tag:theconversation.com,2011:/us/topics/covid-restrictions-107842/articlescovid restrictions – The Conversation2022-09-09T02:04:08Ztag:theconversation.com,2011:article/1903312022-09-09T02:04:08Z2022-09-09T02:04:08ZWhy do we mourn people we don’t know?<p>The death of Queen Elizabeth II has prompted public displays of grief around the world – from public gatherings at Buckingham Palace in London, and condolences from world leaders, to individuals reflecting on social media about what she meant to them.</p>
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<p>Of course, the vast majority of people grieving or acknowledging the queen’s passing will have never met her in person.</p>
<p>So is this outpouring of grief of someone we don’t know any different to mourning someone we were close to?</p>
<p>There are some similarities and some stark differences. There’s also a tussle emerging over how the queen is remembered, which can potentially complicate the grieving process.</p>
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Read more:
<a href="https://theconversation.com/queen-elizabeth-ii-the-end-of-the-new-elizabethan-age-157897">Queen Elizabeth II: the end of the 'new Elizabethan age'</a>
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<h2>How is this grief similar?</h2>
<p>Grieving someone is about reflecting on our lifetime connection and the <a href="https://books.google.com.au/books?hl=en&lr=&id=3kDdOnrVCrUC&oi=fnd&pg=PR11&dq=bowlby+attachment+and+loss&ots=4M02e0fiVm&sig=K0EM_Da4XAn5qiEj06ffwXUtT9U#v=onepage&q=bowlby%20attachment%20and%20loss&f=false">attachment</a> we had with them that no longer physically exists. </p>
<p>Even though the queen may not have been part of our immediate family, many of us have “grown up” with her. </p>
<p>During her 70-year reign, she’s been part of our lives – part of our grandparents’ lives, our parents’ lives and now ours. Think of these as cross-generational connections. We, collectively and across the generations, feel as if we “know” her.</p>
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<p>Globally, we’ve also been preparing for her loss. Her advanced age, health issues, and <a href="https://theconversation.com/operation-london-bridge-why-britain-is-obsessed-with-the-days-that-will-follow-the-queens-death-74725">plans</a> for what happens after her death have been the subjects of much media coverage.</p>
<p>So this “familiarity” means the type of grief we are seeing now can feel very similar to having someone in our own lives, then losing them.</p>
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Read more:
<a href="https://theconversation.com/operation-london-bridge-why-britain-is-obsessed-with-the-days-that-will-follow-the-queens-death-74725">Operation London Bridge: why Britain is obsessed with the days that will follow The Queen's death</a>
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<h2>How is this grief different?</h2>
<p>But grief for a public figure we don’t know, such as the queen, can be quite different.</p>
<p>We’re missing the close connection with that individual. Many do not have personal anecdotes, or one-on-one shared experiences. We don’t have those intertwined memories to reflect on. As that person is out of reach, it’s difficult to create an image of who that person really was and what they mean to us. </p>
<p>Rather than reflecting on an individual relationship with a loved one, after the death of a public figure, we rely on community experiences for a type of collective grief that shapes how we <a href="https://www.tandfonline.com/doi/full/10.1080/07351690.2012.703575?casa_token=HBN2725f33AAAAAA%3Ah97MqiZqEwH8sJDqjXQauUM-MFgWfLasYDM9uTzaeyqhemEId-132Zoxz5vmT9YKUZ3eMNA3rAO26Q">share our grief online</a>. </p>
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Read more:
<a href="https://theconversation.com/covid-deaths-are-now-barely-mentioned-in-the-media-that-changes-the-very-nature-of-grief-184837">COVID deaths are now barely mentioned in the media. That changes the very nature of grief</a>
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<h2>A contested grief</h2>
<p>Because most of us didn’t know the queen personally, our perception of her – her attributes, her personality – is not grounded in facts. </p>
<p>For instance, how an individual might remember her may be coloured by their age, their political views, or whether their lives have been shaped by colonialism.</p>
<p>So a tussle for how she is remembered – in the United Kingdom, in the Commonwealth and more broadly – is being played out on social media. That tussle can also complicate grief when people share differing reactions to her death.</p>
<p>It raises questions of whether we’re allowed to grieve, or who can voice their grief, or even if we disagree whether grieving is appropriate.</p>
<p>We need to make space for all these different reactions to her loss.</p>
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Read more:
<a href="https://theconversation.com/queen-elizabeths-platinum-jubilee-comes-amid-her-declining-health-royal-backlash-and-a-colonial-reckoning-179828">Queen Elizabeth's Platinum Jubilee comes amid her declining health, royal backlash and a colonial reckoning</a>
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<h2>What role does the media play?</h2>
<p>The media plays an <a href="https://journals.sagepub.com/doi/10.1177/2056305117744392">integral role</a> in how we grieve.</p>
<p>Real-time updates and constant coverage, as we’ve seen around the queen’s death, means we’ve been bracing for the news of her passing. Then the news came.</p>
<p>But this front-row seat to unfolding events and the outpouring of public grief that followed can be triggering for some.</p>
<p>For people who have lost a loved one – recently or even years ago – this rolling media coverage <a href="https://journals.sagepub.com/doi/full/10.1177/0269216313483663?casa_token=RONO7XY7GaEAAAAA%3AsHwcUWCT-ohbsOzdAIvw2mwXCUh2hfCtf-NM-31BCVoyt1gnKd8iHD-BFuT20Cr36dPZl3ZZdimnHQ">may trigger memories</a> of what happened when their family member or friend died. </p>
<p>COVID restrictions may have <a href="https://theconversation.com/the-pandemic-changed-what-it-means-to-have-a-good-death-186806">robbed them of their chance</a> to deliver end-of-life care or attend a funeral in-person. </p>
<p>So this 24-hour news cycle, and being updated on every single step of the queen’s illness and now death, can trigger our own lived experiences of loss. We need to be gentle with those varied reactions. </p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/190331/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>Grieving the queen’s passing can be different to grieving the loss of someone we were close to. It’s also complicated by politics, colonialism and the contest about who she really was.Sarah Wayland, Senior Lecturer Social Work, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1898622022-09-02T23:06:11Z2022-09-02T23:06:11ZCutting COVID isolation and mask mandates will mean more damage to business and health in the long run<p>From Friday September 9, the isolation requirements for people with COVID and no symptoms <a href="https://www.health.gov.au/news/national-cabinet-statement-on-covid-19-settings">will be cut</a> from seven days to five days. Masks will no longer be required on domestic flights. </p>
<p>While Australian Medical Association President Steve Robson <a href="https://www.ama.com.au/media/ama-president-professor-steve-robson-calls-national-cabinet-release-medical-and-health-advice">called</a> for the release of the science behind the National Cabinet decision, the change shows we are now rapidly pushing towards a “business-as-usual” pandemic. This political strategy requires the elimination of protections or restrictions, so that life and business can go “back to normal”. </p>
<p>But life is nowhere near normal. COVID is the third most common <a href="https://www.actuaries.digital/2022/08/31/covid-19-excess-mortality-for-may-2022-at-similarly-high-levels-to-earlier-in-2022/">killer of Australians</a>, with <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics">11,746 deaths so far this year</a>. And there is mounting evidence survivors of COVID face the risk of <a href="https://www.idsociety.org/covid-19-real-time-learning-network/disease-manifestations--complications/post-covid-syndrome/">long-term health effects</a> on the lungs, heart, brain and immune system. </p>
<p>In reality, there is no going back to normal now we are living with COVID.</p>
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Read more:
<a href="https://theconversation.com/long-covid-how-researchers-are-zeroing-in-on-the-self-targeted-immune-attacks-that-may-lurk-behind-it-169911">Long COVID: How researchers are zeroing in on the self-targeted immune attacks that may lurk behind it</a>
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<h2>Balancing risk</h2>
<p>So what is driving these changes and what will the impact be? </p>
<p>First and foremost, there is <a href="https://www.ama.com.au/media/ama-president-professor-steve-robson-calls-national-cabinet-release-medical-and-health-advice">no scientific basis</a> for the change. We know that people vary in terms of how <a href="https://theconversation.com/could-i-still-be-infectious-after-covid-isolation-and-should-i-bother-wearing-a-mask-once-im-all-better-182753">long they remain infectious</a> with COVID after testing positive. </p>
<p>Setting a reasonable duration of isolation depends on balancing the risk to the community of ongoing transmission and the benefit of enabling individuals with COVID to go back to work, school and normal activities as quickly as possible. Seven days was already a compromise. And now New South Wales premier Dominic Perrottet has called for <a href="https://www.theguardian.com/australia-news/2022/sep/02/days-after-successfully-lobbying-for-covid-isolation-period-to-be-reduced-nsw-premier-wants-it-scrapped?utm_term=Autofeed&CMP=soc_568&utm_medium=Social&utm_source=Twitter#Echobox=1662089510">isolation to be scrapped</a> altogether. Has the evidence changed with respect to this balance?</p>
<p>There are a number of recent studies in vaccinated people in the Omicron era evaluating how long people shed virus and are potentially infectious after testing positive for COVID. This fresh research shows a significant number of people (between <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794884">one-third</a> and <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2202092">one-half</a>) remain infectious after a five-day isolation period. Another <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00226-0/fulltext">study</a> shows two thirds are infectious after this time.</p>
<p>So, of the 11,734 people reported to be COVID positive on September 1, at least 3,900 would still be infectious on day five. If released from isolation, they could infect others. </p>
<p>With onward transmission, this could result in many additional COVID cases that would not have occurred if an isolation period of seven days had been retained. </p>
<p>While the reduction of the duration of isolation applies only to people who do not have symptoms, it is well accepted transmission <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07440-0">without symptoms occurs</a>. Unfortunately, our politicians have <a href="https://www.canberratimes.com.au/story/7886181/pm-defends-lowering-covid-isolation-period/">equated</a> the absence of symptoms with the inability to transmit the virus to justify the changes. Decision-makers clearly need to be better informed. </p>
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Read more:
<a href="https://theconversation.com/should-states-cut-covid-isolation-from-7-to-5-days-heres-what-theyll-need-to-consider-189387">Should states cut COVID isolation from 7 to 5 days? Here's what they'll need to consider</a>
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<h2>But what about businesses?</h2>
<p>Mandatory isolation places stress on people and businesses. But with numbers of COVID cases <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?facet=none&uniformYAxis=0&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=%7EAUS">falling</a> from the peaks of the BA.4/5 wave throughout Australia, fewer people are now testing positive for COVID than at any time this year. The pressure on individuals and businesses due to mandatory isolation is at a low point for 2022. </p>
<p>So why make the change now? Perhaps the hope is that while we are experiencing reduced transmission due to the large number of people recently infected with COVID, easing our protections will not lead to an immediate increase in cases. </p>
<p>In this confidence trick, politicians can make these changes with no apparent impact. They will continue to do so until all mitigations against transmission are gone. This is all part of a strategy which, in the <a href="https://www.canberratimes.com.au/story/7884542/doctors-query-advice-on-shorter-covid-iso/?src=rss">words of the NSW premier</a>, has “less reliance on public health orders and more reliance on respecting each other”. As if the two concepts are mutually exclusive instead of mutually reinforcing. </p>
<p>Unfortunately, reinfection is common, and we will face another epidemic wave in the future, likely before the end of the year. Then our systematic dismantling of all existing protections will make the next wave come on sooner and affect more people.</p>
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<a href="https://images.theconversation.com/files/482421/original/file-20220902-18322-84vlza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People sitting on plane not wearing masks" src="https://images.theconversation.com/files/482421/original/file-20220902-18322-84vlza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/482421/original/file-20220902-18322-84vlza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/482421/original/file-20220902-18322-84vlza.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/482421/original/file-20220902-18322-84vlza.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/482421/original/file-20220902-18322-84vlza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/482421/original/file-20220902-18322-84vlza.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/482421/original/file-20220902-18322-84vlza.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">Passengers on domestic flights will no longer need to wear masks.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/uOc3ldMSAiY">Gerrie van der Walt/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<h2>Mitigate transmission instead</h2>
<p>Allowing a substantial proportion of people to go back to work while still infectious is not a solution to solving the workforce disruptions COVID is still causing. This is because there will be an increase of infections in workplaces and schools due to the shortened isolation. When our next wave comes, this will result in even more people being furloughed because they are sick with COVID or caring for others, defeating the ultimate purpose of the change. </p>
<p>And, as we have learned with the BA.5 wave – the <a href="https://ourworldindata.org/grapher/current-covid-patients-hospital?country=AUS">highest number of people hospitalised with COVID</a> in Australia since the beginning of the pandemic – reintroducing mandates once they have been removed does not happen even when <a href="https://www.theguardian.com/australia-news/2022/jul/12/victoria-urges-face-masks-indoors-as-states-adapt-to-worsening-covid-wave">medically advised</a>. Once a protection is relaxed there is no going back – it’s a one-way road. </p>
<p>The best way to protect business interests and keep the economy productive is to <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00079-7/fulltext">mitigate transmission</a> of SARS-CoV-2 (the virus that causes COVID) as best we can using a <a href="https://ozsage.org/ventilation-and-vaccine-plus/#:%7E:text=Vaccine%2DPlus%3A%20Vaccines%2C%20masks,COVID%2D19%20at%20the%20time.">vaccine-plus strategy</a>. </p>
<p>In other countries that have shortened the isolation and then abandoned it altogether, such as in the United Kingdom, transmission has only been worsened and the <a href="https://www.bloomberg.com/news/articles/2022-06-13/uk-economy-shrinks-unexpectedly-as-covid-19-testing-winds-down#:%7E:text=The%20UK%20economy%20shrank%20in,for%20National%20Statistics%20said%20Monday.">economic impacts compounded</a>. </p>
<p>Removing mask mandates on planes will mean a greater risk of having your travel disrupted by COVID and also of airport disruptions because of flight crew off sick from increased exposure. </p>
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Read more:
<a href="https://theconversation.com/want-to-cut-your-chance-of-catching-covid-on-a-plane-wear-a-mask-and-avoid-business-class-180333">Want to cut your chance of catching COVID on a plane? Wear a mask and avoid business class</a>
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<p>By reducing isolation and thereby increasing workplace transmission, we make the workplace less safe. The rights of people to a safe workplace must be considered alongside business continuity. </p>
<p>Allowing increased transmission will impact the economy by resulting in higher numbers of people affected by long COVID. In the UK, the model we appear to be emulating, up to <a href="https://www.ft.com/content/33444f29-bab1-4655-85b5-c0b1f68d9653">one in four employers</a> are reporting their productivity is <a href="https://www.cipd.co.uk/about/media/press/08022long-covid#gref">affected by long COVID</a>. </p>
<p>The move to a business-as-usual pandemic leaves us unnecessarily vulnerable and will ultimately disrupt business even more. </p>
<p>The emergence of COVID variants that are more and more infectious and increasingly vaccine-resistant, along with the simultaneous removal of mitigations such as isolation and masks, dooms us to recurrent and disruptive waves of disease. </p>
<p>Our best chance of business continuity is not the one-way road to a disruptive business-as-usual pandemic but a layered strategy. This would include improved booster rates, safer indoor air, masks in public indoor settings and maintaining the current isolation period for those with COVID. </p>
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Read more:
<a href="https://theconversation.com/how-does-omicron-compare-with-delta-heres-what-we-know-about-infectiousness-symptoms-severity-and-vaccine-protection-172963">How does Omicron compare with Delta? Here's what we know about infectiousness, symptoms, severity and vaccine protection</a>
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<img src="https://counter.theconversation.com/content/189862/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre receives funding from NHMRC, MRFF, Sanofi</span></em></p><p class="fine-print"><em><span>Nancy Baxter 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>With the goal of ‘business as usual’, politicians will continue to reduce COVID protections without immediate consequence while transmission is low. But then the next wave will come.Nancy Baxter, Professor and Head of Melbourne School of Population & Global Health, The University of MelbourneC Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1893872022-08-30T05:58:41Z2022-08-30T05:58:41ZShould states cut COVID isolation from 7 to 5 days? Here’s what they’ll need to consider<p>New South Wales Premier Dominic Perrottet is <a href="https://www.smh.com.au/politics/nsw/perrottet-urges-states-to-back-five-day-covid-isolation-20220829-p5bdot.html">driving a push</a> to reduce isolation requirements for people who test positive for COVID from seven to five days. It’s slated for discussion at tomorrow’s National Cabinet meeting, with Perrottet urging a consistent approach across all states and territories. </p>
<p>Others, including Health Services Union president Gerard Hayes, have <a href="https://www.abc.net.au/news/2022-08-30/isolation-debate-covid19-health-union/101385448">called for</a> the isolation requirement to be scrapped altogether, and instead, urging people to stay at home if they’re infectious. </p>
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<p>So what will states be weighing up? Here’s what the available evidence says.</p>
<h2>How many infectious people are in isolation?</h2>
<p>Not everyone tests for infection, even if they suspect they might have COVID. Many people won’t know to test if they have mild or no symptoms and are unaware they’ve been exposed. </p>
<p>Our latest <a href="https://kirby.unsw.edu.au/news/june-almost-half-aussies-had-recently-had-covid-19">serosurvey data</a>, which tests for antibodies in blood donations, suggests around one quarter of the population has had a COVID infection in the three months up to June. That equates to about 6.8 million people. </p>
<p>But only 2.7 million infections were reported in that time period. And these will include cases where the same people had multiple infections. Therefore, it’s likely four to five million infections went untested or unreported.</p>
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Read more:
<a href="https://theconversation.com/can-we-really-rely-on-people-to-isolate-when-theyre-told-to-experts-explain-134027">Can we really rely on people to isolate when they're told to? Experts explain</a>
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<p>Some people who don’t test or report a positive result might still isolate. At the same time, some who do report their infections may not isolate properly. </p>
<p>This isn’t just about people being compliant or not. It also reflects the large number of asymptomatic infections, as well as other respiratory symptoms that can mask COVID. </p>
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Read more:
<a href="https://theconversation.com/could-i-have-had-covid-and-not-realised-it-178630">Could I have had COVID and not realised it?</a>
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<p>A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795246?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=081722">survey of 210 people in the United States</a> found only 44% were aware they’d had a recent Omicron infection. Among those who weren’t aware, 10% reported having had any symptoms which they mostly put down to a common cold or other non–COVID infection.</p>
<p>For those who do test and isolate, it’s important to also ask how far into their infections they are when they start isolating.</p>
<p>Isolation starts with a positive test which, in most cases, follows the onset of symptoms, possibly by a day or two. If someone knows they have been a close contact of a case, they may be on the lookout for signs of infection, knowing they have been exposed. Others may miss the signs initially if they commonly experience respiratory symptoms from other causes. </p>
<h2>How long are we infectious?</h2>
<p>A <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00226-0/fulltext">UK study in The Lancet</a> of 57 people who developed COVID while under daily monitoring tracked participants’ infectious viral load and symptoms. </p>
<p>It found half had an infectious period that lasted up to five days. One-quarter had an infectious period that lasted three days or less. Another quarter were infectious beyond seven days – though with much lower levels of live viral shedding late in their infection. </p>
<p>However, the infections in this study were the Delta variant, so may overstate the duration of infectious periods nowadays. </p>
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Read more:
<a href="https://theconversation.com/how-does-omicron-compare-with-delta-heres-what-we-know-about-infectiousness-symptoms-severity-and-vaccine-protection-172963">How does Omicron compare with Delta? Here's what we know about infectiousness, symptoms, severity and vaccine protection</a>
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<p>A JAMA <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795489">review</a> of the time from exposure to symptoms found the mean incubation period has shortened with each new variant. It went from an average of 5 days for infections caused by Alpha, to 4.4 days for Delta, and 3.4 days for Omicron variant. Omicron may therefore also have a shorter overall infectious period on average than Delta. </p>
<p>In the <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00226-0/fulltext">Lancet study</a>, vaccinated people also had a faster decline in their infectious viral load than those not fully vaccinated. The high rates of vaccination and hybrid immunity in Australia could also be shortening the time we are infectious compared to Delta infections. </p>
<p>The <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00226-0/fulltext">Lancet study</a> also reported one-quarter of people shed infectious virus before symptoms started. Interestingly, it found RATs had the lowest sensitivity during the viral growth phase and viral load peak. This means people were less likely to have a positive result in the first days of their most infectious period. </p>
<p>So some people will not test positive, and therefore not isolate, until one or two days into their infections, even if they’re testing with a RAT every day. </p>
<p>Overall, when you sum up the infectious time for those who do not isolate, and the days before isolation for those who do, people with COVID spend more time infectious in the community than they do in isolation. And this includes the time they are at their most infectious.</p>
<h2>So, how many exposure days are prevented by current isolation rules?</h2>
<p>It’s impossible to know, but based on the above, at most it would be around one quarter, and will probably be much lower than that. </p>
<p>The question, then, is whether reducing isolation by two days towards the tail of the infectious period when infectious viral loads are low will have an impact. </p>
<p>This is unlikely, and that has been the experience overseas, probably because this is a marginal change to a risk-mitigation strategy that can only be partially effective at this stage in the pandemic. </p>
<p>However, there are ways to make the transition from seven to five days safer. This includes:</p>
<ul>
<li><p>requiring acute symptoms experienced in the initial stage of the COVID infection to have resolved before they end isolation, especially fever </p></li>
<li><p>using negative RAT tests to allow people with a persistent cough or other lingering symptoms that may not be associated with an active infection to leave isolation</p></li>
<li><p>screening workers from high-risk settings such as health care and aged care before they return to work</p></li>
<li><p>providing clear information on the infection risk to others in the week following isolation, and how to minimise risk.</p></li>
</ul>
<p>Whether we take half steps away from isolation or a large leap, the small risk that people may still be infectious enough to pass the virus on to others on leaving isolation – whether that’s at five or seven days – needs to be managed. </p>
<p>It will always be important to wear <a href="https://www.healthdirect.gov.au/covid-19/recovery-and-returning-to-normal-activities">well-fitted masks</a>, preferably respirators, when around others and avoid people with compromised immune systems for those <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00226-0/fulltext">first two weeks</a> after a COVID infection begins when you may still be shedding live virus.</p><img src="https://counter.theconversation.com/content/189387/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Bennett receives funding from the National Health & Medical Research Council, Medical Research Future Funds, and VicHealth, and an independent scientific advisor on the AstraZeneca Australian Vaccine advisory group, ResApp Health, and Impact Biotech Healthcare.</span></em></p>Will two fewer days of isolation make much of a difference to COVID case numbers?Catherine Bennett, Chair in Epidemiology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1888062022-08-19T14:48:09Z2022-08-19T14:48:09ZHow drama can help open up conversations on suicide for young people in post-pandemic times<p>Suicide is the <a href="https://www.kff.org/news-summary/suicide-represents-2nd-leading-cause-of-death-among-young-people-ages-15-29-who-notes-on-world-mental-health-day/">second highest cause of death</a> in 15-to-29-year-olds around the world, according to UK charity <a href="https://www.youngminds.org">Young Minds</a>, an organisation set up to help children and young people with mental health issues. </p>
<p>Many young people have experienced problems with their mental health during and since the COVID-19 pandemic, which is <a href="https://www.bmj.com/content/372/bmj.n614">predicted</a> to lead to a mental health epidemic. Factors such as the move to home schooling, physical isolation from friends and uncertainty over easing of restrictions have all contributed to poor mental health. But my <a href="https://www.ingentaconnect.com/contentone/intellect/jaah/2019/00000010/00000003/art00002">research</a> has shown that using drama to explore these sensitive issues could be one way to tackle the emerging crisis.</p>
<p>Against the pandemic backdrop, it is likely that there will be a rise in young people <a href="https://cls.ucl.ac.uk/wp-content/uploads/2020/11/Mental-ill-health-at-age-17-%E2%80%93-CLS-briefing-paper-%E2%80%93-website.pdf">attempting suicide</a> and, in some cases, taking their own lives. Recent research has found that 7% of British children have <a href="https://www.theguardian.com/society/2021/feb/21/uk-17-year-olds-mental-health-crisis">attempted suicide by the age of 17</a>. </p>
<p>So there is an urgent need for early intervention and prevention strategies to be devised and implemented in schools to reverse the potential increase in suicide amongst young people.</p>
<p>In 2019, as a lecturer in performance, I carried out a drama research <a href="https://www.ingentaconnect.com/contentone/intellect/jaah/2019/00000010/00000003/art00002">project</a> in South Ayrshire schools which aimed to change attitudes towards talking about suicide. Contrary to popular belief, if there are serious concerns about someone’s safety, asking them directly if they’re contemplating suicide is recommended by mental health charity <a href="https://www.mind.org.uk/information-support/helping-someone-else/supporting-someone-who-feels-suicidal/talking-about-suicidal-feelings/">Mind</a>.</p>
<p>This project, part of a <a href="https://publichealthscotland.scot/">Public Health Scotland</a> strategy, was called <a href="http://www.healthscotland.com/documents/6021.aspx">Read Between The Lines</a> and aimed to spread this message to young people in the hope of opening up conversations about suicide. My current research aims to develop the work done in Read Between The Lines and, after the restrictions of COVID-19, learn lessons from digital innovations in teaching and learning in addressing mental health issues around suicide.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/sRo5Db_7yVI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>The play’s the thing</h2>
<p>In Read Between The Lines, a short play was presented to an audience of 11-to-18-year-olds which showed the difference talking can make in keeping young people safe. In the play, a teenage girl shows signs of contemplating suicide. </p>
<p>By talking to a friend, she is supported through her difficulties and ultimately turns away from the idea. Using drama to represent such difficult and sensitive conversations allowed the audience to <a href="https://www.ingentaconnect.com/contentone/intellect/jaah/2019/00000010/00000003/art00002">explore these issues in a safe and supportive space</a>.</p>
<p>Without such opportunities to talk freely about subjects like suicide, <a href="https://www.ingentaconnect.com/contentone/intellect/jaah/2019/00000010/00000003/art00002">young people might otherwise be drawn</a> to other fictional and sometimes sensationalised depictions of suicide. Following <a href="https://www.theguardian.com/media/2018/may/11/netflix-criticised-over-return-of-suicide-drama-13-reasons-why">criticism</a> from mental health organisations, in 2019 Netflix <a href="https://www.theguardian.com/tv-and-radio/2019/jul/16/netflix-cuts-controversial-suicide-scene-from-13-reasons-why">removed a controversial scene</a> from its show <a href="https://www.netflix.com/search?q=13%20%20reasons%20why&suggestionId=81233040_collection&jbv=80117470">13 Reasons Why</a> which showed a character taking her own life. </p>
<p>Acknowledging the potential vulnerability of some young people, Netflix then developed a <a href="https://www.wannatalkaboutit.com/gb/">website</a> which offers support for a range of mental and physical wellbeing issues. Despite such resources, there is a need for more direct local responses to suicide prevention education using both digital and in-person approaches. </p>
<p>Building on the Read Between The Lines project, I am currently exploring ways of using digital resources, such as those developed by <a href="http://realtalk.film/">Grassroots Suicide Prevention</a>. This resource, largely aimed at men, is a good example of how conversations on suicide can be generated safely. </p>
<p>But using such digital resources is only part of an effective approach; role playing with young people can be also a powerful tool to <a href="https://www.ingentaconnect.com/contentone/intellect/jaah/2019/00000010/00000003/art00002">bring about change</a>. This is why I believe that drama is one of the best ways to reach young people and help them talk comfortably about issues such as suicide.</p>
<figure class="align-center ">
<img alt="Two teenage girls sit on floor and talk to each other." src="https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A scene from the Read Between The Lines project.</span>
<span class="attribution"><span class="source">James Layton</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Drama: inhabiting different worlds</h2>
<p>Brazilian theatre director and activist <a href="https://www.theguardian.com/world/2009/may/06/augusto-boal-obituary">Augusto Boal</a> argued that drama can allow two worlds to be simultaneously inhabited, which he describes as “<a href="https://uwe-repository.worktribe.com/output/957720/metaxis-the-transition-between-worlds-and-the-consequences-for-education">metaxis</a>”, meaning that someone can play a role without getting lost in a character or situation. In this way, individuals can explore difficult and challenging scenarios.</p>
<p>For Boal, being an active participant is a powerful tool in bringing about change. In a similar way, <a href="https://www.mantleoftheexpert.com/what-is-moe/dorothy-heathcote/">Dorothy Heathcote’s</a> pioneering drama education work of the 1970s placed children in the role of expert in exploring a range of topics.</p>
<p>In a <a href="https://youtu.be/owKiUO99qrw?t=1561">BBC documentary</a> from 1971, a child reflecting on one of Heathcote’s sessions commented that she’d rather explore a drama of her own making rather than a play because “a play is not our own words”. Allowing the children to play out their own (real) world through their own (imagined) drama world is an essential ingredient in Heathcote’s approach and one that helps bring about dialogue. </p>
<p>Drama can produce meaningful and productive dialogue about suicide and the mental health issues around it, as both my own and Heathcote’s work demonstrate. Heathcote’s use of dramatic spaces allows roles to be assumed intuitively, where the relationship between “expert” and “learner” is equally balanced.</p>
<p>In doing so, the boundaries between the expert and the learner become blurred which helps to develop spaces and communities where proper, ongoing dialogue actually happens.</p>
<p>A delicate balance is necessary when dealing with sensitive topics like suicide if it is to help nurture a society where young people can talk and listen to each other. The exploratory nature of drama offers a way to build such an environment and a promising way to tackle a mental health crisis in which lives are needlessly lost.</p>
<p><em>If you’re struggling with suicidal thoughts, the following services can provide you with support:</em></p>
<p><em>In the UK and Ireland – call Samaritans UK at 116 123.</em></p>
<p><em>In the US – call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or IMAlive at 1-800-784-2433.</em></p>
<p><em>In Australia – call Lifeline Australia at 13 11 14.</em></p>
<p><em>In other countries – visit IASP or Suicide.org to find a helpline in your country.</em></p><img src="https://counter.theconversation.com/content/188806/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Layton 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>Role play and drama offer young people struggling with mental health issues an opportunity to explore the feelings that can lead to suicide.James Layton, Lecturer in Performance, University of the West of ScotlandLicensed 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>
<hr>
<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>
<hr>
<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>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.aihw.gov.au/">Australia's Health 2022</a></span>
</figcaption>
</figure>
<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>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.aihw.gov.au/">Australia's Health 2022</a></span>
</figcaption>
</figure>
<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>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.aihw.gov.au/">Australia's Health 2022</a></span>
</figcaption>
</figure>
<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>
<hr>
<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>
</strong>
</em>
</p>
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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>
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<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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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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<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/1832182022-05-23T04:34:01Z2022-05-23T04:34:01ZCases are high and winter is coming. We need to stop ignoring COVID<p>In a <a href="https://www.theguardian.com/australia-news/2021/aug/31/guardian-essential-poll-australians-wary-of-any-living-with-covid-strategy-that-would-lead-to-more-deaths">poll conducted by the Guardian</a> in August of 2021 about the number of deaths Australians would be willing to accept as restrictions eased, only 3% of respondents felt that 5,000 or more COVID-related deaths per year would be acceptable. </p>
<p>Sadly we have surpassed that milestone in the <a href="https://theconversation.com/covid-has-killed-5-600-australians-this-year-and-the-pandemic-isnt-over-ethics-can-shape-our-response-182765">first four months of this year alone</a>.</p>
<p>Each day, an average of 45,000 Australians are <a href="https://www.covid19data.com.au/cases-last-28-days">reporting cases of COVID</a>, a number that is rising and likely a substantial underestimate. </p>
<p>Yet where are the sensible public health measures to stem the tide of illness and death? </p>
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Read more:
<a href="https://theconversation.com/reducing-covid-transmission-by-20-could-save-2-000-australian-lives-this-year-183426">Reducing COVID transmission by 20% could save 2,000 Australian lives this year</a>
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<h2>People are dying <em>of</em> COVID</h2>
<p>Sadly we are now leading the world in <a href="https://www.abc.net.au/news/2022-05-15/covid-infections-in-australia-among-worlds-highest/101062364">COVID cases per capita</a>.</p>
<p>But did these people die of or with COVID? This question is raised often by <a href="https://www.theguardian.com/australia-news/2022/may/18/pm-dismisses-need-for-more-measures-to-limit-covid-deaths-suggests-australians-dying-with-not-of-the-virus">those who wish to diminish the impact</a> of the pandemic, including former prime minister Scott Morrison.</p>
<p>The evidence, however, is clear – of all people who died “of” or “with” COVID during the pandemic in Australia, <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-30-april-2022">90% have died</a> of COVID.</p>
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<p>Even if we concern ourselves only with excess death rates (that is, deaths exceeding what would usually be expected) COVID is a major killer. The Australian Bureau of Statistics evaluated deaths in January 2022, around the time of the peak in COVID cases during the first Omicron wave in Australia. Comparing the observed mortality rate to the usual pre-COVID rate, they found <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/january-2022">22% more deaths</a> in that month than expected. </p>
<p>COVID is currently on track to be <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/january-2022">one of the leading causes of death</a> in Australia this year. </p>
<p>Long COVID will affect many Australians infected, <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">perhaps up to 30%</a>. And the other long-term effects of COVID are not yet known.</p>
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<em>
<strong>
Read more:
<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">The mystery of 'long COVID': up to 1 in 3 people who catch the virus suffer for months. Here's what we know so far</a>
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<p>The number of deaths and long COVID are only part of the story. The health care system right now is in crisis throughout the country with people dying <a href="https://7news.com.au/news/wa/perth-grandma-dies-after-waiting-two-and-a-half-hours-for-ambulance-c-6821728">waiting for ambulances</a>, record levels of <a href="https://trixabia.com/wa-records-new-spike-with-12390-new-covid-cases-after-reporting-third-worst-day-for-ambulance-ramp-up/">ambulance ramping</a> (where patients wait with paramedics for medical attention), prolonged <a href="https://www.abc.net.au/news/2022-05-11/hospital-emergency-department-victoria-regional-health/101056212">emergency stays</a> for patients in <a href="https://www.smh.com.au/national/nsw/hopelessly-overwhelmed-sydney-hospitals-treat-patients-in-corridors-ambulance-trolleys-20220511-p5akjx.html">overcrowded departments</a>, and hospital <a href="https://www.abc.net.au/news/2022-05-18/qld-coronavirus-covid19-hospitals-strained-influenza-season/101076770">staff shortages</a>. </p>
<p>Add to that we are now facing our first flu season in two years, with weekly numbers now exceeding the average for the past <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm#current">five years</a>. </p>
<p>Coupled with a <a href="https://mobile.twitter.com/UQ_News/status/1526801509488410624">lower-than-average uptake</a> of the flu vaccine this year, the flu season is shaping up to potentially be a severe one – <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/7610377A5BEB1D25CA25874B007D9DD2/%24File/2019-Influenza-Season-Summary.pdf">potentially resulting</a> in up to 30,000 people requiring admission to hospital.</p>
<p>With winter coming, and more people gathering indoors as the weather turns cold, COVID cases may also rise in tandem with influenza. </p>
<h2>We can reduce cases</h2>
<p>This looming disaster can be averted: we can reduce transmission and “flatten the curve” with simple actions. </p>
<p>We have seen the impact the relaxation of public health restrictions and protections like mask-wearing mandates have made in terms of driving transmission.</p>
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<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>
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<p>In Western Australia, <a href="https://www.wa.gov.au/government/announcements/public-health-and-social-measures-ease-was-soft-landing-secured#close-contacts">relaxation of public health measures</a> including mask wearing and household contact isolation occurred on April 29. Within days of these changes, case numbers reached <a href="https://twitter.com/profesterman/status/1524250775903686657">record highs</a> – there are now 100 more people hospitalised with COVID every day than before these changes went into effect. </p>
<p>It would stand to reason reinstating these two measures would have the opposite effect – fewer cases, fewer people in hospital, and fewer people dying of COVID. </p>
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<a href="https://images.theconversation.com/files/464439/original/file-20220520-18-9y62l9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man with flag takes off mask" src="https://images.theconversation.com/files/464439/original/file-20220520-18-9y62l9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464439/original/file-20220520-18-9y62l9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464439/original/file-20220520-18-9y62l9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464439/original/file-20220520-18-9y62l9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464439/original/file-20220520-18-9y62l9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464439/original/file-20220520-18-9y62l9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464439/original/file-20220520-18-9y62l9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&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">Western Australia saw a huge uptick in cases after removing masks and isolation requirements.</span>
<span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20220211001622348753?path=/aap_dev15/device/imagearc/2022/02-11/94/0a/da/aapimage-7jo7oxayrkg1bt5afvgo_layout.jpg">AAP Image/Richard Wainwright</a></span>
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<p>The Australian Medical Association has <a href="https://www.theage.com.au/national/victoria/doctors-plead-with-victorians-to-wear-masks-for-the-good-of-us-all-20220516-p5almn.html">called for</a> an increase in voluntary use of masks, yet its pleas are being ignored. It seems without mandates most people are <a href="https://www.ijidonline.com/article/S1201-9712(21)00274-5/fulltext">unwilling to wear masks</a>, so reinstating these mandates for indoor gatherings should be considered. </p>
<h2>Boosters and treatments are vital</h2>
<p>We also need to use the tools we have to prevent serious disease in people who contract COVID.</p>
<p>Although vaccinations have maintained effectiveness for serious illness, hospitalisation, and death, our protection has waned over time and has also been reduced due to Omicron’s increased immune-evasion. </p>
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<p>The impact of a booster dose is substantial, with <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e3.htm">high levels of protection</a> against severe outcomes demonstrated with a third dose. Yet <a href="https://www.health.gov.au/sites/default/files/documents/2022/05/covid-19-vaccine-rollout-update-18-may-2022.pdf">only 70%</a> of the population of Australia has received a booster and numbers are not increasing. </p>
<p>For those who have been boosted, the fourth dose <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2201570">prevents severe disease</a> in those most at-risk, but to date, most eligible people are <a href="https://www.health.gov.au/sites/default/files/documents/2022/05/covid-19-vaccine-rollout-update-18-may-2022.pdf">yet to receive it</a>.</p>
<p>If delivered early to those most at risk of severe disease, antiviral medications <a href="https://www1.racgp.org.au/newsgp/clinical/what-gps-need-to-know-about-the-new-covid-antivira">can reduce the risk</a> of hospitalisation. But to access these medications, patients must have access to testing and a knowledgeable care provider all within five days of the onset of symptoms. The GP community is trying, but inequitable distribution of these treatments will occur without more education and support for the clinicians at the coalface.</p>
<p>A clearly articulated vision of what is at stake and what actions we need to take to avert disaster is the leadership we need right now. </p>
<p>A few simple public health measures such as mask mandates and reinstating isolation for household contacts of positive cases could make a major difference saving lives. And ensuring provision of boosters and early antiviral therapy for those at-risk despite vaccination will also save lives. </p>
<p>Pretending the pandemic is in the rear-vision mirror will help no one.</p>
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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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<img src="https://counter.theconversation.com/content/183218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I have been an unpaid participant on an Ad Board for MSD who make Molnupiravir</span></em></p><p class="fine-print"><em><span>Nicholas Talley receives funding from the NHMRC and the Department of Defence/Breakthrough Human Performance Research Call. He is affiliated with OzSage, the Australian Medical Council (AMC) (Council Member) and the NHMRC Principal Committee (Research Committee).
</span></em></p>Despite rising cases and deaths, governments are have not even raised the prospect of imposing some public health restrictions.Nancy Baxter, Professor and Head of Melbourne School of Population & Global Health, The University of MelbourneNicholas Talley, Distinguished Laureate Professor of Medicine University of Newcastle, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1834262022-05-19T09:42:11Z2022-05-19T09:42:11ZReducing COVID transmission by 20% could save 2,000 Australian lives this year<p>Australia’s <a href="https://www.health.gov.au/sites/default/files/documents/2022/05/coronavirus-covid-19-at-a-glance-9-may-2022.pdf">COVID death toll</a> is rising, yet public health measures to reduce transmission such as mask mandates are largely a thing of the past. </p>
<p>It’s time for governments and the community to consider what measures can be reintroduced to reduce COVID transmission and deaths, particularly during waves of infection. </p>
<p>Cutting COVID transmission by 20% could avert more than one million infections and 500 COVID deaths in Victoria this year, our new modelling shows. </p>
<p>Given Victoria makes up around 25% of Australia’s population, if extrapolated, these results suggest a 20% reduction in transmission could save up to 2,000 lives nationally.</p>
<p>Even if reintroducing public health measures cut COVID transmission by 10%, this could save between 198 and 314 Victorian lives between now and the end of 2022. Again, this would translate to many more lives saved nationally.</p>
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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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<h2>COVID isn’t ‘just like the flu’</h2>
<p>The prevailing view in Australia is we can now treat COVID “like the flu”. However, the dramatic and sustained increase in COVID-related deaths in 2022 tells a very different story. There have been <a href="https://www.health.gov.au/sites/default/files/documents/2022/05/coronavirus-covid-19-at-a-glance-9-may-2022.pdf">5,687 COVID deaths reported</a> in Australia since January 1.</p>
<p>During the Omicron wave in January 2022, COVID was the second most common cause of death nationwide, with <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/latest-release">2,865 more people dying</a> in that month than is normally expected. That’s a 22% increase. </p>
<p>Critically, COVID deaths have not stopped since the January peak: our current <a href="https://www.covid19data.com.au/deaths">seven-day average</a> sits at about 45 deaths per day, or 315 deaths each week. </p>
<p>In comparison, our most recent severe influenza season (2017) caused <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EDeaths%20due%20to%20influenza%7E5">1,255 deaths</a> across the entire year.</p>
<h2>We have vaccines, so why are there so many deaths?</h2>
<p>There are still so many deaths because we have let the virus run. By scaling back public health measures and delivering an “it’s over” message, we have allowed almost unfettered transmission. </p>
<p>Currently, <a href="https://www.health.gov.au/sites/default/files/documents/2022/05/coronavirus-covid-19-at-a-glance-18-may-2022.pdf">381,000 Australians</a> are known to be infected with SARS-CoV-2, the virus that causes COVID. With high case numbers comes a high death toll, even with a reduced case fatality rate (the proportion of those infected who die).</p>
<p>This relaxed policy stance – combined with emerging variants (three new Omicron strains have entered Australia), winter encouraging more time indoors, and waning immunity – suggest high caseloads will continue for some time yet.</p>
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<h2>Who is dying of COVID?</h2>
<p>In order to reduce COVID deaths, it’s important to understand who is dying and why. While some basic information on deaths is available for some states, additional data – for example, whether those who die are eligible for antiviral treatment – is needed. Such data could enable targeted public health action such as improving treatment access. </p>
<p>Nevertheless, with the data we have we know older people continue to be at greatest risk. Last week in NSW, <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/weekly-covid-overview-20220514.pdf">41% of all COVID deaths</a> were in aged care residents, despite very high rates of vaccination. </p>
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<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>
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<p>We often hear those who die from COVID have pre-existing medical conditions. This is true – <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-31-january-2022#deaths-due-to-covid-19-associated-causes-of-death">about 70% of deaths</a> due to COVID were in people with chronic conditions.</p>
<p>But note that <a href="https://www.aihw.gov.au/reports/australias-health/chronic-conditions-and-multimorbidity">half of all Australians</a> have a chronic condition, as do 80% of those aged 65 and older. Given most of those who have died due to COVID are aged over 65, it’s not surprising most also have an underlying condition.</p>
<h2>Are people dying ‘with’ rather than ‘of’ COVID?</h2>
<p><a href="https://www.theguardian.com/australia-news/2022/may/18/pm-dismisses-need-for-more-measures-to-limit-covid-deaths-suggests-australians-dying-with-not-of-the-virus">Some argue</a> the high rates of COVID deaths isn’t as worrying as it seems because people are dying “with” COVID rather than “from” COVID. </p>
<p>But the majority (89.8%) of <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-30-april-2022">COVID deaths</a> are “from” COVID. </p>
<p>For those defined as dying “with” COVID, this means COVID has possibly or probably “contributed” to those deaths. </p>
<p>For example, a person is infected with COVID which weakens their immune system and leads to a bloodstream infection (sepsis). They’re hospitalised and die three weeks after their COVID diagnosis. Although their death is directly “due to” sepsis, it is also “with” COVID because COVID caused the decline in their health which ultimately led to their death. COVID is not incidental in these deaths.</p>
<p>COVID is also killing young people – even children. Eight children aged nine and under have <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics#cases-and-deaths-by-age-and-sex">died in Australia from COVID</a> since the pandemic began, as well as five people aged ten to 19 years, 22 in their twenties, and 65 in their thirties. </p>
<p>It’s impossible to know if COVID will cause significant numbers of premature death in coming years. Given the damage the SARS-CoV-2 virus causes to the heart, brain, kidneys and lungs, we have reason enough to be seriously concerned. </p>
<h2>What could reduce the COVID death toll?</h2>
<p>Vaccination continues to be hugely important, and the main reason we can even contemplate our current open lifestyle. But vaccination alone is not enough. </p>
<p>Improving air quality and/or wearing a high-quality N95/P2 mask in indoor spaces cause minimal disruption to the community but interrupt COVID transmission effectively. </p>
<p>To illustrate the benefit of interventions, we used <a href="https://www.burnet.edu.au/covid-19/129_modelling">our model</a> to simulate three hypothetical scenarios for the state of Victoria for the remainder of 2022. </p>
<p>We first modelled a scenario with no additional interventions (the light blue line). We compared this with two scenarios where, from May 20, hypothetical interventions were introduced that could reduce the risk of transmission per contact by 10% (the dark blue line) or 20% (the red line). </p>
<p>We didn’t specify which specific interventions should be adopted to make up the 10% or 20% reduction. It could be a single intervention a or combination that make up the 10% to 20% reduction. </p>
<p>Between May 20 and the end of 2022, the outcomes from the “no additional intervention” scenario were an extra 2.22-2.38 million infections or reinfections and 1,060-1,450 deaths in Victoria. </p>
<p>With interventions reducing transmission by 10%, 596,000-614,000 infections and 198–314 deaths could be averted (a 16-25% reduction) over this period.</p>
<p>With interventions reducing transmission by 20%, 1.08-1.10 million infections and 462-502 deaths could be averted (a 37-40% reduction). As outlined above, this translates to up to 2000 lives nationally.</p>
<p>These are likely to underestimate the impact of interventions because the analysis was deliberately conservative and didn’t consider new COVID variants or sub-variants (only omicron BA.1 and BA.2). </p>
<p>The simple message is a small reduction in transmission has a big impact on mortality.</p>
<h2>How do we do this modelling?</h2>
<p>The model used for this work was <a href="https://github.com/institutefordiseasemodeling/covasim">COVASIM</a>, a model that can assess the impact of different policies and behaviours on COVID transmission, hospitalisations and deaths. The model has been used to assist policy decisions in Australia, the United States and the United Kingdom. </p>
<p>People in the model are assigned an age (which affects their susceptibility to infection and their disease prognosis), a household, a school (for people aged five to 17) or a workplace (for people over 18, up to 65), and they participate in a number of community activities that may include attending restaurants, pubs, places of worship, community sport, and social gatherings. </p>
<p>The model includes:</p>
<ul>
<li>vaccination (including individual dosing schedules, vaccine types and waning immunity)</li>
<li>testing (PCR or rapid antigen tests)</li>
<li>contact tracing (self-tracing)</li>
<li>quarantine of close contacts</li>
<li>isolation of confirmed cases</li>
<li>masks</li>
<li>a variety of policy restrictions to prevent or reduce transmission in different settings (such as closing schools or workplaces, density limits in hospitality and retail settings, restrictions on social gathering sizes).</li>
</ul>
<figure class="align-center ">
<img alt="Woman in a mask shops for clothes." src="https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The COVASIM model assesses the impact of different policies on behaviours and COVID transmission.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/">Shutterstock</a></span>
</figcaption>
</figure>
<h2>It’s not just about the economy</h2>
<p>Australia successfully mitigated the direct impact of COVID in the first two years of the pandemic. However, recently Australia has made little effort to reduce the impact of COVID. We are quietly, perhaps unknowingly, approving a trade-off between COVID deaths, and economic and social well-being more generally. </p>
<p>Many people seem unaware of the high death numbers, and that simple interventions can make a meaningful difference. </p>
<p>But the value of the current trade-off is unclear. The economic and social benefits of winding back key public health measures, when tens of thousands of COVID cases occur each day, have not been established. Indeed, stories of major COVID-driven disruption are common, suggesting the opposite is true. </p>
<p>Australia must find a middle road, centred around slowing transmission, reinvigorating vaccine roll-out and scaling-up treatment options for people with COVID infections. Otherwise, 10,000 or more COVID deaths per year could well be our new – previously unthinkable – normal.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-at-home-with-covid-when-do-i-need-to-see-a-doctor-and-what-treatments-are-available-176884">I’m at home with COVID. When do I need to see a doctor? And what treatments are available?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/183426/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margaret Hellard has received funding receives funding from the Victorian Government, the Federal Government, the New South Wales Government, the Macquarie Foundation and the Minderoo Foundation for COVID-19 related research. None provided support for this specific work. She also receives funding from the National Health and Medical Research Council of Australia for other research, and Gilead Science and Abbvie for investigator initiated non COVID-19 related research.
</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, & other Australian federal and Victorian State Government bodies.</span></em></p><p class="fine-print"><em><span>Dominic Delport has received funding from the NSW government in 2021 and continues to receive funding from the Victorian government for COVID-19 modelling work.</span></em></p><p class="fine-print"><em><span>Nick Scott receives funding from the Victorian Government for COVID-19 related work, and has previously received funding from the New South Wales Government and Federal Government for COVID-19 related work. No government funding was received for this specific work. He also receives funding from the National Health and Medical Research Council of Australia for research on other diseases. </span></em></p>We modelled the impact small reductions in transmission would have on COVID deaths. We found a 20% drop could save the lives of 500 Victorians this year, or 2,000 people nationally.Margaret Hellard, Deputy Director (Programs), Burnet InstituteBrendan Crabb, Director and CEO, Burnet InstituteDominic Delport, Health modeller, Burnet InstituteNick Scott, Econometrician, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1803812022-04-26T20:47:35Z2022-04-26T20:47:35ZFor people who exercise in groups, ‘we’ has benefits — but don’t lose sight of ‘me’<figure><img src="https://images.theconversation.com/files/459891/original/file-20220426-18-u74v3.jpg?ixlib=rb-1.1.0&rect=243%2C312%2C5548%2C3516&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For people who exercise in a group, their sense of connection to the group may not translate into skills that help them exercise alone.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Anyone who has been part of an exercise group likely knows the power and benefit of group exercise. Exercise group members often identify with their group and develop a <a href="https://doi.org/10.1093/acprof:oso/9780195388275.001.0001">sense of “we” or belonging</a>. </p>
<p>Having this sense of “we” is associated with numerous benefits, including life satisfaction, <a href="https://dx.doi.org/10.1371%2Fjournal.pone.0124609">group cohesion</a>, support and <a href="https://doi.org/10.1111/jasp.12305">exercise confidence</a>. Further, group attendance, effort and a higher exercise volume are more likely when people <a href="https://doi.org/10.1080/15298868.2018.1436084">identify strongly with an exercise group</a>. Belonging to an exercise group seems like a great way to support an exercise routine.</p>
<p>But what happens when people can’t rely on the support of their exercise group? </p>
<p>In our kinesiology lab at the University of Manitoba, we have started to answer this question. People may lose access to their exercise group when they relocate, become a parent or take on a new job with a challenging schedule. In March 2020, many group exercisers lost access to their groups due to the limits on public gatherings that accompanied the COVID-19 pandemic.</p>
<h2>Identifying with a group</h2>
<p>To understand if tying oneself to an exercise group makes it harder to exercise when the group is not available, we asked exercise group members how they would react if their exercise group was no longer available to them. People who strongly identified with their group were less confident about their ability to exercise alone and <a href="https://doi.org/10.1016/j.psychsport.2012.01.007">thought this task would be difficult</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/459892/original/file-20220426-26-hjcs6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A group of people in workout clothes and helmets riding bikes" src="https://images.theconversation.com/files/459892/original/file-20220426-26-hjcs6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/459892/original/file-20220426-26-hjcs6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/459892/original/file-20220426-26-hjcs6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/459892/original/file-20220426-26-hjcs6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/459892/original/file-20220426-26-hjcs6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/459892/original/file-20220426-26-hjcs6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/459892/original/file-20220426-26-hjcs6o.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">People may lose access to their exercise group when they relocate, become a parent, or take on a new job with a challenging schedule.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>We found similar results in two studies yet to be peer reviewed, in which we examined how exercisers reacted when they lost access to their exercise groups because of COVID-19 restrictions on group gatherings. Again, exercisers with a strong sense of “we” felt <a href="https://osf.io/ny6rz/?view_only=111f166f2e0e49329778f62c29ab0978">less confident about exercising alone</a>. This lack of confidence may have stemmed from the challenge of members having to go “cold-turkey” on group participation, and suddenly losing the <a href="https://osf.io/y7r5q/?view_only=adc29bc94ac0482fb4b71e6c06950446">support and accountability that the group provided</a>.</p>
<p>Further, the strength of exercisers’ group identity was unrelated to how much they exercised alone after losing their groups. Exercisers’ sense of connection to the group may not translate into skills that help them exercise alone. Some exercisers we interviewed reportedly stopped exercising altogether during pandemic restrictions. </p>
<p>These findings are consistent with other research that suggests that when exercisers become reliant on others (in this case, exercise leaders) they <a href="https://doi.org/10.1177/1359105307078173">have difficulty exercising alone</a>.</p>
<p>What might equip group exercisers with the skills and motivation to exercise independently? We believe exercise role identity may be a key. When people exercise with a group, they often form an identity not only as a group member, but also with the role of <a href="https://doi.org/10.1080/15298868.2018.1436084">someone who exercises</a>. </p>
<h2>Exercise identity</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/459893/original/file-20220426-19622-9kam5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A group of people in workout clothes in a gym doing lunges." src="https://images.theconversation.com/files/459893/original/file-20220426-19622-9kam5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/459893/original/file-20220426-19622-9kam5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/459893/original/file-20220426-19622-9kam5d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/459893/original/file-20220426-19622-9kam5d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/459893/original/file-20220426-19622-9kam5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/459893/original/file-20220426-19622-9kam5d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/459893/original/file-20220426-19622-9kam5d.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">There are undeniable benefits to group exercise, such as group cohesion and group support.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Identifying as an exerciser (exercise role identity) involves seeing exercise as core to one’s <a href="https://osf.io/y7r5q/?view_only=adc29bc94ac0482fb4b71e6c06950446">sense of self</a> and behaving consistently with the <a href="https://doi.org/10.1080/1612197X.2015.1096292">exerciser role</a>. This may mean engaging in regular exercise or making exercise a priority. Research shows a reliable link between exercise role identity and <a href="https://doi.org/10.1080/17437199.2016.1143334">exercise behaviour</a>. </p>
<p>Group exercisers who have a strong exercise role identity may be in the best position to keep exercising even when they lose access to their group, because exercise is core to their sense of self.</p>
<p>To test this idea, we looked at how exerciser role identity related to group exercisers’ feelings about exercising alone. We found that in both hypothetical and real-world situations where exercisers lost access to their group, people who strongly identified with the exerciser role were more confident in their ability to exercise alone, found this task <a href="https://doi.org/10.1016/j.psychsport.2012.01.007">less challenging</a> and <a href="https://osf.io/ny6rz/?view_only=111f166f2e0e49329778f62c29ab0978">exercised more</a>. </p>
<p>In fact, some exercisers reported seeing the loss of their group during the pandemic as just another challenge to overcome and focused on opportunities to exercise without having to worry about other group members’ schedules or workout preferences. These findings suggest that having a strong sense of “me” may offer exercise group members the tools needed to exercise independently from the group.</p>
<h2>Benefits of ‘we’ and ‘me’</h2>
<figure class="align-center ">
<img alt="A woman in gray workout clothes stretching outdoors." src="https://images.theconversation.com/files/459694/original/file-20220426-16-y7c7y0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/459694/original/file-20220426-16-y7c7y0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/459694/original/file-20220426-16-y7c7y0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/459694/original/file-20220426-16-y7c7y0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/459694/original/file-20220426-16-y7c7y0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/459694/original/file-20220426-16-y7c7y0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/459694/original/file-20220426-16-y7c7y0.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">Exercisers can define what it means to them personally to be an exerciser independent of a group.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>There are undeniable benefits to group exercise. Exclusively solo exercisers do not get the benefits of group cohesion and <a href="https://dx.doi.org/10.1371%2Fjournal.pone.0124609">group support</a>. As exercise adherence experts, we highly recommend group exercise. However, we also argue that exercisers who rely too heavily on their groups may be less resilient in their independent exercise — especially if they suddenly lose access to their group. </p>
<p>We feel it is wise for group exercisers to foster an exerciser role identity in addition to their exercise group identity. What might this look like? Exercisers may clearly define what it means to them personally to be an exerciser independent of the group, or pursue some goals with the group (for example, training for a fun run with group members) and other goals alone (for example, running a race at one’s fastest pace). </p>
<p>Overall, if you are looking to support your exercise routine and stay flexible in the face of challenges, having a sense of “we” is great, but don’t lose sight of your sense of “me.”</p>
<p><em>Sasha Kullman, a student in the Faculty of Kinesiology and Recreation Management at the University of Manitoba, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/180381/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shaelyn Strachan 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>There are benefits to group exercise, but relying too much on a group may leave people less resilient for solo exercise, especially if suddenly cut off from a group as many were during COVID-19.Shaelyn Strachan, Associate Professor, Faculty of Kinesiology and Recreation Management, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1799692022-04-04T19:58:40Z2022-04-04T19:58:40ZCOVID cases are rising but we probably won’t need more restrictions unless a worse variant hits<figure><img src="https://images.theconversation.com/files/455993/original/file-20220404-19-o4hxl9.jpg?ixlib=rb-1.1.0&rect=50%2C0%2C5615%2C3741&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-girl-waiting-twilight-cross-street-1204153150">Shutterstock</a></span></figcaption></figure><p>COVID case numbers are tracking up in Australia, with an average of <a href="https://ourworldindata.org/coronavirus/country/australia">57,000 new cases</a> recorded each day. </p>
<p>New South Wales is recording around 21,000 cases a day, the highest number in two months, while Victoria has around 10,000 a day.</p>
<p>Some states may be at or close to the peak of this latest wave, with their growth in cases slowing, while others continue to track upwards.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/455979/original/file-20220404-23-4cgeaz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455979/original/file-20220404-23-4cgeaz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=366&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455979/original/file-20220404-23-4cgeaz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=366&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455979/original/file-20220404-23-4cgeaz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=366&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455979/original/file-20220404-23-4cgeaz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=459&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455979/original/file-20220404-23-4cgeaz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=459&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455979/original/file-20220404-23-4cgeaz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=459&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This graph shows the number of daily cases for each state and territory, based on a seven-day average.</span>
<span class="attribution"><a class="source" href="https://www.covid19data.com.au/compare-outbreaks">COVID19data.com.au</a></span>
</figcaption>
</figure>
<p>Rising case numbers are due to three factors: </p>
<ul>
<li><p>Omicron BA.2 – a sub-variant of the original Omicron – has become the dominant strain. BA.2 is <a href="https://www.medrxiv.org/content/10.1101/2022.01.28.22270044v1">more infectious</a> than old Omicron, including among the vaccinated</p></li>
<li><p>mask mandates in many settings were dropped in New South Wales, Victoria, the ACT and Queensland in late February and early March</p></li>
<li><p>we’re out out and about more, with a greater number of social contacts each day.</p></li>
</ul>
<p>Omicron BA.2 case numbers are unlikely to reach worrying heights requiring reinstating restrictions. </p>
<p>We do, however, need to be ready to respond to new variants which may be more virulent (think Delta or worse, with high hospitalisation and death rates) and highly infectious (think Omicron or worse). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ba-2-is-like-omicrons-sister-heres-what-we-know-about-it-so-far-176137">BA.2 is like Omicron's sister. Here's what we know about it so far</a>
</strong>
</em>
</p>
<hr>
<h2>Does it matter that case numbers are currently rising?</h2>
<p>Yes. Older people and those with underlying health conditions are at higher risk of hospitalisation and death, and want to avoid COVID infection. For them, it’s important to:</p>
<ul>
<li>keep up-to-date with vaccinations (given they wane in effectiveness)</li>
<li>wear high-quality masks when around other people indoors</li>
<li>ask visitors to have a rapid antigen test before visiting.</li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1507123555687071745"}"></div></p>
<p>But for the younger and vaccinated, Omicron infection is likely a mild illness. </p>
<p>We don’t yet know how people with Omicron are affected by long COVID. But given it causes <a href="https://www.medrxiv.org/content/10.1101/2022.01.11.22269045v2">less severe disease than Delta</a> and is more of an <a href="https://www.bmj.com/content/376/bmj-2021-069761">upper respiratory illness</a> and <a href="https://www.nature.com/articles/d41586-022-00007-8">less likely to infect the lung tissue</a>, long COVID is likely to be less common and less severe.</p>
<p>Therefore, as long as the rising hospitalisation rates do not get to a level that stretches the health system, we don’t need to reinstate restrictions again. Currently, hospital numbers are well shy of overburdening the health system. </p>
<p>There are advantages to Australia’s high levels of immunity through vaccination and infection with Omicron. An <a href="https://www.medrxiv.org/content/10.1101/2021.12.04.21267114v1.full">infection adds to your vaccine-induced immunity</a> and makes you <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00143-8/fulltext">less likely</a> to be reinfected. </p>
<h2>Could lockdowns come back for BA.2?</h2>
<p>Greater restrictions are unlikely to be needed to control Omicron BA.2. But we can never say never with COVID-19. If hospitalisation numbers do increase to a level that stretches health services, we may need to turn back on some public health measures. However lockdowns are still unlikely for BA.2. </p>
<figure class="align-center ">
<img alt="Woman in mask looks out of the window." src="https://images.theconversation.com/files/456010/original/file-20220404-18-zk1i3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456010/original/file-20220404-18-zk1i3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456010/original/file-20220404-18-zk1i3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456010/original/file-20220404-18-zk1i3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456010/original/file-20220404-18-zk1i3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456010/original/file-20220404-18-zk1i3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456010/original/file-20220404-18-zk1i3z.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">Lockdowns are unlikely to be needed to control BA.2.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/melbourne-australia-12-april-2020-woman-1702544878">Shutterstock</a></span>
</figcaption>
</figure>
<p>It wouldn’t take many additional public health restrictions to keep case numbers in check, given our increasing population immunity. It could mean, for instance, returning to mask mandates for all indoor environments and encouraging people to work at home.</p>
<p>We do, however, need to be prepared for new variants. </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>
<h2>How easily could a new variant spread?</h2>
<p>New variants muscle out existing variants because they are either innately more infectious, or have some immune escape, meaning vaccines or previous infection offer less protection. </p>
<p>But there is no natural selection advantage based on innate virulence (how likely it is to cause severe illness, hospitalisation and death). We just don’t know what the next variant will bring. </p>
<p>We’re lucky the variant that came along just as we were largely vaccinated and ready to open up to the world was Omicron with lower virulence. We may not be so lucky next time.</p>
<p>For arguments sake, let’s imagine a new variant arrives in mid-2022 that is as or more virulent than Delta. </p>
<p>We would expect this new variant to not spread as fast, not infect as many people and not hospitalise and kill as many people as if the variant had arrived in 2020. Our immunity from vaccines and natural infection, while not perfect, should slow its spread and result in less serious illness if infected. </p>
<figure class="align-center ">
<img alt="ICU doctors treat COVID patient." src="https://images.theconversation.com/files/456019/original/file-20220404-21-qzp7cr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456019/original/file-20220404-21-qzp7cr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456019/original/file-20220404-21-qzp7cr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456019/original/file-20220404-21-qzp7cr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456019/original/file-20220404-21-qzp7cr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456019/original/file-20220404-21-qzp7cr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456019/original/file-20220404-21-qzp7cr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A new variant could place too much stress on our health system.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coronavirus-covid-19-infected-patient-quarantine-1684283641">Shutterstock</a></span>
</figcaption>
</figure>
<p>However, a new variant could still stress our health systems and society again. So if a new variant arrives that is innately more severe (causing more hospitalisations and death despite our high vaccination and Omicron infection rates), we will probably have to turn some restrictions back on, such as wearing masks indoors and working from home if you can.</p>
<p>We don’t want to have lockdowns again. To avoid that, we need to use the other tools in our toolbox. </p>
<h2>What do we need to do to prepare?</h2>
<p>If we want to keep society open and ticking along in the face of a new, more infectious and more severe variant, we need planning and action in four key areas:</p>
<ul>
<li><p>ongoing improvement of <a href="https://theconversation.com/masks-rats-and-clean-air-how-people-with-disability-can-protect-themselves-from-covid-176789">ventilation of indoor spaces</a> </p></li>
<li><p>large stockpiles of rapid antigen tests (RATs) </p></li>
<li><p>a large stockpile of masks. KN95 and N95 masks <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm">reduce a person’s risk of COVID infection</a> by 83%, compared to 56-66% or so for cloth and surgical masks</p></li>
<li><p>early access to next-generation vaccines that will better protect us against new variants. These should arrive later this year or in 2023 and will be a game-changer for protection.</p></li>
</ul>
<p>Distributing ten high quality masks to all Australians aged 12 and older would also be a game changer in a serious outbreak. But to enable this, federal and state governments will need to stockpile 200 million or more KN95 or N95 masks. </p>
<p>Let’s not repeat the policy failure of not ordering RATs in 2021, and be better prepared.</p><img src="https://counter.theconversation.com/content/179969/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tony Blakely consults for Moderna. He has received funding for COVID-19 research from the Victorian Government and an anonymous philanthropist. </span></em></p>Omicron BA.2 case numbers are unlikely to reach worrying heights requiring reinstating restrictions.Tony Blakely, Professor of Epidemiology, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1797462022-03-22T23:23:45Z2022-03-22T23:23:45ZAs New Zealand relaxes restrictions, here’s what we can still do to limit COVID infections<figure><img src="https://images.theconversation.com/files/453703/original/file-20220322-21-mfo752.jpg?ixlib=rb-1.1.0&rect=18%2C138%2C4007%2C2879&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Phil Walter/Getty Images</span></span></figcaption></figure><p>New Zealanders are about to enjoy cautiously relaxed COVID restrictions under the country’s <a href="https://covid19.govt.nz/traffic-lights/covid-19-protection-framework/">COVID-19 Protection Framework</a>, starting from this weekend.</p>
<p>Prime Minister Jacinda Ardern announced the relaxations today, signalling the end “for now” of vaccine passes, QR codes and vaccine mandates in the education, police and defence sectors from April 4. </p>
<p>Mandates will still apply for health, aged-care, corrections and border control workers, pending more official advice. Settings within the traffic light system have also been revised, but the country remains at the red level and indoor mask use is still required.</p>
<p>New Zealand’s vaccine pass system was designed when we were in the middle of the vaccine rollout, only about one in 400 New Zealanders had had COVID-19, and nobody had even heard of Omicron. </p>
<p>At that time, unvaccinated people had a <a href="https://theconversation.com/your-unvaccinated-friend-is-roughly-20-times-more-likely-to-give-you-covid-170448">much higher risk</a> of catching the virus and spreading it to others. </p>
<p>For this reason, vaccine passes were an important part of safely relaxing the Auckland lockdown. They helped us enjoy a summer with very low case numbers and minimal restrictions. Crucially, this meant we avoided the dual Delta-Omicron epidemic that significantly added to the health burden in places such as <a href="https://www.stuff.co.nz/national/explained/127440590/covid19-the-nsw-omicron-outbreak-is-not-what-you-think">New South Wales</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1506392989945368580"}"></div></p>
<p>The situation we face today is very different. Vaccines remain highly effective at preventing severe illness but aren’t as good at stopping people catching Omicron. And the protection they do provide against infection wanes fairly quickly. </p>
<p>At the same time, increasing numbers of people have some temporary immunity as a result of having had the virus. This means vaccine passes are far less effective as a public health intervention now than they were a few months ago. </p>
<p>But as vaccine passes are phased out, it is important to consider what measures we can use to reduce transmission.</p>
<h2>Vaccines still work</h2>
<p>Vaccines are still highly effective at preventing severe illness and death from COVID-19. Like New Zealand, Hong Kong is now experiencing a major Omicron wave after initially following an elimination strategy. But in the last two months, Hong Kong has had close to 4,000 deaths per five million people compared to New Zealand’s 130. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1503420660869214213"}"></div></p>
<p>Why such a big difference? Vaccines. Hong Kong has much <a href="https://www.ft.com/content/6e610cac-400b-4843-a07b-7d870e8635a3">lower vaccine coverage in older groups</a> than New Zealand does. </p>
<p>But it’s clear vaccines are less effective at preventing infection with Omicron. The <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1061532/Vaccine_surveillance_report_-_week_11.pdf">UK Health Security Agency</a> estimates the effectiveness of two doses of the Pfizer vaccine against symptomatic COVID-19 drops to just 10% after about 25 weeks following the second dose. This jumps to 65% after a booster but also wanes quite quickly to around 40% 15 weeks later.</p>
<p>The proportion of unvaccinated people testing positive is <a href="https://www.newsroom.co.nz/tracking-omicron-in-new-zealand-latest-charts-and-data">not that different</a> from fully vaccinated people. So if you go to a cafe, a hairdressers or a bar, whether or not there are unvaccinated people there makes little difference to your risk of catching the virus.</p>
<p>Other risk factors are more important: are people wearing masks, is it crowded, is the venue well ventilated or outdoors, are people staying away if they have symptoms? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/most-covid-patients-in-nzs-omicron-outbreak-are-vaccinated-but-thats-no-reason-to-doubt-vaccine-benefits-179648">Most COVID patients in NZ's Omicron outbreak are vaccinated, but that's no reason to doubt vaccine benefits</a>
</strong>
</em>
</p>
<hr>
<h2>We still need public health measures to mitigate COVID</h2>
<p>The <a href="https://theconversation.com/to-be-truly-ethical-vaccine-mandates-must-be-about-more-than-just-lifting-jab-rates-169612">limitations</a> the vaccine pass system has placed on people’s freedoms are much harder to justify now. But that doesn’t mean we can end all vaccination requirements or remove all public health measures.</p>
<p>COVID-19 is an airborne disease but a comparison with diseases spread through contaminated water is useful. The spread of cholera from contaminated water is one of the earliest examples of an <a href="https://www.ph.ucla.edu/epi/snow/snowcricketarticle.html">effective public health response</a> to an infectious disease. </p>
<p>The first response was a “boil water” notice, the equivalent of mask wearing to prevent the spread of infections. Longer-term measures involve systemic changes, such as infrastructure for clean water or, in the case of COVID, infrastructure for <a href="https://www.reuters.com/world/europe/italian-study-shows-ventilation-can-cut-school-covid-cases-by-82-2022-03-22/">clean air</a> through ventilation and filtration. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-catching-omicron-is-not-inevitable-heres-why-we-should-all-still-avoid-the-virus-178276">No, catching Omicron is not 'inevitable' – here's why we should all still avoid the virus</a>
</strong>
</em>
</p>
<hr>
<p>The time to remove boil-water notices is not when case numbers are peaking, or even when they are back at half of their peak level. It is when there are sufficient systemic changes in place to keep people safe.</p>
<p>Similarly, isolation periods are intended to stop people from infecting others. For Omicron, studies suggest half of all cases were still <a href="https://dash.harvard.edu/handle/1/37370587">infectious on day five</a> and the infectious period may be as long as ten days. Given wider availability of rapid antigen tests, we could introduce a test-to-return policy to require a negative test before people leave isolation. </p>
<h2>Some vaccine mandates remain</h2>
<p>People working in specific high-risk situations, like healthcare and aged residential care, will still be required to be up to date with their vaccinations to protect the vulnerable people they work with. </p>
<p>We are currently in the middle of a major Omicron wave, with hospitalisations and deaths at record levels. At least as many people will get infected on the way down from the peak as on the way up. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/evidence-supports-mandatory-covid-vaccination-for-aged-care-workers-but-we-need-to-make-it-easier-too-163569">Evidence supports mandatory COVID vaccination for aged-care workers. But we need to make it easier too</a>
</strong>
</em>
</p>
<hr>
<p>And even when this wave subsides, COVID-19 isn’t going to go away. It’s likely we will continue to see daily case numbers in the thousands for some time. Added to other respiratory illnesses like influenza and RSV, this could cause significant strain on healthcare over the winter months. </p>
<p>Altogether, this means we still need <a href="https://blogs.otago.ac.nz/pubhealthexpert/covid-19-hospitalisations-now-peaking-in-aotearoa-nz-but-key-covid-19-control-measures-still-need-to-be-maintained/">a set of sustainable mitigations</a> to reduce transmission and the health impacts of the virus. This includes strategies to address <a href="https://www.stuff.co.nz/pou-tiaki/300482666/government-breached-treaty-principles-in-covid19-response-waitangi-tribunal-finds">vaccine inequity</a> and increase booster uptake, mask use when cases are high, better ventilation and adequate financial support for people to take time off work when they are sick. </p>
<p>COVID vaccine passes have outlived their usefulness at least for now. But COVID-19 is going to be with us for the forseeable future.</p><img src="https://counter.theconversation.com/content/179746/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Plank is affiliated with the University of Canterbury and is funded by the New Zealand Government for mathematical modelling of Covid-19.</span></em></p><p class="fine-print"><em><span>Dion O'Neale receives funding from the NZ Department of Prime Minister and Cabinet for providing modelling and analysis related to COVID-19 and from the NZ Health Research Council for research on modeling and equity impacts of COVID-19 in Aotearoa. He is affiliated with COVID Modelling Aotearoa, The University of Auckland, and Te Pūnaha Matatini. </span></em></p><p class="fine-print"><em><span>Emily Harvey receives funding from the NZ Department of Prime Minister and Cabinet for providing modelling and analysis related to COVID-19 and from the NZ Health Research Council for research on modeling and equity impacts of COVID-19 in Aotearoa. She is affiliated with COVID-19 Modelling Aotearoa, ME Research, Te Pūnaha Matatini, and the University of Auckland.</span></em></p>Vaccine passes have outlived their usefulness, at least for now. But as New Zealand’s Omicron wave begins to subside, other public health measures remain vitally important.Michael Plank, Professor in Applied Mathematics, University of CanterburyDion O'Neale, Project Lead - COVID Modeling Aotearoa; Senior Lecturer - Department of Physics, University of Auckland; Principal Investigator - Te Pūnaha Matatini, University of Auckland, Waipapa Taumata RauEmily Harvey, Principal Investigator, Te Pūnaha Matatini, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772422022-03-22T18:34:44Z2022-03-22T18:34:44ZBuilding back equitably: 4 ways to address mental health inequities magnified by the pandemic, and ensure access to care<figure><img src="https://images.theconversation.com/files/453638/original/file-20220322-15-pnvimp.jpg?ixlib=rb-1.1.0&rect=2416%2C628%2C4683%2C3342&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Responding to the mental health needs of people who are unjustly disadvantaged by the pandemic in Canada will require accurate data.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>You don’t need statistics to appreciate the profound effects that COVID-19 restrictions limiting social connections and access to services have had on our collective mental health. And yet, statistics — paired with qualitative data that offer in-depth descriptions of what people are experiencing — are essential for monitoring improvements, or lack thereof, during the process of recovery from the past two years of cumulative stress. </p>
<p>However, aggregate trends (which combine data from all members of a population) <a href="https://doi.org/10.1177%2F17456916211029964">can be misleading</a>. Even worse, they can exacerbate inequities by giving the erroneous impression that the data apply to everyone in the same way. </p>
<p>For example, Statistics Canada <a href="https://www.canada.ca/en/public-health/services/reports-publications/health-promotion-chronic-disease-prevention-canada-research-policy-practice/vol-42-no-5-2022/self-rated-mental-health-community-belonging-life-satisfaction-perceived-change-mental-health-adults-covid-19-pandemic-canada.html">recently reported</a> a general worsening in self-rated mental health among Canadians. Sixty per cent rated their mental health highly in fall 2020, decreasing to 52 per cent in spring 2021. However, this trend was more pronounced among some population sub-groups. In young adults (18-34 years) the proportion rating their mental health highly dropped from 51 per cent in fall 2020 to 33 per cent in spring 2021. </p>
<p>Understanding how to <a href="https://www.canada.ca/en/privy-council/campaigns/speech-throne/2020/stronger-resilient-canada.html">build back equitably</a> after the pandemic requires gathering the appropriate data and being responsive to the groups who were hardest hit by pandemic-related distress.</p>
<h2>Responding to an ‘echo pandemic’</h2>
<p>In the first year of the pandemic, as public health equity researchers, we anticipated a need for mental health data. Health-care leaders, policy-makers, politicians and members of the public would need access to rigorous data collected over time to monitor and respond to the mental health of groups that are unjustly disadvantaged by the pandemic in Canada.</p>
<p>The Canadian Mental Health Association has <a href="https://cmha.ca/wp-content/uploads/2021/07/EN_COVID-19-Policy-Brief.pdf">warned of an “echo pandemic”</a>: a wave of intensifying mental health concerns caused by pandemic-related stress, including uncertainty, social isolation, unemployment and loss of services.</p>
<figure class="align-center ">
<img alt="A group of friends of varying genders playing cards" src="https://images.theconversation.com/files/453245/original/file-20220321-27-yrhhud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453245/original/file-20220321-27-yrhhud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453245/original/file-20220321-27-yrhhud.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453245/original/file-20220321-27-yrhhud.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453245/original/file-20220321-27-yrhhud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453245/original/file-20220321-27-yrhhud.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453245/original/file-20220321-27-yrhhud.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pandemic’s impact on mental health has been felt disproportionally in marginalized people.</span>
<span class="attribution"><span class="source">(The Gender Spectrum Collection)</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>To better understand and track the differential effects of these pandemic realities, we established the <a href="https://www.bcammhe.ca/">B.C. Alliance for Monitoring Mental Health Equity</a>. Using a newly developed web platform, we host findings from 15+ research studies featuring data from British Columbia, and in some cases, complementary data from the rest of Canada and international locations. </p>
<p>We are committed to <a href="https://dx.doi.org/10.1177/00333549141291S203">reducing and ultimately eliminating avoidable differences</a> in mental health status by social positions and identities. For that reason, we prioritize research that centres socially defined population sub-groups such as those who are two-spirit, lesbian, gay, bisexual, transgender and queer (2S/LGBTQ), Indigenous, Black and people of colour, young or living in low-income households.</p>
<h2>Centring in the margins</h2>
<p>We are inspired by activist and writer bell hooks’s <a href="https://www.routledge.com/Yearning-Race-Gender-and-Cultural-Politics/hooks/p/book/9781138821750">call</a> to “center in the margins,” meaning to focus first on those who have experienced the greatest social marginalization. From several studies in <a href="https://doi.org/10.1016/j.psychres.2021.114327">Canada</a> and <a href="https://doi.org/10.1080/00918369.2020.1868182">elsewhere</a>, we now know that over the past two years, 2S/LGBTQ people have experienced a disproportionate worsening of mental health related to the pandemic. A similar growing disparity in mental health has been observed for those experiencing <a href="https://www.oecd.org/coronavirus/policy-responses/tackling-the-mental-health-impact-of-the-covid-19-crisis-an-integrated-whole-of-society-response-0ccafa0b/">personal financial strain</a> and those with <a href="https://doi.org/10.1016/j.ypmed.2020.106333">pre-existing mental health conditions</a>, or a combination of these factors.</p>
<p>A few common threads can help explain the disproportionate effect of the pandemic on these population sub-groups. </p>
<figure class="align-center ">
<img alt="Two people on a sofa playing video games laughing" src="https://images.theconversation.com/files/453249/original/file-20220321-19-5zb38n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453249/original/file-20220321-19-5zb38n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453249/original/file-20220321-19-5zb38n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453249/original/file-20220321-19-5zb38n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453249/original/file-20220321-19-5zb38n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453249/original/file-20220321-19-5zb38n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453249/original/file-20220321-19-5zb38n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pandemic limited the social connections that can provide a buffer against stress.</span>
<span class="attribution"><span class="source">(The Gender Spectrum Collection)</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>First, members of these groups may be particularly affected by social isolation. For example, before COVID-19, we knew that many 2S/LGBTQ people — who are <a href="https://doi.org/10.1093/eurpub/ckz185.141">less likely to be partnered</a>, more likely to be living alone — experienced <a href="https://highline.huffingtonpost.com/articles/en/gay-loneliness/">reduced social networks due to stigma and exclusion</a>. During the pandemic, these networks have <a href="https://psycnet.apa.org/doi/10.1037/sgd0000510">shrunk further</a>, limiting the social connections that can help buffer against pandemic-related stressors. </p>
<p>Second, the <a href="https://www.who.int/publications/i/item/978924012455">restrictions in access to in-person appointments</a> had a greater impact on those who routinely relied on mental health supports, including those with pre-existing mental illnesses. Before the pandemic, there was already a <a href="https://dx.doi.org/10.1016/S2215-0366(21)00199-1">large gap in access to adequate mental health care</a>. COVID-19-related service restrictions left those with chronic mental health conditions — who already experience significant stigma and discrimination — with <a href="https://doi.org/10.1016/j.apnu.2021.05.002">profound barriers to care</a>, often at the same time that their mental health symptoms were worsening.</p>
<h2>Building back equitably</h2>
<p>Working from the local, equity-informed data compiled by <a href="https://www.bcammhe.ca/about">members of the alliance</a>, we offer four urgent calls to action, with further recommendations available on <a href="https://www.bcammhe.ca/recommendations/">our website</a>. </p>
<ol>
<li><p>Improve funding and programs in accessible mental health services that are tailored to reduce barriers for equity-deserving groups. </p></li>
<li><p>Adopt a <a href="https://dx.doi.org/10.1016/S2215-0366(21)00199-1">population approach to mental health</a>, with the goal of improving mental health across populations. This approach would include promotion (to build contributors to positive mental health), as well as prevention to reduce mental ill health, and treatment for those with a mental health diagnosis.</p></li>
<li><p>Strengthen mental health screening and referral pathways in primary care settings (for example, family practitioners and walk-in clinics) and support rapid access to followup for those who need it.</p></li>
<li><p>Develop guidelines to support <a href="https://doi.org/10.1186/s12939-021-01484-5">digital mental health care </a> solutions such as web-based resources and virtual access to care providers. These solutions must be accessible, supported by evidence, and equity-oriented. </p></li>
</ol>
<p>Decisions that policy-makers make right now will determine how we, as a society, recover and build back mental health in the years to come. With <a href="https://doi.org/10.2105/ajph.2007.114777">equitable investments</a> in mental health promotion, prevention and treatment, we can redress unjust differences in our population’s mental health and work to ensure that good mental health is an achievable goal for all.</p><img src="https://counter.theconversation.com/content/177242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Travis Salway receives funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, Michael Smith Health Research BC, the BC SUPPORT Unit Fraser Centre, SFU's Community-Engaged Research Initiative, and Victoria Foundation (donation from Andrew Beckerman). </span></em></p><p class="fine-print"><em><span>Emily Jenkins, Hasina Samji, and Pierre-julien Coulaud do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The mental health impact of the pandemic has not affected everyone equally. An equitable approach to mental health promotion, prevention and treatment can help ensure equitable access to services.Travis Salway, Assistant Professor, Health Sciences, Simon Fraser UniversityEmily Jenkins, Professor of Nursing, University of British ColumbiaHasina Samji, Assistant Professor, Faculty of Health Sciences, Simon Fraser UniversityPierre-julien Coulaud, Post-doctoral research fellow, Department of Medicine, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1767892022-02-23T19:13:39Z2022-02-23T19:13:39ZMasks, RATs and clean air – how people with disability can protect themselves from COVID<figure><img src="https://images.theconversation.com/files/447695/original/file-20220222-28345-orcmh1.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-asian-daughter-wearing-surgical-face-1801763143">Shutterstock</a></span></figcaption></figure><p>People with disability bear a disproportionate burden of COVID <a href="https://www.medrxiv.org/content/10.1101/2021.02.08.21250525v1">infections</a>, <a href="https://www.bmj.com/content/374/bmj.n1592">serious disease</a> and <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00206-1/fulltext">death</a>. Every time a support worker enters their home, people with disability risk COVID exposure. </p>
<p>But while Australian states have evidence-based measures to reduce the spread of COVID in schools and hospitals – such as improving <a href="https://www2.education.vic.gov.au/pal/ventilation-air-purification/policy">ventilation</a>, mandating <a href="https://www.nsw.gov.au/covid-19/stay-safe/rules/face-mask-rules">masks</a>, and using rapid antigen tests to detect cases – few strategies exist to reduce transmission to people with disability in their homes.</p>
<p>Last Thursday, Australia’s disability royal commission released a “<a href="https://disability.royalcommission.gov.au/news-and-media/media-releases/disability-royal-commission-raises-serious-concerns-about-responses-omicron">statement of ongoing concern</a>” about how Omicron is impacting the health, safety and well-being of people with disability. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1494072645025157120"}"></div></p>
<p>So what do governments need to do to protect people with disability from COVID? And what can people with disability do to mitigate their risk in the meantime?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lets-heed-the-warnings-from-aged-care-we-must-act-now-to-avert-a-covid-19-crisis-in-disability-care-144669">Let's heed the warnings from aged care. We must act now to avert a COVID-19 crisis in disability care</a>
</strong>
</em>
</p>
<hr>
<h2>Free RATs and regular testing for disability workers</h2>
<p>When community prevalence of COVID is high, rapid antigen tests (RATs) are an <a href="https://theconversation.com/how-accurate-is-your-rat-3-scenarios-show-its-about-more-than-looking-for-lines-175515">important tool</a> to identify cases of COVID and prevent transmission. </p>
<p>But RATs are not freely available to all Australians with disability. And there is no clear advice about how RATs should be used by people with disability or support workers who enter their home. </p>
<p>While National Disability Insurance Scheme (NDIS) participants <a href="https://www.ndis.gov.au/news/7308-ndis-participants-can-use-plan-funds-claim-rapid-antigen-tests">can claim</a> the cost of RATs in their NDIS plans, they’re <a href="https://www.health.gov.au/news/ahppc-statement-on-rapid-antigen-testing-for-current-high-community-prevalence-environment">not currently recommended</a> for surveillance of workers, except those working in group homes. </p>
<p>But not all Australians with disability are on the NDIS. Nor are all people with disability on health care cards and <a href="https://www.servicesaustralia.gov.au/get-free-rapid-antigen-tests-rats-if-you-hold-concession-card">entitled to ten free RATs</a> every three months. </p>
<figure class="align-center ">
<img alt="Person takes RAT test out of a packet." src="https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.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">RATs should be free for people with disability and their support workers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/process-coronavirus-testing-examination-home-covid19-1816884032">Shutterstock</a></span>
</figcaption>
</figure>
<p>Given the risks of COVID and the high levels in the community, free RATs should be provided to all people with disability and support workers who come into their homes. </p>
<p>This should come with clear guidance on how frequently to test workers and other people who come into contact with a person with a disability.</p>
<p>In the absence of clear guidelines, support workers should test at least twice a week. But daily testing might be required where a worker is in contact with many people and when someone with a disability is at high risk of serious disease or death if they catch COVID.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-accurate-is-your-rat-3-scenarios-show-its-about-more-than-looking-for-lines-175515">How accurate is your RAT? 3 scenarios show it's about more than looking for lines</a>
</strong>
</em>
</p>
<hr>
<p>However some caution is needed. When there are high levels of community transmission, one negative RAT in someone with symptoms may well be a false negative. So someone with symptoms <a href="https://www.health.gov.au/sites/default/files/documents/2020/07/coronavirus-covid-19-guidance-for-people-tested-for-covid-19.pdf">should isolate</a> irrespective of the RAT result. </p>
<h2>Mandate N95 masks for disability workers</h2>
<p>Cloth and surgical masks are <a href="https://theconversation.com/time-to-upgrade-from-cloth-and-surgical-masks-to-respirators-your-questions-answered-174877">not enough</a> to prevent the spread of Omicron. </p>
<p>Respirators, also called N95, P2, FFP2 and KF94 masks, offer substantially better protection. Respirators <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258191">cut transmission 2.5 times as much as surgical masks</a>, even when they haven’t been professionally fit-tested. And there are <a href="https://www.youtube.com/watch?v=9hgZKABt9QM">good online videos</a> and <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/infectious+disease+control/coronavirus+disease+2019+information+for+health+professionals/infection+control+and+personal+protective+equipment+%28ppe%29+advice">infographics</a> to help people ensure their respirators have a good fit. </p>
<figure class="align-center ">
<img alt="Man wearing an N95 mask." src="https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Respirators should be well-fitted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-shown-wearing-protective-n95-white-1661460151">Shutterstock</a></span>
</figcaption>
</figure>
<p>Respirators can also be re-used, <a href="https://ozsage.org/wp-content/uploads/2022/01/We-urgently-need-better-masks-respirators-OzSAGE-text-only-31-January-2022.pdf">rotating daily over five days</a>, as independent scientific advisory group <a href="https://ozsage.org/wp-content/uploads/2022/01/We-urgently-need-better-masks-respirators-OzSAGE-text-only-31-January-2022.pdf">OzSAGE recommends</a>. </p>
<p>The United States government is <a href="https://www.nbcnews.com/politics/white-house/white-house-says-it-will-distribute-400-million-free-n95-n1287672?cid=sm_npd_ms_tw_ma">providing free respirators to the public</a>, yet Australian governments only recommend respirators in the disability sector when someone with disability is COVID-positive or a worker is a close contact. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/time-to-upgrade-from-cloth-and-surgical-masks-to-respirators-your-questions-answered-174877">Time to upgrade from cloth and surgical masks to respirators? Your questions answered</a>
</strong>
</em>
</p>
<hr>
<p>Given the obvious benefits, and relatively few downsides of respirators, it’s critical they are mandated for disability workers when supporting people with disability indoors. </p>
<p>In the absence of guidelines, people with disability should get workers to wear well-fitted respirators when they are supporting them indoors.</p>
<h2>Improving ventilation</h2>
<p>Good natural or mechanical ventilation can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189751/">reduce COVID transmission</a>. </p>
<p>This can involve simple measures such as opening doors and windows – preferably at the opposite ends of an indoor space to ensure a cross-breeze – and using ceiling fans or pedestal fans placed near a window. </p>
<p>Sometimes it’s not possible to open doors or windows because it’s too hot or cold, especially given some people with disability, such as those with <a href="https://pubmed.ncbi.nlm.nih.gov/30865188/">spinal cord injury</a> or <a href="https://www.tandfonline.com/doi/full/10.1080/23328940.2020.1769007">multiple sclerosis</a> have greater difficulties regulating their temperature. </p>
<p>Spaces like toilets, bathrooms, lifts, and stairwells are also hard to ventilate. </p>
<figure class="align-center ">
<img alt="Man opens window." src="https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.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">Opening a window can improve ventilation, but that’s not always possible.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-hand-opens-window-204104473">Shutterstock</a></span>
</figcaption>
</figure>
<p>You can check the quality of the air inside using <a href="https://journals.sagepub.com/doi/10.1177/1420326X211043564">CO2 monitors</a>. The concentration of CO2 is higher in areas that are poorly ventilated, while outside it’s around 400 ppm. If the level is <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/928720/S0789_EMG_Role_of_Ventilation_in_Controlling_SARS-CoV-2_Transmission.pdf">below 800 ppm</a>, the risk of infection is relatively low.</p>
<p>In situations where CO2 levels are high, a <a href="https://ozsage.org/media_releases/beware-the-air-you-share-ozsage-advice-on-safe-indoor-air-ventilation-for-australia-september-6th/">portable HEPA air purifier</a> could be used. The HEPA filter helps remove very small particles from the air, including the SARS-CoV-2 virus that causes COVID. They <a href="https://pursuit.unimelb.edu.au/articles/which-air-cleaners-work-best-to-remove-aerosols-that-contain-viruses">range in price</a> from A$200 to A$2,000.</p>
<p>CO2 monitors <a href="https://ozsage.org/media_releases/beware-the-air-you-share-ozsage-advice-on-safe-indoor-air-ventilation-for-australia-september-6th">vary in design and cost</a>, with prices starting from around A$50. </p>
<p>CO2 monitors and air purifiers should be available to people with disability requiring support in their own homes for free, potentially through NDIS plans. </p>
<p>In group settings, such as day programs and disability residential settings, services should be required to audit CO2 levels and purchase air purifiers if needed. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/an-investment-in-clean-indoor-air-would-do-more-than-help-us-fight-covid-it-would-help-us-concentrate-with-lasting-benefits-176547">An investment in clean indoor air would do more than help us fight COVID – it would help us concentrate, with lasting benefits</a>
</strong>
</em>
</p>
<hr>
<p>In the absence of clear guidance on ventilation, people with disability should make sure they have as good an airflow as possible and check their air conditioning and heating are working properly. </p>
<p>If they have the resources, they could purchase a CO2 monitor (or borrow one from someone) to check ventilation and where CO2 levels are high, consider an air purifier. </p>
<h2>Governments need to step up</h2>
<p>Nearly two years into the pandemic, it feels like Australians with disability are being forgotten. </p>
<p>Mandatory respirators, RATs for surveillance and cleaner air are relatively inexpensive strategies critical to protecting people with disability in their home. Governments should provide free of cost for all people with disability who need them, not only NDIS participants. </p>
<p>Governments must be proactive and have guidelines and resources in place as we face Omicron and in future, as new variants emerge.</p><img src="https://counter.theconversation.com/content/176789/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Kavanagh receives funding from the NHMRC, ARC, ANROWS, Suicide Prevention Australia, and the Commonwealth and Victorian governments. Anne Kavanagh is a member OzSAGE. </span></em></p><p class="fine-print"><em><span>Helen Dickinson receives funding from the NHMRC, ARC, Children and Young People with Disability Australia and Commonwealth and ACT governments.</span></em></p>While public health measures in schools and hospitals aim to reduce COVID transmission, people with disability who have support workers in their homes have largely been forgotten.Anne Kavanagh, Professor of Disability and Health, Melbourne School of Population and Global Health, The University of MelbourneHelen Dickinson, Professor, Public Service Research, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1750702022-01-24T14:24:31Z2022-01-24T14:24:31ZCOVID in South Africa shows the limits of using courts to fight political battles<figure><img src="https://images.theconversation.com/files/441085/original/file-20220117-15-1xpr70r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">President Cyril Ramaphosa declared a State of Disaster in March 2020.</span> <span class="attribution"><span class="source">GCIS/Flickr</span></span></figcaption></figure><p>The COVID-19 pandemic has changed many aspects of our daily lives. Some of these changes are immediately visible in the everyday wearing of face masks, in the bottles of hand sanitiser found on shop counters, and in the careful spacing of long queues. Others, though, are less obvious. They take place in the structures of the legal system that shapes our relationships to one another and to the state. </p>
<p>In the recent past, as I’ve argued in my book, <a href="https://jacana.co.za/product/south-africas-insurgent-citizens-on-dissent-and-the-possibility-of-politics/">South Africa’s Insurgent Citizens</a> the post-apartheid constitution’s emphasis on the need for state action to be both rational (in the legal sense) and grounded in the fundamentals of the <a href="https://www.justice.gov.za/legislation/constitution/SAConstitution-web-eng-02.pdf">Bill of Rights</a>, has meant that the law and legal activism have become political tools. These tools have often been used by poor communities and civil society bodies to pursue their goals. Attempts such as these to pursue political ends through legal means have been described as <a href="https://projects.iq.harvard.edu/johncomaroff/john-comaroff-explains-lawfare">“lawfare”</a>, and have become common in South Africa.</p>
<p>In the current pandemic, this history of “lawfare” has inspired a new series of legal challenges to the new legal rules and structures that govern the country. </p>
<p>The mechanism through which these new rules are implemented is the <a href="https://www.gov.za/documents/disaster-management-act">Disaster Management Act of 2002</a>. This Act enables the President and the executive to declare a national state of disaster and – so long as the disaster persists – to bypass some of the legal constraints ordinarily placed on the exercise of government powers.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/making-economic-policy-in-south-africa-in-hard-times-the-role-of-human-rights-167409">Making economic policy in South Africa in hard times: the role of human rights</a>
</strong>
</em>
</p>
<hr>
<p>The Act gives the President the power to govern by making regulations that then have legal and binding force on the nation. The President can do so without following the slow processes of passing new legislation.</p>
<p>On 15 March 2020, following the President’s lead, the Minister of Cooperative Government and Traditional Affairs <a href="https://www.gov.za/sites/default/files/gcis_document/202003/43096gon313.pdf">declared</a> such a state of disaster and, shortly afterwards, published <a href="https://www.gov.za/sites/default/files/gcis_document/202003/4314825-3cogta.pdf">the first of several sets of regulations</a>. These regulations established the framework within which South Africa has since been governed. </p>
<p>They were almost immediately challenged in the country’s courts.</p>
<p>These challenges took several forms. Some of the first cases disputed <a href="https://www.hbrfoundation.org.za/img/10.pdf">the legality of the initial declaration</a>, while others questioned specific aspects of the new regulations – such as the decision to ban the sale of alcohol, or the sale of tobacco.</p>
<p>I wrote about these challenges in a recent paper in the <a href="https://www.tandfonline.com/doi/abs/10.1080/02587203.2021.1987156?journalCode=rjhr20">South African Journal on Human Rights</a>, and considered what the successes and failures of these cases might mean for civil society politics during the COVID-19 pandemic. In essence, I argued that the relative failure of these cases has shown the limits of “lawfare” as a political strategy in the context of a widely-recognised disaster. In a time of uncertainty, the courts are more likely to give the executive branch of the state more discretion, reducing the possibility of public oversight of its actions.</p>
<h2>COVID-19 response and lawfare</h2>
<p>In the first six months after the declaration of a state of disaster, a wide range of civil society organisations and political parties challenged the legality of the declaration itself, of the regulations that governed trade, and human movement through curfews and restrictions on national travel.</p>
<p>Although some of these challenges achieved limited success in the courts, the majority failed. The courts proved themselves reluctant to interfere in the exercise of the executive’s power to promulgate and enforce regulations in terms of the Act. In doing so, the courts tacitly accepted that standards of judicial oversight that mark the separation of powers in ordinary times might not be appropriate during the exceptional circumstances of a state of disaster.</p>
<p>It is tempting to explain at least part of this trend by reference to the inept way in which some of the early challenges were argued. The very <a href="https://www.hbrfoundation.org.za/img/10.pdf">first case</a>, for example, argued that the state of disaster should not have been declared because</p>
<blockquote>
<p>COVID-19 … cannot be harmful to Africans.</p>
</blockquote>
<p>But comparable statements were also made in another case - <a href="http://www.saflii.org/cgi-bin/disp.pl?file=za/cases/ZAGPPHC/2020/184.html&query=de%20beer%20liberty%20fighters">De Beer v Minister of Cooperative Affairs</a> that was partially successful. In this case, the <a href="https://www.libertyfighters.co.za/">“Liberty Fighters Network”</a>, a relatively-unknown civil society organisation, argued that the President should not have declared a state of disaster to respond to COVID-19 because a number of other serious diseases were already endemic in South Africa. </p>
<p>The successes and failures of this case – and other cases – revolved around the standard of legal rationality that could be required of the government. The applicants were successful because the judge held that each of the specific regulations had to be justified as ‘rational’ – and that he could therefore strike down isolated aspects of the regulations piecemeal.</p>
<p>But in the majority of the other cases the executive was held to a different standard: most other judges were reluctant to pick apart the threads of the regulations to determine the individual rationality of each one. Instead, they held that the regulations ought to be examined as a whole. If the entire scheme was rationally connected to the purpose of containing and managing the COVID-19 disaster, then the regulations would withstand scrutiny as a whole.</p>
<h2>The limits of lawfare</h2>
<p>Although the De Beer judgment received a great deal of press attention at the time, the standard it applied did not persist. It is the other standard – of overall rather than specific rationality – that went on the shape the jurisprudence. And it is the regular use of this standard that best explains the failures of pandemic “lawfare”.</p>
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Read more:
<a href="https://theconversation.com/what-covid-19-reveals-about-ghanas-justice-system-and-what-needs-to-change-134809">What COVID-19 reveals about Ghana's justice system and what needs to change</a>
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<p>It is obvious that it is much harder to argue that the entire fabric of the regulations is wholly irrational than it is to argue that a specific thread within that fabric – the decision to ban the sale of alcohol, for example – should not have been taken. </p>
<p>It is thus unsurprising that the prospects of “lawfare” by civil society organisations during the first six months of the disaster were bleak. And in the almost 18 months since, little has happened to change that assessment. </p>
<p>Indeed, the willingness of the executive to pre-empt criticism by amending the regulations has arguably strengthened its position. The overall rationality of the links between the regulations, their amendment, and the changing events of the pandemic seems clear – even if a court might be persuaded to doubt the logic of a specific ban or requirement. The regulations are almost immune to challenge.</p>
<p>Overall, this has meant a reduction in the effectiveness of civil society politics. Even as many of the physical spaces in which public gatherings and activism could take place were being closed, the grounds on which organisations could challenge the legal regimes under which South Africa is governed were being steadily narrowed.</p>
<p>I do not know how this will affect the ways in which politics will continue to develop once the pandemic ends. But I think it is fair to suggest that the past two years have shown the limits of “lawfare” as a political tool in this context.</p><img src="https://counter.theconversation.com/content/175070/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Brown does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The willingness of the executive to pre-empt criticism by amending COVID regulations has arguably strengthened its position.Julian Brown, Associate Professor of Political Studies, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1746552022-01-11T13:28:36Z2022-01-11T13:28:36ZNovak Djokovic: the legal problem of having one rule for some, another for everyone else<p>Since the start of the pandemic, anyone wishing to enter Australia has had to contend with one of the strictest immigration and quarantine regimes in the world. While requirements have been loosened for vaccinated visa-holders, tough rules remain in place for the unvaccinated. </p>
<p>Naturally, Australian residents and others around the world were surprised when unvaccinated tennis star Novak Djokovic <a href="https://www.instagram.com/p/CYTe9fer_1K/?utm_source=ig_web_copy_link">announced</a> that he was travelling to Melbourne to defend his Australian Open title, having been exempted from quarantine requirements.</p>
<p>The <a href="https://www.theguardian.com/sport/2022/jan/04/novak-djokovic-secures-medical-exemption-to-play-in-australian-open-tennis">exemption granted to Djokovic</a> looked to many like the rules were being bent for the benefit of the rich and powerful in a way that wouldn’t have happened for an ordinary citizen. The virus hasn’t given him a free pass for being a high-profile tennis player – so why should immigration authorities? </p>
<p>While at the time of writing, the outcome of Djokovic’s visa troubles was uncertain, the double standard of rules raises a much bigger question about the philosophy of law: can the application of a rule be so unfair that we have no valid reason to follow it?</p>
<p>The issue of “one rule for them and another for the rest of us” raises its head frequently. Throughout the pandemic in the UK, the rich and powerful have claimed – often unbelievably – that their actions were permitted by rules that restricted the rest of us. Consider Dominic Cummings’ claim that his 50-mile round trip from Durham to Barnard Castle was a <a href="https://www.chroniclelive.co.uk/news/north-east-news/dominic-cummings-insists-driving-barnard-20683836">“local journey”</a>, or Downing Street officials’ assertions that their late night cheese and wine gatherings were <a href="https://www.bbc.co.uk/news/uk-politics-59577129">not parties, but work meetings</a>. </p>
<p>The consequences of a system where one rule appears to apply to a select few, and another to everyone else, were warned of by legal philosopher <a href="https://www.britannica.com/biography/Gustav-Radbruch">Gustav Radbruch</a>. Given his service as German minister of justice during the Weimar Republic and later, as a respected legal academic, we would do well to draw from his views on how the law is made and upheld.</p>
<p>Radbruch suggested that a rule that does not treat like cases alike could be so unjust that it undermines the stability of the entire legal system. If the wider population thinks that a person is exempted from a rule for no good reason, everyone else would (rightfully) question the point of the rule. They may ask why they should continue to follow it – if enough people do this, the reason for having the rule in the first place disappears completely. </p>
<p>The <a href="https://news.sky.com/story/coronavirus-how-dominic-cummings-trip-to-durham-damaged-trust-in-the-government-12044015">real drop</a> in public adherence to COVID guidelines following Cummings’ trip to Barnard Castle is a good example of exactly this.</p>
<p>This phenomenon is not only damaging for the rule in question, but for the system as a whole. If citizens lack confidence in an individual rule, they may be more sceptical of other rules and refuse to follow them too. Before we know it, we may reach a critical mass where there is so much uncertainty about which rules ought to be followed at all that society will become ungovernable. </p>
<p>Radbruch <a href="https://www.jstor.org/stable/3600538">concludes</a> that a rule that doesn’t treat like cases alike can’t be a law at all. This is because a key requirement of a legal system is that it needs to be stable, which means that people need to know what the law is and when it applies. If a rule doesn’t treat everyone equally, then it does the opposite and increases doubt and uncertainty about what the law even is. And if enough rules exist that create uncertainty about what the law is and when it applies, the system will collapse. A rule that undermines a legal system in this way can’t really be law at all, and legal officials shouldn’t create or uphold them. </p>
<h2>Send him home</h2>
<p>Radbruch would probably conclude that Djokovic’s exemption to Australia’s vaccination requirement was illegitimate and should be rejected. Treating like cases alike requires that we ask only whether Djokovic is vaccinated – he is not, so the government would be right to withdraw his visa. </p>
<p>Djokovic fans might claim that his recent COVID infection means his immunity is equivalent to vaccination and that this should be enough, but regardless of these details, the perception is clearly that Djokovic was treated differently from other visitors. Therefore, the validity of the rule is questionable.</p>
<p>The fact that the Djokovic case has been so ambiguous means we can’t fully understand what the law even is. The stability of our legal system depends on those who make the rules being transparent about those rules – and the reasons behind any exemptions.</p>
<p>COVID restrictions are already being questioned, and Djokovic’s situation deteriorates them further. <a href="https://www.ucl.ac.uk/epidemiology-health-care/news/2021/jan/opinion-people-started-breaking-covid-rules-when-they-saw-those-privilege-ignore-them">Studies from almost a year ago show</a> that people already began to break COVID rules when they saw more privileged people getting away with flouting them. It is likely that this disillusionment will only increase as people’s patience wears thin.</p><img src="https://counter.theconversation.com/content/174655/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joshua Jowitt 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>From tennis players to government officials, double standards in law have big-picture consequences.Joshua Jowitt, Lecturer in Law, Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1736822021-12-14T19:14:54Z2021-12-14T19:14:54ZConservative MP rebellion: ‘human rights’ opposition to new COVID measures doesn’t add up<p>The UK government’s introduction of new restrictions to deal with the “<a href="https://www.bbc.co.uk/news/av/uk-59631541">omicron emergency</a>” has prompted backlash from some politicians. When the changes were put to the House of Commons, 99 Tory MPs voted against the plans. Several expressed concern over the impact measures such as having to show proof of vaccination to enter certain venues would have on people’s “civil liberties”. They have essentially been invoking human rights arguments to oppose pandemic emergency powers. However, their opposition is based on a misguided and libertarian understanding of the nature of human rights. </p>
<p>Such libertarian opposition to the new restrictions can be seen from some MPs’ recent commentary. Conservative MP Steve Baker, who is in the Covid Recovery Group and a vocal backbencher, <a href="https://www.france24.com/en/live-news/20211214-uk-s-johnson-faces-angry-mps-at-vote-on-new-virus-curbs">accused Prime Minister Boris Johnson</a> of creating a “miserable dystopia” by bringing back rules on face masks and testing and introducing vaccine passes.</p>
<p>Libertarians essentially argue that human rights prevent the state from acting or interfering with your freedom. Any interference to which you do not consent is an act of aggression and is therefore illegitimate. In my book <a href="https://bristoluniversitypress.co.uk/emergency-powers-in-a-time-of-pandemic">Emergency Powers in a Time of Pandemic</a>, I argue that libertarian understandings of rights as only restricting the power of the state are inappropriate for dealing with a pandemic. </p>
<p>On the face of it, human rights such as those in the <a href="https://www.echr.coe.int/documents/convention_eng.pdf">European Convention on Human Rights</a> and incorporated into British law by the Human Rights Act 1998 appear to require non-intervention by the state. Everyone has the right to life, everybody has the right to liberty, everybody has the right to privacy, everybody has the right to freedom of expression. Essentially, the state should just leave people alone.</p>
<p>A pandemic, however, actually requires states to be more active, taking positive steps to protect human rights. </p>
<p>For example, the right to life enshrined in Article 2 of the European Convention on Human Rights does not simply require states to refrain from taking people’s lives, it also requires states to protect people from <a href="https://hudoc.echr.coe.int/fre?i=001-58257">“real and immediate risks”</a>. Likewise, the state must spend resources and implement measures to ensure that conditions in state-run institutions (like hospitals and prisons) do not deteriorate to the level that they infringe on people’s rights to humane treatment.</p>
<p>If MPs truly want to protect people’s rights, they should be in favour of a robust pandemic response. A person cannot exercise their other rights if their right to life is not protected. A human rights law limiting the state’s ability to protect people from a deadly threat would not be of much value. Rather than conceiving of human rights law as simply stipulating non-intervention by a state, the key to the success of the human rights movement is its ability empower or “emancipate” people. This places strong obligations on states to protect and vindicate people’s rights. </p>
<h2>Whose rights matter?</h2>
<p>At the time of the vote, over <a href="https://coronavirus.data.gov.uk/">800 people</a> had died within the past seven days from COVID-19. While these numbers appear relatively low when compared with <a href="https://www.theguardian.com/world/2021/jan/20/uk-reports-1820-covid-deaths-in-record-daily-high">the height of the pandemic</a>, they are significantly higher than the deaths caused by other threats that have prompted the British state to enact draconian powers. From April 2003 to March 2020, for example, <a href="https://researchbriefings.files.parliament.uk/documents/CBP-7613/CBP-7613.pdf">95 people were killed</a> in terrorist-related incidents in England and Wales. </p>
<p>It is striking that, while they are opposing new COVID-19 restrictions on a civil liberties basis, MPs are reluctant to voice concerns over other legislation that clearly infringes on human rights. On the very same day as the vote, the government proposed <a href="https://www.gov.uk/government/news/plan-to-reform-human-rights-act">striking changes to the 1998 Human Rights Act</a>, including restricting the right to family life to make it easier to deport people. </p>
<p>Conservative MPs also recently voted through legislation allowing the home secretary to strip people of their British citizenship <a href="https://theconversation.com/stripping-british-citizenship-the-governments-new-bill-explained-173547">without notice</a>, and substantially curtailing <a href="https://www.theguardian.com/commentisfree/2021/dec/01/imprisoned-51-weeks-protesting-britain-police-state">the right of people to protest</a> —- a fundamental right in any democracy. </p>
<p>At best, this is inconsistency. At worst, it is rank hypocrisy.</p>
<p>The reason for this can be boiled down to an “us v. them” mindset. Ultimately, it is the idea that most of “us” – “ordinary”, law-abiding people – will feel that counterterrorist powers do not affect us, or that we ourselves are not at risk of being deported. Instead, we view these kinds of human rights restrictions as only impacting the rights of the “other” -— the terrorist, the undeserving. In contrast, the effects of COVID emergency powers apply to everyone.</p>
<p>While this distinction explains opposition to some rights restrictions but not others, it cannot justify this inconsistency. This idea of those deserving versus those undeserving of civil liberties has no place in human rights. We have rights by virtue of the fact that we are human, not simply because we are good citizens.</p><img src="https://counter.theconversation.com/content/173682/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alan Greene does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The revolt over new restrictions comes in stark contrast to support of other draconian laws.Alan Greene, Reader in Constitutional Law and Human Rights, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1726252021-11-30T04:42:27Z2021-11-30T04:42:27ZWe shouldn’t lift all COVID public health measures until kids are vaccinated. Here’s why<figure><img src="https://images.theconversation.com/files/434355/original/file-20211129-21-100ukyv.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/woman-doctor-putting-medical-plaster-girl-1921268393">Shutterstock</a></span></figcaption></figure><p>Australia’s vaccination rollout got off to a slow start, but we’ve since become one of the most vaccinated countries in the world. More than <a href="https://www.health.gov.au/sites/default/files/documents/2021/11/covid-19-vaccine-rollout-update-28-november-2021.pdf">86% of Australians aged over 16</a> have received two doses, and 75% of adolescents have had their first dose. This is a fantastic achievement, but younger children are missing from this picture.</p>
<p>The majority of parents <a href="https://www.theage.com.au/politics/federal/two-thirds-of-australians-want-all-kids-aged-5-11-to-have-the-jab-but-parents-more-cautious-20211125-p59c51.html">want to vaccinate their children</a>. But kids aren’t yet eligible for vaccination in Australia, despite vaccines being <a href="https://www.cbc.ca/news/canada/ottawa/what-to-know-about-childern-vaccine-1.6262471">approved for children</a> overseas.</p>
<p>It’s therefore not surprising schools have become a major driver of community transmission, with unvaccinated children making up <a href="https://www.smh.com.au/national/nsw/crunch-time-what-do-expect-from-sydney-s-delta-wave-over-summer-20211122-p59b4w.html">about one-third of recent cases</a> in New South Wales. </p>
<p>Despite this, some state governments plan to further dismantle public health measures keeping the virus in check. In NSW, this will include <a href="https://www.abc.net.au/news/2021-11-25/nsw-updates-roadmap-95-percent-double-dose-vaccination/100649860">scrapping mandatory mask rules</a>. </p>
<p>It’s not the right time to do this while our children remain unprotected. </p>
<p>Additionally, the emergence of the <a href="https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern">Omicron variant</a>, which might be more transmissible and reduce the effectiveness of our vaccines, shows Australia needs to take a much more <a href="https://ozsage.org/media_releases/reduce-the-risk-of-lockdowns-during-the-holiday-season/">cautious approach</a> to easing restrictions.</p>
<h2>COVID is not always a mild illness for kids</h2>
<p>Adults are much more likely to experience serious illness than children, but kids are still at risk.</p>
<p>During the first year of the pandemic, it’s estimated that approximately <a href="https://www.science.org/action/downloadSupplement?doi=10.1126%2Fscitranslmed.abg4262&file=abg4262_sm.pdf">one in every 400 children</a> in the United Kingdom who got infected became sick enough to need to go to hospital, and between <a href="https://www.nature.com/articles/s41591-021-01578-1">one in 20,000</a> and <a href="https://link.springer.com/article/10.1007/s10654-020-00698-1">one in 50,000</a> infections were fatal.</p>
<figure class="align-center ">
<img alt="Hospital emergency department entrance." src="https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.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">A small proportion of kids with COVID need to be treated in hospital.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/main-entrance-modern-hospital-building-signs-361382480">Shutterstock.</a></span>
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<p>These figures represent the <em>infection hospitalisation rate</em> and the <em>infection fatality rate</em>, and they capture the full toll of the virus, because they are based on all infections, including the asymptomatic ones that don’t get detected.</p>
<p>However, these estimates pre-date the emergence of the Delta variant, which <a href="https://www1.racgp.org.au/newsgp/clinical/study-suggests-delta-more-than-doubles-death-risk">causes more severe illness</a>. Preliminary evidence from Canada suggests the Delta variant is <a href="https://www.medrxiv.org/content/10.1101/2021.09.25.21264097v1">2.5 times more likely</a> to lead to hospitalisation in children.</p>
<p>This year in Australia, <a href="https://doi.org/10.33321/cdi.2021.45.62">2% of detected cases</a> in children aged 5-11 years resulted in hospitalisation, although some of these were for social reasons. These include cases in which parents were hospitalised with COVID and were temporarily unable to care for their children.</p>
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Read more:
<a href="https://theconversation.com/no-we-cant-treat-covid-19-like-the-flu-we-have-to-consider-the-lasting-health-problems-it-causes-164072">No, we can’t treat COVID-19 like the flu. We have to consider the lasting health problems it causes</a>
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<p>Kids can also be left with persistent symptoms (long COVID) after infection. It’s unclear how often this occurs, but in the UK, <a href="https://www.ons.gov.uk/releases/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk4november2021">an estimated 3,000 children</a> have been living with self-reported long COVID for at least one year.</p>
<h2>How many children are at risk in Australia?</h2>
<p>Because the virus that causes COVID is so contagious, almost everyone will get infected eventually if they aren’t vaccinated. </p>
<p>Even though only a small proportion of cases in children are severe, we can still expect a large number of children to get seriously unwell because there will be so many infections.</p>
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<img alt="Mother takes her sick child's temperature." src="https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&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">More infections means more kids will become severely unwell.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-checking-temperature-sick-daughter-250485763">Shutterstock</a></span>
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<p>There are 3.8 million children in Australia. If we didn’t offer them a chance to get vaccinated, based on the estimated severity of the original strain, we could eventually expect around 9,000 children to be hospitalised and 76 to 191 deaths. If we do these same calculations for the Delta variant, there could be approximately 22,000 hospitalisations in children.</p>
<p>The period over which this occurred would depend on the number of public health measures kept in place. COVID spread rapidly through schools in England after restrictions were lifted. By mid-October, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/22october2021">8% of high school students and 4% of younger children</a> were testing positive.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-cases-rise-when-schools-open-but-more-so-when-teachers-and-students-dont-wear-masks-169928">COVID-19 cases rise when schools open – but more so when teachers and students don't wear masks</a>
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<p>This year in Australia, <a href="https://doi.org/10.33321/cdi.2021.45.62">13 children and 22 adolescents</a> have been admitted to an intensive care unit for COVID (and many more to a general hospital ward), and <a href="https://www.sbs.com.au/news/a-victorian-child-under-10-has-become-australia-s-youngest-person-to-die-with-covid-19/90af458d-1f32-45de-bdfb-9e9a6d750598">one child</a> and <a href="https://www.abc.net.au/news/2021-10-16/victoria-covid-cases-deaths-lockdown-saturday/100544548">one teenager</a> died.</p>
<p>It’s unclear how many children could develop long COVID, but England’s National Health Service has had to open <a href="https://www.england.nhs.uk/2021/06/nhs-sets-up-specialist-young-peoples-services-in-100-million-long-covid-care-expansion/">15 long COVID clinics for children</a>.</p>
<h2>How does COVID compare to other diseases?</h2>
<p>COVID is more risky for children than some other diseases that we already vaccinate against. </p>
<p>Today, children are routinely vaccinated against varicella (chickenpox) in Australia. Prior to the introduction of the vaccine, there were around <a href="https://www.ombo.nsw.gov.au/__data/assets/pdf_file/0019/39412/NCIRS-child-deaths-from-infectious-diseases-report-2016-NSW-Ombudsman-final-1.pdf">five to eight deaths per year</a> from this disease.</p>
<p>COVID also <a href="https://www.thelancet.com/article/S2213-2600(20)30527-0/fulltext">poses a bigger risk to children than influenza</a>. During the 2009 <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2010.01912.x">H1N1 (swine flu) influenza pandemic</a>, more than 1,000 children were hospitalised and 11 died.</p>
<p>It’s statistics like these that were behind the United States’ Centers for Disease Control and Prevention’s decision to <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-11-2-3/08-COVID-Oliver-508.pdf">recommend COVID vaccination for children</a>.</p>
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<a href="https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.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 is more dangerous for children than some diseases we already vaccinate against.</span>
<span class="attribution"><span class="source">CDC</span></span>
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<h2>How can we keep children safe?</h2>
<p>Australia should follow the lead of countries that have already started to vaccinate children against COVID, such as the United States and Canada. However this is unlikely to happen <a href="https://www.smh.com.au/politics/federal/jabs-for-under-12s-won-t-start-until-january-covid-commander-says-20211112-p598do.html">until mid-to-late January next year</a>.</p>
<p>This delay means public health measures will be vital to keep COVID under control in the community. As the experience of England has shown, <a href="https://www.gov.uk/government/news/four-in-five-people-aged-16-and-over-vaccinated-with-both-doses">high adult vaccination levels</a> aren’t sufficient to protect children and prevent the virus from spreading in schools.</p>
<p>States that have planned to <a href="https://www.nsw.gov.au/covid-19/easing-covid-19-restrictions/opening-in-dec">further ease restrictions</a> should pause those plans until children have had the chance to be vaccinated.</p>
<p>We also need to do more to protect our schools. COVID is an <a href="https://onlinelibrary.wiley.com/doi/10.5694/mja2.51131">airborne disease</a>, meaning the virus drifts through the air like cigarette smoke. Masks and ventilation can help protect us, but ventilation involves much more than just opening a window.</p>
<figure class="align-center ">
<img alt="Children wearing masks in a classroom with their teacher." src="https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Masks and ventilation can help protect children now.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-international-caucasian-asian-students-teacher-1814892260">Shutterstock</a></span>
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<p>As the OzSAGE independent scientific advisory group explains, we need a <a href="https://ozsage.org/media_releases/protecting-children-from-covid-19-and-making-schools-and-childcare-safer/">comprehensive package of measures</a>, including the use of HEPA air cleaners, to keep our schools safe.</p>
<p>Even after all of Australia’s children have had the chance to be vaccinated, we’ll <a href="https://theconversation.com/covid-doesnt-need-to-run-rampant-here-are-6-ways-to-keep-cases-low-in-the-next-year-170207">need to keep</a> some basic public health measures, such as improved ventilation, in place.</p>
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Read more:
<a href="https://theconversation.com/covid-doesnt-need-to-run-rampant-here-are-6-ways-to-keep-cases-low-in-the-next-year-170207">COVID doesn't need to run rampant. Here are 6 ways to keep cases low in the next year</a>
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<p>COVID vaccines are very effective at preventing severe disease, but they’re not perfect and don’t completely prevent transmission. Their effectiveness may also diminish in the face of new variants of the virus.</p>
<p>As the sudden emergence of the <a href="https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern">Omicron variant</a> has shown, the pandemic won’t end until global vaccination levels are much higher. Australia can do our bit by vaccinating as much of our population as possible, while also <a href="https://endcovidforall.com/">donating vaccines and manufacturing technology</a> to developing countries in the region.</p><img src="https://counter.theconversation.com/content/172625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Zoë Hyde is a member of the OzSAGE independent scientific advisory group.</span></em></p>The delay in vaccinating children means public health measures will be vital in keeping COVID under control in the community.Zoë Hyde, Research Fellow, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1720482021-11-19T01:06:15Z2021-11-19T01:06:15Z9 ways to support your teen’s mental health as restrictions ease<figure><img src="https://images.theconversation.com/files/432548/original/file-20211118-24-g6fx8c.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/mixed-race-african-american-biracial-teenager-1907943571">Shutterstock</a></span></figcaption></figure><p>Headlines about the <a href="https://www.aihw.gov.au/reports/children-youth/covid-19-and-young-people">impact of the pandemic on youth mental health</a> have left many parents worried about their children and unsure what they can do to help. </p>
<p>Now, as restrictions are eased – and school, home and social lives return to something resembling normal – young people are having to make significant adjustments as they face new pressures. </p>
<p>Parents need clear, evidence-based, practical strategies to support their teen’s mental health. But this can be hard to find.</p>
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Read more:
<a href="https://theconversation.com/treating-a-childs-mental-illness-sometimes-means-getting-the-whole-family-involved-169729">Treating a child's mental illness sometimes means getting the whole family involved</a>
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<p>To fill this gap, our yet-to-be-published study asked 35 international experts (researchers, health professionals and parent advocates) what parents can do to support their teenager’s mental health during the pandemic. </p>
<p>Here are their nine key tips:</p>
<h2>1. Parents, look after yourselves</h2>
<p>While parents’ natural instincts are to be concerned about their children (and possibly ageing parents), looking after your own needs will put you in a better position to support those you care about.</p>
<h2>2. Keep the conversation open</h2>
<p>Constantly changing local regulations and restrictions, and rules around reopening, can make teens more anxious. </p>
<p>Help your teen feel more in control by providing them with clear, up-to-date and age-appropriate information about the pandemic and restrictions when the situation changes. </p>
<p>Teenagers are likely to seek answers from their peers, online, and from social media. Help your teen get information from reliable and credible sources, such as government websites or the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports">World Health Organization</a>. </p>
<p>Talking about the pandemic and easing of restrictions can help them understand and cope with what they’re hearing. </p>
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<img alt="Father and daughter look at a laptop together." src="https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.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">Direct your teen to reliable information.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-indian-father-helping-school-child-1951471369">Shutterstock</a></span>
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<h2>3. Support teens to follow the local rules and restrictions</h2>
<p>Be a good role model by following the local regulations and restrictions yourself. </p>
<p>Model flexibility and problem-solving by showing your teen how you adjust your daily life in response to changing regulations and restrictions.</p>
<h2>4. Accept your teen’s emotions</h2>
<p>It’s normal for teens to feel a wide range of strong emotions at different points during the pandemic: angry, scared, sad, frustrated, grief, worried, bored, confused, isolated, concerned. </p>
<p>You can help your teen cope with these by: </p>
<p><strong>Asking and listening</strong>. Ask how they’re feeling and coping, especially as the situation changes. When they open up, focus on listening – what they need most is empathy, compassion and comfort. </p>
<p><strong>Showing them how you do it</strong>. Teens look to their parents to see how to respond and how worried they should be. Try to set a good example by appearing as calm as you can, and using healthy coping strategies yourself. </p>
<p><strong>Being patient</strong>, perhaps more than usual. </p>
<p><strong>Being reassuring but realistic</strong>. Despite negative news they may be hearing, teens need their parents’ reassurance their family will get through the pandemic together and things will improve over time. But be careful not to make unrealistic promises.</p>
<p><strong>Monitoring</strong>. Keep an eye on your teen’s stress levels – look for changes in their behaviour, health and how they’re thinking and feeling. Encourage them to do things that have helped them cope with stressful times in the past.</p>
<h2>5. Help your teen work out what they can and can’t control</h2>
<p>Encourage them to focus on what they can control. For example, young people can control their own COVID-safe behaviours (such as wearing masks and following local restrictions), but need to accept they can’t control the behaviour of others.</p>
<p>Model helpful ways of dealing with uncertainty by showing them how you accept what is outside your control and focus your effort on things you can control. </p>
<p>Show appreciation for their efforts to adjust to pandemic challenges, big or small. </p>
<h2>6. Provide support as needed</h2>
<p>The ongoing uncertainties during the pandemic can affect teens many months after local restrictions have eased. </p>
<p>So be prepared to provide ongoing emotional support as needed, rather than assume all will be well because life is “back to normal”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-in-4-people-with-a-mental-illness-develop-symptoms-before-age-25-we-need-a-stronger-focus-on-prevention-126180">3 in 4 people with a mental illness develop symptoms before age 25. We need a stronger focus on prevention</a>
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<h2>7. Establish routines</h2>
<p>Routines help teens feel more organised, in control, safe and secure and less stressed – this can help protect their mental health. </p>
<p>Ensure your teen’s routine includes set times for homework, meals and snacks, physical activity, free time for fun and relaxation, and time for socialising. </p>
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<img alt="Four older teens in masks look down at a notebook." src="https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.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">Make sure your teen has time for fun and socialising.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-young-people-meeting-outdoors-wearing-1838916244">Shutterstock</a></span>
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<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079221000149">Regular sleep routines</a> are also important. This means having a regular bed time and wake time, and minimising the use of electronic devices before bed. Review and adjust this routine with your teen as needed, such as when local restrictions change.</p>
<h2>8. Adjust your expectations</h2>
<p>With the changes and uncertainty caused by the pandemic, you may need to adjust some expectations of your teenager and of yourself. Focus on emotional and physical well-being rather than perfection or high productivity. </p>
<p>Try to practice self-compassion and forgiveness towards your teen and yourself if either of you don’t meet your expectations.</p>
<h2>9. Look for silver linings</h2>
<p>Try to convey a sense of confidence to your teen that things will improve over time. Encourage any optimism or hope your teen shows. </p>
<p>Showing compassion, empathy and kindness to others can also benefit your teen. It can help them gain perspective, give a sense of achievement and pride, and give opportunities for social interaction. Encourage your teen to take up opportunities to help others when they can. </p>
<h2>When to get help</h2>
<p>Seek professional mental health support if your teen has major difficulties adjusting to challenges of the pandemic or reopening, or you are struggling with your own mental health. </p>
<p>Some signs you or your teen might need professional support include changes in mood or behaviour that impact school, work or relationships, withdrawal from friends or family, intense distress, and problems that don’t seem to be improving with time. </p>
<p>Remember, by seeking support for yourself when needed, you are also setting a good example for your teen.</p>
<p>For more helpful tips, see the <a href="https://www.parentingstrategies.net/">Parenting Strategies</a> website. Parents across Australia can also access the evidence-based <a href="https://partnersinparenting.com.au/">Partners in Parenting</a> online program for free. </p>
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<strong>
Read more:
<a href="https://theconversation.com/anorexia-spiked-during-the-pandemic-as-adolescents-felt-the-impact-of-covid-restrictions-169466">Anorexia spiked during the pandemic, as adolescents felt the impact of COVID restrictions</a>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/172048/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie Yap receives funding from the Department of Health, National Health and Medical Research Council, and Suicide Prevention Australia. She is a member of the Parenting and Family Research Alliance, Treasurer for the Alliance for the Prevention of Mental Disorders, Deputy Editor of Mental Health & Prevention, and co-chair of the Scientific Committee and member of the Steering Committee of Growing Minds Australia. </span></em></p><p class="fine-print"><em><span>Anthony Jorm receives funding from the National Health and Medical Research Council. He is a member of the Board of Mental Health First Aid International, Chair of the Scientific Advisory Committee of Prevention United, Editor-in-Chief of Mental Health & Prevention and a member of the Association for Psychological Science.</span></em></p><p class="fine-print"><em><span>Mairead Cardamone-Breen receives funding from the the National Health and Medical Research Council. </span></em></p>Teens have been through a lot in the pandemic and things won’t simply go back to normal as the nation opens up. Here’s how to support their mental health during the transition.Marie Yap, Associate Professor, Psychology, Monash UniversityAnthony Jorm, Professor emeritus, The University of MelbourneMairead Cardamone-Breen, Research Fellow & Psychologist, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1694662021-10-14T02:40:34Z2021-10-14T02:40:34ZAnorexia spiked during the pandemic, as adolescents felt the impact of COVID restrictions<figure><img src="https://images.theconversation.com/files/426090/original/file-20211013-19-1g00st2.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-alone-sitting-besides-river-1834505998">Shutterstock</a></span></figcaption></figure><p>The COVID-19 pandemic has changed the way we live, go to school or work, and socialise. It has also increased <a href="https://www.nejm.org/doi/full/10.1056/nejmp2008017">mental health concerns</a>, with a <a href="https://www.mdpi.com/1660-4601/17/6/2032">rise</a> in levels of distress, anxiety and <a href="https://journals.sagepub.com/doi/full/10.1177/0020764020915212">depression</a>. </p>
<p>Adolescents have been particularly affected. The shift to online learning and limitations on catching up with friends have disrupted both their educational and social routines, and many have missed important milestones. </p>
<p>Some young people have also changed their <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/eat.23317">eating and exercise habits</a>. This includes those with eating disorders such as anorexia nervosa, a restrictive eating disorder that affects mainly adolescent girls. </p>
<p>We’ve seen an increase in the number of adolescents <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.15755">seeking treatment</a> for anorexia nervosa and other eating disorders, including a 63% jump at our clinic in Melbourne.</p>
<h2>What are the complications?</h2>
<p>Anorexia nervosa is often associated with ongoing physical and mental health problems. </p>
<p>Decreased bone density can leave people <a href="https://pubmed.ncbi.nlm.nih.gov/23706279/">at risk of fracture</a>, altered blood vessel properties may predispose them to <a href="https://pubmed.ncbi.nlm.nih.gov/29559196/">heart disease</a>, and fertility problems may be detected when patients <a href="https://www.jwatch.org/wh201109080000001/2011/09/08/long-term-effects-eating-disorders-fertility-and">attempt to have children</a>. </p>
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Read more:
<a href="https://theconversation.com/anxious-teenage-girls-at-higher-risk-of-eating-disorder-symptoms-127884">Anxious teenage girls at higher risk of eating-disorder symptoms</a>
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<p>Many people continue to battle with negative thoughts and feelings towards food even if they’re <a href="https://pubmed.ncbi.nlm.nih.gov/9356884/">able to reach a healthy body weight</a>. This can cause high levels of stress and anxiety on a daily basis. </p>
<p>Treatment for anorexia nervosa aims to address both the physical and mental health components of the illness. </p>
<h2>Rise in presentations mirrored restrictions</h2>
<p>My research, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.15755">published recently in the Journal of Paediatrics and Child Health</a>, shows presentations to the Royal Children’s Hospital eating disorder service <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.15755">increased by 63%</a> during 2020 compared to the previous three years. Presentations went from an average of 99 in 2017-2019 to 161 in 2020. </p>
<p>The clinic mainly treats restrictive eating disorders, which affect the person’s ability to get enough nutrients to sustain the key functions of their body; anorexia nervosa accounts for 70-80% of patients each year. Patients range in age from nine to 18 years and more than 80% are female. </p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/covid-has-presented-unique-challenges-for-people-with-eating-disorders-theyll-need-support-beyond-the-pandemic-148903">COVID has presented unique challenges for people with eating disorders. They'll need support beyond the pandemic</a>
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<p>The increase in anorexia nervosa presentations in 2020 closely matched the implementation of COVID-19 restrictions. There was a rapid surge from May, which meant patients had to go on the waiting list for treatment. Numbers then started to decline from September, with the easing of restrictions. </p>
<p>We’re yet to analyse the numbers for 2021, but these are expected to be higher again.</p>
<h2>The role of COVID</h2>
<p>Restrictions play a key role in many individuals’ eating disorders. </p>
<p>Some 40% of anorexia nervosa patients at the Royal Children’s Hospital eating disorder service in 2020 reported COVID restrictions were the trigger for their disordered behaviours. </p>
<p>A further 13% of existing patients relapsed during lockdown. </p>
<p><a href="https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00295-3">Past research has shown</a> isolation, loneliness and boredom are key triggers for disordered eating. </p>
<p>In our study, COVID restrictions resulted in feelings of isolation and loneliness in one-third of the 2020 patients, and one-quarter reported boredom. </p>
<p>People who develop eating disorders typically have strict thoughts and feelings in relation to food and/or exercise. When they encounter external stressors, they revert to these behaviours <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-294">as a means of control</a>.</p>
<p>One-quarter of the patients in our study recognised changes to their normal routine during COVID restrictions contributed to developing an eating disorder. </p>
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Read more:
<a href="https://theconversation.com/disease-evolution-the-origins-of-anorexia-and-how-its-shaped-by-culture-and-time-54571">Disease evolution: the origins of anorexia and how it's shaped by culture and time</a>
</strong>
</em>
</p>
<hr>
<p>Patients and their families also commonly voiced about fearing the “expected weight gain during isolation” and being “worried about getting fat and losing fitness”. </p>
<p>This may have contributed to initial weight loss, which is a another <a href="https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00295-3">trigger</a> for developing restrictive eating disorders.</p>
<figure class="align-center ">
<img alt="A person steps onto bathroom scales, their ankles and feet visible." src="https://images.theconversation.com/files/426327/original/file-20211014-23-wi9o2z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426327/original/file-20211014-23-wi9o2z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426327/original/file-20211014-23-wi9o2z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426327/original/file-20211014-23-wi9o2z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426327/original/file-20211014-23-wi9o2z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426327/original/file-20211014-23-wi9o2z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426327/original/file-20211014-23-wi9o2z.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">Weight loss is a trigger for eating disorders.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/feet-standing-on-electronic-scales-weight-1851139591">Shutterstock</a></span>
</figcaption>
</figure>
<h2>But disorders weren’t more severe</h2>
<p>Despite an increase in anorexia nervosa presentations during the pandemic, there has been no increase in the severity of illness. Anorexia nervosa presentations throughout 2020 were actually less severe than in previous years. </p>
<p>There was also no change in the number of patients presenting to the eating disorder clinic experiencing depression or anxiety. </p>
<p>We’ve also seen similar increases in patient presentations for disordered eating and exercise behaviours <a href="https://nedc.com.au/research-and-resources/show/issue-69-the-impact-of-covid-19-on-eating-disorders">in other parts of Australia</a> during the pandemic.</p>
<h2>What does this mean for the future?</h2>
<p>The foundations for mental well-being are <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00579-1/fulltext">formed during adolescence</a>, so access to timely, quality health care for emerging mental health problems is vital.</p>
<p>Since COVID restrictions can be a trigger, families should keep an eye on their children and adolescents to identify disordered behaviours. </p>
<p>Early and intense treatment is often crucial to recovery and maintaining this long-term. With restrictions on social interactions, families play a much bigger support role and should be empowered to assist the young person during this time of uncertainty.</p>
<p>There is also likely to be increased demand for eating disorder services moving out of lockdown, as more people who have developed disordered behaviours become ill and seek treatment. </p>
<p><em>If this article has raised issues for you or your child, you can call Lifeline on 13 11 14 or Kids Helpline on 1800 55 1800. Resources are also available at <a href="https://butterfly.org.au/">The Butterfly Foundation</a>.</em></p><img src="https://counter.theconversation.com/content/169466/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabriella Springall receives funding from the Australian Commonwealth Government via the Research Training Program Scholarship scheme. </span></em></p>Presentations to a Melbourne eating disorder clinic jumped by 63% in 2020, as young people struggled with isolation, loneliness and boredom.Gabriella Springall, PhD candidate, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1696172021-10-11T19:10:50Z2021-10-11T19:10:50ZKeeping workers COVID-safe requires more than just following public health orders<figure><img src="https://images.theconversation.com/files/425640/original/file-20211011-15-bufz1f.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/african-american-businessman-working-modern-office-1836680287">Shutterstock</a></span></figcaption></figure><p>So far in the pandemic, state public health advice has been front and centre of public messaging about protecting the community from the spread of COVID-19. </p>
<p>But merely following the public health orders won’t necessarily meet employers’ obligations to protect staff from COVID, especially <a href="https://www.nsw.gov.au/covid-19/easing-covid-19-restrictions/70-percent">as restrictions ease</a> in the Eastern states. </p>
<p>Protecting employees from COVID is good for staff, of course, and also good for the organisation because it will reduce the potential for staff being off sick.</p>
<p>Vaccination alone won’t guarantee a COVID-safe workplace. Even double-vaccinated people can be infected. Vaccination reduces the chance of infection by <a href="https://www.premier.vic.gov.au/sites/default/files/2021-09/210919%20-%20Burnet%20Institute%20-%20Vic%20Roadmap.pdf">between 60% (AstraZeneca) and 80% (Pfizer)</a>. And double-vaccinated people can <a href="https://www.premier.vic.gov.au/sites/default/files/2021-09/210919%20-%20Burnet%20Institute%20-%20Vic%20Roadmap.pdf">also transmit the virus</a>, although again at a much lower rate.</p>
<p>As part of the scientific advisory group <a href="https://ozsage.org/">OzSAGE</a>, we’re issuing <a href="https://ozsage.org/media_releases/creating-safe-workplaces-during-the-covid-19-pandemic/">guidance to employers about creating COVID-safe working environments</a>. We propose organisations follow a four-level <a href="https://www.cdc.gov/niosh/topics/hierarchy/default.html">hierarchy of COVID controls</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/425631/original/file-20211011-23-x84z4z.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/425631/original/file-20211011-23-x84z4z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/425631/original/file-20211011-23-x84z4z.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/425631/original/file-20211011-23-x84z4z.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/425631/original/file-20211011-23-x84z4z.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/425631/original/file-20211011-23-x84z4z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=313&fit=crop&dpr=1 754w, https://images.theconversation.com/files/425631/original/file-20211011-23-x84z4z.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=313&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/425631/original/file-20211011-23-x84z4z.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=313&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Employers need to consider four key areas.</span>
<span class="attribution"><span class="source">OzSAGE</span></span>
</figcaption>
</figure>
<h2>Level 1: vaccination and working from home</h2>
<p>The most effective protections against COVID are vaccinating to reduce the risk of infection, and limiting interactions with infected people. These are the two standard public health measures seen in state public health orders.</p>
<p>Employers should encourage employees to get vaccinated by providing:</p>
<ul>
<li>leave or paid time off to get vaccinated</li>
<li>reliable and up-to-date information on the effectiveness of vaccinations</li>
<li>the details of the locations nearby where vaccinations are available</li>
<li>on-site vaccination, if possible, for shift workers and those who can’t easily attend a GP or vaccine hub appointment</li>
<li>incentives, such as additional annual leave days for vaccinated workers.</li>
</ul>
<p>In some circumstances – especially where the organisation is responsible for caring for people at a higher risk of infection – mandatory vaccination of employees might also be considered.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-youre-going-to-mandate-covid-vaccination-at-your-workplace-heres-how-to-do-it-ethically-166110">If you're going to mandate COVID vaccination at your workplace, here's how to do it ethically</a>
</strong>
</em>
</p>
<hr>
<p>Staff should be encouraged to work from home if that’s possible, while risk of infection is still high. Working from home doesn’t eliminate the risk of COVID, but it eliminates the risk of contracting (and transmitting) COVID in the workplace. </p>
<p>Putting in place “hybrid” working arrangements reduces the number of people in the workplace at any one time, and therefore the risk of transmission.</p>
<h2>Level 2: safe indoor air</h2>
<p>State public health orders have essentially focused on density limits. These are important, but don’t guarantee good ventilation and clean air.</p>
<p>COVID spreads by aerosols. Respiratory aerosols from breathing and speaking accumulate in indoor spaces, resulting in increasing risk over time. </p>
<p>Poor ventilation (stagnant air) in public buildings, workplaces, schools, hospitals, and aged care homes contributes to viral spread. </p>
<figure class="align-center ">
<img alt="Masked woman with a clipboard surveys a storeroom." src="https://images.theconversation.com/files/425647/original/file-20211011-19-kev8ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/425647/original/file-20211011-19-kev8ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/425647/original/file-20211011-19-kev8ke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/425647/original/file-20211011-19-kev8ke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/425647/original/file-20211011-19-kev8ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/425647/original/file-20211011-19-kev8ke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/425647/original/file-20211011-19-kev8ke.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">Poor ventilation is a risk for transmitting COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-worker-medical-mask-holding-clipboard-1846320985">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-must-get-serious-about-airborne-infection-transmission-heres-what-we-need-to-do-164622">Australia must get serious about airborne infection transmission. Here's what we need to do</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://ozsage.org/wp-content/uploads/2021/09/Safe-Indoor-Air-advice.pdf">Good ventilation</a> is a key part of reducing the risk of COVID transmission.</p>
<p>As the number of people inside a space increases, CO₂ will increase to varying degrees, depending on the effectiveness of ventilation and the volume of the space. Measuring carbon dioxide (CO₂) is therefore a useful surrogate indicator to assess the relative infection risk of COVID in an indoor space.</p>
<p>It’s recommended employers invest in CO₂ monitoring and use that as a trigger to reduce occupancy and/or increase the provision of outdoor air and HEPA (high-efficiency particulate air) filtering to ensure the risk of COVID-19 is appropriately mitigated. </p>
<p>Having automated alerts (in non-HEPA filtered areas) from CO₂ monitors will prompt action to improve ventilation or leave the workplace.</p>
<h2>Level 3: administrative measures</h2>
<p>Organisations should be ready to manage COVID outbreaks – especially in New South Wales and Victoria, where public health contact tracing is at capacity. </p>
<p>Organisations might also use regular rapid antigen testing (where practical and feasible, considering cost and logistics), to prevent or limit outbreaks when people are shedding the virus but are asymptomatic.</p>
<figure class="align-center ">
<img alt="Man holds rapid COVID testing stick." src="https://images.theconversation.com/files/425643/original/file-20211011-25-1mbdmz9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/425643/original/file-20211011-25-1mbdmz9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/425643/original/file-20211011-25-1mbdmz9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/425643/original/file-20211011-25-1mbdmz9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/425643/original/file-20211011-25-1mbdmz9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/425643/original/file-20211011-25-1mbdmz9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/425643/original/file-20211011-25-1mbdmz9.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">Rapid tests can help detect COVID in those with no symptoms.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/patient-preparing-antigen-self-test-quick-1939238734">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rapid-antigen-tests-have-long-been-used-overseas-to-detect-covid-heres-what-australia-can-learn-168490">Rapid antigen tests have long been used overseas to detect COVID. Here's what Australia can learn</a>
</strong>
</em>
</p>
<hr>
<p>The risk of an organisation-wide shutdown can be minimised by creating work bubbles – teams coming to work on different days – and other measures to reduce physical interactions. </p>
<p>Staggering work hours to reduce congregating at lift spaces is another useful, low-cost strategy.</p>
<h2>Level 4: masks</h2>
<p>COVID-19 is an airborne disease, so the <a href="https://ozsage.org/media_releases/community-mask-use/">use of masks is integral to reduce transmission</a> and to offer some protection if there is any breakdown of other controls. </p>
<p>Masks are also essential because 30–70% of transmission <a href="https://www.nature.com/articles/d41586-021-02259-2">may be asymptomatic</a>: from infected people who look and feel well and may not be aware they are infected. </p>
<p>Basic cloth masks and surgical masks reduce the transmission of COVID. The effectiveness of masks increases when they fit snugly on the wearer’s face. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/evidence-shows-that-yes-masks-prevent-covid-19-and-surgical-masks-are-the-way-to-go-167963">Evidence shows that, yes, masks prevent COVID-19 – and surgical masks are the way to go</a>
</strong>
</em>
</p>
<hr>
<p>Workers should be provided with appropriate fitted masks and should be trained in how and when to use them. At a minimum, where workplaces are in areas with community transmission of COVID, masks should be worn whenever workers are indoors.</p>
<p>Rates of COVID are still high in NSW, Victoria, and the ACT. Employers, especially in those jurisdictions, should review their work health and safety plans to ensure their workers and customers are properly protected.</p>
<p><em>This article was co-authored by occupational and environmental physician Karina Powers, engineer and scientist <a href="https://www.colehealth.com.au/about">Kate Cole</a>, Flinders University Professor Richard Nunes-Vaz, and other members of the <a href="https://ozsage.org/">OzSAGE</a> advice for business working group.</em></p><img src="https://counter.theconversation.com/content/169617/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett is member of OzSAGE's independent experts group.
Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities, as disclosed on its website.</span></em></p>Employers need to go beyond the public health orders to ensure their workers are safe from COVID. Here are four key areas to focus on.Stephen Duckett, Director, Health and Aged Care Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1688332021-09-29T07:21:37Z2021-09-29T07:21:37ZRelying only on vaccination in NSW from December 1 isn’t enough – here’s what we need for sustained freedom<figure><img src="https://images.theconversation.com/files/423730/original/file-20210929-28-g22igw.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://photos.aap.com.au/">Dan Himbrechts/AAP</a></span></figcaption></figure><p>The latest <a href="https://www.nsw.gov.au/media-releases/roadmap-to-recovery-reveals-path-forward-for-all-nsw">New South Wales roadmap to recovery</a> outlines a range of freedoms for fully vaccinated people in the state when 80% of those aged 16 and over are vaccinated.</p>
<p>Unvaccinated people will remain restricted, but will have the same freedoms by December 1, when <a href="https://www.theguardian.com/australia-news/2021/sep/27/nsw-covid-update-unvaccinated-nsw-residents-to-wait-until-december-to-get-freedoms">90% of adults</a> are expected to be vaccinated.</p>
<p>The relaxing of restrictions will occur in three stages, at the 70%, 80% and 90% vaccination mark, with many restrictions dropped by December 1. </p>
<p>This includes relaxing the 4 square metre density rule to 2 square metres in most indoor venues; and no indoor mask mandates in most venues except public transport, airports and for front-of-house hospitality staff.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1442300304762966016"}"></div></p>
<p>The problem is, other countries such as Israel already tried relying mostly on vaccines to relax restrictions – and <a href="https://www.forbes.com/sites/roberthart/2021/06/24/israel-prepares-to-reinstate-mask-mandate-as-delta-variant-drives-new-covid-surge/?sh=ace806d6d091">failed</a>, albeit at lower vaccination levels than NSW is aiming for. </p>
<p>Vaccines alone may not enough to protect against the highly contagious Delta variant. </p>
<p>So who is most vulnerable under the current plan, and how should the NSW reopening plan change to protect these groups and the wider population?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nsw-risks-a-second-larger-covid-peak-by-christmas-if-it-eases-restrictions-too-quickly-167877">NSW risks a second larger COVID peak by Christmas if it eases restrictions too quickly</a>
</strong>
</em>
</p>
<hr>
<h2>Vulnerable group 1: children</h2>
<p>About <a href="http://www.healthstats.nsw.gov.au/Indicator/dem_pop_age/dem_pop_age">20% of the population is under 16 years</a>. The 80% adult target corresponds to less than 70% of the whole population, leaving plenty of room for Delta to spread. </p>
<p><a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/COVID-19/COVID19/Public_Hearings">One in three children</a> aged 12 to 15 have had a single dose of vaccine, but it may be next year before this age group is fully vaccinated.</p>
<p>Another 1.2 million NSW children under 12 will remain unvaccinated. This is the <a href="https://ozsage.org/media_releases/ozsage-comment-on-the-ncirs-report-covid-19-delta-variant-in-schools-and-early-childhood-education-and-care-services-in-nsw-australia-16-june-to-31-july-2021/">largest unvaccinated group</a>. With no requirements for unvaccinated primary school children to wear masks, and no plan to ventilate classrooms, outbreaks will almost certainly occur. </p>
<figure class="align-center ">
<img alt="Children sit in a classroom, raising their hands." src="https://images.theconversation.com/files/423744/original/file-20210929-24-1huya9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423744/original/file-20210929-24-1huya9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=347&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423744/original/file-20210929-24-1huya9s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=347&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423744/original/file-20210929-24-1huya9s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=347&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423744/original/file-20210929-24-1huya9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=437&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423744/original/file-20210929-24-1huya9s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=437&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423744/original/file-20210929-24-1huya9s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=437&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children generally get a mild infection from COVID but a small proportion need care in hospital.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pupils-raising-their-hands-during-class-251933845">Shutterstock</a></span>
</figcaption>
</figure>
<p>In the US, counties with school mask mandates had <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7039e3.htm?s_cid=mm7039e3_w">much lower rates</a> of COVID in children than counties that did not mandate masks. One unvaccinated teacher who took off her mask to read to a primary school class <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e2.htm">resulted in 26 people</a> becoming infected. </p>
<p>While children get mild infection compared to adults, <a href="https://www.ncirs.org.au/covid-19-delta-variant-schools-and-early-childhood-education-and-care-services-nsw-australia-16">around 2%</a> of children who get Delta are hospitalised. Of these, some will require <a href="https://www.politico.com/states/florida/story/2021/09/09/child-covid-fatalities-nearly-double-in-florida-1390807">ICU care</a> and a proportion will die. This <a href="https://twitter.com/drgregkelly/status/1440525626574737414">becomes more apparent</a> when there is high community transmission, and high case numbers in unvaccinated children. </p>
<p>The <a href="https://www.doherty.edu.au/uploads/content_doc/DohertyModelling_NationalPlan_and_Addendum_20210810.pdf">Doherty report estimates</a> 276,000 Australian children will be infected in the first six months after reopening in the most likely scenario, with 2,400 hospitalisations, 206 ICU admissions and 57 child deaths in that time.</p>
<h2>Vulnerable group 2: Aboriginal people</h2>
<p>Aboriginal communities in NSW are <a href="https://www.aboriginalaffairs.nsw.gov.au/media/website_pages/research-and-publications/facts-and-figures/KEY-DATA-ABORIGINAL-PEOPLE-SEP-2020.pdf">especially vulnerable</a> to epidemics, contracting COVID and getting severe disease. </p>
<p>There are relatively more children in the under 12 age category in Aboriginal communities, which leaves a much higher proportion of the community unvaccinated. </p>
<p>We saw in the <a href="https://www.theguardian.com/australia-news/2021/aug/21/indigenous-australians-going-through-hell-as-wilcannia-covid-outbreak-worsens">Wilcannia outbreak</a> that a high proportion of cases were in children.</p>
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Read more:
<a href="https://theconversation.com/covid-in-wilcannia-a-national-disgrace-we-all-saw-coming-167348">COVID in Wilcannia: a national disgrace we all saw coming</a>
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<p>Despite this, vaccination rates for Aboriginal communities <a href="https://ozsage.org/media_releases/covid-19-in-aboriginal-and-torres-strait-islander-people-update-sept-27-2021/">continue to lag</a> about 20% behind the rest of NSW.</p>
<p>Allowing unrestrained travel into these communities before vaccination rates are high enough to afford protection may be disastrous. </p>
<h2>Vulnerable group 3: regional NSW</h2>
<p>Remote and regional communities are also vulnerable, because of fewer health services and difficulties with access to care. </p>
<p>An outbreak would <a href="https://www.abc.net.au/news/2021-09-10/lifting-of-covid-lockdown-coming-too-soon-regional-doctors-say/100450622">disproportionately affect</a> regional NSW.</p>
<h2>Vulnerable group 4: people with disability</h2>
<p>People with disability, many of whom have <a href="https://www.aihw.gov.au/reports/disability/people-with-disability-in-australia/contents/health/chronic-conditions-and-disability">significant</a> health conditions, are also at high risk. </p>
<p>Vaccination rates for NSW participants in Australia’s National Disability Insurance Scheme <a href="https://www.theguardian.com/australia-news/2021/sep/16/fears-vulnerable-people-on-ndis-will-be-left-unvaccinated-when-nsw-reopens">lag state rates</a> by about 14% despite being prioritised in the national rollout. </p>
<p>In the UK, <a href="https://doi.org/10.1101/2021.06.10.21258693">58% of COVID deaths</a> in the United Kingdom were among people who had a disability. People with intellectual disability were <a href="https://www.bmj.com/content/374/bmj.n1592">eight times more likely to die</a> of COVID than the general population.</p>
<h2>Vulnerable group 5: people with cancer and other conditions</h2>
<p>Adults and children living with cancer and other conditions that suppress the immune system may have a <a href="https://www.researchsquare.com/article/rs-916303/v1">poorer response</a> to COVID vaccines, and may <a href="https://www.cancertherapyadvisor.com/home/cancer-topics/general-oncology/covid-19-vaccines-cancer-tumor-treatment/">need a third dose</a>. </p>
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Read more:
<a href="https://theconversation.com/why-is-a-third-covid-19-vaccine-dose-important-for-people-who-are-immunocompromised-166569">Why is a third COVID-19 vaccine dose important for people who are immunocompromised?</a>
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<p>The need for third dose boosters in susceptible people is recognised and programs to deliver these are underway in many countries. </p>
<p>Some are vaccinating specific groups: the United States and United Kingdom are providing boosters to all people 65 and 50 years and over respectively. </p>
<p>Others, such as Israel and many European nations, are starting with older adults and immunosuppressed people, and later including the rest of the population.</p>
<p>Australia is yet to formulate such a plan.</p>
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<img alt="Older person's arm with a bandaid after being vaccinated." src="https://images.theconversation.com/files/423746/original/file-20210929-22-al3o40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423746/original/file-20210929-22-al3o40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423746/original/file-20210929-22-al3o40.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423746/original/file-20210929-22-al3o40.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423746/original/file-20210929-22-al3o40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423746/original/file-20210929-22-al3o40.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423746/original/file-20210929-22-al3o40.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">Some countries have already started giving boosters.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-senior-face-mask-after-receiving-1988203364">Shutterstock</a></span>
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<p>Children under 12 years with cancer (not yet eligible for vaccination), also deserve to be protected, by vaccines and/or other measures to stop the spread of COVID in the community. </p>
<p>The consequences of overwhelmed health systems on timely diagnoses and treatment of cancer and other serious illness is already being seen in NSW.</p>
<h2>A layered plan for a safer reopening</h2>
<p>Currently available vaccines alone will not be enough to control Delta. We will need layered protection including safe indoor air, testing, tracing and masks to continue our lives freely when lockdowns lift. </p>
<p>Here’s what we propose:</p>
<p><strong>1. Implement vaccine targets for at-risk groups</strong></p>
<p>We need to make sure no disadvantaged group is left behind, and that vaccine targets are met for all these groups. </p>
<p>For Aboriginal people, we <a href="https://ozsage.org/media_releases/covid-19-in-aboriginal-and-torres-strait-islander-people-update-sept-27-2021/">recommend</a> 85-90% targets be met.</p>
<p>For other groups such as people with disability, particularly those living in congregate settings, higher vaccine targets should also be considered. </p>
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<strong>
Read more:
<a href="https://theconversation.com/vaccinations-need-to-reach-90-of-first-nations-adults-and-teens-to-protect-vulnerable-communities-167800">Vaccinations need to reach 90% of First Nations adults and teens to protect vulnerable communities</a>
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<p><strong>2. Make indoor air safer</strong></p>
<p>NSW needs a plan to address <a href="https://www.abc.net.au/news/2021-09-22/qld-school-ventilation-paradigm-shift-coronavirus-prevention/100479408">indoor ventilation</a>, because the virus is airborne.</p>
<p>This has already occurred in <a href="https://www.abc.net.au/news/2021-09-23/victoria-melbourne-schools-plan-covers-ventilation-vaccination/100483622">Victorian schools</a>, and should be an important part of lifting restrictions in NSW. </p>
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Read more:
<a href="https://theconversation.com/from-vaccination-to-ventilation-5-ways-to-keep-kids-safe-from-covid-when-schools-reopen-166734">From vaccination to ventilation: 5 ways to keep kids safe from COVID when schools reopen</a>
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<p>The plan should ensure homes, businesses, schools and other public venues have safe indoor air, and that the community is as <a href="https://ozsage.org/media_releases/beware-the-air-you-share-ozsage-advice-on-safe-indoor-air-ventilation-for-australia-september-6th/">well informed on safe air</a> as it is on handwashing, so that people are empowered to mitigate risk in their own homes. </p>
<p><strong>3. Maintain high rates of testing and tracing</strong></p>
<p>We must maintain high testing capacity, make <a href="https://www.news.com.au/world/coronavirus/australia/tga-admits-delay-in-athome-testing-until-vax-rates-higher-was-deliberate/news-story/43626bc665945d721d532a9f62713a6c">rapid antigen testing</a> widely available, and improve contact tracing capacity. </p>
<p><a href="https://www.smh.com.au/politics/nsw/architect-of-qr-codes-says-system-will-eventually-be-turned-off-20210927-p58v4w.html">Suggestions</a> of <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30512-0/fulltext">stopping QR code scanning</a> and thereby reducing contact tracing capacity are misguided, and will result in a resurgence of infection.</p>
<p>We do contact tracing routinely for all serious infections such as TB, meningitis and measles, and need to continue this for COVID-19. </p>
<p><strong>4. Plan for booster doses</strong></p>
<p>We also need to <a href="https://twitter.com/EricTopol/status/1437890711139995648">address waning immunity from vaccines</a> and be pro-active about booster doses, particularly for those with reduced immunity or who are immunocompromised, and for health care workers. </p>
<p>For the rest of the population, there is enough <a href="https://www.wsj.com/articles/biden-administration-plans-covid-19-vaccine-boosters-at-six-months-instead-of-eight-11629919356?mod=djemalertNEWS">real-world evidence</a> protection starts to wane as early as five to six months after vaccination. </p>
<p>It is urgent we address this for health workers and other priority groups such as aged care residents, who were mostly vaccinated six months ago or longer. This is not only for their own safety but to prevent health system collapse from under-staffing <a href="https://www.smh.com.au/politics/federal/doctors-and-nurses-will-be-sitting-ducks-without-booster-shot-plan-20210831-p58nji.html">due to illness or burnout</a>.</p>
<h2>Let’s avoid future lockdowns</h2>
<p>In the post-lock down world, NSW will likely face a Delta resurgence if multiple restrictions are simultaneously relaxed, as we have seen in countries overseas. </p>
<p>Dropping most restrictions <a href="https://www.philstar.com/opinion/2021/04/30/2094760/editorial-lockdown-cycle">is also likely to result in</a> repeated stop-start lockdown cycles, prompted by health system strain when cases surge. </p>
<p>Only <a href="https://ozsage.org/ventilation-and-vaccine-plus/">layered, combined protections</a> will provide a chance of safer and sustainable re-opening until we await the promise of second generation vaccines, boosters and smarter vaccine strategies.</p><img src="https://counter.theconversation.com/content/168833/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre receives funding from NHMRC (Principal Research Fellowship and Centre for Research Excellence) and MRFF.</span></em></p><p class="fine-print"><em><span>Anne Kavanagh receives funding from the NHMRC, ARC, and the Victorian and Commonwealth governments. </span></em></p><p class="fine-print"><em><span><a href="mailto:eva.segelov@monash.edu">eva.segelov@monash.edu</a> receives funding from Cancer Australia</span></em></p><p class="fine-print"><em><span>Lisa Jackson Pulver has received ARC grants and NHMRC grants.</span></em></p>Vaccines alone aren’t enough to protect against the highly contagious Delta variant.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyAnne Kavanagh, Professor of Disability and Health, Melbourne School of Population and Global Health, The University of MelbourneEva Segelov, Professor of Oncology, Monash UniversityLisa Jackson Pulver, Deputy Vice-Chancellor, Professor of Public Health and Epidemiology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1682452021-09-19T10:52:16Z2021-09-19T10:52:16ZWith a post-lockdown Victoria in sight, the more we can contain transmission now, the easier the road ahead<p>Victoria’s <a href="https://www.premier.vic.gov.au/victorias-roadmap-delivering-national-plan">roadmap</a> out of lockdown, released today, marks an important milestone. It’s a clear commitment to delivering on the <a href="https://www.pmc.gov.au/national-plan-transition-australias-national-covid-response">National Plan</a>, and provides much-needed clarity on where we are heading and what the next few months will look like. It is staged and sensible, striking the balance between opening up and maintaining a level of control over transmission. </p>
<p>The roadmap charts a course of staged reopening as more Victorians become vaccinated. It’s informed by modelling from the <a href="https://burnet.edu.au/news/1517">Burnet Institute</a>, which makes some sobering predictions on the number of cases and the strain on our health system, no matter what course we take from here. </p>
<p>It steps us through what things will look like as we move from 80% of those aged 16 and older having had at least one dose, to 70% fully vaccinated, through to and 80% and beyond. </p>
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<p>The potential risk of easing restrictions will be managed through a continued focus on outdoor activity and leveraging the lower risk of infection and, even more so, hospitalisation, in the growing number who are fully vaccinated.</p>
<p>Having a clear vision for where you are heading can make all the difference, especially when the time horizons are now within weeks. We need this, as it will still be a difficult transition through “the gateway” to living with COVID. </p>
<h2>Balancing the risks</h2>
<p>The roadmap was only one of five scenarios the Burnet team modelled and is in fact the least cautious. But the decision was taken to balance these risks with the direct and indirect health costs of delaying the easing of restrictions further. </p>
<p>The modelling forecasts twice the peak in case numbers, ICU admissions and deaths under the proposed path compared with staying under lockdown, or the other more restricted scenarios.</p>
<p>But it also shows that maintaining high levels of testing can mitigate some of this additional risk. </p>
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<p>We have a road out, and one we can make less costly by testing when symptomatic, and abiding by the public health orders now the end is in reach. </p>
<p>So what does the plan say?</p>
<h2>When 80% of Victorians have had a single vaccination dose</h2>
<p>At 80% single dose coverage among those aged 16 and over, expected by September 26, the travel limit in Melbourne will extend to 15km.</p>
<p>Outdoor activities such as basketball, golf, tennis will be allowed, subject to the same people limits as picnics: two adults if unvaccinated, or up to five fully vaccinated. </p>
<p>In regional Victoria, final year VCAL (Victorian Certificate of Applied Learning) students will be allowed back to study onsite. Masks will no longer be required for beauty or personal care services.</p>
<h2>When 70% of over-16s are double dosed</h2>
<p>October heralds the staged return to partial onsite schooling, with further changes once 70% of those 16 and older are fully vaccinated, expected by October 26. </p>
<p>This marks the official ending of what we know as lockdown. </p>
<p>The curfew will also end in metro Melbourne and outdoor hospitality will open to those fully vaccinated. </p>
<p>Weddings and funerals will be allowed outdoors for up to 50. </p>
<p>Students from all years will be able to return to face-to-face learning for at least part of the week in both Melbourne and regional Victoria. </p>
<p>Regional Victoria will also see further easing with up to 30 fully vaccinated patrons allowed indoors in hospitality venues. </p>
<h2>When 80% of over 16s are double-dose vaxxed</h2>
<p>When we get to 80% double dose coverage, projected for November 5, all of Victoria will share the same more modest restrictions.</p>
<p>Indoor activity will open further for those fully vaccinated, including retail, and caps will lift to 150 for organised indoor events and 500 outdoors. </p>
<p>Private gatherings of up to 30 people outdoors will be allowed, but only ten guests are allowed in the home, the setting deemed the highest risk. </p>
<p>Masks will only be required indoors.*</p>
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Read more:
<a href="https://theconversation.com/weve-become-used-to-wearing-masks-during-covid-but-does-that-mean-the-habit-will-stick-163971">We've become used to wearing masks during COVID. But does that mean the habit will stick?</a>
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<h2>By the end of the year</h2>
<p>By year’s end, as we exceed 80% of adults fully vaccinated and aim for 80% including 12- to 15-year-olds, more visitors to the home will be allowed, possibly extending to 30 by Christmas. </p>
<p>International travel might be possible by then too, at least to low-risk countries.</p>
<p>Interstate travel will also be on the cards, although this might be limited to New South Wales and ACT until other states also move to living with the virus.</p>
<h2>Why lift restrictions on outdoor activities and for the vaccinated?</h2>
<p>It makes sense to use outdoor settings and individual and population vaccination protection to progress on this road out to manage transmission risk. </p>
<p>Remaining unvaccinated is a greater risk now, even with these rules in place – 204 people in hospital this week, and only <a href="https://www.dhhs.vic.gov.au/coronavirus-update-victoria-19-september-2021">1% of these fully vaccinated</a>. </p>
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<p>Vaccine passports won’t be a permanent fixture, but allow us to do more things earlier than otherwise possible. </p>
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Read more:
<a href="https://theconversation.com/vaccine-passports-are-coming-to-australia-how-will-they-work-and-what-will-you-need-them-for-167531">Vaccine passports are coming to Australia. How will they work and what will you need them for?</a>
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<h2>But it could be worse – or better</h2>
<p>It’s important to recognise that the steps along the way may end up looking somewhat different depending on case numbers, perhaps for the better. </p>
<p>Lower case numbers as we start this transition will put us in a better position, as the Doherty modellers reported last week. So the more we contain transmission while in lockdown, the easier the road ahead and lowest impact on hospitals. </p>
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<p>The immediate challenge has not changed. We still need to do everything we can to keep case numbers from rising and, if possible, bring them down. We still need to get vaccinated as quickly as possible and push coverage in those over 16 up to 80%, and beyond. </p>
<p>What has changed is that we can see clearly where we are heading and how our hard work to prevent further waves while waiting for the vaccine roll-out now translates into greater freedoms in coming months. </p>
<p>This is a critical transition period that will test us all, and it helps to see vaccination levels that can provide some relief within reach after a gruelling 18 months. With the end of this “pre-vaccine” phase within sight, a final push to control transmission over this last stretch makes this a safer and quicker passage through the gateway to living with the virus. </p>
<p>If we do better than the Burnet modelling assumes by getting tested when symptomatic, vaccinated or not, and abiding by the rules in place, we will come in well under the forecast case and death counts.</p>
<p>Victoria and NSW are watching and learning from each other as each state eases out of lockdown while keeping a level of control over the virus. Success will reassure other states and territories of how this can work, and allow Australia to once again be open for business.</p>
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Read more:
<a href="https://theconversation.com/nsw-risks-a-second-larger-covid-peak-by-christmas-if-it-eases-restrictions-too-quickly-167877">NSW risks a second larger COVID peak by Christmas if it eases restrictions too quickly</a>
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<p><em>*Correction: This article originally said masks would only be required outdoors. This has now been corrected.</em></p><img src="https://counter.theconversation.com/content/168245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Bennett receives funding from Medical Research Future Find and the National Health and Medical research Council, and was appointed as a independent advisor on the AstraZeneca COVID Vaccine Advisory Board</span></em></p><p class="fine-print"><em><span>Hassan Vally does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The potential risk of easing restrictions will be managed through a continued focus on outdoor activity and greater freedoms only for those who are vaccinated.Catherine Bennett, Chair in Epidemiology, Deakin UniversityHassan Vally, Associate Professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1678772021-09-14T05:02:37Z2021-09-14T05:02:37ZNSW risks a second larger COVID peak by Christmas if it eases restrictions too quickly<p>New South Wales <a href="https://www.nsw.gov.au/media-releases/roadmap-to-freedom-unveiled-for-fully-vaccinated">plans to relax restrictions</a> when vaccination targets of 70% and 80% of those aged 16 years and over are met. </p>
<p>The national plan was based on the assumption there <a href="https://www.abc.net.au/news/2021-08-24/head-of-doherty-institute-covid19-nsw-vaccine-vic-scott-morrison/100401082">would be just 30 cases</a> when restrictions were lifted. However, NSW may have cases in the hundreds or thousands when restrictions are relaxed.</p>
<p>The current discussion has been around “the peak” occurring during current restrictions. </p>
<p>But <a href="https://www.ozsage.org/icu-modelling/">modelling</a> from my team at UNSW shows if current restrictions are relaxed while a large proportion of the community is unvaccinated, a larger, second peak may occur that may overwhelms our hospitals – unless countermeasures are taken to prevent that. </p>
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Read more:
<a href="https://theconversation.com/flattening-the-covid-curve-3-weeks-of-tougher-lockdowns-in-sydneys-hotspots-halved-expected-case-numbers-167778">Flattening the COVID curve: 3 weeks of tougher lockdowns in Sydney's hotspots halved expected case numbers</a>
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<h2>What would a second peak look like?</h2>
<p>The 70-80% adult vaccination targets correspond to 56-64% of the whole population, leaving plenty of room for the virus to spread among increasingly mobile people. </p>
<p>If the first relaxation of restrictions occurs around October 18, our modelling predicts a second, larger peak <a href="https://www.ozsage.org/media_releases/modelling-of-nsw-roadmap-to-freedom-icu-capacity-for-the-delta-epidemic-2021/">will occur</a> between December 24-29 2021. </p>
<p>If restrictions are only relaxed around November 6 when the 80% target is met, the peak occurs later, between January 6-12 2022 instead of around Christmas day. </p>
<p>The current strategy of mass vaccination is vital to our exit plan. But vaccination alone cannot control an epidemic that <a href="https://www.9news.com.au/national/coronavirus-australia-dead-last-in-oecd-for-vaccinated-people/51dbd565-25fe-4e07-891f-2c689c39c467">began</a> when fully vaccinated rates were extremely low. </p>
<p>This is because the virus spreads much faster (days) than the time taken to benefit from vaccine immunity after two doses (two months, with a six week interval between doses and two weeks after the second dose to get maximal immunity). </p>
<p>Also current vaccines are <a href="https://www.nejm.org/doi/10.1056/NEJMc2112981?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">not as effective</a> against the Delta variant due to a combination of vaccine escape (meaning they’re not exactly matched to the Delta strain) and waning immunity. </p>
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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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<p>The restrictions used in NSW since the end of June have kept a lid on it, but case numbers have continued to grow. <a href="https://www.ozsage.org/icu-modelling/">We estimated</a> the 70% target may be met around October 18, and case numbers at that time may be in the thousands. </p>
<p>Depending on what steps accompany that relaxation, many different scenarios are possible. Modelling allows us to look at best and worst case scenarios and ensure the worst never occurs. </p>
<h2>Weighing the harms</h2>
<p>Controlling an epidemic is like balancing a set of old fashioned scales. Imagine the virus is a large, menacing metal weight sitting on one side, and the public health measures are a bunch of weights on the other, which are combined to keep the fight even.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/420996/original/file-20210914-21-kxhtjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420996/original/file-20210914-21-kxhtjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=302&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420996/original/file-20210914-21-kxhtjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=302&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420996/original/file-20210914-21-kxhtjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=302&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420996/original/file-20210914-21-kxhtjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=379&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420996/original/file-20210914-21-kxhtjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=379&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420996/original/file-20210914-21-kxhtjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=379&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Modelling shows the effect of changes on either side of the scale.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/balance-between-diverse-objects-unequal-shapes-1385539847">Shutterstock</a></span>
</figcaption>
</figure>
<p>The Delta virus is very heavy, so we need many public health “weights” to keep it from winning. Vaccination alone is not enough, as we have seen in the United States, United Kingdom and Israel. </p>
<p>The public health “weights” include:</p>
<ul>
<li>vaccination </li>
<li>testing (identifying infected people and isolating them)</li>
<li>rapid contact tracing (within 24 hours of identifying an infected person)</li>
<li>restricting mixing and movement of people</li>
<li>masks</li>
<li>ventilation (safe indoor air).</li>
</ul>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/nWnOR3O-ZF0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">COVID-19 spreads through air.</span></figcaption>
</figure>
<p>Modelling can help us work out the effect of changes on either side of the scale. What if the epidemic is bigger? What if we remove movement restrictions? </p>
<p>That will tip the scales in favour of the virus, so we need to add more into the public health bowl to compensate for that removal. Maybe we can add more contact tracing, mask use or testing.</p>
<p>It’s a constant dance in trying to outwit the virus, and modelling helps by allowing to forecast the impact of different approaches to relaxing restrictions. </p>
<h2>Vaccination alone isn’t enough</h2>
<p>We already know that to relax restrictions, we need high vaccination rates. But because <a href="https://www.science.org/news/2021/08/grim-warning-israel-vaccination-blunts-does-not-defeat-delta">the vaccine is not enough against Delta</a>, at the 70-80% adult targets (which correspond to 56-65% of the whole population) there is still plenty of scope for the virus to spread. </p>
<p>COVID-19 will find under-vaccinated pockets and communities, whether it be disadvantaged urban communities or remote Aboriginal communities like <a href="https://www.abc.net.au/news/2021-08-26/covid-delta-unvaccinated-indigenous-communities-outbreak/100406682">Wilcannia</a>, which had a <a href="https://insightplus.mja.com.au/2021/34/vaccination-alone-not-enough-to-control-covid-19/">7% rate of full vaccination</a> when the Sydney outbreak arrived there. </p>
<p>So, our modelling shows that if you remove restrictions on movement, you need to add more weights to the public health bowl to stop the scales tipping in favour of the virus. This is the vaccine-plus and ventilation strategy recommended by <a href="https://www.ozsage.org/media_releases/september-2/">OzSAGE</a>, a new independent expert network I’m part of, which outlines a safe pandemic exit strategy. </p>
<p>It means when we open schools, we need to open classroom windows too, ensure clean air in classrooms, ensure parents and teachers are vaccinated, and have kids wearing masks. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-vaccination-to-ventilation-5-ways-to-keep-kids-safe-from-covid-when-schools-reopen-166734">From vaccination to ventilation: 5 ways to keep kids safe from COVID when schools reopen</a>
</strong>
</em>
</p>
<hr>
<p>We estimated the NSW capacity to rapidly trace contacts dropped off in mid-August. </p>
<p>So, in preparation of increasing mixing of people, we could <a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30251-X/fulltext">massively scale up</a> contact tracing capacity using digital methods. This would be adding more weight to the public health bowl. </p>
<p>We need to make sure testing capacity remains high and think about making rapid testing more widely available in schools, workplaces and homes.</p>
<p>We could also retain the outdoor mask mandate to ensure at least the protection of masks is not also reduced in the public health bowl (the current roadmap indicates outdoor mask mandates will be dropped). </p>
<h2>How bad could it get?</h2>
<p>We modelled six different scenarios and ways of adjusting the weights in the scales to ensure we do not overwhelm the health system. </p>
<p>We used the NSW definition of “<a href="https://www.news.com.au/lifestyle/health/health-problems/nsw-hospitals-preparing-to-move-to-code-black-as-covid19-icu-admissions-surge/news-story/74a3b87803f9416a72c30d42d646390a">code black</a>” – when there are not enough ICU beds and alternative models of care are needed. We used this to forecast scenarios that could cause or avoid code black conditions. </p>
<p>The <a href="https://www.ozsage.org/icu-modelling/">best case scenarios</a> would only have a single relaxing of restrictions and retain high mask use, scale up contact tracing, and retain some reduction of mixing between people. </p>
<p>On the other hand, relaxing restrictions progressively between the 70% and 80% targets, or drastically increasing mixing, while reducing mask use at the same time, and not improving contact tracing, will be taking too many weights out of the public health bowl. This would allow the virus to overwhelm the health system. </p>
<p>In the worst case scenario, there may be five weeks of code black conditions. In the best case scenario, code black is avoided. </p>
<p>If ICU care cannot be provided, the death rate will increase because all people who need ICU cannot receive it. So it’s essential we avoid code black conditions. </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>There are an infinite number of scenarios we could model, but the general trade-off between both sides of the scales are demonstrated by the model. </p>
<p>All models have uncertainty in them. Models predict a range of possibilities under different conditions, and worst-case scenarios usually do not eventuate, because authorities use the models to inform the prevention of severe scenarios. They may also reinstate restrictions if the health system is under threat. </p>
<p>Models are a valuable tool to guide and provide transparency to decision-making. At the moment, the choices in NSW are between “not great” and “terrible”. But that will change. </p>
<p>In time, we will have better vaccines (matched to Delta), boosters and higher vaccination rates in all Australians including children. These will add more weight to the public health side of the scales, and hopefully prevent the virus from winning.</p><img src="https://counter.theconversation.com/content/167877/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre receives funding from NHMRC, MRFF and is a member of OzSAGE, which is a voluntary, unpaid role.</span></em></p>An 80% adult vaccination rate corresponds to 64% of the overall population, leaving plenty of people susceptible to the virus if restrictions ease too quickly.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1677782021-09-14T03:05:02Z2021-09-14T03:05:02ZFlattening the COVID curve: 3 weeks of tougher lockdowns in Sydney’s hotspots halved expected case numbers<p>In a pandemic, you expect that as new public health measures are introduced, there’s an observable impact on the spread of the disease. </p>
<p>But while that might have been the case in <a href="https://www.medrxiv.org/content/10.1101/2021.05.29.21258055v1">Melbourne’s second wave</a> last year, the highly contagious Delta variant is different. In Sydney’s current second wave, none of the increased restrictions seemed to directly decrease the spread of COVID-19. Until now. </p>
<p>Our modelling shows the curfew with the other restrictions introduced on the August 23 in the <a href="https://www.nsw.gov.au/covid-19/rules/affected-area">12 local government areas</a> (LGAs) of concern has worked to halt the rise in cases.</p>
<p>And this wasn’t due to the level of vaccinations achieved so far. It suggests other LGAs with rising case numbers should not rely solely on vaccination to cut case numbers in the short to medium term. They may need to tighten restrictions to get outbreaks under control.</p>
<h2>What are the tighter restrictions?</h2>
<p>Restrictions across Sydney have been in place in various forms <a href="https://theconversation.com/a-tougher-4-week-lockdown-could-save-sydney-months-of-stay-at-home-orders-our-modelling-shows-164483">since June 23</a>. But daily case numbers only plateaued in the 12 LGAs after the latest <a href="https://gazette.legislation.nsw.gov.au/so/download.w3p?id=Gazette_2021_2021-407.pdf">round of restrictions</a> were introduced on August 23. </p>
<p>These included:</p>
<ul>
<li>a curfew from 9pm to 5am, to reduce the movement of young people</li>
<li>restricting public access to hardware, garden supplies, office supplies and pet stores to click-and-collect only</li>
<li>closure of face-to-face teaching and assessment in most educational institutes that remained open</li>
<li>limiting outdoor exercise to one hour a day. </li>
</ul>
<p>These came on top of the existing restrictions in these 12 LGAs: only four reasons for leaving home (work/education, care/compassion, shopping for essential supplies, and exercise), 5km travel restrictions and the closure of non-essential shops. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-tougher-4-week-lockdown-could-save-sydney-months-of-stay-at-home-orders-our-modelling-shows-164483">A tougher 4-week lockdown could save Sydney months of stay-at-home orders, our modelling shows</a>
</strong>
</em>
</p>
<hr>
<h2>What impact did these restrictions have?</h2>
<p>There was a marked and significant decrease in the growth of the outbreak in the 12 LGAs of concern, starting a week after restrictions were introduced. </p>
<p>The expected growth rate of the Delta variant, in the absence of any controls, has a <a href="https://www.nytimes.com/2021/07/30/health/covid-cdc-delta-masks.html">R0 between 5 and 9</a>. This means one infected person would be expected to pass the virus on to five to nine others. </p>
<p>In the 12 LGAs, the Reff — which takes into account how many others one infected person will transmit the virus to with public health measures in place — reduced from 1.35 to 1.0. That means one case currently infects just one other person. </p>
<p>Cases numbers went from doubling every 11 days to case numbers being constant. </p>
<p>Without the additional restrictions introduced on August 23, the outbreak would have continued with close to an exponential increase (see the dashed orange line in Figure 1 below).</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/420956/original/file-20210914-25-2oouij.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420956/original/file-20210914-25-2oouij.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420956/original/file-20210914-25-2oouij.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420956/original/file-20210914-25-2oouij.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420956/original/file-20210914-25-2oouij.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420956/original/file-20210914-25-2oouij.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420956/original/file-20210914-25-2oouij.png?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">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Burnet Institute</span></span>
</figcaption>
</figure>
<p>Without these stricter measures we expect about 2,000 cases per day by now and about 4,000 per day by the end of the month instead of the 1,000 per day currently in these 12 LGAs. </p>
<p>It’s not possible to assign which specific part or parts of the restrictions package were important, or how they functioned. Nevertheless, it’s encouraging to see a direct association of restrictions and impact on COVID-19 cases. </p>
<h2>Vaccination rates have risen, but that’s not the reason</h2>
<p>Vaccination rates have steadily risen in the 12 LGAs of concern. Currently, <a href="https://www.nsw.gov.au/covid-19/find-the-facts-about-covid-19">74-86%</a> of those aged 16 and over have had least one dose, and 34-42% have had both doses. </p>
<p>These vaccination levels have increased substantially in the past month from about 45% with at least one dose and only 22% fully vaccinated. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pfizer-vaccinations-for-16-to-39-year-olds-is-welcome-news-but-astrazeneca-remains-a-good-option-166486">Pfizer vaccinations for 16 to 39-year-olds is welcome news. But AstraZeneca remains a good option</a>
</strong>
</em>
</p>
<hr>
<p>However, taking into account that it takes about two weeks for vaccination to be fully effective, we calculate that from August 23 to September 9, the increased vaccination rates will have only reduced the transmission of COVID by about 9% in the these LGAs. This is nowhere near enough to account for the dramatic change in the case numbers.</p>
<p>Interestingly, outside these 12 LGAs, there was a gradual slowing of the growth rate that very closely matched the decrease in growth expected from increased vaccine coverage – but no sign of the abrupt change seen in the 12 LGAs of concern.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/420957/original/file-20210914-22-1db3kxx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420957/original/file-20210914-22-1db3kxx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420957/original/file-20210914-22-1db3kxx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420957/original/file-20210914-22-1db3kxx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420957/original/file-20210914-22-1db3kxx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420957/original/file-20210914-22-1db3kxx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420957/original/file-20210914-22-1db3kxx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Burnet Institute</span></span>
</figcaption>
</figure>
<h2>What does this mean for other parts of Sydney?</h2>
<p>The gains associated with the more stringent restrictions are readily reversible. If they are lifted before vaccination can permanently reduce growth, COVID-19 cases could rapidly increase again in these 12 LGAs.</p>
<p>Meanwhile, COVID-19 cases outside the 12 LGAs of concern continue to grow strongly. With the current restrictions in place, cases in the rest of Sydney will soon overtake the cases within these 12 LGAs.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1436868283240574979"}"></div></p>
<p>Having slowed the growth in the 12 LGAs of concern, it would be devastating if the strong growth in the rest of the state resulted in hospitals being further overloaded and a substantial increase in severe disease and deaths. </p>
<p>It may be necessary to impose greater restrictions — such as curfews and restricting retail outlets such as hardware stores to click-and-collect only — in at least in some of the LGAs with higher growth rates to curb this growth.</p>
<h2>Why we need a vaccine-plus strategy</h2>
<p>Increased levels of vaccination remains both crucial and urgent to prevent death and severe disease from COVID-19. But we are some way from vaccination levels that can allow us to relax.</p>
<p>While the national plan aims for 70% and 80% initial vaccination coverage it’s not yet clear how vaccination levels will impact on case numbers, given we still don’t know how well vaccines reduce transmission of the Delta variant. </p>
<p>Our ability to keep case numbers in check will be highly dependent on the efficiency of ongoing public health measures such as the contact tracing. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-life-going-to-look-like-once-we-hit-70-vaccination-167049">What is life going to look like once we hit 70% vaccination?</a>
</strong>
</em>
</p>
<hr>
<p>As low case numbers remain a <a href="https://www.doherty.edu.au/uploads/content_doc/DohertyModelling_NationalPlan_and_Addendum_20210810.pdf">crucial component of a safe exit</a>, “lockdown” restrictions will be important for some time yet to maintain these lower levels in NSW and Victoria. </p>
<p>States and regions that have no community transmission should fiercely protect that status until vaccine levels reach very high levels or else they may also face stringent restrictions.</p>
<p>But lockdowns are clearly not sustainable in the long term. At best, they give health services a temporary breathing space until we get high levels of vaccine coverage.</p><img src="https://counter.theconversation.com/content/167778/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Burnet Institutes receives funding from the NSW Government for COVASIM modelling. Brendan Crabb receives funding from state and federal government for other projects. He is a member of the National COVID-19 Health and Research Advisory Committee research advisory committee and OzSAGE (Scientific Advisory Group for Emergencies).</span></em></p><p class="fine-print"><em><span>Mark Stoové is a recipient of a National Health and Medical Research Council (NHMRC) Senior Research Fellowship and has received investigator initiated research funding from Gilead Sciences and AbbVie, and consultant fees from Gilead Sciences, for activities unrelated to this work. He has also received funding to support research and program activities from the Commonwealth and Australian jurisdictional governments.</span></em></p><p class="fine-print"><em><span>Allan Saul does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The curfew and other tougher restrictions imposed on the 12 Sydney local government areas of concern have cut the expected COVID cases numbers by half so far.Allan Saul, Senior Principal Research Fellow (Honorary), Burnet InstituteBrendan Crabb, Director and CEO, Burnet InstituteMark Stoové, Head of HIV/STI research, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1677892021-09-14T00:48:36Z2021-09-14T00:48:36Z5 questions to ask yourself before you dob — advice for adults and kids, from an ethicist<p>COVID lockdown rules have thrust “dobbing” <a href="https://www.abc.net.au/news/2020-09-14/why-people-are-angered-by-covid-breakers-want-to-phone-police/12656920">into the spotlight</a>, with some asking whether Australia is <a href="https://www.theguardian.com/commentisfree/2021/aug/27/the-pandemic-is-creating-a-nation-of-dobbers-and-all-australians-reap-the-consequences">a nation of dobbers</a>.</p>
<p>But when is dobbing ethical and when is it wrong? This is a tricky question for adults and kids alike.</p>
<p>There is clearly a place for reporting wrongdoing — it can halt bad behaviour, see wrongdoers punished, help set societal expectations and <a href="https://www.skynews.com.au/australia-news/coronavirus/rulebreakers-ransom-the-future-dobbers-turn-neighbours-in-for-covid-breaches/news-story/89a512f60495a77f266ed7d2b0414666">prevent harm</a>. </p>
<p>Still, there are reasons to be cautious about dobbing. It isn’t <em>always</em> the right thing to do. </p>
<p>A lot of our ideas about dobbing are formed in childhood — and as any parent, carer or teacher knows, not all dobbing is warranted. </p>
<p>Here are five questions worth thinking about before blowing the whistle — and how to talk to kids about dobbing.</p>
<h2>1. Is it a clear violation?</h2>
<p>Think carefully about exactly what behaviour you’re dobbing on, what rule it breaks and be sure you haven’t made assumptions.</p>
<p>There is no point calling authorities if the behaviour you’re dobbing on has a reasonable explanation.</p>
<p>For example, there may be <a href="https://www.abc.net.au/news/2020-05-21/victoria-coronavirus-restrictions-reports-of-suspected-breaches/12270018">ambiguity in the rules</a> that you’ve failed to consider. </p>
<p>Or perhaps what you assumed was a violation wasn’t ever one at all, because the person had a valid exemption (such as a <a href="https://www.abc.net.au/news/2021-07-28/sa-mask-wearing-mandatory-but-dont-be-gladys-kravitz/100329124">medical reasons for not wearing a mask</a>). </p>
<p>Think before you dob.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-has-a-long-history-of-coercing-people-into-work-there-are-better-options-than-dobbing-in-156296">Australia has a long history of coercing people into work. There are better options than 'dobbing in'</a>
</strong>
</em>
</p>
<hr>
<h2>2. Is there a risk of genuine harm?</h2>
<p>There are plenty of rule violations we typically don’t report. You probably don’t call the police when you see someone jaywalking, or a car parked improperly. You might even think it’s “none of my business”.</p>
<p>When someone reports us to the authorities, they essentially take a position of authority. They aren’t the police, but they are policing our behaviour. Widespread dobbing can also make us feel like we are <a href="https://www.theguardian.com/commentisfree/2021/aug/27/the-pandemic-is-creating-a-nation-of-dobbers-and-all-australians-reap-the-consequences">continually being watched</a>. So it’s perhaps no surprise many of us find dobbing for low-level breaches somewhat affronting.</p>
<p>However, these reasons shouldn’t stop us reporting if there is a real risk of harm. </p>
<p>In a pandemic, rule breaking can have grave or even <a href="https://www.mamamia.com.au/breaking-covid-rules/">deadly</a> consequences, especially for vulnerable populations.</p>
<p>On this basis, repeated and flagrant violations are especially worth reporting. Such violations are also <a href="https://www.abc.net.au/news/2020-09-14/why-people-are-angered-by-covid-breakers-want-to-phone-police/12656920">unfair</a>; it is frustrating to see a person refuse to be bound by the rules the rest of us must accept.</p>
<p>For example, if a neighbour who is self-quarantining because they have tested positive to COVID seems to be having friends over, the authorities should be contacted. The risk of harm to others is very high.</p>
<h2>3. What’s my relationship to the person I am dobbing on?</h2>
<p>If you have an important relationship with the rule-breaker, that could be a reason to be cautious about reporting. For example, you might think carefully about <a href="https://www.abc.net.au/news/2020-09-14/why-people-are-angered-by-covid-breakers-want-to-phone-police/12656920">poisoning an otherwise good relationship with a neighbour</a> over a one-off or minor infraction. </p>
<p>But it’s also worth reflecting on whether you have a <em>bad</em> relationship with the person, or dislike them. If you’re dobbing on someone primarily because you don’t like them, or want them to get in trouble, you should examine your motivations closely. </p>
<p>This factor may play a role in public reporting on <a href="https://www.smh.com.au/national/nsw/i-am-not-going-to-waste-police-time-tony-abbott-fined-for-not-wearing-a-mask-20210911-p58qty.html">politicians’ mask wearing</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1436529275293736965"}"></div></p>
<p>If the community is taking on a reporting role, it needs to be done fairly.</p>
<h2>4. Can I resolve this informally?</h2>
<p>Most of us have, at least once, forgotten to grab a mask, or to put it on.</p>
<p>Sometimes, a gentle reminder might be all that’s required. If you think an informal approach is likely to work, that may be a better option.</p>
<p>Just as children should learn to try to resolve their differences before seeking out an adult adjudicator, many of us could do more to find informal resolutions before involving authorities.</p>
<p>Of course, people can respond unpredictably and aggressively, even to good-natured approaches. An obligation to report doesn’t require putting yourself in harm’s way.</p>
<p>If you’re unsure about your safety, I think it’s ethically defensible to go straight to a higher authority.</p>
<p>(And if you’re the person being dobbed on and you think “Why couldn’t they have just said something to my face? I would have been fine about it,” just remember: it may have been impossible for your accuser to know that.)</p>
<h2>5. What are my motivations?</h2>
<p>There is a little bit of the <a href="https://www.psychologytoday.com/au/blog/evolution-the-self/202101/righteous-vs-self-righteous">self-righteous</a> busybody in most of us. Dobbing can deliver a sense of authority and power (especially to those, like kids who are younger siblings, who may crave a fleeting sense of power because they have relatively little of it in their day to day life).</p>
<p>While it’s not easy to objectively survey your own motivations, it’s worth trying to make sure your heart’s in the right place.</p>
<h2>Talk to children about the difference between dobbing and whistleblowing</h2>
<p>We all learned about “dobbing” in the schoolyard. Children might encourage a social norm against dobbing because they think the rules are unfair, or because since they all break <em>some</em> rules, everyone is better off if nobody dobs. </p>
<p>But parents too can be frustrated by dobbing, such as when children seem to delight in getting a sibling into trouble. </p>
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<a href="https://images.theconversation.com/files/420726/original/file-20210913-23-z21j8i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/420726/original/file-20210913-23-z21j8i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420726/original/file-20210913-23-z21j8i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420726/original/file-20210913-23-z21j8i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420726/original/file-20210913-23-z21j8i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420726/original/file-20210913-23-z21j8i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420726/original/file-20210913-23-z21j8i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420726/original/file-20210913-23-z21j8i.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">Talk to your children about the difference between dobbing and whistleblowing.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Talk to your children about the difference between dobbing and whistleblowing. If the rule-breaking is clear and someone could be harmed, it’s important children know they should come forward. It’s always right to tell someone if you feel unsafe, or if someone is making you feel scared.</p>
<p>Equally though, not everything in life requires reporting to authorities. We all need to learn how to manage relationships with friends and siblings, and to resist the thrill of getting others into trouble.</p>
<h2>When you’re the one getting dobbed on</h2>
<p>An article on dobbing wouldn’t be complete without mentioning human beings are enormously clever about <a href="https://link.springer.com/article/10.1007/s10551-007-9641-8">justifying rule-breaking</a>. </p>
<p>We tell ourselves elaborate stories about how our “special” circumstances mean the rules shouldn’t apply to us. </p>
<p>When someone reports us, it can be tempting to feel outraged. But in doing so, we may avoid facing up to our own culpability. </p>
<p>Just as there is an ethics of dobbing, there is also an ethics of accepting responsibility.</p>
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Read more:
<a href="https://theconversation.com/troublemakers-and-traitors-its-no-fun-being-a-whistleblower-50755">Troublemakers and traitors - it's no fun being a whistleblower</a>
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<img src="https://counter.theconversation.com/content/167789/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>To dob or not to dob? What are our reporting obligations in a pandemic? An ethicist steps you through five questions to ask yourself before you dob (and the same rules apply for kids, too).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/1671862021-09-09T05:55:19Z2021-09-09T05:55:19ZThe Philippines passes the 2 million mark as COVID-19 cases surge in Southeast Asia<figure><img src="https://images.theconversation.com/files/420164/original/file-20210909-21-1m6blpt.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://photos.aap.com.au/">Mark R. Cristino/AP</a></span></figcaption></figure><p>Since May, the Delta variant of the SARS-CoV-2 virus has spread rapidly through most of Southeast Asia. </p>
<p>Of the ten member nations of <a href="https://www.dfat.gov.au/international-relations/regional-architecture/asean#:%7E:text=ASEAN%2520brings%2520together%2520ten%2520Southeast,and%2520Vietnam%2520%25E2%2580%2593%2520into%2520one%2520organisation.">ASEAN</a> (Association of Southeast Asian Nations), all but Brunei have experienced recent surges, most of which have seen the highest number of cases since the pandemic began. However, these nine countries have experienced different COVID-19 trends. </p>
<p>Thailand, Laos, Cambodia and Vietnam reported very low daily cases throughout 2020 but are all now experiencing record surges in cases. Vietnam and Thailand are reporting 13,000-14,000 cases daily.</p>
<p>Singapore had a huge first wave in early 2020, reaching 1,000 cases a day, mainly affecting migrant workers. The country has now fully vaccinated <a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">79% of its entire population</a> but is currently experiencing a spike in new cases. </p>
<p><a href="https://www.worldometers.info/coronavirus/country/myanmar/">Myanmar</a> had a surge in late 2020 and a lethal second wave this July, and cases are once again increasing.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-a-perfect-storm-of-events-is-turning-myanmar-into-a-super-spreader-covid-state-165174">How a perfect storm of events is turning Myanmar into a 'super-spreader' COVID state</a>
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<p>The three outliers that have struggled throughout most of the pandemic are Indonesia, Malaysia and the Philippines. Indonesia’s massive third wave is now in <a href="https://www.worldometers.info/coronavirus/country/indonesia/">steep decline</a> but more than 80,000 deaths have occurred since early June. </p>
<p><a href="https://www.worldometers.info/coronavirus/country/malaysia/">Malaysia</a> began to report an increase in cases in September 2020, which led to a peak in February and then to a huge ongoing third wave. </p>
<p>It’s now the Philippines that is cause for most concern in the region. The country has <a href="https://covid19.who.int/region/wpro/country/ph">reported</a> more than two million cases and 34,000 deaths. The daily case rate is the second highest in Southeast Asia, after Malaysia. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420183/original/file-20210909-13-tqz2sb.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/420183/original/file-20210909-13-tqz2sb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420183/original/file-20210909-13-tqz2sb.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=302&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420183/original/file-20210909-13-tqz2sb.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=302&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420183/original/file-20210909-13-tqz2sb.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=302&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420183/original/file-20210909-13-tqz2sb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=379&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420183/original/file-20210909-13-tqz2sb.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=379&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420183/original/file-20210909-13-tqz2sb.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=379&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://ourworldindata.org/covid-cases">Our World In Data/Johns Hopkins University</a></span>
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Read more:
<a href="https://theconversation.com/indonesia-records-its-highest-increase-in-covid-cases-and-numbers-are-likely-to-rise-again-before-they-fall-164063">Indonesia records its highest increase in COVID cases – and numbers are likely to rise again before they fall</a>
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<h2>The Philippines’ fourth wave</h2>
<p>The Philippines has experienced four waves of COVID-19. The first wave was modest, reaching a peak seven-day rolling average of 316 in <a href="https://www.worldometers.info/coronavirus/country/philippines/">early April 2020</a>. </p>
<p>From early June 2020, cases began to steadily increase leading into the second wave, which reached a peak of around 4,300 daily cases in late August. </p>
<p>The third wave reached a peak of 11,000 average daily cases in mid-April 2021. </p>
<p>However, it is the fourth wave, fuelled by the Delta variant, which is the most severe since the pandemic began and shows no sign of slowing. By September 8, the daily average had reached almost <a href="https://covid19.who.int/region/wpro/country/ph">19,000 cases</a>. </p>
<h2>How has the Philippines responded?</h2>
<p>The Philippines government imposed strict restrictions early in the pandemic. In mid-March 2020, President Rodrigo Duterte ordered Metro Manila and adjacent provinces to be put under “<a href="https://journals.sagepub.com/doi/full/10.1177/1868103421994261">enhanced community quarantine</a>” (ECQ). </p>
<p>Under ECQ, mass gatherings were prohibited, government employees worked from home, school and university classes were suspended, only essential businesses stayed open, mass transportation was restricted, and people were ordered to observe social distancing.</p>
<p>When ECQ was imposed on March 15, the country had reported just 140 cases and 12 deaths. Despite the restrictions, the totals reached 5,453 cases and 349 deaths one month later.</p>
<p>The government relied heavily on the police and military to ensure all health protocols were followed. This led critics to <a href="https://news.abs-cbn.com/news/07/22/20/f-as-in-falfak-ph-govt-gets-failing-marks-in-covid-19-response-from-these-experts">denounce</a> its militarist approach. Some civic groups providing assistance to communities faced harassment and attacks.</p>
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<img alt="Philippine President Rodrigo Duterte delivers his State of the Nation Address (SONA) in Quezon City, Metro Manila, Philippines, 26 July 2021." src="https://images.theconversation.com/files/420162/original/file-20210909-17-1ifleeu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420162/original/file-20210909-17-1ifleeu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420162/original/file-20210909-17-1ifleeu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420162/original/file-20210909-17-1ifleeu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420162/original/file-20210909-17-1ifleeu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420162/original/file-20210909-17-1ifleeu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420162/original/file-20210909-17-1ifleeu.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">Philippine President Rodrigo Duterte’s early response to COVID was among the strictest in the world.</span>
<span class="attribution"><a class="source" href="https://photos.aap.com.au/">Lisa Marie David/Pool/EPA</a></span>
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<p>Others criticised the government for taking a war-like approach that focused on identifying and punishing those who breached the rules rather than working cooperatively with, and providing financial support to, affected communities. </p>
<p>The term “<a href="https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdab234/6308520">pasaway</a>”, a Filipino word referring to a stubborn person, became a punitive target in government communications. Amid the lockdown, the term pasaway referred to people violating government-imposed health protocols.</p>
<p>At the end of May 2020, restrictions were <a href="https://thediplomat.com/2020/05/philippines-will-gradually-ease-lockdowns-as-testing-relief-payments-remain-stalled/">gradually loosened</a>, entailing the re-introduction of mass transportation and the opening of government offices and certain businesses. At this time, the average had risen to 578 daily cases, the highest since the pandemic began. </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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<p>The easing of restrictions was driven by economic factors – the unemployment rate had risen to <a href="https://psa.gov.ph/content/employment-situation-april-2020">17.7%</a> and <a href="https://www.pna.gov.ph/articles/1109217">26% of businesses</a> had closed.</p>
<p>Amid the gradual easing of quarantine restrictions, the Philippines saw an accelerating increase of COVID-19 cases. By the end of July, <a href="https://journals.sagepub.com/doi/full/10.1177/1868103421994261">75% of beds in intensive care units</a>, 82% of isolation beds and 85% of ward beds in Metro Manila were occupied.</p>
<h2>The fourth lockdown</h2>
<p>Fast forward to early August 2021 as daily cases surged past 8,000. A <a href="https://newsinfo.inquirer.net/1468403/lockdowns-in-ph-a-brief-history">new lockdown</a> was announced in the National Capital District, which comprises more than half the country’s economy. </p>
<p>By August 20, Manila and surrounding provinces had been in either ECQ (enhanced community quarantine) or modified community quarantine for a total of 170 days since the beginning of the pandemic. </p>
<p>On that day, <a href="https://www.aljazeera.com/news/2021/8/21/philippines-eases-lockdown-amid-record-covid-19-infections">restrictions were eased</a> even as daily cases surged to a record high of 17,231 and 317 deaths. More than 26% of samples tested positive, the country’s highest positivity rate so far.</p>
<p>The Philippines is trying desperately to spur activity in an economy that contracted a <a href="https://www.bworldonline.com/philippine-gdp-shrinks-by-record-9-5-in-2020/#:%7E:text=THE%2520PHILIPPINE%2520ECONOMY%2520suff,statistics%2520agency%2520said%2520on%2520Thursday.">record 9.5%</a> last year. </p>
<p>However, this risks having the health system totally overwhelmed. Many hospitals fear a mass exodus of nurses who are overworked, underpaid and constantly exposed to the virus. Filipino nurses are paid the <a href="https://iprice.ph/trends/insights/filipino-frontliners-earn-least-compared-asean-peers-data-shows/?nocache=1">lowest salaries</a> among nurses in Southeast Asia.</p>
<h2>What’s needed now?</h2>
<p>The response by the Philippines has often been among the strictest in the world. However, the imposition and lifting of restrictions have not always been based on the caseload. The easing of restrictions has been driven by a desire for economic revival. </p>
<p>With only <a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">14% of the population</a> fully vaccinated and case numbers <a href="https://cnnphilippines.com/news/2021/9/6/PH-covid-cases-new-record-high.html">continuing to soar</a>, the country is unlikely to vaccinate itself out of this outbreak before the health system is overwhelmed. </p>
<p>With cases now occurring in all 17 provinces, a clear national “<a href="https://www.smh.com.au/national/surging-global-cases-of-covid-19-threaten-australia-s-vaccine-exit-strategy-20210414-p57j9j.html">vaccine plus</a>” policy needs to be urgently implemented to save both lives and livelihoods. </p>
<p>This means while accelerating the vaccine rollout, there also need to be other preventive measures, such as mask wearing, physical distancing, attention to indoor ventilation, an effective test-trace-isolate system and, when necessary, localised lockdowns. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/from-ground-zero-to-zero-tolerance-how-china-learnt-from-its-covid-response-to-quickly-stamp-out-its-latest-outbreak-165963">From ground zero to zero tolerance – how China learnt from its COVID response to quickly stamp out its latest outbreak</a>
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<img src="https://counter.theconversation.com/content/167186/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>The Philippines has reported 34,000 deaths in the pandemic. It’s now in its fourth wave and with vaccination levels at just 14%, case numbers continue to soar.Michael Toole, Professor of International Health, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.