tag:theconversation.com,2011:/ca/topics/quarantine-11847/articlesQuarantine – The Conversation2023-04-18T20:01:07Ztag:theconversation.com,2011:article/2015692023-04-18T20:01:07Z2023-04-18T20:01:07ZDiseases gave us the rise of Christianity, the end of the Aztecs and public sanitation. How might future plagues change human history?<figure><img src="https://images.theconversation.com/files/517613/original/file-20230327-27-ualse4.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C4439%2C3183&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Elena Mozhvilo/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>“Every once in a while a book lands on your desk that changes the way you perceive the world you live in, a book that fundamentally challenges your understanding of human history.” So began the blurb that came with this book. Aha! I thought. The usual advertising hyperbole, a gross exaggeration. </p>
<p>Yet <a href="https://www.penguin.com.au/books/pathogenesis-9781911709053">Pathogenesis</a> <em>did</em> challenge much of my understanding of world history. Who knew that if it wasn’t for an Ebola-like pandemic in the 2nd century CE, Christianity would never have become a world religion? Or that if it weren’t for retroviruses, women would be laying eggs rather than having live births? (According to the book’s author, a retrovirus inserted DNA into our ancestor’s genome that caused the placenta to develop.)</p>
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<p><em>Book review: Pathogenesis: How germs made history – by Jonathan Kennedy (Torva)</em></p>
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<p>However, this is not another book of Amazing Facts: it is a work of scholarship, with nearly 700 references and notes. At the same time, it is very readable, and even amusing at times. </p>
<p>Many books have been written about the impact of disease on civilisation. I have even written my own modest <a href="https://medium.com/@adrian.esterman/infectious-diseases-and-their-impact-on-civilisation-4eb8ac72cc5b">essay</a> on the topic. However,
Pathogenesis delves deeply into the social history of the world. </p>
<p>Jonathan Kennedy has a PhD in sociology from the University of Cambridge, and his sociological bent comes through strongly. In eight chapters, and some 350 pages, Kennedy takes us on a whirlwind tour of social history, describing how infectious diseases have shaped humanity at every stage. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/viruses-are-both-the-villains-and-heroes-of-life-as-we-know-it-169131">Viruses are both the villains and heroes of life as we know it</a>
</strong>
</em>
</p>
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<h2>‘It’s a bacterial world’</h2>
<p>Kennedy starts by describing the three great branches of living organisms, <a href="https://theconversation.com/from-peaceful-coexistence-to-potential-peril-the-bacteria-that-live-in-and-on-us-104110">bacteria</a>, <a href="https://microbiologysociety.org/why-microbiology-matters/what-is-microbiology/archaea.html">archaea</a>, and <a href="https://www.britannica.com/science/eukaryote">eukaryotes</a> – it is the latter that contains all complex life forms, including humans. However, fewer than 0.001% of all species are eukaryotes. </p>
<p>Bacteria, on the other hand, are the dominant life form on this planet. As Kennedy puts it, “it’s a bacterial world, and we’re just squatting here”. </p>
<p>Our own species, <em><a href="https://theconversation.com/rethinking-homo-sapiens-the-story-of-our-origins-gets-dizzyingly-complicated-99760">Homo sapiens</a></em>, arose some 315,000 years ago, living for the most part in Africa. At the same time, human species such as Neanderthals and <a href="https://theconversation.com/dna-from-elusive-human-relatives-the-denisovans-has-left-a-curious-mark-on-modern-people-in-new-guinea-196113">Denisovans</a> spread out into Europe. However, about 50,000 years ago, <em>Homo sapiens</em> burst out of Africa and spread across the world, while all other human species simply vanished. There are many <a href="https://www.scientificamerican.com/article/how-homo-sapiens-became-the-ultimate-invasive-species/">theories</a> as to why and how this occurred – for example, perhaps <em>Homo sapiens</em> were just smarter. </p>
<p>However, Kennedy proposes his own theory. Because <em>Homo sapiens</em> lived primarily in Africa, they were exposed to many pathogens, and eventually acquired genetic changes that gave them some protection. The exodus out of Africa exposed other species to these pathogens, causing their demise. </p>
<p>He describes the <a href="https://theconversation.com/who-were-the-mysterious-neolithic-people-that-enabled-the-rise-of-ancient-egypt-heres-what-weve-learned-on-our-digs-121070">Neolithic</a> revolution, which took place about 12,000 years ago and which saw the change from hunter-gatherers to farmers. Because of their nomadic existence in small groups, hunter-gatherers tended to be relatively healthy, with an average lifespan of 72 - better than the average lifespan in some countries today! </p>
<p>It has always been assumed that this revolution was a good thing, bringing better nutrition and more leisure time. However, in Kennedy’s view, the Neolithic revolution led to the emergence of despotism, inequality, poverty and backbreaking work. He describes how settlement and the farming of domestic animals led to the emergence of zoonotic diseases – that is, <a href="https://theconversation.com/preventing-future-pandemics-starts-with-recognizing-links-between-human-and-animal-health-167617">diseases spread by animals</a>. </p>
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<a href="https://images.theconversation.com/files/517617/original/file-20230327-24-pz4erz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/517617/original/file-20230327-24-pz4erz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517617/original/file-20230327-24-pz4erz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517617/original/file-20230327-24-pz4erz.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517617/original/file-20230327-24-pz4erz.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517617/original/file-20230327-24-pz4erz.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517617/original/file-20230327-24-pz4erz.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517617/original/file-20230327-24-pz4erz.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Settlement and the farming of domestic animals led to the emergence of diseases spread by animals.</span>
<span class="attribution"><span class="source">kallerna/Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/disease-evolution-our-long-history-of-fighting-viruses-54569">Disease evolution: our long history of fighting viruses</a>
</strong>
</em>
</p>
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<h2>Plagues and social upheavals</h2>
<p>In a chapter on ancient plagues, Kennedy quotes from Monty Python’s <a href="https://theconversation.com/life-of-brian-at-40-an-assertion-of-individual-freedom-that-still-resonates-114743">The Life of Brian</a>: </p>
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<p>All right, but apart from the sanitation, the medicine, education, wine, public order, irrigation, roads, a fresh water system, and public health, what have the Romans ever done for us?</p>
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<p>He points out that Roman cities were, in fact, “filthy, stinking and disease-ridden”, and goes on to describe the great plagues <a href="https://theconversation.com/how-3-prior-pandemics-triggered-massive-societal-shifts-146467">that weakened the Roman Empire</a>. The first was the Antonine Plague, possibly caused by smallpox. This was followed some 70 years later by the Plague of Cyprian from AD 249-262, which led to the splitting of the Roman Empire and the rise of Christianity. </p>
<p>Kennedy completes this chapter with a description of the Plague of Justinian, caused by bubonic plague. The massive deaths caused by this epidemic led to the demise of the Roman Empire, and the Muslim conquest of the Middle East. </p>
<p>In the period 1346–53, the <a href="https://theconversation.com/did-the-black-death-give-birth-to-modern-plagues-3820">Black Death</a> tore through North Africa and Europe, killing an <a href="https://en.wikipedia.org/wiki/Black_Death">estimated</a> 75 million to 200 million people. Kennedy describes the devastation and huge social upheavals that resulted from this pandemic. Until then, the Roman Catholic Church dominated society. But:</p>
<blockquote>
<p>During the Black Death and subsequent plague outbreaks, people looked to the Church for comfort. All too often they didn’t find it. </p>
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<span class="caption">The Black Death killed an estimated 75–200 million people in Europe and North Africa. Hugo Simberg Black Death.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>This led to the rise of Protestantism, aided by the invention of the printing press - a shortage of labour encouraged the development of such labour-saving devices. Over the next 200 years, waves of plague repeatedly hit Europe. A quarantine system was developed in Venice, and <em>cordon sanitaires</em> established, to prevent movement of people between cities - ring any bells? </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-the-black-death-give-birth-to-modern-plagues-3820">Did the Black Death give birth to modern plagues?</a>
</strong>
</em>
</p>
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<h2>Pathogens as New World killers</h2>
<p>In the period from 1500 onwards, white colonialists nearly wiped out indigenous people by infecting them. Kennedy starts with the early 16th century, when Spanish conquistador Hernán Cortés led an expedition to Mexico. His arrival <a href="https://theconversation.com/how-smallpox-devastated-the-aztecs-and-helped-spain-conquer-an-american-civilization-500-years-ago-111579">introduced smallpox</a>, which resulted in the total destruction of the Aztec Empire within just two years. However, this was just the start. </p>
<p>In the early 1530s, Mexico was hit by an epidemic of <a href="https://theconversation.com/measles-new-efforts-needed-to-stop-an-old-disease-13706">measles</a> that killed 80% of its population, making it the deadliest epidemic in recorded history. Over the following decades, across the whole of the Americas, the introduction of infectious diseases from Europe resulted in a 90% fall in the population. </p>
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<a href="https://images.theconversation.com/files/517624/original/file-20230327-15-s0x2ks.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/517624/original/file-20230327-15-s0x2ks.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517624/original/file-20230327-15-s0x2ks.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517624/original/file-20230327-15-s0x2ks.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517624/original/file-20230327-15-s0x2ks.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517624/original/file-20230327-15-s0x2ks.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=554&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517624/original/file-20230327-15-s0x2ks.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=554&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517624/original/file-20230327-15-s0x2ks.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=554&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Hernán Cortés brought smallpox to Mexico, resulting in the total destruction of the Aztec Empire within two years, as illustrated in this 16th-century drawing of Aztec smallpox victims.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
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<p>However, during this period, it wasn’t just the New World that was profoundly affected by pathogens. On the west coast of Africa, explorers and would-be colonialists died in droves from <a href="https://theconversation.com/worlds-first-mass-malaria-vaccine-rollout-could-prevent-thousands-of-children-dying-169457">malaria</a> and <a href="https://theconversation.com/zika-dengue-yellow-fever-what-are-flaviviruses-53969">yellow fever</a>. </p>
<p>Interestingly, Kennedy starts his chapter on revolutionary plagues with the murder of <a href="https://theconversation.com/george-floyd-deserved-a-better-life-a-new-book-charts-his-trajectory-from-poverty-to-the-us-prison-industrial-complex-and-the-impact-of-his-death-182947">George Floyd</a> and the <a href="https://theconversation.com/the-black-lives-matter-movement-has-provoked-a-cultural-reckoning-about-how-black-stories-are-told-149544">Black Lives Matter</a> movement, before delving deep into the history of slavery. He describes slavery in Greek and Roman times, and the booming trade in slaves in the medieval Mediterranean. </p>
<p>The association between black Africans and <a href="https://theconversation.com/slavery-is-not-a-crime-in-almost-half-the-countries-of-the-world-new-research-115596">slavery</a> only began in the 15th century. In fact, only 3% of the 12.5 million humans trafficked across the Atlantic ended up in the United States. The most common destinations of the slave ships were the European colonies in the Caribbean, where African slave labour was first used more than a century before their shipment to North America. </p>
<p>Meanwhile, in the Caribbean, slave labour from tropical West Africa toiled on sugar plantations owned by the English, Spanish, French and Dutch. Yellow fever carried by mosquitoes wiped out many of the Europeans, including military garrisons, leading to slave revolts.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-a-slave-state-how-blackbirding-in-colonial-australia-created-a-legacy-of-racism-187782">Friday essay: a slave state - how blackbirding in colonial Australia created a legacy of racism</a>
</strong>
</em>
</p>
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<h2>Diseases ‘thrived’ in Dickensian habitats</h2>
<p>When Kennedy switches his focus to Britain, and the industrial revolution, he describes it as the change from a Thomas Hardy novel to one by <a href="https://theconversation.com/great-expectations-by-charles-dickens-class-prejudices-the-convict-stain-and-a-corpse-bride-159816">Charles Dickens</a>. The crowded and unsanitary conditions in working-class urban districts created new habitats, in which pathogens thrived. </p>
<p>Kennedy again evokes Monty Python to invoke the scenery of those days, reminding readers of the famous four Yorkshiremen sketch. The scene made me think of a different quote from the same sketch:</p>
<blockquote>
<p>You were lucky to have a house! We used to live in one room, all hundred and twenty-six of us, no furniture. Half the floor was missing; we were all huddled together in one corner for fear of falling!</p>
</blockquote>
<p>Every Epidemiology 101 course covers the story of <a href="https://www.newscientist.com/people/john-snow/">John Snow</a> (no – not the “Winter is coming” one!). <a href="https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section2.html">Two decades</a> before the development of the microscope, Snow examined cholera outbreaks to discover the cause of disease and how to prevent it. </p>
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<span class="caption">John Snow proved in 1854 that cholera is a waterborne disease: a London pub is named for him.</span>
<span class="attribution"><a class="source" href="https://www.geograph.org.uk/profile/6699">ceridwen/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>During the third UK cholera outbreak in 1854, Snow famously removed London’s Broad Street water pump, to demonstrate that cholera was a waterborne disease. For those interested, there is a <a href="https://londonspubswherehistoryreallyhappened.wordpress.com/2019/03/05/john-snow/">John Snow</a> pub in London. Kennedy, of course, includes this story in his book.</p>
<p>Kennedy points out that 3.5 billion people – half of the world’s population – have no access to proper toilets, while a billion don’t have clean drinking water and 1.5 million people, mainly children, die every year from waterborne diarrhoeal diseases. </p>
<p>We still have massive <a href="https://theconversation.com/explainer-why-cholera-remains-a-public-health-threat-74444">cholera outbreaks</a>, especially in areas where normal life has been disrupted by war or natural disasters. <a href="https://theconversation.com/tuberculosis-kills-as-many-people-each-year-as-covid-19-its-time-we-found-a-better-vaccine-151590">Tuberculosis</a> still kills 1.2 million people a year, despite the availability of antibiotics. Malaria kills another 600,000. </p>
<p>Finally in this section, he briefly covers <a href="https://theconversation.com/covid-hospitalisations-and-deaths-are-rising-faster-than-cases-but-that-doesnt-mean-more-severe-disease-187163">COVID</a>. He points out that not everyone in the world benefited from the medical advances that came about because of COVID, and the self-interested actions of high-income countries have deprived the poorer countries. As he puts it, “pathogens thrive on inequality and injustice”. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fleas-to-flu-to-coronavirus-how-death-ships-spread-disease-through-the-ages-137061">Fleas to flu to coronavirus: how 'death ships' spread disease through the ages</a>
</strong>
</em>
</p>
<hr>
<h2>Future plagues</h2>
<p>Kennedy concludes by looking at future plagues. He points out humanity’s precarious position: we live on a planet dominated by bacteria and viruses. He believes our best chance of surviving the threat posed by pathogens will come from working collaboratively and reducing inequality both within and between countries. </p>
<p>Based on its title, I assumed this book would be about the role of pathogens in shaping civilisation. Instead, I found a social history of the world, with the odd foray into diseases and their influence on society. Nonetheless, I thoroughly enjoyed the book, and can highly recommend it to those with an interest in history, sociology and epidemiology.</p><img src="https://counter.theconversation.com/content/201569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrian Esterman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This whirlwind tour of social history describes how infectious diseases have shaped humanity at every stage. It suggests reducing inequality will give us our best chance of surviving future plagues.Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1774262022-03-04T13:20:14Z2022-03-04T13:20:14ZClarifying the CDC’s COVID-19 quarantine and isolation guidelines – an infectious disease doc looks at the latest research<figure><img src="https://images.theconversation.com/files/448147/original/file-20220223-19-100j9b3.jpg?ixlib=rb-1.1.0&rect=85%2C0%2C5090%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The CDC's new recommendations have caused consternation among the public, the media and even among doctors.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-woman-with-mask-looking-through-window-royalty-free-image/1215755299?adppopup=true">Justin Paget/DigitalVision via Getty Images</a></span></figcaption></figure><p>In December 2021, the U.S. Centers for Disease Control and Prevention updated its guidelines for <a href="https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html">how long people should isolate</a> following a COVID-19 infection. The agency shortened the isolation from 10 days to five, followed by five days of wearing a mask for those no longer symptomatic. </p>
<p>The change came during the height of the <a href="https://theconversation.com/will-omicron-the-new-coronavirus-variant-of-concern-be-more-contagious-than-delta-a-virus-evolution-expert-explains-what-researchers-know-and-what-they-dont-169020">omicron variant’s surge</a> and <a href="https://www.cnn.com/2022/01/03/us/omicron-variant-covid-local-impacts/index.html">related staffing shortages</a> at hospitals, schools and businesses. Some critics suspected that the move was <a href="https://www.pbs.org/newshour/health/new-cdc-isolation-quarantine-guidelines-confuses-some-and-raises-questions">more practically motivated than science-based</a> to allow workers, especially health care and other essential personnel, to return to their jobs quicker.</p>
<p>As a result, I thought it useful to review the data behind the latest recommendations to help people think through best practices.</p>
<p><a href="https://med.virginia.edu/pathology/contact/william-a-petri-jr-m-d-ph-d/">I’m an infectious diseases specialist</a> at the University of Virginia. I take care of patients hospitalized with COVID-19 and conduct research on how the immune system responds to infection. </p>
<h2>The CDC’s current strategy</h2>
<p>First, <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html?">let’s make a distinction</a> between <a href="https://www.hhs.gov/answers/public-health-and-safety/what-is-the-difference-between-isolation-and-quarantine/index.html">the terms “isolation” and “quarantine.”</a> During the pandemic, people have often used them interchangeably. But isolation is meant to separate infected people from those who aren’t, whereas quarantine separates those who were exposed to COVID-19 but have not yet tested positive or are not symptomatic. </p>
<p>That said: If you are infected with COVID-19, the CDC’s latest guidelines have cut your isolation period by half, to five days from the onset of symptoms, or the first positive test if you do not have symptoms. After five days, as long as you are getting better, the CDC says you no longer need to isolate but should mask around others for five more days. </p>
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<figcaption><span class="caption">Why the CDC changed its COVID-19 quarantine restrictions.</span></figcaption>
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<p>If you are exposed to COVID-19 and have not had your booster shot, the CDC recommends that you quarantine for five days following exposure. Between days five to seven, you should be tested, and if the test is negative, you can end the quarantine. Consider yourself exposed if you are within 6 feet of an infected person for 15 minutes or more over a 24-hour period. And the CDC says if you are vaccinated and boosted, you don’t need to quarantine at all after an exposure to COVID-19 – though you should get tested five days later and mask for at least 10 days after exposure.</p>
<p>Regardless of vaccination status, the CDC recommends that you take a <a href="https://theconversation.com/over-the-counter-rapid-antigen-tests-can-help-slow-the-spread-of-covid-19-heres-how-to-use-them-effectively-166869">rapid antigen test</a> or a <a href="https://theconversation.com/whats-the-difference-between-a-pcr-and-antigen-covid-19-test-a-molecular-biologist-explains-170917">PCR test</a> five to seven days after exposure to confirm that you did not acquire COVID-19 prior to leaving quarantine.</p>
<h2>New studies support these CDC recommendations</h2>
<p>What is the evidence behind these recommendations? Although researchers are still learning about omicron – as the CDC says, “<a href="https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine-isolation-background.html">the science is evolving</a>” – some reports suggest its symptoms appear more rapidly after exposure when compared with the <a href="https://theconversation.com/delta-variant-makes-it-even-more-important-to-get-a-covid-19-vaccine-even-if-youve-already-had-the-coronavirus-164203">delta variant</a>. That includes the results of four small studies from Nebraska, Norway, Japan and the National Basketball Association in the U.S. </p>
<p>In Nebraska, a family of six was exposed at the same time to the omicron variant of SARS-CoV-2, the virus that causes COVID-19. Symptoms of infection appeared within <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm705152e3.htm">one to three days of exposure</a>, which is one to two days faster than the delta variant. This finding supports the CDC recommendations. In Norway, approximately 100 guests were exposed to omicron at a Christmas party; most got COVID-19, with symptoms appearing and <a href="https://doi.org/10.2807/1560-7917.ES.2021.26.50.2101147">infections detected within two to five days</a> after exposure, again earlier than would have been expected for delta. </p>
<p>In Japan, a study of 21 people infected with omicron found that the amount of virus was highest three to six days <a href="https://www.niid.go.jp/niid/en/2019-ncov-e/10884-covid19-66-en.html">after diagnosis or symptom onset</a>. And a study from the NBA COVID-19 surveillance system discovered that a person with omicron was <a href="https://dash.harvard.edu/handle/1/37370587">typically no longer infectious by day five</a>. </p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-youresmart">You can read us daily by subscribing to our newsletter</a>.]</p>
<p>Taken together, these studies suggest that most people who were infected with the omicron variant or who had an exposure no longer transmitted the virus by day five.</p>
<p>These four studies illustrate the reasoning behind the CDC’s shortening of its isolation and quarantine recommendations to five days. By that point post-infection, the vast majority of people aren’t going to spread the virus to others, so it makes sense that they can get back to their normal routines.</p>
<h2>The follow-up test is critical if you were exposed and in quarantine</h2>
<p>But remember the caveat: Without a rapid antigen or PCR test five to seven days after the beginning of quarantine, transmission rates of COVID-19 <a href="https://doi.org/10.1101/2022.01.13.22269257">might only be reduced by half</a>.</p>
<p>That’s why both the CDC and the World Health Organization <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-Contact-tracing-and-quarantine-Omicron-variant-2022.1">are recommending the follow-up tests</a> within five to seven days of the start of quarantine.</p>
<p>Mathematical models demonstrate that <a href="http://dx.doi.org/10.1136/bmjopen-2021-050473">either rapid antigen or PCR testing</a> allows for <a href="http://dx.doi.org/10.1136/bmjopen-2021-050473">shortening of quarantine time</a> without compromising public safety.</p>
<p>And one footnote: As of early March 2022, nearly 57% of Americans who are fully vaccinated <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total">have not received the booster</a>. That means tens of millions of Americans have yet to take this extra step to more fully protect themselves from this virus.</p><img src="https://counter.theconversation.com/content/177426/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Petri receives funding from the NIH and the Gates Foundation.</span></em></p>The CDC’s controversial recommendation changes are based on new studies showing that most omicron transmission takes place within five days of the onset of illness.William Petri, Professor of Medicine, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1766162022-02-17T13:58:04Z2022-02-17T13:58:04ZCOVID-19 self-testing: it’s time developing countries took the leap<figure><img src="https://images.theconversation.com/files/445655/original/file-20220210-19-xve0n8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID self-testing is widespread in developed countries. </span> <span class="attribution"><span class="source">George Frey/Getty Images</span></span></figcaption></figure><p>Laboratory testing plays a critical role for diagnosis of COVID-19. It’s the cornerstone of the global public health response, informing control measures and preventing transmission of SARS-CoV-2. </p>
<p>The basis of infectious disease testing depends on the pathophysiology of the infection and the disease that it causes, the clinical course as well as the host immune response. </p>
<p>There are two types of tests for acute SARS-CoV-2 infection whether it is symptomatic or asymptomatic: COVID-19 PCR and antigen tests also called “lateral flow tests”. Both detect viral components, but differ in design and complexity. </p>
<p>COVID-19 antigen tests are a game-changer, even at this stage of the pandemic when the world is no longer hoping to achieve containment of SARS-CoV-2 but rather looking at mitigating strategies to prevent infection in those who face the biggest threat from the virus. </p>
<p>Antigen tests are cheap and quick. They can help identify infected individuals and interrupt viral transmission by quarantining infected individuals immediately. In South Africa the proportion of COVID-19 antigen tests compared to PCR remains low. In <a href="https://www.nicd.ac.za/wp-content/uploads/2022/01/COVID-19-Testing-Summary-Week-3-2022.pdf">week 3</a> of January 191,510 COVID-19 tests were done. Only 22.8% of these were antigen tests. None of these tests were done by individuals – this <a href="https://www.groundup.org.za/article/covid-19-it-time-allow-home-testing/">isn’t allowed</a> under the country’s regulations. </p>
<p>It is difficult to discern why countries in Africa have not taken up COVID-19 antigen testing. Access and price don’t seem to be the issue. The <a href="https://africacdc.org/news-item/new-guidance-to-expand-rapid-antigen-testing-for-covid-19-response-in-Africa-released/">Africa Centres for Disease Control</a> has even published clear guidelines on how to use them. But there is a lingering mistrust in test quality that has limited their use. </p>
<p>It is true that there are concerns about <a href="https://www.who.int/publications/i/item/antigen-detection-in-the-diagnosis-of-sars-cov-2infection-using-rapid-immunoassays">self-testing</a>. But, in my view, the benefits are substantial. Individuals are able to access cheaper and faster tests. This, in turn, helps limit exposure to those at risk of infection. Public health specialists in developing countries are putting <a href="https://t.co/1OWMfQWFY2">pressure</a> on authorities for greater use of antigen tests – particularly for self-testing to be allowed. </p>
<h2>The two tests</h2>
<p>COVID-19 <a href="https://link.springer.com/article/10.1007/s10096-020-03913-9">PCR tests</a> amplify viral gene targets and are very sensitive. Over 1000 commercial ones are now <a href="https://www.theglobalfund.org/media/9629/covid19_diagnosticproducts_list_en.pdf">available</a>. They are able to detect viral components slightly before symptoms start in infected individuals and many weeks after infection – even when there is no longer any risk of transmissibility. </p>
<p>The COVID-19 PCR tests have their drawbacks. For example, measures have been put in place – such as hospital admissions and travel bans – on the basis of positive results even though this hasn’t been strictly necessary. </p>
<p>COVID-19 PCR test performance depends on several factors. These include design, the clinical characteristics of the patient, timing of the sample, sample type and transport conditions and laboratory techniques. They are also expensive, technically difficult, require specialised staff and reagents, specimen transport and processing.</p>
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Read more:
<a href="https://theconversation.com/antibody-tests-arent-a-covid-19-panacea-but-theyre-a-useful-additional-tool-142516">Antibody tests aren't a COVID-19 panacea. But they're a useful additional tool</a>
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<p>For their part, COVID-19 antigen tests are immunoassay rapid diagnostic tests that have different viral antigenic targets and designs. </p>
<p>Rapid diagnostic tests are used extensively for the diagnosis of other respiratory infectious diseases like influenza in clinics, community settings and home-based self-testing. Most use a nitrocellulose membrane embedded in a plastic cassette which contains two lines. The one is a control line to inform that the test is working and the second is a detection line to indicate the presence of the virus. The reaction is based on coloured labels (nanoparticles) that change colour when they encounter the target.</p>
<p>COVID-19 antigen tests perform better when there is a high viral load and in patients that are symptomatic. They are usually positive from 5 and up to 12 days after onset of symptoms. They correlate with competent <a href="https://journals.asm.org/doi/10.1128/JCM.00469-21">viral replication</a> and thus transmission potential. </p>
<h2>Self-testing</h2>
<p>Self-testing with COVID-19 antigen tests was first <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-covid-19-test-self-testing-home">authorised</a> by the US Food and Drug Administration in November 2020 to allow symptomatic people and those that had COVID-19 contacts to test themselves. </p>
<p>By 2021 antigen tests and <a href="https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/public-health/high-quality-covid-19-testing_en">self testing</a> was firmly entrenched in most <a href="https://www.healthdirect.gov.au/blog/what-are-covid-19-rapid-antigen-tests">developed countries</a>. Their widespread use for self-testing has sparked a range of <a href="https://www.nature.com/articles/d41586-021-00332-4">debates</a>. They hinge on three issues: </p>
<p><strong>Is the test sensitive enough?</strong> </p>
<p>A test’s sensitivity is its ability to identify the infection if it is present and also not to miss infections. Sensitivity depends on the test design which in turn impacts its level of detection. Antigen tests differ in sensitivities. Some are excellent compared to PCR tests. </p>
<p><strong>Is the sample adequate?</strong> </p>
<p>Simplifying the sample type to include saliva – which is an easier and more standardised sample to access – has increasingly been the direction of <a href="https://www.medrxiv.org/content/10.1101/2021.02.17.21251863v1">most COVID-19 antigen tests</a>. </p>
<p><strong>Is the test result easy to read and interpret?</strong> </p>
<p>Reading a rapid COVID-19 antigen test visually may sometimes be difficult. Sometimes faint lines appear in the detection window and it is difficult to work out if the test is positive or negative.</p>
<p>Interpretation is also critical. This is particularly true with negative results. These may not definitively exclude infection. A retest may then be necessary. </p>
<p>In addition, interpreting the result correctly is complex even if clear instructions are provided.</p>
<p>In a large US <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2788656">study</a> on self-testing showed that 1 in 3 individuals misinterpreted their COVID-19 antigen result. The study found that clarity of the information given to the patients doing the self-testing via a variety of different formats was extremely important to a good test outcome. </p>
<p>Individuals in the study drew false reassurance from a negative results. </p>
<p>A recent study also showed that trained <a href="https://www.medrxiv.org/content/10.1101/2021.01.13.21249563v2.full.pdf">laboratory personnel</a> do the tests better than individuals. </p>
<h2>What next?</h2>
<p>It’s clear that there are a number of caveats to self-testing with antigen tests.</p>
<p>However, on balance, I still believe that they should be allowed more widely in countries like South Africa.</p>
<p>One reason is that the failure to authorise the tests is driving a thriving <a href="https://www.businesslive.co.za/fm/features/2022-02-03-why-covid-home-tests-remain-illegal-in-sa/">black market</a> in them. Many are of unknown quality. </p>
<p>Secondly, if used widely they could help control transmission risks as more people would know their status. </p>
<p>However, governments need to issue national guidelines and provide appropriate instructions.</p><img src="https://counter.theconversation.com/content/176616/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eftyhia Vardas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One of the consequences of the failure of developing countries like South Africa to authorise self-testing is that it is driving a thriving black market.Eftyhia Vardas, Clinical specialist Virology, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1728322021-11-29T19:31:31Z2021-11-29T19:31:31ZOmicron: Senior Nigerian scientist considers fallout, and why travel bans are a waste of time<figure><img src="https://images.theconversation.com/files/434530/original/file-20211129-13-copt6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nigeria's President Buhari at the 2021 Intra-African Trade Fair in Durban, South Africa. </span> <span class="attribution"><span class="source">Darren Stewart/Gallo Images via Getty Images</span></span></figcaption></figure><p><em>Nigeria recently received <a href="https://www.gov.za/speeches/our-nation-west-africa-29-nov-2021-0000">President Cyril Ramaphosa</a>, who led a delegation made up of government and business representatives, in the midst of the possible spread of the new COVID <a href="https://theconversation.com/omicron-is-the-new-covid-kid-on-the-block-five-steps-to-avoid-ten-to-take-immediately-172739">Omicron variant</a> and a rash of global <a href="https://edition.cnn.com/world/live-news/covid-variant-omicron-11-29-21/index.html">travel restrictions</a>. In Nigeria concerns were <a href="https://punchng.com/ramaphosa-visit-omicron-virologists-differ-as-fg-lists-delegates-for-testing-on-day-two/">raised</a> about the visit contributing to the spread of the new variant. Adejuwon Soyinka, The Conversation Africa’s regional editor for West Africa, asked Dr. Doyin Odubanjo, a leading public health expert, what he thinks of travel bans and of Nigeria’s handling of COVID so far.</em> </p>
<p><strong>What is your view of travel bans?</strong></p>
<p>I understand the intention. But I think they have very limited effectiveness at this point. We have passed the early days of the pandemic and the disease has established itself with community transmission in each country. In this context travel bans have little value. </p>
<p>Also, by the time a variant is detected and announced, it has probably already spread to many unidentifiable countries. Shutting borders now will probably only cause greater socioeconomic damage rather than limit the spread of the disease.</p>
<p>The current spate of travel bans is rather hasty and irrational given that we know that the variant is in <a href="https://www.reuters.com/world/new-coronavirus-variant-omicron-keeps-spreading-australia-detects-cases-2021-11-28/">several countries</a> already and there is no clear linkage between them yet.</p>
<p>The announcement by South Africa was that <a href="https://theconversation.com/the-hunt-for-coronavirus-variants-how-the-new-one-was-found-and-what-we-know-so-far-172692">of detection</a> and not in any way a proof of origin. There’s still a great deal that’s not known. It’s still not clear where this variant originated. Or how infection from it differs from previous variants, or whether vaccines will be effective against it.</p>
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Read more:
<a href="https://theconversation.com/omicron-is-the-new-covid-kid-on-the-block-five-steps-to-avoid-ten-to-take-immediately-172739">Omicron is the new COVID kid on the block: five steps to avoid, ten to take immediately</a>
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<p>Also, there is <a href="https://www.bbc.co.uk/news/uk-59442141">no proof</a> that the Omicron variant has caused any significant damage or deaths anywhere. Virtually all detected <a href="https://www.bbc.com/news/uk-59453744;%20https://www.reuters.com/world/new-coronavirus-variant-omicron-keeps-spreading-australia-detects-cases-2021-11-28/">cases</a> so far are in people who seemed otherwise well. If anything, Europe is the region having a <a href="https://www.euronews.com/2021/11/27/germany-reported-first-suspected-case-of-omicron-covid-19-variant">rather surprising rise</a> in cases (despite the relatively higher vaccination rate, compared to Africa). </p>
<p><strong>Nigeria has set down conditions for travellers coming in. Are they sufficient?</strong></p>
<p>The <a href="https://www.dfa.ie/travel/travel-advice/a-z-list-of-countries/nigeria/">Nigerian guidelines</a> for incoming travellers are focused on detecting COVID with PCR tests (especially within 72 hours before travel and on the second day of arrival) and the use of non-pharmaceutical interventions. Unvaccinated passengers will also need to isolate for seven days as well as do additional PCR test at the end of the isolation period. </p>
<p>Travellers are expected to self-isolate till they receive a negative test result. It is good if it is implemented efficiently. </p>
<p><strong>Is the Nigerian government doing enough to protect its citizens from the pandemic?</strong></p>
<p>There seems to be fatigue everywhere and many things are no longer functioning as they used to. </p>
<p>Take testing at government facilities. This has reduced significantly and much of what is happening now depends on people paying for tests at private laboratories. The government was providing free testing across the country but much of that has stopped. So, many patients will not be able to afford the tests now.</p>
<p>People are also tired of complying with the non-pharmaceutical measures such as wearing face masks, handwashing and distancing. Instead they are now more concerned about making a living, more so with the <a href="https://theconversation.com/nigerias-food-inflation-losers-winners-and-a-possible-solution-172313">fast-rising inflation</a>. </p>
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Read more:
<a href="https://theconversation.com/nigeria-needs-to-address-incessant-strikes-by-doctors-it-cant-afford-not-to-168777">Nigeria needs to address incessant strikes by doctors. It can't afford not to</a>
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<p>Lastly, I think the government’s capacity to respond has been diminished because it’s lost credibility over time in relation to managing COVID. For example, in the way it has used resources, including human resources. Right in the midst of the pandemic, there have been <a href="https://www.premiumtimesng.com/news/headlines/419037-covid-19-nigerian-health-workers-lament-non-payment-of-allowances-after-closure-of-isolation-centres.html">strikes</a> by health workers because of non-payment of remuneration, including allowances meant to be for COVID response. </p>
<p><strong>What has Nigeria done right. And what has it done wrong?</strong></p>
<p>At the beginning of the outbreak Nigeria set up a management system that was fairly effective given the circumstances. There was a speedy development of testing capacity to detect the disease around the country. There was also engagement of the private sector to support the national and sub-national response, among other things.</p>
<p>But many things were wrong too. I will emphasise the failure to effectively engage the health workers and communities. Unfortunately, these are such critically important entities that the country was faced with an uphill task once we failed to engage them properly. The health workforce are the foot soldiers needed to combat the disease while, ultimately, controlling the disease is dependent on controlling human behaviour (in the communities). </p>
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Read more:
<a href="https://theconversation.com/how-the-private-sector-can-boost-covid-vaccination-in-nigeria-171758">How the private sector can boost COVID vaccination in Nigeria</a>
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<p><strong>Now what?</strong></p>
<p>Better late than never. It is time to engage the citizenry the right way and to use the right tools.</p>
<p>Get the scientists and community leaders to lead this effort, the right way. They can engage to disseminate information better as people have more trust in them than politicians.</p>
<p>Nigeria has to get to where people use the non-pharmaceutical measures readily and happily by communicating effectively with them. Instructions and enforcement come after clear information and answering the questions people may have. </p>
<p>And the government must be more effective with border control. I’m not referring to travel bans here. They must effectively test, quarantine and treat where necessary, and trace contacts. </p>
<p>They should also create an advantage for the vaccinated traveller. They could, for example, impose fewer testing requirements on those who have been vaccinated.</p>
<p>The most important thing is that the goal must be to limit the spread of disease – not entirely discourage travel.</p><img src="https://counter.theconversation.com/content/172832/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Doyin Odubanjo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The current spate of travel bans is rather hasty and irrational given that we know that the variant is in several countries already.Doyin Odubanjo, Executive Secretary, Nigerian Academy of ScienceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1723822021-11-23T02:12:48Z2021-11-23T02:12:48ZMorrison’s opening of the door to international students leaves many in the sector blindsided and scrambling to catch up<p>Fully vaccinated international students from around the world <a href="https://www.pm.gov.au/media/further-steps-reopen-australia-and-secure-our-economic-recovery">will be allowed</a> into Australia from next week, without needing to apply for a travel exemption. Prime Minister Scott Morrison made the announcement yesterday.</p>
<p>Although university bodies such as <a href="https://www.universitiesaustralia.edu.au/media-item/green-light-for-international-students/">Universities Australia</a> and the <a href="https://go8.edu.au/media-release-go8-welcomes-back-our-international-students">Group of Eight</a> welcomed the announcement, sources in the higher education sector have said they were blindsided by it and are now scrambling to update their plans.</p>
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<h2>States in confusion</h2>
<p>Prior to the prime minister’s announcement, only small numbers of students had been able to apply for a <a href="https://covid19.homeaffairs.gov.au/travel-restrictions">travel exemption</a> to enter the country. They included research students with Australian government funding, medical, dental, nursing or allied health students who would undertake work placements, and secondary school students in years 11 and 12.</p>
<p>This announcement is a major change from less than a month ago <a href="https://theconversation.com/why-the-international-education-crisis-will-linger-long-after-students-return-to-australia-170360">when it was still unclear</a> how and when the <a href="https://www.dese.gov.au/international-education/data-and-research/data-visualisations-set-2">over 145,000 international student visa holders</a> would be be able to enter Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-the-international-education-crisis-will-linger-long-after-students-return-to-australia-170360">Why the international education crisis will linger long after students return to Australia</a>
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<p>On October 15, New South Wales Premier <a href="https://www.theaustralian.com.au/higher-education/international-students-hopes-of-return-raised-then-dashed/news-story/d144674db9ebeab0e21c5d28d8de23ae">Dominic Perrottet announced</a> quarantine restrictions would be scrapped from November 1 for all fully vaccinated international arrivals to the state. But the <a href="https://www.theguardian.com/australia-news/2021/oct/15/nsw-to-end-all-quarantine-home-hotel-for-fully-vaccinated-international-arrivals-travel-travellers">prime minister slammed</a> the brakes on the NSW plan to open up to the world, saying:</p>
<blockquote>
<p>The federal government is not opening it up to anyone other than Australian residents and citizens and their immediate families.</p>
</blockquote>
<p>Such confusion put states in a difficult position. Before Morrison’s announcement yesterday, NSW and Victoria – the states hosting the most international students – both developed pilot programs to return international students. <a href="https://covid19.homeaffairs.gov.au/international-student-arrival-plans">The NSW plan</a> was to allow up to 250 international students studying with state education providers to return each fortnight from early December 2021. That figure would increase to 500 students per fortnight by the end of the year.</p>
<p><a href="https://www.coronavirus.vic.gov.au/international-student-arrivals-plan">Victoria’s proposal</a> would at first allow 120 currently enrolled students nominated by universities to enter the state each week. Numbers would be expanded to more students and other providers over time.</p>
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<p>Universities in both states had been working frantically to organise details such as prioritising students selected for the programs and chartered flights. The Commonwealth’s dropping of restrictions on international travel now seems to have superseded these pilot plans. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-government-keeps-shelving-plans-to-bring-international-students-back-to-australia-it-owes-them-an-explanation-158778">The government keeps shelving plans to bring international students back to Australia. It owes them an explanation</a>
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<p>This will probably mean the caps of 250 per fortnight in NSW and 120 per week for Victoria will no longer be in place.</p>
<p>The only aspects of the pilot programs in NSW and Victoria likely to remain could be the already organised chartered flights. These will slightly ease the burden on commercial airlines, which may need more time to ensure capacity. </p>
<p>The <a href="https://www.sydney.edu.au/covid-19/students/return-of-international-students.html">University of Sydney</a> has updated its information, saying:</p>
<blockquote>
<p>The […] pilot program will continue as planned, with the University providing a supported return program for current students who are eligible and choose to participate. The first charter flight of international students is due to arrive on 6 December 2021. Eligible students will be contacted directly as more flights are announced. </p>
</blockquote>
<p>However, most of the states’ universities have not yet updated their plans.</p>
<h2>Different rules for different states</h2>
<p>Both NSW and Victoria had already <a href="https://www.abc.net.au/news/2021-10-21/victoria-to-scrap-covid-19-quarantine-for-international-arrivals/100558560">scrapped their quarantine requirements</a> for fully vaccinated arrivals. But international students entering other states may still face a range of restrictions. In the case of <a href="https://www.mbanews.com.au/international-students-look-elsewhere-queensland-quarantine/">Queensland</a> this includes having to pay for a mandatory two-week stay in an isolated quarantine facility. </p>
<p>Entering Western Australia <a href="https://www.wa.gov.au/organisation/department-of-the-premier-and-cabinet/covid-19-coronavirus-travel-wa">may be impossible altogether</a>, given the state’s plan to ease border controls only once a 90% two-dose vaccination target is achieved.</p>
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<p>It’s also important to note international student pilot programs were restricted to universities, <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp2021/Quick_Guides/OverseasStudents">where only around half of all international students</a>`are enrolled. The latest announcement now means students in other kinds of international education, such as the vocational education and training sector and English language courses, can start arriving. </p>
<p>It’s unclear, however, what the announcement means for international school students, as those under 18 are less likely to be vaccinated.</p>
<p>Under the new arrangements to begin from December 1, <a href="https://www.pm.gov.au/media/further-steps-reopen-australia-and-secure-our-economic-recovery">travellers must</a>:</p>
<ul>
<li>depart from their home country</li>
<li>be fully vaccinated with a completed dosage of a vaccine approved or recognised by the TGA</li>
<li>hold a valid Australian visa</li>
<li>provide proof of their vaccination status</li>
<li>present a negative COVID-19 PCR test taken within three days of departure.</li>
</ul>
<p>Eligible visa holders include skilled and student cohorts, as well as humanitarian, working holidaymaker and provisional family visa holders.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/as-hopes-of-international-students-return-fade-closed-borders-could-cost-20bn-a-year-in-2022-half-the-sectors-value-159328">As hopes of international students' return fade, closed borders could cost $20bn a year in 2022 – half the sector's value</a>
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<p>School students are more likely to be interested in coming early in the next year anyway. But international tertiary students could be interested in arriving soon to work here over the summer, given Australia’s skill shortages in industries that commonly employ them – such as hospitality.</p>
<p>The big question now is how long it will take airlines to ramp up to full capacity. In pre-COVID times, this would have been a walk in the park. There were <a href="https://www.bitre.gov.au/publications/ongoing/international_airline_activity-time_series">21.3 million international arrivals</a> in Australia in 2019, or around 1.8 million inbound passengers per month.</p>
<p>In October, the <a href="https://www.iata.org/en/iata-repository/publications/economic-reports/airline-industry-economic-performance---october-2021---report/">International Air Transport Association estimated</a> international air travel is at only 40% of pre-COVID levels in 2021. It may take a long time to reach pre-COVID levels again, but at least we’re on our way.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/as-international-students-start-trickling-back-the-new-year-will-be-crunch-time-169529">As international students start trickling back, the new year will be crunch time</a>
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<img src="https://counter.theconversation.com/content/172382/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Ziguras is past President of the International Education Association of Australia and has had a role as the Association's Research Director.</span></em></p>The federal government has for months been unclear about when international students could return to Australia. And there are still many uncertainties about the latest announcement.Christopher Ziguras, Professor of Global Studies, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1699242021-10-21T12:45:18Z2021-10-21T12:45:18ZThe American founders didn’t believe your sacred freedom means you can do whatever you want – not even when it comes to vaccines and your own body<figure><img src="https://images.theconversation.com/files/427319/original/file-20211019-18-atnfa9.jpeg?ixlib=rb-1.1.0&rect=23%2C0%2C5298%2C3766&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protests against mandates and quarantines get the Founding Fathers' ideas wrong.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/small-group-of-approximately-50-people-hold-open-solvang-news-photo/1222462576?adppopup=true">George Rose/Getty Images</a></span></figcaption></figure><p>President <a href="https://www.nytimes.com/2021/09/09/us/politics/biden-mandates-vaccines.html">Joe Biden has mandated vaccines</a> for a large part of the American workforce, a requirement that has prompted <a href="https://www.bostonglobe.com/2021/10/14/metro/new-hampshire-protests-over-covid-mandates-roil-state-local-governments/">protest from those opposed to the measure</a>.</p>
<p>Meanwhile, a similar move in New York City to enforce vaccinations has resulted in more than <a href="https://nypost.com/2021/10/09/over-a-dozen-businesses-fined-for-flouting-nyc-vaccine-mandate/">a dozen businesses’ being fined for flouting the rules</a>.</p>
<p>The basic idea behind the objections: Such mandates, which also extend to requirements to wear masks and quarantine if exposed to COVID-19, are a breach of the Constitution’s <a href="https://www.law.cornell.edu/constitution/amendmentxiv">14th Amendment</a>, which states that “no state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States.” </p>
<p>The objectors ask: Aren’t mandates un-American?</p>
<p>As a scholar who has spent decades trying to unravel the hurdles that mark the beginning of this nation, I offer some facts in response to that question – a few very American facts: Vaccination mandates have <a href="https://www.governing.com/now/the-long-history-of-mandated-vaccines-in-the-united-states">existed in the past</a>, even though they have similarly <a href="https://www.nytimes.com/2021/09/09/us/politics/vaccine-mandates-history.html">sparked popular rage</a>. </p>
<p>No vaccination foe, no latter-day fan of the Gadsden Flag’s “<a href="https://theconversation.com/yellow-gadsden-flag-prominent-in-capitol-takeover-carries-a-long-and-shifting-history-145142">DONT TREAD ON ME</a>” message, would ever gain the posthumous approval of the American founders.</p>
<p>George Washington, John Adams, Thomas Jefferson, Alexander Hamilton and the rest of the group cultivated different visions about America. But they agreed on one principle: They were unrelenting on the notion that circumstances often emerge that require public officials to pass acts that abridge individual freedoms.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427287/original/file-20211019-19-2btmux.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A print of Gen. George Washington standing among his fellow Revolutionary War generals." src="https://images.theconversation.com/files/427287/original/file-20211019-19-2btmux.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427287/original/file-20211019-19-2btmux.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=421&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427287/original/file-20211019-19-2btmux.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=421&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427287/original/file-20211019-19-2btmux.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=421&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427287/original/file-20211019-19-2btmux.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=529&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427287/original/file-20211019-19-2btmux.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=529&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427287/original/file-20211019-19-2btmux.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=529&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Gen. George Washington, center, ordered smallpox inoculations for his soldiers, saying there was ‘no possible way of saving the lives of most of those who had not had it, but by introducing innoculation generally.’</span>
<span class="attribution"><a class="source" href="https://lccn.loc.gov/2006691571">Ritchie, Alexander Hay, engraver; Library of Congress Prints and Photographs Division</a></span>
</figcaption>
</figure>
<h2>Keen sense of civic duty</h2>
<p>Most of the founders, to begin with, were slave owners, not especially concerned about trampling over and <a href="https://constitution.congress.gov/constitution/amendment-1/">abridging</a> the rights of the persons they held in bondage. But even when they dealt with those they deemed to be their peers, American citizens, their attitude was rather authoritarian – at least by today’s standards.</p>
<p>In 1777, during the American Revolution, Washington had his officers and troops <a href="https://www.mountvernon.org/video/view/7O5xE5hMNkU?pid=PLr40fFkNNADFEgbM2t-CG0kGnHRDHZoje">inoculated against smallpox</a>. The procedure was <a href="https://www.monticello.org/site/research-and-collections/inoculation">risky</a>. But for Washington, the pros outweighed the cons. It was an order, an actual mandate, not an option that individuals could discuss and eventually decide. </p>
<p>“After every attempt to stop the progress of the small Pox,” Washington explained to the New York Convention, “I found, that it gained such head among the Southern Troops, that there was no possible way of saving the lives of most of those who had not had it, <a href="https://founders.archives.gov/?q=%22After%20every%20attempt%20to%20stop%20the%20progress%20of%20the%20small%20Pox%22&s=1111311111&sa=&r=1&sr=">but by introducing innoculation generally</a>.”</p>
<p>During the summer of 1793 an epidemic of yellow fever <a href="https://www.history.com/news/yellow-fever-outbreak-philadelphia">struck Philadelphia</a>, then the American capital. It shattered the city’s health and political infrastructure. Food supplies dwindled; business stopped. Government – federal, state and municipal – was suspended. Within just three months, 5,000 out of nearly 55,000 inhabitants died of the infection.</p>
<p>Public hysteria took off. Philadelphians at first pinned the outbreak on the arrival of refugees from the French colony of Saint-Domingue who were escaping that island’s <a href="https://www.britannica.com/topic/Haitian-Revolution">slave revolution</a>. </p>
<p>But there was also heroism. Black clergymen <a href="https://www.britannica.com/biography/Richard-Allen">Richard Allen</a> and <a href="https://en.wikipedia.org/wiki/Absalom_Jones">Absalom Jones</a>, for example, <a href="https://theconversation.com/how-philadelphias-black-churches-overcame-disease-depression-and-civil-strife-153374">tirelessly transported the sick, administered remedies and buried the dead</a>. </p>
<p><a href="https://www.pabook.libraries.psu.edu/literary-cultural-heritage-map-pa/feature-articles/philadelphia-under-siege-yellow-fever-1793">Urged on by Gov. Thomas Mifflin</a>, the Pennsylvania state Legislature imposed sweeping quarantines. And almost everyone complied. </p>
<p><a href="https://www.britannica.com/biography/Henry-Knox">Henry Knox, then the U.S. secretary of war</a>, didn’t object. Knox had fought during the Revolution. He had risked his life on many battles. He had developed a keen sense of what “civic duty” means: “I have yet six days quarantine to perform,” he wrote to President Washington, “which of the choice of evils <a href="https://founders.archives.gov/?q=%22I%20have%20yet%20six%20days%C2%A0quarantine%C2%A0to%20perform%22&s=1111311111&sa=&r=1&sr=">is the least</a>.”</p>
<h2>‘Without a flinch’</h2>
<p>The epidemic didn’t abate as quickly as expected. By September 1794 <a href="https://www.pbs.org/wgbh/americanexperience/features/fever-major-american-epidemics-of-yellow-fever/">the yellow fever lingered in Baltimore</a>, where it had spread from Philadelphia. In 1795 it reached New York City.</p>
<p>One John Coverdale, from Henderskelfe, Yorkshire, England, wrote President Washington a long letter. He advocated more drastic measures, including three weeks of quarantine and policemen strategically placed in every corner to hinder people from passing from zone to zone; and he wanted people “to carry with them <a href="https://founders.archives.gov/?q=%22certificates%20either%20of%20their%20coming%20from%20places%20not%20infected%22&s=1111311111&sa=&r=1&sr=">certificates</a> either of their coming from places not infected or of their passing the line by permission.”</p>
<p>In other words, a quarantine, lockdown and vaccine passports. </p>
<p>No politician we know of at the time considered such measures un-American. In May of 1796, Congress adopted, and President Washington signed, the <a href="https://archive.org/details/lawsofunitedstat03unit/page/314/mode/2up?view=theater">first federal quarantine law</a>. There wasn’t much controversy. In 1799, Congress passed a second and more restrictive <a href="https://www.loc.gov/resource/rbpe.22401000/?sp=1">quarantine law</a>. President Adams signed it without a flinch.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427271/original/file-20211019-19-a5pf9z.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A head-and-shoulders portrait of Alexander Hamilton." src="https://images.theconversation.com/files/427271/original/file-20211019-19-a5pf9z.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427271/original/file-20211019-19-a5pf9z.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=753&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427271/original/file-20211019-19-a5pf9z.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=753&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427271/original/file-20211019-19-a5pf9z.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=753&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427271/original/file-20211019-19-a5pf9z.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=946&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427271/original/file-20211019-19-a5pf9z.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=946&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427271/original/file-20211019-19-a5pf9z.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=946&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Founding Father Alexander Hamilton stated, ‘It shall never be said, with any color of truth, that my ambition or interest has stood in the way of the public good.’</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/item/2016816335/">Library of Congress Prints and Photographs Division</a></span>
</figcaption>
</figure>
<h2>‘Ambition’ vs. public good</h2>
<p>So apparently it’s not certificates, quarantines and vaccine mandates that are un-American, <a href="https://twitter.com/Jim_Jordan/status/1434978332513292291">as some maintain today</a>. </p>
<p>The argument that individual rights trump the greater good is un-American, or at least out of step with American tradition. It’s an attitude that the founders would have put under <a href="https://yalebooks.yale.edu/book/9780300182804/ambition-history">the encompassing banner of “ambition</a>.”</p>
<p>“Ambition” comes when individuals are blinded by their little – or large – egotisms and personal interests. They lose track of higher goals: the community, the republic, the nation. In the most severe cases, ambition turns anti-social.</p>
<p>Ambitious individuals, the founders were sure, are persons stripped of their membership in a community. They choose to relegate themselves to their solitary imagination. They have become slaves to their own opinions.</p>
<p><a href="https://en.wikipedia.org/wiki/Alexander_Hamilton">Alexander Hamilton</a> was tired of being turned into the butt of endless accusations: “<a href="https://founders.archives.gov/?q=%22my%20ambition%20or%20interest%20has%20stood%20in%20the%20way%22&s=1111311111&sa=&r=2&sr=">It shall never be said</a>, with any color of truth, that my ambition or interest has stood in the way of the public good.”</p>
<p>When facing a quarantine, a mandate, or similar momentary abridgments of their liberties, many Americans today react the same way Hamilton did. Like Hamilton, they look beyond themselves, their opinions, their interests. They don’t lose sight of the public good.</p>
<p>Others remain ambitious.</p>
<p>[<em>The Conversation’s Politics + Society editors pick need-to-know stories.</em> <a href="https://theconversation.com/us/newsletters/politics-weekly-74/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=politics-need-to-know">Sign up for Politics Weekly</a>._]</p><img src="https://counter.theconversation.com/content/169924/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maurizio Valsania does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Founding Fathers were unrelenting in their commitment to the idea that circumstances can arise that require public officials to take actions abridging individual freedoms.Maurizio Valsania, Professor of American History, Università di TorinoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1690822021-10-06T12:28:20Z2021-10-06T12:28:20ZAs American independence rang, a sweeping lockdown and mass inoculations fought off a smallpox outbreak<figure><img src="https://images.theconversation.com/files/424543/original/file-20211004-15-1sh5x21.jpg?ixlib=rb-1.1.0&rect=41%2C48%2C2106%2C3266&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The first reading of the Declaration of Independence in Boston, July 18, 1776.</span> <span class="attribution"><a class="source" href="https://ark.digitalcommonwealth.org/ark:/50959/wh246s47c">Tichnor Brothers Collection, Boston Public Library via Digital Commonwealth</a></span></figcaption></figure><p>Many Americans of the founding era denounced government tyranny, celebrated the Declaration of Independence – and favored lockdowns and mass inoculations to combat a viciously contagious disease.</p>
<p>Unchecked, <a href="https://en.wikipedia.org/wiki/Smallpox">smallpox</a> kills more than one in 10 of its victims, leaving many of the rest blind, disfigured and sometimes sterile. Many <a href="https://doi.org/10.1353/jmh.2004.0012">historians</a> say the reason George Washington never had children was his near-fatal bout of smallpox in 1751.</p>
<p>The summer of 1776 was a time of crisis for the budding republic. A <a href="https://www.worldcat.org/title/pox-americana-the-great-smallpox-epidemic-of-1775-82/oclc/872598533">smallpox outbreak in the Continental Army</a> killed hundreds. And as the soldiers came home from a failed invasion of Canada, they brought the disease to Boston.</p>
<p>Yet the country badly needed healthy men: <a href="http://www.ouramericanrevolution.org/index.cfm/page/view/p0217">The British landed on Staten Island on July 2</a>, the same day <a href="https://constitutioncenter.org/blog/on-this-day-the-declaration-of-independence-is-officially-signed">Congress declared independence</a>. </p>
<p>A perfect solution beckoned: <a href="https://www.worldcat.org/title/pox-americana-the-great-smallpox-epidemic-of-1775-82/oclc/872598533">inoculation</a>, the 18th-century precursor to vaccination. As <a href="https://www.worldcat.org/title/pox-americana-the-great-smallpox-epidemic-of-1775-82/oclc/872598533">historian Elizabeth Fenn explains</a>, the physician would make small incisions in the patient’s skin, then introduce scabs or pus from a person with smallpox. The inoculee would then contract a mild form of the virus, only one-tenth as lethal as the accidentally acquired version.</p>
<p>It would be 20 years before English scientist <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/">Edward Jenner</a> pioneered the practice of immunizing people against smallpox with the similar cowpox virus, which is harmless to humans. Since the Latin word for cow is “vacca,” that process became known as vaccination.</p>
<p>In Colonial times, people who got inoculated generally did so in groups in order to keep down the cost and logistical complications. For the several weeks that they remained contagious, they would take over a home or tavern and proclaim it a <a href="https://www.worldcat.org/title/pox-americana-the-great-smallpox-epidemic-of-1775-82/oclc/872598533">smallpox hospital</a>: off-limits to everyone but inoculees.</p>
<h2>Imposing a lockdown</h2>
<p>Boston and other towns required people undergoing inoculation to remain indoors and post <a href="https://boston1775.blogspot.com/2007/04/newspapers-on-flag-at-liberty-tree.html">red warning flags</a> around the immunization site. Sometimes, though, restless individuals would slip out, endangering neighbors who either could not afford the expensive procedure or chose not to undergo it. Even when inoculees remained indoors, townspeople so feared catching this horrific disease that they often <a href="https://www.jstor.org/stable/25652028">rioted</a> against doctors who set up inoculation sites.</p>
<p>But by early summer 1776, the majority of not-yet-inoculated Bostonians were eager for the procedure – and so were many out-of-towners. Abigail Adams, famous today for imploring the Continental Congress to “<a href="https://www.masshist.org/digitaladams/archive/doc?id=L17760331aa&bc=%2Fdigitaladams%2Farchive%2Fbrowse%2Fdate%2Fall_1776.php">Remember the Ladies</a>,” acted quickly to inoculate herself and her children. Traveling from the nearby town of Braintree to Boston for the treatment, she wrote her husband, future president John Adams, “<a href="https://www.washingtonpost.com/history/2020/12/12/abigail-adams-smallpox-coronavirus-vaccine/">Our Little ones stood the operation Manfully</a> … The Little folks are very sick then and puke every morning, but after that they are comfortable.”</p>
<p>Still, others refused, and Boston’s selectmen (city council) could not just let everyone decide for themselves. A patchwork of families, some undergoing and some refusing inoculation, would assuredly have set off an epidemic. So Massachusetts legislators made a <a href="https://babel.hathitrust.org/cgi/pt?id=umn.31951002355939u&view=1up&seq=557&skin=2021">bold decision</a>. Since most Bostonians wanted to be inoculated, they would not, per usual, have to confine themselves to smallpox hospitals. </p>
<p>Instead, they would have the run of Boston, and the anti-inoculators would be the ones who had to either <a href="https://babel.hathitrust.org/cgi/pt?id=umn.31951002355939u&view=1up&seq=557&skin=2021">lock down or get out of town</a> before inoculation began. </p>
<p>Until the city was deemed safe, guards would be posted at the sole road and several ferry landings connecting Boston to the wider world. Only those who had already had smallpox would be allowed in, and no one could leave until the selectmen deemed them smallpox-free.</p>
<p>By July 18, when Col. Thomas Crafts stepped out onto the balcony of the Massachusetts State House to read the just-received Declaration of Independence, no one in attendance needed to fear either catching smallpox or giving it to someone else.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/424545/original/file-20211004-15-79s80p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A painting of a woman" src="https://images.theconversation.com/files/424545/original/file-20211004-15-79s80p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/424545/original/file-20211004-15-79s80p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=790&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424545/original/file-20211004-15-79s80p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=790&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424545/original/file-20211004-15-79s80p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=790&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424545/original/file-20211004-15-79s80p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=993&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424545/original/file-20211004-15-79s80p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=993&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424545/original/file-20211004-15-79s80p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=993&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Abigail Adams remarked upon the cheering crowds in a locked-down Boston.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/File:Abigail_Adams.jpg">Benjamin Blyth via Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Abigail Adams was among the “<a href="https://www.masshist.org/digitaladams/archive/doc?id=L17760721aa">Multitude</a>” who attended the reading. As Crafts finished the Declaration of Independence and shouted, “God Save our American States,” Adams reported, “<a href="https://www.masshist.org/digitaladams/archive/doc?id=L17760721aa">the Bells rang … the cannon were discharged, the platoons followed and every face appeard joyfull</a>.” </p>
<p>As late as August 26, Boston leaders were still trying to stamp out vestiges of the smallpox virus, but their bold action had prevented an epidemic. <a href="https://www.washingtonpost.com/outlook/2021/07/02/we-can-repeat-bostons-1776-freedom-summer/">Nearly 5,000 people</a> had been inoculated. That was equivalent to a <a href="https://www.nar.realtor/blogs/economists-outlook/largest-cities-in-the-united-states-in-1776-and-in-2076">third of Boston’s population</a>, though about half of the inoculees were actually out-of-towners like the Adams family.</p>
<h2>Conflicting notions of freedom</h2>
<p>At the time, Boston had five newspapers, but no one used their pages to complain about the lockdown and other enforcement measures.</p>
<p>Some people took their belief in the individual’s responsibility to the community to extremes. The claim that “<a href="https://archive.csac.history.wisc.edu/Benjamin_Rush.pdf">Every man in a republic is public property</a>” came not from some crazed utopian but from Benjamin Rush, a signer of the Declaration of Independence. And Benjamin Franklin, in a Christmas 1783 letter advocating federal taxes to pay off the Revolutionary War debt, conceded that citizens have the right to retain enough property for their survival and for “the Propagation of the Species.” But he added: “<a href="https://founders.archives.gov/documents/Franklin/01-41-02-0231">all Property superfluous to such purposes is the Property of the Publick</a>.”</p>
<p>Few Americans today would go as far as Rush and Franklin, but their comments, like Boston’s July 1776 decision to turn itself into one giant immunization site, remind us of the American Revolutionaries’ provocative conviction that communities have rights, too.</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/169082/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Woody Holton received funding from the National Endowment for the Humanities Henry E. Huntington Library, and Newberry Library.</span></em></p>In the summer of 1776, Boston offered smallpox inoculation to everyone and required those who declined to leave town or stay in their homes.Woody Holton, Professor of History, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1675332021-09-09T05:43:08Z2021-09-09T05:43:08ZI’d prefer an ankle tag: why home quarantine apps are a bad idea<figure><img src="https://images.theconversation.com/files/420169/original/file-20210909-27-jq43gr.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1997%2C1332&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>South Australia has begun <a href="https://www.abc.net.au/news/2021-08-23/how-will-south-australias-home-quarantine-trial-work/100398878">a trial</a> of a new COVID app to monitor arrivals into the state. SA Premier Steven Marshall claimed “every South Australian should feel pretty proud that we are the national pilot for the home-based quarantine app”.</p>
<p>He then doubled down with the boast that he was “pretty sure the technology that we have developed within the South Australia government will become the national standard and will be rolled out across the country.” </p>
<p>Victoria too has announced impending “<a href="https://www.abc.net.au/news/2021-09-09/victoria-border-area-exemptions-allow-home-quarantine/100444532">technologically supported</a>” home quarantine, though details remain unclear. Home quarantine will also eventually be <a href="https://www.abc.net.au/news/2021-09-09/scott-morrison-message-australians-overseas-covid19-quarantine/100445680">available for international arrivals</a>, according to Prime Minister Scott Morrison. </p>
<p>The South Australian app has received little attention in Australia, but in the US the left-leaning Atlantic magazine called it “<a href="https://www.theatlantic.com/ideas/archive/2021/09/pandemic-australia-still-liberal-democracy/619940/">as Orwellian as any in the free world</a>”. Right-wing outlets such as <a href="https://www.theguardian.com/australia-news/2021/sep/04/south-australia-facial-recognition-trial-covid-app-blasted-by-fox-and-breitbart-criticised-over-lack-of-safeguards">Fox News and Breitbart</a> also joined the attack, and for once I find myself in agreement with them. </p>
<h2>Location tracking and facial recognition</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/420161/original/file-20210909-24-zwjrys.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/420161/original/file-20210909-24-zwjrys.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/420161/original/file-20210909-24-zwjrys.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1176&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420161/original/file-20210909-24-zwjrys.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1176&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420161/original/file-20210909-24-zwjrys.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1176&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420161/original/file-20210909-24-zwjrys.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1477&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420161/original/file-20210909-24-zwjrys.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1477&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420161/original/file-20210909-24-zwjrys.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1477&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The South Australian home quarantine app uses facial recognition software to identify users.</span>
<span class="attribution"><a class="source" href="https://apps.apple.com/au/app/home-quarantine-sa/id1567354245#?platform=iphone">Government of South Australia</a></span>
</figcaption>
</figure>
<p>Despite the SA Premier’s claims, this isn’t the first such app to be used in Australia. A similar <a href="https://www.wa.gov.au/government/publications/covid-19-coronavirus-g2g-now">home-quarantine app</a> is already in use for arrivals into WA, and <a href="https://www.g2gnow.com.au/about">in some cases the Northern Territory</a>. </p>
<p>Both apps uses geolocation and facial recognition software to track and identify those in quarantine. Users are required to prove they are at home when randomly prompted by the application. </p>
<p>In SA, you have 15 minutes to get the face recognition software to verify you’re still at home. In WA, it is more of a race. You have just 5 minutes before you risk a knock on the door from the police. </p>
<p>Another difference is that the SA app is opt-in. Currently. The WA app is already mandatory for arrivals from high risk areas like Victoria. For extreme risk areas like NSW, it’s straight into a quarantine hotel.</p>
<h2>Reasons for concern</h2>
<p>But why are we developing such home-quarantine apps in the first place, when we already have a cheap technology to do this? If we want to monitor that people are at home (and that’s a big <em>if</em>), wouldn’t one of the ankle tags already used by our corrective services for home detention be much simpler, safer and more robust? </p>
<p>There are many reasons to be concerned about home-quarantine apps. </p>
<p>First, they’ll likely be much easier to hack than ankle tags. How many of us have hacked geo-blocks to access Netflix in the US, or to watch other digital content from another country? <a href="https://www.lifewire.com/fake-gps-location-4165524">Faking GPS location on a smartphone</a> is not much more difficult. </p>
<p>Second, facial recognition software is often flawed, and is frequently biased against people of colour and against women. The documentary <a href="https://www.netflix.com/title/81328723">Coded Bias</a> does a great job unpicking these biases.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/jZl55PsfZJQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The documentary Coded Bias explains the common inbuilt flaws of facial recognition software.</span></figcaption>
</figure>
<p>Despite years of effort, even the big tech giants like Google and Amazon have been <a href="https://venturebeat.com/2021/09/03/bias-persists-in-face-detection-systems-from-amazon-microsoft-and-google/">unable to eliminate these biases from their software</a>. I have little hope the SA government or the WA company GenVis, the developers of the two Australian home-quarantine apps, will have done better.</p>
<p>Indeed, the Australian Human Rights Commission has called for <a href="https://tech.humanrights.gov.au/overview/summary">a moratorium on the use of facial recognition software</a> in high-risk settings such as policing until better regulation is in place to protect human rights and privacy.</p>
<p>Third, there needs to be a much more detailed and public debate around issues like privacy, and safeguards put in place based on this discussion, in advance of the technology being used. </p>
<p>With COVID check-in apps, we were promised the data would only be used for public health purposes. But police forces around Australia have <a href="https://theconversation.com/police-access-to-covid-check-in-data-is-an-affront-to-our-privacy-we-need-stronger-and-more-consistent-rules-in-place-167360">accessed this information for other ends on at least six occasions</a>. This severely undermines the public’s confidence and use of such apps.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/police-access-to-covid-check-in-data-is-an-affront-to-our-privacy-we-need-stronger-and-more-consistent-rules-in-place-167360">Police access to COVID check-in data is an affront to our privacy. We need stronger and more consistent rules in place</a>
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<p>Before it was launched, the Commonwealth’s COVIDSafe app had legislative prohibitions put in place on the use of the data collected for anything but contact tracing. This perhaps gave us a false sense of security as the state-produced COVID check-in apps did not have any such legal safeguards. Only some states have retrospectively introduced legislation to provide such protections. </p>
<p>Fourth, we have to worry about how software like this legitimises technologies like facial recognition that ultimately erode fundamental rights such as the right to privacy. </p>
<p>If home-quarantine apps work successfully, will they open the door to facial recognition being used in other settings? To identify shop lifters? To provide access to welfare? Or to healthcare? What Orwellian world will this take us to? </p>
<h2>The perils of facial recognition</h2>
<p>In China, we have already seen <a href="https://www.theguardian.com/news/2019/apr/11/china-hi-tech-war-on-muslim-minority-xinjiang-uighurs-surveillance-face-recognition">facial recognition software used to monitor and persecute the Uighur minority</a>. In the US, at least three Black people have already wrongly ended up in jail due to <a href="https://www.nytimes.com/2020/12/29/technology/facial-recognition-misidentify-jail.html">facial recognition errors</a>.</p>
<p>Facial recognition is a technology that is dangerous if it doesn’t work (as it often the case). And dangerous if it does. It changes the speed, scale and cost of surveillance. </p>
<p>With facial recognition software behind the CCTV cameras found on many street corners, you can be tracked 24/7. You are no longer anonymous when you go out to the shops. Or when you protest about Black lives mattering or the climate emergency. </p>
<h2>High technology is not the solution</h2>
<p>High tech software like facial recognition isn’t a fix for the problems that have plagued Australia’s response to the pandemic. It can’t remedy the failure to buy enough vaccines, the failure to build dedicated quarantine facilities, or the in-fighting and point-scoring between states and with the Commonwealth.</p>
<p>I never thought I’d say this but, all in all, I think I’d prefer an ankle tag. And if the image of the ankle tag seems too unsettling for you, we could do what Hong Kong has done and <a href="https://www.nytimes.com/2020/04/08/world/asia/hong-kong-coronavirus-quarantine-wristband.html">make it a wristband</a>.</p><img src="https://counter.theconversation.com/content/167533/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Toby Walsh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Home quarantine apps face serious privacy, security and bias issues. Home detention ankle tags might be a better option.Toby Walsh, Professor of AI at UNSW, Research Group Leader, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1638042021-07-04T20:14:47Z2021-07-04T20:14:47ZAustralia has a new four-phase plan for a return to normality. Here’s what we know so far<figure><img src="https://images.theconversation.com/files/409439/original/file-20210702-21-7kocu4.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/yes-we-open-sign-on-glass-1495100507">from www.shutterstock.com</a></span></figcaption></figure><p>Prime Minister Scott Morrison has received <a href="http://www.roymorgan.com/findings/8683-roy-morgan-survey-on-pfizer-morrison-handling-covid-19-april-19-2021-202104190611">criticism</a> from the general public for not having a concrete plan to take us out of the COVID-19 pandemic.</p>
<p>However, he went some way to addressing this on Friday, announcing national cabinet had agreed to <a href="https://www.abc.net.au/news/2021-07-02/covid-live-updates-lockdown-press-conference/100261144">a four-phase plan</a> to get us back to something resembling our pre-COVID way of life. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1410782312233570309"}"></div></p>
<p>It’s not yet very detailed, and no dates have been set out for the various phases. But we do have some idea of what’s being proposed, and Morrison said moving through each phase will depend on reaching vaccination targets determined from modelling, currently being undertaken by Melbourne’s Peter Doherty Institute.</p>
<p>The idea is to transition from our current priority of suppressing transmission of the virus, to a focus on the prevention of serious illness, hospitalisation and deaths. </p>
<p>Let me take you through each phase and what we know so far.</p>
<h2>Phase 1: vaccinate, prepare and pilot</h2>
<p>We are in Phase 1 now, and the aim is to continue to minimise community transmission. </p>
<p>Lockdowns may continue to be used in this phase, although only as a last resort. </p>
<p>The international arrivals cap will now be reduced by 50% to take pressure off our hotel quarantine system due to the increased infectiousness of the <a href="https://theconversation.com/whats-the-delta-covid-variant-found-in-melbourne-is-it-more-infectious-and-does-it-spread-more-in-kids-a-virologist-explains-162170">Delta variant</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-delta-covid-variant-found-in-melbourne-is-it-more-infectious-and-does-it-spread-more-in-kids-a-virologist-explains-162170">What's the Delta COVID variant found in Melbourne? Is it more infectious and does it spread more in kids? A virologist explains</a>
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<p>Morrison has indicated he expects the cap to stay in place until at least the beginning of 2022.</p>
<p>However, the federal government will facilitate increased <a href="https://www.smh.com.au/politics/federal/australia-to-slash-traveller-intake-pm-announces-pathway-out-of-covid-19-20210702-p5869s.html">repatriation flights</a> to Darwin for quarantine at Howard Springs.</p>
<p>Also, as part of this current phase, there will be a <a href="https://www.9news.com.au/national/coronavirus-home-quarantine-to-be-trialled-for-vaccinate-travellers/c6a0b4ef-46bd-4efe-96fc-d1aa5e55c031">trial of home quarantine</a> for fully vaccinated returnees. This will be for seven days rather than 14.</p>
<p><a href="https://www.smh.com.au/politics/federal/australia-to-slash-traveller-intake-pm-announces-pathway-out-of-covid-19-20210702-p5869s.html">South Australia</a> has already indicated it would be willing to take part in this trial. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/home-quarantine-for-vaccinated-returned-travellers-is-extremely-low-risk-and-wont-damage-their-mental-health-162436">Home quarantine for vaccinated returned travellers is extremely low risk, and won't damage their mental health</a>
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<h2>Phase 2: post-vaccination</h2>
<p>In this phase, the international arrival cap will be restored to current levels for unvaccinated passengers, and a larger cap applied to fully vaccinated passengers.</p>
<p>Lockdowns would rarely be needed, and fully vaccinated people would have eased restrictions in any outbreak with respect to lockdowns or border closures. More students and economic visitors will also be allowed in.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1410820938904399873"}"></div></p>
<p>Although no dates or vaccine rollout targets have been set, for us to reach Phase 2, we would clearly need a high percentage of our population to be fully vaccinated. </p>
<p>As it will take at least until the end of year for the whole adult population to have received their first dose, Phase 2 is likely to kick in some time in the first half of 2022.</p>
<h2>Phase 3: consolidation</h2>
<p>In Phase 3, COVID would be treated more like the flu, presumably with annual booster shots to account for new variants. Fully vaccinated Australians would be able to travel abroad.</p>
<p>There would be no lockdowns, no cap on returning vaccinated travellers, and no domestic restrictions for vaccinated residents. We would be able to have travel bubbles with countries in a similar situation.</p>
<p>There would also be increased, albeit still capped, entries for international students. </p>
<p>Realistically, we are probably talking about the second half of 2022 before we can enter Phase 3.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/view-from-the-hill-covid-transition-plan-has-bad-news-for-returning-travellers-163818">View from The Hill: COVID transition plan has bad news for returning travellers</a>
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<h2>Phase 4: final</h2>
<p>Here life returns to relative normality, very similar to the way it was before the pandemic began. However, there would still be pre- and post-flight testing for unvaccinated arrivals, and a <a href="https://edition.cnn.com/travel/article/what-vaccine-means-for-international-travel-scn/index.html">vaccine passport</a> system will likely be in place. I imagine there will still be a focus on hand hygiene and coughing etiquette.</p>
<p>The plan depends to a large extent on vaccine availability, any new and more transmissible variants arising, and persuading enough Australians to get vaccinated.</p>
<p>It will create a two-class system of those who are fully vaccinated and who will have lots of freedoms, and those not. Although there are some people who, for medical or even religious reasons, might not be able to be vaccinated, for the vast majority, it is a choice.</p>
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Read more:
<a href="https://theconversation.com/a-vaccine-will-be-a-game-changer-for-international-travel-but-its-not-everything-151214">A vaccine will be a game-changer for international travel. But it's not everything</a>
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<p>Morrison’s statement says the plan will depend very much on the percentage of Australians 16 years and older who are fully vaccinated.</p>
<p>However, the Delta variant may be spreading more easily in <a href="https://www.news.com.au/world/coronavirus/australia/coronavirus-sydney-delta-strain-big-worry-for-children-more-infectious/news-story/5ad706057b10f404e503ccd79460c644">children</a>, although it’s not yet clear whether this is simply a function of the variant being more transmissible in general. It’s also <a href="https://www.bmj.com/content/373/bmj.n1513">unclear</a> whether this leads to increased serious illness in those children infected.</p>
<p>Overall, I think the plan is sensible, if somewhat vague. Phase 1 calls for lockdowns to be a last resort, although I think this a big ask given the low percentage of the population currently fully vaccinated. <a href="https://www.news.com.au/world/asia/singapores-surprising-new-plan-to-live-with-covid-revealed/news-story/52fa2c29252daeb4a3c634e1658f6901">Singapore</a> has proposed a similar plan, but is way ahead of us in its vaccine rollout, with more than 60% of its population likely to be fully vaccinated by August.</p>
<p>So, for those desperate for international holidays, there is light at the end of the tunnel. You can potentially start packing in the second half of next year.</p><img src="https://counter.theconversation.com/content/163804/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrian Esterman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For those desperate for international holidays, there is light at the end of the tunnel.Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1630412021-07-01T13:34:25Z2021-07-01T13:34:25ZHow Olympic training schedules have been hit by quarantine<p>Although athletes <a href="https://www.theguardian.com/sport/2020/mar/24/tokyo-olympics-to-be-postponed-to-2021-due-to-coronavirus-pandemic">broadly accepted</a> the reason the Tokyo Olympic Games was <a href="https://theconversation.com/postponing-the-olympics-is-the-right-call-curbing-the-coronavirus-pandemic-matters-more-than-money-134577">postponed</a> in 2020, it has not been an easy year. If many found the decision <a href="https://edition.cnn.com/2020/03/25/sport/athletes-reaction-tokyo-2020-olympics-postpone-spt-intl/index.html">heartbreaking</a>, it was in part because not all were certain they could take part this year. </p>
<p>Several have <a href="https://www.globaltimes.cn/content/1194004.shtml#:%7E:text=New%20Zealand%20rider%20Dawkins%20retired,the%20wait%20was%20too%20long">since retired</a>. Japanese women’s volleyball player Risa Shinnabe, who was a bronze medallist in 2012, <a href="https://www.insidethegames.biz/articles/1109206/big-read-athlete-retirements-tokyo-2020">cited</a> fears that she would not be able to maintain her condition as one of the reasons for doing so. </p>
<p>Maintaining physical condition, mental focus and motivation over the 15 months has been a huge challenge for athletes. For those who are competing in Tokyo, the recent announcement that arrivals from certain countries, including Great Britain, may be subject to a <a href="https://www.theguardian.com/sport/2021/jun/15/tokyo-covid-rule-breakers-risk-losing-olympic-and-paralympic-medals">six-day quarantine</a> has dealt another blow. This is an additional stress not only for the athletes but also for their support staff. </p>
<p>Tennis players competing in the 2021 Australian Open faced <a href="https://www.theguardian.com/sport/2021/jan/29/australian-open-tennis-players-leave-quarantine-as-those-remaining-express-frustration">similar conditions</a>. Some were able to train at limited times. Others were restricted to their hotel rooms for 14 days due to a positive COVID test on an incoming flight. </p>
<p><a href="https://www.itv.com/news/2021-01-18/gbs-heather-watson-finds-novel-way-to-train-while-isolating-ahead-of-the-australian-open-completing-5k-in-hotel-room">Social media was awash</a> with tennis players coming up with innovative ways to practice using hotel furniture and room windows. The media might love these anecdotes, but these are circumstances that would have been unimaginable, pre-COVID. And in the days leading up to the Tokyo competitions, they will be less than optimal. </p>
<h2>Training adjustments</h2>
<p>Following the postponement last year, training plans have no doubt been scrapped and rewritten, potentially multiple times. Ongoing uncertainty and the cancellation of pre-Games competitions has made planning difficult. The coaches of those athletes heading to Tokyo have had a difficult time ensuring that <a href="https://theconversation.com/coronavirus-for-the-sake-of-athletes-its-too-soon-to-cancel-the-tokyo-2020-olympics-133749">training programmes</a> would enable peak performance during the Olympics, which opens on July 23. </p>
<p>Some national teams may have envisaged organisers imposing some form of self-isolation and adapted travel plans accordingly. For many, though, this might not have been achievable given the tight time constraints on training and competition schedules. </p>
<p>Research conducted over the previous year has shown that being in quarantine for the general population has an impact on our <a href="https://www.nature.com/articles/s41380-021-01019-y">mental health</a>. People have <a href="https://link.springer.com/article/10.1007/s00406-020-01196-x">suffered from</a> depression, stress, anxiety and anger, especially those who are more vulnerable. </p>
<p>Elite athletes are not considered a vulnerable population group, but they have nonetheless been shown to experience mental health disorders and symptoms at a <a href="https://bjsm.bmj.com/content/53/11/667">similar or higher rate</a> than non-athletes. The continued uncertainty and a looming quarantine is likely to amplify already heightened anxiety levels. </p>
<p>This could result in greater fatigue, more difficulties in training and sleep disorders. As the games approach, athletes may have to rely more on psychological support than they might have previously. Such support, however, may not be available to all competing athletes. </p>
<p>Among elite athletes, inadequate sleep is a known problem. Research has found 50-78% suffer from <a href="https://bjsm.bmj.com/content/55/7/356">sleep disturbance</a>. Unfamiliar sleeping environments, long-haul travel, and training sessions and competitions scheduled early or late in the day, which the athletes may not be used to, <a href="https://bjsm.bmj.com/content/55/7/356">does not help</a> – nor does being confined to a hotel room for six days. </p>
<p>Typically, endurance and strength-based athletes <a href="https://pubmed.ncbi.nlm.nih.gov/17762369/">reduce their training load</a> in the days or weeks leading up to a competition. This strategy enables them to recover from the fatigue of training, while ensuring that they retain or enhance subsequent performance. The strategy, known as tapering, is highly individualised and is likely to be heavily affected by a period of quarantine. Unless of course athletes have access to exercise equipment, such as treadmills, gym bikes or weights, in their rooms. </p>
<p>For some sports, swimming or shooting, for example, athletes simply won’t be able to train in a hotel room. They can of course continue with conditioning, but not actual preparations. Stress levels may be exacerbated further knowing that close rivals, who do not face the same quarantine measures, may have full access to essential facilities. </p>
<p>Many athletes will have probably undertaken <a href="https://www.tandfonline.com/doi/full/10.1080/23328940.2019.1666624">heat acclimation</a> before arriving to train their bodies to cope with the hot and humid conditions of a Japanese summer. In July and August temperatures range from 28°C - 31°C, with relative humidity exceeding 60%. </p>
<p>For heat acclimation to work, you need to do it as close to the competition event as possible, without it affecting your pre-travel and competition training and recovery. Athletes often also do final training sessions in the competition environment, which won’t be possible if you have to spend six days in an air-conditioned hotel room. They might, however, put their hotel room facilities to best use and have <a href="https://www.frontiersin.org/articles/10.3389/fphys.2018.01851/full">hot baths, post exercise</a> instead, to induce a heat-related physiological response. </p>
<p>Ultimately, not being able to train for six days will not lead to so-called de-training effects: typically it takes two weeks or more for such losses on physical condition to be <a href="https://link.springer.com/article/10.2165/00007256-200030020-00002">noticeable</a>. A six-day quarantine could, however, hamper those final preparations that make the difference between winning a medal and going home empty handed. The margin between the two, at the Olympic level, is incredibly tight.</p><img src="https://counter.theconversation.com/content/163041/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katy Griggs does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Athletes headed to Tokyo have trained throughout an unusually stressful year. Missing out on final preparations could hinder their chances at a medalKaty Griggs, Senior Lecturer in Sport Engineering, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1630122021-06-25T04:13:41Z2021-06-25T04:13:41ZA mining camp won’t cut it: Australia’s quarantine system needs a smarter design<figure><img src="https://images.theconversation.com/files/407365/original/file-20210621-35088-18jz92x.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Screen Shot at am</span> </figcaption></figure><p>The <a href="https://www.theage.com.au/national/victoria/victoria-records-no-new-cases-as-restrictions-ease-exposure-sites-grow-20210625-p5845r.html">announcement</a> that the Victorian and federal governments will build a 1,000-bed COVID quarantine hub at Mickleham in Melbourne’s north marks a welcome end, or at least a fresh chapter, to the finger-pointing over Australia’s quarantine saga.</p>
<p>Time is of the essence when protecting Australians from COVID, so hats off to both governments for setting an ambitious timeline that could see the facility up and running by the end of this year. </p>
<p>But in their haste to deliver an alternative to hotel quarantine, we believe the governments haven’t taken advantage of the newest available innovations.</p>
<p>The <a href="https://www.vic.gov.au/alternative-quarantine-accommodation-project-summary">plan</a> for the proposed quarantine facility produced by the Victorian government is, by its own admission, little more than a specced-up version of a mining camp, similar to the Howard Springs facility already in use in the Northern Territory. In turn, this type of construction harks back to the postwar quarantine facilities built from the 1950s onwards.</p>
<p>Part of the problem with the current proposal is the focus on the “hardware”, with almost no discussion of the “software”. By hardware, we mean buildings, physical structures, road layouts and infrastructure; by software, we mean how it will be used, the operational patterns and processes, and “softer” operational modes of use and their technologies. </p>
<p>This hardware-centric approach would be more reassuring if the hardware were the best and fittest for use, but unfortunately the proposal has reached for what it knows, and what it knows is around 70 years old.</p>
<h2>A smarter way</h2>
<p>We and our colleagues at the <a href="https://building4pointzero.org/">Building 4.0 Cooperative Research Centre</a>, funded jointly by the federal government and a consortium of industry, are developing a state-of-the-art design, called <a href="https://building4pointzero.org/wp-content/uploads/2021/05/Building-4.0-CRC-Q_smart-Proposal-1.pdf">Q_Smart</a>, which we submitted to the Victorian government in March 2021. </p>
<p>In our proposal, building services, controls, sensors and management systems (alongside well-designed and efficiently produced buildings) all play a role in preventing the transmission of COVID-19. We might think of this as a correction towards a more “software-driven” approach, as it seeks to use a <a href="https://www.linkedin.com/pulse/covid-19-why-intelligent-healthy-quarantine-now-future-jeff-connolly/">range of processes, techniques and technologies</a> already available from our collaborators at Siemens to augment the work done by the physical structures.</p>
<p>In terms of the physical layout, our design avoids the large common corridors, inadequate air-tightness controls for rooms, or unhygienic air handling systems that have emerged as problems with current hotel stock. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/407364/original/file-20210621-35700-1lrqh3o.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Table listing design features of Q_Smart" src="https://images.theconversation.com/files/407364/original/file-20210621-35700-1lrqh3o.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/407364/original/file-20210621-35700-1lrqh3o.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/407364/original/file-20210621-35700-1lrqh3o.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/407364/original/file-20210621-35700-1lrqh3o.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/407364/original/file-20210621-35700-1lrqh3o.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/407364/original/file-20210621-35700-1lrqh3o.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/407364/original/file-20210621-35700-1lrqh3o.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://building4pointzero.org/wp-content/uploads/2021/05/Building-4.0-CRC-Q_smart-Proposal-1.pdf">Building 4.0 CRC</a></span>
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<p>As leading infection control experts have <a href="https://theconversation.com/this-is-how-we-should-build-and-staff-victorias-new-quarantine-facility-say-two-infection-control-experts-162157">already pointed out</a>, mining dongas may have worked well so far for quarantine at the repurposed Howard Springs facility in the Northern Territory. But from an epidemiological point of view, the current design is concerning for the proximity of neighbouring verandahs, especially in cases where more than one group of quarantine residents is housed in a unit. </p>
<p>The government’s provisional staffing patterns for the new facility suggests that separation between residents will rely on strict protocols around staff movements and quarantine measures intended to slow and limit the spread of disease, should a breach occur.</p>
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Read more:
<a href="https://theconversation.com/this-is-how-we-should-build-and-staff-victorias-new-quarantine-facility-say-two-infection-control-experts-162157">This is how we should build and staff Victoria's new quarantine facility, say two infection control experts</a>
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<p>In contrast, the smart building management system we are developing would not “wait” for a breach to occur, but would aim to stop such contact ever being made. A door would not open, an airlock would have its contents automatically evacuated, and UV light would cleanse contaminated surfaces or air in ducting. </p>
<p>Some of these features, such as proximity authentication, are innovations that we routinely expect from our 20-year-old cars. If we turn to our now ubiquitous smartphones, there are yet further possibilities to safely and conveniently track and control movement in more humane way that would not need to reach for punitive ankle bracelets and the like. And, yes, should a breach occur, such systems could ultimately carry out near-instantaneous contact-tracing.</p>
<p>But such a system could only work if the “hardware” and “software” are fully integrated and planned together from the start.</p>
<h2>An eye on the future</h2>
<p>There are many ways to deal with quarantine, and although it may be too late to integrate our designs into the proposed Victorian facility, perhaps other states and territories embarking on building ventures might yet consider this advice.</p>
<p>In viewing the current proposed plan of closely spaced mining dongas, arranged in “mini-districts”, it is nigh-on impossible to imagine it being used for anything other than a quarantine facility, or perhaps a correctional centre. </p>
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<a href="https://images.theconversation.com/files/408309/original/file-20210625-17-k4rasx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Proposed layout for the new quarantine hub" src="https://images.theconversation.com/files/408309/original/file-20210625-17-k4rasx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408309/original/file-20210625-17-k4rasx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=317&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408309/original/file-20210625-17-k4rasx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=317&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408309/original/file-20210625-17-k4rasx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=317&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408309/original/file-20210625-17-k4rasx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408309/original/file-20210625-17-k4rasx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408309/original/file-20210625-17-k4rasx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The plan for the proposed quarantine hub makes it hard to imagine it being used for anything other than quarantine - or perhaps a correctional facility.</span>
<span class="attribution"><span class="source">Vic.gov.au</span></span>
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Read more:
<a href="https://theconversation.com/hotel-quarantine-causes-1-outbreak-for-every-204-infected-travellers-its-far-from-fit-for-purpose-161815">Hotel quarantine causes 1 outbreak for every 204 infected travellers. It's far from ‘fit for purpose’</a>
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<p>Q_Smart, on the other hand, was designed to be flexible, reusable and adaptable to different sites, which, for example, may not necessarily have large amounts of flat open space. This would potentially allow facilities built for quarantine to be reused for other purposes after the pandemic. Transforming the building’s operational pattern would be a matter of simply flipping a few (virtual) switches. Depending on the use case, certain controls could be activated or deactivated, new patterns of movement through the buildings could be enabled or disabled almost instantaneously. </p>
<p>With more thinking and development, perhaps such buildings could also be used as affordable housing, or disaster relief accommodation or — how’s this for ironic — future hotels.</p>
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<p><em>This article was coauthored by <a href="https://building4pointzero.org/people/dr-bronwyn-evans/">Dr Bronwyn Evans AM</a>, chair of <a href="https://building4pointzero.org/">Building 4.0 CRC</a> and chief executive of <a href="https://www.engineersaustralia.org.au/">Engineers Australia</a>.</em></p><img src="https://counter.theconversation.com/content/163012/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mathew Aitchison is CEO of Building 4.0 CRC, a Commonwealth Government funded R&D centre. The Q_Smart initiative was carried out in collaboration with Siemens.</span></em></p>We can do better than building a village of glorified dongas. Smart quarantine can be much higher-tech, and more adaptable for future uses once the pandemic is over.Mathew Aitchison, Professor of Architecture and CEO of Building 4.0 CRC, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1621572021-06-04T04:51:11Z2021-06-04T04:51:11ZThis is how we should build and staff Victoria’s new quarantine facility, say two infection control experts<p>Earlier this year, we visited the Howard Springs quarantine facility in the Northern Territory, Australia’s alternative to the hotel quarantine system.</p>
<p>Now Victoria is set to build its own <a href="https://www.abc.net.au/news/2021-06-04/new-quarantine-hub-to-be-built-in-victoria/100189846">dedicated COVID-19 quarantine facility</a>, with backing from the federal government, at a yet-to-be-confirmed location. </p>
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<p>There is much we can learn from what Howard Springs provides, in terms of how it’s staffed and its physical infrastructure. There’s a lot that’s working really well. </p>
<p>But if we were designing something from scratch, what could it look like? Here’s are some of our thoughts on how it could work.</p>
<h2>We want to minimise people interacting</h2>
<p>We want to minimise the number of unnecessary face-to-face interactions between staff and residents, and similarly avoid moving residents where possible. </p>
<p>We need to support and meet the medical needs of residents. However, where these or any other support services can be done remotely or through technology, this should be encouraged. By doing this, we reduce the number of staff at the facility. </p>
<p>We also want to prevent residents from physically interacting with each other. These measures reduce the chance of being exposed to the virus, and spreading it.</p>
<p>At Howard Springs, residents are right next to each other, in separate but neighbouring cabins. When they’re on their verandah, they can potentially come into close contact with a person on the verandah next to them. That’s not surprising as Howard Springs was designed to accommodate miners, not as a quarantine facility.</p>
<p>So in a dedicated new facility, we need to design to avoid these types of close contacts and to have clear separation of residents’ living quarters.</p>
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Read more:
<a href="https://theconversation.com/it-may-not-be-possible-to-bring-all-australians-with-covid-home-from-india-but-we-can-do-better-than-we-are-now-161084">It may not be possible to bring all Australians with COVID home from India. But we can do better than we are now</a>
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<p>Howard Springs provides a separate cabin per person, in line with its original function as a mine camp. But in a newly-built facility we need to provide a variety of separate living quarters, such as separate units or apartments. For instance, we need to be able to accommodate not just single people, but family groups, especially ones with young kids.</p>
<p>There must be no communal areas, such as shared playgrounds, which can be challenging for young kids who want to go out and play.</p>
<p>There must be no shared kitchens or laundry facilities. This might mean designing units with a small kitchenette or simple laundry facilities, such as a sink and a washing line. </p>
<p>We don’t want anything too complex that will be difficult to maintain. Maintenance means people coming in from outside, which we want to avoid.</p>
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<h2>Well ventilated and easy to clean</h2>
<p>Each unit needs its own ventilation system; there must be no shared ventilation between units. In Howard Springs, there’s an individual split-system airconditioning unit (to allow heating and cooling) per cabin.</p>
<p>Windows need to open, for ventilation. Importantly, air flow must not create a risk to others, either in other rooms or people coming to the door.</p>
<p>Each unit should have its own outdoor area, such as a verandah. But it needs to be covered, to allow residents to be protected from the weather (particularly for Melbourne’s climate). </p>
<p>Sitting on a verandah also allows residents to see other residents across the pathway, and to safely talk to them, from several metres away. If safe social contact is possible through design, that would be ideal. </p>
<p>Verandahs are also where all interactions between staff and residents can take place, such as swabbing of residents for COVID testing.</p>
<figure class="align-center ">
<img alt="A graphic render of a room in proposed alternate quarantine accommodation" src="https://images.theconversation.com/files/404406/original/file-20210604-23-qk6esa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/404406/original/file-20210604-23-qk6esa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/404406/original/file-20210604-23-qk6esa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/404406/original/file-20210604-23-qk6esa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/404406/original/file-20210604-23-qk6esa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/404406/original/file-20210604-23-qk6esa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/404406/original/file-20210604-23-qk6esa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">All rooms should have a their own ventilation systems, and a verandah.</span>
<span class="attribution"><span class="source">Graphic render supplied by the Victorian Government</span></span>
</figcaption>
</figure>
<p>Units need to be easy to clean and wipe down. We need hard surfaces, like the ones we might see in a hospital, and ones that can be disinfected.</p>
<p>All up, the design of these units needs to be pretty simple. They need to be single-level, not double. That means residents can see each other, and staff can better keep an eye on residents.</p>
<figure class="align-center ">
<img alt="A graphic render of a room in proposed alternate quarantine accommodation" src="https://images.theconversation.com/files/404405/original/file-20210604-15-1of3p4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/404405/original/file-20210604-15-1of3p4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/404405/original/file-20210604-15-1of3p4r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/404405/original/file-20210604-15-1of3p4r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/404405/original/file-20210604-15-1of3p4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/404405/original/file-20210604-15-1of3p4r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/404405/original/file-20210604-15-1of3p4r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rooms should have hard surfaces that are easy to clean.</span>
<span class="attribution"><span class="source">Graphic render supplied by the Victorian Government</span></span>
</figcaption>
</figure>
<h2>We need an on-site clinic</h2>
<p>We need a GP-type clinic on site. For example, there will be pregnant women who need antenatal check-ups and people with chronic diseases who need monitoring. Then there should be protocols for transferring people to hospital, if they need higher levels of care.</p>
<p>We’ll need health-care workers — primarily nurses but also doctors. While the level of medical care is not going to be particularly complex or high, health-care workers clearly need advanced skills in infection prevention and control. Auditing and monitoring compliance with infection control measures, including cleaning, will be important. </p>
<p>Like health-care workers, security staff and cleaners also need to be trained and tested in using personal protective equipment, such as masks and gloves.</p>
<p>All staff need to be fully vaccinated (with two doses) of the COVID vaccine.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-we-vaccinate-all-returned-travellers-in-hotel-quarantine-its-no-magic-fix-but-it-could-reduce-risks-160711">Should we vaccinate all returned travellers in hotel quarantine? It's no magic fix but it could reduce risks</a>
</strong>
</em>
</p>
<hr>
<h2>We need to know who’s arriving and what they need</h2>
<p>We need a good understanding of who’s arriving. Do they have specific medical needs? Do they have dietary requirements? We need to ask them before they arrive in Australia, so staff can prepare.</p>
<p>We also need clear and consistent policies about infection control, COVID-19 testing, and transfers of residents, both in and out of the facility.</p>
<p>We are uniquely placed to build a dedicated, purpose-built quarantine facility, not only for this pandemic, but for future ones. Including suggestions like these will place Victoria and Australia well to meet these challenges.</p><img src="https://counter.theconversation.com/content/162157/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Russo receives funding from the National Health and Medical Research Council, and has received research funding from the Rosemary Norman Foundation, Cardinal Health, Australian College of Nursing and the Cabrini Institute. He is the President of the Australasian College for Infection Prevention and Control, a member of the COVID19 Evidence Taskforce Steering Committee, the Australian Strategic and Technical Advisory Group on AMR, the Healthcare Associated Infection Advisory Committee to the Australian Commission on Safety and Quality in Health Care, a member of the Australian College of Nursing, is a credentialed Expert by the Australasian College for Infection Prevention and Control, and was involved in a review of hotel quarantine for the Victorian Department of Health.</span></em></p><p class="fine-print"><em><span>Brett Mitchell has received research funding from the NHMRC, HCF Foundation, Medtronics, Australasian College for Infection Prevention and Control, Nurses Memorial Centre, Senver, GAMA Healthcare, Ian Potter Foundation and Commonwealth (Innovation Connections grant). Professor Mitchell is a Fellow of the Australasian College for Infection Prevention and Control and a Fellow of the Australian College of Nursing. He has run infection prevention and control programs for hospitals and at a State level, and is a credential Expert by the Australasian College for Infection Prevention and Control.</span></em></p>We have the chance to build a world class, dedicated quarantine facility. Here’s how we could do it.Philip Russo, Associate Professor, Director Cabrini Monash University Department of Nursing Research, Monash UniversityBrett Mitchell, Professor of Nursing, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1613412021-05-23T20:15:15Z2021-05-23T20:15:15ZCOVID is surging in unvaccinated Taiwan. Australia should take heed<p>Alarm bells rang internationally last week when <a href="https://www.cdc.gov.tw/En/Bulletin/Detail/5XjPsJ0tCzWc-fxv77tPkg?typeid=158">Taiwan announced</a> it was moving to its second highest COVID alert level after a recent surge of cases.</p>
<p>The country last year recorded zero cases of community transmission for <a href="https://www.nytimes.com/2021/05/20/world/asia/taiwan-covid-outbreak.html">eight straight months</a>.</p>
<p>The recent increase in cases has led many people to wonder: what happened to <a href="https://theconversation.com/how-taiwan-beat-covid-19-new-study-reveals-clues-to-its-success-158900">Taiwan’s COVID success story</a>?</p>
<p>One part of the answer is a very slow vaccine rollout. Australia should take heed.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1395513738984181760"}"></div></p>
<h2>How serious is Taiwan’s current outbreak?</h2>
<p>On May 9, Taiwan recorded zero new community cases of COVID-19 (there was one imported case in quarantine). But only five days later, new local cases had <a href="https://www.cbsnews.com/news/taiwan-covid-cases-previous-success-story-now-record-coronavirus-surge/">risen exponentially to 29</a>, and then to a peak of <a href="https://www.reuters.com/article/health-coronavirus-taiwan-cases-idUSB9N2L2027">333 on May 17</a>. And on Saturday, the country’s health department retrospectively <a href="https://www.taiwannews.com.tw/en/news/4208341">added an extra 400 cases</a> to the previous week which were not included in earlier reports. </p>
<p>Although these numbers are still very low in comparison to many other countries, the fact that these new cases were spread across many cities and counties alarmed health officials. Previously, when Taiwan had its first peak — <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&pickerSort=desc&pickerMetric=new_cases_smoothed_per_million&hideControls=true&Metric=Confirmed+cases&Interval=New+per+day&Relative+to+Population=false&Align+outbreaks=false&country=%7ETWN">in March 2020 with 27 new cases</a> — almost all cases were from overseas and were successfully isolated. Now the opposite is happening, with almost all new cases spreading in the community.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-taiwan-beat-covid-19-new-study-reveals-clues-to-its-success-158900">How Taiwan beat COVID-19 – new study reveals clues to its success</a>
</strong>
</em>
</p>
<hr>
<p>The <a href="https://www.theguardian.com/world/2021/may/19/taiwan-raises-covid-alert-level-amid-rise-in-infections">current alert level three</a> mandates wearing masks outside the home and limits people gatherings to five indoors and ten outdoors. This falls short of establishing a lockdown.</p>
<p>Taiwan is also temporarily barring any non-residents and transit travellers from entering the country. And there are restrictions on attending public venues, as well as sporting, entertainment and recreational events.</p>
<p>Level four, the highest level of the country’s restrictions would include the country’s first mass lockdown. This would <a href="https://www.taiwannews.com.tw/en/news/4203460">only be triggered</a> after 14 consecutive days of more than 100 cases, with 50% or more being of unknown origin.</p>
<h2>Taiwan’s recent COVID surge</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/402088/original/file-20210521-23-1fx6sp4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/402088/original/file-20210521-23-1fx6sp4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/402088/original/file-20210521-23-1fx6sp4.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/402088/original/file-20210521-23-1fx6sp4.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/402088/original/file-20210521-23-1fx6sp4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/402088/original/file-20210521-23-1fx6sp4.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/402088/original/file-20210521-23-1fx6sp4.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Data up to May 21, 2021.</span>
<span class="attribution"><a class="source" href="https://ourworldindata.org/covid-cases">Our World in Data</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>What went wrong?</h2>
<p>Until now, Taiwan was able to prevent the virus from spreading in the community, and contain it to a few imported cases, by its extensive public health infrastructure. This includes quarantine in a government facility <a href="https://www.boca.gov.tw/cp-220-5081-c06dc-2.html">or at home</a> <a href="https://www.smartraveller.gov.au/destinations/asia/taiwan">for incoming travellers</a>, and quarantine of close contacts of positive cases. This infrastructure was established before COVID and <a href="https://doi.org/10.1016/j.lanwpc.2020.100044">enabled the country to respond</a> quickly and in a coordinated manner to it.</p>
<p>Taiwan’s effective methods for isolation and quarantine were aided by using digital technologies for identifying potential cases, and widespread use of face masks.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1393953036473671682"}"></div></p>
<p>This previous COVID success might have led to the government to focus on other priorities rather than investing in resources for mass COVID testing. Indeed, in Taiwan it <a href="https://www.theguardian.com/world/2021/may/19/taiwan-raises-covid-alert-level-amid-rise-in-infections">hasn’t been seen as cost-effective</a> to roll out mass testing without many (or any) cases.</p>
<p>Now, Taiwan has ramped up its testing capacity over the past week as much as possible, but still falls short in comparison to Australia, which conducts far more tests per 1,000 population.</p>
<p>Taiwan’s success also may have led to its people having <a href="https://www.nytimes.com/live/2021/05/20/world/covid-vaccine-coronavirus-mask/for-a-year-taiwan-kept-the-virus-at-bay-no-longer">less of an urgency</a> to get vaccinated.</p>
<h2>Where does Taiwan stand on COVID vaccinations?</h2>
<p>Only about <a href="https://www.nytimes.com/2021/05/20/world/asia/taiwan-covid-outbreak.html">1% of the population</a> was vaccinated against COVID when this outbreak started.</p>
<p>Taiwan’s government invested early in <a href="https://www.nytimes.com/2021/05/20/world/asia/taiwan-covid-outbreak.html">developing a local vaccine</a>, which has yet to come to market. This could be <a href="https://www.nytimes.com/2021/05/20/world/asia/taiwan-covid-outbreak.html">one explanation</a> for why Taiwan came late to ordering vaccines from international suppliers, and is still awaiting further shipments from overseas.</p>
<p>Only last week did a second shipment of the AstraZeneca vaccine <a href="https://focustaiwan.tw/society/202105190021">arrive in Taiwan</a> through the global <a href="https://www.gavi.org/covax-facility">COVAX facility</a>. However, this <a href="https://www.cdc.gov.tw/En/Bulletin/Detail/P2GKkWEQ6H7Yr21JWgzRGA?typeid=158">contained only 410,400 vaccine doses</a>. Taiwan’s population is 23 million.</p>
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<h2>This is a warning sign for Australia</h2>
<p>Whatever the reasons for the slow rollout of vaccines so far, for the time being and months to come, neither Taiwan nor Australia are even close to herd immunity against COVID.</p>
<p><iframe id="Z3bz0" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Z3bz0/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Testing, tracing and isolation are still going to be important long into the future for both countries.</p>
<p>In saying that, even countries with the highest per capita vaccine rollout can suffer a new wave of the virus, <a href="https://theconversation.com/covid-is-surging-in-the-worlds-most-vaccinated-country-why-160869">for example Seychelles</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-is-surging-in-the-worlds-most-vaccinated-country-why-160869">COVID is surging in the world's most vaccinated country. Why?</a>
</strong>
</em>
</p>
<hr>
<p>There may be outbreaks in places where not enough people have been vaccinated to achieve herd immunity, or where variants of the coronavirus are resulting in less protection in those vaccinated against the original strain.</p>
<p>Nevertheless, short of attempting to eliminate the virus by strict isolation (not only of cases but of the whole population from abroad) and severe quarantine or lockdown measures, getting everyone vaccinated as soon as possible is the best approach to a lasting COVID-free world. </p>
<p>Taiwan’s COVID surge demonstrates this virus has the capacity to break through isolation and quarantine barriers at any time, in any country. Many countries <a href="https://theindependentpanel.org">need to be better prepared</a>.</p>
<p>The current situation in Taiwan should be a warning to other countries that you can’t let your guard down anywhere yet.</p><img src="https://counter.theconversation.com/content/161341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maximilian de Courten is director of the Mitchell Institute a Think Tank for Education and Health Policy. </span></em></p>Only about 1% of the population was vaccinated against COVID when this outbreak started.Maximilian de Courten, Professor in Global Public Health and Director of the Mitchell Institute, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1516562021-05-18T20:05:42Z2021-05-18T20:05:42ZFor teenagers, the internet helps during lockdowns but it’s no substitute for the outside world<figure><img src="https://images.theconversation.com/files/401381/original/file-20210518-17-1n2gc8k.jpeg?ixlib=rb-1.1.0&rect=0%2C7%2C5054%2C3351&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The internet has helped teenagers continue learning and connect with others.</span> <span class="attribution"><span class="source">(Aziz Achkari/Unsplash)</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The ongoing COVID-19 pandemic has accelerated the creation — and evolution — of a new socio-technical environment around the world. Lockdowns across Canada spurred an unprecedented surge in online communication as people moved school, work and social lives online. </p>
<p>In the midst of the first lockdowns in Canada in 2020, a group of teens in Kingston, Ont., explored and analyzed their own experiences of connection during this unparalleled time of social isolation. With the sudden shift to virtual learning and restrictions on in-person gatherings, they wanted to explore how their reliance on technology and networked devices for communication and socialization effected their sense of connection to themselves and others.</p>
<p>These teens had previously collaborated in 2017 on a <a href="http://www.equalityproject.ca/resources/disconnectionchallenge/">research project</a> <a href="https://doi.org/10.17269/s41997-020-00347-w">focused on how social media use shapes our sense of connectedness</a>. </p>
<p>As vaccinations roll out across Canada, thoughts are cautiously turning to getting back to normal and what that will look like. As decision-makers begin to shape the world moving forward, it’s a good time to share the <a href="http://www.marissabellino.com/uploads/7/6/6/1/7661682/revolutionizing_education__youth_participatory_action_research__critical_youth_studies_.pdf">Youth Participatory Action Research</a> project that we, and this same dynamic team of teenaged co-researchers, conducted during the spring of 2020.</p>
<figure>
<iframe src="https://player.vimeo.com/video/488580779" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Teenagers participating in the eQuality Project examine their relationship to technology by disconnecting.</span></figcaption>
</figure>
<h2>Maintaining links</h2>
<p>The teens had originally come together in 2019 to learn more about their relationship with technology by disconnecting from their devices for a week and tracking the impact this had on them. When pandemic-related stay-at-home and physical distancing orders forced them to disconnect from everything but technology, it was a perfect opportunity to reconvene and relaunch our experiment, and think through the ways that technology can and can’t connect us when we’re physically isolated.</p>
<p>People often <a href="https://www.basicbooks.com/titles/john-palfrey/born-digital/9780465053926/">assume that teens have an uncomplicated relationship with technology</a>. Yet, this this is not always the case, especially for young people who are marginalized. Certainly, the youth members of our research team were the first to admit that they had it easy during the first lockdown: safe houses to live in, families for company and support, and, sufficient internet access for school, work and socializing — things which many others in their communities and around the world don’t have.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/401399/original/file-20210518-21-uvw3ez.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A girl sits at a desk in front of her laptop and writes on a notepad" src="https://images.theconversation.com/files/401399/original/file-20210518-21-uvw3ez.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/401399/original/file-20210518-21-uvw3ez.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/401399/original/file-20210518-21-uvw3ez.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/401399/original/file-20210518-21-uvw3ez.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/401399/original/file-20210518-21-uvw3ez.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/401399/original/file-20210518-21-uvw3ez.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/401399/original/file-20210518-21-uvw3ez.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Access to the internet is important for maintaining connections.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>At the same time, after examining their own experiences of using networked technologies during the first lockdown, our teen researchers concluded that connecting over computers can only connect you so much. Although they continued to chat online with their closest friends, the link between them and their wider community of peers was much more difficult to maintain virtually. Reflecting on this loss, one research team member said: </p>
<blockquote>
<p>“Normally I would consider myself to be friends with people that I would see and talk with at school, or at extracurriculars. Now, I only have frequent contact with very few people that I am close with, and I am missing out on talking to these other people. I do not know them well enough to Facetime them one-on-one, or to have a lengthy conversation online.” </p>
</blockquote>
<p>Beyond their connections with their peers, the youth also reflected on their connections to their broader community:</p>
<blockquote>
<p>“My sense of community is changed during isolation. I would normally feel like a part of a community through experiences of walking outside in the neighbourhood and seeing other people walking or being out in the garden. I didn’t have to actually speak with them, but I would see people around me and feel connected. This experience made me realize that feeling like a part of a community really affects how connected you feel to others, and can’t be replaced by some online communication.”</p>
</blockquote>
<h2>Real world connection</h2>
<p>Even though these teens had access to a lot of technology — and by extension, the ability to communicate online with others — being so physically disconnected felt incredibly lonely.</p>
<p>The limits of online interaction highlights how important physical co-presence is to a sense of belonging. One of the youth shared their experiences during lockdown:</p>
<blockquote>
<p>“I think for me loneliness isn’t just talking to someone. I feel like I need to be in a group or just be able to see and be physically close with someone who I am talking to. Because even if I am in a group and I am not speaking to people around me, I can actually see that I am a part of something bigger. And not in a philosophical way, but as part of a community, whatever the community it.</p>
<p>So that is what stops the loneliness. I don’t think it’s talking to someone, it’s just being around people. And I think that has to be something that is physically present and that the virtual world doesn’t carry across. Because in spite of all the technology in the world, I still notice that I am alone in my room.”</p>
</blockquote>
<p>Our teen researchers’ results certainly challenge the common misunderstanding that <a href="https://www.theguardian.com/technology/2013/oct/21/teenagers-careless-about-online-privacy">young people are digital natives who were born into the digital environment with the will and ability to navigate it with relative ease</a>. While they continue to manage, every member of our teen research team says that they would take the offline world over the online world any day. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/401405/original/file-20210518-23-1ho2gxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Seven children running down a school hallway" src="https://images.theconversation.com/files/401405/original/file-20210518-23-1ho2gxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/401405/original/file-20210518-23-1ho2gxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/401405/original/file-20210518-23-1ho2gxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/401405/original/file-20210518-23-1ho2gxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/401405/original/file-20210518-23-1ho2gxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/401405/original/file-20210518-23-1ho2gxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/401405/original/file-20210518-23-1ho2gxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Teenagers look forward to getting back out in the world — the internet isn’t a substitute for in-person interactions.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Face-to-face community</h2>
<p>Our teen researchers want decision-makers to know that relying on networked communications is not working. As one put it: </p>
<blockquote>
<p>“It is strange. I feel like as humans we interact better on a face to face basis. So now that I have been talking to my friends more online, I want to see them in person now and have those face to face conversations because I feel like they are more valuable and they are better.”</p>
</blockquote>
<p>It’s important for adult decision-makers to learn from young people’s experiences of the pandemic isolation and to take their perspectives and needs seriously. This team of teen researchers reminds us that: “The world of technology is huge but the world of our actual world is way bigger. And we all feel like that is so much more valuable.” </p>
<p>As we readjust to life as the pandemic moves towards some kind of resolution, let’s ensure we protect that real world.</p>
<p><em>This article is based on the primary research of our youth research team: Catriona Farquharson, Isobel Moore, Lucas Olmstead, Lily Rich and Adam Tibi.</em></p><img src="https://counter.theconversation.com/content/151656/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Valerie Michaelson receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Robert Porter receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Valerie Steeves receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p>Teens have acutely felt the effects of the pandemic lockdowns on their social lives. As the end of stay-at-home orders draws nearer, it’s important to consider teenagers’ social and emotional needs.Valerie Michaelson, Assistant Professor, Department of Health Sciences, Brock UniversityRobert Porter, L’Université d’Ottawa/University of OttawaValerie Steeves, Full Professor, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1610842021-05-18T10:03:43Z2021-05-18T10:03:43ZIt may not be possible to bring all Australians with COVID home from India. But we can do better than we are now<p>A 47-year-old Sydney man has <a href="https://www.smh.com.au/national/sydney-man-dies-in-india-after-contracting-covid-19-20210518-p57sv8.html">died in India</a> after contracting COVID-19. </p>
<p>This news comes amid anger after <a href="https://www.theguardian.com/australia-news/2021/may/15/half-full-india-repatriation-flight-lands-in-darwin-after-travel-ban-lifts">the first repatriation flight</a> from India following the controversial <a href="https://www.theguardian.com/australia-news/2021/may/06/australias-india-travel-ban-how-other-countries-are-managing-their-returning-citizens">travel ban</a> arrived in Darwin half empty on Saturday. Some 40 passengers tested positive for COVID-19 meaning neither they, nor their close contacts, were allowed to travel.</p>
<p>There’s no suggestion the Sydney man was due to board that flight, or any subsequent repatriation flight. But his case puts a spotlight on the current situation in India, where countless Australians <a href="https://www.canberratimes.com.au/story/7237941/heartbreak-of-australians-trapped-in-india/">are imploring</a> the government to bring them home from a country in deep COVID crisis. </p>
<p>I would argue we can, and should, bring home at least some COVID-positive Australians — particularly those at highest risk of needing hospital-level care.</p>
<h2>Weighing up the risks</h2>
<p>Since Saturday’s repatriation flight, there’s also been controversy over the <a href="https://www.abc.net.au/news/2021-05-16/india-repatriation-flight-covid-19-passengers-test-negative-lab/100142182">reliability of the tests</a> which deemed so many passengers ineligible to travel. It’s critical the Australian government irons this out to ensure pre-flight testing is as accurate as possible.</p>
<p>Although, even if all passengers do test negative before flying, we still can’t guarantee a flight out of India, or any country, will have no positive cases on board. There’s a blind spot in testing between the time a person is exposed and when testing will reveal the infection. This gap could be up to ten days, but for most would be <a href="https://www.health.gov.au/resources/publications/phln-evidence-review-on-the-utility-of-covid-19-testing-to-reduce-the-14-day-quarantine-period">two to three days</a>.</p>
<p>We know even with pre-flight screening requirements <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/covid-surveillance-report-20210513.pdf">up to 1% of passengers</a> are positive by the time they arrive in Australia. </p>
<p>At least if we know certain passengers are COVID positive at the time of boarding, we can manage the risk of transmission in transit.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-australias-india-travel-ban-legal-a-citizenship-law-expert-explains-160178">Is Australia's India travel ban legal? A citizenship law expert explains</a>
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<h2>Flying COVID-positive Australians home safely</h2>
<p>Despite our best efforts, we can’t rule out the risk of transmission if there are COVID-positive travellers on a flight.</p>
<p>However, transmission on planes appears to have been relatively infrequent. Recent reports of <a href="https://www.news.com.au/world/asia/47-passengers-test-positive-after-overseas-flight/news-story/66440c32e75883100c3728927a557423">high positive rates</a> on arrival and in quarantine may signal high rates of pre-flight exposure and transmission in transit — it’s hard to assess to what degree on-board transmission is a factor.</p>
<p>Although we know being in an enclosed space with someone with COVID-19 for a long time is high risk, the air in the cabin is filtered and turned over very regularly and therefore <a href="https://theconversation.com/worried-about-covid-risk-on-a-flight-heres-what-you-can-do-to-protect-yourself-and-how-airlines-can-step-up-150735">protects against viral spread</a>. This could be why transmission on flights is not as common as we might expect.</p>
<p>That said, if we do knowingly put COVID-positive people on a flight with other passengers and crew, it would be important to take extra precautions. </p>
<figure class="align-center ">
<img alt="A woman sleeping on a plane, wearing headphones and a face mask." src="https://images.theconversation.com/files/401207/original/file-20210518-21-1kgbw9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/401207/original/file-20210518-21-1kgbw9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/401207/original/file-20210518-21-1kgbw9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/401207/original/file-20210518-21-1kgbw9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/401207/original/file-20210518-21-1kgbw9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/401207/original/file-20210518-21-1kgbw9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/401207/original/file-20210518-21-1kgbw9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the age of COVID, there’s always some level of risk associated with taking a flight.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>All crew on repatriation flights should be vaccinated regardless. To minimise the risk further, all crew dealing directly with COVID-positive passengers should be wearing full personal protective equipment (PPE). </p>
<p>COVID-positive passengers should be seated in a separate section of the plane to those who have tested COVID negative. An analysis of <a href="https://wwwnc.cdc.gov/eid/article/26/11/20-3299_article">possible on-board transmission</a> during a flight from London to Hanoi demonstrated most infection risk was restricted to the business class section, with attack rates dropping when people were two or more seats apart.</p>
<p>Commissioning large planes with more space to spread passengers out and group them according to risk would help in this regard.</p>
<p>It’s already a requirement that everyone on board must wear a mask unless eating or drinking. Of course, none of this eliminates the risk completely, just as negative tests might still allow someone incubating the virus on board. </p>
<p>It would also be important to consider end-to-end safety including using separate buses from the airport for COVID-positive patients.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-can-the-world-help-india-and-where-does-that-help-need-to-go-160174">How can the world help India — and where does that help need to go?</a>
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<p>Another option would be dedicated flights for COVID-positive passengers.</p>
<p>Either way, it’s essential to have medical staff on board to provide care for travellers, if needed, and oversee infection control. </p>
<h2>Accommodating COVID-positive returned travellers in quarantine</h2>
<p>At present, Howard Springs, the Darwin quarantine facility housing returned Australians from India, is aiming to keep the number of COVID-positive residents <a href="https://www.abc.net.au/news/2021-05-17/nt-new-covid-case-from-india-repatriation-flight-darwin/100143632">at 50 or below</a>.</p>
<p>Over time, COVID cases are increasingly likely to be asymptomatic or have mild disease if more people are vaccinated, and therefore shouldn’t need high levels of medical care. If most can stay in normal quarantine accommodation, maybe this could see the number of positive cases Howard Springs can accommodate increased. </p>
<p>If there’s a sound reason for this cap to remain as is, we should still use this capacity to enable evacuation of known cases at high risk of needing hospital care in India.</p>
<p>Sticking to a cap of 50 would likely mean we couldn’t accommodate every COVID-positive Australian who wanted to return home. But we could prioritise those at greatest risk of serious COVID disease, such as older people and those with underlying illnesses. Medical professionals would be on the ground to decide who qualifies as the highest priority.</p>
<h2>We need to shift our mindset</h2>
<p>Would we feel we had balanced the risks well if our thorough off-shore screening were to result in only a few positive cases in Howard Springs this month, while some people left in India were to die as a result of the virus and inadequate hospital care?</p>
<p>We pat ourselves on the back for what we achieved in containing the first wave by moving hard and fast, and rightly so. But as we’ve learnt more about the virus, we have become more determined to simply keep it out rather than use our knowledge and increased public health response capacity to control it.</p>
<p>We are now vulnerable and are resorting to inhumane steps to protect ourselves. Given the devastating situation in India, I believe it’s time to step back and weight up the true costs of the “zero tolerance” strategy underpinning our approach to repatriation. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-variants-are-most-likely-to-blame-for-indias-covid-surge-159911">Why variants are most likely to blame for India's COVID surge</a>
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<img src="https://counter.theconversation.com/content/161084/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Bennett receives funding from NHMRC and MRFF. Catherine is an independent expert advisor on the nelwy formed Advisory Board for AstraZeneca Australia.</span></em></p>It’s feasible to bring home at least some of the COVID-positive Australians stranded in India. Here’s how we can do it while keeping infection risk at a minimum.Catherine Bennett, Chair in Epidemiology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1608652021-05-16T19:56:21Z2021-05-16T19:56:21ZAustralia risks becoming a hermit nation. Here’s a five-step road-map to reopen our borders safely<figure><img src="https://images.theconversation.com/files/400881/original/file-20210516-13-ivn34j.png?ixlib=rb-1.1.0&rect=269%2C0%2C3724%2C2000&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Wes Mountain/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>National capability — and you might also say, national character — can be revealed in a crisis. So, what has COVID-19 taught us about Australia?</p>
<p>It has taught us, amid many examples of failed leadership across the world, that Australia possesses a strong capacity for effective action in times of need. </p>
<p>Our leaders and people have been able to act with bipartisan unity. Our expert institutions, including our public health bodies, have proved generally up to the task of protecting our people. </p>
<p>And government has been prepared to take significant measures to avoid a catastrophic economic downturn.</p>
<h2>A return to isolation and protectionism</h2>
<p>As for the national character, the picture is more mixed.</p>
<p>The pandemic has certainly illustrated the limits of any mythological notion of “Australianness”.</p>
<p>Despite our celebration of larrikinism, the pandemic has demonstrated we are a <a href="https://theconversation.com/an-obedient-nation-of-larrikins-why-victorians-are-not-revolting-145675">compliant people</a> when it comes to taking orders from authorities – though this has arguably helped in ensuring high levels of adherence to public health orders.</p>
<p>Nor has the pandemic demonstrated a clear triumph of Australian egalitarianism and the fair go. There were times when we’ve resembled an individualistic rabble, what with the widespread hoarding of supplies in the early stages of the pandemic. A fair go wasn’t necessarily extended to Asian Australians, who have experienced a <a href="https://www.sbs.com.au/news/the-feed/what-it-s-like-to-be-asian-in-australia-since-covid-came-knocking">significant spike in racism</a> during this pandemic.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1286394255095693312"}"></div></p>
<p>One historic aspect of the national character, though, has indisputably come to the fore. We’ve seen a return of a “<a href="https://theconversation.com/fortress-australia-what-are-the-costs-of-closing-ourselves-off-to-the-world-160612">Fortress Australia</a>” mentality. This sees Australia as an island nation forever beset by threats from outside, whether it’s people or pathogens.</p>
<p>For many Australians, there is nothing bad at all with having national borders closed indefinitely. We shouldn’t rush to re-engage with the world, not when there’s a deadly virus in circulation. </p>
<p>National isolation is seen as a fair price to ensure the country stays “safe”. People who journey beyond our shores to be with their loved ones as they die or reunite with their partners and children are castigated for putting us all at risk.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/fortress-australia-what-are-the-costs-of-closing-ourselves-off-to-the-world-160612">'Fortress Australia': what are the costs of closing ourselves off to the world?</a>
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<h2>Moving away from fear towards recovery</h2>
<p>That’s one way to look at COVID-19. But, for the past six months, as part of a <a href="https://www.sydney.edu.au/sydney-policy-lab/our-research/open-society-common-purpose-taskforce.html">collaborative taskforce</a> examining how Australia should respond to COVID-19, we have been exploring an alternative to Fortress Australia.</p>
<p>There should be no false choice between remaining closed or open: modern Australia simply can’t exist in parochial isolation. Our economy depends on trade and immigration. Our society and culture are deeply connected to the rest of the world. The majority of Australians were either born overseas or have a parent who was.</p>
<p>However, this version of Australia is now being put at risk by the prospect of an indefinite extension of our closed borders, and by some national politicians who revel in the protectionism it invites.</p>
<p>We believe the urgency Australia showed in initially suppressing and then locally eliminating COVID-19 now needs to be shown towards preparing the country to reopen to the rest of the world. </p>
<p>If Australia isn’t ready to reopen effectively when the world recovers from the worst of the pandemic, we will face enormous social dislocation and prolonged economic pain. We need to move from fear and anxiety to a more confident stance of national recovery. Otherwise, we will be left behind as a hermit nation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/garbage-and-cash-cows-temporary-migrants-describe-anguish-of-exclusion-and-racism-during-covid-19-146098">'Garbage' and 'cash cows': temporary migrants describe anguish of exclusion and racism during COVID-19</a>
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<p>Indeed, we can’t do as some suggest — only open up when zero COVID transmissions can be guaranteed. The reason is simple, and it’s based on the science. The virus causing COVID-19 (SARS CoV-2) will not disappear from the world. We need to acknowledge and respond to this reality.</p>
<p>Here’s a more realistic and sensible option: we need a plan to re-open Australia to the world in a controlled, risk-weighted and staged manner. This would prevent any large outbreaks associated with an excessive burden on the health care system or loss of life.</p>
<p>In some respects, Australia has already proven it can do this. Since the emergence of COVID-19, <a href="https://www.abs.gov.au/statistics/industry/tourism-and-transport/overseas-arrivals-and-departures-australia/latest-release#resident-returns-calendar-year-2020">some 250,000 people</a> (citizens, permanent residents and short-term visitors) have arrived on our shores. And cases have been kept to a minimum, despite the creakiness of hotel quarantine.</p>
<h2>A five-step roadmap for reopening</h2>
<p>We provide the <a href="https://www.sydney.edu.au/content/dam/corporate/documents/sydney-policy-lab/open-society-common-purpose.pdf">following roadmap</a> for Australia to reopen to the world. Australia needs to pursue:</p>
<ol>
<li><p>a comprehensive and successful vaccination program </p></li>
<li><p>pilot programs for re-opening prior to the conclusion of the vaccination program to support industries critical to Australia’s economy, including tourism and the creative industries, horticultural farming and international education</p></li>
<li><p>a certification scheme, across these programs, which permits only those with documented vaccination and/or SARS CoV-2 immunity to enter Australia or travel overseas</p></li>
<li><p>improved border protection measures involving rapid testing on arrival</p></li>
<li><p>a new range of new risk-weighted quarantine measures, complementing the maintenance of hotel quarantine for those who come from high-risk countries, refuse testing or test positive on arrival.</p></li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-we-vaccinate-all-returned-travellers-in-hotel-quarantine-its-no-magic-fix-but-it-could-reduce-risks-160711">Should we vaccinate all returned travellers in hotel quarantine? It's no magic fix but it could reduce risks</a>
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<p>If Australia were to pursue this, it would be in a strong position to restore its immigration program to its pre-COVID levels by 2022-23, assuming the continuing suppression of the virus.</p>
<p>This challenge is a long way from the comforts of a retreat to Fortress Australia. But it’s necessary – at least if we want to remain a country that is engaged with the world.</p>
<p>One thing, though, is clear. Reopening requires not only building a path towards rapid large-scale vaccination of the Australian population and changes to our quarantine system, it requires the urgent building of a “psychological runway” for reopening. We need Australians to be mentally ready for re-engagement. </p>
<p>Yes, we can take pride in how Australia has been winning the “war” against COVID-19. But it’s time now for us to start thinking about winning the “peace”.</p><img src="https://counter.theconversation.com/content/160865/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We can’t retreat to the comforts of ‘Fortress Australia’ if we want to remain a country that is engaged with the world.Tim Soutphommasane, Professor of Practice (Sociology and Political Theory) Director, Culture Strategy, University of SydneyMarc Stears, Professor and Director, Sydney Policy Lab, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1601322021-05-13T15:28:47Z2021-05-13T15:28:47ZQuarantine hotels: A history of controversy and occasional comfort<figure><img src="https://images.theconversation.com/files/398787/original/file-20210505-19-cftczk.jpg?ixlib=rb-1.1.0&rect=68%2C0%2C6422%2C4378&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A person stands in the window in a room at a government-authorized COVID-19 quarantine hotel in Richmond, B.C.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><p>When governments in <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/latest-travel-health-advice/mandatory-hotel-stay-air-travellers.html">Canada</a>, the <a href="https://www.gov.uk/guidance/booking-and-staying-in-a-quarantine-hotel-when-you-arrive-in-england">United Kingdom</a>, <a href="https://www.gov.ie/en/publication/a6975-mandatory-hotel-quarantine/">Ireland</a>, <a href="https://www.miq.govt.nz/being-in-managed-isolation/entering-isolation/welcome-pack/welcome-pack/">New Zealand</a> and <a href="https://www.euronews.com/travel/2021/02/24/quarantine-hotels-which-countries-are-using-them-to-stop-arrivals-spreading-covid">elsewhere</a> instituted mandatory hotel quarantines for travellers arriving in their countries as a way of monitoring the spread of COVID-19, they received both <a href="https://ipolitics.ca/2021/03/25/most-canadians-in-favour-of-hotel-quarantine-rules-mainstreet-poll/">praise</a> and <a href="https://www.ctvnews.ca/health/coronavirus/canada-s-covid-19-isolation-hotels-complaints-of-secrecy-poor-communication-1.5304344">criticism</a>. </p>
<p>Some citizens questioned why their <a href="https://nationalpost.com/news/federal-court-refuses-to-end-quarantine-hotel-rules-saying-health-order-remains-until-full-hearing-in-june">rights of mobility were being curtailed</a> in their own countries. Would-be travellers factored additional costs into their budgets or deferred travel. And others sought to <a href="https://www.ctvnews.ca/health/coronavirus/canadians-avoiding-hotel-quarantines-for-air-travellers-fuel-taxi-boom-on-u-s-border-1.5401771">evade the measures</a>. </p>
<p>Exploring the history of quarantine hotels reveals ambivalences and inequities that continue to fuel debates over their effectiveness in the era of COVID-19.</p>
<h2>Hotels make sense</h2>
<p>There is a logic behind choosing hotels for mandatory quarantine and for other COVID-19-era public-health measures such as re-housing people experiencing homelessness. The latter was done at the former Roehampton Hotel in Toronto, where it was met with <a href="https://www.blogto.com/city/2021/02/toronto-buildings-turned-into-homeless-shelters-past-year">controversy from affluent community members</a>. </p>
<p>Hotels supply space. Their capacity and interior organization means that individuals and households can be separated and monitored. Meals can be supplied with minimal contact and movements can be tracked. </p>
<p>Historian Kenneth Morrison, an expert on hotels in times of crisis, says:</p>
<blockquote>
<p>“Hotels are exceptionally adaptable buildings. Recently, of course, we have seen hotels repurposed as quarantine centres or temporarily used as large homeless shelters to protect those most vulnerable from the ravages of the COVID-19 pandemic. And while they are built for a commercial purpose, hotels’ internal infrastructures mean that these spaces can be adapted to function effectively in quite different circumstances.”</p>
</blockquote>
<figure class="align-center ">
<img alt="Man holds up bracelet on wrist" src="https://images.theconversation.com/files/398785/original/file-20210505-21-2upbj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398785/original/file-20210505-21-2upbj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398785/original/file-20210505-21-2upbj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398785/original/file-20210505-21-2upbj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398785/original/file-20210505-21-2upbj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398785/original/file-20210505-21-2upbj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398785/original/file-20210505-21-2upbj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A traveller holds up an electronic monitoring bracelet he is required to wear after returning from abroad at the Ben Gurion airport near Tel Aviv, Israel. The bracelets are an alternative to quarantine hotels.</span>
<span class="attribution"><span class="source">(AP Photo/Sebastian Scheiner)</span></span>
</figcaption>
</figure>
<p>Governments have been tapping into a long tradition of adapting hotels for new purposes. When that happens, values popularly attached to hotel life can change. </p>
<h2>Hotels as vectors of disease</h2>
<p>We imagine hotels as places of freedom and even anonymity — despite being tracked by eyes and cameras from arrival to departure, our credit cards being on file and each swipe of our key card revealing our comings and goings. The quarantine hotel renders such operations visible, conjuring the <a href="https://www.youtube.com/watch?v=jVHhV3A5C5c">Eagles’ <em>Hotel California</em></a>, a place “you can never leave.” </p>
<p>Bob Davidson, a researcher who looks at cultural theories of space, food and hospitality, says: </p>
<blockquote>
<p>“Hotels have a long history of detention. Easily repurposed, their spaces can quickly change from leisure to confinement, with lobbies becoming checkpoints and rooms ostensible cells for those who cannot wait to go home.” </p>
</blockquote>
<p>And for many hotel residents — <a href="https://www.cdc.gov/legionella/about/history.html">refugees awaiting processing</a>, for instance — a stay at a hotel resembles none of the glamour and exhilaration associated with the comfort and style of sleek modern buildings or historic grand hotels. In fact, experiences of hotel immobility have been highly conditioned by citizenship status as well as class. When emergencies lay bare the tensions between customary expectations amongst travellers and the requirements of the state, they offer opportunities to reflect on hotels’ role in such debates.</p>
<p>Hotels have been seen in times of public-health emergencies as vectors of disease. The rapid spread of <a href="https://www.cdc.gov/legionella/about/history.html">Legionnaires’ disease</a> during a convention in 1976 in Philadelphia offers a tragic case in point.</p>
<p>History offers many such cases of anxiety focused on hotels. With their transient populations, disease could spread quickly within, and beyond their walls. Staff cycle in and out, and guests come and go. </p>
<p>Medical authorities have often decided to confine ill and potentially ill people within a hotel at first sight of an outbreak. Hence the frequency of hotel quarantine, not just in the eras of smallpox and diphtheria, but also, <a href="https://www.reuters.com/article/us-flu-hongkong-sb-idUKTRE54054T20090501">more recently during H1N1</a>. </p>
<h2>From grim to luxurious</h2>
<p>Efforts to enforce hotel quarantines have often been fraught. Historically, many hotels in <a href="https://www.cpha.ca/sites/default/files/assets/history/book/history-book-print_all_e.pdf">places of high transience</a> — such as ports — housed workers of lower socioeconomic status attracted particular concern. They attracted concern, and anxieties were partially due to the quality of amenities in the buildings, which were susceptible to spread disease. </p>
<p>When buildings were placed under lockdown <a href="https://theconversation.com/why-are-australians-so-accepting-of-hotel-quarantine-a-long-history-of-confining-threats-to-the-state-155747">in the face of smallpox</a>, for instance, the experience could be grim. </p>
<p>But experiences of quarantine could also be comfortable — and even luxurious. A case from summer 1903 in Canada illustrates this point. <em>The Toronto Daily Star</em> reported that a health inspector imposed a quarantine on Gouldie House, a summer resort hotel in Dwight, Ont., after the proprietor’s daughter died of diphtheria. Residents continued to swim and enjoy conversation with other cottagers and friends, albeit at a 20-foot distance.</p>
<p>We might draw parallels today with cultures of resistance to enforced stays, even in the <a href="https://www.huffingtonpost.ca/entry/canada-quarantine-hotels-price-location_ca_60342506c5b67c32961fe829">comparative comfort of a modern hotel</a>, where food is delivered to rooms and Wi-Fi and basic comforts are on offer. </p>
<figure class="align-center ">
<img alt="People with suitcases" src="https://images.theconversation.com/files/398789/original/file-20210505-15-1gb4qkw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398789/original/file-20210505-15-1gb4qkw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=416&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398789/original/file-20210505-15-1gb4qkw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=416&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398789/original/file-20210505-15-1gb4qkw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=416&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398789/original/file-20210505-15-1gb4qkw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398789/original/file-20210505-15-1gb4qkw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398789/original/file-20210505-15-1gb4qkw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Travellers arrive at a government-authorized COVID-19 quarantine hotel in Richmond, B.C. last February.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
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<p>There is something about the prescriptive nature of the quarantine that seems to turn the historical openness of the hotel as an institution on its head. This is especially true for people who equate hotel stays with an unusual degree of freedom, whether pilfering the cleaning cart for extra bottles of shampoo or making gratuitous use of towels. The idea of being confined to even a resort hotel challenges many travellers’ belief in their right to come and leave on their own terms. </p>
<h2>Quarantine hotels have been around for decades</h2>
<p>While hotels have often been associated with the problem of contagion, occasionally they have been treated, proactively, as institutions standing at the first line of defence. </p>
<p>When influenza visited Toronto as part of a global pandemic in 1918, two hotels in the city — Mossop Hotel and the Arlington Hotel — <a href="https://www.canadianletters.ca/content/document-354">were readied to accept patients</a>. In Quebec, <em>The Globe and Mail</em> reported in 1937 that the Queen’s Hotel was closed due to several cases of flu and was converted into an influenza hospital. Similarly, during the First and Second World Wars, hotels were adapted to receive the wounded as Canada rushed to <a href="https://www.utpjournals.press/doi/pdf/10.3138/cbmh.16.1.25">increase its hospital capacity</a>. </p>
<p>Many governments around the world have mobilized hotels as part of a precautionary COVID-19 strategy in addressing transborder viral transmission.</p>
<p>In Canada, the federal government has required international air travellers to <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/latest-travel-health-advice/mandatory-hotel-stay-air-travellers/list-government-authorized-hotels-booking.html">quarantine in an approved hotel</a>, at the travellers’ expense. In <a href="https://www.cbc.ca/news/canada/new-brunswick/new-brunswick-hotel-travel-restriction-hotel-quarantine-1.6002253">New Brunswick</a>, similar restrictions were introduced in late April 2021. Considerable controversy has greeted these restrictions: from the alleged porousness of the quarantine to how different rules apply when <a href="https://www.cbc.ca/news/canada/border-land-crossings-1.5994627">crossing the border by car</a>. </p>
<p>Through their precautionary functions, hotels under this regime of travel isolation evoke <a href="https://www.thecanadianencyclopedia.ca/en/article/quarantine-act">historical quarantine stations</a> on countries’ borders. Immigrants were <a href="https://cha-shc.ca/_uploads/5c374fa1a3341.pdf">often kept in such stations</a> upon arrival at land borders and ports, segregated from the wider community until their health status could be determined. </p>
<p>On June 2, 1900, <em>The Globe</em> reported that an outbreak of the bubonic plague in Honolulu led to the confinement of many travellers at a <a href="https://metchosinmuseum.ca/heritage-sites/quarantine-station/">quarantine station at William Head</a> on Vancouver Island. In addition to hospital buildings, a “well-furnished, cheery” home had been separately established for “first-class passengers,” with its own extensive grounds and 9-hole golf course. Most people in this station enjoyed few such luxuries, underscoring just how much hotel life under quarantine was, and remains, shaped by the status and resources of the traveller.</p>
<p>Hotels have unique capacities which have long made them adaptable in emergency conditions. The state has often found uses for them that extend far beyond conventional purpose of housing guests who come and go at their leisure. In the process, the state has had to navigate customary expectations of how hotels should operate. </p>
<p>Experiences under COVID-19 invite us to critically think about how hotels are controlled and inhabited, in different ways, by different populations, and to question assumptions about their association with unfettered freedom and mobility.</p><img src="https://counter.theconversation.com/content/160132/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kevin James receives funding from the Social Sciences and Humanities Research Council of Canada Insight Grant programme.</span></em></p>Exploring the history of quarantine hotels reveals ambivalences and inequities that continue to fuel debates over their effectiveness in the era of COVID-19.Kevin James, Professor, History, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1599962021-05-04T20:06:27Z2021-05-04T20:06:27ZWe have so many good reasons to give international students hope, so why the lack of government urgency?<figure><img src="https://images.theconversation.com/files/398323/original/file-20210503-19-ubycuu.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5742%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Indications are that the federal government is <a href="https://www.theage.com.au/national/victoria/schools-summit-monday-story-20210426-p57ml8.html">very cautious</a> about accepting a Victorian government <a href="https://www.9news.com.au/national/plans-underway-for-international-students-actors-major-event-workers-to-enter-victoria/97aa0b69-db70-4f9f-bbc2-6b1d4d5eed97">proposal</a> to establish an <a href="https://www.theage.com.au/politics/federal/victoria-asks-to-start-second-stream-of-hotel-quarantine-for-business-travellers-20210426-p57mkq.html">additional hotel quarantine stream</a>. The plan is to start bringing back 120 international students and event workers per week from May 24. It might seem like a <a href="https://www.thesaturdaypaper.com.au/news/politics/2021/04/24/getting-overseas-students-back/161918640011524">drop in the ocean</a> – more than <a href="https://theconversation.com/the-government-keeps-shelving-plans-to-bring-international-students-back-to-australia-it-owes-them-an-explanation-158778">150,000 students</a> are stranded overseas – but it’s an important start. </p>
<p>Australia benefits from international students returning: not just directly in the <a href="https://theconversation.com/as-hopes-of-international-students-return-fade-closed-borders-could-cost-20bn-a-year-in-2022-half-the-sectors-value-159328%22%22">higher education sector</a>, which has had <a href="https://theconversation.com/the-coronavirus-outbreak-is-the-biggest-crisis-ever-to-hit-international-education-131138">massive job losses</a> since Australia closed its borders, but also in the <a href="https://theconversation.com/australian-universities-could-lose-19-billion-in-the-next-3-years-our-economy-will-suffer-with-them-136251">flow-on economic benefits</a> from <a href="https://theconversation.com/as-hopes-of-international-students-return-fade-closed-borders-could-cost-20bn-a-year-in-2022-half-the-sectors-value-159328">student spending</a> in areas like housing, food and services. Before the COVID-19 pandemic, international education was Australia’s third-largest export industry, worth about <a href="https://theconversation.com/2021-is-the-year-australias-international-student-crisis-really-bites-153180">A$40 billion a year</a> to the wider economy.</p>
<iframe title="Australian earnings from international education by sector" aria-label="Interactive area chart" id="datawrapper-chart-y4Ly2" src="https://datawrapper.dwcdn.net/y4Ly2/2/" scrolling="no" frameborder="0" style="border: none;" width="100%" height="400"></iframe>
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Read more:
<a href="https://theconversation.com/as-hopes-of-international-students-return-fade-closed-borders-could-cost-20bn-a-year-in-2022-half-the-sectors-value-159328">As hopes of international students' return fade, closed borders could cost $20bn a year in 2022 – half the sector's value</a>
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<p>If a solution is not found soon, there might be fewer international students to return. Australia risks <a href="https://theconversation.com/5-ways-australia-can-get-ahead-in-attracting-and-retaining-chinese-international-students-148444">falling behind competitors</a>, like the <a href="https://www.theguardian.com/australia-news/2021/apr/30/only-7-of-international-students-willing-to-complete-australian-courses-online-survey-shows">United Kingdom, Canada</a> and the <a href="https://thenewdaily.com.au/news/coronavirus/2021/04/28/us-cdc-mask-guidance/">United States</a>, that are welcoming and assisting international students. The long-term impact on <a href="https://www.lowyinstitute.org/the-interpreter/economic-diplomacy-global-tax-education-exports-and-team-australia">Australia’s reputation as a study destination</a> should also be considered.</p>
<p>Many international students have been very tenacious in continuing to study, but they are finding it <a href="https://www.crikey.com.au/2021/04/16/stranded-abroad-international-students-beg-for-end-border-closures/">extremely difficult</a>. They need to believe <a href="https://theconversation.com/the-government-keeps-shelving-plans-to-bring-international-students-back-to-australia-it-owes-them-an-explanation-158778">there is some hope of return</a>.</p>
<p>Victoria’s current proposal is less ambitious than some of its <a href="https://www.theage.com.au/national/universities-hatch-desperate-plan-to-fly-students-in-quarantine-them-20210406-p57gvo.html">earlier plans</a>. It’s a shame it didn’t take up plans to <a href="https://theconversation.com/the-government-keeps-shelving-plans-to-bring-international-students-back-to-australia-it-owes-them-an-explanation-158778">use student accommodation</a> for quarantine. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-unis-can-use-student-housing-to-solve-international-student-quarantine-issues-150180">How unis can use student housing to solve international student quarantine issues</a>
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<p>And it’s a real shame it didn’t look at <a href="https://australiainstitute.org.au/wp-content/uploads/2021/04/P1064-Bringing-back-Chinese-students-WEB.pdf">options other than hotel quarantine</a> for students from low-risk locations. </p>
<p>The return of students from places like Vietnam or Taiwan poses a <a href="https://theconversation.com/whats-the-risk-if-australia-opens-its-international-borders-an-epidemiologist-explains-159208">negligible risk</a> to the Australian community. Ideally the system design should reflect this, leaving more quarantine spots available for those who need them.</p>
<p>Even with these faults, Victoria’s proposal is the first plan that would enable an ongoing stream of international students to return. It doesn’t pit international students against returning Australians: it’s an additional program, so it won’t take a single place from those who are trying to get home. It could build confidence to scale up – and give international students some comfort.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/32Mc5Dp4qfE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Victoria has announced a plan, subject to federal government approval, to enable international students to start returning later this month.</span></figcaption>
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<h2>Why the year-long wait for a plan?</h2>
<p>With such a strong self-interest case for Australia, the question is why this hasn’t been tried sooner. Pilot programs for South Australia and the ACT were <a href="https://www.abc.net.au/news/2020-08-17/return-of-international-students-amid-coronavirus-defended/12564432">announced</a> then <a href="https://www.adelaidenow.com.au/education/sa-international-student-flight-program-postponed-in-covid19-lockdown/news-story/cb3d0a3dad1da18e5adba39115d5c0cd">postponed</a>. New South Wales has called for expressions of interest, but there are <a href="https://www.thesaturdaypaper.com.au/news/politics/2021/04/24/getting-overseas-students-back/161918640011524">no firm plans</a>. The only pilot that <a href="https://www.abc.net.au/news/2020-11-30/international-students-arrive-in-australia-coronavirus-nt/12933370">actually went ahead</a> brought back <a href="https://www.abc.net.au/news/2020-11-30/international-students-arrive-in-australia-coronavirus-nt/12933370">63 incredibly lucky students</a> to Charles Darwin University.</p>
<p>So why hasn’t there been more urgency? Some of the explanations apply to all groups who want to return. </p>
<p>The federal government does not want to take responsibility for quarantine. We saw that again the last few days in <a href="https://www.abc.net.au/news/2021-04-30/victoria-covid-19-quarantine-hub-mickleham-peter-dutton/100106962">its response</a> to Victoria’s plans for cabin-style quarantine on federal land. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/GETItfOfPjw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The federal government is clearly reluctant to take on more responsibility for quarantine arrangements from the states.</span></figcaption>
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<p>Outbreaks from quarantine hotels have spooked state governments and the public. Victoria, which suffered one of the world’s longest lockdowns, has not been as strong an advocate as might have been expected from a state whose <a href="https://djpr.vic.gov.au/priority-industries-sectors/international-education/economic-value-of-victorias-international-education#:%7E:text=International%20education%20has%20been%20Victoria's,almost%2079%2C000%20jobs%20in%202018.">biggest export industry</a> is international education. </p>
<hr>
<p>
<em>
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Read more:
<a href="https://theconversation.com/the-government-keeps-shelving-plans-to-bring-international-students-back-to-australia-it-owes-them-an-explanation-158778">The government keeps shelving plans to bring international students back to Australia. It owes them an explanation</a>
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<h2>Isolationism ultimately hurts Australia</h2>
<p>The lack of urgency in finding solutions to enable travel is hard to explain given the sheer number of people and groups affected, including <a href="https://theconversation.com/the-crisis-in-india-is-a-terrifying-example-of-why-we-need-a-better-way-to-get-australians-home-159917">at least 34,000 stranded Australians</a>, international students, workers in the tourism sector and <a href="https://theconversation.com/as-hopes-of-international-students-return-fade-closed-borders-could-cost-20bn-a-year-in-2022-half-the-sectors-value-159328">ultimately every business</a> that depends on students and migrants. Cutting itself off from the world <a href="https://www.lowyinstitute.org/the-interpreter/strange-connections-isolation">harms Australia deeply</a>.</p>
<p>Prime Minister Scott Morrison’s statement that Australia is in “<a href="https://www.theguardian.com/australia-news/2021/apr/18/australia-plans-staggered-reopening-of-international-borders-in-second-half-of-year">no hurry</a>” to reopen was jarring. Perhaps the <a href="https://thenewdaily.com.au/news/national/2021/05/02/india-travel-ban-australia/?utm_source=Adestra&utm_medium=email&utm_campaign=Sunday%20Best%20-%2020210502">strong reaction</a> to making it a crime to return from India might cause the government to reconsider. <a href="https://www.lowyinstitute.org/publications/covidpoll-2021">Opinion polling</a> shows 33% think the federal government has not done enough to help Australians to return.</p>
<p>For international students in particular the problem has been compounded by the federal government’s lack of sympathy – <a href="https://www.smh.com.au/national/australian-universities-cower-as-disaster-looms-20200920-p55xh6.html">bordering on antipathy</a> – towards the higher education sector. Some of this is likely to be party politics, but one factor worth considering is the impact of <a href="https://www.abc.net.au/news/2019-10-14/chinese-communist-party-gtcom-connection-australian-universities/11586118">defence and security concerns</a> about China in stigmatising international engagement by Australia’s universities. </p>
<p>Australia’s success in international education is now being viewed as <a href="https://www.aspistrategist.org.au/australian-universities-must-rethink-their-broken-business-model-or-risk-failure/">dependence</a>. Some see it as a positive that the higher education sector is being forced into <a href="https://www.aspistrategist.org.au/government-partnership-needed-to-rebuild-universities-business-model/">structural reform</a>. Federal MP Bob Katter went so far as calling universities “prostitutes” who have “<a href="https://www.sbs.com.au/news/the-feed/prostitutes-mp-says-australian-universities-have-sold-out-to-china">sold their bodies and souls</a>” to the Chinese Communist Party. Federal Education Minister Alan Tudge has explicitly <a href="https://www.alantudge.com.au/latest-news/challenges-and-opportunities-in-international-education/">called on</a> universities to diversify <a href="https://theconversation.com/which-universities-are-best-placed-financially-to-weather-covid-154079">students’ source countries</a>.</p>
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Read more:
<a href="https://theconversation.com/which-universities-are-best-placed-financially-to-weather-covid-154079">Which universities are best placed financially to weather COVID?</a>
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<p>It will be a tragedy if Australia manages to kill off its third-largest export industry. Rational economic and public health policy would be for Australia to pull out all stops to help international students to return, particularly those from low-risk countries. Any steps in this direction, no matter how small, would be welcome.</p><img src="https://counter.theconversation.com/content/159996/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Conley Tyler does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>International students have been admirably persistent in studying online for more than a year. But as other countries open their doors, Australia risks losing them if it fails to show they are wanted.Melissa Conley Tyler, Research Associate, Asia Institute, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1577932021-05-04T14:23:04Z2021-05-04T14:23:04ZParents, for your ‘quaranteenager’s’ sexual health, talk to them about taking risks<figure><img src="https://images.theconversation.com/files/398206/original/file-20210501-19-3lsedm.jpg?ixlib=rb-1.1.0&rect=0%2C73%2C5472%2C2973&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For teens, the pandemic has spotlit the risk of not being able to take risks associated with establishing new intimate relationships outside of the family. </span> <span class="attribution"><span class="source">(Pexels/ Helena Lopes)</span></span></figcaption></figure><p>For the past year, the pandemic has shaped <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks.html">how young people have been forced to consider risk</a>. Masks, social distancing, hand washing, staying home — these are new norms of safety for life <a href="https://www.edu.gov.mb.ca/k12/covid/support/rsssn_docs/quaranteen.pdf">as what’s popularly been dubbed</a> a “<a href="https://www.nytimes.com/2020/03/19/well/family/coronavirus-covid-teenagers-teens-parents-kids-family-advice.html">quaranteenager</a>.”</p>
<p>And yet, as the weather warms, and we take tentative steps outside, teenagers will begin to navigate their own <a href="https://www.blogto.com/travel/2021/04/ontario-cottage-country-taking-drastic-lockdown-measures/">desire for face-to-face contact and socializing</a> and their need to stay safe in the pandemic. </p>
<p>As parents work to support teenagers’ emotional and physical well-being this spring and summer, let’s not forget the ways this pandemic has interrupted their sexual development. Teens are <a href="https://doi.org/10.1017/9781108116121">supposed to be establishing new intimate relationships outside of the family</a>.</p>
<p>Instead, a year-long lockdown <a href="https://onlinelibrary.wiley.com/doi/full/10.1363/psrh.12151">has kept teens close to home and increased their time with parents or household members</a> and cut them off from most physical contact with peers. </p>
<p>Just as COVID-19 has required parents to have difficult and frank conversations with the teens about health risks, the pandemic provides an opportunity for parents to have frank conversations about sexuality and safety as well. </p>
<figure class="align-center ">
<img alt="Two people holding hands." src="https://images.theconversation.com/files/398207/original/file-20210501-19-lqr2mp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398207/original/file-20210501-19-lqr2mp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398207/original/file-20210501-19-lqr2mp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398207/original/file-20210501-19-lqr2mp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398207/original/file-20210501-19-lqr2mp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398207/original/file-20210501-19-lqr2mp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398207/original/file-20210501-19-lqr2mp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pandemic provides an opportunity for parents to have frank conversations about sexuality and safety.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Teenage years interrupted</h2>
<p>Like adults, teens have spent the year in various stages of lockdown, but the cost of this time in isolation affects teens differently. Gone are many of the familiar experiences that are important to developing an emerging sense of self and the wider world in high school: dances, sleepovers, concerts, sports, parties, field trips. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-help-high-school-seniors-cope-with-milestones-missed-due-to-coronavirus-139147">How to help high school seniors cope with milestones missed due to coronavirus</a>
</strong>
</em>
</p>
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<p>All these losses add up for teens and emerging research shows the pandemic has taken a <a href="https://www.sickkids.ca/en/news/archive/2021/impact-of-covid-19-pandemic-on-child-youth-mental-health/">toll of young people’s mental well-being</a>. </p>
<p>Sexual health researchers caution that sex education could get lost in a shift to online learning at school. They also speculate that one of the short-term effects of the pandemic on teenagers’ sexual health could be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7515564">less contact with sexual partners — and that “longer term outcomes will almost certainly affect sexual activity and intimate relationships</a>.” </p>
<p>Some clinicians testify that in their pandemic practice they’ve noticed young people are having <a href="https://www.nytimes.com/2020/09/21/well/family/for-young-peoples-sexual-health-the-pandemic-changes-the-game.html">less sex and with fewer partners</a>. </p>
<p>But none of this means teens have given up on sex: A <a href="https://www.scholars.northwestern.edu/en/publications/physical-sex-is-over-for-now-impact-of-covid-19-on-the-well-being">study of gay and bisexual boys aged 14-17 in the United States finds they they are watching more porn</a>. </p>
<p>A study of <a href="https://doi.org/10.3167/ghs.2020.130306">female-identifying Canadian teens aged between 16 and 19 finds girls were more reliant than ever on new media to initiate and maintain dating relationships</a>, using online apps and social media to virtually flirt and hook up. </p>
<h2>Reorienting after COVID-19</h2>
<p>Reorienting ourselves after a year of living under the threat of COVID-19 social, economic and health effects will be difficult. </p>
<p>Besides worrying about viral infection, parents have spent the year concerned about <a href="https://www.stcatharinesstandard.ca/news/niagara-region/2020/05/28/early-research-results-show-impact-of-social-isolation-on-children.html">social isolation</a>, <a href="https://www.cbc.ca/news/health/phys-ed-covid-1.5767912">lack of exercise</a> and <a href="https://www.theglobeandmail.com/canada/article-why-its-time-to-stop-worrying-about-your-childrens-screen-time-during/">digital over-exposure</a>.</p>
<p>As teens slowly emerge from the pandemic and reconnect in real life with their peers, they will bring this experience of living under lockdown to their dating and romantic relationships. </p>
<figure class="align-center ">
<img alt="Teens walk in an alley." src="https://images.theconversation.com/files/397196/original/file-20210426-15-1obshp6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/397196/original/file-20210426-15-1obshp6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/397196/original/file-20210426-15-1obshp6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/397196/original/file-20210426-15-1obshp6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/397196/original/file-20210426-15-1obshp6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/397196/original/file-20210426-15-1obshp6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/397196/original/file-20210426-15-1obshp6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A group of teens walk through Fan Tan Alley in downtown Victoria, Nov. 26, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Marissa Tiel</span></span>
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</figure>
<h2>Rethinking ‘good’ parenting of teens</h2>
<p>Many social researchers insist that a <a href="https://theconversation.com/returning-to-normal-post-coronavirus-would-be-inhumane-136558">post-pandemic life should not be a return to normal</a>. As they argue, <a href="https://onlinelibrary.wiley.com/doi/10.1002/ajhb.23499">normal life was marked by glaring social inequalities that have only deepened during the pandemic</a>. For parents of teens, as well, a return to normal would signal a return to concerns about the risks of sexual activity. But what if the pandemic was an occasion for parents’ to rethink their relationship to their teen’s sexual risk-taking? </p>
<p>As social work and sexuality scholar Laina Bay-Cheng argues, too often <a href="https://doi.org/10.1080/14681811.2012.700280">“good” parenting of teens has meant restricting access to sexual information in the name of protection</a>. </p>
<p>She advocates for an ethical shift that asks parents to normalize teen sexual behaviour, provide access to information and resources and transform the social conditions that make teen sexual activity dangerous. </p>
<h2>The risk of no risks</h2>
<p>One lesson the pandemic offers is a chance to notice the risk of not having opportunities to take risks. Perhaps the pandemic can provide a chance for parents to grant their teenage children what <a href="https://www.ideas-idees.ca/blog/rethinking-capacity-preserving-dignity-risk">disability scholars have called</a> “<a href="https://doi.org/10.1080/13698575.2018.1519115">the dignity of risk</a>.” Our duty of care cannot trump teenagers’ evolving capability to reasonably assess risks worth taking.</p>
<p>Rather than frame risk as something to be avoided, young people could be supported to make decisions about risk in their lives, including sexual risk, in ways that don’t put their own or others’ well-being in jeopardy. Yes, this means talking to teens about consent, but <a href="https://www.tcpress.com/sex-ed-for-caring-schools-9780807753989">these conversations also should touch on the ordinary risks we all take in our sexual lives</a>, including the risk of rejection and the surprise of pleasure. </p>
<p>As my research has explored, how we talk to youth about sexuality matters among other reasons because the most intimate of our experiences can come to shape how we see and act in the world. Seen from this point of view, risk is not an <a href="https://www.upress.umn.edu/book-division/books/sexuality-in-school">obstacle to development but the very grounds of its possibility</a>. </p>
<h2>Talking with teens</h2>
<p>Let’s talk with teens about the relationships that matter to them.</p>
<p>As teens venture out to explore and experiment with sexuality and forge their new, post-pandemic identities, let’s not begin every conversation about sexuality with worries about pregnancy and disease. </p>
<p>Instead, let’s afford young people the “dignity of risk,” not only in their sexual development but in their whole lives — their friendships, their schooling and their work. </p>
<p>Such conversations can lay the groundwork for the possibility of teens or <a href="https://qz.com/1894046/the-economic-and-social-benefits-of-living-with-your-parents-as-an-adult">young adults still enjoying spending time at home whether during the pandemic</a> or beyond.</p><img src="https://counter.theconversation.com/content/157793/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jen Gilbert receives funding from SSHRC.</span></em></p>As teens forge their post-pandemic identities, let’s afford them the ‘dignity of risk,’ in their whole lives including their sexualities.Jen Gilbert, Associate Professor, Education, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1592082021-04-19T06:12:18Z2021-04-19T06:12:18ZWhat’s the risk if Australia opens its international borders? An epidemiologist explains<p>Coinciding with the Trans-Tasman travel bubble <a href="https://www.abc.net.au/news/2021-04-19/travel-bubble-opens-new-zealand-journey-home/100077854">starting today</a>, over the past week there have been <a href="https://www.smh.com.au/national/quarantining-at-home-on-the-agenda-for-travelling-australians-20210415-p57jkr.html">murmurings</a> Australia could soon relax its borders further, through mechanisms such as home quarantine or letting in vaccinated people.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1382790351807684616"}"></div></p>
<p>But what are the risks?</p>
<p>Here I propose three things we must consider:</p>
<ul>
<li><p>the prevalence of the virus in the country from where travellers are coming, including the strain of virus</p></li>
<li><p>measures taken for the people travelling, including home quarantine and whether travellers are vaccinated</p></li>
<li><p>the percentage of our population who are immune.</p></li>
</ul>
<p>Importantly, all these factors matter. It’s not simply a case of needing to ensure all travellers are vaccinated. </p>
<h2>The level of infection in the country of origin matters enormously</h2>
<p>At around Christmas time, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/8january2021">roughly 2%</a> of the UK population was infected. That percentage is now considerably less, but it’s still likely around 1,000 times higher or more than the risk in China and other East Asian countries. The risk is near zero for New Zealand, Taiwan and many Pacific countries.</p>
<p>However, things will change. At the moment the United States seems to be maintaining high infection rates while also rapidly vaccinating the population. This is probably because of more transmissible variants, and society loosening up, offsetting gains from more people being immune. But at some point, perhaps around mid-year, the infection rate in the US should plummet as the percentage of people immune increases to somewhere around 60-80%. All this is to say we can expect infection rates in countries to vary a lot in the next six to 12 months.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-covid-variants-have-changed-the-game-and-vaccines-will-not-be-enough-we-need-global-maximum-suppression-157870">New COVID variants have changed the game, and vaccines will not be enough. We need global 'maximum suppression'</a>
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<p>Let’s work through an example of the United Kingdom. Assume the UK has another surge of infections such that 0.5% of British people are infected and unaware of it, and could jump on a plane to Australia. Let’s assume we decide to let 10,000 Brits come to Australia each month. So 0.5% of 10,000 would mean roughly 50 infected people arriving per month.</p>
<h2>Mitigating the risk of travellers</h2>
<p>Of course, we would do more to reduce the risk. We could test people before they get on the plane and when they arrive. Let’s assume that weeds out another 50%, as the other half may be still incubating and not yet testing positive. That’s 25 COVID-positive British people arriving per month.</p>
<p>Next, let’s assume we require all travellers to be vaccinated. That will reduce their risk of unwittingly carrying the virus (through either symptomatic or asymptomatic infection) by <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3779160">between 66% for the UK variant and 81% for “normal” virus for the AstraZeneca vaccine</a>. Data are still sketchy on any infection for Pfizer, but it’s likely 90% or more, given 95% protection against symptomatic disease in <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2034577">Pfizer’s clinical trial</a>. If we assume 80%, we are now down to five infected Brits arriving here per month.</p>
<p>Importantly, the vaccine also reduces both the duration of the disease and its infectiousness, for vaccinated people unlucky enough to get infected. We don’t know by how much as the real-world evidence is still accruing, although <a href="https://www.sciencedirect.com/science/article/pii/S0092867421000787">animal data</a> on peak viral load and duration of likely infective viral load supports this contention.</p>
<p>If we assume (conservatively in my view) that there is a 50% reduction in duration and 50% reduction in peak infectivity for hapless vaccinated people who still get infected, that is 25% of the risk of passing it on (that is, 50% of 50%).</p>
<p>Therefore, if an unvaccinated person, infected with the UK variant, was going to infect an average of 3.5 people in the absence of any social measures such as mask-wearing, the infected-after-vaccination person would only infect 0.875 other people — a 75% reduction in the reproductive rate. So our remaining five infected Brits are less infectious.</p>
<h2>Intensity of quarantine measures for arrivals</h2>
<p>Let’s consider the option of home quarantine. We don’t know how effective this will be, because of potential compliance issues.</p>
<p>But the risk of home quarantine breaches can be reduced by technology like <a href="https://www.heraldsun.com.au/news/nsw-womans-death-likely-linked-to-vaccination-finds-therapeutic-goods-administration/news-story/cdb9024ae952ebe4cbf11f4bc5573ac9">ankle bracelets</a>, GPS tracking on travellers’ phones to ensure they stay home, and only allowing home quarantine if any other members of the household are also vaccinated, to give an extra layer of protection.</p>
<p>Let’s assume home quarantine with these extra measures stops 80% of infected people getting out and about in Australia while infectious.</p>
<p>So we are now down to one infected British person who has slipped through per month. But given they are also vaccinated, they’re less likely to pass on the infection. And this risk can be reduced further still by ensuring they’re wearing a mask — although if they “breached” home quarantine rules they may not be likely to wear a mask.</p>
<p>It’s important to remember even “proper” quarantine isn’t foolproof. About <a href="https://www.medrxiv.org/content/10.1101/2021.02.17.21251946v1">one in 250 infected people</a> last year in hotel quarantine caused a leakage.</p>
<h2>Is Australia a tinderbox?</h2>
<p>Yes. Perhaps only 5% of us are immune. Even if, via the above measures, we get just one infected person a month in Australia — the situation could blow up. Keep in mind the above example assumes we’re only allowing travellers from one country too. More countries means more travellers means more risk — although as above, the risk varies based on the infection rate in the origin country.</p>
<p>You can play with various scenarios in our <a href="https://populationinterventions.science.unimelb.edu.au/">COVID-19 Pandemic Trade-offs</a> tool, launched two weeks ago. What you’ll find is that until most adults in Australia are vaccinated, any loosening up of how we respond to the virus incursion is unwise. If contact tracing cannot mop up the inevitable incursions, we’ll still need to use social restrictions, including lockdowns, until the vaccination rollout is complete.</p>
<p>But we can probably think about inching forward to some increased risk once all over-50s are vaccinated (phase 2A), with some modest relaxation of the border. Yet we can never totally escape the risk of outbreaks.</p>
<h2>So what can we do now with borders?</h2>
<p>First, continue with the Trans-Tasman bubble.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-quarantine-free-trans-tasman-bubble-opens-on-april-19-but-flyer-beware-remains-the-reality-of-pandemic-travel-158423">A quarantine-free trans-Tasman bubble opens on April 19, but 'flyer beware' remains the reality of pandemic travel</a>
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</em>
</p>
<hr>
<p>Second, remove or greatly reduce quarantine for vaccinated travellers from many East Asian countries, which present a low risk to Australia. As an example, the average number of known active infectious people in China at any point in time recently is <a href="https://www.worldometers.info/coronavirus/">about 250</a>. Let’s assume this equates to about 100 unknown infections at any point in time (that is, people who are not yet symptomatic or detected). For a population of 1.4 billion, that’s a 0.000007% risk of any person in China being infected.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1383707100619018245"}"></div></p>
<p>This suggests that for 10,000 vaccinated arrivals from China per month with modified quarantine, the expected number of infected people unwittingly getting out into the Australian population per month is 0.000014. Or, put another way, our above UK example presents 70,000 times the risk of an arrival from China. Given such low risk, it’s hard to justify why university students from China cannot start in time for semester two this year if they’re vaccinated and going into some form of modified quarantine.</p>
<p>Third, we need a national framework to assess the risk. Focusing on one measure alone isn’t wise — you have to look at the whole system. Such a framework can be developed now, at the same time as setting our risk thresholds so policy-makers, airlines and other industries can start planning.</p><img src="https://counter.theconversation.com/content/159208/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tony Blakely does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The amount of risk from overseas arrivals depends not just on Australia’s vaccination rates, but also on the particular circumstances of the country from which people are travelling.Tony Blakely, Professor of Epidemiology, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1556322021-02-28T13:36:45Z2021-02-28T13:36:45ZCOVID-19 hotel quarantine: Exemption for ‘essential’ medical travel confuses doctors, patients<figure><img src="https://images.theconversation.com/files/386485/original/file-20210225-17-1the6o1.JPG?ixlib=rb-1.1.0&rect=14%2C7%2C4820%2C3196&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A guest looks out from a Sheraton hotel window in Mississauga, Ont., on Feb. 22, 2021, as new air travel rules come into effect in Canada.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Cole Burston</span></span></figcaption></figure><p>The coronavirus pandemic has changed how we live, where we go, and who we spend time with. These changes are shaped by government policies that have evolved as the pandemic continues. And just when we get used to new policies and procedures, they change again in response to shifting circumstances and new information. </p>
<p>Perhaps the most talked about <a href="https://orders-in-council.canada.ca/attachment.php?attach=40252&lang=en">recent policy changes</a> are the new testing and quarantine measures put in place at Canada’s international borders as of Feb. 22. Along with providing proof of a negative <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/national-laboratory-testing-indication.html">polymerase reaction chain (PCR) test</a> within 72 hours before departure, arrivals by air must quarantine in a designated hotel for three nights at their own expense until they receive the <a href="https://www.ctvnews.ca/health/coronavirus/a-breakdown-of-canada-s-isolation-sites-as-details-are-revealed-on-hotel-requirements-1.5300410">results of a PCR test taken upon arrival</a>. They then complete the required 14-day quarantine at home if their test result is negative or in a government-designated facility if it is positive.</p>
<p>These requirements are coupled with <a href="https://www.cbc.ca/news/politics/negative-test-land-1.5906962">new land border measures</a>. Non-essential travellers must show proof of either a negative PCR test taken within 72 hours or a positive COVID-19 test conducted between 14 and 90 days before arrival. Within 24-hours of arrival, a traveller is tested at either a land border crossing or quarantine location (using a self swab). A self-swab test is used again on day 10. The costs for some of this testing may be borne by the traveller.</p>
<h2>Exemptions for essential care</h2>
<p>In mid-February, the Canadian government clarified which groups are exempt from these measures and thus spared the costs and logistics involved. One exemption is for people who have gone abroad for <a href="https://www.cbc.ca/news/business/hotel-quarantine-canada-air-passengers-1.5922086">“essential” medical services or treatment</a>. This exemption requires travellers to <a href="https://travel.gc.ca/travel-covid/travel-restrictions/isolation#exemptions">provide written evidence from a licensed health-care practitioner in Canada stating that the treatment or service sought is essential</a>. It also requires <a href="https://orders-in-council.canada.ca/attachment.php?attach=40249&lang=en">similar documentation from a provider in the destination country upon return to Canada</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/386477/original/file-20210225-15-1rbzfp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman wearing a face mask and carrying a suitcase" src="https://images.theconversation.com/files/386477/original/file-20210225-15-1rbzfp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386477/original/file-20210225-15-1rbzfp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=453&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386477/original/file-20210225-15-1rbzfp5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=453&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386477/original/file-20210225-15-1rbzfp5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=453&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386477/original/file-20210225-15-1rbzfp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=569&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386477/original/file-20210225-15-1rbzfp5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=569&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386477/original/file-20210225-15-1rbzfp5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=569&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">International air travellers load their luggage onto a shuttle bus to take them to one of the quarantine hotels on Feb. 22, 2021 in Montréal.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
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</figure>
<p>While intending to provide clarity regarding who should be exempt from these new border measures, this particular exemption instead compounds uncertainty. No guidelines for what constitutes “essential” medical care are provided. And there has already been <a href="https://www.cbc.ca/radio/checkup/is-it-time-to-ban-non-essential-travel-1.5882508/amid-calls-for-international-travel-ban-experts-say-rules-on-essential-trips-must-be-clarified-1.5885418">criticism of the lack of clarity as to what constitutes “essential” travel during this pandemic</a>.</p>
<p>We are a team of researchers and physicians with expertise in <a href="https://doi.org/10.1186/s12875-015-0245-6">international health travel</a> and <a href="https://theprovince.com/opinion/kelley-lee-and-anne-marie-nicol-why-canada-doesnt-know-how-many-covid-19-cases-are-linked-to-travel">pandemic border measures</a>. Our research suggests the lack of clarity around what constitutes essential medical treatment can pose ethical dilemmas for physicians. While some cases may be clear cut, such as <a href="https://www.cbc.ca/news/politics/patients-medical-treatment-covid19-blair-1.5916105">a cancer patient registered in a clinical trial who must travel to the United States monthly</a>, others are not.</p>
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Read more:
<a href="https://theconversation.com/medical-treatment-not-approved-yet-no-problem-welcome-to-circumvention-tourism-35070">Medical treatment not approved yet? No problem! Welcome to circumvention tourism</a>
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<h2>Ethical dilemmas</h2>
<p>Physicians are normally strong advocates for patients and accept fiduciary responsibility for their care. This requires physicians to balance the benefits of a treatment with the risks inherent in travelling during a pandemic. </p>
<p>Ambiguous cases will present ethical dilemmas for physicians. They will need to weigh the potential harms and benefits for patients wanting to contravene <a href="https://travel.gc.ca/travelling/advisories">general public health orders</a> and travel abroad for medical care during the pandemic. </p>
<p>Patients who travel for medical care may unwittingly endanger the lives of themselves or others. New variants of concern are spreading quickly around the world. This is particularly serious for those with certain underlying medical conditions who are already known to <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">experience worse COVID-19 outcomes</a>. </p>
<p>People returning from medical treatments may also act as vectors, bringing more contagious variants back home. This is <a href="https://globalnews.ca/news/7638289/coronavirus-hunting-for-variants-travel-restrictions/">a real risk</a>. Physicians who believe the risks to public health outweigh the likely benefits to a patient may, for ethical justifications, decline to write a letter in support of a testing and quarantine hotel exemption.</p>
<figure class="align-center ">
<img alt="Two women wait in the snow outside a hotel" src="https://images.theconversation.com/files/386481/original/file-20210225-15-1wcc30l.jpg?ixlib=rb-1.1.0&rect=12%2C6%2C4189%2C2992&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386481/original/file-20210225-15-1wcc30l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386481/original/file-20210225-15-1wcc30l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386481/original/file-20210225-15-1wcc30l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386481/original/file-20210225-15-1wcc30l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386481/original/file-20210225-15-1wcc30l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386481/original/file-20210225-15-1wcc30l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">International air travellers wait to enter one of the quarantine hotels on Feb. 22 in Montréal for the mandatory three-day quarantine.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
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</figure>
<p>Asking physicians to decide what is essential or non-essential medical care also risks devaluing some treatments. This can create disagreements about how to categorize treatments important to patients’ quality of life. </p>
<p>How “essential” are treatments for conditions that are not immediately life-threatening but cause pain or impacts on well-being, such as joint replacement, bariatric surgery, mental health and addictions care, in-vitro fertilization and dental procedures? What about diagnostic testing?</p>
<p>Some physicians will also find it ethically problematic to write exemption letters in support of care that is untested and unproven, causing further conflict with patients who may already present with symptoms of uncertain cause despite extensive investigation.</p>
<h2>Removing ambiguity</h2>
<p>Long-term patient-physician relationships are <a href="https://doi.org/10.1111/j.1468-0009.2005.00409.x">the foundation of the highest quality care</a>. Having physicians, and not policies, as the adjudicators of what constitutes “essential” medical care may harm these very relationships.</p>
<p>Just as <a href="https://www.ctvnews.ca/politics/what-is-non-essential-travel-experts-say-canada-s-definition-is-too-vague-1.5256285">border experts have called for greater definitional clarity</a> on “essential” travel, we must do the same for the new exemption on travel for “essential” medical purposes. </p>
<p>After more than one year into this pandemic, unclear and ambiguous policies risk causing harm to physicians and patients alike.</p><img src="https://counter.theconversation.com/content/155632/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Valorie A. Crooks receives funding from the Canadian Institutes of Health Research, Michael Smith Foundation for Health Research, and Canada Research Chairs Secretariat.</span></em></p><p class="fine-print"><em><span>Anne-Marie Nicol receives funding from the Canadian Partnership Against Cancer. </span></em></p><p class="fine-print"><em><span>Kelley Lee receives funding from the New Frontiers in Research Fund and Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Eric Cadesky and Jeremy Snyder do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Canadian government travel restrictions are an attempt to curb the spread of COVID-19 variants. But vague language around exemptions for medical travel may confuse the physicians who can grant them.Valorie A. Crooks, Professor, Department of Geography and Canada Research Chair in Health Service Geographies, Simon Fraser UniversityAnne-Marie Nicol, Associate Professor, Health Sciences, Simon Fraser UniversityEric Cadesky, Clinical Associate Professor, Faculty of Medicine, University of British ColumbiaJeremy Snyder, Professor, Faculty of Health Sciences, Simon Fraser UniversityKelley Lee, Professor of Global Health Policy, Canada Research Chair in Global Health Governance, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1546432021-02-05T01:15:07Z2021-02-05T01:15:07ZIt’s still too soon for NZ to relax COVID-19 border restrictions for travellers from low-risk countries<p>Relaxing border restrictions for travellers from low COVID-19 risk countries would increase the risk of community cases in New Zealand by around 25%, says an <a href="https://www.nzma.org.nz/journal-articles/estimating-the-effect-of-selective-border-relaxation-on-covid-19-in-new-zealand">article</a> published today in the New Zealand Medical Journal. </p>
<p>This might not sound like a big increase in risk, but it means breaches like the one at the <a href="https://www.nzherald.co.nz/nz/covid-19-coronavirus-two-more-cases-linked-to-pullman-hotel-being-investigated-by-health-officials/YEMCD54DH43JOI7SMDJKY3R5EU/">Pullman Hotel</a> in Auckland last month will occur 25% more frequently.</p>
<p>This increases the chance of a community outbreak and the possibility that an alert level change would be needed to contain it.</p>
<p>With new <a href="https://theconversation.com/why-the-covid-19-variants-are-so-dangerous-and-how-to-stop-them-spreading-153535">more transmissible variants</a> and more COVID-19 cases worldwide than ever before, this adds up to a significant risk. </p>
<h2>Risk from isolation facilities</h2>
<p>The work in the article builds on a mathematical model (originally <a href="https://www.medrxiv.org/content/10.1101/2020.07.15.20154955v3" title="Managing the risk of a COVID-19 outbreak from border">developed by our team</a>) to estimate the chances of community cases arising from our managed isolation facilities.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/if-were-to-defend-our-borders-from-the-pandemic-what-do-we-mean-by-borders-154176">If we're to defend our borders from the pandemic, what do we mean by borders?</a>
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<p>There is a small risk an infected traveller might arrive in managed isolation, return two negative tests, but be released after 14 days while still infectious.</p>
<p>The gold-standard nasal swab <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-health-advice-public/assessment-and-testing-covid-19/how-covid-19-testing-works">PCR test</a> is good, but it can miss cases, especially in people who are early or late in the course of their infections.</p>
<p>So far, we haven’t seen this happen in New Zealand’s managed isolation system even though more than 100,000 people have passed through. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1357365093424451585"}"></div></p>
<h2>Risk from new arrivals</h2>
<p>Instead, New Zealand’s problems in managed isolation have been caused by infected arrivals who go on to infect other guests or workers in the facility. Someone who picked up an infection in the last few days of their stay would leave the facility at their most infectious.</p>
<p>This is what happened last week at the <a href="https://www.health.govt.nz/news-media/media-releases/3-new-cases-covid-19-border-and-update-border-related-cases-auckland">Pullman</a>, where during their stay several people were infected with the <a href="https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/scientific-brief-emerging-variants.html">B.1.351 variant</a> first identified in South Africa. We were lucky this incident didn’t spark a community outbreak.</p>
<p>Right now, we believe we need to do everything we can to reduce the risk of this type of breach. Otherwise another lockdown will become an inevitability.</p>
<p>The authors of the study claim the recent requirement for a pre-departure test will mitigate this risk. But pre-departure tests are not perfect and many travellers have already been taking these because they were required to by their airline or the country through which they transited. This alone is not enough. </p>
<h2>We need the vaccinations</h2>
<p>Once vaccines start to be more widely available, cases worldwide should start to drop to levels where a risk analysis like the one laid out in this new article will become useful. This will need to be accompanied by high vaccination rates here in New Zealand so our population is protected against the virus.</p>
<p>But we would not recommend using this recent risk analysis because it uses COVID-19 case numbers and fatality rates to estimate how prevalent the virus is in different countries.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1356773524799594496"}"></div></p>
<p>This is not a reliable approach because it tells us how prevalent COVID-19 was two to three weeks ago, and by taking a country-wide average it could mask major variations within a country.</p>
<p>If we had been using this methodology last winter, Melbourne’s outbreak in June may well have spread here by the time border restrictions were brought back. </p>
<p>Instead, it would be better to use other indicators that give a more up-to-date and precise picture of COVID-19 hotspots. These would need to include how reliable a country’s COVID surveillance system was.</p>
<p>It will also be crucial to recognise the risk of people catching COVID-19 on their journey to New Zealand.</p>
<h2>In-flight passenger transmission</h2>
<p>The new study uses a very low estimate of the risk of in-flight transmission, whereas we know it is possible for a significant number of <a href="https://research.esr.cri.nz/articles/preprint/A_case_study_of_extended_in-flight_transmission_of_SARS-CoV-2_en_route_to_Aotearoa_New_Zealand/13257914">passengers to get infected</a> on a long-haul flight.</p>
<p>People travelling from a low-prevalence country will often be on the same plane as others from high-prevalence countries, and this means there is a significant infection risk for everyone on the flight.</p>
<p>Many of us with friends and family across the Tasman have been looking forward to a <a href="https://www.tvnz.co.nz/one-news/new-zealand/ardern-still-holds-ambition-trans-tasman-travel-bubble-in-coming-months">travel bubble</a> with Australia. Air New Zealand — which helped <a href="https://www.stuff.co.nz/business/industries/124154521/covid19-relaxing-border-restrictions-by-arrival-country-too-risky-experts-say">fund this new study</a> — would also like to see an increased flow of travellers.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/frontline-border-workers-to-be-vaccinated-first-as-new-zealand-approves-pfizer-vaccine-150720">Frontline border workers to be vaccinated first as New Zealand approves Pfizer vaccine</a>
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<p>At the moment, we could allow visitors from Australia to enter with little extra risk as there are very few cases in the community there. </p>
<p>But — and it’s a big but — a travel bubble with Australia would free up places in managed isolation that might be filled by travellers from higher-risk countries. This would increase the chances of a serious border breach.</p>
<p>Right now, a travel bubble with Australia would need to be accompanied by a reduction in managed isolation capacity to not increase the risks of a community outbreak here in New Zealand. </p>
<p>It makes sense to have a risk-based border system based on the current rate of COVID-19 in different countries and we will need a framework of this type to relax border restrictions once the world begins to emerge from the pandemic.</p>
<p>But COVID-19 is more prevalent now than at almost any point in the past. At the moment, we need to do everything we can to reduce the risk of importing COVID-19 into the community, rather than take on additional risk.</p>
<p>As more dangerous variants of COVID-19 emerge, many other countries are <a href="https://www.theguardian.com/world/2021/jan/25/new-quarantine-rules-expected-for-travellers-to-uk">tightening their border restrictions</a> not relaxing them.</p><img src="https://counter.theconversation.com/content/154643/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Plank is affiliated with the University of Canterbury and receives funding from the Ministry of Business, Innovation and Employment (MBIE) and Te Pūnaha Matatini, New Zealand's Centre of Research Excellence in complex systems. </span></em></p><p class="fine-print"><em><span>Shaun Hendy is affiliated with the University of Auckland and receives funding from the Ministry of Business, Innovation and Employment (MBIE) and Te Pūnaha Matatini, New Zealand's Centre of Research Excellence in complex systems.
</span></em></p>A new study argues for selective border relaxations. But with COVID-19 more prevalent now than at almost any point in the past, the risk would be substantial.Michael Plank, Professor in Applied Mathematics, University of CanterburyShaun Hendy, Professor of Physics, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1541762021-02-03T01:18:42Z2021-02-03T01:18:42ZIf we’re to defend our borders from the pandemic, what do we mean by borders?<figure><img src="https://images.theconversation.com/files/381839/original/file-20210202-23-180pxtp.jpg?ixlib=rb-1.1.0&rect=562%2C11%2C3431%2C1916&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock/Novikov Aleksey</span></span></figcaption></figure><p>Before COVID-19 hit New Zealand’s shores last year, most people’s understanding of defending a border would have come from watching TV reality show <a href="https://www.nzherald.co.nz/entertainment/anna-murray-what-the-years-most-watched-tv-says-about-nz/TLM5LO6LTT7CYZZVPDNQIHCAJ4/">Border Patrol</a>.</p>
<p>It is easy to understand — on the maps, our country is surrounded by an ocean moat, a natural border. This makes controlling risks arriving from overseas relatively easy as there are limited points at which they can enter New Zealand.</p>
<p>Since February 2, 2020, when a travel ban on non-citizens who had travelled through China was <a href="https://www.nzherald.co.nz/nz/coronavirus-new-zealand-bans-travellers-from-china-to-protect-new-zealanders-from-deadly-virus/SYFNHQSE46TBA2NISX4BF3IGEM/">introduced</a>, borders have been very much in the news.</p>
<p>Most recently, Northland iwi announced Te Tai Tokerau Border Control would be <a href="https://www.rnz.co.nz/news/national/435248/opinion-divided-over-reinstating-iwi-border-control-checkpoints">introducing check points</a> in the region in response to a community case of COVID-19.</p>
<p>Those actions have been controversial, with the police subsequently <a href="https://www.nzherald.co.nz/nz/covid-19-coronavirus-police-close-down-northland-iwi-checkpoint-set-up-at-waiomio-to-stop-spread-of-virus/XJ5IABUROA54ESUCYL2VO3ECUI/">closing down the check points</a> on <a href="https://www.rnz.co.nz/national/programmes/checkpoint/audio/2018781357/police-shut-tai-tokerau-covid-19-checkpoints-citing-safety-issues">grounds of safety</a>, even though they supported the same checkpoints in August 2020 during the Auckland community outbreak.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/OJN4_VgUMHA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Community checkpoints in Te Tai Tokerau have been shut down by police who say they risked public safety and people’s right to travel freely.</span></figcaption>
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<p>This raises the question of what sort of border is Te Tai Tokerau trying to control, and is it a border at all?</p>
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Read more:
<a href="https://theconversation.com/if-border-restrictions-increase-to-combat-new-covid-19-strains-what-rights-do-returning-new-zealanders-have-153962">If border restrictions increase to combat new COVID-19 strains, what rights do returning New Zealanders have?</a>
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<h2>What’s a border anyway?</h2>
<p>There are three important things to realise about <a href="https://www.tandfonline.com/doi/abs/10.1080/08865655.2003.9695598" title="On borders and power: A theoretical framework">borders</a> — humans create them, they don’t just occur at the external edge of a state, and not all borders involve the government.</p>
<p>You may find the first idea challenging. We did not make up our physical geography. The ocean border is real. But humans did create the map that depicts our country.</p>
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<a href="https://images.theconversation.com/files/381855/original/file-20210202-23-1pitej6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A map showing New Zealand's administrative divisions." src="https://images.theconversation.com/files/381855/original/file-20210202-23-1pitej6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381855/original/file-20210202-23-1pitej6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381855/original/file-20210202-23-1pitej6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381855/original/file-20210202-23-1pitej6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381855/original/file-20210202-23-1pitej6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381855/original/file-20210202-23-1pitej6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381855/original/file-20210202-23-1pitej6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">New Zealand already has several human-defined borders such as the administrative divisions.</span>
<span class="attribution"><span class="source">Monika Hunackova Shutterstock</span></span>
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<p>We know from our history that the state of New Zealand originated from British colonisation, that its name is now often referred to as <a href="https://www.newshub.co.nz/home/politics/2019/12/using-aotearoa-and-new-zealand-together-as-it-should-be-jacinda-ardern.html">Aotearoa New Zealand</a>, reflecting Te Tiriti o Waitangi.</p>
<p>The <a href="https://www.legislation.govt.nz/regulation/public/1983/0225/latest/DLM90805.html">Realm of New Zealand</a> includes other states and dependencies — Niue, Cook Islands, Tokelau and the Ross Dependency in Antarctica.</p>
<p>From this, we see that even our description of New Zealand can vary, depending on where we stand. By extension, our description of New Zealand’s border will vary.</p>
<p>We can now start to see that borders are more than lines on the map. Borders create spaces that can be used for different purposes, such as security or safety, with associated processes.</p>
<h2>Borders define ‘us’ and ‘them’</h2>
<p>Borders also have many effects, one of which is on our identity. For example, gated communities are bordered spaces, fenced and patrolled business premises are bordered spaces. </p>
<p>If we are inside a gated community, we will identify with that community and its desire for safety and privacy. Outside the gate is everyone else and, potentially, risk and insecurity. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/381860/original/file-20210202-17-g4ngiq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An intercom at the entrance of a gated community." src="https://images.theconversation.com/files/381860/original/file-20210202-17-g4ngiq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381860/original/file-20210202-17-g4ngiq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381860/original/file-20210202-17-g4ngiq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381860/original/file-20210202-17-g4ngiq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381860/original/file-20210202-17-g4ngiq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381860/original/file-20210202-17-g4ngiq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381860/original/file-20210202-17-g4ngiq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Gated communities also define borders between ‘us’ and ‘them’.</span>
<span class="attribution"><span class="source">Shutterstock/Johnny Habell</span></span>
</figcaption>
</figure>
<p>To get inside the gated community, particular processes are needed such as membership of the community through ownership of property, or access to a gate key. The means of containment, the border, creates an “us” and “them”. </p>
<p>When we apply this thinking to the external border, our society is bordered by the controls at gateway sea ports and airports. Before foreign visitors pass through these controls, they are “them”. </p>
<p>After they enter New Zealand, we might not know them, but societally they become part of “us”, albeit temporarily.</p>
<p>Managing the COVID-19 threat has involved creating types of borders not familiar to New Zealanders, from societal lockdowns to the creation of specifically bordered spaces — for example, the Managed Isolation and Quarantine facilities (MIQs) and the land borders during the Auckland community outbreak in August.</p>
<p>Most significantly for the many people prevented from travelling internationally, government policy has bordered our lives by keeping us confined to our own island nation.</p>
<p>All these borders have had effects on New Zealand society. </p>
<p>One important effect has been to change whom we identify with — whom we see as “us” and “them”. </p>
<p>Achieving a COVID-free New Zealand has involved creating a range of borders that differentiate, and in some cases separate, the safe “us” from the risky “them”.</p>
<p>Even close family members can temporarily become “them”. We see this in <a href="https://www.rnz.co.nz/news/national/434431/confronted-in-supermarkets-flatmates-move-out-miq-staff-face-huge-stigma">reports</a> of MIQ staff being isolated by their friends, family and business contacts when they are off duty.</p>
<h2>The iwi borders</h2>
<p>Let us now return to those iwi borders. What are they exactly?</p>
<p>Their stated purpose is to <a href="https://theconversation.com/research-shows-maori-are-more-likely-to-die-from-covid-19-than-other-new-zealanders-145453">protect the iwi population</a>, many of whom are at high risk from COVID-19, as well as provide a community service by preventing the virus spreading.</p>
<p>The former is certainly identifying with their tribal group and the particular needs and vulnerabilities of that group, but they are also identifying with the COVID-free New Zealand — the so-called team of five million.</p>
<p>This type of border raises a further question about who has, or should have, control of different types of borders.</p>
<p>It is hard to argue against Te Tai Tokerau’s case, but in New Zealand law they have no authority to limit the free movement of people. Only agencies of state have that.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nz-needs-an-evolving-pandemic-strategy-if-its-to-keep-the-publics-trust-154053">NZ needs an evolving pandemic strategy if it's to keep the public's trust</a>
</strong>
</em>
</p>
<hr>
<p>Multiple borders have always existed in Aotearoa New Zealand. We just haven’t been aware of them before.</p>
<p>These examples start to reveal them. For some people, these new borders are restrictions, for others they provide a certain freedom — maybe not freedom from fear but freedom to move about within different sized bubbles in relative safety.</p>
<p>Seeing them as a part of New Zealand’s border landscape makes evident issues such as human rights, security, legal authority and equity. A bigger discussion about New Zealand’s borders is clearly needed.</p><img src="https://counter.theconversation.com/content/154176/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Germana Nicklin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Multiple borders have always existed in Aotearoa New Zealand. We just weren’t as aware of them before the pandemic started locking down communities.Germana Nicklin, Senior Lecturer in Border and Resource Security, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1496992021-02-02T21:36:45Z2021-02-02T21:36:45ZParenting in a pandemic: How to develop stronger family relationships during COVID-19<figure><img src="https://images.theconversation.com/files/381488/original/file-20210130-23-u4sag8.jpg?ixlib=rb-1.1.0&rect=0%2C36%2C3029%2C1964&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Emotional regulation includes the ability to pay attention to and accept our emotions, and to differentiate emotions.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The COVID-19 pandemic has undoubtedly affected us. It has increased our worries <a href="https://www.who.int/news-room/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---physical-activity?gclid=CjwKCAiApNSABhAlEiwANuR9YD7-WIM083wDoJCiIvdcTHGy8mDShbVi-AM9G-GoGH2AlHrZMOrmUxoC2VYQAvD_BwE">and concerns about physical health</a>. COVID-19 has added to the existing challenges parents face, and has also created greater awareness surrounding the fragility of mental health. </p>
<p>Yet, the second wave has also paved the way for a larger discussion on <a href="https://www.irishtimes.com/life-and-style/health-family/how-to-fight-the-psychological-fatigue-of-covid-19-s-second-wave-1.4362467">ways to promote mental well-being</a>.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/381026/original/file-20210128-19-6f718q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cover of Healthy Minds, Healthy Schools" src="https://images.theconversation.com/files/381026/original/file-20210128-19-6f718q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/381026/original/file-20210128-19-6f718q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=779&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381026/original/file-20210128-19-6f718q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=779&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381026/original/file-20210128-19-6f718q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=779&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381026/original/file-20210128-19-6f718q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=979&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381026/original/file-20210128-19-6f718q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=979&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381026/original/file-20210128-19-6f718q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=979&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Healthy Minds, Healthy Schools: Strategies for Happy and Successful Learners.</span>
<span class="attribution"><span class="source">(Canadian Scholars' Press)</span></span>
</figcaption>
</figure>
<p>As a researcher and a clinical psychologist, I lead a research group that investigates how emotion regulation, values and beliefs affect the development and inter-generational transmission of mental or behavioural disorders, and how these problems can impact educational achievement. </p>
<p>The <a href="https://tinamontreuil.wixsite.com/carelab">Childhood Anxiety and Regulation of Emotions (C.A.R.E.) research group</a> has developed a <a href="https://c94135d2-bd21-4eaf-b7a2-2537728fda2f.filesusr.com/ugd/042f0d_827037fc47524827adfccd9dc7ca1fc3.pdf">school-based program</a> as well as a <a href="https://tinamontreuil.wixsite.com/carelab/parenting-c-a-r-e">parenting program</a>, both of which teach core coping skills that have been associated with resilience. <a href="https://c94135d2-bd21-4eaf-b7a2-2537728fda2f.filesusr.com/ugd/042f0d_c76a73a5849a4a2fa5c0e8e689980583.pdf">Resilience</a> is the capacity for an individual to remain engaged, available and optimistic instead of withdrawn, overwhelmed and defeated when faced with hardship and adversity. </p>
<p>Our research group believes that when parents are aware of their own emotional self-regulation, and when they can find space to structure meaningful family activities that promote mutual bonding, both they and their children are in a better position to learn core coping skills that will benefit individuals and family relationships. </p>
<h2>Impact of the pandemic on family life</h2>
<p>A <a href="https://humanrights.gov.au/our-work/childrens-rights/publications/impacts-covid-19-children-and-young-people-who-contact-kids">recent report</a> by the Australian Human Rights Commission investigated COVID-19-related concerns experienced by children aged five and older and emerging adults from January to April 2020. The report suggested that “mental health concerns resulting from COVID-19” and “impacts on family life” were among the top five concerns endorsed by youth. </p>
<p>Similarly, a July 2020 <a href="https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2020043-eng.htm">Statistics Canada report</a> revealed three out of four parents experienced concerns and worries about balancing child care, their child’s schooling and their own professional work irrespective of the child’s age. More than half of parents surveyed reported greater difficulty managing their child’s emotions as well as their own. </p>
<p>The arising parenting challenges surrounding the COVID-19 pandemic may represent an opportune time for us to improve our resilience and model more adaptive strategies and skills. In turn, such skills can promote the development of resilient behaviours in our children. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-build-childrens-resilience-and-your-own-amid-coronavirus-unknowns-135789">How to build children's resilience, and your own, amid coronavirus unknowns</a>
</strong>
</em>
</p>
<hr>
<p>As the picture below illustrates, not everyone reacts in the same way to a given situation. The ability to manage strong negative emotions and shift our mindset to a more adaptive perspective can be developed at any age. Since our brain is most adept at performing a new task early in life, it’s most beneficial for people to become socialized in these fundamental life skills early. This will help children to become self-regulated, adaptive and thriving adults. </p>
<figure class="align-center ">
<img alt="Slide showing glasses pointing to different perspectives." src="https://images.theconversation.com/files/381512/original/file-20210131-19353-1ks29l4.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381512/original/file-20210131-19353-1ks29l4.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381512/original/file-20210131-19353-1ks29l4.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381512/original/file-20210131-19353-1ks29l4.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381512/original/file-20210131-19353-1ks29l4.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381512/original/file-20210131-19353-1ks29l4.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381512/original/file-20210131-19353-1ks29l4.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parents can encourage children to see pandemic changes as an opportunity as opposed to a source of anxiety.</span>
<span class="attribution"><span class="source">(Tina Montreuil)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Parental emotions</h2>
<p>Findings from our research group’s <a href="https://doi.org/10.1111/fare.12501">recent study</a>, conducted with mothers, suggest that parents’ abilities to regulate their own emotions predicted how frequently and effectively they rely on supportive parenting practices. Supportive practices are things like comforting children when they experience negative emotions; engaging in problem-solving strategies aimed at reducing children’s distress; and discussing children’s emotional experiences with them. As such, these results suggest that supportive parenting is associated with children who are better at managing difficult emotions. </p>
<p>We also found that <a href="https://doi.org/10.1007/s10804-019-09340-1">invalidating children’s emotional expression or ignoring or dismissing the child’s emotions contributed to poorer emotion regulation skills in children</a>, and that such less-supportive parenting practices were linked to anxiety in adulthood. When parents themselves match or exceed their child’s emotions, they also offer less adaptive emotional coaching. </p>
<p>Parents may have heard the airplane safety tip to always don one’s own oxygen mask before helping a child: the same applies with emotional regulation. As parents, when we prioritize <a href="https://theworkingmind.ca/sites/default/files/resources/r2mr_poster_en.pdf">managing our own stress, tolerating greater uncertainty</a> and engaging in self-care activities like exercise, good sleep hygiene and relaxation, this expands our capacity to respond calmly. This teaches our children that they too can <a href="https://videos.dialogue.co/watch/Msw19vECevPCRqsiviVh7n">cope and manage stress and related threats</a>.</p>
<p>Supportive parenting is best achieved when a connected, caring and responsive relationship with children is fostered early on. Supportive parenting that builds resilience is comparable to an early investment that grows with time. It is key to create as many early positive and reinforcing experiences as possible. </p>
<figure class="align-center ">
<img alt="Emotions drawn on a line of balls." src="https://images.theconversation.com/files/381523/original/file-20210131-20580-18ltfu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381523/original/file-20210131-20580-18ltfu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381523/original/file-20210131-20580-18ltfu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381523/original/file-20210131-20580-18ltfu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381523/original/file-20210131-20580-18ltfu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381523/original/file-20210131-20580-18ltfu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381523/original/file-20210131-20580-18ltfu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Supportive parenting involves discussing emotions and engaging in problem-solving strategies aimed at reducing distress.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Failure: An opportunity for growth</h2>
<p>Parenting is difficult and striving for perfection is unrealistic and unattainable. We can instead chose to model that mistakes and failures can be a renewed opportunity for growth. Raising resilient children means that we value teaching them self-compassion, gratitude, delayed gratification and self worth to leverage life experiences that facilitate the development of their sense of purpose. </p>
<p>It is as critical for parents to value teaching children these core social emotional skills, just as much as we might encourage them to become expert swimmers or gifted mathematicians.</p>
<p>When supportive parenting and strong family relationships consistently provide opportunities to strengthen coping skills and the ability to regulate emotions, these are also opportunities for children to become skilled at accepting hardship and remaining committed toward achievement. <a href="https://tinamontreuil.wixsite.com/carelab/parent-teacher-ressources">Supportive parental practices</a> contribute to children’s long-term healthy emotional and psychological development.</p>
<p>Parents can help their children develop these key social-emotional abilities in a variety of ways. </p>
<ol>
<li><p>As a first step, parents should evaluate whether their own emotional and psychological needs are met and do their best to find, advocate for or create structures or supports to meet these. In return, they may gain the capacity to model these adaptive behaviours. </p></li>
<li><p>Parents can <a href="https://www.canadianscholars.ca/books/healthy-minds-healthy-schools">learn more about core coping skills like emotional regulation</a>. This includes the ability to pay attention to and accept (not judge) our emotions, to label and differentiate emotions. It also means understanding varying levels of emotional intensity, to learn how to tolerate and be open to the experience of distressing emotions and to control our emotions by changing how we think about the situation at hand. Mindfulness and problem solving can also be easily taught through interactive read-along activities and lessons. </p></li>
<li><p>Regardless of a family’s structure, parents can improve family relationships and connectedness. They can do this by dedicating common time for the family members to congregate and bond with one another through activities like meal time, game or movie night and outdoor or sport activities. </p></li>
<li><p>Parents can work on identifying mutual family values through activities like developing a <a href="https://learnykids.com/worksheets/my-values-coat-of-arms">values coat of arms</a>. Identifying mutual values can be useful when seeking to carve out time spent together based on identified commonalities and shared interests. </p></li>
</ol>
<p>Adversity creates accidental opportunities to build skills to endure ongoing or future hardship. This is the essence of resilience: accepting that a door has closed behind us, and being optimistic about what awaits. By being more emotionally and mentally grounded as parents, parents can lead collectively stronger families. Let’s stay strong together!</p><img src="https://counter.theconversation.com/content/149699/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tina Montreuil has received funding from the Social Sciences and Humanities Research Council of Canada (SSHRC), the Canadian Institutes of Health Research (CIHR), les Fonds de recherche du Québec - Société et culture (FRQSC), Fonds de recherche du Québec - Nature et technologie (FRQNT), the McGill Interdisciplinary Initiative in Infection and Immunity (Mi4), McGill Social Sciences and Humanities Development Grants, and Le Récit.</span></em></p>Growing core coping skills isn’t just a matter of learning not to be triggered by children’s strong feelings; it’s also about creating positive meaningful activities that promote mutual bonding.Tina Montreuil, Assistant Professor, Department of Educational and Counselling Psychology, Associate Member, Department of Psychiatry, and Director of Childhood Anxiety and Regulations of Emotions (C.A.R.E.) Research Group, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1535952021-01-20T12:02:15Z2021-01-20T12:02:15ZLockdown, quarantine and self-isolation: how different COVID restrictions affect our mental health<figure><img src="https://images.theconversation.com/files/379604/original/file-20210119-13-afcggx.jpg?ixlib=rb-1.1.0&rect=591%2C575%2C4633%2C2891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/corona-virus-staying-work-home-selfisolation-1789063880">Zamuruew/Shutterstock</a></span></figcaption></figure><p>In the year since the city of Wuhan, China, went into the world’s first coronavirus lockdown, we have all had to live under some form of pandemic-related restriction. </p>
<p>Some countries have opted for strict national lockdowns, like the one currently in place in the UK, while other countries such as <a href="https://www.bbc.com/news/world-asia-55269729">Taiwan</a> have opted for border closures and mandatory quarantine for overseas arrivals. Such different approaches to restricting movement have different effects on our well-being. </p>
<p>It is now <a href="https://journals.sagepub.com/doi/full/10.1177/0020764020915212">well documented</a> that the pandemic has generally contributed to a <a href="https://pubmed.ncbi.nlm.nih.gov/32563745/">number of mental health problems</a> including stress, anxiety and depression. But what role do restrictions on movement play in this? And how do they differ?</p>
<h2>Different pandemic restrictions</h2>
<p>Researchers around the world are now focusing on what the specific impact of lockdown, quarantine and isolation might have upon our mental health. Lockdown, in the context of COVID-19, refers to implementation of strict community restrictions on travel and social interaction as well as denying access to public spaces. </p>
<p>Quarantine is a restriction of movement of those people who have been exposed to a contagious disease to observe whether they will become ill. In Australia, for example, all overseas arrivals must spend 14 days in hotel quarantine before being allowed into the community. </p>
<p>Self-isolation, meanwhile, is the separation of those who have become sick as a result of a contagious disease in order to separate them from others who are not sick.</p>
<h2>Quarantine</h2>
<p>Looking to past pandemics can help us understand this one. A <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30460-8/fulltext?fbclid=IwAR36LpFsHEjd2YHpM-UR7ip_qV8ZPIKmPiEatpm5fkSuhV8bhCSNT0cy_r8">recent academic review</a> examined studies of people who had been quarantined as a result of other disease outbreaks such as Ebola, SARS and swine flu. The review concluded that quarantine can lead to a number of harmful psychological effects. </p>
<p>One outcome is the fear and anxiety that can increase due to worries about catching or transmitting the virus, and concerns about the health, social and economic effects of the pandemic. Individuals can also experience anger at the changing policies and protocols that impinge upon their everyday life and feelings of control. </p>
<p>And the long-term effects of quarantine can lead to some people subsequently developing a post-traumatic stress reaction, which can manifest in feelings of exhaustion, low mood and irritability.</p>
<h2>Lockdown vs self-isolation</h2>
<p>For lockdown and self-isolation measures, we have data from the COVID-19 pandemic itself. </p>
<p>Research from Italy, which was hit hard early in the pandemic and had an extensive lockdown, has found that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169930/">more than one-third</a> of the general public experienced significant psychological distress during the second month of coronavirus restrictions. </p>
<p>In a forthcoming study, my colleagues and I looked at what impact lockdown and had on psychological well-being and happiness compared to self-isolation. From March to July 2020, we assessed a sample of UK adults who were under one of three types of restrictions: self-isolation, full lockdown or partial lockdown (full lockdown is remaining at home and not going to work, whereas partial lockdown allows you to go to work). </p>
<p>After controlling for variations in age and sex, we found that those in self-isolation reported significantly lower levels of psychological well-being and happiness when compared to those in lockdown or those in partial lockdown, with no difference between the last two groups. </p>
<p>These findings suggest that self-isolation impairs psychological well-being and happiness to a greater degree than lockdown.</p>
<h2>Caging the social animal</h2>
<p>COVID-19 restrictions heighten the <a href="https://psycnet.apa.org/record/2020-27302-001">fears</a> people have about health and safety as well as financial and social consequences. Self-isolation may add to this due to a prolonged separation from friends and family – those who provide a close support network. This is because during self-isolation you should avoid contact with everyone, even those in your household.</p>
<p>The finding of no difference between those in full lockdown and partial lockdown is equally interesting. This suggests that people can maintain a sense of satisfaction, optimism, engagement and a positive mood state despite the restrictions placed upon them, testifying to the <a href="https://theconversation.com/wellbeing-levels-fell-during-the-pandemic-but-improved-under-lockdown-data-analysis-shows-143367">resilience of humans under difficult conditions</a>.</p>
<p>Humans are <a href="https://theconversation.com/coronavirus-experts-in-evolution-explain-why-social-distancing-feels-so-unnatural-134271">essentially social animals</a>. Our large brains have developed to embrace social contact and develop skills that have helped us survive and prosper. These skills include language, problem-solving and planning, as well as empathy and care for others. We are hard-wired for social contact and communication.</p>
<p>Social isolation breaks many of these forms of communication and interactions, which are key to forming strong social bonds. It should therefore come as no surprise to find that prolonged periods of isolation can lead to a range of psychological problems, just as it does in the abnormal behaviour and communication found in a caged animal.</p>
<p>One year on, we are still yet to understand the full psychological fallout of COVID-19. But working out how different restrictions affect us our inner social animal is an important place to start as we navigate our way out of this pandemic and prepare for the next one.</p><img src="https://counter.theconversation.com/content/153595/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tom Heffernan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We are still only beginning to understand the psychological effects that pandemic restrictions are having on us.Tom Heffernan, Programme Leader in Psychology with Criminology, Northumbria University, NewcastleLicensed as Creative Commons – attribution, no derivatives.