is something you can’t control. The

health assessment team can’t control if someone’s got a sore throat and is just not

telling anyone, correct? 5


MR BEASLEY: The only control is keep people on the ship or don’t keep people

on the ship, correct? 10

MS RESSLER: And that wasn’t in my power either.

MR BEASLEY: No. Understood. All right. I want to ask you, in the end, all those

COVID tests came back negative, correct? 15


MR BEASLEY: All right. Okay. And so people were then – the new passengers

were then allowed on the ship? 20


MR BEASLEY: All right. You started to have some communications with Dr von

Watzdorf on a – on WhatsApp from the 8th of March. You remember that? 25

MS RESSLER: Yes.

MR BEASLEY: And transcript of those WhatsApp messages is behind tab 2 of

your statement. I just want to ask you some questions about some of the messages 30

you’ve exchanged with the doctor on the 8th of March. Seems as though you’re

exchanging – first of all, who – who’s idea – where – where did you first meet or

come in contact with Dr von Watzdorf?

MS RESSLER: The first time I met her in person was the 8th of March. 35

MR BEASLEY: So when you went on board?

MS RESSLER: Yes.

40

MR BEASLEY: Did you have a discussion with her about what you were doing and

– and what level of illness there’d been on the ship? General discussion about that at

all, do you recall?

MS RESSLER: I had a lot of discussions with her. I’m not sure specifically what 45

you mean.



MR BEASLEY: Let’s stick with the 8th of March. Did you have a discussion with

her about the number of people on board who had presented with acute respiratory

disease?

MS RESSLER: Yes. 5

MR BEASLEY: And what was that discussion?


10

MR BEASLEY: Did you have a discussion with her about whether there seemed to

be a high number of people with acute respiratory disease on board?

MS RESSLER: I likely would have, although I can’t recall specifically.

15

MR BEASLEY: All right. Did you have a discussion with her about any concern

she may have had or you may have had about COVID-19 on board?

MS RESSLER: We were all concerned about COVID-19. There was no - - -

20

MR BEASLEY: No, no. I – I’m sure you were - - -

MS RESSLER: We were - - -

MR BEASLEY: - - - but just listen to – the question was, did you have a discussion 25

that you recall with Dr von Watzdorf about COVID-19 generally?

MS RESSLER: Yes.

MR BEASLEY: First of all - - - 30

MS RESSLER: Of course.

MR BEASLEY: All right. What do you recall of that discussion?

35

MS RESSLER: I can’t specifically recall. I discussed COVID with almost every

doctor on the ships and I can’t specifically recall what was said with Dr von

Watzdorf.

MR BEASLEY: Do you recall whether she was concerned about COVID-19 on the 40

Ruby Princess?

MS RESSLER: She was concerned. But that is not because she thought there were

cases but because it was an environment of increasing concern. She didn’t tell me

that she “Thought there were cases there.” 45

MR BEASLEY: Yes. No.



MS RESSLER: But she did express concern about the cruising environment and the

rising risk.

MR BEASLEY: And no doubt, don’t let me put words into your mouth. But that,

the background to that is, obviously, she on the sister ship of the Diamond Princess 5

which has had a massive outbreak. There is other ships that are owned by Carnival

or Princess Cruises that have had COVID-19 cases. So it’s I guess, a concern for

that fleet generally, correct?

MS RESSLER: It was a concern for all ships. 10

MR BEASLEY: Yes. All right. Okay. Is there anything else of significance that

you can recall in terms of having a discussion with Dr von Watzdorf while you were

onboard the ship, on the 8th?

15

MS RESSLER: Not of concern - - -

MR BEASLEY: All right. Did she - - -

MS RESSLER: - - - not out of - - - 20

MR BEASLEY: - - - sorry, go on, yes.

MS RESSLER: - - - not unusual.

25

MR BEASLEY: Okay. Did she play any role in terms of providing assistance to

what the Health Assessment Team was doing?

MS RESSLER: She was doing – she stayed in the medical centre and when patients

were identified for swabbing - - - 30

MR BEASLEY: Yes.

MS RESSLER: - - - they were taken down to her. I don’t know if she was doing

the swabbing but she was overseeing the swabbing and perhaps, doing the swabbing. 35

MR BEASLEY: All right. 366 people in this restaurant, were people close together

or they what we would describe as physically distancing? The 6 foot, 1.5 metre rule?

MS RESSLER: They were close together. 40

MR BEASLEY: All right. Were they sitting at tables?

MS RESSLER: Yes.

45

MR BEASLEY: And did it concern you that they were so close together, so many

people in the one room?



MS RESSLER: Yes.

MR BEASLEY: Did you do anything because of that?

MS RESSLER: We ensured that they were all wearing masks. 5

MR BEASLEY: Did they have masks on when you got there?

MS RESSLER: Some of them did, but not all of them.

10

MR BEASLEY: So masks were provided to those that didn’t?

MS RESSLER: Yes.

MR BEASLEY: But outside of that, with that many people in the room, I – there 15

wasn’t many options for you in terms of keeping them separate? Is that - - -

MR BEASLEY: No, that’s correct.

MR BEASLEY: - - - all right. Okay. All right. 20

MS RESSLER: It was just not able to be done.

MR BEASLEY: Okay. Can you just look at behind tab 2 of your statement. Who

suggested to who to start communicating on, via WhatsApp? 25

MS RESSLER: Dr Ilse mentioned WhatsApp as part of an unrelated conversation

and I suggested that, “Maybe we should use WhatsApp.” Because of the trouble that

we had been having with the satellite phones.”

30

MR BEASLEY: I see. So it was a – it was suggested, merely, as a way – a more

convenient way - - -

MS RESSLER: Mmm.

35

MR BEASLEY: - - - or perhaps, even a more reliable way, of communicating if you

needed to, given the environment at the time?

MS RESSLER: Exactly.

40

MR BEASLEY: All right. Commissioner, do you know what WhatsApp is?

COMMISSIONER: Not really.

MR BEASLEY: All right. 45

COMMISSIONER: But I don’t want to, either.



MR BEASLEY: But do I need to explain it?

COMMISSIONER: No. Please don’t.

MR BEASLEY: Or should we move on? All right. 5

COMMISSIONER: Please don’t.

MR BEASLEY: On the 8th of March, you’ve had some exchanges with the doctor

to keep her informed as to what the results were with these COVID swabs, correct? 10

MS RESSLER: Yes.

MR BEASLEY: And you’ve told her:

15

They all came back negative and [you] phoned Valerie

That’s a Port Agent for Ruby – Princess Cruises or Carnival - - -

MS RESSLER: Yes. 20

MR BEASLEY: - - - Australia. Do you know her?

MS RESSLER: Yes.

25

MR BEASLEY: You do?

MS RESSLER: I met her for the first time that day, as well.

MR BEASLEY: All right. Okay. So you let her know, as well. Then it’s got at 30

8.41.23 pm, Dr von Watzdorf saying to you:

Confirmed all contacted and informed, disembarked them and advised on

general precautions. Thank you again for cooperation. Hopefully, they’ll

behave this cruise. 35

With some sort of an emoji looking like an exasperated doctor or an exasperated

person. Do you know what she was meaning by saying:

Hopefully, they’ll behave this cruise. 40

MS RESSLER: Hopefully they won’t become unwell.

MR BEASLEY: Okay. Okay. All right. It wasn’t about the way people were - - -

45

MS RESSLER: No.



MR BEASLEY: - - - conducting themselves on the - - -

MS RESSLER: No.

MR BEASLEY: All right. Then on the 13th of March, you’ve sent her a message 5

saying:

Hi Ilse, just heard Princess is stopping all sailings for two months. Sensible

decision.

10

Why did you consider that a “sensible decision”?

MS RESSLER: That was one conversation I’d had with Dr Ilse. She said to me on

the 8th, “We just had to stop all cruise ships.” And I hadn’t - - -

15

MR BEASLEY: She said that to you on the 8th?

MS RESSLER: She did.

MR BEASLEY: You recall that now? 20

MS RESSLER: Yes.

MR BEASLEY: Okay. Yes.

25

MS RESSLER: Yes. That’s what I said that:

Sensible decision.

MR BEASLEY: And - - - 30

MS RESSLER: It was – it was a passing comment. And she just said, “We just

have to stop all cruises.”

MR BEASLEY: Did you have a discussion with her that you recall now – having 35

been prompted via the WhatsApp messages – as to what the context of that was?

Did you take that to being, “This is becoming so inherently risky.”

MS RESSLER: Yes. That’s what I - - -

40

MR BEASLEY: Or something like that?

MS RESSLER: Yes.

MR BEASLEY: In terms of COVID contraction on cruise ships? 45

MS RESSLER: Yes. Exactly.



MR BEASLEY: All right. Did you have any further discussion with her about that?

MS RESSLER: No.

MR BEASLEY: All right. Okay. I want you to turn to – actually, these documents 5

I want to ask you about, these emails aren’t in your statement – do you have in front

of you, have you been provided with some emails you exchanged with Dr von

Watzdorf during the cruise - - -

MS RESSLER: Yes. 10

MR BEASLEY: - - - on the 15th of March?

MS RESSLER: I have that.

15

MR BEASLEY: You do have them. Thank you. So in terms of this chain of

emails, on the 14th of March, Dr von Watzdorf has sent you an email at 3.04 pm. It

could be New Zealand Time, I think :

G’day Kelly-Anne, 20

I want to ask you, do you want me to keep you updated as we have our

respiratory cases present onboard every few days? Or do you prefer us to

update you only in the days prior to arrival?

25

She goes on:

We’ve got a few people with sniffles, etc. Nothing I am currently concerned

about clinically in terms of COVID-19.

30

You say:

Happy to stay in touch, we will collect information prior to your arrival. You

might have to call me if I don’t respond to your email.

35

And then on the 15th of March at 8.57, you’ve received an email from Dr von

Watzdorf saying:

Hi Kelly,

40

We are in the moment, it seems we are in the early stages of an influenza A

outbreak onboard.

Now, you might be able to tell me from the epi curve that I can’t read at the bottom

of that email but by “early phases of an influenza A outbreak” were you told 45

numbers, at the time?



MS RESSLER: It looks like the epi curve has been cut off. But I would have had it

at the time.

MR BEASLEY: All right. In terms of any discussion with Dr von Watzdorf,

though, at this stage was it all by email rather than, there was no telephone calls? 5

MS RESSLER: There could have been telephone calls, I’m not sure.

MR BEASLEY: You - - -

10

MS RESSLER: She did phone me.

MR BEASLEY: Right. When you say she did phone you, for example, did she

phone you to tell you people had been swabbed for COVID in Wellington?

15

MS RESSLER: No.

MR BEASLEY: And what the results were. Or did you find this out through this

email?

20

MS RESSLER: Yes. I found that out later.

MR BEASLEY: The phone conversations you had with Dr von Watzdorf, do you

think they pre-dated this chain of emails, or were they after?

25

MS RESSLER: No. They were after.

MR BEASLEY: After. All right. And doing your best you can before we move

onto any other documents were, what did you discuss with Dr von Watzdorf during

those phone conversations? Was it about the number of people that were attending 30

her medical clinic with relevant symptoms?

MS RESSLER: I can only be sure about one phone conversation, that she phoned

me on the 18th, in the morning.

35

MR BEASLEY: Yes.

MS RESSLER: And it was discussing the swabs that were available for testing.

She’s - - -

40

MR BEASLEY: Now, we should pause there and I should have asked you, but you

provided Dr von Watzdorf with some swabs for COVID testing before the ship left

on the 8th of March; is that right?

MS RESSLER: Yes, a whole box. 45

MR BEASLEY: And is my memory something like 25.



MS RESSLER: I think it was 25. It was a full box.

MR BEASLEY: Yes.

MS RESSLER: However many is in a box. 5


MS RESSLER: She used some of them for the testing in Wellington.

10

MR BEASLEY: Yes. Okay. All right. Sorry, did you want to what you were

saying when I cut you off then?

MS RESSLER: So the conversation that she had with me on the morning of the 18th

was about – she’s taken 10 swabs. 15

MR BEASLEY: Yes.

MS RESSLER: Do I want to continue collecting swabs, and I said yes, she said “I

only have five left”. 20

MR BEASLEY: Yes.

MS RESSLER: I said you only need one swab per person now, we’re not doing a

respiratory panel, we’re only doing the COVID testing, so please collect another five 25

swabs from people who you think should be tested.

MR BEASLEY: Right. Okay.

MS RESSLER: And we discussed the ARD log, which I had open on my screen, 30

and I raised the possibility of testing the people who were American citizens.

MR BEASLEY: Yes.

MS RESSLER: Because there were quite a few of them on the log. 35

MR BEASLEY: Right.

MS RESSLER: And we assumed that – I assumed that they probably travelled into

Sydney to board the ship, and therefore had a international travel history. 40

MR BEASLEY: All right. Just before we get to the log that was sent in response to

New South Wales Health’ request, I think this is behind tab 7 – 11, I’m sorry, of your

statement, there’s a email after the response from the ship, the prior email from

Laura-Jayne Quinn to Dr von Watzdorf, saying: 45

We want, before 9 am tomorrow –



That is – sorry, “by 9 am tomorrow”, that is the 18th of March:

…we want the full ARD log and please provide us with the rest of the

information we’re seeking.

5

MS RESSLER: Yes.

MR BEASLEY: Laura-Jayne Quinn sent that email to assist you in your workload,

was that - - -

10


MR BEASLEY: - - - about right?

MS RESSLER: Yes. 15

MR BEASLEY: Okay. And by – shortly after the 9 am deadline, at 9.39 am, Dr

von Watzdorf responded to that email, and I think there was a separate email sent to

you by Valerie Burrows that just contained the log.

20

MS RESSLER: Yes. All right.

MR BEASLEY: In addition to giving you the log, it also gave you information

about the two patients that required ambulance transfer.

25

MS RESSLER: Yes.


MS RESSLER: Yes. 30

MR BEASLEY: And the fact that they had febrile upper respiratory tract infections,

amongst other problems, and then tested negative for influenza and they’d been

swabbed for COVID, but obviously no test results, correct?

35


MR BEASLEY: All of that information is the information that then went on to the

expert health panel to make a determination of low, high, medium, correct?

40


MR BEASLEY: Can I ask you this: did you have an opportunity yourself to look at

the ARD log?

45

MS RESSLER: Yes. I had already looked at the ARD log.



MR BEASLEY: So you looked at the ARD log attached to this email at 9.39 am on

18 March.

MS RESSLER: Yes.

5

MR BEASLEY: Did you notice how many people had reported to the medical

centre in just the last 24 to 36 hours on the log? Did you make a count for that

number?

MS RESSLER: So on the 17th of March? 10

MR BEASLEY: Yes. Do you recall doing that, firstly?

MS RESSLER: I don’t recall. It’s likely I did.

15

MR BEASLEY: All right. Did you – if it’s likely you did, would you remember

that of the 102 people that had presented, more than 50 were just on that day? Do

you remember noticing that? If you didn’t, you didn’t, but do you - - -

MS RESSLER: I did. 20

MR BEASLEY: You did.

MS RESSLER: Yes. And I knew that that was in response to the – well, I assumed

that was in response to the announcements that were being made. 25

MR BEASLEY: All right. Nevertheless, you noticed that of the 102 people that

you were advised had - - -

MS RESSLER: 104. 30

MR BEASLEY: - - - gone to the medical centre with acute respiratory disease

symptoms, just slightly more than half of those had gone in the space of 24 hours.

You noticed that?

35

MS RESSLER: I don’t remember noticing that specifically, no.

MR BEASLEY: All right. And did you notice that very low numbers of people had

gone to the medical centre with acute respiratory disease symptoms in the first days

of the cruise? Sometimes only one person a day. Did you notice that? 40

MS RESSLER: I don’t remember noticing that, but that’s not unusual.

MR BEASLEY: All right. Did it occur to you that people were – as a general

measure, in terms of the information and the log, that more people were reporting 45

with symptoms of acute respiratory disease the longer this cruise went on?



MS RESSLER: Yes.

MR BEASLEY: All right. Okay.

COMMISSIONER: Is that qualifying your use of the languages, the beginning of an 5

outbreak?

MS RESSLER: Yes. An influenza A outbreak is what we were thinking – what I

was thinking.

10

COMMISSIONER: Not because you had a diagnosis of influenza A, but in your

experience that’s probably what it was?

MS RESSLER: No. Because there were positive – quite a lot of positive flu swabs.

15

COMMISSIONER: You don’t, I take it, in your line of business interpret a negative

flue swab as a falsely negative flu swab, do you?

MS RESSLER: It would either be a falsely negative flue swab or it could be another

respiratory pathogen. 20

COMMISSIONER: Quite. Yes. And by the 17th, 18th of March you were aware

that observations permitted of the possibility that you could have COVID-19 while

also having influenza?

25

MS RESSLER: I knew that was a possibility, yes, Commissioner.

MR BEASLEY: Could I just pause there, Commissioner, and just in case if there’s

– if there’s anyone from New South Wales ambulance waiting here they should

probably be allowed to - - - 30

COMMISSIONER: Yes.

MR BEASLEY: - - - leave if there’s anyone left or they’ve already gone.

35

COMMISSIONER: Yes.

MR BEASLEY: Good. Thank you.


MR BEASLEY: Very wise. That - - -

COMMISSIONER: Sorry, could I – I – my mistake I’m sure. Mr Beasley, you’d

referred to 102. How does that relate to the 104 on the cruise ship screening - - - 45

MR BEASLEY: It may have been me - - -



COMMISSIONER: - - - procedure form?

MR BEASLEY: It may have been me misspeaking, but there is - - -

COMMISSIONER: That’s all right. 5

MR BEASLEY: There is 102 mentioned somewhere.

COMMISSIONER: I know.

10

MR BEASLEY: And then there’s 104. But you’re quite right. It’s 100 – when we

get to the – the risk assessment form, you’re right, it’s 104.


15

MR BEASLEY: Yes.

MS RESSLER: Yes.

MR BEASLEY: The – the risk assessment form and the logs, we know were – well, 20

it certainly they’re logs. Yes. I withdraw everything I just said and I’ll start again to

get it out in English to help you.

MS RESSLER: Okay.

25

MR BEASLEY: Tab 13 of your statement has Ms Quinn sending to the Health

Assessment Panel for their purposes of their determination, at about 10.55 am,

what’s called the RA, which I assume means the risk assessment.


MR BEASLEY: And the logs.

MS FURNESS: Can – can I just interrupt? I apologise, Commissioner. That email

is only to Professor Ferson. It’s not to the panel. 35

MR BEASLEY: You’re quite right. It’s – Professor Ferson, cc’d Dr Sheppeard.

Was Dr Sheppeard on this Health Assessment Panel? People are shaking their head.

Okay. It only went to Professor Ferson. That’s what we know about this email. It

just went to Professor Ferson in terms of the Health Assessment Panel, and to you, 40

correct?

MS RESSLER: Yes.

MR BEASLEY: All right. At some stage, it must have reached the other people on 45

the Health Assessment Panel?



MS RESSLER: Yes.

MR BEASLEY: We would assume. Okay.

MS RESSLER: It did. 5

MR BEASLEY: I want you to turn to tab 14, but I want you to ignore for a moment

your email to Professor Ferson and the others listed there. And go over the page to

the pre-arrival risk assessment form. That, again, was completed by Ms Quinn.

10

MS RESSLER: Yes.

MR BEASLEY: It is Ms – it’s not Dr Quinn?

MS RESSLER: No. It’s Ms. 15

MR BEASLEY: Ms Quinn. And why did she prepare that rather than you?

MS RESSLER: She was – she was doing all the risk assessments that day.

20

MR BEASLEY: I see. Okay. And over the page she’s – what we can see from this

report is that there’s the 104 figure for people that have presented with acute

respiratory illness this cruise. Which is also expressed as a percentage as 2.7 per

cent.

25

MS RESSLER: Yes.

MR BEASLEY: If it’s only the ILI percentage of reaching one per cent that’s the

main issue to be considered based on you past experience at least, why express 2.7

per cent for acute respiratory illness? 30

MS RESSLER: Because we wanted the expert panel to have all of the information.

MR BEASLEY: Right. And 36 with ILI - - -

35

MS RESSLER: Yes.

MR BEASLEY: - - - reaching .94 per cent. 48 swabbed for flu and 24 testing

positive for influenza A, and another – you’ve got the notation about the five tested

in Wellington that came back negative for COVID-19. 40

COMMISSIONER: Sorry. Can I – that 10, number of swabs available for COVID-

19 testing. Again, I should read available as meaning the number of swabs that have

been used and may now be tested in - - -

45

MS RESSLER: Yes.



COMMISSIONER: - - - the laboratory, I’m sure - - -


COMMISSIONER: - - - for COVID-19. 5

MS RESSLER: Yes.

COMMISSIONER: Why is that only 10?

10

MR BEASLEY: Yes.

MS RESSLER: She only had 15 swabs.

COMMISSIONER: And the – so you add 10 with five in Wellington - - - 15

MS RESSLER: No. The five in Wellington are of the 25 we gave her, which – she

would have done two swabs per person. So that would have been 10 swabs used for

Wellington, which means she had 15 swabs left on board. She had already taken 10

and she, at the time that I had this conversation with her, had five left that she could 20

take. By the time the ship came in, she only took another three. So there was 13 in

total .....

COMMISSIONER: That’s when you, in effect, said, “Look, don’t worry about flu

now. Just test for COVID?” 25

MS RESSLER: Yes.

COMMISSIONER: Swab for COVID. Yes.

30

MS RESSLER: So she was still doing the point of care test for flu.

COMMISSIONER: Yes.

MS RESSLER: What I told her not to do is collect a swab for our laboratory to test 35

for flu.

COMMISSIONER: All right. Thank you.

MS RESSLER: Yes. 40

COMMISSIONER: So I should understand that 10 as what – simply and solely

because the ship didn’t have enough swabs or was there, as you could understand it,

a systemic failure to take a COVID-19 swab when you took a flu swab?

45



MS RESSLER: It appears from the log that she was using the same criteria that we

were using on 8 March. She wasn’t taking a swab for people who had a flu positive

test.

COMMISSIONER: Now, I can’t find that in any of the protocols or procedures. 5

MS RESSLER: No.

COMMISSIONER: Which seem pretty clear to the effect that you should take both,

is that right? 10


COMMISSIONER: Who should I ask about that?

15

MS RESSLER: Whoever wrote the protocol, Commissioner. I don’t know.

COMMISSIONER: You have no idea who wrote the protocol?

MS RESSLER: No. 20

COMMISSIONER: Thank you. Although while on that screening procedure form,

at – there’s a reference to the number of ill passengers and crew who have been in

countries included in the Australian COVID-19 testing criteria in the 14 days before

embarkation, do you see that? 25

MS RESSLER: Yes.

COMMISSIONER: Was that out of date - - -

30

MS RESSLER: Yes.

COMMISSIONER: - - - by then? Yes. Thanks.

MS RESSLER: Yes. We - - - 35

COMMISSIONER: That’s all right. Thanks. I think you’ve addressed that in your

statement.

MS RESSLER: Yes. 40

COMMISSIONER: Yes.

MR BEASLEY: The figures in this pre-assessment – pre-arrival risk assessment

form for – of 104 for acute respiratory illness and 36 for influenza-like illness were, 45

of course, figures that were current no later than about 9 am on 18 March, correct?



MS RESSLER: Yes.

MR BEASLEY: The ship is berthing in Sydney at about 3 am the next day, correct?

MS RESSLER: Yes. 5

MR BEASLEY: The – don’t take this as a criticism, but the form doesn’t contain a

cell to indicate how many people have presented with acute respiratory illness in the

last couple of days of the cruise, correct?

10


MR BEASLEY: But that information is available by looking at the log, correct?

MS RESSLER: Yes. 15

MR BEASLEY: It’s obvious enough, isn’t it, that given that this information is

supplied by the ship roughly 20 hours out and that’s the material presented to the

Health Assessment Panel, that the numbers might have changed by the time the ship

actually pulls up at a dock at – in Sydney Harbour, correct? 20

MS RESSLER: Yes.

COMMISSIONER: And at least where criterial like 1 per cent are important, if they

are in the decision making process, you would agree that’s probably a flaw in the 25

system?

MS RESSLER: Yes.

COMMISSIONER: Just two more ILI and it would have been 1 per cent or more; 30

is that right?

MS RESSLER: Yes, that’s correct. Just two more.

COMMISSIONER: And what about if just one more? 35

MS RESSLER: Not just one more, but two more.

COMMISSIONER: But if it was just one more, it would produce a figure so close

to 1. 40

MS RESSLER: Yes.

COMMISSIONER: That if we’re talking about nuances, I for one - - -

45

MS RESSLER: Yes.



COMMISSIONER: - - - don’t understand why an expert assessment would not have

paused at that point. Now, I appreciate you’re not a clinician.

MS RESSLER: Because – I know.

5

COMMISSIONER: I appreciate your job is not to make these expert assessments,

but you are assisting in the process.

MS RESSLER: Yes.

10

COMMISSIONER: And so I’m wondering whether you have heard anything,

whether there’s been any discussion with you, about near enough being close enough

for these, what I’ll call, arbitrary thresholds.

MS RESSLER: No, Commissioner. We drew a line at 9 am. We should have had a 15

buffer. I acknowledge that. There wasn’t a discussion around that. We were – I was

nervous about the decision, but I was okay with the decision, because we had 24 of

36 positive for flu A, it looked like a flu A outbreak, and everybody was being told to

go into 14 day isolation and there were no new cruises happening, and we just had to

get everybody home and the cruising stopped, and this was the last day that 20

passengers were arriving.

COMMISSIONER: Look, I know I should - - -

MS RESSLER: So those are the nuances, Commissioner. 25


MS RESSLER: With the decision.

30


MS RESSLER: In my mind.

MR BEASLEY: Sorry, are they nuances - - - 35

COMMISSIONER: I know I should remember this detail, there’s 36 with ILI,

there’s also – there’s 24 positive results for the influenza A test.

MS RESSLER: Yes. 40

COMMISSIONER: And I know I should remember this, but I don’t: where does

the 12 come from? That I add 12 to 36 to get 48 for the number of people who were

tested.

45



MS RESSLER: Dr Ilse has made a decision to test another 12 people who didn’t

have fever, and I don’t know why she made that decision, but she did that, and a lot

of ships were doing that. They were testing everybody.

COMMISSIONER: Right. 5

MS RESSLER: So I don’t know that - - -

COMMISSIONER: I’m not suggesting it’s a bad thing.

10

MS RESSLER: No.

COMMISSIONER: But do we happen to know whether any of the people without

fever tested positive for influenza A.

15

MS RESSLER: One, from my knowledge.

COMMISSIONER: And do we happen to know whether all 24 positive tests for

influenza A, bar that one, came from the 36 who presented with ILI symptoms.

20

MS RESSLER: Yes, they did.


MR BEASLEY: I think some – I mean, this isn’t a question for the witness, but I 25

think we can look at this later, but of those extra 12 tested for flu, that “didn’t have a

fever”, they had temperatures approaching 38. They had temperatures above normal.

So that might have been why they were also selected for influenza testing, but that’s

an analysis of the log.

30

COMMISSIONER: Might be a nuance. Yes. All right.

MS RESSLER: Yes.

MR BEASLEY: I want to, as far as I can, explore your memory of any deliberations 35

the expert health panel had based on the information that was supplied to them. I

understand there was no telephone discussion this time.

MS RESSLER: Yes.

40

MR BEASLEY: Is that your understanding?


MR BEASLEY: That the decision was made by an exchange of emails? 45

MS RESSLER: Yes.



MR BEASLEY: If you look behind tab 14 of your statement, where we were,

there’s an email from you to Professor Ferson, Dr Sheppeard, Ms Quinn, and

someone called Hanna Hildenbrand, who’s Hanna Hildenbrand?

MS RESSLER: She’s my admin assistant. 5

MR BEASLEY: I see. Okay. You have addressed this, “Hi Mark and Vicky”.

You have attached the risk assessment we have just discussed that Ms Quinn

completed based on the log and the other information provided by the ship, then you

have used the word, “Plan:”, and you stated: 10

Receive swabs at lab as soon as ship embarks.

COMMISSIONER: That means docks, I take it, does it?

15

MR BEASLEY: Docks. Allowed dis - - -

COMMISSIONER: Does embarks mean docks?

MS RESSLER: Yes, I’m sorry. 20

COMMISSIONER: Don’t apologise.

MS RESSLER: I did this very quickly, this email.

25

COMMISSIONER: Doesn’t matter. That’s all right.

MR BEASLEY: It’s all right:

…allow disembarkation, all passengers go to home isolation. Passengers who 30

are swabbed and plan to fly can’t do so until result is received. Doctor has

been advised to tell ambos about two people who need medical transfer.

Just going back, tell me if I’m wrong, but that appears to be a form of

recommendation you’re making, at least, to Professor Ferson? 35

MS RESSLER: Yes. Based on a low assessment.

MR BEASLEY: All right. And that was based on you having looked at the

completed pre-arrival risk assessment form completed by Ms Quinn, correct? 40


MR BEASLEY: And the log?

45

MS RESSLER: And the log and my discussions with the doctor.



MR BEASLEY: Right. Okay.

COMMISSIONER: The ship’s doctor?

MS RESSLER: The ship’s doctor. 5

MR BEASLEY: And your discussions with Dr von Watzdorf?

MS RESSLER: Yes. And I possibly also had a discussion with Dr Sheppeard or

Professor Ferson. 10

MR BEASLEY: All right. Dealing one at a time, what was the discussion with Dr

von Watzdorf?

MS RESSLER: Just the phone conversation I recalled earlier about the swabs. 15

MR BEASLEY: Right.

COMMISSIONER: This is the number of swabs?

20

MS RESSLER: Yes. And we – together – had a look at the ARD log identifying

people who might – should – be swabbed - - -

MR BEASLEY: All right. Did she - - -

25

MS RESSLER: - - - so that conversation - - -

MR BEASLEY: Sorry.

MS RESSLER: Yes. 30

MR BEASLEY: Don’t let me cut you off.

MS RESSLER: No, that’s all.

35

MR BEASLEY: Tell me if I have. If – during the course of this discussion – did

she say to you:

Look, by the way, Kelly, I hope you’ve noticed we’ve had 50 people today that

came in with acute respiratory disease symptoms. 40

Did she say anything like that?

MS RESSLER: No.

45



MR BEASLEY: Yes. All right. Did she say anything to you about that was further

to her advice on the 15th of March that she seemed – the ship seemed – to be in the

beginning of an influenza outbreak?

MS RESSLER: She – what I recall is that she was fairly convinced it was an 5

influenza outbreak, not only because of the positive swabs, but because even the

people who were negative were responding to oseltamivir - - -

MR BEASLEY: Right. Explain - - -

10

MS RESSLER: - - - and were getting better.

MR BEASLEY: - - - what is the significance of that? What is that? And what is

the significance of it?

15

MS RESSLER: So it’s an antiviral medication used to prevent – used to treat and

prevent influenza.

MR BEASLEY: All right. Did - - -

20

COMMISSIONER: It’s, in old-fashioned terms, it’s a “trial of treatment”.


COMMISSIONER: You – if it responds to treatment for X, maybe it’s X? 25


COMMISSIONER: Yes. Thanks.

30

MR BEASLEY: Do you recall her actually saying to you words to the effect, “I

think, this is influenza.”

MS RESSLER: Yes. I think so.

35

MR BEASLEY: Was there a discussion that it could be COVID?

MS RESSLER: There was a discussion about taking precautions for COVID - - -

MR BEASLEY: By - - - 40

MS RESSLER: - - - even though it looked like influenza.

MR BEASLEY: Right. By precautions, you mean protective equipment for people?

45

MS RESSLER: Yes.



MR BEASLEY: Can I just ask you, if she said to you, “I think, it’s influenza.” I

have to ask you this, do you think that influenced you, in terms of your thinking?

MS RESSLER: No. I had seen on the logs that it – there was 24 of 36 ILIs with

positive flu swabs. And there was - - - 5

COMMISSIONER: Are you perhaps, falling into a habit of thought that says, “If

it’s flu, it’s not COVID-19”?

MS RESSLER: It was less likely, not that it’s not. 10

COMMISSIONER: Did you – was there information available to you showing that,

probabilistically, it was less likely?

MS RESSLER: No. I didn’t have any information about that. It was all so new. 15

COMMISSIONER: It was also?

MS RESSLER: It was all so new - - -

20

COMMISSIONER: Yes. Novel Coronavirus - - -

MS RESSLER: - - - the whole situation was new.


MS RESSLER: Yes.

COMMISSIONER: Yes. Yes.

30

MR BEASLEY: Do you think you – did you take it into account – that it was Dr

von Watzdorf’s opinion that, “This is a flu outbreak and nothing else.” Or likely to

be a flu outbreak and nothing else?

MS RESSLER: I think I was too scared of a coronavirus outbreak on a cruise ship 35

to think it was nothing else.

MR BEASLEY: Right.

MS RESSLER: We tried to - - - 40

MR BEASLEY: Did you put any weight on her expression of opinion, “As a

doctor, I think, this is a flu outbreak”?

MS RESSLER: Yes. 45



MR BEASLEY: All right. Did you pass that on to Professor Ferson or anyone else

on the Medical Assessment Panel?

MS RESSLER: Most likely.

5

MR BEASLEY: In a telephone or face-to-face discussion?

MS RESSLER: Well, Mark was in copy with these emails where she was advising

us that they were in the early stages of an influenza A outbreak.

10

MR BEASLEY: Yes. True. Yes.

MS RESSLER: So he was already aware of that. There was an awful lot going on

that day, that week. So I can’t be sure.

15

MR BEASLEY: All right. Look, I have no doubt – just rest assured that I am

making the assumption in everything I ask you that things were busy - - -

MS RESSLER: Yes.

20

MR BEASLEY: All right. I really do understand that. What I was asking you

though, “Do you recall” – and if you don’t recall, that’s fine – but do you recall

having a discussion with Professor Ferson or Dr Sheppeard or anyone else on the

Health Panel about the discussions you had had with Dr von Watzdorf?

25

MS RESSLER: About the swabs?

MR BEASLEY: Either about the swabs or about her view that this is influenza.

MS RESSLER: I don’t recall having a telephone discussion with Dr Ilse about her 30

view that it was influenza A. That was probably just taken from the emails

exchanged.

MR BEASLEY: Okay.

35

MS RESSLER: And I don’t remember discussing that with Dr Sheppeard or Dr

Ferson.

MR BEASLEY: I must have either misheard you or misinterpreted something you

said. When you said, Dr von Watzdorf’s view was that she thought this was 40

influenza or fairly convinced that it was an influenza outbreak, was that your

assumptions based on the email advices you were receiving? Or was that based, in

part, on any telephone discussion you had with her?

MS RESSLER: It could have also been a telephone discussion. 45

MR BEASLEY: Right.



MS RESSLER: But I can’t recall - - -


MS RESSLER: - - - what was said on the telephone discussion. But that view was 5

taken, also, because of the information on the log.

MR BEASLEY: Yes. All right. But what I was asking you was whether you have

any recollection of passing onto either Professor Ferson, Dr Sheppeard – excuse me

– or anyone on the Expert Health Panel that had to make a determination here, words 10

to the effect, “The ship doctor considers it’s likely it’s flu or influenza”?


MR BEASLEY: All right. Outside of – so you – you – sent this plan email to 15

Professor Ferson and Dr Sheppeard. Did you have any telephone discussion with

them about the contents of this email?

MS RESSLER: Not a telephone discussion. But I – we were in the same office. I

could have had a discussion with them about it. 20

MR BEASLEY: Not – well you just said, “Not a telephone,” so that means you

could have had, like, a face-to-face discussion?

MS RESSLER: Yes. 25


MS RESSLER: I could have.

30

MR BEASLEY: Do you recall one of those? I apologise.


MR BEASLEY: You can’t recall. Okay. 35

MS RESSLER: I can’t recall. It’s – it’s a little unusual that I put a plan down like

that. I didn’t do that for most ships. So it’s possible that I took the information I had

from all of the phone conversations and the WhatsApp messages and everything I

had and had a conversation with – probably Dr Sheppeard – about a plan - - - 40

MR BEASLEY: Yes.

MS RESSLER: - - - and then put it in an email.

45

MR BEASLEY: Yes.



MS RESSLER: But I may not have. It was very busy and it’s also quite possible

that I just threw my thoughts onto an email.

MR BEASLEY: Sure. Okay. And ultimately, in the end, it’s – the ultimate

decision or determination is not yours – correct? 5


MR BEASLEY: All right. Professor Ferson, I think, responds first and we’re going

behind tab 15 now, with an email that he sends at 1 pm on the 18th of March. And 10

this is to Dr Tobin, I think it’s Professor Forssman and Dr Hess, they are the other

people that are on the panel to determine risk for the Ruby Princess for 19 March,

correct?


MR BEASLEY: And he has copied Dr Sheppeard in and he has copied Ms Quinn

in. I can’t see a note – I can’t see any reference to you in that – did you get this

email?

20

MS RESSLER: So the Public Health Unit Cruise Ship Surveillance email is

monitored by me.

MR BEASLEY: Okay. All right. So you would have seen it that way?

25

MS RESSLER: Yes.

MR BEASLEY: Can you tell me who Sinead Hansen is?

MS RESSLER: Sinead. 30

MR BEASLEY: Sinead, I’m sorry.

MS RESSLER: Sinead is another EHO who was helping - - -

35

MR BEASLEY: All right. I - - -

MS RESSLER: - - - with some of the risk assessments.

MR BEASLEY: - - - apologise - - - 40

MS RESSLER: That’s okay.

MR BEASLEY: - - - to them for the way I’ve butchered their Christian name. Toni

Cains, have I said that correctly? 45

MS RESSLER: Yes.



MR BEASLEY: And their position is?

MS RESSLER: Senior Environmental Health Officer at the Public Health Unit.

MR BEASLEY: Right. And Leena Gupta? 5

MS RESSLER: She’s the Director of the Sydney Public Health Unit.

MR BEASLEY: Why are these people copied in, as well?

10

MS RESSLER: So Leena was on the panel when she could be, or she deferred it to

Isabel.

MR BEASLEY: I see.

15

MS RESSLER: And the environmental health officers were assisting with the risk

assessment process.

MR BEASLEY: When you say assisting – that’s why I’m asking you this.

Assisting with the risk assessment process, are the people that are cc’d in, is there an 20

expectation that they make a contribution to the decision making?

MS RESSLER: No.

MR BEASLEY: Why are they cc’d in again then? 25

MS RESSLER: So that we know that it has been sent and a decision will be coming

soon. Toni Cains and Sinead had come on board on the 8th. And so if a probably

low decision isn’t taken, they’re likely to be having to be ready to come on board the

next day. 30

MR BEASLEY: All right. So – obviously this is Professor Ferson’s email, so the

main person to ask him about it is him, but he tells - - -

MS RESSLER: Yes. 35

MR BEASLEY: - - - the recipients of the email that he’s expressing the opinion that

the Ruby Princess is probably low, but higher rate of acute respiratory illness, but

none are travellers. But ILI, less than 1 per cent and flu A pos. That’ the

information that’s conveyed in that email? 40

MS RESSLER: Yes.

MR BEASLEY: And one difficulty in relation to that information that we’ve

already discussed as a flaw is that, had Professor Ferson been given the latest version 45

of the log when this decision is made, those words “But ILI less than 1 per cent”

would not be there?




MR BEASLEY: Yes.

COMMISSIONER: Did you – have you ever discussed with Professor Ferson what 5

the expression “but higher rate of ARI” means? Higher than what? For – but my

first question – sorry, my only question is have you discussed that with - - -

MS RESSLER: No.

10


MR BEASLEY: At the back of the – now, on the last page of the – firstly, I want to

check that I’m right. The last page, the pre-arrival risk assessment form, contains

information about the two medical disembarkations? 15

MS RESSLER: Yes.

MR BEASLEY: That was part of the information that went to the expert health

panel as well. 20

MS RESSLER: Yes.

MR BEASLEY: Was it just a matter of course that medical disembarkations were

notified to the health panel or was it the fact that febrile upper respiratory tract 25

infections were involved?

MS RESSLER: The panel usually asked us – so in the beginning when we did the

risk assessments, we may just put a number unrelated to respiratory, but the panel

generally asked us what they were. So as time went on, we included the information. 30

So it’s not necessarily because respiratory infection is there, but in anticipation of the

questions.

MR BEASLEY: All right. Do you recall any discussion with anyone on the Health

Assessment Panel about the fact that two passengers were being medically 35

disembarked that had fevers, upper-respiratory tract infection and had tested negative

to influenza?

MS RESSLER: I don’t recall. But what I do recall is – I don’t know if it was said

or I just thought it, but the way this medical disembarkation information is provided 40

- - -

MR BEASLEY: Yes.

MS RESSLER: - - - led us to believe that they weren’t being transferred because of 45

their respiratory illness, but because of other health issues.



MR BEASLEY: And that – did you read that information - - -

MS RESSLER: Yes.

MR BEASLEY: - - - when it – and it actually – I think you’re getting to the point 5

which I was going to take you to. It actually nominates a reason for the medical

disembarkation - - -

MS RESSLER: Yes.

10

MR BEASLEY: - - - which is unrelated in both cases to the febrile upper-

respiratory tract infection and points to another reason why this particular – these two

particular passengers need medical disembarkation?


MR BEASLEY: Right. So one being a heart issue and the other being a nerve

compression.

MS RESSLER: Yes. 20

MR BEASLEY: And that – did that – do you recall that giving you any comfort that

these people aren’t so unwell with the febrile upper respiratory tract infection they

need an ambulance transfer because of that?

25

MS RESSLER: Yes. And as a – and – and particularly because it also says they’re

improving on .....

COMMISSIONER: Is that both of them?

30

MS RESSLER: Well, actually only one does say that.

MR BEASLEY: Yes.

MS RESSLER: Yes. 35

MR BEASLEY: Although both have tested negative for influenza, which, despite

the somewhat his and miss nature of those tests raises the - - -

MS RESSLER: Yes. 40

MR BEASLEY: - - - prospect that the cause of the febrile upper respiratory tract

infection is something other than flu.

MS RESSLER: Yes. It does. 45

MR BEASLEY: Yes. All right. Okay.



MS RESSLER: That’s one possibility, yes.

MR BEASLEY: Behind tab 16, I think, what we’ve been provided with is the – and

tell me if there’s anything more than you’re aware of, are the email exchanges behind

tab 18 amongst the members of the Health Assessment Panel the complete record of 5

their – the written part of their decision making?

MS RESSLER: As far as I’m aware, yes.

MR BEASLEY: Yes. And – and did you have any phone conversations with 10

anyone on the Health Assessment Panel concerning any of these emails where the

other members are agreeing that it’s low risk for Ruby Princess?

MS RESSLER: I don’t believe so, no.

15

MR BEASLEY: Did anyone on this Health Assessment Panel ask you for your

view behind you having suggested an email, “How about this for a plan?”

MS RESSLER: No. I wasn’t asked.

20

MR BEASLEY: All right. Did they ask you for you or anyone else that you know

of in the health unit for more information?

MS RESSLER: I don’t think so.

25

MR BEASLEY: All right. And you’re not aware that they had any phone

discussions?

MS RESSLER: I’m not aware, no.

30

MR BEASLEY: Or are you possibly aware that they did not have the phone

discussions?

MS RESSLER: I am not aware of that possibility.

35

MR BEASLEY: Right. All right. Okay.

COMMISSIONER: Could I just ask about some timing, please?

MS RESSLER: Sure. 40

COMMISSIONER: Your plan email went out at 12.25 pm on 18 March?

MS RESSLER: Yes.

45

COMMISSIONER: Don’t do that from memory. Tab 14. Yes.



MS RESSLER: Yes. We have – yes, tab 14.

COMMISSIONER: One way of reading the documents is that whether it was by

way of response or not. After that, at 1 pm on 18 March, Professor Ferson made his

response that we find at tab 15; is that right? 5

MS RESSLER: Yes.

COMMISSIONER: But if I go into tab 16 and three pages in, how should I read –

well, what’s the relevance of the subject being described as Sea Princess? It’s one of 10

the three ships being assessed; is that right?

MS RESSLER: Yes, I think so.

COMMISSIONER: I’m finding it difficult to understand the relevance then of what 15

I see as the email from Professor Ferson of 17 March at 3.21, 17 March at 3.22 and

Professor Tobin, 17 March 3.38. They’ve got nothing to do with it, I take it, have

they? They’re all just Sea Princess, are they?

MS RESSLER: I think so. 20


MS RESSLER: That is confusing.

25

COMMISSIONER: Yes. It probably isn’t. I just wanted to make sure that - - -

MR BEASLEY: Yes. I think you’re right, Commissioner.

COMMISSIONER: - - - I’m not missing something. 30

MR BEASLEY: I think those first ones are Sea Princess. Yes.

COMMISSIONER: They’ve got nothing to do with it?

35

MS RESSLER: Yes.

COMMISSIONER: Well, I’m not asking for any extension of terms of reference,

believe me. I’m not interested in the Sea Princess.

40

MR BEASLEY: Is the manner in which the health panel conveys its final decision,

was that just done through this chain of emails or is there a final email that says

“Kelly,” or whoever, “This is low risk?” Or is that it?

MS RESSLER: In the beginning, there was. The risk assessment would be changed 45

from draft into final.



MR BEASLEY: Right.

MS RESSLER: And the documentation of the decision made included on the end.

Things just got so busy that that stopped.

5

MR BEASLEY: I see. So it may well be that there’s actually – that the entire

decision-making process is encapsulated by these emails without some other

document created, ticked low risk or whatever it is.

MS RESSLER: Yes. 10

MR BEASLEY: Or some summary of thinking or - - -

MS RESSLER: But if I was unclear if everyone had decided, I would always check

with Dr Shepherd or Dr Ferson that it was okay for me to give the response to the 15

ship.

MR BEASLEY: All right. After the final – after the emails are all in, where there’s

agreement low risk, did you have – did you feel as though you had sufficient

information to understand, “This is low risk. I don’t need any clarification. We’re 20

not going on board. I can now tell the ship that?”

MS RESSLER: No, not for this one in particular, because I was still waiting on

instruction in regard to who was enforcing the home – home isolation.

25

COMMISSIONER: So when you say enforcing, you mean informing?

MS RESSLER: Informing.

COMMISSIONER: That’s all right. 30

MS RESSLER: Yes. I mean informing.

MR BEASLEY: That’s all right.

35

MS RESSLER: And I also wasn’t sure that a decision had been made in regard to

the people who were being tested.

MR BEASLEY: I see. Of the - - -

40

COMMISSIONER: Yes. I just want to ask one thing. This may be obvious. This

panel is simply a procedure adopted by people talking to each other within the public

health unit. Is that right? It doesn’t come from a statute. It’s just an arrangement

among people?

45

MS RESSLER: Yes. I’m not sure how it was arranged.



COMMISSIONER: Did you have an understanding that they formally are to be

understood as helping the chief human biosecurity officer make a decision?

MS RESSLER: Yes.

5

COMMISSIONER: And did you understand that was Professor Tobin?

MS RESSLER: I did, yes.

COMMISSIONER: And did you understand that among other things, the decision 10

would involve what would be required in order that the ship be granted pratique? If

you don’t understand that - - -

MS RESSLER: No. I understand that. I understood that pratique would not be

granted until the risk assessment process had been completed from New South Wales 15

health, yes.

COMMISSIONER: I’m not going to administer a law exam, it’s all right, but I want

to find out your understanding. Have you had any training or instruction in the way

in which the control of maritime arrivals and disembarkations by the thing – by the 20

concept called pratique was effected by a combination of Commonwealth and State

decision making?

MS RESSLER: I had no formal training, no.

25

COMMISSIONER: Is that still true as we speak today?



MS RESSLER: I had training in using the Maritime Arrivals Reporting System.


35

MR BEASLEY: If you go to tab 18, you will see an email that you’ve sent to Sarah

Marshall at about 4.38 pm on 18 March. Ms Marshall is the operations manager of

the Sydney Port Authority. You know who she is?

MS RESSLER: Yes, I do. 40

MR BEASLEY: And I don’t need to take you through the whole details, but she

had been someone generally in communication with you since the Ruby Princess had

been in Sydney on 8 March, seeking to make sure that if there was illness on board a

ship and in particular, if New South Wales Health were going to board a ship, that 45

she was informed and informed of the reasons?



MS RESSLER: Yes.

MR BEASLEY: Yes. This email is sent at 4.38 where you’ve said to her:

The ship has been assessed at low risk. 5

MS RESSLER: Yes.

MR BEASLEY:

10

So we won’t be there.

As a matter of obviousness, at least by 4.38 pm, you were aware that that decision

had been made.

15

MS RESSLER: Yes.

MR BEASLEY: Again I just want to ask; was it conveyed in any way to you other

than through the email chain we’ve already gone through? Did you, for example,

speak to anyone on the Health Assessment Panel and say, “I’ve got to get back to a 20

query from Sarah Marshall of Sydney Ports and I want to be able to tell her what the

determination is.”

MS RESSLER: I didn’t say that specifically, but it is possible that I had a

conversation with Professor Ferson about the decision. 25


COMMISSIONER: What about the statement:

30

The ship does have elevated numbers of respiratory disease.

MS RESSLER: Yes.

COMMISSIONER: Is that your own individual assessment or are you there passing 35

on - - -

MS RESSLER: No, this is mine.

COMMISSIONER: - - - the observation of someone else. 40

MS RESSLER: This is just my assessment.

COMMISSIONER: Right. Assessment – what numbers are they?

45

MS RESSLER: The 104?



COMMISSIONER: You thought that was relevant?

MS RESSLER: I thought it was elevated, yes.

COMMISSIONER: You thought it was relevant? 5

MS RESSLER: Relevant? Yes. It was considered that there was elevated levels of

respiratory illness on board. Most of those with ILI were positive for flu. So that

was relevant, yes. We thought they were flu A. I thought they were flu A.

10

COMMISSIONER: Not the whole 104?

MS RESSLER: No.

MR BEASLEY: You then tell Ms Marshall that there has been some testing done 15

for COVID in Wellington that was negative, but they will be sending 15 samples for

testing to your lab just to be cautious.


20

MR BEASLEY: What did you mean by “just to be cautious?”

MS RESSLER: The panel decided to go ahead and test the specimens.

MR BEASLEY: Is that exercising caution? 25

MS RESSLER: Yes. It was not part of a low risk assessment?

COMMISSIONER: Why not?

30

MS RESSLER: I don’t know, Commissioner. I would have liked to have tested - - -

COMMISSIONER: A low risk - - -

MS RESSLER: - - - all of the samples that were collected over – over the time, but 35

that was the protocol.

COMMISSIONER: Yes. A low risk of a lethal outcome normally calls for some

kind of response unless it’s unreasonably expensive, wouldn’t it?

40

MS RESSLER: I didn’t make that decision, Commissioner.

COMMISSIONER: True, but would you, as a public health professional, you would

agree with that as a general approach, wouldn’t you?

45

MS RESSLER: Yes. I would have liked to have tested all of the specimens that

were collected from all the cruise ships.



COMMISSIONER: If you could straightforwardly take a precaution which is not

unreasonably expensive, in order to guard against or reduce the incidence of death, it

would be a public health instinct to do so; isn’t that right?

MS RESSLER: It is. However, the testing criteria at the time, that was being used 5

in hospitals, was not to do that. And it wasn’t my decision, the testing criteria in

New South Wales and - - -

COMMISSIONER: No, no, no. I think I speak for Mr Beasley here. Neither of our

questions about this are intended to be a criticism of you in terms of policy. But we 10

are trying to understand what you mean “just to be cautious.”

MS RESSLER: It was above and beyond the actions that we needed to take for a

low risk assessment ship.

15

COMMISSIONER: You had no role in the decision making as to what would be

tested; is that correct?

MS RESSLER: No. I had no role.

20

COMMISSIONER: That’s why there won’t be a criticism of you in relation to it,

you see. Thank you.

MR BEASLEY: Later, very soon after on the afternoon of 18 March behind tab 19

of your statement now, you’ve emailed Dr von Watzdorf and other people on the 25

ship and involved with Carnival off the ship at 5.07 pm that the panel has assessed

the Ruby Princess is not requiring on board health assessment, but telling them you

want the 15 samples for COVID testing and sending a lab result and telling them that

they’re free to disembark and about self-isolation and providing some information

about that. 30

MS RESSLER: Mmm.

MR BEASLEY: Was this the only means by which you conveyed to Dr Watzdorf,

“We’re not going to be boarding the ship.” Did you have a phone conversation first 35

or you did it by this email?

MS RESSLER: I did it by this email. There might have been a WhatsApp message

after but I didn’t have a phone conversation with her.

40

MR BEASLEY: All right. Now, coming to the – I want to ask you some questions

about the actual testing of the COVID swabs in a minute but given you’ve raised

WhatsApp.

MS RESSLER: Yes. 45



MR BEASLEY: You discovered that when the swabs came off the ship, that

someone was being swabbed wasn’t on the log.

MS RESSLER: Yes.

5

MR BEASLEY: And that prompted you to go back to Dr von Watzdorf and say –

raise that as a query?

MS RESSLER: Yes.

10


MS RESSLER: Yes.

MR BEASLEY: And you end up the following day, that is, the 20th, with a new 15

log?


MR BEASLEY: Correct? And I don’t want to go through the new log with you, but 20

you understand there’s more passengers and crew listed on that log for 20 March that

have been noted as having symptoms of either acute respiratory illness or influenza-

like illness?

MS RESSLER: Yes. 25

MR BEASLEY: And without asking you to do the maths, let’s assume that the ILI

rate has gone at least above 1.3 per cent - - -

MS RESSLER: Yes. 30

MR BEASLEY: - - - on that log.

COMMISSIONER: And is that – does that, as you understand it, arise from the

addition of passengers who left on the 19th, or is it only from crew who stayed on the 35

ship?

MR BEASLEY: No, no. This is an updated log for - - -

COMMISSIONER: No, I know. I’m just asking the - - - 40

MS RESSLER: The people – the additional people on that log were people who

presented after 9.38 - - -

COMMISSIONER: On the 18th. 45

MS RESSLER: - - - on the 18th.



COMMISSIONER: Quite. So - - -

MS RESSLER: Most of them were on the 18th.

COMMISSIONER: So that we’re not talking about an increase as at the 20th - - - 5

MS RESSLER: No.

COMMISSIONER: - - - of, say, crew members staying on the ship being wholly the

explanation for the increase over the 1 per cent. We’re talking about passengers - - - 10

MS RESSLER: Yes.

COMMISSIONER: - - - who, on the 20th, were reported as having had, by the 19th,

a condition which, had it been notified earlier, would have exceeded the 1 per cent 15

threshold.

MS RESSLER: Yes.

MR BEASLEY: I think these are – there’s actually – there’s a mix of crew and 20

passengers, but we’re talking about people reporting with these symptoms, whether

it’s acute respiratory disease or influenza-like illness, prior to disembarkation.

Correct?

MS RESSLER: That’s correct. Yes. 25

MR BEASLEY: I don’ want to ask you a question about what you think the Health

Assessment Panel would have done, but I do want to ask you about your email to

them, suggesting a plan of a way forward. Had you had available to you at the time

you sent your email to the Assessment Panel on the midmorning of 18 March, had 30

you known that the figures, for example, for ILI were about – just over 1.3 per cent

at least, and the figures for the acute respiratory disease were increased as well,

would you have sent that – still sent that email, or would you have suggested

something different to what you did, I’m sorry, the date is – the time is 12.25 pm.

Would you have suggested something different? 35

MS RESSLER: Yes.

COMMISSIONER: Something different, I take it?

40

MS RESSLER: Yes.

MR BEASLEY: And what would that have been?

MS RESSLER: An onboard risk assessment. 45

MS RESSLER: All right.



COMMISSIONER: Is that more or less in accordance with high risk or more or less

in accordance with medium risk?

MS RESSLER: With medium risk.

5

COMMISSIONER: Thank you. So would people have been leaving before test

results came back or not?

MS RESSLER: So if we had have applied the same procedure that was taken on 8

March, we would have conducted the assessment. We would have worked out who 10

fit our criteria for testing. We then would have allowed everybody to disembark.

We possibly would have kept those people on board until the results were received,

yes.


MS RESSLER: But others would have been allowed to disembark, yes.

COMMISSIONER: Could I – I note the time.

20

MR BEASLEY: I only have - - -

COMMISSIONER: Could I just take you back to - - -

MR BEASLEY: - - - a couple more questions. 25

COMMISSIONER: - - - tab 19, please?

MS RESSLER: I’m in 19, yes.

30

COMMISSIONER: Tab 19. Your notification to the relevant Ruby Princess

people, of the decision, following the assessment by the expert panel, it doesn’t say

anything there about people understood to be leaving the ship to go to the airport to

get on a plane to go somewhere else, awaiting the outcome of COVID testing.

35

MS RESSLER: No.

COMMISSIONER: Can you explain that to me?

MS RESSLER: I know that in my original plan I had recommended that people 40

who were being tested not fly.

COMMISSIONER: Until the results were there.

MS RESSLER: Until the results were received. 45

COMMISSIONER: Yes.



MS RESSLER: But I can’t find anywhere that I followed that up or communicated

that on. And so I can only tell you, Commissioner, that it was likely an oversight on

such a busy day, and I can’t remember if that decision was – and I don’t know if that

decision was discussed with the expert panel.

5

COMMISSIONER: But that – isn’t that something you had raised with them?

MS RESSLER: Yes, I had. But I can’t find anything after that.

COMMISSIONER: What I’m suggesting is if – why wouldn’t I find then that that 10

was a matter of their responsibility? I’m not asking you to blame people. I don’t

want to make you feel more awkward than you are, but - - -

MS RESSLER: Yes.

15

COMMISSIONER: - - - that’s a suggestion you had raised with them, as you

understand it.

MS RESSLER: Yes.

20


MR BEASLEY: I just want to ask you a few more questions. I’ve nearly completed

- - -

25

MS RESSLER: Okay.

MR BEASLEY: - - - the examination. I just want to ask you – I want to go back to

the WhatsApp log behind tab 2 and ask you some questions about that. If you go to

the – if you’ve got the same order I have, if you go three pages in. 30

MS RESSLER: Yes.

MR BEASLEY: At the top there’s some exchanges on 20 March about you asking:

35

Do you have the updated ARI log? Some of the later people swabbed aren’t on

the one I have.

MS RESSLER: Yes.

40

MR BEASLEY: And Dr von Watzdorf says:

I’ll send it now. Sorry, I forgot. The last one was from the morning. It was so

crazy.

45

Just dropping down, you then are discussing the fact that swabs have now been tested

and some people have got positive swabs.



MS RESSLER: Yes.

MR BEASLEY: In about the middle of the page there’s this exchange from Dr von

Watzdorf:

5

I know – although I keep asking myself what I could have done better to

protect people –

You respond:

10

Yeah, there will be a – there will be more cases, probably a lot.

MS RESSLER: Yes.

MR BEASLEY: What was your thinking there? What do you mean by that? 15

MS RESSLER: Because I knew that coronavirus on a cruise ship is a big problem.

It’s very infectious and it - - -

COMMISSIONER: Well, don’t you mean contagious? 20

MS RESSLER: Contagious, infectious.

MR BEASLEY: Transmissible.

25

MS RESSLER: Transmissible. Sorry.

MR BEASLEY: Was the thought you were conveying there “we now know that

there were people that had COVID-19 on this ship”.

30

MS RESSLER: Yes.

MR BEASLEY: “It’s likely that there’s going to be significant spread”. Is that the

fear you were expressing there?

35

MS RESSLER: That was my fear, yes. Absolutely.

MR BEASLEY: Because it’s relatively without - - -

MS RESSLER: Because we know what it does on a cruise ship. 40

MR BEASLEY: Because it can be transmitted with relatively – relative ease

through the air and through touching things and whatnot.

MS RESSLER: Yes. And because we knew from the Diamond Princess that you 45

don’t have a lot of success controlling the infection on a cruise ship.



MR BEASLEY: Sure. I want to finish by just asking you some questions about

your statement, and I want you to feel free to actually look at the statement and

because it’s – there’s just something that’s confused me from about paragraph 88

onwards. And this is you telling the Commissioner about the actual testing of these

COVID swabs. You say in 88 you understand the swabs were collected from the 5

ship for testing at around 3 am on 19 March. You then move on to say you went to

work the next day. You had a look at the laboratory logs and found that these swabs

hadn’t been logged into the system.

MS RESSLER: Yes. 10

MR BEASLEY: Then at 4 pm the testing from a 10 am run, that is, testing – if – I

take it that means if swabs get to the lab by 10 am, you should have the results by 4

pm?

15


MR BEASLEY: And you logged back into the system, and the swab still hadn’t

been logged in - - -

20

MS RESSLER: Yes.

MR BEASLEY: - - - and so hadn’t been tested. So you then phone the lab who

located the swabs and advised they would put them on the next run. My question –

and it’s clearly obviously not critical of you – but why was it that these swabs didn’t 25

get tested in a – the fastest manner possible. What happened in the lab?

MS RESSLER: I don’t know, Mr Beasley.

MR BEASLEY: This was crucial, wasn’t it, to get this done quickly? 30

MS RESSLER: There was a lot of samples being submitted to the lab and I - - -

MR BEASLEY: I’m not suggesting there wasn’t.

35

COMMISSIONER: Maybe so, but not all that many from ships that were about to

disembark passengers; is that right?


40

COMMISSIONER: Were you aware of any other set of circumstances more time-

urgent for the testing of swabs than from the Ruby Princess that day in Sydney.

MS RESSLER: .....

45

COMMISSIONER: Were you?



MS RESSLER: No. There was a lot of testing that day. There - - -

COMMISSIONER: I’ve no doubt.

MS RESSLER: Yeah. 5

COMMISSIONER: Have you heard in any of the discussions between you and your

colleagues since then of anything which was more urgent that morning in terms of

timely testing of swabs than swabs from a ship from which many people were about

to disembark? 10

MS RESSLER: My understanding is that the technician didn’t realise that they were

cruise ship samples and so they were just put into the queue as per normal. They

weren’t tested as priority. Having said that, this was a low-risk ship, and I hadn’t

escalated for the specimens to be tested as a priority. 15

COMMISSIONER: There was a means, was there, of escalating by saying, “I really

need to have this back urgently”?

MS RESSLER: No. Cruise ship samples should have been tested urgently - - - 20

MR BEASLEY: You wouldn’t have been – you wouldn’t have been - - - - - -

MS RESSLER: But I did do that.

25

MR BEASLEY: - - - checking the log at the time you did unless you expected

they’d be there; correct?

MS RESSLER: I did expect they’d be there, yes.

30

MR BEASLEY: Yes. Were they labelled, where they were from?

MS RESSLER: Yes.

COMMISSIONER: So if it said Ruby Princess, you couldn’t really mistake that for 35

anything other than a cruise ship, could you?

MS RESSLER: Commissioner, this is not my mistake.

COMMISSIONER: I know that, and that’s why you’re not being criticised. 40

MR BEASLEY: No, no. We’re – I thought I said - - -

MS RESSLER: And I - - -

45

COMMISSIONER: We’re trying to find out what happened.



MS RESSLER: - - - also didn’t press the lab as to what happened. I - - -

COMMISSIONER: I’m not inviting you to - - -

MS RESSLER: Okay. 5

COMMISSIONER: - - - be so critical of yourself, let me tell you. I’m just trying to

find out what the system was. If it’s labelled Ruby Princess, I’m asking myself and I

would like you to help me to answer this question - - -

10

MS RESSLER: Sure.

COMMISSIONER: - - - how could you think that was anything other than a cruise

ship?

15

MS FURNESS: Well, Commissioner, this witness is not the lab.

COMMISSIONER: No, no, no. I understand that but - - -

MS RESSLER: I – Commissioner, possibly – and I’m just making guesses that they 20

– the lab had put on a whole lot of new people to try and cope with the demand and

perhaps they hadn’t been given that information. I don’t know, but that’s possible.

There was a lot of search stuff coming into the public health unit. There was a lot of

training needs that we had to do, and I assume that was happening in the lab as well.

25

COMMISSIONER: And the sample remains labelled with its origin throughout its

attendance at the lab, does it, so far as you know?

MS RESSLER: So far as I know, it’s – yeah. I’m not sure about the labelling of

each sampling. 30

COMMISSIONER: Do you remember who it was you spoke to that you refer to in

paragraph 91 as the laboratory who located the swabs?

MS RESSLER: I don’t remember who I spoke to, not with enough confidence to 35

say.


MR BEASLEY: Was any further explanation offered that’s not in your statement 40

about why they hadn’t been tested yet?

MS RESSLER: I had a conversation with Professor Rawlinson at the lab in regard

to – I actually don’t think it was the Ruby Princess; I think it was a different ship –

and he had realised that somebody who logged a specimen for a cruise ship hadn’t 45

recognised it as being a cruise ship specimen, and he said that should not have



happened, but I don’t think that was the Ruby Princess. I think that conversation was

a different ship.

MR BEASLEY: Right.

5

COMMISSIONER: Before or after the Ruby Princess?

MS RESSLER: After.


MR BEASLEY: I don’t intend to take that any further. And I – no, I don’t have any

further questions for the witness, Commissioner.

COMMISSIONER: Is there any application to question this witness? 15

MR McLURE: Commissioner, I may wish to ask some questions of Ms Ressler. I

was wondering if that is going to be done, if that could be done on Friday if that’s

convenient. Between now and then I’ll of course consider whether that’s necessary.

20

COMMISSIONER: Well, I would like this witness’s experience to be over sooner

rather than later - - -

MR McLURE: Of course.

25

COMMISSIONER: - - - for her. I appreciate that you didn’t get the material till this

morning, and this is not said by way of threat but by way of reality – you still have to

get leave from me to ask anything.

MR McLURE: Of course. 30

COMMISSIONER: First of all, I’d like the witness to be excused now if I may.

You can step down now.

MS RESSLER: Thank you. 35

COMMISSIONER: But you may be required to come back, and you’ll be told

about that very soon.

MS RESSLER: Okay. 40

<THE WITNESS WITHDREW [4.24 pm]

45

COMMISSIONER: Mr McLure, I understand this is provisional and I won’t hold

you to this, but it will help me in my thinking about timing: can you indicate what



your tentative thought are at the moment about the topics that you would want leave

to question about?

MR McLURE: Well, one area is some evidence was given about numerous

interactions between Ms Ressler and Dr von Watzdorf. 5

COMMISSIONER: Yes.

MR McLURE: I’d like to take instructions from my - - -

10

COMMISSIONER: Yes.

MR McLURE: - - - clients about that.

COMMISSIONER: Yes. Right. Thank you. Yes. 15

MR McLURE: Secondly, there was some evidence about provision of testing kits

- - -

COMMISSIONER: Yes, the swabs. Yes. Yes. 20

MR McLURE: - - - I may wish – swabs, yes. I’d like to ask – may wish to ask

some questions about that.


MR McLURE: There were some others. I’ve made a lot of notes as the day’s been

going on, but there at least two.

COMMISSIONER: And are you in a position, given physical locations globally, to 30

get instructions overnight?

MR McLURE: The difficulty is I believe Dr von Watzdorf is still on the ship - - -

COMMISSIONER: Yes, that’s why I asked. Yes. 35

MR McLURE: - - - so there may be some challenges there. But I doubt very much

I’d be in a position to – well, we’re not sitting tomorrow, as I understand it.

COMMISSIONER: We’re sitting tomorrow not Thursday. 40

MR McLURE: I’m sorry. I very much doubt that I’d be in a position to tell you

about that first thing tomorrow morning.

COMMISSIONER: Well, could I urge as much dispatch on you and those assisting 45

you and instructing you in that regard. I’d like to return to this topic not first of all

tomorrow but at some stage, a convenient stage tomorrow, because I would very



much like this witness to be informed as soon as possible whether she’s required to

return. Now, Ms Furness, what about from your point of view? Is there an

application?

MS FURNESS: It depends somewhat on my friend’s ultimate application, the 5

topics and, Commissioner, your ruling.

COMMISSIONER: Yes. Yes. Yes, it does. Yes. Very well. Well, we’ll leave

that provisional as well. I hope – I know both of you will anxiously consider the

interests of the witness in that regard. 10

MS FURNESS: I most certainly will, Commissioner.

COMMISSIONER: Yes. And I’d be obliged, Ms Furness, if you could explain to

the witness that we are not able to give her certainty about that now, but we will as 15

soon as possible.

MS FURNESS: Yes, Commissioner.

MR BEASLEY: Just one further thing before we adjourn, Commissioner, is I think 20

I passed on to Mr McLure that Ms Tokovic has a problem on Friday - - -

COMMISSIONER: Yes.

MR BEASLEY: - - - and so we said she could be first tomorrow. 25

COMMISSIONER: Yes.

MR BEASLEY: That won’t change but Mr Kirby and I will consider this witness

list in light of the fact that Ms Ressler took all day - - - 30

COMMISSIONER: Yes. Yes.

MR BEASLEY: - - - and hopefully be able to break it up into people only required

Friday. 35

COMMISSIONER: Good. Thank you. I’m obliged. We’ll adjourn until 9.30

tomorrow morning. Thank you.

MR BEASLEY: Thank you. 40

MATTER ADJOURNED at 4.27 pm UNTIL WEDNESDAY, 6 MAY 2020



Index of Witness Events

KELLY-ANNE RESSLER, AFFIRMED P-295

EXAMINATION BY MR BEASLEY P-295

THE WITNESS WITHDREW P-449

Index of Exhibits and MFIs

MFI #3 STATEMENT OF KELLY-ANNE RESSLER WITH


P-297

EXHIBIT #16 STATEMENT OF KELLY-ANNE RESSLER WITH


P-298

TRANSCRIPT OF PROCEEDINGS · 5/5/2020 · TRANSCRIPT OF PROCEEDINGS O/N H-1193679 MR B. WALKER SC,...

Documents

Transcript of TRANSCRIPT OF PROCEEDINGS · 5/5/2020 · TRANSCRIPT OF PROCEEDINGS O/N H-1193679 MR B. WALKER SC,...