tag:theconversation.com,2011:/us/topics/covid-deaths-101497/articlesCOVID deaths – The Conversation2023-09-08T16:30:15Ztag:theconversation.com,2011:article/2131702023-09-08T16:30:15Z2023-09-08T16:30:15ZWhy are those lost to COVID not formally memorialised? How politics shapes what we remember<p>Every Friday, volunteers gather on the Albert Embankment at the River Thames in London to lovingly retouch thousands of red hearts inscribed on a Portland stone wall directly opposite the Houses of Parliament. Each heart is dedicated to a British victim of COVID. It is a deeply social space – a place where the COVID bereaved come together to honour their dead and share memories.</p>
<p>The so-called <a href="https://www.nationalcovidmemorialwall.org/">National Covid Memorial Wall</a> is not, however, officially sanctioned. In fact, ever since activists from COVID-19 Bereaved Families for Justice (CBFFJ) daubed the first hearts on the wall in March 2021 it has been a thorn in the side of the authorities. </p>
<p>Featured in the media whenever there is a new revelation about <a href="https://theconversation.com/europe/topics/partygate-115248">partygate</a>, the wall is a symbol of the government’s blundering response to the pandemic and an implicit rebuke to former prime minister Boris Johnson and other government staff who breached coronavirus restrictions. </p>
<p>As one writer put it, viewed from parliament the hearts resemble “<a href="https://www.mirror.co.uk/news/uk-news/guerrilla-act-memorial-began-180000-26550275">a reproachful smear of blood</a>”. Little wonder that the only time Johnson visited the wall was under the cover of darkness to avoid the TV cameras. His successor Rishi Sunak has been similarly reluctant to acknowledge the wall or say what might take its place as a more formal memorial to those lost in the pandemic.</p>
<p>Though in April the UK Commission on COVID Commemoration presented Sunak with a <a href="https://www.gov.uk/government/news/the-uk-commission-on-covid-commemoration">report</a> on how the pandemic should be remembered, Sunak has yet to reveal the commission’s recommendations. </p>
<p>Lady Heather Hallett, the former high court judge who chairs the public inquiry into COVID, has attempted to acknowledge the trauma of the bereaved by commissioning a <a href="https://covid19.public-inquiry.uk/news/first-commemorative-tapestry-panels-unveiled-at-covid-inquiry-hearing-centre/">tapestry</a> to capture the experiences of people who “suffered hardship and loss” during the pandemic. Yet such initiatives are no substitute for state-sponsored memorials.</p>
<h2>What is remembered and what is forgotten?</h2>
<p>This political vacuum is odd when you consider that the United Kingdom, like other countries, engages in many other commemorative activities central to national identity. The fallen of the first world war and other military conflicts are commemorated in a Remembrance Sunday ceremony held every November at the <a href="https://www.britishlegion.org.uk/get-involved/remembrance/remembrance-events/remembrance-sunday">Cenotaph</a> in London, for example. </p>
<p>But while wars lend themselves to compelling moral narratives, it is difficult to locate meaning in the random mutations of a virus. And while wars draw on a familiar repertoire of symbols and rituals, pandemics have few templates.</p>
<p>For instance, despite killing more than 50 million globally, there are <a href="https://markhonigsbaum.substack.com/p/drinking-the-waters-of-lethe">virtually no memorials</a> to the 1918-1919 “Spanish” influenza pandemic. Nor does the UK have a memorial to victims of HIV/AIDS. As the memory studies scholar <a href="https://journals.sagepub.com/doi/10.1177/1750698020943014">Astrid Erll puts it</a>, pandemics have not been sufficiently “mediated” in collective memory. </p>
<p>As a rule, they do not feature in famous paintings, novels or films or in the oral histories passed down as part of family lore. Nor are they able to draw on familiar cultural materials such as poppies, gun carriages, catafalques and royal salutes. Without such symbols and schemata, Erll argues, we struggle to incorporate pandemics into our collective remembering systems.</p>
<p>This lacuna was brought home to me last September when tens of thousands of Britons flocked to the south bank of the Thames to pay their respects to Britain’s longest serving monarch. By coincidence, the police directed the queue for the late Queen’s lying-in-state in Westminster Hall over Lambeth Bridge and along Albert Embankment. </p>
<p>But few of the people I spoke to in the queue seemed to realise what the hearts signified. It was as if the spectacle of a royal death had eclipsed the suffering of the COVID bereaved, rendering the wall <a href="https://markhonigsbaum.substack.com/p/reign-of-silence">all but invisible.</a></p>
<h2>Waiting for answers</h2>
<p>Another place where the pandemic could be embedded in collective memory is at the public inquiry. Opening the preliminary hearing last October into the UK’s resilience and preparedness for a pandemic, Lady Hallett promised to put the estimated 6.8 million Britons mourning the death of a family member or friend to COVID at the heart of the legal process. “I am listening to them; their loss will be recognised,” she said.</p>
<p>But though Lady Hallett has strategically placed photographs of the hearts throughout the inquiry’s offices in Bayswater and has invited the bereaved to relate their experiences to “<a href="https://covid19.public-inquiry.uk/every-story-matters/">Every Story Matters</a>”, the hearing room is dominated by ranks of lawyers. And except when a prominent minister or official is called to testify, the proceedings rarely make the news.</p>
<p>This is partly the fault of the inquiry process itself. The hearings are due to last until 2025, with the report on the first stage of the process not expected until the summer of 2024. As Lucy Easthope, an emergency planner and veteran of several disasters, <a href="https://policy.bristoluniversitypress.co.uk/when-this-is-over">puts it</a>: “one of the most painful frustrations of the inquiry will be temporal. It will simply take too long.”</p>
<p>The inquiry has also been beset by bureaucratic obfuscation, not least by the Cabinet Office which attempted (unsuccessfully in the end) to <a href="https://www.judiciary.uk/wp-content/uploads/2023/07/Cab-Off-v-Covid-Enquiry-6.7.23-approved-judgment-002.pdf">block the release of WhatsApp messages</a> relating to discussions between ministers and Downing Street officials in the run-up to lockdown. </p>
<p>To the inquiry’s critics, the obvious parallel is with the Grenfell inquiry, which promised to “learn lessons” from the <a href="https://theconversation.com/europe/topics/grenfell-tower-39675">devastating fire</a> that engulfed the west London tower in 2017 but has so far ended up <a href="https://assets.grenfelltowerinquiry.org.uk/GTI%20-%20Phase%201%20report%20Executive%20Summary.pdf">blurring the lines of corporate responsibility</a> and forestalling a political reckoning.</p>
<p>The real work of holding the government to account and making memories takes place every Friday at the wall and the other places where people come together to spontaneously mourn and remember absent loved ones. These are the lives that demand to be “seen”. They are the ghosts that haunt our amnesic political culture.</p><img src="https://counter.theconversation.com/content/213170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Honigsbaum receives funding from the Higher Education Innovation Fund.</span></em></p>Hundreds of thousands of red hearts adorn a wall directly opposite parliament, yet successive prime ministers have nothing to say about officially marking the lives lost in the pandemic.Mark Honigsbaum, Senior Lecturer in Journalism, City, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1962812022-12-12T04:15:39Z2022-12-12T04:15:39ZThousands more Australians died in 2022 than expected. COVID was behind the majority of them<figure><img src="https://images.theconversation.com/files/500267/original/file-20221212-94530-9fo5k3.jpg?ixlib=rb-1.1.0&rect=43%2C34%2C5699%2C3794&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/melbourne-australia-july-29-2022-600w-2184218879.jpg">Shutterstock/David L Young</a></span></figcaption></figure><p>Last month, the Australian Bureau of Statistics (ABS) released a <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/jan-jul-2022">report</a> of mortality statistics. It showed that from January to July 2022, there were 17% more deaths (16,375) than the average expected for these months. </p>
<p>This historical average is based on an average of the deaths for 2017, 2018, 2019 and 2021. They did not include 2020 in the baseline for 2022 data because it included periods where numbers of deaths were significantly lower than expected. The difference between the expected number of deaths based on historical data, and the actual number, is called “excess deaths”. </p>
<p>However, as the ABS points out in its report, using previous years as the predictor for the expected number of deaths does not take into account changes in population age structure over time, or potential improvements in mortality rates. </p>
<p>As we will see, the excess deaths this year were likely lower than the ABS estimate – but still overwhelmingly related to COVID and its effects on health.</p>
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<h2>A different approach</h2>
<p>Last week, the Australian Actuaries Institute released its <a href="https://www.actuaries.digital/2022/12/07/covid-19-mortality-working-group-excess-mortality-continues-in-august-2022/">report</a> looking at excess deaths. Actuaries are statisticians who specialise in assessing risk, and most often work for insurance companies, superannuation funds, banks or government departments. </p>
<p>Unlike the ABS, the actuaries’ report adjusts the expected deaths for differences in age distributions over time using a <a href="https://www.aihw.gov.au/getmedia/95237794-4b77-4683-9f00-77c4d33e0e7c/13406.pdf.aspx?inline=true#:%7E:text=Direct%20age%2Dstandardisation%20accounts%20for,distribution%20of%20a%20standard%20population.">method</a> called “direct age-standardisation”. </p>
<p>The report also uses a <a href="https://en.wikipedia.org/wiki/Counterfactual_thinking">counterfactual</a> approach which basically asks, what would the number of deaths have been in the absence of the pandemic? Their comparison between recorded and expected deaths is likely to be more accurate than the ABS comparison. </p>
<h2>What the actuaries saw</h2>
<p>Both the Actuaries Institute report and the ABS separate COVID deaths into two categories:</p>
<ul>
<li><p>deaths from COVID, where COVID is listed as the primary or underlying cause of death</p></li>
<li><p>deaths with COVID, where the underlying cause of death has been determined as something other than COVID, but the virus was a contributing factor.</p></li>
</ul>
<p>The Actuaries Institute report shows 13% excess mortality for the first eight months of 2022 (approximately 15,400 deaths), substantially lower than the ABS estimate for the first seven months. </p>
<p>Just over half of the excess mortality – 8,200 deaths, are deaths <em>from</em> COVID. Another 2,100 deaths are deaths <em>with</em> COVID. The remaining excess of 5,100 deaths makes no mention of COVID on the death certificate.</p>
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<a href="https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="black hearse at cemetery" src="https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500270/original/file-20221212-94717-p3m533.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"></a>
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<span class="caption">COVID was not listed on thousands of death certificates, but was still likely a factor in many.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sydney-nsw-australia-february-25-600w-1936556404.jpg">Shutterstock/Rose Makin</a></span>
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Read more:
<a href="https://theconversation.com/even-mild-covid-raises-the-chance-of-heart-attack-and-stroke-what-to-know-about-the-risks-ahead-190552">Even mild COVID raises the chance of heart attack and stroke. What to know about the risks ahead</a>
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<h2>So what is the likely cause of those non-COVID excess deaths?</h2>
<p>The actuaries’ report gives the following possible explanations for excess deaths not listed as from or with COVID:</p>
<p><strong>Long COVID and interactions with other serious health conditions</strong></p>
<p>A previous COVID infection can cause later illness or death. We know COVID is associated with higher <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(22)00087-4/fulltext">risk</a> of death from heart disease, cancer and other causes. </p>
<p>But a doctor tasked with completing a death certificate may not identify a link between the death and a COVID infection months earlier. Therefore, it seems likely some deaths were due to late COVID effects.</p>
<p><strong>Delayed deaths from other causes</strong></p>
<p>Deaths from respiratory disease in 2020 and 2021 were <a href="https://medicalrepublic.com.au/respiratory-deaths-fell-during-second-covid-19-wave/38109">lower</a> than expected. This is presumably due to public health measures like mask wearing. While those measures were in place, people caught fewer respiratory diseases. Some people may have died earlier had their systems been stressed by respiratory disease during this time. So, some of the reported non-COVID excess deaths may be due to the catch-up effect of those people succumbing to underlying illnesses. </p>
<p><strong>Delays in emergency care</strong></p>
<p>Around Australia, our health systems are under pressure, with staff absences due to COVID, ambulance ramping, and bed blocks in our acute hospitals. </p>
<p>Unfortunately, there have been <a href="https://www.abc.net.au/news/2022-09-13/report-released-into-south-australia-ambulance-delays/101434904">cases</a> of people dying while waiting for an ambulance. It could be that people with conditions such as heart disease, cancer or diabetes may not be getting lifesaving emergency care due to these factors. </p>
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Read more:
<a href="https://theconversation.com/covid-death-data-can-be-shared-to-make-it-look-like-vaccines-dont-work-or-worse-but-thats-not-the-whole-picture-172411">COVID death data can be shared to make it look like vaccines don't work, or worse – but that's not the whole picture</a>
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<p><strong>Delays in routine care</strong></p>
<p>Over the pandemic period we have seen <a href="https://ahpa.com.au/advocacy/australians-are-delaying-healthcare-appointments-and-tests-during-covid-19/#:%7E:text=Of%20those%20surveyed%2C%2059%25%20were,services%20would%20be%20too%20busy.">delays</a> in people <a href="https://www.pwc.com.au/media/2021/pwc-global-health-industry-issues-survey.html">seeking</a> routine health care or attending <a href="https://www.aihw.gov.au/reports/australias-health/cancer-screening-and-treatment#How%20has%20the%20COVID-19%20pandemic%20impacted%20the%20cancer%20screening%20programs?">screening tests</a> for breast and cervical cancer. </p>
<p>There have also been <a href="https://9now.nine.com.au/a-current-affair/coronavirus-elective-surgery-covid19-holds-become-ticking-time-bombs-for-aussie-patients/630d03bc-87e9-4ba9-b6b4-791d2690bda2">delays</a> in elective surgery. And people may have been <a href="https://janesthanalgcritcare.biomedcentral.com/articles/10.1186/s44158-021-00032-5">avoiding</a> health-care settings due to fear of catching COVID. These delays in routine care may have led to deaths that would have been prevented in previous years. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="person getting blood pressure checked" src="https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500274/original/file-20221212-96198-4pofku.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>
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<span class="caption">Many people have delayed routine health checks since the start of the pandemic.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-american-patient-undergoing-routine-600w-2099534764.jpg">Shutterstock</a></span>
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<p><strong>Pandemic lifestyle changes</strong></p>
<p>There is evidence in <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11971-7">Australia</a> and the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540284/">United Kingdom</a> a higher proportion of people made less healthy lifestyle choices during lockdowns, such as drinking more alcohol and exercising less. Higher risks for childhood obesity were also <a href="https://www.bmj.com/content/374/bmj.n1716">noted</a>. We could be starting to see the impact of these changes.</p>
<p><strong>Undiagnosed COVID</strong></p>
<p>It is almost certain some of the excess deaths are from unidentified COVID. Unfortunately in Australia, we have no firm data on the percentage of undiagnosed COVID cases, and even less on how that percentage might have changed over time. </p>
<p>So, the good news is the ABS excess death estimate of 17% more deaths in the first eight months of this year is likely an over-estimate, with the true rate closer to 13%. Of this 13%, some 7% are deaths from COVID, 2% are deaths with COVID, and much of the remaining 4% is likely to still be COVID-related in some way. </p>
<p>Last week, there were <a href="https://www.covid19data.com.au/deaths">219</a> COVID-related deaths reported. If the actuaries’ analysis is accurate, then the true number of COVID-related deaths last week was closer to 250 – a sobering thought as we approach the festive season. </p>
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<p>
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Read more:
<a href="https://theconversation.com/we-were-on-a-global-panel-looking-at-the-staggering-costs-of-covid-17-7m-deaths-and-counting-here-are-11-ways-to-stop-history-repeating-itself-190658">We were on a global panel looking at the staggering costs of COVID – 17.7m deaths and counting. Here are 11 ways to stop history repeating itself</a>
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<p><em>Editor’s note: After publication, the ABS contacted The Conversation to clarify its Provisional Mortality Statistics should not be used or reported as official excess mortality estimates.</em></p><img src="https://counter.theconversation.com/content/196281/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrian Esterman receives funding from the MRFF, the NHMRC and the ARC.</span></em></p>There were deaths from COVID and deaths with COVID – but other deaths are also likely linked to the virus’s impact on our health and our medical care.Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1920332022-10-06T13:57:45Z2022-10-06T13:57:45ZAusterity led to twice as many excess UK deaths as previously thought – here’s what that means for future cuts<p>Cuts to public services and living standards across Britain from 2010 contributed to 335,000 excess deaths – twice as many as previously thought, according to new research. These austerity measures were introduced by the coalition government elected into office that year, partly in response to the banking crash of 2008.</p>
<p>Previous estimates had suggested that <a href="https://bmjopen.bmj.com/content/7/11/e017722">152,000</a> people died prematurely between 2015 and 2019 due to <a href="https://theconversation.com/austerity-was-necessary-in-2010-but-we-dont-need-much-more-37939">austerity</a>. The <a href="https://jech.bmj.com/content/jech/early/2022/09/26/jech-2022-219645.full.pdf">new study</a>, conducted by researchers at the University of Glasgow and the Glasgow Centre for Population Health and published in the Journal of Epidemiology and Community Health, suggests this was an underestimate and also suggests that austerity had a growing effect over time. </p>
<p>These findings are troubling for several reasons. They suggest that men were much more affected than <a href="https://www.dannydorling.org/?page_id=3970">we first thought</a>. Furthermore, the UK government now plans to embark on a <a href="https://www.theguardian.com/commentisfree/2022/oct/04/liz-truss-kwasi-kwarteng-chancellor-u-turn-tax-cuts-public-services-benefits">new round</a> of very large public spending cuts. Against this backdrop, these new numbers of excess deaths linked to a previous period of stringent public spending cuts <a href="https://conservativehome.com/2022/10/03/our-survey-over-two-in-five-party-members-want-spending-cuts-as-well-as-tax-cuts-not-more-borrowing/">can give us an idea</a> of what might lie ahead this time round too.</p>
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<p>There were actual <a href="https://academic.oup.com/bmb/article/133/1/4/5812717">overall falls</a> in UK life expectancy between 2014 and 2018, with large falls for particular groups such as the poorest tenth of the population, although the health of people living in the best-off areas continued to improve. Previous <a href="https://www.gov.uk/government/publications/recent-trends-in-mortality-in-england-review-and-data-packs">suggestions</a> that flu or particularly cold winters might have been key reasons don’t stand up to scrutiny, given that, during this period, there was neither an unusual flu outbreak nor any notably cold winter.</p>
<p>Before this new study, some disputed the idea that austerity could be blamed for the increase in deaths by pointing out that most of those who had died prematurely were old and so had benefited from the <a href="https://www.unbiased.co.uk/life/pensions-retirement/what-is-the-triple-lock-pension-and-how-does-it-affect-me">“triple lock”</a> of the UK state pension. </p>
<p>This safeguarding mechanism was introduced in 2010 to ensure that pensions would rise by the highest of inflation, earnings growth, or 2.5% a year. In theory this meant that pensioners – the over-66s – were sheltered from the effects of austerity. Sadly, that was not true. </p>
<p>Between 2010 and 2020 the average UK pensioner saw their real-terms weekly income (after housing costs) rise by only £12, to £331 a week. That represents a meagre 3.8% rise <a href="https://www.gov.uk/government/statistics/pensioners-incomes-series-financial-year-2019-to-2020/pensioners-incomes-series-financial-year-2019-to-2020">over the whole decade</a>, which works out to £1.71 extra per day. This in no way compensates for rising fuel and other costs that <a href="https://news.sky.com/story/state-pensioners-set-to-be-left-with-just-11-a-day-from-april-as-energy-bills-soar-12684106">especially hurt</a> poorer pensioners. </p>
<p>The overall rise in weekly income was this small because other state benefits that pensioners received, and relied upon to ensure they could cope, were reduced in real terms. For example the proportion of pensioners receiving disability payments <a href="https://www.gov.uk/government/statistics/pensioners-incomes-series-financial-year-2019-to-2020/pensioners-incomes-series-financial-year-2019-to-2020#sources-of-pensioner-incomes">fell from 23% to 19%</a> between 2010 and 2020. </p>
<p>Poorer pensioners and those in most need were also most harmed by cuts to state services. They lost their adult social worker and carer visits, local government help, and so much else that existed in 2010 – but was largely gone by 2019.</p>
<p>It is now becoming clear that far more people died prematurely due to the direct and indirect effects of austerity and government policy than we had at first believed to be the case. In international comparisons, only in the UK and US were the cuts as bad and <a href="https://www.bmj.com/content/362/bmj.k2562">their impacts on health and wellbeing</a> so sustained. </p>
<p>Government policy in the US <a href="https://www.cnbc.com/2021/10/26/social-security-what-a-new-plan-in-congress-would-mean-for-benefits.html">has changed</a> since the election of Joe Biden and his taking office in January 2021. The UK, by contrast, has moved in the opposite direction. </p>
<p>Data reporter John Burn-Murdoch <a href="https://www.ft.com/content/d5f1d564-8c08-4711-b11d-9c6c7759f2b8">recently argued</a> that, in adopting what might well be “the most extreme economic position of any major party in the developed world”, Liz Truss’s Conservative government has “become unmoored from the British people.” </p>
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<p>More people in Britain died due to austerity in the five years before the pandemic, than died from COVID-19 in the first three years of the pandemic. The effects of austerity continued after the pandemic hit, but initially became harder to discern. </p>
<p>However, in August 2022 the Financial Times <a href="https://www.ft.com/content/f36c5daa-9c14-4a92-9136-19b26508b9d2">published</a> estimates suggesting a large proportion of recent non-COVID-related deaths could be ascribed to just one aspect of austerity: waiting over 12 hours to be seen in accident and emergency departments.</p>
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<p>The pandemic has not gone away. Cases are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/infections">rising again</a>. So too are austerity-related deaths. </p>
<p>Most worrying is the coming winter. The last time the UK suffered a <a href="https://www.theguardian.com/business/2022/aug/14/house-freezing-life-blackouts-1970s-britain">similar energy crisis</a> was during Edward Heath’s term of office (1970-1974). That was also the last time a prime minster in Britain came into office upon winning a general election and left it on losing one. </p>
<p>Today, despite all the deaths from austerity and the pandemic, the UK has a far <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/bulletins/estimatesoftheveryoldincludingcentenarians/2002to2020">larger elderly and frail population</a> than it did in the early 1970s. That decade was characterised by much greater social solidarity and income and wealth inequalities were at an <a href="https://www.dannydorling.org/books/onepercent/Material_files/Media/Figure0-1/Figure0-1.jpg">all-time low</a>. Life expectancy never fell or even slowed in its rise, <a href="https://themanc.com/news/significant-risk-of-uk-gas-shortages-this-winter-regulator-warns/">despite rising heating costs and power cuts</a>. </p>
<p>The situation we face now is more akin the 1930s. Then, we were <a href="https://www.dannydorling.org/books/newsocialatlasofbritain/">as unequal as today</a>. Mortality rates were very high in poorer areas. Most people were poor. There were few average areas. And the very wealthy were protected by their wealth.</p><img src="https://counter.theconversation.com/content/192033/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danny Dorling 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>More people died from the austerity in the five years before the pandemic than have died from COVID since.Danny Dorling, Halford Mackinder Professor of Geography, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1905452022-09-14T20:03:38Z2022-09-14T20:03:38ZImagining COVID is ‘like the flu’ is cutting thousands of lives short. It’s time to wake up<figure><img src="https://images.theconversation.com/files/484472/original/file-20220914-20-7gfwsx.jpg?ixlib=rb-1.1.0&rect=87%2C53%2C4324%2C2856&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Preview/20220506001655360229?assetType=IMAGE&path=/aap_dev16/device/imagearc/2022/05-06/6d/12/2d/aapimage-7kv348wuie8r08d3i4g_minihighres.jpg">AP Photo/Francisco Seco</a></span></figcaption></figure><p>It is difficult to understand the ease with which we have accepted a major proportion of the Australian population getting infected with COVID in just a matter of months. Many have been infected multiple times, potentially exposing them to long COVID and other problems we are only beginning to understand. In the past 75 years, only <a href="https://www.abs.gov.au/ausstats/abs@.nsf/featurearticlesbytitle/00753BC276CCB154CA2570FF000075A8?OpenDocument#:%7E:text=Australia%20lost%2034%2C000%20service%20personnel,became%20prisoners%2Dof%2Dwar.">the second world war</a> has had a greater demographic impact on Australia than COVID in 2022.</p>
<p>As of September 12, Australia had reported more than <a href="https://www.worldometers.info/coronavirus/country/australia/">10 million cases</a> of COVID. Of those, 96% were reported in 2022, coinciding with a succession of various Omicron sub-variants and the removal of most protective measures. What’s more, the number of reported cases is probably an <a href="https://kirby.unsw.edu.au/news/national-antibody-study-confirms-covid-19-cases-higher-reported">underestimate</a>.</p>
<p>While the midsummer wave of Omicron led to the highest number of reported cases since the pandemic began, the subsequent winter waves have killed thousands more people.</p>
<p>Between January 5 and March 16 this year, 3,341 <a href="https://ourworldindata.org/coronavirus/country/australia">Australians died</a> with COVID, compared with 8,034 between April 4 and September 16, with August being the most deadly month of the pandemic for Australia. One often forgotten impact of these deaths is that <a href="https://imperialcollegelondon.github.io/orphanhood_calculator/#/country/Australia">an estimated 2,000 Australian children</a> have lost at least one parent as a result of the COVID pandemic. </p>
<p>Rather than national cabinet looking at <a href="https://www.abc.net.au/news/2022-09-14/covid-pandemic-leave-payments-extended/101438020">pandemic leave</a> and under pressure to cut isolation periods, what’s needed is a shared vision and a strategic COVID plan that acknowledges it is not “just like the flu”. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/484489/original/file-20220914-22-uxtp3y.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/484489/original/file-20220914-22-uxtp3y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484489/original/file-20220914-22-uxtp3y.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484489/original/file-20220914-22-uxtp3y.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484489/original/file-20220914-22-uxtp3y.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484489/original/file-20220914-22-uxtp3y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484489/original/file-20220914-22-uxtp3y.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484489/original/file-20220914-22-uxtp3y.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://ourworldindata.org/coronavirus/country/australia">Our World In Data</a></span>
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</figure>
<h2>A disease evolving quicker than our defences</h2>
<p>The deadly July-August wave happened despite greatly increased immunity from third- and fourth-dose vaccination, natural infection, and lifesaving therapies introduced in April this year. </p>
<p>In other words, Omicron has evolved faster than the tools we are using to combat it. So far in 2022, <a href="https://ourworldindata.org/coronavirus/country/australia">more than 12,000 Australians</a> have died with COVID, six times the number of deaths in the previous two years.</p>
<p>This is a disease so significant it has reduced <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/padr.12477">global life expectancy</a>, one of the best measures of human development. </p>
<p>No other war or disease has done that in more than 65 years, not even the HIV pandemic. The global estimates have been reinforced in several countries, including the United States, where <a href="https://www.cdc.gov/nchs/data/vsrr/vsrr023.pdf">life expectancy</a> has fallen by almost three years since 2019. </p>
<p>Changes in life expectancy only happen when very large numbers of people die “before their time”. In Australia there were 17% more deaths reported this year to the end of May by the <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/latest-release">Australian Bureau of Statistics</a> than the five-year average. This does not count our most recent and lethal BA.5 wave. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/484474/original/file-20220914-20-kl7w7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/484474/original/file-20220914-20-kl7w7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484474/original/file-20220914-20-kl7w7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484474/original/file-20220914-20-kl7w7j.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484474/original/file-20220914-20-kl7w7j.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484474/original/file-20220914-20-kl7w7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484474/original/file-20220914-20-kl7w7j.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484474/original/file-20220914-20-kl7w7j.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&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"></span>
<span class="attribution"><a class="source" href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&hideControls=false&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=~AUS">World in Data</a></span>
</figcaption>
</figure>
<p>The ABS report shows two things. First, COVID is killing large numbers of people both directly and indirectly. At this rate, we can expect to lose many more lives by year’s end. Second, people are <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/padr.12477">dying earlier</a> than they otherwise would have, meaning our life expectancy trajectory will take a hit. </p>
<p>Then there is all we know about <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00323-0/fulltext">long COVID</a> and its effects on the lungs, heart, brain, kidneys and immune system. It affects <a href="https://www.science.org/content/article/what-causes-long-covid-three-leading-theories?cookieSet=1">at least 4%</a> of those infected with Omicron, including those vaccinated and those with mild initial illness. </p>
<p>We are being <a href="https://www.canberratimes.com.au/story/7843242/national-response-to-long-covid-in-works/">warned</a> to prepare for what is effectively a mass disabling event with no known cure or end point. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/long-covid-should-make-us-rethink-disability-and-the-way-we-offer-support-to-those-with-invisible-conditions-187531">Long COVID should make us rethink disability – and the way we offer support to those with 'invisible conditions'</a>
</strong>
</em>
</p>
<hr>
<h2>Not ‘like the flu’</h2>
<p>How did we come to this point? A key reason we have become so complacent is the common narrative <a href="https://www.2gb.com/nsw-premier-warns-influenza-outbreak-is-more-severe-than-covid-19/">comparing COVID to influenza</a> – in the sense that we should live with COVID in the same way we do with the flu.</p>
<p>The statistics demonstrate a different picture. From the start of this year to <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surveil-no11-22.htm">August 28</a>, there had been just under 218,000 reported cases of flu and 288 deaths this year. There have been 44 times as many COVID cases and 42 times as many related deaths. (It is worth noting here authorities are <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/666B3904B28E059BCA257D1700135B16/$File/Australian%20Influenza%20Surveillance%20Report%20No.%2011%20-%2015%20August%20to%2028%20August%202022.pdf">urging caution</a> when comparing this flu season to previous years, given COVID measures and changes in health behaviour.)</p>
<p>Around 1,700 people have been hospitalised with the flu this year. Yet on just <a href="https://www.theguardian.com/australia-news/2022/jul/26/covid-hospitalisations-in-australia-hit-new-record-surpassing-january-peak">one day in July</a>, 5,429 COVID patients were in hospital.</p>
<p>In Australia, we have just had our worst COVID wave in terms of the number of deaths and people admitted to hospital, a wave that is ongoing with thousands still in hospital and around <a href="https://www.worldometers.info/coronavirus/weekly-trends/#weekly_table">360 people dying</a> each week. </p>
<p>Government <a href="https://www.news.com.au/world/coronavirus/australia/australias-chief-medical-officer-paul-kelly-issues-ominous-covid19-warning/news-story/cb02f7c105e0efa88909bee8ba1078fd">health advisers</a> are warning of another COVID wave in the coming months. Independent MP Monique Ryan is <a href="https://www.abc.net.au/radionational/programs/breakfast/independent-mp-calls-on-government-to-rethink-covid-management/101437210">calling</a> for a national COVID summit and more transparency regarding planning. In contrast, this year’s influenza wave <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm#current">looks to be over</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-virus-families-that-could-cause-the-next-pandemic-according-to-the-experts-189622">5 virus families that could cause the next pandemic, according to the experts</a>
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</p>
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<h2>Expendable lives</h2>
<p>This has been a devastating year for older Australians. More than <a href="https://www.theage.com.au/politics/federal/terrifying-three-quarters-of-covid-deaths-in-aged-care-have-occurred-in-2022-20220908-p5bghw.html">3,000 residents</a> of aged care facilities have died of COVID, triple the combined number who died in 2020 and 2021. As things stand, these lives appear invisible and expendable.</p>
<p>The most important discussion now is not about changes to any one intervention. It is one of overall strategy, one that focuses on reducing the spread of the virus. </p>
<p>Immunity from infection is, of course, real. It’s why people usually recover from infection, why waves disappear, and indeed what drives viral evolution to “escape immunity”. </p>
<p>But the more important questions are how much protection it offers, for how long, and at what cost? We now know immunity from Omicron infection is relatively <a href="https://www.imperial.ac.uk/news/237315/omicron-infection-poor-booster-covid-19-immunity/">poor and short-lived</a> and is outpaced by <a href="https://www.nature.com/articles/d41586-022-01771-3">rapid viral evolution</a>, even in the face of vaccination. </p>
<p>Although vaccination vastly reduces the risk of serious illness, waves of infection continue to sweep through large populations, with many <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2209479">susceptible to reinfection</a> within months. This continues to damage our short and long-term health, our health system, and our society.</p>
<p>COVID is nothing at all like the flu. It is causing a vastly worse scale of damage. We must change our tactics to dramatically <a href="https://theconversation.com/reducing-covid-transmission-by-20-could-save-2-000-australian-lives-this-year-183426">cut transmission</a>. In addition to a more vigorous campaign to increase vaccine booster coverage, we need to invest in indoor ventilation and actively promote the benefits of wearing high-quality masks in crowded indoor settings. </p>
<p>And we need a powerful messaging campaign to wake us from our “just like the flu” slumber.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-pandemic-changed-what-it-means-to-have-a-good-death-186806">The pandemic changed what it means to have a 'good death'</a>
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</p>
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<img src="https://counter.theconversation.com/content/190545/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Toole receives funding from the National Health and Medical Research Council.</span></em></p><p class="fine-print"><em><span>Brendan Crabb and the Institute he leads receives research grant funding from the National Health & Medical Research Council of Australia and other Australian federal and Victorian State Government bodies. He is the Chair of The Australian Global Health Alliance and the Pacific Friends of Global Health, both in an honourary capacity. And he serves on the Board of the Telethon Kids Institute</span></em></p>So far in 2022, more than 12,000 Australians have died with COVID, six times the number of deaths in the previous two years.Michael Toole, Associate Principal Research Fellow, Burnet InstituteBrendan Crabb, Director and CEO, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1877752022-07-28T20:05:14Z2022-07-28T20:05:14Z4 in 10 nursing homes have a COVID outbreak and the death rate is high. What’s going wrong?<figure><img src="https://images.theconversation.com/files/476418/original/file-20220728-8389-nlh11g.jpg?ixlib=rb-1.1.0&rect=84%2C28%2C6196%2C3961&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/caregiver-spray-alcohol-cleanning-walker-aids-1727078452">Shutterstock</a></span></figcaption></figure><p><a href="https://www.health.gov.au/resources/collections/covid-19-outbreaks-in-australian-residential-aged-care-facilities">Around 3%</a> (6,100) of the <a href="https://theconversation.com/australias-residential-aged-care-facilities-are-getting-bigger-and-less-home-like-103521#:%7E:text=Today%2C%20more%20than%20200%2C000%20Australians,around%2075%20beds%20per%20facility.">200,000 residents</a> in Australia’s aged care facilities had COVID, as of July 22, in addition to 3,400 staff. </p>
<p>About 1,000 facilities – nearly 40% of <a href="https://theconversation.com/australias-residential-aged-care-facilities-are-getting-bigger-and-less-home-like-103521#:%7E:text=Today%2C%20more%20than%20200%2C000%20Australians,around%2075%20beds%20per%20facility.">the total</a> – had an outbreak. </p>
<p>Aged care residents are also disproportionately dying of COVID. Those in nursing homes account for <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/covid-19-outbreaks-in-australian-residential-aged-care-facilities-22-july-2022.pdf">nearly 30%</a> of the 11,000 deaths from COVID in Australia throughout the pandemic. </p>
<h2>Why is this happening?</h2>
<p>Age is a major <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics">risk factor for COVID</a>. People aged 70 and over make up 85% of all reported COVID deaths. </p>
<p>People in residential care are the most frail and at risk. Aged care residents make up around 40% of the deaths of older Australians, but <a href="https://www.aihw.gov.au/reports/older-people/older-australians/contents/summary">only about 5%</a> of the population aged 65 and over live in residential care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-response-to-covid-in-the-first-2-years-was-one-of-the-best-in-the-world-why-do-we-rank-so-poorly-now-187606">Australia’s response to COVID in the first 2 years was one of the best in the world. Why do we rank so poorly now?</a>
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<hr>
<p>We’ve long known how to reduce the spread of COVID and unnecessary deaths. Effective responses throughout the aged care sector include:</p>
<ul>
<li>all residents and staff being fully vaccinated</li>
<li>appropriate availability of personal protective equipment and rapid antigen tests (RATs)</li>
<li>mask mandates for staff and visitors</li>
<li>widespread use of antiviral treatments for those who catch COVID </li>
<li>rapid responses to outbreaks, including a surge workforce and coordination with home care, GPs and hospital services. </li>
</ul>
<p>But while mask mandates remain a requirement in residential aged care for staff and visitors, and RATS and PPE are now generally available, the other responses are still patchy, piecemeal and poorly coordinated. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1552156830603702274"}"></div></p>
<h2>Vaccination</h2>
<p>Vaccination is the most important protection against COVID. People who are unvaccinated are about <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e2.htm">50 times more likely to die from COVID</a> compared with those who are fully vaccinated. </p>
<p>Yet, vaccinations in residential aged care has been <a href="https://theconversation.com/is-the-covid-vaccine-rollout-the-greatest-public-policy-failure-in-recent-australian-history-164396">a shambles</a>. Early on in the rollout for aged care, staff weren’t fully vaccinated, there were squabbles over staff vaccination mandates, vaccination data was unavailable, and it was unclear who was responsible for making sure vaccination occurred.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-the-covid-vaccine-rollout-the-greatest-public-policy-failure-in-recent-australian-history-164396">Is the COVID vaccine rollout the greatest public policy failure in recent Australian history?</a>
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<p>While mandates have lifted worker vaccination rates, in June this year, only 50% of aged care residents were <a href="https://www.theguardian.com/australia-news/2022/jun/15/only-50-of-aged-care-residents-are-fully-boosted-against-covid-with-vaccine-rollout-labelled-too-slow">fully boosted</a> with fourth doses.</p>
<p>That has improved following pressure from the new government. But even now, <a href="https://www.health.gov.au/resources/collections/covid-19-outbreaks-in-australian-residential-aged-care-facilities">a quarter of residents</a> are still not fully vaccinated with recommended boosters. </p>
<p>More needs to be done to systematically follow up facilities with low vaccination rates. </p>
<figure class="align-center ">
<img alt="Nurse puts bandaid on resident's arm" src="https://images.theconversation.com/files/476432/original/file-20220728-20578-74irdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476432/original/file-20220728-20578-74irdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476432/original/file-20220728-20578-74irdy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476432/original/file-20220728-20578-74irdy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476432/original/file-20220728-20578-74irdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476432/original/file-20220728-20578-74irdy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476432/original/file-20220728-20578-74irdy.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">One in four residents aren’t fully boosted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/aged-caucasian-man-eyeglasses-mask-staring-1847937256">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Antivirals</h2>
<p>Early use of antivirals significantly reduces the risk of hospitalisation and <a href="https://www1.racgp.org.au/newsgp/clinical/first-real-world-studies-on-covid-19-oral-antivira">death from COVID</a>, possibly as much as 80%. </p>
<p>It has been clear for about six months that antivirals are a safe and effective COVID treatment. However, it wasn’t until July 11 that the Commonwealth Chief Medical Officer <a href="https://www.health.gov.au/news/chief-medical-officers-statement-on-standard-of-care-on-covid-19-oral-antiviral-treatments-in-residential-aged-care-facilities">advised</a> that all Australians 70 or older should be offered antiviral treatment within 24 hours when they test positive for COVID (where clinically appropriate). </p>
<p>The reality is that many older people who could benefit from antivirals aren’t getting them and <a href="https://www.theguardian.com/australia-news/2022/jul/22/government-urges-take-up-of-covid-antivirals-as-almost-500000-in-australian-stockpile-near-expiry-date">they are going to waste</a>, with thousands of doses nearing their use-by dates.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-drugs-in-australia-whats-available-and-how-to-get-them-186907">COVID drugs in Australia: what's available and how to get them</a>
</strong>
</em>
</p>
<hr>
<h2>Rapid responses to out outbreaks</h2>
<p>The new federal government appears to be tackling the issue with new urgency. The new aged care minister, Anika Wells, has released a “<a href="https://www.health.gov.au/sites/default/files/documents/2022/07/winter-plan-a-guide-for-residential-aged-care-providers_0.pdf">winter plan</a>” to try to address the aged care crisis. </p>
<p>The plan includes prevention, outbreak management and recovery. But the plan continues to put most of the responsibility of prevention and management on individual providers – a strategy that has been ineffective in the past.</p>
<figure class="align-center ">
<img alt="Aged care worker takes a nasal swab from a resident" src="https://images.theconversation.com/files/476430/original/file-20220728-19-25ovqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476430/original/file-20220728-19-25ovqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476430/original/file-20220728-19-25ovqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476430/original/file-20220728-19-25ovqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476430/original/file-20220728-19-25ovqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476430/original/file-20220728-19-25ovqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476430/original/file-20220728-19-25ovqv.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">Individual providers bear most responsibility for their COVID response.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-woman-sitting-on-hospital-bed-1859594485">Shutterstock</a></span>
</figcaption>
</figure>
<p>The federal government has almost no capacity to effectively coordinate a winter response across residential care, home care and health and support services within local service networks where it is needed. </p>
<p>Ideally, this would see close working relationships between aged care facilities, GPs and local hospitals, including the redeployment of clinical and support staff across facilities as required. This happened in Victoria during the 2020 outbreak.</p>
<p>But despite the recent Royal Commission’s recommendation to do so, the federal government has not put in place local or regional bodies or authorities to plan, coordinate and manage aged care.</p>
<h2>Staff shortages</h2>
<p>These pressures are hugely exacerbated by staff shortages. The <a href="https://theconversation.com/quality-costs-more-very-few-aged-care-facilities-deliver-high-quality-care-while-also-making-a-profit-178022">over-reliance on a privatised market model</a> for aged care and the decades-long under-investment in training, supervision, pay and conditions for aged care workers has come home to roost at the worst possible time. </p>
<p>Estimates suggest there is a shortfall of <a href="https://www.ceda.com.au/ResearchAndPolicies/Research/Economy/Duty-of-Care-Aged-Care-in-Crisis">35,000 workers in aged care</a>, double the problem last year. </p>
<p>The industry is hoping the work value case before the Fair Work Commission will make a difference on these issues. Personal care workers in aged care are paid about the same as workers at McDonald’s – in some cases, less. Unions are arguing for a <a href="https://www.afr.com/politics/federal/government-secures-aged-care-pay-case-delay-20220607-p5arqh">25% increase in pay</a>, which should make aged care a more desirable job, but this case won’t be determined for months.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/labors-plans-for-aged-care-are-targeted-but-fall-short-of-whats-needed-180497">Labor's plans for aged care are targeted but fall short of what's needed</a>
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<hr>
<p>In the meantime, the industry still does not have a realistic workforce strategy. The federal government is scrambling to implement short-term measures through a “surge workforce”, including the recent deployment of 200 military personnel. </p>
<p>But this is <a href="https://amp.theguardian.com/australia-news/2022/jul/25/aged-care-sector-warns-adf-assistance-not-enough-to-address-stark-staff-shortages">unlikely to be enough</a> to address the staff shortages associated with the winter wave. Some providers are now reporting they are down 20-40% of staff. </p>
<p>The result is excess hospitalisation and death, misery for residents and their families, and stress for staff and providers. If the situation continues to deteriorate, this will have to become a major priority for National Cabinet. </p>
<p>And the already stretched state health systems will have to play a greater role to fix the immediate problems.</p><img src="https://counter.theconversation.com/content/187775/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Non Executive Director of Murray PHN
Non Executive Director of Bendigo Kangan Institute</span></em></p>Australia should have been better prepared for the predictable winter COVID wave in aged care.Hal Swerissen, Emeritus Professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1876062022-07-27T20:12:58Z2022-07-27T20:12:58ZAustralia’s response to COVID in the first 2 years was one of the best in the world. Why do we rank so poorly now?<p>Australia’s elimination strategy during the first two years of the COVID pandemic was one of the most effective in the world. Through a combination of early border closures, widespread testing and meticulous contact tracing, localised lockdowns and mask mandates, the number of reported cases was kept to around <a href="https://www.worldometers.info/coronavirus/country/australia/">28,000 in 2020</a>. </p>
<p>This compared with 805,000 in 2020 in <a href="https://www.worldometers.info/coronavirus/country/netherlands/">the Netherlands</a>, which has a population nine million fewer than Australia. </p>
<p>In 2021, Australia recorded 402,000 cases. The increase was largely due to the Delta outbreak in the second half of the year.</p>
<p>Fast forward to mid-2022, when Australia has leapt in rank to <a href="https://www.worldometers.info/coronavirus/#countries">15th</a> in the world for total cases over the course of the pandemic – well ahead of countries with a similar population, such as Taiwan and Chile, and larger countries, such as Canada, Mexico and Iran.</p>
<p>The situation has changed dramatically this year. While Australia has <a href="https://www.worldometers.info/coronavirus/country/australia/">reported</a> 9,225,519 cases since early 2020, 96% have been this year. This has led to Australia’s global ranking of cases, hospitalisations and deaths being among the highest in the world.</p>
<h2>Australia’s cases, hospitalisations and deaths</h2>
<p>The seven-day average of new daily cases is currently just under 47,000, which is lower than the peak of 103,000 in mid-January. </p>
<p>Somewhat surprisingly, the number of COVID <a href="https://covidlive.com.au/report/hospitalised">patients in hospital</a> (5,359) is the <a href="https://www.covid19data.com.au/hospitalisations-icu">highest</a> since the pandemic began.</p>
<p>However, the number of infected persons admitted to an ICU is <a href="https://www.covid19data.com.au/hospitalisations-icu">well below</a> the January peak. </p>
<p>This may be due to higher vaccination rates than at the beginning of the year and the availability of antiviral drugs, resulting in fewer hospital cases with very severe illness. Though it’s worth noting aged care residents have been <a href="https://www.sbs.com.au/news/article/thousands-of-aged-care-residents-infected-as-covid-19-hits-a-third-of-facilities-across-australia/s93exvixx">highly affected</a> and many never made it to ICU despite severe illness.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1551749144405954560"}"></div></p>
<p>Why is the ratio of cases to hospitalisations so high? </p>
<p>It’s possible that case numbers have been underestimated. A recent <a href="https://theconversation.com/covid-hospitalisations-and-deaths-are-rising-faster-than-cases-but-that-doesnt-mean-more-severe-disease-187163">Conversation</a> piece provided a number of reasons why this might be the case. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-hospitalisations-and-deaths-are-rising-faster-than-cases-but-that-doesnt-mean-more-severe-disease-187163">COVID hospitalisations and deaths are rising faster than cases – but that doesn't mean more severe disease</a>
</strong>
</em>
</p>
<hr>
<p>It’s also possible that BA.5 is more virulent than its Omicron predecessors, perhaps because it <a href="https://www.business-standard.com/article/current-affairs/omicron-sub-variants-may-target-lungs-evade-vax-prior-infection-studies-122062301066_1.html">targets the lungs</a>, or simply because it is more distantly related to ancestral SARS-Cov-2 and so better at immune escape than its predecessors. This might explain the high number of deaths in residential aged care facilities. </p>
<p>Whatever the reason, it is not unique to Australia. In Portugal, a third dose booster was associated with a 93% reduction in hospitalisation for BA.2 infections compared with just a 77% reduction for BA.5. This is equivalent to <a href="https://www.medrxiv.org/content/10.1101/2022.07.25.22277996v1">three times</a> the risk of hospitalisation with BA.5 than BA.2. </p>
<p>The seven-day average of daily deaths (72) has <a href="https://www.worldometers.info/coronavirus/country/australia/">doubled</a> since mid-May. </p>
<p>Recent data from <a href="https://www.abc.net.au/news/2022-07-21/third-of-victorias-2022-covid-19-deaths-unvaccinated/101253540">Victoria</a> revealed those who had not received a third vaccine dose made up 72% of those who died with, or due to, COVID. </p>
<p>Boosters may not prevent infection but they are essential to prevent severe illness and death, especially among the elderly. And they may <a href="https://www.nature.com/articles/d41586-022-01453-0#:%7E:text=The%2520researchers%2520found%2520that%2520vaccination,found%2520much%2520higher%2520protection%2520rates.">reduce</a> the incidence of long COVID.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/triple-vaccination-seems-to-reduce-the-chance-of-long-covid-but-we-still-need-to-prepare-for-a-jump-in-cases-183428">Triple vaccination seems to reduce the chance of long COVID – but we still need to prepare for a jump in cases</a>
</strong>
</em>
</p>
<hr>
<h2>How does Australia rank globally?</h2>
<p>Over the past week, Australia has <a href="https://www.worldometers.info/coronavirus/weekly-trends/#weekly_table">ranked second in the world</a> for reported cases per million, behind Brunei and ahead of New Zealand, Singapore and South Korea, excluding small island states. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476165/original/file-20220726-10216-exuq11.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/476165/original/file-20220726-10216-exuq11.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476165/original/file-20220726-10216-exuq11.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=322&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476165/original/file-20220726-10216-exuq11.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=322&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476165/original/file-20220726-10216-exuq11.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=322&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476165/original/file-20220726-10216-exuq11.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=404&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476165/original/file-20220726-10216-exuq11.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=404&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476165/original/file-20220726-10216-exuq11.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=404&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2021-12-07..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=USA~GBR~CAN~AUS~SGP~KOR~BRN~NZL">Johns Hopkins University CSSE COVID-19 Data</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>It’s worth noting all five of these countries had effective responses to the pandemic in its first two years.</p>
<p>Fewer than 40 countries provide up-to-date figures on COVID hospital admissions; among them, Australia ranks second. The current Australian COVID <a href="https://ourworldindata.org/covid-hospitalizations">hospitalisation rate</a> of 21 per 100,000 compares to 30 in France, 19 in Italy, 14 in Canada and Japan, 11 in the United States, and three in Malaysia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-two-frontline-covid-doctors-heres-what-we-see-as-case-numbers-rise-167195">We're two frontline COVID doctors. Here's what we see as case numbers rise</a>
</strong>
</em>
</p>
<hr>
<p>Up until July 26, 11,285 Australians have lost their lives with COVID; 80% of those deaths occurred in 2022. Australia ranks second for <a href="https://www.worldometers.info/coronavirus/weekly-trends/#weekly_table">deaths per capita</a> behind New Zealand and ahead of Croatia, Taiwan and Spain.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476166/original/file-20220726-23-t2u8ln.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/476166/original/file-20220726-23-t2u8ln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476166/original/file-20220726-23-t2u8ln.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=322&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476166/original/file-20220726-23-t2u8ln.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=322&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476166/original/file-20220726-23-t2u8ln.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=322&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476166/original/file-20220726-23-t2u8ln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=404&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476166/original/file-20220726-23-t2u8ln.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=404&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476166/original/file-20220726-23-t2u8ln.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=404&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2022-06-24..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=USA~GBR~ITA~AUS~NZL~HRV~TWN~ESP">Johns Hopkins University CSSE COVID-19 Data</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Why does Australia rank so poorly on key COVID indicators?</h2>
<p><strong>Low population immunity</strong></p>
<p>It’s tempting to explain the current COVID situation in Australia by the relatively low exposure to the virus by the population in the first two years of the pandemic.</p>
<p>A study of SARS-CoV-2 (the virus that causes COVID) antibodies by the <a href="https://www.theguardian.com/world/2022/apr/22/seven-in-10-people-in-england-have-had-covid-research-shows-omicron">United Kingdom Office for National Statistics</a> found 71% of people in England had been infected by the end of February 2022. </p>
<p>A <a href="https://www.webmd.com/lung/news/20220426/almost-60-percent-infected-by-covid">similar study</a> in the United States found 58% of Americans had been infected during the same period.</p>
<p>By contrast, a <a href="https://kirby.unsw.edu.au/news/national-antibody-study-confirms-covid-19-cases-higher-reported">study</a> by the Kirby Institute found just 17% of Australians had been infected by the virus up until the end of February. A more recent <a href="https://www.abc.net.au/news/2022-07-27/almost-half-of-australians-had-a-recent-case-of-covid-by-june/101271784">survey in June</a> found that this figure had jumped to 46% but it’s still lower than the US and UK. </p>
<p>While low population immunity may partially explain the Omicron wave in Australia in January 2022, it doesn’t explain the spike in July by Omicron sub-variants that have been shown to <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2206576">evade</a> the immunity acquired from previous infections.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-soon-can-i-get-covid-again-experts-now-say-28-days-but-you-can-protect-yourself-185491">How soon can I get COVID again? Experts now say 28 days – but you can protect yourself</a>
</strong>
</em>
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<hr>
<p><strong>Seasonal effects</strong></p>
<p>It’s difficult to interpret the impact of climate on COVID. Large waves occurred during the summer of 2021 in the United States and huge outbreaks occurred during the hot season in India and Japan. Australia’s largest wave occurred in the summer of 2022. </p>
<p>Right now, it’s summer in the northern hemisphere and winter here. That may partially explain the high case rates in Australia and New Zealand but not in Brunei, South Korea and Singapore.</p>
<p><strong>Low vaccine booster rate</strong></p>
<p>Just over 70% of eligible Australians have <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/covid-19-vaccine-rollout-update-26-july-2022.pdf">received a third dose</a> of a COVID vaccine. This leaves around 5.7 million adult Australians unprotected against the Omicron variant. </p>
<p>When measured as a proportion of the entire population, Australia’s third dose booster rate <a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">ranks 35th</a> in the world. </p>
<p>But this doesn’t explain the high case rates in South Korea, Singapore and New Zealand, which all have much higher booster rates than Australia.</p>
<p><strong>Masks and other measures</strong></p>
<p>A review of <a href="https://worldpopulationreview.com/country-rankings/countries-with-mask-mandates">mask mandates</a> reveals very little difference between Australia and the rest of the world. </p>
<p>Most countries still mandate masks on public transport and health care and aged care facilities, while universal mask mandates remain in China and in some indoor settings in South Korea. </p>
<p>It is difficult to find reliable data on compliance. However, anecdotally, mask compliance is much higher in countries like Japan and Italy than Australia.</p>
<h2>No one reason for Australia’s poor ranking</h2>
<p>It’s hard to identify a single reason why Australia’s key COVID indicators rank so poorly. It’s probably a combination of low population immunity via a combination of low vaccine booster rates and less natural exposure than other countries (noting that less infection is a very good thing overall), and the relaxation of almost all mitigation measures and seasonal factors. </p>
<p>However, overall it reflects the narrative by political leaders since the beginning of the year that the pandemic is in the past tense. That has profoundly affected the attitudes and behaviours of the public.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-we-care-enough-about-covid-187356">Do we care enough about COVID?</a>
</strong>
</em>
</p>
<hr>
<p>Given the current effective reproductive rate is a little over 1, it just needs to get below 1 to halt the spread of the virus. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1551405964124831744"}"></div></p>
<p>Increased booster rates, indoor mask mandates and provision, a greater focus on testing and isolating and an investment in improved ventilation would take us through this wave to a more secure health and economic situation. We need stronger leadership to get us there.</p><img src="https://counter.theconversation.com/content/187606/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Toole receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Brendan Crabb and the Institute he leads receives research grant funding from the National Health & Medical Research Council of Australia and other Australian federal and Victorian State Government bodies. He is the Chair of The Australian Global Health Alliance and the Pacific Friends of Global Health, both in an honourary capacity. And he has recently joined the Board of the Telethon Kids Institute.</span></em></p>In the first two years of the pandemic, Australia’s COVID elimination strategy was among the most effective in the world. Now we rank second in the world for the most cases per capita.Michael Toole, Associate Principal Research Fellow, Burnet InstituteBrendan Crabb, Director and CEO, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1864612022-07-06T19:55:29Z2022-07-06T19:55:29ZHow has COVID affected Australians’ health? New report shows where we’ve failed and done well<figure><img src="https://images.theconversation.com/files/472675/original/file-20220706-15194-nv0k2t.jpg?ixlib=rb-1.1.0&rect=159%2C35%2C5712%2C3515&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sydney-people-face-mask-covered-crossed-1678667335">Shutterstock</a></span></figcaption></figure><p>The SARS-CoV-2 virus was <a href="https://www.abc.net.au/news/2020-01-25/first-confirmed-coronavirus-case-australian-as-china-toll-rises/11900428">first detected</a> in Australia on January 25 2020. Within <a href="https://deborahalupton.medium.com/timeline-of-covid-19-in-australia-1f7df6ca5f23">two months</a>, the lives of all Australian were upended.</p>
<p>Australians were stranded overseas as external borders were slammed shut. State borders were closed to people from other states. Lockdowns severely restricted movement of the population. People watched in fascination as case numbers went up and then down. </p>
<p>The daily drama dragged on for months, with premiers and chief health officers fronting the media with announcements of case numbers and tightening or loosening of restrictions. </p>
<p>But the daily spectacle made it difficult to see the wood for the trees. Now, new data from the <a href="https://www.aihw.gov.au/reports-data/australias-health">Australian Institute of Health and Welfare</a> shows how Australians’ health changed over the course of the pandemic. It allows us to step back and assess what happened, and to whom. </p>
<p>Australia’s management of the pandemic was overall very good, leading to about <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02796-3/fulltext">18,000 deaths averted</a> in 2020 and 2021. This was primarily due to <a href="https://academic.oup.com/jtm/article/27/5/taaa081/5842100">restricting arrivals</a> and hotel quarantine for those who did arrive, and lockdowns <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.51240">when quarantine was breached</a>, which inevitable happened. </p>
<p>From late 2021, with more than half the total population vaccinated, these restrictions were lifted following the Morrison government’s <a href="https://www.australia.gov.au/national-plan">national plan</a>, released on August 6 2021. </p>
<p>However, the pandemic is not over. The <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics">number of deaths</a> in the eleven months since the plan was released is almost ten times the number than in the 18 months before. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-should-an-australian-centre-for-disease-control-prepare-us-for-the-next-pandemic-184149">How should an Australian 'centre for disease control' prepare us for the next pandemic?</a>
</strong>
</em>
</p>
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<h2>COVID became less deadly, but some Australians were disproportionately affected</h2>
<p>Australia has had four pandemic waves so far. Daily deaths during the first three waves peaked at around 20 per day. The peak in the current wave is much higher, around 90 deaths per day.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/472719/original/file-20220706-17-9dmrfm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/472719/original/file-20220706-17-9dmrfm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472719/original/file-20220706-17-9dmrfm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=479&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472719/original/file-20220706-17-9dmrfm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=479&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472719/original/file-20220706-17-9dmrfm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=479&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472719/original/file-20220706-17-9dmrfm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=602&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472719/original/file-20220706-17-9dmrfm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=602&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472719/original/file-20220706-17-9dmrfm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=602&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://www.aihw.gov.au/">Australia's Health 2022</a></span>
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<p>Although more transmissible, the current variant of the virus is less deadly, with a death rate in April 2022 about 0.1% compared to a rate of over 3% in April 2021. </p>
<p>However, the number of daily new infections, some of whom will become <a href="https://www.bmj.com/content/374/bmj.n1648.abstract">long COVID cases</a>, is much higher than in 2021.</p>
<p>Although most deaths throughout the pandemic were in people aged over 60, each of those was a shortened life. Thousands of years of life have been lost prematurely because of COVID.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/472728/original/file-20220706-14-1k44z5.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/472728/original/file-20220706-14-1k44z5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472728/original/file-20220706-14-1k44z5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472728/original/file-20220706-14-1k44z5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472728/original/file-20220706-14-1k44z5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472728/original/file-20220706-14-1k44z5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472728/original/file-20220706-14-1k44z5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472728/original/file-20220706-14-1k44z5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&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://www.aihw.gov.au/">Australia's Health 2022</a></span>
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<p>Deaths did not fall evenly. Those born overseas had twice the death rate of Australian born. The death rate in cities was three to four times that in regional areas. </p>
<p>The <a href="https://agedcare.royalcommission.gov.au/publications/aged-care-and-covid-19-special-report">bungled management of COVID in residential aged care facilities</a> resulted in deaths in aged care accounting for three-quarters of all COVID deaths in 2020. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1544057914565922816"}"></div></p>
<p>The residential age care death rates in 2021 (17%) and 2022 (26%) are tragically high. </p>
<p>People living in the poorest communities had death rates three times that in wealthier communities.</p>
<p>For younger people, COVID was a disease which led to disability rather death, although this does not diminish the impact on those who suffered – and might still be suffering – as a result of the infection or long COVID. </p>
<h2>Warnings of things to come</h2>
<p>Some preventive care was deferred during the pandemic, which could mean some diseases weren’t detected in their early stages, resulting in poorer outcomes.</p>
<p>Endoscopies are procedures where clinicians look inside the body using a long tube with camera attached, sometimes to detect cancer. Rates of endoscopies were down, suggesting some <a href="https://www.canceraustralia.gov.au/the-impact-of-COVID-19-on-cancer-related-medical-services-and-procedures-in-Australia-in-2020">cancers may have been missed</a>. </p>
<p>The rate of Indigenous health checks also took a downturn:</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/472729/original/file-20220706-19-6d6wtn.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/472729/original/file-20220706-19-6d6wtn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472729/original/file-20220706-19-6d6wtn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=725&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472729/original/file-20220706-19-6d6wtn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=725&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472729/original/file-20220706-19-6d6wtn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=725&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472729/original/file-20220706-19-6d6wtn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=912&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472729/original/file-20220706-19-6d6wtn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=912&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472729/original/file-20220706-19-6d6wtn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=912&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://www.aihw.gov.au/">Australia's Health 2022</a></span>
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<p>This may mean it will be even harder to close the gap between the health of First Nations Australians and the rest of the population.</p>
<p>The overall pattern about mental health is mixed, with raw numbers suggesting no statistically significant change in long-term patterns.</p>
<p>However, there were upticks of reported psychological distress in early 2022, and so the underlying pattern may not yet be clear.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-slashed-health-care-use-by-more-than-one-third-across-the-globe-but-the-news-isnt-all-bad-148537">COVID-19 slashed health-care use by more than one-third across the globe. But the news isn't all bad</a>
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<h2>Outcomes have been good so far, but we’re still in the pandemic</h2>
<p>Extended border closures led to <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-022-00807-7">stress on those separated from their families</a>, and so too did the <a href="https://onlinelibrary.wiley.com/doi/10.1111/ajr.12845">state border closures</a>. Overall, however, outcomes from the pandemic have been good so far.</p>
<p>But the Australian Institute of Health and Welfare report was released in the same week the 10,000th Australian COVID death was reported. The ongoing deaths from COVID are barely reported in the media and appear to be ignored by policymakers.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1539931604906549248"}"></div></p>
<p>The previous prime minister <a href="https://7news.com.au/lifestyle/health-wellbeing/scott-morrison-declares-were-not-going-back-to-lockdowns-as-australias-covid-19-cases-surge-to-an-all-time-high-c-5035678">dichotomised potential COVID responses</a> into lockdowns or “living with COVID”. This was never the case. </p>
<p>A more nuanced response – supplementing a drive to increase vaccination rates with mask mandates and density limits when required, and improving ventilation – was always part of the public health response.</p>
<p>Unfortunately, third dose vaccination rates are sitting at <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/covid-19-vaccine-rollout-update-6-july-2022.pdf">around 70% of those eligible</a>, leaving many Australians dangerously exposed to the virus. </p>
<p>There should be a return to the <a href="https://insightplus.mja.com.au/2021/34/vaccination-alone-not-enough-to-control-covid-19/">“vaccine-plus” strategy</a>, where we focus on lifting vaccination rates and implementing other public health measures – such as mask mandates or density limits – where required.</p>
<p>Otherwise we risk all the good work done in 2020 and 2021 being completely negated and more unnecessary deaths occurring, especially among the most disadvantaged.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-covid-hit-disadvantaged-communities-harder-now-long-covid-delivers-them-a-further-blow-183908">First, COVID hit disadvantaged communities harder. Now, long COVID delivers them a further blow</a>
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</p>
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<img src="https://counter.theconversation.com/content/186461/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett 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>While COVID has become less deadly, it has disproportionately claimed the lives of older and poorer Australians. Others have missed out on necessary preventative care during the pandemic.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1848372022-06-22T20:03:04Z2022-06-22T20:03:04ZCOVID deaths are now barely mentioned in the media. That changes the very nature of grief<figure><img src="https://images.theconversation.com/files/468936/original/file-20220615-25-fma87d.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C667&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/husband-trying-comfort-his-wife-graveyard-1230613846">Shutterstock</a></span></figcaption></figure><p>About a year ago, many of us were in lockdown. State premiers fronted the media every day to reveal how many people had tested positive for COVID and how many people had died.</p>
<p>The number of deaths were prominent in news bulletins. We would lament the sadness of it all, until the next day’s data arrived.</p>
<p>A year later, Australia has an average of about 50 COVID deaths a day. We have had <a href="https://ourworldindata.org/covid-deaths?country=%7EAUS">more than 9,300 COVID deaths</a> since the pandemic began. Yet, these deaths are barely mentioned in the Australian media.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1539508854509084672"}"></div></p>
<p>We seem to have lost the collective opportunity to acknowledge lives lost. And when we don’t talk about these traumatic deaths, there’s a long-term impact on those left behind.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-has-changed-how-we-live-how-we-die-and-how-we-grieve-177731">COVID has changed how we live, how we die, and how we grieve</a>
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</em>
</p>
<hr>
<h2>Is traumatic loss different?</h2>
<p>All grief is hard to cope with. But when grief is combined with the type of trauma we’d see with a violent or sudden death, we can see something different over the long term.</p>
<p>If the media doesn’t discuss the losses, this can <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2021.638874/full">complicate the traumatic grief</a> and lead to something called <a href="https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1183832314">prolonged grief disorder</a>.</p>
<p>This type of grief can extend far beyond the first year after the loss. People yearn for their life before their loved one was taken away. This impacts their capacity to keep moving forward, long after the death occurs.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-care-workers-share-our-trauma-during-the-coronavirus-pandemic-on-top-of-their-own-137887">Health-care workers share our trauma during the coronavirus pandemic – on top of their own</a>
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<hr>
<h2>How does this apply to COVID?</h2>
<p>People who have lost a loved one to COVID can feel <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2021.638874/full">lonely and isolated</a>. They can <a href="https://pubmed.ncbi.nlm.nih.gov/32360895/">also develop</a> prolonged grief disorder.</p>
<p>It can be traumatic to say goodbye under hospital restrictions or losing the opportunity for grief rituals – viewings, funerals and sharing the loss with others – despite many others going through a similar loss.</p>
<p>People who develop prolonged grief disorder after losing a loved one to COVID may find they have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194880/">more severe</a> and prolonged grief responses. This can lead to adverse outcomes such as an increased pre-occupation with their grief, intense emotions and difficulty connecting with their life after the loss. </p>
<p>But if we look to Australian media, it appears the community is no longer focused on the faces of those lives lost.</p>
<h2>What has the media got to do with it?</h2>
<p>Media coverage has long been <a href="https://link.springer.com/article/10.1007/s11089-009-0227-5">intertwined</a> with how we grieve. </p>
<p>When the media publicises first-person accounts of people’s lives, images or faces of people who died, or continually updates the toll of lives lost, this has an impact on those left behind, especially if there was a sudden and traumatic death.</p>
<p>This type of media coverage allows viewers to collectively empathise with people left behind, placing stories against the abstract statistics of death. The community can share in that sorrow vicariously and the media exposure increases the community’s understanding of what that loss means.</p>
<p>We’ve seen examples of this on social media, for instance with the <a href="https://twitter.com/FacesOfCOVID">@FacesOfCOVID</a> Twitter account, which pays tribute to five or six people a day who have died of COVID.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1525458966402191360"}"></div></p>
<p>However, we haven’t seen the equivalent tributes, on a daily basis, in the mainstream media.</p>
<p>If we don’t pay tribute to lives lost, this can affect people left behind in many ways:</p>
<ul>
<li><p>fewer shared images, names or acknowledgments limits how many people hear about someone who’s died, so fewer can express their grief</p></li>
<li><p>families lose the chance to say to others “this is the person I have lost” to show people their pain </p></li>
<li><p>people who have also lost someone don’t get to see others bearing the same pain.</p></li>
</ul>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-five-stages-of-grief-dont-come-in-fixed-steps-everyone-feels-differently-96111">The five stages of grief don't come in fixed steps – everyone feels differently</a>
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<h2>Each traumatic loss affects many others</h2>
<p>More people are impacted by a sudden or traumatic loss, such as a homicide or suicide, than we once thought. One study suggests as many as <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/sltb.12450">135 people</a> are significantly affected. For each COVID death, another study shows <a href="https://pubmed.ncbi.nlm.nih.gov/32651279/">up to nine people</a> are impacted.</p>
<p>Irrespective of whether there are nine or 135 people feeling the ripple effects, the number of deaths we have experienced in Australia tells us thousands are living with the grief of a traumatic COVID death.</p>
<p>This grief will shape people’s experiences of the world, dulling possibilities for joy, making it difficult to accept the finality of a loss. This will be exacerbated by how little we focused on those losses as a community. </p>
<p>A lack of media coverage of COVID deaths means we have also lost moments of shared empathy – a space for others to see people who are travelling the same path.</p><img src="https://counter.theconversation.com/content/184837/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Wayland 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 have also lost moments of shared empathy – a space for others to see people who are travelling the same path.Sarah Wayland, Senior Lecturer Social Work, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1836092022-05-24T00:42:15Z2022-05-24T00:42:15ZTo protect vulnerable Australians from COVID this winter, we need to pick up the pace on third doses<figure><img src="https://images.theconversation.com/files/464733/original/file-20220523-22-9aas5g.jpg?ixlib=rb-1.1.0&rect=13%2C44%2C2982%2C1953&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/y5C4QTKbu_k">CDC/Unsplash</a></span></figcaption></figure><p>Anthony Albanese campaigned on <a href="https://anthonyalbanese.com.au/labors-covid-plan">better pandemic management</a>. Giving the vaccination program a shot in the arm will be his first test.</p>
<p>Not long ago, every shipment of vaccines was a news item and people were queuing around the block to get a jab. </p>
<p>Today, despite rising COVID cases and deaths, Australians seem to have lost interest. The vaccination rate for third doses has <a href="https://www.abc.net.au/news/2021-03-02/charting-australias-covid-vaccine-rollout/13197518#dosesaus">almost stalled</a>. </p>
<p>Speeding up third doses will be critical to protecting Australians against Omicron variants as we move into winter. But without a focus on equal access, that protection will remain uneven. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-has-killed-5-600-australians-this-year-and-the-pandemic-isnt-over-ethics-can-shape-our-response-182765">COVID has killed 5,600 Australians this year and the pandemic isn't over. Ethics can shape our response</a>
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<hr>
<h2>Australia is losing the race</h2>
<p>After a shaky start, Australia got near the <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=People+vaccinated+%28by+dose%29&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=USA%7EGBR%7ECAN%7EDEU%7EITA%7EIND%7EAUS%7EESP%7EKOR">top of the charts</a> for second dose coverage. </p>
<p>But only about <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?tab=table&zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Vaccine+booster+doses&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=USA%7EGBR%7ECAN%7EDEU%7EITA%7EIND%7EAUS%7EESP%7EKOR">half</a> the population has had a third dose. That puts us back in the middle of the OECD pack, and we’re falling further behind the leaders.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/464725/original/file-20220523-56160-k4cnkk.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/464725/original/file-20220523-56160-k4cnkk.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464725/original/file-20220523-56160-k4cnkk.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464725/original/file-20220523-56160-k4cnkk.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464725/original/file-20220523-56160-k4cnkk.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464725/original/file-20220523-56160-k4cnkk.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464725/original/file-20220523-56160-k4cnkk.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464725/original/file-20220523-56160-k4cnkk.PNG?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"></a>
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<p>At the current rate, it would take about two years for every Australian who had a second dose to get their third. That’s not nearly fast enough to improve protection before winter.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/464727/original/file-20220523-13-q2y5qt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464727/original/file-20220523-13-q2y5qt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464727/original/file-20220523-13-q2y5qt.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464727/original/file-20220523-13-q2y5qt.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464727/original/file-20220523-13-q2y5qt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464727/original/file-20220523-13-q2y5qt.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464727/original/file-20220523-13-q2y5qt.PNG?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">
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<h2>Vaccination still matters</h2>
<p>Thousands of hospital beds across Australia are <a href="https://www.abc.net.au/news/2020-03-17/coronavirus-cases-data-reveals-how-covid-19-spreads-in-australia/12060704#hospitalisation">occupied by people with COVID</a>. Freeing up those beds is urgent. </p>
<p>The flu season is looming, and hospitals are facing a perfect storm heading into winter: emergency departments overflowing, elective surgery wait lists ballooning, and the health workforce stretched to the limit. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cases-are-high-and-winter-is-coming-we-need-to-stop-ignoring-covid-183218">Cases are high and winter is coming. We need to stop ignoring COVID</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1075115/COVID-19_vaccine_surveillance_report_12_May_2022_week_19.pdf">Data from the United Kingdom</a> show third doses substantially reduce symptomatic infections and hospitalisations. </p>
<p>Against Omicron, protection falls quickly after the second dose, until a third dose boosts it and keeps it higher for longer. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1492273303729635328"}"></div></p>
<p>That makes high third dose coverage important. It’s also easier than the other steps required for a comprehensive plan to reduce severe illness from COVID, such as national ventilation standards, better access to tests, more antiviral doses, and promoting mask use. </p>
<p>Compared to those measures, vaccination is straightforward. We’ve bought the doses, we’ve done it before, and it’s <a href="https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report/current">effective and safe</a>. </p>
<p>But we’re moving too slowly overall, and parts of the country are being left behind.</p>
<h2>There are wide gaps in coverage</h2>
<p>The Department of Health <a href="https://www.health.gov.au/resources/collections/covid-19-vaccination-geographic-vaccination-rates-lga">publishes data</a> on the proportion of the eligible population that has received second and third doses in different parts of Australia (the international comparison above uses the share of the whole population).</p>
<p>Our analysis shows that the share of eligible Australians without a third dose is three times higher in the least-vaccinated areas compared to the most-vaccinated. </p>
<p>This problem isn’t new. By early November in 2021, half of the local areas in Australia had reached 80% second dose coverage. Today, about one in 20 still haven’t made it.</p>
<p>It’s not random who misses out. Poor areas are more likely to have low vaccination rates (see chart below), even though they should have the highest. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/464739/original/file-20220523-25-hfuo71.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464739/original/file-20220523-25-hfuo71.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464739/original/file-20220523-25-hfuo71.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464739/original/file-20220523-25-hfuo71.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464739/original/file-20220523-25-hfuo71.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464739/original/file-20220523-25-hfuo71.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464739/original/file-20220523-25-hfuo71.PNG?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">
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<p>People living in poor areas are more exposed, because more of them have in-person jobs and live in larger households. If they get infected, their chance of severe illness is higher, because they are <a href="https://www.aihw.gov.au/reports/australias-health/health-across-socioeconomic-groups">more likely to have risk factors</a> such as chronic disease. Low vaccination coverage only adds to their risk of harm. </p>
<p>Likewise, people living in <a href="https://www.abc.net.au/news/2021-03-02/charting-australias-covid-vaccine-rollout/13197518#region">remote areas</a> have lower vaccination, as do <a href="https://www.abc.net.au/news/2021-03-02/charting-australias-covid-vaccine-rollout/13197518#indigenous">Aboriginal people</a> in many parts of Australia, even though these groups are at greater risk. </p>
<p>A key lesson of Victoria’s second wave in 2020, and NSW’s in 2021, is the importance of vaccinating people at higher risk, including those in lower-income areas, to slow the spread of COVID and reduce severe illness. The data show this critical lesson of the pandemic has not been learned. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-is-failing-marginalised-people-and-it-shows-in-covid-death-rates-177224">Australia is failing marginalised people, and it shows in COVID death rates</a>
</strong>
</em>
</p>
<hr>
<h2>How can we get faster … and fairer?</h2>
<p>Getting higher – and fairer – vaccination rates will require national and local action.</p>
<p>Government advertising and political leadership helped raise the vaccination rate before. The Albanese government should lead the way on third doses, promoting the importance, safety, and impact of vaccination. </p>
<p>The government should set ambitious coverage targets for vulnerable groups and areas, and support tailored, local solutions to achieve them. </p>
<p><a href="https://www.health.gov.au/initiatives-and-programs/phn">Primary Health Networks</a> (PHNs) are regional bodies responsible for improving primary care, which is health care given outside a hospital, typically without a referral. That includes vaccinations at GP clinics and community pharmacies. Their role includes improving access to care for people at risk of missing out. PHNs should work with local communities to lift third dose rates, with new funding for the PHNs that have the lowest rates in their area, linked to targets they must hit. </p>
<p>Local barriers are different from place to place, but there are many proven ways to overcome them. Clinics reaching out to people <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005188.pub4/full?highlightAbstract=vaccin%257Cuptake%257Cuptak%257Cvaccination">is effective</a>. Aboriginal-controlled services can <a href="https://www.rrh.org.au/journal/article/7043">play a critical role</a> in their communities. There is experience here and <a href="https://link.springer.com/article/10.1007/s11524-021-00594-3">overseas</a> <a href="https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0126">about</a> partnering with community leaders and organisations, countering distrust, and vaccinating in different community settings.</p>
<p>Tough vaccine mandates have worked to increase uptake. If other measures fail, and hospitalisations rise, they should be considered again.</p>
<p>Without strong leadership, the vaccination rate will remain low and uneven. Getting it right will make a difference now and give us the playbook for the next dose, the next vaccine, and the <a href="https://www.amazon.com/Prevent-Next-Pandemic-Bill-Gates-ebook/dp/B09MT3H6XT">next pandemic</a>.</p><img src="https://counter.theconversation.com/content/183609/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Breadon 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>Poor areas are more likely to have low COVID vaccination rates, even though residents in these areas have greater exposure to the virus.Peter Breadon, Program Director, Health and Aged Care, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1827652022-05-18T20:59:02Z2022-05-18T20:59:02ZCOVID has killed 5,600 Australians this year and the pandemic isn’t over. Ethics can shape our response<figure><img src="https://images.theconversation.com/files/463828/original/file-20220518-21-1l19yr.jpg?ixlib=rb-1.1.0&rect=82%2C34%2C4525%2C3233&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos.aap.com.au/">Luis Ascui/AAP</a></span></figcaption></figure><p>It’s difficult to ask, but how many fatalities should Australia accept from COVID in 2022?</p>
<p>The World Health Organization <a href="https://www.who.int/news/item/05-05-2022-14.9-million-excess-deaths-were-associated-with-the-covid-19-pandemic-in-2020-and-2021">says</a> worldwide there were almost 15 million excess deaths in 2020–21 due to the pandemic.</p>
<p>In Australia, <a href="https://www.smh.com.au/national/we-re-living-with-covid-but-more-of-us-are-dying-than-ever-20220429-p5ah7y.html">deaths have surged</a>, with more than 5,600 so far this year and hundreds each week. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/463552/original/file-20220517-14-10xuby.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/463552/original/file-20220517-14-10xuby.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463552/original/file-20220517-14-10xuby.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=285&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463552/original/file-20220517-14-10xuby.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=285&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463552/original/file-20220517-14-10xuby.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=285&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463552/original/file-20220517-14-10xuby.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=358&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463552/original/file-20220517-14-10xuby.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=358&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463552/original/file-20220517-14-10xuby.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=358&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">COVID deaths have been rising since March.</span>
<span class="attribution"><a class="source" href="https://www.covid19data.com.au/deaths">Covid19data.com</a></span>
</figcaption>
</figure>
<p>Some epidemiologists, including <a href="https://www.abc.net.au/news/2022-04-30/qld-covid19-coronavirus-data-cases-tolerate-deaths-australia/101024646">Mike Toole</a> from the Burnet Institute and <a href="https://twitter.com/oldlillipilli/status/1526448328577122304">other public figures</a>, are critical that little attention is being paid to these fatalities.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1524938883384877079"}"></div></p>
<p>Public health officials <a href="https://protect-au.mimecast.com/s/GxTdC2xZzgHpq1wRMtBEkC3?domain=smh.com.au">are focused on hospitalisations</a>, which remain relatively low, and the case fatality rate (the proportion of those with the illness who die), which is falling, in part due to the high vaccination rate. So governments are easing the remaining restrictions.</p>
<p>Prime Minister Scott Morrison <a href="https://www.abc.net.au/news/2022-05-18/election-live-blog-may-18-scott-morrison-anthony-albanese/101074930">said yesterday</a> that every COVID death was a “terrible loss” but Australians wanted to “move on”.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1526727237135106050"}"></div></p>
<p>Do we have the balance right, from an ethics perspective? </p>
<h2>Our ethical responsibilities</h2>
<p>COVID policy-making and ethical decision-making are challenging, and there is room for a diversity of views. But there are three areas of responsibility we should focus on.</p>
<p>First, in the election run-up, voters deserve to know where each party stands, such as their intended policy response to any surge in fatalities (perhaps driven by a new virus variant). There also must be a review of lessons learned.</p>
<p>Second, we should each consider what we are personally willing to do for the wider community. Getting that booster, or vaccinating your children, can be both personally and socially worthwhile. </p>
<p>Third, our community has vulnerable people, for whom infection might be a death sentence. If we see someone wearing a mask and carefully socially distancing, we should respect their efforts. Above all, if you have any indication you might be infected, take extra care not to risk exposing others. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-mask-mandates-might-be-largely-gone-but-here-are-5-reasons-to-keep-wearing-yours-177824">COVID mask mandates might be largely gone but here are 5 reasons to keep wearing yours</a>
</strong>
</em>
</p>
<hr>
<p>Simply put, the pandemic isn’t over yet, and we’re going to have to continue relying on each other.</p>
<h2>Questions of political and personal ethics</h2>
<p>When we’re thinking about how many COVID fatalities are acceptable, we need to distinguish the different ethical questions that face us.</p>
<p>One is the question of policy. What should our governments be doing in response to the high death toll? Should they employ some new mix of vaccine/booster mandates, lockdowns, contact-tracing, travel restrictions, mask mandates, and the like?</p>
<p>Then there’s the question of our own personal behaviour. We can all make efforts to limit the risk of spreading the virus to other, perhaps vulnerable, people.</p>
<p>Ethics is a higher standard than law, and not every moral obligation should be compelled by government.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/many-places-are-starting-to-wind-back-covid-restrictions-but-this-doesnt-mean-the-pandemic-is-over-yet-180856">Many places are starting to wind back COVID restrictions, but this doesn't mean the pandemic is over yet</a>
</strong>
</em>
</p>
<hr>
<h2>Guidance from ethical theory: utilitarianism</h2>
<p>It can seem commonsense that we should do all we can to prevent harms to vulnerable people. But mainstream ethical theories resist this intuitive idea.</p>
<p>The theory of <a href="https://www.britannica.com/topic/utilitarianism-philosophy">utilitarianism</a> focuses purely on consequences. Utilitarianism tells us to maximise the sum total happiness of all sentient beings. While this approach can be very demanding, it would resist a stringent response to COVID, for two reasons. </p>
<p>First, utilitarianism gives no special obligation to fellow citizens. Because we live in a wealthy country, our best strategic investment is usually to look further afield, and to <a href="https://www.thelifeyoucansave.org.au/the-book/">reduce global extreme poverty</a>. This focus would be the same for COVID too, such as by directing our efforts to boost global vaccine efforts.</p>
<p>Second, utilitarianism will note that most COVID fatalities <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics#:%7E:text=Deaths%20have%20been%20reported%20in,aged%2070%20years%20and%20over.">are among the elderly</a>. Utilitarianism values all happiness equally – whether of a child or a 90-year-old. </p>
<p>But saving the life of a 90-year-old is likely only to net a few more years of happy existence. Saving the life of a child would likely deliver more than 20 times that number. In technical terms (such as those used by the <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/158">World Health Organization</a>), saving the child yields an enormous net gain in “<a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/158">disability-adjusted life-years</a>” (DALYs). </p>
<p>For both these reasons, with widespread vaccination limiting COVID’s harms in Australia, the utilitarian would resist directing enormous efforts to constrain local fatalities.</p>
<figure class="align-center ">
<img alt="Vaccinator in India gives a COVID shot." src="https://images.theconversation.com/files/463839/original/file-20220518-22-1d61h1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463839/original/file-20220518-22-1d61h1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463839/original/file-20220518-22-1d61h1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463839/original/file-20220518-22-1d61h1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463839/original/file-20220518-22-1d61h1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463839/original/file-20220518-22-1d61h1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463839/original/file-20220518-22-1d61h1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Utilitarianism would have us direct our efforts to boost global vaccine coverage.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/first-time-covid-vaccination-1518-age-2099888143">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Guidance from ethical theory: duties and rights</h2>
<p>Another common ethical approach is to focus on actions rather than outcomes. For these duty-based approaches (the technical term is “<a href="https://www.britannica.com/topic/deontological-ethics">deontological</a>”), the end does not justify the means.</p>
<p>Unlike utilitarianism, duty-based approaches would allow us to prioritise locals. They also would be wary about discriminating between young and old, as all life is equally valuable.</p>
<p><a href="https://www.bmj.com/content/309/6948/184.abstract#:%7E:text=The%20four%20prima%20facie%20principles,conflicts%20with%20another%20moral%20principle%20%E2%80%A6">Duty-based approaches</a> hold we should avoid risking harm to others, and should be generous to those in need. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/disabled-people-are-being-left-out-of-covid-recovery-here-are-five-ways-to-change-that-181362">Disabled people are being left out of COVID recovery. Here are five ways to change that</a>
</strong>
</em>
</p>
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<p>However, because duty-based approaches value things like freedom, responsibility and integrity, they <a href="https://journals.sagepub.com/doi/abs/10.1111/1467-9248.12150">limit these obligations</a>. </p>
<p>Sweeping obligations to save others erodes the space for people to pursue their chosen callings, fashion their own diverse life plans, and nurture close relationships. </p>
<h2>Consider a comparison</h2>
<p>Both ethical theories align in treating COVID consistently with other threats to life and well-being. This makes sense. </p>
<p>Consider <a href="https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death">one of the leading causes of death in Australia</a>: cancer. Australia employs many policy responses to this ongoing threat. We ban asbestos and tax cigarettes. We publicly fund medical research and healthcare. We run campaigns to slip, slop, slap.</p>
<p>Yet we could do more. We could raise taxes and direct more resources into research and treatments. We could ban tobacco outright. We could even ban going to the beach during high-UV periods! </p>
<p>Instead – and taking a leaf from the ethical theories considered above – we direct our efforts towards impactful policies, and avoid intruding too far into people’s personal decision-making. </p>
<p>Sensible ethical responses to COVID will behave similarly. In terms of both public policy and personal decision-making, we need to remember the pandemic isn’t over yet. Just as we do for other serious threats to our lives and well-being, we will all have a continuing role to play.</p><img src="https://counter.theconversation.com/content/182765/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hugh Breakey 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>Prime Minister Scott Morrison says every COVID death is a terrible loss but Australians want to move on. Here’s how ethics can shape our response to this stage of the pandemic.Hugh Breakey, Deputy Director, Institute for Ethics, Governance & Law. President, Australian Association for Professional & Applied Ethics., Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1790812022-03-31T12:44:17Z2022-03-31T12:44:17ZBrains are bad at big numbers, making it impossible to grasp what a million COVID-19 deaths really means<figure><img src="https://images.theconversation.com/files/455044/original/file-20220329-13-xqeqii.jpg?ixlib=rb-1.1.0&rect=0%2C335%2C7000%2C6371&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The human brain isn't built to understand large numbers.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/digital-binary-code-human-head-illustration-royalty-free-image/1324553121?adppopup=true">OsakaWayne Studios/Moment via Getty Images</a></span></figcaption></figure><p>On May 12, 2022, President Joe Biden marked the grim milestone of <a href="https://www.cbsnews.com/news/covid-deaths-1-million-biden/">1 million confirmed COVID-19 deaths</a> in the U.S. For most people, visualizing what a million of anything looks like is an impossible task. The human brain just isn’t built to comprehend such large numbers.</p>
<p>We are two neuroscientists who study the processes of <a href="https://scholar.google.com/citations?user=Z54dOfYAAAAJ&hl=en&oi=ao">learning</a> and <a href="https://scholar.google.com/citations?user=0JIqhZwAAAAJ&hl=en&oi=ao">numerical cognition</a> – how people use and understand numbers. While there is still much to discover about the mathematical abilities of the human brain, one thing is certain: People are <a href="https://nautil.us/how-to-understand-extreme-numbers-5854/">terrible at processing large numbers</a>.</p>
<p>During the peak of the omicron wave, over 3,000 U.S. residents died per day – <a href="https://www.nytimes.com/interactive/2022/02/01/science/covid-deaths-united-states.html">a rate faster than in any other large high-income country</a>. A rate of 3,000 deaths per day is already an incomprehensible number; 1 million is unfathomably larger. Modern neuroscience research can shed light on the limitations of the brain in how it deals with large numbers – limitations that have likely factored in to how the American public perceives and responds to COVID-related deaths. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/455047/original/file-20220329-19-ubf0jd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A balance with a large ball on one side and a small ball on the other side." src="https://images.theconversation.com/files/455047/original/file-20220329-19-ubf0jd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455047/original/file-20220329-19-ubf0jd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455047/original/file-20220329-19-ubf0jd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455047/original/file-20220329-19-ubf0jd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455047/original/file-20220329-19-ubf0jd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455047/original/file-20220329-19-ubf0jd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455047/original/file-20220329-19-ubf0jd.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">Brains are much better at thinking of large numbers in terms of what is bigger or smaller than in assessing absolute values.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/balance-royalty-free-image/1310052459">Daniel Grizelj/Digital Vision via Getty Images</a></span>
</figcaption>
</figure>
<h2>The brain is built to compare, not to count</h2>
<p>Humans process numbers using networks of interconnected neurons throughout the brain. Many of these pathways involve the <a href="https://doi.org/10.1080/02643290244000239">parietal cortex</a> – a region of the brain located just above the ears. It’s responsible for processing all different sorts of quantities or magnitudes, including <a href="https://doi.org/10.1016/j.tics.2003.09.002">time, speed and distance</a>, and <a href="https://dx.doi.org/10.1098%2Frstb.2009.0028">provides a foundation</a> for other numerical abilities.</p>
<p>While the written symbols and spoken words that humans use to represent numbers are a cultural invention, understanding quantities themselves is not. Humans – as well as many animals including <a href="https://doi.org/10.1098/rstb.2016.0511">fish</a>, <a href="https://doi.org/10.1098/rspb.2008.0702">birds</a> and <a href="https://doi.org/10.1037/0097-7403.33.1.32">monkeys</a> – show rudimentary numerical abilities shortly after birth. Infants, adults and even rats find it <a href="https://doi.org/10.1016/S0166-2236(98)01263-6">easier to distinguish between relatively small numbers</a> than larger ones. The difference between 2 and 5 is much easier to visualize than the difference between 62 and 65, despite the fact that both number sets differ by only 3. </p>
<p>The brain is optimized to recognize small quantities because smaller numbers are what people tend to interact with most on a daily basis. Research has shown that when presented with different numbers of dots, both <a href="https://doi.org/10.1111/j.2044-835X.1995.tb00688.x">children</a> and <a href="https://doi.org/10.1037/0096-3445.111.1.1">adults</a> can intuitively and rapidly recognize quantities less than three or four. Beyond that, people have to count, and as the numbers get higher, intuitive understanding is replaced by abstract concepts of large, individual numbers.</p>
<p>This bias toward smaller numbers even plays out day to day in the grocery store. When researchers asked shoppers in a checkout line to estimate the total cost of their purchase, <a href="https://doi.org/10.1037/dec0000089">people reliably named a lower price than the actual amount</a>. And this distortion increased with price – the more expensive the groceries were, the larger the gap between the estimated and actual amounts. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/oN63x7ryR34?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Once you get into large numbers like millions and billions, the brain begins to start thinking of these values as categories rather than actual numbers. J Baikoff via Youtube.</span></figcaption>
</figure>
<h2>Bad at big numbers</h2>
<p>Since anything bigger than 5 is too large a quantity to intuitively recognize, it follows that the brain must rely on different methods of thinking when confronted with much bigger numbers.</p>
<p>One prominent theory proposes that the brain relies on an inexact method whereby it represents <a href="https://doi.org/10.1016/j.tics.2004.05.002">approximate quantities</a> through a sort of <a href="https://doi.org/10.1016/j.cognition.2007.06.004">mental number line</a>. This line, imagined in our mind’s eye, organizes small to large numbers from left to right (though this orientation depends on <a href="https://journals.sagepub.com/doi/10.1177/0022022111406251">cultural convention</a>). People tend to make consistent errors when using this internal number line, often <a href="https://doi.org/10.1016/j.cognition.2007.06.004">underestimating extremely large quantities and overestimating relatively smaller quantities</a>. For example, research has shown that college students in geology and biology courses commonly underestimate the time <a href="https://doi.org/10.5408/1089-9995-55.5.413">between the appearance of the first life on Earth and the dinosaurs</a> – which is billions of years – but overestimate how long dinosaurs actually lived on Earth – millions of years. </p>
<p>Further research looking at how people estimate the value of large numbers shows that many people <a href="https://doi.org/10.1111/cogs.12028">place the number 1 million halfway</a> between 1,000 and 1 billion on a number line. In reality, a million is 1,000 times closer to 1,000 than 1 billion. This number line gaffe may visually represent how people people <a href="https://doi.org/10.1111/cogs.12342">use words like “thousand” and “billion” as category markers</a> that represent “big” and “bigger” rather than distinct values.</p>
<p>When grappling with numbers outside of everyday experience, precise values just mean less. </p>
<h2>1,000,000 deaths</h2>
<p>Numbers are a useful, clear and efficient way to summarize the harms of the pandemic, but the truth is that the brain simply can’t understand what it means that a million people have died. By abstracting deaths into impossibly large numbers, people fall prey to the limitations of the mind. In doing so, it’s easy to forget that every single numerical increase represents the entire lived experience of another human being.</p>
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<p>This pandemic has been full of hard-to-comprehend numbers. The <a href="https://doi.org/10.1001/jamainternmed.2020.4221">filtration efficiency of various face masks</a>, the <a href="https://theconversation.com/coronavirus-tests-are-pretty-accurate-but-far-from-perfect-136671">accuracy of different COVID-19 tests</a>, statewide case numbers and <a href="https://theconversation.com/why-coronavirus-death-rates-cant-be-summed-up-in-one-simple-number-135758">worldwide death rates</a> are all complicated concepts far beyond the brain’s intuitive number processing abilities. Yet these numbers – <a href="https://doi.org/10.1377/hlthaff.26.3.741">and how they are presented</a> – matter immensely. </p>
<p>If the brain were built to understand these kinds of numbers, perhaps we would have made <a href="https://doi.org/10.1038/s41562-020-0884-z">different individual decisions or taken different collective action</a>. Instead, we now mourn for the million people behind the number.</p><img src="https://counter.theconversation.com/content/179081/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 organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The brain can count small numbers or compare large ones. But it struggles to understand the value of a single large number. This fact may be influencing how people react to numbers about the pandemic.Lindsey Hasak, Doctoral Candidate in Developmental and Psychological Sciences, Stanford UniversityElizabeth Y. Toomarian, Director, Brainwave Learning Center, Synapse School & Research Associate, Stanford UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1775092022-02-24T13:53:35Z2022-02-24T13:53:35ZIf I am vaccinated and get COVID-19, what are my chances of dying? The answer is surprisingly hard to find<figure><img src="https://images.theconversation.com/files/448171/original/file-20220223-19-hf3m0c.jpg?ixlib=rb-1.1.0&rect=0%2C149%2C2356%2C1359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccination has allowed people to be more social again with much less risk of serious illness, but less cautious behaviors put people at an increased risk of catching the virus.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-multiracial-people-drinking-cocktails-at-home-royalty-free-image/1297963782">Sabrina Bracher / iStock via Getty Images Plus</a></span></figcaption></figure><p>Thankfully, most people who get COVID–19 don’t become seriously ill – especially those who are vaccinated. But a small fraction do get hospitalized, and a smaller fraction do die. If you are vaccinated and catch the coronavirus, what are your chances of getting hospitalized or dying?</p>
<p>As <a href="https://coloradosph.cuanschutz.edu/resources/directory/directory-profile/Miller-Lisa-UCD5695">an epidemiologist</a>, I have been asked to respond to this question in one form or another throughout the pandemic. This is a very reasonable question to ask, but a challenging one to answer. </p>
<p>To calculate the risk of hospitalization or death after getting infected with SARS-CoV-2 you need to know the total number of infections. The problem is that nobody knows exactly how many people have been infected by the coronavirus. So while it is very hard to estimate the true risk of dying if you are vaccinated and come down with COVID-19, there are some ways to better understand the risks.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/448163/original/file-20220223-15-q2x9b4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign for a testing location." src="https://images.theconversation.com/files/448163/original/file-20220223-15-q2x9b4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448163/original/file-20220223-15-q2x9b4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448163/original/file-20220223-15-q2x9b4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448163/original/file-20220223-15-q2x9b4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448163/original/file-20220223-15-q2x9b4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448163/original/file-20220223-15-q2x9b4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448163/original/file-20220223-15-q2x9b4.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">Testing can catch a large number of coronavirus cases, but will never detect all of them.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakMaryland/948d4f8300724f7e9419d2269e103435/photo?Query=covid%20testing%20site&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=3192&currentItemNo=7">AP Photo/Susan Walsh</a></span>
</figcaption>
</figure>
<h2>Counting infections</h2>
<p>The first thing to consider when thinking about risk is that the data has to be fresh. Each new variant has its own characteristics that change the risk it poses to those it infects. Omicron came on quickly and seems to be leaving quickly, so there has been little time for researchers or health officials to collect and publish data that can be used to estimate the risk of hospitalization or death. </p>
<p>If you have enough good data, it would be possible to calculate the risk of hospitalization or death. You would need to count the number of people who were hospitalized or died and divide that number by the total number of infections. It’s also important to take into account time delays between infection, hospitalization and death. Doing this calculation would give you the true infection hospitalization or fatality rate. The trouble is health officials <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burden.html">don’t know with certainty how many people have been infected</a>.</p>
<p>The omicron variant is incredibly infectious, but the <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e4.htm?s_cid=mm7104e4_w">risk of it causing significant illness is much lower</a> compared to previous strains. It’s great that omicron is less severe, but that may lead to fewer people seeking tests if they are infected.</p>
<p>Further complicating things is the widespread availability of at-home test kits. Recent <a href="https://sph.cuny.edu/research/covid-19-survey-january-2022/">data from New York City</a> suggests that 55% of the population had ordered these and that about a quarter of individuals who tested positive during the omicron surge used a home test. Many people who use home tests report their results, <a href="https://www.verywellhealth.com/should-you-report-your-covid-19-home-test-results-5215274">but many do not</a>. </p>
<p>Finally, some people who do get symptoms simply may not get tested because they can’t readily access testing resources, or they don’t see a benefit in doing so. </p>
<p>When you combine all these factors, the result is that the official, reported count of coronavirus cases in the U.S. is <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burden.html">far lower than the actual number</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/448165/original/file-20220223-25-1o02s28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A graph showing two different curves and coronaviruses." src="https://images.theconversation.com/files/448165/original/file-20220223-25-1o02s28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448165/original/file-20220223-25-1o02s28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448165/original/file-20220223-25-1o02s28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448165/original/file-20220223-25-1o02s28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448165/original/file-20220223-25-1o02s28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448165/original/file-20220223-25-1o02s28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448165/original/file-20220223-25-1o02s28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mathematical models can be used to estimate total numbers of cases, but they don’t have specific enough data to be used for precise risk calculations.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/flattening-the-virus-disease-curve-vector-royalty-free-illustration/1244458380?adppopup=true">Mironov Konstantin / iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>Estimating cases</h2>
<p>Since the beginning of the pandemic, epidemiologists have been working on ways to estimate the true number of infections. There are a few ways to do this.</p>
<p>Researchers have previously used <a href="https://doi.org/10.3389/fpubh.2021.753487">antibody tests results</a> from large populations to estimate the prevalence of the virus. This type of testing takes time to organize, and as of late February 2022, it doesn’t appear that anyone has done this for omicron.</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>Another way to estimate cases is to rely on <a href="https://covid19.healthdata.org/global?view=vaccinations&tab=trend">mathematical models</a>.
Researchers have used these models to make estimates of <a href="https://covid19.healthdata.org/projections">total case numbers</a> and also for <a href="https://doi.org/10.1186/s12889-021-11127-7">infection fatality rates</a>. But the models don’t distinguish between estimated infections of vaccinated and unvaccinated individuals. </p>
<p>Research has shown time and again that vaccination <a href="https://www.wsj.com/articles/covid-19-vaccine-booster-shot-cuts-omicron-death-risk-by-95-u-k-study-shows-11643302875">greatly reduces one’s risk of serious illness or death</a>. This means that calculating the risk of death is only really useful if you can distinguish by vaccination status, and existing models don’t enable this.</p>
<h2>What’s known and what to do?</h2>
<p>Without a good estimate of total cases by vaccination status, the best data available is known cases, hospitalizations and deaths. While this limited information doesn’t allow researchers to calculate the absolute risk an individual faces, it is possible to compare the risk between vaccinated and unvaccinated people.</p>
<p>The most <a href="https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitalizations-vaccinations">recent data from the Centers for Disease Control and Prevention</a> shows that hospitalization rates are 16 times higher in unvaccinated adults compared to fully vaccinated ones, and <a href="https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-status">rates of death are 14 times higher</a>.</p>
<p>What is there to take away from all this? Most importantly, <a href="https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitalizations-vaccination">vaccination greatly reduces the risk</a> of hospitalization and death by many times.</p>
<p>But perhaps a second lesson is that the risks of hospitalization or death are much more complicated to understand and study than you might have thought – and the same goes for deciding how to react to those risks.</p>
<p>I look at the numbers and feel confident in the ability of my COVID-19 vaccination and booster to protect me from severe disease. I also choose to wear a high-quality mask when I’m indoors with lots of people to lessen my own risk even further and to protect those who may be unable to get vaccinated. </p>
<p>There have been many lessons learned from this pandemic, and there are many things researchers and the public still need to do better. It turns out that studying and talking about risk is one of them.</p><img src="https://counter.theconversation.com/content/177509/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>In the past, Lisa Miller has received funding from the Centers for Disease Control and Prevention, mentioned in this article. </span></em></p>Calculating your risk of death or hospitalization if you are infected with the coronavirus requires good data – notably, the total number of infections in the US. Unfortunately, that data is fuzzy.Lisa Miller, Professor of Epidemiology, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1755812022-01-26T17:30:01Z2022-01-26T17:30:01ZDon’t believe the claim that only 17,371 people have died from COVID in England and Wales<p>There is no doubt that the pandemic has led to many deaths; however, in the past week, new claims have emerged that the true number of people who have died from COVID in England and Wales is much lower than previously thought. These claims have been widely shared on social media and even <a href="https://twitter.com/DavidDavisMP/status/1485667919698796545">amplified by a senior MP</a>. Can it really be true that new data shows that COVID has killed far fewer people than we previously thought?</p>
<p>To arrive at an answer, we first need to delve into the various ways that COVID deaths are counted in England and Wales. There are two main sources of this data: the first, published by the UK Health Security Agency (UKHSA) and featured prominently on the <a href="https://coronavirus.data.gov.uk/">government’s coronavirus dashboard</a>, is a simple count of all deaths that occur within 28 days of a positive COVID test. </p>
<p>The second, published by the Office for National Statistics (ONS) is based on death certificates that list COVID as a cause of death. Being based on a medical assessment of the circumstances of each individual death, the ONS figures represent the gold standard. </p>
<p>The UKHSA figures will include some deaths that are clearly unrelated to COVID – for example, somebody who has a mild case of COVID and is involved in a car accident three weeks later – and exclude some COVID deaths where someone is in hospital for more than 28 days. The UKHSA data gives us a picture of what is happening now – albeit an imperfect one – while the ONS data takes several weeks to process.</p>
<p>We also need to understand how death certificates work in England and Wales. When somebody passes away, a medical professional completes a death certificate. This includes a field for the “disease or condition directly leading to death” – often called the “underlying cause”. It also includes the option to list one or two diseases or conditions that were not the underlying cause, but which contributed to the death (“contributory causes”). </p>
<p>The data that the ONS publishes shows that, in 2020 and 2021 combined, 157,889 deaths were registered where COVID was mentioned on the death certificate. Of these, 139,839 listed COVID as the underlying cause. In almost 90% of cases where COVID was a factor in somebody’s death, it was considered by medical professionals to be the primary reason they died. So where does the figure of 17,371 COVID deaths come from?</p>
<h2>Freedom of information request</h2>
<p>This <a href="https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/deathsfromcovid19withnootherunderlyingcauses">figure originates</a> from a freedom of information request to the Office for National Statistics that asked for the number of deaths where COVID was the only cause of death recorded. This is complicated by the fact that often COVID itself can cause complications, such as severe respiratory difficulties or organ failure, which will then be listed alongside COVID on the death certificate. </p>
<p>To exclude these deaths, the ONS responded by giving the number of deaths where no “pre-existing conditions” were listed on the death certificate. Which comes to 17,371 for the period up to the end of September 2021. But what is a “pre-existing condition”?</p>
<p><strong>Pre-existing conditions and their International Classification of Diseases (ICD) codes</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/442721/original/file-20220126-27-1isp92z.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/442721/original/file-20220126-27-1isp92z.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442721/original/file-20220126-27-1isp92z.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442721/original/file-20220126-27-1isp92z.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442721/original/file-20220126-27-1isp92z.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442721/original/file-20220126-27-1isp92z.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442721/original/file-20220126-27-1isp92z.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442721/original/file-20220126-27-1isp92z.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Office for National Statistics</span></span>
</figcaption>
</figure>
<p>This list is extensive, including high blood pressure, asthma, COPD, diabetes and a wide range of other common conditions. The argument being made by some is that 17,371 is the true number of COVID deaths, because people with these pre-existing conditions, who make up the vast majority of deaths that list COVID on the death certificate, were already sick. But even a cursory glance at the list makes it clear that this will be incorrect for a great many people. </p>
<p>Over a quarter of adults have <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/873605/Summary_of_hypertension_prevalence_estimates_in_England__1_.pdf">high blood pressure</a>, 4 million people in England <a href="https://fingertips.phe.org.uk/profile/diabetes-ft/data">have diabetes</a> and a similar number <a href="https://fingertips.phe.org.uk/search/asthma">have asthma</a>. Having one of these conditions is neither a death sentence nor a sign of being in poor health. You almost certainly know several people with one or more of them, or are living with one yourself. </p>
<p>The idea that people with a pre-existing condition are at death’s door is simply untrue. Over half of people aged 50 and over have at least one <a href="https://t.co/RcNoet94nn">long-term health condition</a>. But if someone with one of these conditions is unlucky enough to catch COVID and subsequently die, all it takes is for the condition to have some impact for it to end up being listed as a contributory cause on the death certificate.</p>
<p>Let’s take asthma as an example. COVID frequently attacks victims’ lungs, leading them to require ventilation. As a respiratory condition, asthma may well exacerbate these difficulties and will therefore be listed on the death certificate if the person dies. It would be bizarre to claim that the person died of asthma on this basis. Perhaps they would not have died if they didn’t have asthma, but they certainly wouldn’t have died if they hadn’t got COVID.</p>
<p>The vast majority of people who get seriously ill with COVID were living <a href="https://t.co/CJCqeenYyx">full, independent lives</a> before they were hospitalised. And reasonable estimates suggest that the average number of years of life lost per COVID death is <a href="https://t.co/a1txzioxWL">around ten</a>. The idea that people who died from COVID are all extremely ill and would have died soon anyway is not borne out by the facts. </p>
<p>To argue that the deaths from COVID of people with pre-existing conditions don’t count as true COVID deaths is to say that people with pre-existing conditions don’t matter; that their lives are expendable and shouldn’t be considered when assessing the impact of the pandemic. Over 140,000 people with pre-existing conditions have died of COVID in the last two years. We should be mourning this tragic loss of life, not minimising it.</p><img src="https://counter.theconversation.com/content/175581/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colin Angus 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>A freedom of information request is only useful if you know how to read the data.Colin Angus, Senior Research Fellow in the Sheffield Alcohol Research Group, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1751412022-01-23T19:09:49Z2022-01-23T19:09:49Z1,100 Australian aged care homes are locked down due to COVID. What have we learnt from deaths in care?<figure><img src="https://images.theconversation.com/files/441889/original/file-20220121-9056-1nksr7b.jpg?ixlib=rb-1.1.0&rect=15%2C23%2C5160%2C3422&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/adult-woman-old-person-has-600w-1617269392.jpg">Shutterstock</a></span></figcaption></figure><p>Australia’s aged care homes are being devastated by the current wave of COVID infections, with more than <a href="https://www.sbs.com.au/news/fears-aged-care-homes-are-at-breaking-point-as-covid-19-outbreaks-rise/59d0dd8c-b3b9-41c6-97b9-0d80402b20a0">1,100 outbreaks</a> affecting over 7,000 residents and staff. Fear of outbreaks has prompted other homes to lock down and their residents are suffering the serious physical and psychological effects of isolation and, sometimes, inadequate care, due to major staff shortages. </p>
<p>Government responses to last May’s Aged Care Royal Commission’s <a href="https://agedcare.royalcommission.gov.au/publications/final-report">recommendations</a> have only begun to scratch the surface of longstanding problems in the aged care sector. Major workforce issues remain and responses of aged care providers to the threat of COVID in their facilities are highly variable. </p>
<p>Government decisions about broader community public health can have significant and damaging impacts on the health and well-being of aged care residents and staff.</p>
<h2>A high risk group</h2>
<p>Early in the COVID pandemic it became clear that residents of aged care homes were at high risk of serious illness and death. During 2020, Australia had a relatively low rate of COVID deaths at 3.6 per 100,000 population. However, three quarters of all deaths (685 of 910) were <a href="https://www.health.gov.au/sites/default/files/documents/2021/11/coronavirus-covid-19-independent-review-of-covid-19-outbreaks-in-australian-residential-aged-care-facilities-independent-review-of-covid-19-outbreaks-in-australian-residential-aged-care-facilities_0.docx">aged care residents</a>, at a rate of around 309 per 100,000 residents.</p>
<p>Infections and deaths are not the whole story. Independent <a href="https://www.google.com/url?q=https://www.health.gov.au/sites/default/files/documents/2020/08/coronavirus-covid-19-review-of-dorothy-henderson-lodge-covid-19-outbreak-review-of-dorothy-henderson-lodge-covid-19-outbreak.pdf&sa=D&source=docs&ust=1642725612623670&usg=AOvVaw2dMHv2NUZkG7PZRcZcD_vI">reviews</a> of COVID outbreaks in agedcare <a href="https://www.google.com/url?q=https://www.health.gov.au/sites/default/files/documents/2020/08/coronavirus-covid-19-newmarch-house-covid-19-outbreak-independent-review-newmarch-house-covid-19-outbreak-independent-review-final-report.pdf&sa=D&source=docs&ust=1642725612623910&usg=AOvVaw27_cKGL6F9d3C-hRObQNjC">identified</a> other serious adverse effects of lockdowns. </p>
<p>Residents were <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/coronavirus-covid-19-independent-review-of-covid-19-outbreaks-at-st-basil-s-and-epping-gardens-aged-care-facilities.pdf">confined</a> to their rooms and visitors excluded. Family members were often unable to communicate with loved ones for weeks. Staff who were infected or close contacts were replaced by “surge” workers, many of whom had no experience in aged care or infection control. Many residents became depressed, confused, or deconditioned from lack of exercise. </p>
<p>In some homes, remaining staff were overwhelmed by excessive workloads and could <a href="https://www.smh.com.au/politics/federal/malnourished-aged-care-residents-left-to-fend-for-themselves-during-covid-outbreaks-20211102-p59592.html">not provide adequate care</a>. Some were abused by angry relatives or vilified by the media. </p>
<p>A <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2020-10/aged-care-and-covid-19-a-special-report.pdf">special report</a> into COVID by the Aged Care Royal Commission, in September 2020, concluded </p>
<blockquote>
<p>The COVID-19 pandemic has been the greatest challenge Australia’s aged care sector has faced […] Thousands of residents […] have endured months of isolation which has had a terrible effect on their physical, mental and emotional wellbeing.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/older-australians-are-already-bamboozled-by-a-complex-home-care-system-so-why-give-them-more-of-the-same-173326">Older Australians are already bamboozled by a complex home-care system. So why give them more of the same?</a>
</strong>
</em>
</p>
<hr>
<h2>What went wrong?</h2>
<p>The reviews identified leadership and communication failures, shortages of properly trained staff and poor infection control as major problems – but there was wide variation between homes. </p>
<p>Support from commonwealth and state government agencies was essential during outbreaks – for public health and infection control advice, laboratory testing and staff replacements. But many homes were let down by poor communication and coordination, inadequate planning and preparation and contradictory advice. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="elderly woman's hand" src="https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.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">Although the special report into what went wrong in aged care during 2020 was damning, conditions have only changed marginally.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-old-woman-patient-hold-bed-1048637588">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Not much has changed</h2>
<p>In response to the Royal Commission’s recommendations, the federal government promised <a href="https://www.abc.net.au/news/2021-05-11/federal-budget-2021-aged-care-funding/13339356">nearly $18 billion</a> in additional funding over five years – a fraction of what was recommended, and most of it yet to be allocated. </p>
<p>Aged care homes must now employ a nurse with approved infection control training, but their responsibilities and ongoing support and training remain undefined. There have been no moves to improve pay, working conditions or training of aged care workers, whose <a href="https://anmj.org.au/government-must-do-more-to-stop-the-nations-escalating-covid-19-aged-care-crisis-anmf-says/">numbers have fallen</a> since 2020. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/budget-package-doesnt-guarantee-aged-care-residents-will-get-better-care-160611">Budget package doesn't guarantee aged-care residents will get better care</a>
</strong>
</em>
</p>
<hr>
<p>There is a plethora of advice from expert committees and government agencies but little information about how effectively or consistently it is being implemented. To date, about 90% of aged care residents and almost all aged care staff have received two vaccine doses but earlier delays in the vaccine rollout mean many are <a href="https://www.theage.com.au/politics/victoria/hundreds-of-aged-care-homes-around-country-yet-to-get-vaccine-boosters-20220109-p59mw7.html">yet to receive boosters</a>.</p>
<p>Despite improvements, the aged care sector is currently under extreme pressure. The number of homes with COVID outbreaks more than <a href="https://www.smh.com.au/national/more-than-7000-covid-19-cases-in-aged-care-as-hundreds-of-homes-locked-down-20220114-p59oer.html">doubled</a> between January 7 and 14.</p>
<p>There have been relatively few deaths, so far, but government assurances that Omicron is not significantly impacting residents’ health, contradicts reports from the <a href="https://www.theguardian.com/australia-news/2022/jan/13/genuinely-diabolical-in-home-aged-care-struggling-to-meet-critical-needs-under-omicron-surge">frontline</a>. Many facilities are in lockdown, whether or not there is an outbreak and staff shortages are critical. </p>
<p>The serious adverse effects of isolation and neglect are potentially as severe and more widespread than in 2020 and likely to contribute to premature deaths. Unlike cases and deaths from Omicron, they will not be documented as COVID-related but likely attributed to old age or other underlying conditions. </p>
<p>It is not clear whether political leaders who advocated lifting restrictions and “<a href="https://theconversation.com/grattan-on-friday-scott-morrisons-ministerial-team-looks-far-from-match-fit-175343">pushing through</a>” the Omicron wave considered the human rights of aged care residents. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1484243952471805953"}"></div></p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/grattan-on-friday-scott-morrisons-ministerial-team-looks-far-from-match-fit-175343">Grattan on Friday: Scott Morrison's ministerial team looks far from match-fit</a>
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<h2>An urgent need for reform and future planning</h2>
<p>Measures introduced to protect the community from Omicron have been widely criticised as too little, too late and easing of restrictions too premature. Aged-care residents and other vulnerable groups have been disproportionately affected by the massive surge in community transmission. They will be again, in future waves, unless their needs are considered through more nuanced, proactive strategies than either “let it rip” or lockout/lockdown. </p>
<p>There is an urgent need for the Royal Commission’s recommendations to be fully implemented as soon as possible and for aged care reform to be coordinated with reform of the whole care system: hospitals, aged, disability and primary care, and public health. </p>
<p>The Royal Commission highlighted longstanding deficiencies in the aged care sector, but they can’t be fixed during a crisis. Aged care providers need support to build resilience and ensure service continuity. This will require significant financial commitment from government. </p>
<p>Addressing the aged care staff crisis will require an effective campaign – planned in consultation with frontline workers, managers and clients – to attract workers by offering better pay, conditions, training and career structures.</p><img src="https://counter.theconversation.com/content/175141/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lyn Gilbert (and Adj/Professor Alan Lilly) received funding from the Department of Health to undertake independent reviews of COVID-19 outbreaks in residential aged care facilities. The Department had no input into the selection of participants, interviews, survey or workshops conducted during the reviews or analysis and reporting of findings.
</span></em></p>Despite improvements, the aged care sector is currently under extreme pressure. The serious effects of isolation and neglect are potentially as severe now and more widespread than in 2020.Lyn Gilbert, Honorary Professor Faculty of Health and Medical Science, Univeristy of Sydney; Senior Researcher Sydney Institue for Infectious Disease, University of Sydney., University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1697792021-11-16T15:23:10Z2021-11-16T15:23:10ZHow Peru became the country with the highest COVID death rate in the world<p>With <a href="https://ourworldindata.org/coronavirus/country/peru#what-is-the-cumulative-number-of-confirmed-deaths">200,000</a> COVID deaths in a population of less than 33 million, the impact of the pandemic in Peru has been particularly devastating: the country has the <a href="https://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/">highest COVID death rate</a> per head of population worldwide. It’s also estimated to have one of the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01253-8/fulltext">world’s worst rates</a> of children being orphaned or bereft of their caregivers due to COVID. </p>
<p>Yet, compared to many other countries, on paper Peru was relatively well-placed to handle COVID. It is an <a href="https://data.worldbank.org/income-level/upper-middle-income">upper-middle-income country</a> – and before COVID had been <a href="https://cnnespanol.cnn.com/2020/03/13/peru-el-potencial-y-la-oportunidad-de-su-economia/">performing well economically</a>. Life expectancy <a href="https://data.worldbank.org/country/peru">had been rising</a> and poverty falling, and it had been making good progress on improving public health, with <a href="https://dashboards.sdgindex.org/profiles/peru">access to healthcare increasing</a>.</p>
<p>Peru was also one of the first Latin American countries to demand that <a href="https://busquedas.elperuano.pe/normaslegales/decreto-supremo-que-declara-estado-de-emergencia-nacional-po-decreto-supremo-n-044-2020-pcm-1864948-2/">people stay at home</a> to stop the virus spreading. Unlike in some other badly affected Latin American countries, such as <a href="https://www.bbc.co.uk/news/world-latin-america-52080830">Brazil</a> or <a href="https://www.washingtonpost.com/world/the_americas/coronavirus-mexico-lockdown-lopez-obrador/2021/01/25/8d6311aa-50fc-11eb-a1f5-fdaf28cfca90_story.html">Mexico</a>, authorities in Peru didn’t deny the threat of the pandemic.</p>
<p>So how has it still ended up in such a bad situation?</p>
<h2>Not built for lockdown</h2>
<p>On March 15 2020, with 28 confirmed cases and no reported deaths, the Peruvian government <a href="https://cdn.www.gob.pe/uploads/document/file/566448/DS044-PCM_1864948-2.pdf">declared</a> a nationwide state of emergency. This quickly introduced a series of strong control measures, which included closing borders, restricting freedom of movement nationwide and banning crowds from gathering. Schools, universities and churches were closed. In general, all non-essential activities or services were restricted, including non-emergency primary healthcare.</p>
<p>But unfortunately, the early adoption of these measures wasn’t enough to lessen the impact of the pandemic. Cases immediately <a href="https://ourworldindata.org/coronavirus/country/peru">started to climb</a>. </p>
<p>The government had acknowledged that adopting a strict lockdown would be difficult. Peru has a <a href="https://www.statista.com/statistics/1039975/informal-employment-share-peru/">large informal workforce</a> and a fairly limited social security system – meaning that staying at home, off work, would be hard for many. So the government announced a series of policies, such as cash transfers, to try to protect people’s livelihoods while asking them to stay at home.</p>
<p>But the state didn’t have the capacity to deliver cash and food in a way that prevented citizens from needing to venture out. People still had to go out and <a href="https://edition.cnn.com/2020/05/25/americas/peru-covid-hotspot-why-intl/index.html">form long queues</a> in banks to receive their cash transfers. Many also still needed to <a href="https://www.bmj.com/content/373/bmj.n1442">travel daily to food markets</a>. Both became potential infection hotspots. </p>
<h2>Weaknesses in healthcare</h2>
<p>Rising cases then revealed <a href="https://www.tandfonline.com/doi/full/10.1080/02255189.2020.1843009">structural weaknesses</a> in the Peruvian health system. Despite recent economic growth and general improvements in public health, the overall health infrastructure of the country was still poor prior to the pandemic.</p>
<p>In January 2020, according to the ministry of health, <a href="https://www.comexperu.org.pe/public/articulo/como-empieza-el-sector-salud-en-2020-infraestructura-y-equipamiento">78% of health and medical centres</a> had inadequate capacity to provide services, which included having obsolete, inoperative or insufficient equipment. By the beginning of 2021, this had <a href="https://www.comexperu.org.pe/articulo/el-97-de-los-establecimientos-de-salud-del-primer-nivel-de-atencion-cuenta-con-capacidad-instalada-inadecuada">risen to 97% of primary services</a>. </p>
<p>Similarly, before the pandemic Peru had <a href="https://www.oecd-ilibrary.org/sites/63d94877-en/index.html?itemId=/content/component/63d94877-en">29 intensive care beds</a> per million people, below other countries in the region such as Brazil (206), Colombia (105), Chile (73) and Ecuador (69). Staffing levels were also insufficient to allow many health facilities to function properly. This all hampered Peru’s ability to effectively respond to a crisis situation.</p>
<p>The health system is also highly fragmented, which has made coordinating the COVID response across the country challenging, jeopardising its effectiveness at protecting the most vulnerable. And on top of this, there are also persistent inequalities within the system, with access to healthcare often determined by wealth, gender, ethnicity and geography.</p>
<p>For instance, the indigenous peoples in the Peruvian Amazon region are among those who have <a href="https://www.thenewhumanitarian.org/photo-feature/2020/09/01/Peru-Amazon-Indigenous-coronavirus-health">suffered most</a> from the epidemic. Their lack of access to health services, water and sanitation, as well as their high rates of poverty and child malnutrition, placed these ethnic groups in a situation of greater vulnerability.</p>
<h2>An expensive system</h2>
<p>Despite Peru making some progress towards providing free universal healthcare, it’s been estimated that <a href="https://www.researchgate.net/publication/51605005_The_health_system_of_Peru">between 10% and 20%</a> of the population still don’t have access to any health coverage at all. Even those who can access care through public health facilities have to pay some fees – and before the pandemic, this <a href="https://www.lse.ac.uk/business/consulting/reports/latin-america-healthcare-system-overview">out-of-pocket spending</a> on healthcare was increasing. </p>
<p>The pandemic then exposed how drastically costly this could end up being. And for those without private insurance or access to good state-provided care, the costs could be even higher still, with medicines and care charged at <a href="https://elcomercio.pe/lima/sucesos/coronavirus-peru-denuncian-que-clinica-san-pablo-cobro-165-soles-por-medicamento-que-en-el-sector-publico-cuesta-1-sol-omeprazol-nndc-noticia/">vastly inflated rates</a> in some private hospitals. For some the costs will have stopped them seeking care altogether. Income is another barrier to accessing care.</p>
<p>The problem is that there is <a href="https://www.fondoeditorial.pucp.edu.pe/ciencia-politica/1141-patologias-del-sistema-de-salud-peruano.html">little regulation</a> of the health sector in Peru. The same private company can end up providing health insurance, health services, and medicines and medical supplies without any price control mechanism. </p>
<p>The private sector has had a negative influence elsewhere too. Peru also suffered a <a href="https://foreignpolicy.com/2020/10/06/peru-coronavirus-covid-pandemic-oxygen-health-care/">shortage of medical oxygen</a>, which was exacerbated during the early stages of the pandemic by the country’s history of manufacturing oxygen at a higher concentration than the international standard (meaning there was less to go around). </p>
<p>Peru’s competition authority concluded nearly a decade ago that there was no good scientific reason for doing this – and that the norm was adopted <a href="https://www.indecopi.gob.pe/documents/20182/143803/0334_ResfinalOperadorMINSARevocRazonab_PDF.pdf">simply to benefit</a> the interests of several private oxygen manufacturers in the country. Only during the country’s oxygen crisis was the convention overturned.</p>
<p>As vaccination levels have <a href="https://ourworldindata.org/coronavirus/country/peru#how-many-covid-19-vaccine-doses-are-administered-daily">increased</a> from mid-2021 onwards, cases and deaths in Peru have fallen and stabilised at a low level. However, the crisis has unveiled the susceptibility of the country’s health system, and in particular the potentially negative influence of the private sector. The capacity and accessibility of Peru’s health system need to be much better – otherwise disasters like this could happen again.</p><img src="https://counter.theconversation.com/content/169779/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Camila Gianella Malca receives funding from the Norwegian Research Council and Prociencias.</span></em></p><p class="fine-print"><em><span>Jasmine Gideon receives funding from the UK Research and Innovation Global Challenges Research Fund. </span></em></p><p class="fine-print"><em><span>María José Romero is affiliated with the European Network on Debt and Development, Eurodad, which is a non-profit organisation working in the field of development finance. This article does not represent the views of Eurodad. </span></em></p>The country moved quickly to contain the virus, but its health system struggled to look after those who got sick.Camila Gianella Malca, Director of the Center for Sociological, Economic, Political and Anthropological Research, Pontificia Universidad Católica de PerúJasmine Gideon, Reader in Gender, Health and International Development, Birkbeck, University of LondonMaría José Romero, PhD candidate in Development Economics, SOAS, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1695132021-10-15T11:34:57Z2021-10-15T11:34:57ZHow many lives have coronavirus vaccines saved? We used state data on deaths and vaccination rates to find out<figure><img src="https://images.theconversation.com/files/425999/original/file-20211012-15-dzt98d.jpg?ixlib=rb-1.1.0&rect=145%2C218%2C5246%2C3370&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Clinical trials demonstrate how effective vaccines are individually, but the real world shows how effective they are at a population level.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/APTOPIXVirusOutbreakPfizerVaccineNewYork/f7e1e80cffb948e9aeca625578ba6487/photo?Query=pfizer%20AND%20vaccine&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=4431&currentItemNo=8">AP Photo/Mark Lennihan, Pool</a></span></figcaption></figure><figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/426256/original/file-20211013-27-1g7zmpv.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/426256/original/file-20211013-27-1g7zmpv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426256/original/file-20211013-27-1g7zmpv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426256/original/file-20211013-27-1g7zmpv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426256/original/file-20211013-27-1g7zmpv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426256/original/file-20211013-27-1g7zmpv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426256/original/file-20211013-27-1g7zmpv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426256/original/file-20211013-27-1g7zmpv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=321&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="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>More than 200 million U.S. residents have gotten at least one shot of a COVID-19 vaccine with the expectation that the vaccines slow virus transmission and save lives. </p>
<p>Researchers know the efficacy of the vaccines from <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-conclude-phase-3-study-covid-19-vaccine">large-scale clinical trials</a>, the gold standard for medical research. The studies found the vaccines to be <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7009e4.htm?s_cid=mm7009e4_w">very effective at preventing severe COVID–19</a> and <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm">especially good at preventing death</a>. But it’s important to track any new treatment in the real world as the population-level benefits of vaccines could <a href="https://www.who.int/news-room/feature-stories/detail/vaccine-efficacy-effectiveness-and-protection">differ from the efficacy found in clinical trials</a>. </p>
<p>For instance, some people in the U.S. have <a href="https://www.newsweek.com/texas-reporting-second-shot-hesitancy-nearly-2m-skipped-last-covid-vaccine-dose-1629100">only been getting the first shot</a> of a two-shot vaccine and are therefore <a href="https://abc7.com/pfizer-vaccine-moderna-covid-19-first-dose-of/10458064/">less protected than a fully vaccinated person</a>. Alternatively, vaccinated people are <a href="https://www.nbcnews.com/health/health-news/vaccinated-people-are-less-likely-spread-covid-new-research-finds-n1280583">much less likely to transmit COVID-19 to others</a>, including those who are not vaccinated. This could make vaccines more effective at a population level than in the clinical trials. </p>
<p><a href="https://scholar.google.com/citations?user=2flNbOIAAAAJ&hl=en&oi=ao">I am a health economist</a>, and my team and I have been studying the effects of public policy interventions like vaccination have had on the pandemic. We wanted to know how many lives vaccines may have saved due to the states’ COVID-19 vaccination campaigns in the U.S. </p>
<h2>Building an accurate model</h2>
<p>In March 2021, when weekly data on state COVID-19 vaccinations started to become reliably available from state agencies, my team began to analyze the association between state vaccination rates and the subsequent COVID-19 cases and deaths in each state. Our goal was to build a model that was accurate enough to measure the effect of vaccination within the complicated web of factors that influence COVID–19 deaths.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/426254/original/file-20211013-27-avfc28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A map of the U.S. with coronavirus particles connecting different areas." src="https://images.theconversation.com/files/426254/original/file-20211013-27-avfc28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426254/original/file-20211013-27-avfc28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426254/original/file-20211013-27-avfc28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426254/original/file-20211013-27-avfc28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426254/original/file-20211013-27-avfc28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426254/original/file-20211013-27-avfc28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426254/original/file-20211013-27-avfc28.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>
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<span class="caption">State data for vaccination rates and COVID–19 deaths can shed light on the real-world effectiveness of the vaccines.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/america-virus-propagation-map-community-royalty-free-illustration/1213737233?adppopup=true">DeskCube/iStock via Getty Images</a></span>
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<p>To do this, our model compares COVID-19 incidence in states with high vaccination rates against states with low vaccination rates. As part of the analysis, we controlled for things that influence the spread of the coronavirus, like state–by–state differences in <a href="https://dx.doi.org/10.1016%2Fj.scitotenv.2020.143783">weather</a> and <a href="https://doi.org/10.1371/journal.pone.0242398">population density</a>, <a href="https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/safe-activities-during-covid19/art-20489385">seasonally driven changes in social behavior</a> and <a href="https://statepolicies.com/">non-pharmaceutical interventions</a> like stay-at-home orders, mask mandates and overnight business closures. We also accounted for the fact that there is a delay between when a person is first vaccinated and when their <a href="https://news.weill.cornell.edu/news/2021/02/covid-19-vaccines-and-immunity-how-long-does-it-take-for-the-vaccines-to-provide">immune system has built up protection</a>. </p>
<h2>Vaccines saved lives</h2>
<p>To check the strength of our model before playing with variables, we first compared reported deaths with an estimate that our model produced.</p>
<p>When we fed it all of the information available – including vaccination rates – the model calculated that by May 9, 2021, there should have been 569,193 COVID-19 deaths in the U.S. The <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">reported death count</a> by that date was 578,862, less than a 2% difference from our model’s prediction.</p>
<p>Equipped with our well-working statistical model, we were then able to “turn off” the vaccination effect and see how much of a difference vaccines made. </p>
<p>Using near real-time <a href="https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/">data of state vaccination rates</a>, coronavirus cases and deaths in our model, we found that in the absence of vaccines, 708,586 people would have died by May 9, 2021. We then compared that to our model estimate of deaths with vaccines: 569,193. The difference between those two numbers is just under 140,000. Our model suggests that vaccines <a href="https://doi.org/10.1377/hlthaff.2021.00619">saved 140,000 lives</a> by May 9, 2021.</p>
<p>Our study only looked at the few months just after vaccination began. Even in that short time frame, COVID-19 vaccinations saved many thousands of lives despite vaccination rates still being fairly low in several states by the end of our study period. I can say with certainty that vaccines have since then saved many more lives – and will continue to do so as long as the coronavirus is still around.</p><img src="https://counter.theconversation.com/content/169513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sumedha Gupta receives funding from National Institute of Health, National Pharmaceutical Council, and Fairbanks Foundation. </span></em></p>Using a robust statistical model, researchers estimate that coronavirus vaccines had prevented 140,000 deaths by May 9, 2021.Sumedha Gupta, Associate Professor of Economics, IUPUILicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1655382021-09-28T20:13:20Z2021-09-28T20:13:20ZHow contagious is Delta? How long are you infectious? Is it more deadly? A quick guide to the latest science<figure><img src="https://images.theconversation.com/files/422542/original/file-20210922-23-68rivz.jpg?ixlib=rb-1.1.0&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/young-woman-face-mask-using-mobile-1685691625">Shutterstock</a></span></figcaption></figure><p>Delta was recognised as a SARS-CoV-2 <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html#anchor_1632154493691">variant of concern</a> in <a href="https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/">May 2021</a> and has proved extremely difficult to control in unvaccinated populations. </p>
<p>Delta has managed to <a href="https://medicalxpress.com/news/2021-09-delta-overwhelming-covid-variants.html">out-compete</a> other variants, including Alpha. Variants are classified as “of concern” because they’re either more contagious than the original, cause more hospitalisations and deaths, or are better at evading vaccines and therapies. Or all of the above. </p>
<p>So how does Delta fare on these measures? And what have we learnt since Delta was first listed as a variant of concern?</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-delta-defeating-us-heres-why-the-variant-makes-contact-tracing-so-much-harder-164780">Is Delta defeating us? Here's why the variant makes contact tracing so much harder</a>
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<h2>How contagious is Delta?</h2>
<p>The R0 tells us how many other people, on average, one infected person will pass the virus on to. </p>
<p>Delta has an <a href="https://www.bbc.com/news/health-57431420">R0 of 5-8</a>, meaning one infected person passes it onto five to eight others, on average.</p>
<p>This compares with an R0 of 1.5-3 for the original strain. </p>
<p>So Delta is twice to five times as contagious as the virus that circulated in 2020. </p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/423286/original/file-20210927-17-1pk7d7a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423286/original/file-20210927-17-1pk7d7a.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1023&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423286/original/file-20210927-17-1pk7d7a.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1023&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423286/original/file-20210927-17-1pk7d7a.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1023&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423286/original/file-20210927-17-1pk7d7a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1285&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423286/original/file-20210927-17-1pk7d7a.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1285&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423286/original/file-20210927-17-1pk7d7a.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1285&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<hr>
<h2>What happens when you’re exposed to Delta?</h2>
<p>SARS-CoV-2 is the virus that causes COVID-19. SARS-CoV-2 is transmitted through droplets an infected person releases when they breathe, cough or sneeze. </p>
<p>In some circumstances, transmission also occurs when a person touches a contaminated object, then touches their face. </p>
<figure class="align-center ">
<img alt="Four Turkish men walk across an open town space." src="https://images.theconversation.com/files/422547/original/file-20210922-27-v13dlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422547/original/file-20210922-27-v13dlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422547/original/file-20210922-27-v13dlg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422547/original/file-20210922-27-v13dlg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422547/original/file-20210922-27-v13dlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422547/original/file-20210922-27-v13dlg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422547/original/file-20210922-27-v13dlg.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">
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<span class="caption">One person infected with Delta infects, on average, five to eight others.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/turkey-03-20-2020-four-people-1678223533">Shutterstock</a></span>
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<p>Once SARS-CoV-2 enters your body – usually through your nose or mouth – it starts to replicate. </p>
<p>The period from exposure to the virus being detectable by a PCR test is called the <em>latent</em> period. For Delta, one study suggests this is an <a href="https://www.medrxiv.org/content/10.1101/2021.07.07.21260122v2">average of four days</a> (with a range of three to five days). </p>
<p>That’s two days faster than the original strain, which took roughly six days (with a range of five to eight days). </p>
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<img alt="" src="https://images.theconversation.com/files/423460/original/file-20210928-21-19maks8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423460/original/file-20210928-21-19maks8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=761&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423460/original/file-20210928-21-19maks8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=761&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423460/original/file-20210928-21-19maks8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=761&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423460/original/file-20210928-21-19maks8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=957&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423460/original/file-20210928-21-19maks8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=957&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423460/original/file-20210928-21-19maks8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=957&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<hr>
<p>The virus then continues to replicate. Although often there are no symptoms yet, the person has become infectious. </p>
<p>People with COVID-19 <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2783099">appear to be</a> most infectious two days before to three days after symptoms start, though it’s unclear whether this differs with Delta. </p>
<p>The time from virus exposure to symptoms is called the <em>incubation</em> period. But there is often a gap between when a person becomes infectious to others to when they show symptoms. </p>
<p>As the virus replicates, the viral load increases. For Delta, the viral load is up to <a href="https://www.nature.com/articles/d41586-021-01986-w">roughly 1,200 times higher</a> than the original strain.</p>
<p>With faster replication and higher viral loads it is easy to see why Delta is challenging contact tracers and spreading so rapidly.</p>
<h2>What are the possible complications?</h2>
<p>Like the original strain, the Delta variant can affect many of the body’s organs including the lungs, heart and kidneys. </p>
<p>Complications include blood clots, which at their most severe <a href="https://www.abc.net.au/news/2021-08-07/delta-variant-of-covid-19-causing-heart-problems-young-people/100352868">can result in strokes or heart attacks</a>. </p>
<p>Around 10-30% of people with COVID-19 will experience prolonged symptoms, known as <a href="https://theconversation.com/the-mystery-of-long-covid-up-to-1-in-3-people-who-catch-the-virus-suffer-for-months-heres-what-we-know-so-far-161174">long COVID</a>, which can last for months and cause significant impairment, including in people who were previously well.</p>
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<img alt="Woman in a mask waits in hospital waiting room." src="https://images.theconversation.com/files/422545/original/file-20210922-17-1m6p5qa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422545/original/file-20210922-17-1m6p5qa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422545/original/file-20210922-17-1m6p5qa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422545/original/file-20210922-17-1m6p5qa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422545/original/file-20210922-17-1m6p5qa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422545/original/file-20210922-17-1m6p5qa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422545/original/file-20210922-17-1m6p5qa.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">
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<span class="caption">Even previously well people can get long COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coronavirus-hospital-covid-19-woman-medical-1721906755">Shutterstock</a></span>
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<p>Longer-lasting symptoms can include fatigue, shortness of breath, chest pain, heart palpitations, headaches, brain fog, muscle aches, sleep disturbance, depression and the loss of smell and taste.</p>
<h2>Is it more deadly?</h2>
<p>Evidence the Delta variant makes people sicker than the original virus is growing. </p>
<p>Preliminary studies from <a href="https://www.medrxiv.org/content/10.1101/2021.07.05.21260050v2">Canada</a> and <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3861566">Singapore</a> found people infected with Delta were more likely to require hospitalisation and were at greater risk of dying than those with the original virus. </p>
<p>In the Canadian study, Delta resulted in a 6.1% chance of hospitalisation and a 1.6% chance of ICU admission. This compared with other variants of concern which landed 5.4% of people in hospital and 1.2% in intensive care.</p>
<p>In the Singapore study, patients with Delta had a 49% chance of developing pneumonia and a 28% chance of needing extra oxygen. This compared with a 38% chance of developing pneumonia and 11% needing oxygen with the original strain. </p>
<p>Similarly, a published study from <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fulltext">Scotland</a> found Delta doubled the risk of hospitalisation compared to the Alpha variant. </p>
<figure class="align-center ">
<img alt="Older man with cold symptoms lays down, wrapped in a blanket, cradling his head, holding a tissue to his nose." src="https://images.theconversation.com/files/422541/original/file-20210922-5935-1eqsau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422541/original/file-20210922-5935-1eqsau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422541/original/file-20210922-5935-1eqsau.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422541/original/file-20210922-5935-1eqsau.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422541/original/file-20210922-5935-1eqsau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422541/original/file-20210922-5935-1eqsau.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422541/original/file-20210922-5935-1eqsau.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">
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<span class="caption">Emerging evidence suggests Delta is more likely to cause severe disease than the original strain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coronavirus-warning-old-people-senior-man-1505023982">Shutterstock</a></span>
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<h2>How do the vaccines stack up against Delta?</h2>
<p>So far, the <a href="https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v1.full.pdf">data show</a> a complete course of the <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2108891">Pfizer</a>, <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3777268">AstraZeneca</a> or <a href="https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v1.full.pdf">Moderna</a> vaccine reduces your chance of severe disease (requiring hospitalisation) by more than 85%. </p>
<p>While protection is lower for Delta than the original strain, studies show good coverage for all vaccines after two doses. </p>
<h2>Can you still get COVID after being vaccinated?</h2>
<p>Yes. <a href="https://theconversation.com/why-are-we-seeing-more-covid-cases-in-fully-vaccinated-people-an-expert-explains-166741">Breakthrough</a> infection occurs when a vaccinated person tests positive for SARS-Cov-2, regardless of whether they have symptoms. </p>
<p>Breakthrough infection <a href="https://theconversation.com/what-is-a-breakthrough-infection-6-questions-answered-about-catching-covid-19-after-vaccination-164909">appears more common</a> with Delta than the original strains.</p>
<p>Most symptoms of breakthrough infection <a href="https://theconversation.com/yes-you-can-still-get-covid-after-being-vaccinated-but-youre-unlikely-to-get-as-sick-163870">are mild</a> and don’t last as long. </p>
<p>It’s <a href="https://www.bbc.com/news/health-52446965#:%7E:text=Researchers%20conclude%20reinfection%20is%20uncommon,have%20had%20antibodies%20or%20not.">also possible</a> to get COVID twice, though this isn’t common. </p>
<h2>How likely are you to die from COVID-19?</h2>
<p>In Australia, over the life of the pandemic, 1.4% of people with COVID-19 have died from it, compared with 1.6% in the United States and 1.8% in the United Kingdom. </p>
<p>Data from the United States <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm?s_cid=mm7037e1_w#T1_down">shows</a> people who were vaccinated were ten times less likely than those who weren’t to die from the virus. </p>
<p>The Delta variant is currently proving to be a challenge to control on a global scale, but with full vaccination and maintaining our social distancing practices, we reduce the spread. </p>
<hr>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/why-is-delta-such-a-worry-its-more-infectious-probably-causes-more-severe-disease-and-challenges-our-vaccines-163579">Why is Delta such a worry? It's more infectious, probably causes more severe disease, and challenges our vaccines</a>
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<p class="fine-print"><em><span>Lara Herrero 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>Delta is more contagious and appears to be more deadly. And it’s more likely to land those infected in hospital and intensive care. Here’s what the latest evidence says about the dominant variant.Lara Herrero, Research Leader in Virology and Infectious Disease, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1670092021-09-01T14:22:43Z2021-09-01T14:22:43ZScotland’s COVID inquiry must be credible, timely and thorough – here’s what needs to happen<figure><img src="https://images.theconversation.com/files/418868/original/file-20210901-24-1ryi3ns.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C562&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/coronavirus-covid-19-infected-patient-quarantine-1684283641https://www.shutterstock.com/image-photo/coronavirus-covid-19-infected-patient-quarantine-1684283641">shutter_o/Shutterstock</a></span></figcaption></figure><p>Scotland will be the <a href="https://www.bbc.co.uk/news/uk-scotland-scotland-politics-58318778">first UK nation</a> to launch an <a href="https://www.gov.scot/publications/covid-19-inquiry/">independent COVID inquiry</a> to be chaired by a judge, as announced by the first minister, Nicola Sturgeon, in late August. It will begin later this year against a backdrop of substantial health, social and economic harms caused by the pandemic, and as recent events have revealed, a <a href="https://fortune.com/2021/08/26/school-year-covid-19-cases-spike-uk-england-scotland-delta-variant/">worrying rise</a> in COVID cases.</p>
<p>Up to August 27, Scotland officially <a href="https://public.tableau.com/app/profile/phs.covid.19/viz/COVID-19DailyDashboard_15960160643010/Overview">recorded</a> more than 400,000 positive COVID tests, almost 30,000 hospital admissions and more than 8,000 COVID deaths. There are also <a href="https://www.scotsman.com/health/devastating-impact-as-81000-scots-living-with-long-covid-3293534">80,000 people</a> now estimated to be living with long COVID. The inquiry will need to take some fundamental actions and address a range of critical issues and criticisms if it is to succeed.</p>
<h2>Four steps for a successful inquiry</h2>
<p>Chiefly, the inquiry must meet high public expectations, demonstrate independence, rigour and depth, and provide answers to many technical and policy questions. These are formidable demands made more difficult because of past UK inquiry failures.</p>
<p>Several recent Scottish government investigations and inquiries have been seriously flawed. This is partly because of a lack of public confidence in the <a href="https://www.scottishlegal.com/article/scott-styles-reforming-the-roles-of-lord-advocate-and-solicitor-general">role of senior law officers</a> who acted as government ministers and chief legal advisers, and partly because of <a href="https://www.holyrood.com/news/view,scottish-government-fails-to-meet-a-deadline-for-releasing-legal-advice-in-alex-salmond-case">government reluctance</a> to provide necessary information, as happened in the Alex Salmond case. The Scottish government failed to meet a deadline to disclose the legal advice it was given during the Salmond judicial review to a committee investigating the government’s handling of sexual harassment claims against the former SNP leader.</p>
<p>But if a judge from outside Scotland is appointed chair, perceived conflicts of interest would be removed and there would be no major, or indeed any, role for the <a href="https://www.copfs.gov.uk/about-us/who-we-are/lord-advocate-biography">Lord Advocate</a> – Scotland’s most senior law officer – in the inquiry’s work.</p>
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<p>The Scottish government has called for “stakeholders” to comment on its inquiry aims and principles to shape the important terms of reference it will set, but doesn’t specify who these stakeholders are. So patient and support groups, professional bodies, scientific and policy researchers, trade unions and others will all be responding to the call. Already there are fears about the limits, delays and additional caveats the Scottish government might produce at the end of this process. Here are four main areas the inquiry must deliver on:</p>
<p><strong>1. No delays:</strong> First of all, to allay and remove fears about stalling, the inquiry should not be <a href="https://www.thenational.scot/news/19541039.covid-expert-calls-judge-outside-scotland-lead-inquiry/?ref=twtrec">delayed or restricted</a> by waiting for the UK government to act or provide information. The Holyrood government has indicated a desire to avoid duplication in any later UK-wide inquiries. As Scotland has taken the lead, it will be for other countries to avoid duplication.</p>
<p>From the outset, the chair should be able to <a href="https://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/">compare</a> Scotland’s rate of COVID <a href="https://www.healthline.com/health/morbidity-vs-mortality">morbidity</a> (those who have the condition) and mortality, policies and practices against the best international examples and alternative strategies such as <a href="https://zerocovid.uk/category/scotland/">Zero COVID Scotland</a>, which created a detailed plan to suppress COVID at an early date.</p>
<p><strong>2. Devolved matters only:</strong> The Scottish government has indicated the inquiry will only look at <a href="https://archive2021.parliament.scot/visitandlearn/12506.aspx">devolved matters</a>, meaning those areas that fall under the Scottish goverment’s responsibility as opposed to Westminster’s. This does not and should not prevent detailed examination of COVID outbreaks.</p>
<p>The relationship between, and decisions made by the Scottish government, civil servants, advisers, public health organisations, care inspectorates and local authorities should all be examined.</p>
<p>The way COVID incident management teams worked should be scrutinised. The <a href="https://www.health-ni.gov.uk/news/joint-chief-medical-officers-statement-evolving-profile-covid-19-across-island">influence</a> of meetings with all the UK’s chief scientific, medical and nursing officers, <a href="https://www.gov.uk/government/organisations/scientific-advisory-group-for-emergencies">Scientific Advisory Group for Emergencies</a> (SAGE) and experts on Scottish government pandemic planning and decision-making can all be captured.</p>
<p>An examination of why the Scottish government relied on the <a href="https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation">Joint Committee on Vaccination and Immunisation</a> (JCVI) advice (on not vaccinating 12 to 15-year-olds or various groups of workers) when it did not need to, should also be included. </p>
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<img alt="Scotland's first minister Nicola Sturgeon in a cream jacket holding a microphone." src="https://images.theconversation.com/files/418877/original/file-20210901-19-al6x5t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418877/original/file-20210901-19-al6x5t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418877/original/file-20210901-19-al6x5t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418877/original/file-20210901-19-al6x5t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418877/original/file-20210901-19-al6x5t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418877/original/file-20210901-19-al6x5t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418877/original/file-20210901-19-al6x5t.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">
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<span class="caption">Nicola Sturgeon’s government was the first in the UK to announce a COVID inquiry.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/brussels-belgium-june-11-2019-nicola-1421681585">Evan Lamos/Shutterstock</a></span>
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<p><strong>3. What has worked and what hasn’t:</strong> The inquiry’s <a href="https://www.gov.scot/publications/covid-19-inquiry/">aims and principles document</a> currently refers to harms and events, but not explicitly to policies and practices that may have worked well or badly. This should change. Areas including lockdowns, ventilation, physical distancing, quarantine, travel, PPE, masks and long COVID all need to be analysed.</p>
<p>The treatment of key workers also requires major investigation. They must be central to any effective inquiry of events in addition to what happened in and around care homes, for example. Proper scrutiny of middle, long and short-term impacts of COVID policy would then be possible, providing access is given to the evidence base used by the Scottish government to develop and justify all its COVID policies and actions since March 2020.</p>
<p>This will also require analysis of the COVID exclusion, elimination, suppression, and mitigation strategies that underpinned what happened in hospitals, care homes, schools and workplaces. The inquiry would then be able to fully explore the Scottish government’s <a href="https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2021/02/coronavirus-covid-19-strategic-framework-update-february-2021/documents/coronavirus-covid-19-scotlands-strategic-framework-update-february-2021---pdf-version/coronavirus-covid-19-scotlands-strategic-framework-update-february-2021---pdf-version/govscot%3Adocument/COVID-19%2B-%2BScotland%2527s%2BStrategic%2BFramework%2Bupdate%2B-%2BFebruary%2B2021%2B-%2BPDF%2Bversion.pdf">shifting suppression policies</a> over time.</p>
<p><strong>4. Public response:</strong> The public has already <a href="https://www.gov.scot/news/a-covid-19-inquiry-for-scotland/">begun to respond</a> to the Scottish government with thoughts on how the inquiry can avoid many of the pitfalls that befell other high-profile Scottish inquiries in 2021. Avoiding delays due to civil actions, police and other ongoing investigations of COVID-19 in care homes will be important. So too will be measures to ensure witnesses – including ministers, civil servants and advisers – provide evidence without repeated stalling or refusals to co-operate.</p>
<p>Interim reports provided at intervals as investigations are completed will be welcome – for example on the NHS or care homes – but only if they are not subject to editing by government law officers beforehand.</p>
<p>If the Scottish government takes on board these views and avoids the tarnished legacy of past inquiries, it will escape the public discontent and lack of credibility that has blighted previous investigations. An open, transparent, thorough and timely inquiry that is perceived to be independent will be widely welcomed across Scotland – and lead the way for other UK inquiries in the future.</p><img src="https://counter.theconversation.com/content/167009/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Watterson 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 inquiry must meet high public expectations, demonstrate independence and provide answers to many technical and policy questions – all made more difficult because of past inquiry failures.Andrew Watterson, Chair in Health Effectiveness, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1654152021-08-04T14:57:47Z2021-08-04T14:57:47ZCOVID-19: how democracies have fared compared with authoritarian regimes<p>When Francis Fukuyama published his bestselling book, <a href="https://www.penguin.co.uk/books/133/13399/the-end-of-history-and-the-last-man/9780241991039.html">The End of History</a>, in 1992, democracies were on the rise. Today, democracies across the world are declining in number, <a href="https://freedomhouse.org/report/freedom-world/2021/democracy-under-siege">according to Freedom House</a>, a think tank which tracks comparative regime changes over time. Fukuyama’s argument then was that liberal democracy had triumphed over the alternative Soviet model, because it provided efficient and accountable governance that delivered a prosperous economy, effective healthcare, education and welfare. In sharp contrast communism had failed. </p>
<p>COVID-19 has been the biggest challenge to the effectiveness of governments this century, and one argument that has been put forward, particularly by China, is that the one-party state model is more effective at dealing with the pandemic than are democracies. The assertion is that disagreements and confusions in democracies stand in the way of effective collective action and disturb “social harmony”. The success of the Chinese economy in <a href="https://www.bbc.co.uk/news/business-56768663">recovering from the pandemic</a> means this idea has to be taken seriously. But when it comes to the COVID crisis, is this argument actually true?</p>
<p>There are clearly many factors that will go into judging how successful different countries are in containing the pandemic, including lockdowns and quarantines. But a look at how countries categorised as democracies or authoritarian regimes performed in relation to death rates suggests further enquiry will be needed to answer the question. Death rates are not a simple measure, with different data sources, healthcare systems and variations in spending across countries complicating the picture. That said, the <a href="https://covid19.who.int/?adgroupsurvey=%7Badgroupsurvey%7D&gclid=Cj0KCQjw0emHBhC1ARIsAL1QGNdMQ8WG-duC_NpkmcBMBLwe63tw5sfIDZOXdlIgHN7Co_Uva1e_zokaAgTpEALw_wcB">World Health Organisation</a> has the most reliable data available on COVID deaths as a percentage of cases across the world.</p>
<p>Freedom House rates the state of democracy across the world by looking at factors such as freedom of speech, the existence of free and fair elections, the right to participate in politics and respect for the rule of law in more than 200 countries and territories across the world. In a <a href="https://freedomhouse.org/report/freedom-world/2021/democracy-under-siege">recent report</a> they classified all states and territories into three categories: “Not free”, “partially free” and “free”. </p>
<p>Altogether the report identified 54 authoritarian or “not free” states and territories including China and Russia – a number that has increased by nine since 2005. In addition, they classified 59 countries as semi-authoritarian or “partially free”, such as the Philippines, with one additional state joining this group since 2005. Finally, they classify 82 countries as democracies or “free”, a tally that has declined by seven over the 15-year period. The report gloomily concluded that “since it spread around the world in early 2020, COVID has exacerbated the global decline in freedom”.</p>
<h2>Death rates</h2>
<p>Some 20 months into the worldwide pandemic we can start to test the claim of the superiority of authoritarian regimes over democracies in managing it. WHO data on COVID death rates is one way to begin to judge how effective different states have been in dealing with the pandemic.</p>
<p>The WHO <a href="https://covid19.who.int/?adgroupsurvey=%7Badgroupsurvey%7D&gclid=Cj0KCQjw0emHBhC1ARIsAL1QGNdMQ8WG-duC_NpkmcBMBLwe63tw5sfIDZOXdlIgHN7Co_Uva1e_zokaAgTpEALw_wcB">provides data</a> on the cumulative number of cases and the total number of deaths in each state or territory since the start of the pandemic. </p>
<p>A useful measure of the performance on these states in handling the pandemic – and one used by researchers at Johns Hopkins University in the US – is the percentage of cases ending up in deaths. If a large proportion of the cases result in deaths, it suggests that a ccountry’s health service may be performing poorly in managing the pandemic. </p>
<p>To illustrate this using the US, the WHO data published on August 23, 2021 showed that it had a total of 11,301 cumulative cases and 188 deaths per 100,000 population, so the percentage of deaths per cases was 1.7%.</p>
<p>Again it is important to remember that many factors may explain variations in death rates across countries, reflecting geography, population density, standards of living, inequality, the quality of governance and the state of democracy. </p>
<p><strong>COVID deaths by region (%), August 2021</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/419039/original/file-20210902-26-1buai8l.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Graph showing the percentage of deaths relative to case numbers in a variety of regions representing 222 countries" src="https://images.theconversation.com/files/419039/original/file-20210902-26-1buai8l.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419039/original/file-20210902-26-1buai8l.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419039/original/file-20210902-26-1buai8l.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419039/original/file-20210902-26-1buai8l.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419039/original/file-20210902-26-1buai8l.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419039/original/file-20210902-26-1buai8l.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419039/original/file-20210902-26-1buai8l.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cumulative percentage of deaths in relation to cases in WHO regions in July 2021 (222 countries and territories).</span>
<span class="attribution"><span class="source">World Health Organization</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The WHO categorises all countries and territories into six geographical regions and the figure above shows the death rates in each of them. </p>
<p>Clearly, South-East Asia and Western Pacific countries did best in when it came to controlling the death rates, the latter including China, which had a death rate of 4.7%, nearly three times larger than the US, although the region as a whole did better than the Americas. </p>
<p>Interestingly, Europe and South-East Asia had rather similar death rates in this respect. In contrast, the Eastern Mediterranean region stands out clearly as the worst of all. This region contains failed states such as Sudan as well as countries wracked by internal wars such as Syria and Iraq. Not surprisingly, war really weakens a state’s response to COVID-19. The worst case in that region and indeed in the world was Yemen, with percentage of deaths per cases reaching 19%. </p>
<p>These averages conceal large variations. In Africa, the Seychelles had a death rate of 0.5%, whereas in Zimbabwe it was 3.5%. Similarly, in the Americas, Cuba had a rate of 0.7% and so did very much better than Peru at just over 9%. The best performing territory in Europe was the Faroe Islands, in the North Atlantic, at 0.1% and the worst was Bosnia and Herzegovina with a rate of 4.7%. In Britain the rate was 2%.</p>
<h2>COVID and democracy</h2>
<p>But what of the relationship between performance in handling the pandemic and democracy? This appears in the graph below, which shows the average death rates using the Freedom House classification. The figure shows that democracies had significantly fewer deaths per 100,000 cases than authoritarian regimes such as China and semi-authoritarian regimes such as the Philippines. </p>
<p><strong>COVID deaths by political category (%)</strong></p>
<figure class="align-center ">
<img alt="Bar graph showing the ratio of deaths to cases broken down into different levels of authoritarianism." src="https://images.theconversation.com/files/419042/original/file-20210902-13-6mjjlt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419042/original/file-20210902-13-6mjjlt.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419042/original/file-20210902-13-6mjjlt.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419042/original/file-20210902-13-6mjjlt.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419042/original/file-20210902-13-6mjjlt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419042/original/file-20210902-13-6mjjlt.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419042/original/file-20210902-13-6mjjlt.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ratio of cumulative deaths to cases in authoritarian and democratic systems.</span>
<span class="attribution"><span class="source">Paul Whiteley/University of Essex</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>An obvious factor which could explain this is that democracies tend to be richer than authoritarian regimes and so they clearly have the resources to fight COVID that other states may lack. However, while there is a relationship between GDP or national income and the death rate, it’s rather weak. The correlation between these two measures was -0.16 across the world, indicating that national income has only a rather modest role in reducing death rates. Note that if a 1% increase in GDP produced a 1% decrease in the death rate the correlation would be -1.0, whereas the actual correlation was much weaker.</p>
<p>Further analysis is needed to explore the many other factors that might be at work in explaining state responsiveness to COVID. But it’s clear the argument that authoritarian states are superior to democratic states when it comes to dealing with the pandemic is not supported by these comparative death rates.</p>
<p>The complexities of the relationship between governance and the pandemic is highly complex and so we are starting a research project to examine this issue in more detail, looking at the comparative politics of COVID. But for now looking at the big picture certainly suggests that countries that have abandoned democracy over the years aren’t simply “better” dealing with the pandemic.</p><img src="https://counter.theconversation.com/content/165415/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Whiteley receives funding from the British Academy and the ESRC. </span></em></p>Why the argument that authoritarian regimes are better at handling pandemics isn’t that simple.Paul Whiteley, Professor, Department of Government, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1640632021-07-14T06:29:05Z2021-07-14T06:29:05ZIndonesia records its highest increase in COVID cases – and numbers are likely to rise again before they fall<p>Indonesia is currently experiencing a massive <a href="https://apnews.com/article/indonesia-coronavirus-pandemic-science-coronavirus-vaccine-lifestyle-9fdfe390a7e008ff7a3663646a849cf7">spike in COVID-19 infection and deaths</a>, as experts (including myself) have unfortunately <a href="https://www.aljazeera.com/news/2021/6/18/indonesia-covid">been predicting</a>.</p>
<p>The country recorded its largest single-day increase in new cases on July 13, with <a href="https://www.reuters.com/world/asia-pacific/indonesia-reports-record-daily-increase-covid-19-infections-2021-07-13/">more than 47,000 infections</a>.</p>
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<p>And this is likely to be a huge undercount because too few people are getting tested. </p>
<p>The positivity rate — the percentage of people taking COVID tests who return a positive result — currently sits at <a href="https://ourworldindata.org/coronavirus/country/indonesia">26%, according to Our World In Data</a>, which indicates Indonesia is almost certainly missing many more cases. Local research <a href="https://www.abc.net.au/news/2021-07-12/covid-19-antibodies-jakarta-almost-half-of-population/100285384">found</a> 44% of Jakarta residents had antibodies against the virus. Only 8% had actually been confirmed cases.</p>
<p>One reason for the low testing rates is a lack of access to COVID tests. Free tests are <a href="https://theconversation.com/poor-and-rich-indonesians-do-not-get-equal-access-to-covid-19-tests-this-is-why-its-a-problem-136248">only available</a> in health-care facilities for people with symptoms or who have been in contact with confirmed cases. The price private laboratories charge for COVID tests <a href="https://www.smh.com.au/world/asia/more-than-a-months-salary-for-a-covid-test-welcome-to-indonesia-20200714-p55bvq.html">can be prohibitive</a>.</p>
<h2>What’s gone wrong?</h2>
<p>The central government had resisted lockdowns, despite the hospital system hitting <a href="https://www.theguardian.com/global-development/2021/jul/02/broken-indonesias-hospitals-in-crisis-as-doctors-treat-covid-patients-in-streets">crisis point</a>, and has instead prioritised <a href="https://www.abc.net.au/news/2020-09-16/economic-recovery-still-priority-in-indonesia-covid-19-response/12662218">keeping the economy open</a>. </p>
<p>Over the past 16 months, health authorities have struggled to implement <a href="https://cdn.who.int/media/docs/default-source/searo/indonesia/covid19/external-situation-report-61_30-june-2021.pdf?sfvrsn=682a1a93_5">contact tracing systems</a>, where people who may have come in contact with the virus are asked to isolate to stop them spreading the virus. </p>
<p>The government has downplayed the pandemic since the beginning, both underestimating the risk in its pandemic planning, and understating the harms in its public communication. There has been little transparency and poor public communication about the disease. </p>
<p>These shortcomings have put Indonesia in an extremely <a href="https://www.wsws.org/en/articles/2021/07/08/mvkd-j08.html">vulnerable position</a>. The islands of Java and Bali in particular are seeing record-breaking numbers of new cases and deaths.</p>
<p>The faster-spreading <a href="https://edition.cnn.com/2021/07/05/asia/indonesia-covid-outbreak-intl-hnk/index.html">Delta variant</a> is playing a significant role. Genomic analysis shows Delta has <a href="https://theconversation.com/why-is-delta-such-a-worry-its-more-infectious-probably-causes-more-severe-disease-and-challenges-our-vaccines-163579">displaced other SARS-CoV-2 variants</a> which first circulated in Indonesia.</p>
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Read more:
<a href="https://theconversation.com/why-is-delta-such-a-worry-its-more-infectious-probably-causes-more-severe-disease-and-challenges-our-vaccines-163579">Why is Delta such a worry? It's more infectious, probably causes more severe disease, and challenges our vaccines</a>
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<h2>What has the government done so far?</h2>
<p>On July 1, the government announced a semi-lockdown for <a href="https://www.abc.net.au/news/2021-07-01/indonesia-to-impose-emergency-measures-as-covid-19-cases-spike/100261228">Java and Bali</a>. Under <a href="https://www.bbc.com/news/world-asia-57647693">the restrictions</a>, all employees in non-essential industries must work from home, while 50% of employees in essential industries, including finance, can work in an office.</p>
<p>Critical sectors, such as health facilities and food outlets, may operate with total capacity on-site. Shopping malls must close, and grocery stores and supermarkets can operate until 8pm daily at 50% capacity. Food outlets can only offer takeaway or delivery services.</p>
<p>Public transport may operate at <a href="https://www.garda.com/crisis24/news-alerts/497141/indonesia-officials-to-implement-emergency-covid-19-restrictions-in-java-and-bali-july-3-20-update-76">70% capacity</a>. Air and long-distance bus and train travellers <a href="https://jakartaglobe.id/news/vaccination-card-required-in-domestic-travels-under-new-restrictions">must produce a vaccine card</a> indicating at least one dose of a COVID vaccine.</p>
<p>Face masks are mandatory in public areas.</p>
<p>Authorities have instructed security forces to enforce the protocols.</p>
<p>On July 7, these restrictions were <a href="https://www.theaustralian.com.au/world/indonesia-imposes-national-lockdown-to-stem-delta-covid19-variant/news-story/ae77fdf9f246ce1e2be30f419c620ed6">expanded</a> to all other parts of the country. </p>
<p>A large part of the current strategy focuses on COVID vaccination. By the end of June the country was administering <a href="https://en.tempo.co/read/1477132/indonesias-daily-vaccination-rate-has-surpassed-one-million-doses">one million vaccine doses a day</a>, and has maintained a similar rate since then.</p>
<p>But Indonesia currently lacks a robust system of testing, contact tracing and isolating, which should be the main strategy in dealing with a pandemic; the goal of restrictions should be to supplement and strengthen this strategy. </p>
<h2>When it will reach the peak?</h2>
<p>Based on my calculations, if the restrictions and mask mandates are adhered to, I <a href="https://www.kompas.id/baca/humaniora/2021/06/29/belajarlah-dari-kegagalan-dan-keberhasilan-india">estimate</a> COVID cases in Indonesia could peak in late July or early August, with <a href="https://www.kompas.id/baca/humaniora/2021/06/29/belajarlah-dari-kegagalan-dan-keberhasilan-india">new case numbers rising</a> to 200,000 a day.</p>
<p>But if restrictions are ineffective, <a href="https://www.scmp.com/week-asia/health-environment/article/3139501/are-indonesias-new-coronavirus-measures-strict-enough">we could see</a> up to 400,000 new daily cases at the peak.</p>
<p>I base these projections on a few factors. I start with the assumption that reported cases are a massive undercount. Then I use an estimate of the spreading rate of COVID under certain assumptions, including whether or not restrictions are adhered to.</p>
<p>I also use the number of reported deaths and work backwards to estimate how many cases are likely to have caused that many deaths. For example, over the last few days Indonesia has recorded around 1,000 deaths per day. Deaths lag cases, so let’s look at new daily cases from three weeks ago — they were around 15,000 a day. But if we assume a case fatality rate of around 2%, that means 1,000 deaths could translate to 50,000 cases. Because reported deaths are likely to be an undercount too, that figure could be more like 100,000 cases. So the real number of cases could be three to six times higher than reported cases. And that was three weeks ago. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1412923546859233282"}"></div></p>
<p>I also <a href="https://www.kompas.id/baca/humaniora/2021/06/29/belajarlah-dari-kegagalan-dan-keberhasilan-india">estimate</a> the number of deaths each day will peak at the end of July or early August, with 1,000 to 2,300 deaths per day. The number of people in hospital and ICUs could reach 93,000 and 20,000 per day, respectively.</p>
<h2>What challenges must be overcome?</h2>
<p>The Indonesian government faces a number of challenges in controlling the COVID crisis.</p>
<p>Some parts of Indonesia are densely populated, including the COVID epicentres Java, Bali and Madura, which makes it easier for the virus to spread. Therefore, the success of Indonesia’s pandemic control will depend on how the government handles the situation on these islands. </p>
<p>Hospitals are increasingly <a href="https://www.sbs.com.au/news/indonesian-hospitals-overwhelmed-as-the-country-crumbles-under-its-deadliest-covid-19-outbreak-yet">becoming overwhelmed</a> with some <a href="https://www.abc.net.au/news/2021-06-30/oxygen-prices-leap-in-indonesia-s-capital/100253966">running out of oxygen</a>.</p>
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<p>Other challenges include regional disparities in COVID vaccination rates, the spread of false COVID information, vaccine hesitancy, a lack of universal access to clean water, low immunisation coverage <a href="https://monitor.co.id/2021/07/13/temuan-dan-rekomendasi-kpai-hasil-pemantauan-vaksinasi-covid-pada-anak/">among children</a>, and the poor socioeconomic status of most of the population.</p>
<p>This makes it difficult for the government to apply stricter public health measures to contain the virus, as we’ve seen in more socioeconomically advantaged countries.</p>
<h2>Australia’s role</h2>
<p>As a high GDP country which has been successful in suppressing COVID, <a href="https://www.aspistrategist.org.au/australia-must-urgently-help-indonesia-with-its-covid-19-crisis/">Australia has an obligation to help</a> protect Indonesia and the region by providing international aid.</p>
<p>Last week Australia announced <a href="https://www.abc.net.au/news/2021-07-07/indonesia-australia-aid-astrazeneca-vaccines-covid/100275938">a support package</a>, with 2.5 million AstraZeneca vaccines, along with oxygen supplies, rapid testing kits, and ventilators.</p>
<p>Bilateral and regional cooperation is essential during the COVID crisis; no country can be safe until all countries are safe.</p>
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Read more:
<a href="https://theconversation.com/3-ways-to-vaccinate-the-world-and-make-sure-everyone-benefits-rich-and-poor-155943">3 ways to vaccinate the world and make sure everyone benefits, rich and poor</a>
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<img src="https://counter.theconversation.com/content/164063/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dicky Budiman 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>COVID-19 cases in Indonesia are rising and are expected to keep doing so for another two weeks until the effects of restrictions and mask mandates are seen.Dicky Budiman, MD, Epidemiologist and PhD Candidate on Global Health Security, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1634382021-07-11T09:49:08Z2021-07-11T09:49:08ZLatest data from Lusaka morgue analysis shows spike in COVID-19 deaths<figure><img src="https://images.theconversation.com/files/409699/original/file-20210705-24485-rlw0xa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The research was conducted at the Zambia University Teaching Hospital morgue.</span> <span class="attribution"><span class="source">Salim Dawood/AFP via Getty Images</span></span></figcaption></figure><p>Understanding the epidemiology of infectious diseases often rests heavily on the local resources available to conduct surveillance work. It is very easy to fall into the trap of believing that the absence of information about a given country or region means that diseases are not having an impact in those places. </p>
<p>The apparently <a href="https://theconversation.com/covid-19-examining-theories-for-africas-low-death-rates-147393">low rates of COVID-19</a> on the African continent are an example of this. </p>
<p>Much of what we think we know about the impact of COVID-19 globally rests on aggregated data presented through portals like the Johns Hopkins COVID-19 <a href="https://coronavirus.jhu.edu/">website</a>. Based on this, one could easily conclude that the pandemic hit the US harder than anywhere else in the world and that Africa has largely been spared. </p>
<p>But COVID-19 spreads wherever the concentration of people allows. What distinguishes the US from most African countries is that the US has the most resources for disease surveillance in the world, including the <a href="https://www.cdc.gov/">US Centers for Disease Control and Prevention</a>. </p>
<p>The existence and reliability of data may differ as a function of local capacity, expertise, resources and political will. In Africa, the highest concentration of cases <a href="https://www.worldometers.info/coronavirus/country/south-africa/">appears</a> to be in South Africa – a relatively <a href="https://www.worldbank.org/en/country/southafrica/overview">high-income country</a> with excellent <a href="https://www.nicd.ac.za/wp-content/uploads/2020/10/Updated-Prioritised-Covid-19-Testing-Guidance-Oct-2020.pdf">capacity and resources</a> for testing and surveillance.</p>
<p>We have been measuring the fatal impact of COVID-19 <a href="https://www.bmj.com/content/372/bmj.n334.long">in Zambia’s capital Lusaka</a>. It has shown us how difficult it is to do systematic surveillance. And yet the global health community has largely treated the low rates in most of Africa as <a href="https://covid19africawatch.org/experts-tackle-the-mystery-of-africas-low-death-rate/">a mystery</a>. The most likely explanation is that the necessary resources for surveillance are inadequate and hence that we are not seeing a complete picture about what is really going on. </p>
<p>For over four years, we have been collecting data on infant deaths as part of a project to study other diseases. When the COVID-19 pandemic broke out, we were able to amend our surveillance work to include this new virus and to determine what proportion of individuals across all ages in Lusaka tested positive through postmortem sampling. This was work funded by the Gates Foundation, and we shared our findings with the Zambian Ministry of Health. </p>
<p>These <a href="https://www.bmj.com/content/372/bmj.n334">data</a> are representative and generalisable because we are sampling at the University Teaching Hospital morgue, which captures nearly all deaths that occur in the city across all age groups. While we lacked the resources to sample all deaths – 30-40 deaths per day is quite typical – we sampled a random sub-set of those. </p>
<p>What we observed from June to September 2020 was that roughly one in five deceased individuals tested positive for SARS-CoV-2 in our molecular laboratory in Lusaka. The rates we were seeing were roughly 10 times higher than what was being reported officially at the time.</p>
<p>Since that initial report, we have continued to monitor COVID-19 deaths at the same morgue. The situation has clearly grown worse. Up to June 2021, we were detecting SARS-CoV-2 in roughly 25% of deaths. But in June itself the rate rose to an astonishing 87% of all deaths. </p>
<p>We are currently in the process of an excess mortality analysis, comparing the COVID-19 year against the background rate of seasonal mortality over the preceding three years. This will help us better measure the impact of COVID-19. </p>
<h2>A lack of surveillance</h2>
<p>Our team is based at the University Teaching Hospital morgue. We attempt to enrol every third to fifth death that comes through, approaching the family or next of kin to obtain informed consent. Our consent rates have been very high (about 90%). </p>
<p>We then obtain some clinical information about the events leading to the fatal illness, and obtain a nasal swab sample for testing. We use the US Centers for Disease Control’s testing kits, which are considered to be a global gold standard.</p>
<p>If we included detection of SARS-CoV-2 at any level of signal intensity on the PCR assay, we found it in 19% of all deaths between June and September 2020. Nearly three quarters of those deaths occurred outside medical care. Of these, none had been tested for the virus prior to death. Among the deaths that occurred at a hospital, only about a third had been tested prior to death. </p>
<p>This tells us that the seemingly low rate of COVID-19 reported elsewhere was explained by a lack of systematic surveillance. COVID-19 seemed rare only because testing was rarely done. Of the 70 COVID-19 deaths we detected out of 342 deceased individuals, only six had been tested for COVID-19 before they died. And yet nearly all had had symptoms suggestive of COVID-19 - cough, fever, shortness of breath.</p>
<p>In Zambia there are insufficient funds and capacity to do thorough surveillance. Zambia ranked <a href="https://www.worldbank.org/en/country/zambia/overview">117th out of 128 countries</a> in terms of economic competitiveness back in 2007. </p>
<h2>Wider picture</h2>
<p>The key concern is whether these <a href="https://www.bmj.com/content/372/bmj.n334">results</a> are unique to Zambia. We doubt it. It seems most likely that COVID-19 is having a severe impact in many (possibly most) parts of Africa, but this is simply going undocumented.</p>
<p>As we have seen in the US - which has largely reopened its society after vaccinating over 180 million citizens - the only way out of this human calamity is vaccines. </p>
<p>Only <a href="https://covid19.who.int/region/afro/country/zm">a few percent of Zambia’s population</a> has received any COVID vaccine. And while the goal is to vaccinate the population, Zambia’s access to vaccines is severely limited. We hope that the <a href="https://www.who.int/initiatives/act-accelerator/covax">COVAX initiative</a> may change this situation.</p>
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Read more:
<a href="https://theconversation.com/interested-in-vaccine-rollouts-across-africa-heres-a-map-to-guide-you-156802">Interested in vaccine rollouts across Africa? Here's a map to guide you</a>
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<p>As long as Africa’s “low COVID-19 rate” continues to be viewed as a puzzling enigma rather than a sign of inadequate surveillance, African countries will be at the back of the bus to get these life-saving commodities. In all likelihood, this is a catastrophe that is occurring on a continental scale yet is simply going unreported and hence unappreciated.</p>
<p>To solve a problem like COVID-19, it is obviously essential to have accurate information about the true status of the situation.</p><img src="https://counter.theconversation.com/content/163438/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher J. Gill serves as the chair of a blinded COVID case adjudication committee for the company CureVac. He owns no stocks in the company and works only on blinded data sets. He does not view this as a conflict of interest. </span></em></p>To solve a problem like COVID-19, it is obviously essential to have accurate information about the true status of the situation.Christopher J. Gill, Associate Professor, Dept of Global Health; Infectious Diseases Specialist, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1574752021-04-01T11:38:44Z2021-04-01T11:38:44ZHow can all schools safely reopen?<figure><img src="https://images.theconversation.com/files/391439/original/file-20210324-13-8gggy4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6048%2C4019&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In-person learning can start as long as schools operate safely, says the CDC.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/teacher-walks-among-the-the-masked-students-sitting-in-a-news-photo/1231771424?adppopup=true">Jon Cherry/Getty Images</a></span></figcaption></figure><p>The question of when and how to open schools for full in-person learning in the midst of the COVID-19 pandemic is one of the most consequential the U.S. currently faces. A <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/operation-strategy.html">wealth of evidence</a> suggests that schools can provide in-person instruction with a very <a href="https://doi.org/10.15585/mmwr.mm7012e3">low level of risk</a> when <a href="https://doi.org/10.1093/cid/ciab230">safety protocols</a> are <a href="https://doi.org/10.15585/mmwr.mm7012e3">successfully implemented</a>. </p>
<p>So, what do school districts, teachers, families and students need to know? As an infectious disease epidemiologist with more than <a href="https://scholar.google.com/citations?user=mJvMJGIAAAAJ&hl=en&oi=ao">15 years of research experience</a> – and as co-editor of the <a href="https://depts.washington.edu/pandemicalliance/covid-19-literature-report/latest-reports/">COVID-19 Literature Situation Report</a>, which produces a daily summary of the most relevant newly published and pre-print literature related to COVID-19 – I offer answers to some of the most urgent questions about how schools can safely resume in-person instruction. Some of this evidence is gleaned from preprint studies that may change after they are peer-reviewed.</p>
<h2>Will school make children more likely to transmit COVID-19?</h2>
<p>Infection with the COVID-19 virus has been less common in school-age children, especially those in elementary school, than among other age groups. Evidence from <a href="https://doi.org/10.15585/mmwr.mm7012e2">Florida</a>, <a href="https://doi.org/10.15585/mmwr.mm7012e3">Utah</a>, <a href="https://doi.org/10.15585/mmwr.mm7012e4">Missouri</a> and elsewhere indicates that less than 1% of school-age children have had COVID-19, despite <a href="https://doi.org/10.15585/mmwr.mm7012e2">most being in school in person</a>. <a href="https://doi.org/10.15585/mmwr.mm7012e2">Most cases</a> have not been linked to school exposures.</p>
<p>While school <a href="https://doi.org/10.2807/1560-7917.ES.2020.25.29.2001352">outbreaks</a> have occurred, most have been <a href="https://doi.org/10.15585/mmwr.mm7012e2">small</a> in scale. <a href="https://doi.org/10.1542/peds.2021-050605">Transmission</a> from an infected student to others in the household or community has been <a href="https://doi.org/10.15585/mmwr.mm7012e4">rare</a>.</p>
<p>While not definitively proved by scientific studies, indications are that elementary school-age children are less likely than older children and adults to <a href="https://doi.org/10.3201/eid2610.201315">transmit</a> the COVID-19 virus to others.</p>
<h2>What about teacher and staff vaccinations?</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/391449/original/file-20210324-15-1yo7p5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A first grade teacher wearing a mask puts materials on her students' desks." src="https://images.theconversation.com/files/391449/original/file-20210324-15-1yo7p5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/391449/original/file-20210324-15-1yo7p5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=410&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391449/original/file-20210324-15-1yo7p5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=410&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391449/original/file-20210324-15-1yo7p5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=410&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391449/original/file-20210324-15-1yo7p5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391449/original/file-20210324-15-1yo7p5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391449/original/file-20210324-15-1yo7p5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A first grade teacher puts out erasers at each desk in her classroom.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/first-grade-teacher-dianna-accordino-puts-out-erasers-at-news-photo/1267680262?adppopup=true">Ben Hasty/MediaNews Group/Reading Eagle via Getty Images</a></span>
</figcaption>
</figure>
<p>Spread of COVID-19 through in-person K-12 schooling has been <a href="https://doi.org/10.15585/mmwr.mm7012e2">limited</a>, even without vaccinations. Teachers are now <a href="https://www.nytimes.com/interactive/2021/us/covid-19-vaccine-eligibility.html">eligible</a> to be vaccinated in all states in the U.S., which means that the risk to teachers and staff who are vaccinated, as well as to students and others who may not be willing or able to be vaccinated, is greatly reduced. No studies give us a magic number for the proportion of teachers and staff who need to be vaccinated before in-person learning can be implemented. In fact, the Centers for Disease Control and Prevention advises that in-person learning can start <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/operation-strategy.html">safely</a> as long as other mitigation protocols like mask-wearing and adequate ventilation are in place. Vaccines offer an added level of protection. </p>
<p>The vaccines currently approved for use in the U.S. under emergency use authorization are all highly effective at preventing mild, moderate and severe COVID-19 disease, and they also <a href="https://doi.org/10.15585/mmwr.mm7013e3">prevent infections</a>.</p>
<p>This means that these vaccines both protect the vaccinated person and <a href="https://doi.org/10.1056/NEJMoa2101765">reduce the risk of transmission</a> from a vaccinated to an unvaccinated person. This is critical, because at this time there are no vaccines approved for use in those under the age of 16 in the U.S. </p>
<p><a href="https://theconversation.com/when-can-kids-get-the-covid-19-vaccine-a-pediatrician-answers-5-questions-parents-are-asking-157512">Pfizer and Moderna have trials underway in adolescents</a> and hope to have results by late spring or early summer. In the meantime, to protect students from infection, it will help to vaccinate as many adults as possible in schools.</p>
<p>Transmission is far more common from <a href="https://doi.org/10.1016/S1473-3099(20)30882-3">teacher to student</a> and <a href="https://doi.org/10.15585/mmwr.mm7008e4">teacher to teacher</a> than from student to teacher. So far, research that has not yet been peer-reviewed shows that the vaccines approved for use in the U.S. have <a href="https://www.fda.gov/media/146217/download">similar efficacy</a> against the newly emerging <a href="https://doi.org/10.1101/2021.03.09.21253218">variants of concern</a>, especially in terms of preventing severe disease.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/392670/original/file-20210330-17-gzugwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Grade school students line up to walk to school." src="https://images.theconversation.com/files/392670/original/file-20210330-17-gzugwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392670/original/file-20210330-17-gzugwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392670/original/file-20210330-17-gzugwi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392670/original/file-20210330-17-gzugwi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392670/original/file-20210330-17-gzugwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392670/original/file-20210330-17-gzugwi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392670/original/file-20210330-17-gzugwi.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">Students enter a Bronx school in February 2021.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/students-enter-school-as-mayor-bill-de-blasio-visit-of-news-photo/1231388333?adppopup=true">Lev Radin/Pacific Press/LightRocket via Getty Images</a></span>
</figcaption>
</figure>
<h2>What is the right amount of physical distancing?</h2>
<p>So long as people are wearing masks, there is no evidence that 6-foot physical distancing between students is more effective than <a href="https://doi.org/10.1093/cid/ciab230">3-foot distancing</a>. This led the CDC to shift its guidance to <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/operation-strategy.html">recommend a physical distancing of only 3 feet</a> in classrooms. Three-foot distancing allows for much more flexibility in terms of classroom size and layout. Face masks are <a href="https://doi.org/10.3201/eid2701.203450">highly effective</a> in reducing infection and transmission risk and are therefore a critical mitigation measure.</p>
<p>In addition, early research suggests that keeping students in groups, or cohorts, and limiting contact among <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/operation-strategy.html">cohorts</a> may reduce the potential for <a href="https://doi.org/10.1101/2020.11.30.20241166">widespread transmission</a> if a case occurs in a school. Cohorting can also minimize the number of students who would need to be quarantined.</p>
<h2>On the bus or other transportation</h2>
<p>Just as in the classroom, <a href="https://doi.org/10.15585/mmwr.mm6934e2">masks work</a> when transporting students to and from school. <a href="https://doi.org/10.15585/mmwr.mm7007e1">Double-masking</a> is probably best, especially in <a href="https://doi.org/10.3201/eid2607.200764">indoor spaces</a>, including cars and buses. Ventilation with outside air – either by opening windows or avoiding ventilation that recirculates air – may help to reduce the risk of transmission in <a href="https://doi.org/10.1001/jamainternmed.2020.5225">buses</a>. Students should space out as much as possible, given the elevated risk of transmission seen among passengers sitting close to an infected individual on <a href="https://doi.org/10.3201/eid2611.203299">airplanes</a>, although universal mask usage is likely to reduce the importance of physical spacing.</p>
<p>While droplet and airborne transmission of the COVID-19 virus appear to be the <a href="https://doi.org/10.17226/25958">dominant modes</a> of transmission, hand-washing and using hand sanitizers before entering buses and upon exit may help reduce the risk of transmission through contact with <a href="https://doi.org/10.1093/infdis/jiaa437">contaminated surfaces</a>.</p>
<h2>The gym, recess and after-school sports</h2>
<p>Growing <a href="https://doi.org/10.1101/2021.02.18.21251986">evidence</a> shows that kids can play sports and have recess if they are <a href="https://doi.org/10.1101/2021.01.19.21250116">outdoors</a> and players have no or low contact. Based on studies, including some that have not yet been peer-reviewed, activities such as <a href="https://doi.org/10.4085/610-20">soccer</a>, <a href="https://doi.org/10.1101/2021.02.18.21251986">tennis</a> and <a href="https://doi.org/10.1101/2021.02.18.21251986">cross-country</a> are fine.</p>
<p>The <a href="https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports">American Academy of Pediatrics</a> recommends that athletes participating in indoor sports wear masks, except those participating in swimming and diving, cheerleading, gymnastics and wrestling, to prevent choking or suffocation. Some indoor sports, particularly <a href="https://doi.org/10.15585/mmwr.mm7004e4">wrestling</a> and <a href="https://doi.org/10.15585/mmwr.mm6941a4">hockey</a>, have been associated with large outbreaks. Also, outbreaks of COVID-19 have been associated with <a href="https://doi.org/10.15585/mmwr.mm7011a3">football teams</a>. </p>
<p>An important finding from a number of investigations is that many of the cases of transmission, including on football teams, appear to be linked to <a href="https://doi.org/10.15585/mmwr.mm7011a3">activities</a> not directly related to the sport itself, such as meetings in <a href="https://doi.org/10.15585/mmwr.mm7004e2">enclosed spaces without masks</a>, eating together and <a href="https://doi.org/10.15585/mmwr.mm6943e5">parties and social events</a>.</p>
<h2>Are masks still required?</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/392666/original/file-20210330-15-196r7uy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young black girl wears a mask and a face shield over her face." src="https://images.theconversation.com/files/392666/original/file-20210330-15-196r7uy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/392666/original/file-20210330-15-196r7uy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392666/original/file-20210330-15-196r7uy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392666/original/file-20210330-15-196r7uy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392666/original/file-20210330-15-196r7uy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392666/original/file-20210330-15-196r7uy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392666/original/file-20210330-15-196r7uy.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">A child wearing a face shield and mask stands in the cafeteria of Medora Elementary School in 2021.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/child-wearing-a-face-shield-and-mask-stands-in-the-news-photo/1231771412?adppopup=true">Jon Cherry/Getty Images</a></span>
</figcaption>
</figure>
<p>Masks are likely to be a critical part of protocols to prevent COVID-19 in schools, at least until vaccines are universally available, including for children. Even then, the potential emergence of new variants that are resistant to existing vaccines may make mask usage a necessity for some time. Schools that have provided in-person instruction during the COVID-19 pandemic, including during periods of high community transmission, have experienced <a href="https://doi.org/10.15585/mmwr.mm7012e2">few</a> widespread outbreaks directly related to school transmission when <a href="https://doi.org/10.15585/mmwr.mm7012e3">masks</a> are used.</p>
<p>This has been true in <a href="https://doi.org/10.15585/mmwr.mm7012e2">Florida</a>, <a href="https://doi.org/10.1093/cid/ciab230">Massachusetts</a>, <a href="https://doi.org/10.15585/mmwr.mm7012e3">Salt Lake City</a>, <a href="https://doi.org/10.1016/S1473-3099(20)30882-3">England</a> and elsewhere. </p>
<p>In contrast, not wearing masks was a problem in schools in <a href="https://doi.org/10.1073/pnas.2020834118">Sweden</a>. In this Scandinavian country, younger secondary-school students returned to full-time, in-person learning without masks and with few other mitigation measures. Older secondary-school students continued with remote learning. Students and staff who went to school in person and without masks or other safety measures had a somewhat higher likelihood of having COVID-19 compared with those learning remotely, although the absolute risk was still quite low.</p>
<h2>How critical is soap or hand sanitizer?</h2>
<p>While the coronavirus that causes COVID-19 has been detected on <a href="https://doi.org/10.1093/infdis/jiaa437">surfaces</a>, touching those surfaces doesn’t appear to be the dominant route of transmission. Even so, hand-washing and using hand sanitizers are still good ideas. Face masks and physical distancing are more important, though.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/157475/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brandon Guthrie receives funding from the National Institutes of Health, the Washington State Department of Health, and Gilead Sciences. </span></em></p>In-person learning can safely resume as long as schools take steps to mitigate the spread of COVID-19.Brandon Guthrie, Assistant Professor of Global Health and Epidemiology, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1562642021-03-12T14:46:55Z2021-03-12T14:46:55ZAfter COVID: why we need a change in care home culture<figure><img src="https://images.theconversation.com/files/389281/original/file-20210312-16-1nc1lcd.jpg?ixlib=rb-1.1.0&rect=27%2C9%2C6011%2C4010&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many care workers feel society does not value them or the people they look after. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-her-caregiver-home-146517530">Alexander Raths/Shutterstock</a></span></figcaption></figure><p>For years, observers have spoken of a “social care crisis” in Scotland. Coronavirus has exposed existing weaknesses in the sector and created new problems. We know the dreadful impact <a href="https://www.bbc.co.uk/news/uk-scotland-55753816">COVID-19 had on care homes</a> highlighting this need for fundamental change.</p>
<p>In Scotland, out of a total of nearly 10,000 coronavirus deaths, more than <a href="https://www.gov.scot/publications/coronavirus-covid-19-daily-data-for-scotland/">34%</a> occurred in care homes. This has rightly been seen as a <a href="https://www.ft.com/content/d60cbffc-5b65-459a-92b6-895468c9c8a5">scandal</a>. A new culture of care is needed to underpin the sector, not piecemeal reform. Now, as we begin to contemplate a world after COVID-19, is the moment for such reform. And initial debates and ideas look promising.</p>
<p>Less often discussed is how care workers have been affected by the virus and what it has meant for their working conditions and overall job quality. <a href="https://www.gov.scot/publications/coronavirus-covid-19-daily-data-for-scotland/">Scottish government statistics</a> show that 26 care workers have died with the virus since the start of the pandemic, though it is not clear whether they contracted it at work.</p>
<p>At the same time, while NHS workers have been celebrated as heroes, care workers remained an afterthought. These overlooked workers were not surprised. Participants in our <a href="https://dwsc-research.org/">research project</a> on working conditions in care homes told us they have for long felt that society cares little about the elderly, and, by extension, cares little about those who work with them. As one told us:</p>
<blockquote>
<p>I don’t think society values care workers or the people we look after – they don’t treat them or us with the respect and support we deserve.</p>
</blockquote>
<h2>Fair and decent work</h2>
<p>Our project explored what care workers in Scotland think about their job quality and what needs changing. Chiefly, participants claimed the important factors that “make work decent” are in short supply.</p>
<p>Care workers want more supportive managers who themselves are supported better; decent pay which takes into account the real skills that care work requires and is based on systematic job evaluations; decent terms and conditions including sick pay beyond the statutory minimum; and job security with a curb on casual employment.</p>
<figure class="align-center ">
<img alt="A couple outside their house clapping for the NHS during COVID." src="https://images.theconversation.com/files/389283/original/file-20210312-23-1la1yzi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389283/original/file-20210312-23-1la1yzi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389283/original/file-20210312-23-1la1yzi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389283/original/file-20210312-23-1la1yzi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389283/original/file-20210312-23-1la1yzi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389283/original/file-20210312-23-1la1yzi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389283/original/file-20210312-23-1la1yzi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Did the nation overlook the contribution of care workers in favour of the NHS during COVID?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/uckfield-sussex-united-kingdom-april-30-1718817454">Sarah Bardsley/Shutterstock</a></span>
</figcaption>
</figure>
<p>Of course, a safer work environment was listed as important too. Many said they felt their mental and physical health mattered little in their workplaces even before COVID-19, which made the issue only more severe. One factor crucial to making work feel decent and worthwhile is purpose and meaning. Many care workers say they remain in the job because their work has an abundance of both: </p>
<blockquote>
<p>It keeps you going when other aspects of the work aren’t so good. Just knowing that you’re enriching someone’s life is a reward.</p>
</blockquote>
<p>The lack of social recognition is key to understanding why, overall, their job
quality is low. Many interviewees were angry about care work being seen as merely “wiping bums” and requiring few skills. The lack of recognition should be understood in context of the high regard in which the NHS is held.</p>
<p>Despite the many years of <a href="https://www.legislation.gov.uk/asp/2014/9/contents/enacted">health and social care integration</a> at policy and strategy levels, Scottish care workers see their sector pitted against the NHS. Those working in the care sector, even care home managers, are made to feel like failures: “Why don’t you work in the NHS?”, is a question they hear too often. It is little wonder that the clap for NHS workers, during the height of the first wave of the pandemic, was perceived badly by most participants: </p>
<blockquote>
<p>Social care is very hard and difficult; people forget about us and only focus on doctors and nurses. It was all about ‘save our NHS '– how about us? </p>
</blockquote>
<p>Few of these findings came as a surprise as job quality problems have been noted before, by the Scottish <a href="https://www.fairworkconvention.scot/our-report-on-fair-work-in-social-care/">Fair Work Convention</a> in 2019 for example. What is striking is that so little has been done about them since. However, when interviewing representatives from local government, health and social care partnerships or industry umbrella organisations, we found that none were willing to take the lead in making decent work a priority. Responsibility for job quality always lies somewhere else. </p>
<h2>Do we need a national care service?</h2>
<p>Like every crisis, COVID-19 creates opportunities for change. For care workers, decent work should be on the cards now. The argument for improving job quality can be made by pointing out that consistently high-quality care – which is what everyone says they want for the most vulnerable in society – requires at least decent job quality.</p>
<p>The Scottish government’s <a href="https://www.gov.scot/binaries/content/documents/govscot/publications/independent-report/2021/02/independent-review-adult-social-care-scotland/documents/independent-review-adult-care-scotland/independent-review-adult-care-scotland/govscot%3Adocument/independent-review-adult-care-scotland.pdf">Feeley Review</a> of adult social care, set into motion in September 2020, is one of the most important initiatives regarding reform. Recommending a national care service for Scotland, the review appears to have the workforce at the heart of its thinking about a whole change in the culture of adult social care.</p>
<figure class="align-center ">
<img alt="The fence of a care home with a banner saying 'Heroes Work Here' against a rainbow." src="https://images.theconversation.com/files/389282/original/file-20210312-19-rdisjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389282/original/file-20210312-19-rdisjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389282/original/file-20210312-19-rdisjp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389282/original/file-20210312-19-rdisjp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389282/original/file-20210312-19-rdisjp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=463&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389282/original/file-20210312-19-rdisjp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=463&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389282/original/file-20210312-19-rdisjp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=463&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In Scotland, 26 care home workers died of COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sign-outside-residential-care-home-elderly-1763719250">Peter Fleming/Shutterstock</a></span>
</figcaption>
</figure>
<p>It recommends minimum standards around what it calls “fair work” when it comes to local authorities buying in services from care providers and coordinated workforce planning. There is an encouraging endorsement of a job evaluation exercise around care jobs – this might help to create pay parity between social care and health care.</p>
<p>However, such changes would not address other job quality issues, which all connect to each other. One central problem is not sufficiently dealt with: why it is that social care workers are undervalued and experience low social esteem? Here, uncomfortable cultural questions need to be raised, with generational divides and ageism creating a demand for a new culture of care that recognises those needing care and those providing it.</p>
<p>Such a culture can be the foundation for efforts that create high-quality social care with a workforce that enjoys decent work, recognised skills and proper respect.</p><img src="https://counter.theconversation.com/content/156264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hartwig Pautz received funding for this research project from the British Academy's COVID-19 small research grant. </span></em></p><p class="fine-print"><em><span>Stephen Gibb received funding for this research project from the British Academy's COVID-19 small research grant.
</span></em></p>After the devastating impact of COVID, changing the culture of social care must start with valuing, respecting and rewarding the people who look after our vulnerable old people.Hartwig Pautz, Senior Lecturer in Social Sciences, University of the West of ScotlandStephen Gibb, Reader, School of Business and Creative Industries, University of the West of ScotlandLicensed as Creative Commons – attribution, no derivatives.