tag:theconversation.com,2011:/us/topics/public-health-measures-97280/articlesPublic health measures – The Conversation2023-08-23T20:09:39Ztag:theconversation.com,2011:article/2118192023-08-23T20:09:39Z2023-08-23T20:09:39ZWith COVID now endemic, modelling suggests targeted protection will be more effective than blanket measures<p>Interventions designed to limit the spread of COVID have been rolled back around the world. In New Zealand, the government removed <a href="https://www.beehive.govt.nz/release/all-covid-19-requirements-removed">all remaining public health measures</a> last week.</p>
<p>But although the <a href="https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic">emergency is over</a> and the disease is rapidly becoming endemic, the risk of <a href="https://www.nature.com/articles/d41586-023-02656-9">new variants</a> remains. COVID is still causing a significant health burden. </p>
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<p>Is there more we could be doing to prevent infections? </p>
<p>We <a href="https://time.com/6252107/we-dont-know-what-works-best-slow-spread-covid-19/">lack quality evidence</a> about how effective different interventions are. But simple maths shows that, in the long term, the prevalence of a highly infectious endemic virus like SARS-CoV-2 is quite difficult to budge.</p>
<h2>The basic reproduction number</h2>
<p>Back in 2020, we heard a lot about the basic reproduction number or R0. This is the average number of people someone infects when the whole population is susceptible to the disease. With a susceptible population, if R0 is above 1 the disease spreads exponentially. </p>
<p>This situation prompted governments around the world to implement intensive response measures, including lockdowns, to prevent health systems from becoming completely overwhelmed. </p>
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<p>The situation in 2023 is vastly different. Almost everyone has some form of immunity, acquired either from vaccination, previous infection, or both. However, people will eventually become susceptible again because of waning immunity and new variants.</p>
<p>This in turn means the virus won’t disappear altogether. Instead, the prevalence of infection will eventually reach what mathematicians call an endemic equilibrium. This is a state of balance: the loss of immunity due to its waning (and the cycle of births and deaths) is balanced by new immunity due to infections and vaccinations.</p>
<p>We don’t expect infection rates to be perfectly steady. Prevalence will rise and fall, influenced by seasons, school holidays and new subvariants, but it will always be pulled back towards the equilibrium level.</p>
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<h2>Controlling the disease</h2>
<p>Unlike measles or polio, it’s impossible to eliminate COVID with the tools currently available. But that doesn’t mean we can’t reduce its impacts. Effective control measures should reduce the number of contacts infectious people have, or the risk of infection per contact. And this should lower the level of the endemic equilibrium, meaning there are fewer infections.</p>
<p>That’s certainly true, but how much effect do control measures realistically have for a virus like SARS-CoV-2?</p>
<p>R0 for the Omicron variant has been <a href="https://www.nature.com/articles/s41467-023-39661-5">estimated between 6 and 10</a>. But the effective reproduction number – the average number of people someone infects at the present time – is much closer to 1. In New Zealand, this number has hovered between 0.8 and 1.2 for the past year. </p>
<p>This tells us something about the amount of immunity in the population. If an average person would infect six people in a fully susceptible population, but only infects one person in reality, that means five out of six people must be immune. If R0=10, then nine out of ten people must be immune, and so on.</p>
<h2>The maths of immunity</h2>
<p>People may have acquired immunity through vaccination, but the protection vaccines provide against infection with current Omicron variants is <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1164943/vaccine-surveillance-report-2023-week-23.pdf">relatively low and short-lived</a>. </p>
<p>The majority of immunity comes from previous infections, including infections in vaccinated people. This is called “<a href="https://www.who.int/news/item/01-06-2022-interim-statement-on-hybrid-immunity-and-increasing-population-seroprevalence-rates">hybrid immunity</a>” and it provides <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00801-5/fulltext">better protection</a> than infection or vaccination alone. (This doesn’t mean that getting infected to get immunity should ever be a goal, but it is an important side effect).</p>
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Read more:
<a href="https://theconversation.com/hybrid-immunity-a-combination-of-vaccination-and-prior-infection-probably-offers-the-best-protection-against-covid-183943">Hybrid immunity: a combination of vaccination and prior infection probably offers the best protection against COVID</a>
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<p>A consequence of this is that the fraction of the population that is immune at a given point in time is proportional to the number of infections per year. It turns out this allows us to estimate the benefit of interventions. </p>
<p>For example, suppose R0=6 and a control measure, such as isolation of all confirmed cases, reduces infectious contacts by 20%. That’s equivalent to reducing R0 to 4.8, which means the immune fraction is reduced from 83% of the population to 79%. That’s only a 5% relative reduction in the number of yearly infections, even though the transmission rate was reduced by 20%.</p>
<p>If R0=10, the maths is even more dismal: the same control measure only gives a 3% reduction in infections.</p>
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<img alt="This graph shows the relative reduction in infections as a result of a control measure to limit infectious contacts. For highly infectious diseases with a large R0, the curves are relatively flat on the left side of the graph, which means a moderate reduc" src="https://images.theconversation.com/files/543354/original/file-20230817-29-haki9e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543354/original/file-20230817-29-haki9e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=348&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543354/original/file-20230817-29-haki9e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=348&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543354/original/file-20230817-29-haki9e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=348&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543354/original/file-20230817-29-haki9e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=437&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543354/original/file-20230817-29-haki9e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=437&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543354/original/file-20230817-29-haki9e.png?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">
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<span class="caption">This graph shows the relative reduction in infections as a result of a control measure to limit infectious contacts. For highly infectious diseases with a large R0, the curves are relatively flat on the left side of the graph, which means a moderate reduction in infectious contacts has a relatively small effect on disease prevalence.</span>
<span class="attribution"><span class="source">Author provided</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>What’s the reason for this surprising finding? To begin with, the intervention reduces the number of infections, which is good. But an unfortunate side effect is that fewer people become immune, which means infections start to increase again. </p>
<p>Things eventually balance out at a lower level than without the intervention, but most of the benefit is sucked up by compensating for the lost immunity in the population.</p>
<p>For pathogens that are much less infectious than SARS-CoV-2, the opposite can be true. If R0=1.2, then a 20% reduction in infectious contacts would be enough to set the disease on a trajectory towards total elimination.</p>
<h2>Targeted protection</h2>
<p>The arguments above come from a mathematical model that captures the processes behind disease transmission in a simple way. Reality is more complicated. The susceptible-immune binary is a simplification because immunity is not black and white but shades of grey.</p>
<p>And populations are highly varied, not homogeneous. Infections will be more frequent in groups with high contact rates, which typically means younger people. Mathematically, that means infection rates will be harder to budge in younger groups and relatively easier to bring down in older groups.</p>
<p>Interventions targeted towards vulnerable groups are likely to be more effective than blanket measures. Importantly, although reducing infection rates in the long term is difficult, vaccines provide direct protection for those who take them and continue to be <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4445191">highly effective at preventing severe disease</a>. </p>
<p>None of this is an argument that we shouldn’t try to reduce the prevalence of endemic diseases like COVID. But it does mean we can’t assume that a reduction in the number of infectious contacts will translate to an equivalent reduction in infection rates.</p>
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<p>Decreasing the number of SARS-CoV-2 infections would be highly beneficial. It would reduce the acute health burden, the incidence of long COVID, and the level of risk for vulnerable groups.</p>
<p>But it’s not a goal we can afford to pursue at any cost. There is a range of healthcare needs competing for limited resources, so any measures need to be cost effective. And that means being realistic about the size of the benefits they’re likely to deliver.</p><img src="https://counter.theconversation.com/content/211819/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Plank receives funding from the New Zealand Ministry of Health for research related to mathematical modelling of COVID-19.</span></em></p><p class="fine-print"><em><span>Freya Shearer receives funding from the Australian National Health and Medical Research Council and the Australian Government Department of Health and Aged Care. </span></em></p><p class="fine-print"><em><span>James McCaw receives funding from the Australian Government Departments of Health and Foreign Affairs and Trade, the Australian Research Council and the National Health and Medical Research Council. He is an invited expert member of the Communicable Disease Network of Australia and between January 2020 and May 2022 was an invited expert member of the Australian Health Protection Principal Committee.</span></em></p><p class="fine-print"><em><span>James Wood receives funding the National Health and Medical Research Council for projects on COVID-19. He previously received funding from NSW Health (2021-23) the federal government (2020-21) and from WHO Western Pacific Regional Office (2020) as part of COVID responses. He is a current member of the Australian Technical Advisory Committee on Immunisation. </span></em></p>As COVID finds its equilibrium, infection rates will rise and fall, influenced by seasons, school holidays and new subvariants. Managing the risk is complex and needs to be cost effective.Michael Plank, Professor in Applied Mathematics, University of CanterburyFreya Shearer, Research Fellow, Epidemic Decision Support, The University of MelbourneJames McCaw, Professor in Mathematical Biology, The University of MelbourneJames Wood, Professor, epidemiological modelling of infectious diseases, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1930072022-10-31T12:35:35Z2022-10-31T12:35:35ZWho sees what you flush? Wastewater surveillance for public health is on the rise, but a new survey reveals many US adults are still unaware<figure><img src="https://images.theconversation.com/files/492137/original/file-20221027-41745-jsbvpb.jpg?ixlib=rb-1.1.0&rect=582%2C97%2C4809%2C3492&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Whether a wastewater sample is taken at the street level or a treatment plant affects the size of the group of people it represents.</span> <span class="attribution"><span class="source">University of Louisville</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Flush and forget? Not if you have a toilet that flushes to one of <a href="https://arcg.is/1aummW">over 3,000 sites around the world</a> where researchers are using wastewater to track SARS-CoV-2, the virus that causes COVID-19.</p>
<p>But <a href="https://doi.org/10.1021/acsestwater.1c00405">what do members of the public actually know</a> about wastewater surveillance? And what do they think about researchers tracking what they send down the drain at their home?</p>
<p>While not new, this form of public health surveillance has gained attention since the early days of the COVID-19 pandemic. Tracking the rise and fall of the level of coronavirus in wastewater provides officials with a snapshot of how much SARS-CoV-2 is circulating in a community. Together with data on case counts, health officials can use this information to guide their local actions – for example, choosing to increase testing or vaccination campaigns. Where available, immunocompromised individuals may also find it useful to access data for their local area <a href="https://arcg.is/1aummW">via online dashboards</a> as they try to manage their overall exposure risk.</p>
<p>In our recent study, <a href="https://scholar.google.com/citations?user=FZnnXt0AAAAJ&hl=en&oi=ao">my</a> <a href="https://scholar.google.com/citations?user=AXvaPbMAAAAJ&hl=en&oi=sra">colleagues</a> <a href="https://scholar.google.com/citations?user=9XQ1LJoAAAAJ&hl=en&oi=sra">and</a> I <a href="https://doi.org/10.1371/journal.pone.0275075">explored public perceptions</a> of using sewer samples for monitoring community health in the United States. Using an online survey of more than 3,000 adults in the U.S., we were able to gauge respondents’ general boundaries in this expanding field of community monitoring. We didn’t find much consensus, suggesting the need for more public outreach and education.</p>
<h2>What happens after you flush</h2>
<p>Households connected to sewer lines pay utilities to remove their waste. In the absence of a sewer problem, most people are able to flush and forget.</p>
<p>Sewage typically travels through publicly owned infrastructure to a treatment plant operated by a utility. Researchers and officials currently sample wastewater not just for the coronavirus but also <a href="https://doi.org/10.1136/bmj.o2211">for polio</a> <a href="https://doi.org/10.1038/s41598-022-20076-z">and flu monitoring</a>. Samples are usually collected with permission of the utility, but no one asks the households being sampled if they are willing to participate. <a href="https://www.epa.gov/npdes/municipal-wastewater">Treatment plants conduct</a> other kinds of Environmental Protection Agency-mandated testing, such as looking for pollutants in wastewater.</p>
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<p>In our survey, we found that a large portion of the public was unaware that sewage surveillance takes place for public health purposes in many areas. Respondents were more aware of other forms of public health monitoring, such as restaurant inspections and water quality testing.</p>
<p>That about half of respondents didn’t even know sewage monitoring is happening underscores the fact that no one asks individual residents for permission to test an area’s wastewater.</p>
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<p>We found more support for monitoring external threats in wastewater, such as diseases, environmental toxins and terrorist threats like anthrax. Fewer people expressed support for tracking lifestyle behaviors, such as smoking or use of birth control, diet, and indicators of mental health, <a href="https://doi.org/10.1016/j.scitotenv.2022.155961">including stress hormones</a>, which are emerging areas of monitoring not yet tracked in many local areas.</p>
<p>Our results suggest that the public may not want unchecked monitoring of their toilet flushes.</p>
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<p>When we asked people to consider the various scales at which wastewater surveillance can happen, we found a general theme of “the bigger, the better.” Sampling from a larger area is a way to protect privacy, since one person’s information is mixed in with many others’.</p>
<p>More respondents said they were OK with monitoring an entire city compared with monitoring at the level of individual residences. Notably, more respondents who self-reported living in urban areas endorsed monitoring the entire city than those who self-reported living in suburban areas.</p>
<h2>Looking at flushes is not going away</h2>
<p>My colleagues and I did not find significant nationwide fear about sewage surveillance among our survey respondents. But those surveyed certainly had opinions that officials may want to consider more deeply when it comes to wastewater tracking. </p>
<p>While wastewater surveillance in urban or suburban areas provides good coverage for an overall picture of COVID-19 in the community, coverage is still not fully inclusive of the entire public. It would not capture data from the approximately 15% of the United States population whose homes <a href="https://www.unwater.org/publications/who/unicef-joint-monitoring-program-water-supply-sanitation-and-hygiene-jmp-progress-0">do not have a sewer connection</a>. That group includes people who have septic tanks in more rural areas. </p>
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<span class="caption">Sampling wastewater can be done at a range of scale from a single building to a whole neighborhood or city.</span>
<span class="attribution"><span class="source">University of Louisville</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>How protected is individual privacy? Confirming that SARS-CoV-2 is present in a city is different than confirming it’s present in a neighborhood, and that’s different from confirming it’s present in a dormitory or prison building. Looking at a wider area ensures the sample stays anonymous. At the moment, there are no health privacy protection laws or regulations about sewage surveillance in the U.S. Officials rely on goodwill from utilities to gain access to wastewater and the health information it holds, and often partner with commercial laboratories, <a href="https://biobot.io">such as Biobot</a>.</p>
<p>Wastewater data is immensely valuable. However this public health surveillance tool is used in the future, our survey suggests that there’s room for more education and conversation with the public. After all, they’re the one’s being monitored.</p><img src="https://counter.theconversation.com/content/193007/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rochelle H. Holm receives funding from the Rockefeller Foundation, as well as grants from the James Graham Brown Foundation and the Owsley Brown II Family Foundation. </span></em></p>Public health officials monitor sewage in local communities to track COVID, polio, flu and more. But no one asks the people being monitored for their permission – raising some questions and concerns.Rochelle H. Holm, Associate Professor of Medicine, University of LouisvilleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1906152022-09-22T16:33:38Z2022-09-22T16:33:38ZMonkeypox case numbers are falling, but that doesn’t mean it’s going away anytime soon<figure><img src="https://images.theconversation.com/files/486067/original/file-20220922-13134-sl18qt.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5613%2C3731&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccinating at-risk groups is just one of the public health strategies many countries are using. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medicine-vaccination-healthcare-concept-doctor-syringe-745024336">Ground Picture/ Shutterstock</a></span></figcaption></figure><p>The global outbreak of monkeypox has been going on for nearly five months now. In that time, <a href="https://ourworldindata.org/monkeypox">over 60,000 people</a> have been infected in over 100 countries. Most of the cases have been in young men and the disease has disproportionately affected <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7132e3.htm">men who have sex with men</a>.</p>
<p>The outbreak appears to have peaked in mid-August. Since then, the number of <a href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20220907_monkeypox_external_sitrep-5.pdf">cases has been falling steadily</a>. It’s likely that the drop in infections can be attributed to the combined effect of the many public-health measures deployed to combat the virus’s spread. </p>
<p>But while it’s promising to see that case numbers have fallen, monkeypox isn’t likely to go away anytime soon. So it’s important to continue using all the public health measures that have been deployed against it.</p>
<p>One of the main strategies many countries have been using to curb the spread of monkeypox is <a href="https://www.gov.uk/government/publications/monkeypox-vaccination-resources/protecting-you-from-monkeypox-information-on-the-smallpox-vaccination">vaccinating people at high risk of catching the virus</a> and people who have been exposed to the virus. The smallpox vaccine has been used, as the monkeypox virus is closely related to the smallpox virus. </p>
<p>It’s thought the smallpox vaccine offers around <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hsr2.798">85% protection against monkeypox</a>. However, it’s not certain how effective it is against the current monkeypox strain or <a href="https://www.science.org/content/article/how-effective-monkeypox-vaccine-scientists-scramble-clues-trials-ramp">how long the vaccine protection lasts</a>. </p>
<p>It will probably stop some monkeypox infections (and it has the added benefit of reducing the <a href="https://www.nature.com/articles/s41577-022-00775-4">severity of symptoms in those already infected</a>). But the recent fall in infections in the UK is probably not <a href="https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-7#part-3-monkeypox-vaccination">due to the vaccine programme alone</a>. </p>
<p>The factor that has probably played a more significant role in the fall in infection numbers is changes in people’s behaviour. A <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7135e1.htm?s_cid=mm7135e1_e&ACSTrackingID=USCDC_921-DM88652&ACSTrackingLabel=MMWR%20Early%20Release%20-%20Vol.%2071%2C%20August%2026%2C%202022&deliveryName=USCDC_921-DM88652">recent US survey</a> of men who have sex with men found that around half had reduced their number of sex partners and avoided one-off sexual encounters. The latter may be significant in reducing case numbers and curbing the spread. </p>
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<p>A separate <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7135e2.htm?s_cid=mm7135e2_w">US study</a> suggested that having 40% fewer one-off partnerships could result in a 20-31% decrease in infections among men who have sex with men. One-off partnerships lead to around half of daily monkeypox transmission despite only accounting for 3% of daily sexual partnerships and 16% of daily sex acts. </p>
<p>This change in behaviour may, therefore, have had a big effect on delaying the spread of the outbreak. The danger then is what happens when people’s behaviour reverts to what it was before the current outbreak began. This could lead to infection numbers rebounding.</p>
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<img alt="A queue of men waiting to receive the monkeypox vaccine." src="https://images.theconversation.com/files/486070/original/file-20220922-30154-898w7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486070/original/file-20220922-30154-898w7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486070/original/file-20220922-30154-898w7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486070/original/file-20220922-30154-898w7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486070/original/file-20220922-30154-898w7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486070/original/file-20220922-30154-898w7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486070/original/file-20220922-30154-898w7p.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">It’s important that public health measures stay in place to protect those most at risk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-wait-line-receive-monkeypox-vaccine-2180628993">Ringo Chiu/ Shutterstock</a></span>
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</figure>
<p>So far, most of the infections have been limited to men who have sex with men. We have <a href="https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-7">not seen much spread to other parts of the population</a> yet, but this could still happen. The possibility of monkeypox spreading further, especially in networks of people with multiple sexual partners, is currently <a href="https://www.ecdc.europa.eu/en/news-events/monkeypox-situation-update">considered to be highly likely</a>. This is why effective public health messaging, early detection, contact tracing, isolation and vaccinations are all essential to keeping the outbreak in check.</p>
<p>And though infections with the current monkeypox variant are <a href="https://www.gov.uk/guidance/hcid-status-of-monkeypox">generally less severe</a> than with <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010141">previous outbreaks</a> caused by other variants, that doesn’t mean monkeypox should be treated lightly – especially considering the current variant seems to be <a href="https://www.nature.com/articles/s41577-022-00775-4">more transmissible</a>. Infections have also led to many serious complications, including <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2207323">acute kidney injury and myocarditis (inflammation of the heart muscle)</a>, as well as <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7138e1.htm?s_cid=mm7138e1_e&ACSTrackingID=DM89842-USCDC_921&ACSTrackingLabel=MMWR%20Early%20Release%20-%20Vol.%2071%2C%20September%2013%2C%202022&deliveryName=DM89842-USCDC_921">encephalomyelitis (inflammation of the brain and spinal cord)</a>. Of the European cases reported, 6% were hospitalised – and of these, a third <a href="https://cdn.who.int/media/docs/librariesprovider2/monkeypox/monkeypox_euro_ecdc_draft_jointreport_2022-09-14.pdf?sfvrsn=ddad86b5_3&download=true">required treatment from a doctor</a>. </p>
<h2>The future of the outbreak</h2>
<p>While the number of monkeypox infections appears to be in retreat, globally, it’s not likely to disappear anytime soon. It may fester at low levels in the population and re-emerge intermittently with future outbreaks. </p>
<p>Eliminating monkeypox would require sustained efforts from health authorities and the public to stamp it out over several years. We must be careful not to stigmatise the condition lest we drive it underground and make it more difficult for infected people to seek healthcare.</p>
<p>We should also be mindful that monkeypox continues to circulate in parts of <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007791">central and west Africa</a> where it has been endemic for years. This year there have been <a href="https://www.who.int/publications/m/item/multi-country-outbreak-of-monkeypox--external-situation-report--5---7-september-2022">over 500 cases and ten deaths</a>. </p>
<p>These numbers are probably underestimates because of the limitations of disease surveillance in these countries. There remains a risk that monkeypox could be imported from these areas, as has <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.38.1800509?crawler=true">happened in recent years</a>. </p>
<p>Unfortunately, there are a lack of monkeypox vaccination and disease control programmes in Africa. It has also been suggested that the end of smallpox vaccination programmes there before 1980 may have <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007791">contributed to the resurgence of monkeypox</a> in the years afterwards. </p>
<p>Consequently, if the ultimate aim is to eradicate the threat of monkeypox, far greater disease prevention and control measures will be needed in countries where the disease is endemic.</p><img src="https://counter.theconversation.com/content/190615/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Lee has previously received research funding from the National Institute for Health Research. He is a member of the UK Faculty of Public Health and the Royal Society for Public Health.</span></em></p>Public health measures have played a big role in curbing the current outbreak.Andrew Lee, Professor of Public Health, University of SheffieldLicensed 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>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1564398397020221440"}"></div></p>
<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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<p>
<em>
<strong>
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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<p>
<em>
<strong>
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>
<hr>
<p>
<em>
<strong>
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/1861692022-08-14T13:14:54Z2022-08-14T13:14:54ZWhy it’s important to tell people that monkeypox is predominately affecting gay and bisexual men<figure><img src="https://images.theconversation.com/files/478989/original/file-20220812-2527-jwfwgd.JPG?ixlib=rb-1.1.0&rect=444%2C22%2C2550%2C2097&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People inquire about receiving a monkeypox vaccine at an outdoor walk-in clinic in Montréal on July 23, 2022. The World Health Organization has declared the virus a global health emergency.
</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/why-it-s-important-to-tell-people-that-monkeypox-is-predominately-affecting-gay-and-bisexual-men" width="100%" height="400"></iframe>
<p>Monkeypox virus, or MPXV, is an <a href="https://doi.org/10.1371/journal.pntd.0010141">emerging threat</a> to public health. The World Health Organization recently declared the current outbreak a <a href="https://doi.org/10.1001/jama.2022.12513">global public health emergency</a>.</p>
<p>For decades, several African countries have experienced ongoing <a href="https://doi.org/10.1371/journal.pntd.0007791">outbreaks of MPXV</a>, driven primarily by contact with animals and transmission within households. However, before last year, most people in Europe and North America had never even heard of the disease. That was until the current outbreak among gay, bisexual and other men who have sex with men.</p>
<h2>Debates over the epidemiology of MPXV</h2>
<p>Over the past several months, <a href="https://www.cdc.gov/poxvirus/monkeypox/reducing-stigma.html">a controversy</a> has raged about whether it’s OK to say that the current MPXV outbreak is primarily affecting gay and bisexual men, and that it is primarily being spread through close personal contact, such as sex. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/metaphors-matter-why-changing-the-name-monkeypox-may-help-curb-the-discriminatory-language-used-to-discuss-it-185343">Metaphors matter: Why changing the name 'monkeypox' may help curb the discriminatory language used to discuss it</a>
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<p>As a social and behavioural epidemiologist working with marginalized populations, including gay and bisexual men, I believe it’s important that people know that sexual and gender minority men are the primary victims of this MPXV outbreak. I believe this knowledge will help us end the outbreak before it bridges into other communities. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/478988/original/file-20220812-1300-s3i976.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Yellow ovals (monkeypox virus particles) spread over a blue cell background" src="https://images.theconversation.com/files/478988/original/file-20220812-1300-s3i976.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/478988/original/file-20220812-1300-s3i976.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=589&fit=crop&dpr=1 600w, https://images.theconversation.com/files/478988/original/file-20220812-1300-s3i976.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=589&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/478988/original/file-20220812-1300-s3i976.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=589&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/478988/original/file-20220812-1300-s3i976.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=740&fit=crop&dpr=1 754w, https://images.theconversation.com/files/478988/original/file-20220812-1300-s3i976.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=740&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/478988/original/file-20220812-1300-s3i976.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=740&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">Monkeypox particles in an infected cell.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>For reference, more than <a href="https://doi.org/10.1056/NEJMe2210673">90 per cent of cases in non-endemic countries</a> have been transmitted through intimate sexual contact, and the vast majority of cases are among gay men. Very few cases are linked to community transmission. </p>
<p>While these statistics are undisputed, some have feared that identifying sexual behaviour as the primary cause of current MPXV transmission <a href="https://www.usatoday.com/story/life/health-wellness/2022/08/04/monkeypox-cases-spread-sti-std-stigma/10172342002/">would dampen the public health response</a>. Others have warned that connecting MPXV to an already stigmatized community will <a href="https://www.npr.org/2022/07/26/1113713684/monkeypox-stigma-gay-community">worsen stigma towards gay sex</a>. </p>
<h2>Non-sexual transmission is possible, and a considerable threat</h2>
<p><a href="https://www.cdc.gov/poxvirus/monkeypox/transmission.html">It is true that MPXV can transmit through more</a> casual contact and through fomites (<a href="https://www.news-medical.net/health/What-are-Fomites.aspx">inanimate objects</a> on which some microbes can survive, such as bed linens, towels or tables). </p>
<p>However, months into the current outbreak, we have not seen these routes emerge as important pathways of transmission. This may be due to <a href="https://www.newsweek.com/monkeypox-transmission-has-changed-scientists-dont-know-why-airborne-1715276">changes in the fundamental transmission dynamic of MPXV</a> or due to enhanced cleaning procedures implemented in response to COVID-19 in places such as gyms and restrooms. </p>
<h2>Why it’s crucial to know MPXV affects gay and bisexual men</h2>
<p>Informing the public about MPXV is important because public opinion plays an important role in <a href="https://doi.org/10.1001/jama.2020.11623">shaping public health policies</a>, such as who gets access to vaccines and what interventions are used to stop disease transmission. </p>
<p>A <a href="https://doi.org/10.1186/s12889-022-13539-5">recent study</a> conducted by my team aimed to demonstrate the importance of public health education by asking Canadians to participate in a discrete choice experiment. </p>
<figure class="align-center ">
<img alt="An arm with a tattoo of a flower and leaves being injected with a syringe" src="https://images.theconversation.com/files/478993/original/file-20220812-3855-u3hkeu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/478993/original/file-20220812-3855-u3hkeu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/478993/original/file-20220812-3855-u3hkeu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/478993/original/file-20220812-3855-u3hkeu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/478993/original/file-20220812-3855-u3hkeu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/478993/original/file-20220812-3855-u3hkeu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/478993/original/file-20220812-3855-u3hkeu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A man receives a monkeypox vaccine at an outdoor walk-in clinic in Montréal on July 23, 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>We asked participants to choose between two hypothetical public health programs across eight head-to-head comparisons. Descriptions for each hypothetical program identified the number of years of life gained by patients, the health condition it addressed and the population it was tailored for. </p>
<p>From our analyses of this data, we learned a lot about how the public wants public health dollars to be spent and how their knowledge and bias shapes these preferences. There were five major takeaways:</p>
<ol>
<li><p><a href="https://doi.org/10.1016/j.socscimed.2014.11.022">People preferred interventions that added more years to participants’ life expectancy</a>. In fact, for one year of marginal life gained, there was a 15 per cent increase in the odds that participants chose that program. </p></li>
<li><p>We found that people tended to favour interventions that focused on treatment rather than prevention. While this approach is emotionally intuitive, large bodies of evidence suggest that <a href="https://www.rwjf.org/en/library/research/2009/09/cost-savings-and-cost-effectiveness-of-clinical-preventive-care.html">it is more cost-effective to prevent disease than to treat it</a>. As the old saying goes: An ounce of prevention is worth a pound of cure. </p></li>
<li><p>People generally preferred interventions for common chronic diseases — such as heart disease, diabetes and cancer — and were <a href="http://dx.doi.org/10.1136/bmjopen-2019-029747">less likely to favour interventions for behaviour-related conditions</a>, such as sexually transmitted infections. </p></li>
<li><p>People generally preferred programs focused on the general population as opposed to those tailored for key <a href="https://doi.org/10.1016/j.vhri.2018.05.004">marginalized populations</a>. In fact, people were least likely to prefer interventions tailored for sexual and gender minorities. </p></li>
<li><p>The bias against behavioural interventions and those tailored for key populations was overcome when the programs addressed a health condition that was widely understood to be linked to the population the program was tailored to. For example, people were more likely to support interventions for sexually transmitted infections when these interventions were tailored for people engaged in sex work or for gay and bisexual men.</p></li>
</ol>
<p>This study highlights why it is important to educate the public about health inequities. People are smarter, more pragmatic, and more compassionate than we give them credit for. If we take the time to share evidence with them about the challenges that stigmatized communities face, they will be more willing to support policies and efforts to address these challenges. </p>
<p>Ending MPXV quickly is critical, especially since the virus <a href="https://doi.org/10.1038/s41591-022-01907-y">has the potential to evolve</a> in ways that could make the disease more infectious. <a href="https://doi.org/10.1186/s40249-022-01007-6">Protecting gay and bisexual men first, protects everyone</a>.</p>
<p>We should, of course, always be aware of the potential harms and the corrosive effects of stigma. However, in public health, honesty really is the best policy.</p><img src="https://counter.theconversation.com/content/186169/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kiffer George Card receives funding from the Canadian Institutes for Health Research, the Canadian Research Coordinating Committee, Michael Smith Health Research BC, and Social Sciences and Humanities Research Council. He is affiliated with Simon Fraser University's Faculty of Health Sciences, The Institute for Social Connection, The Community-based Research Centre, the GenWell Project, The Island Sexual Health Society, and the Mental Health and Climate Change Alliance.</span></em></p>Engaging in open and honest dialogue with the public to increase understanding of health inequities has never been more important.Kiffer George Card, Assistant Professor in Health Sciences, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1846822022-07-25T16:03:40Z2022-07-25T16:03:40ZHow COVID-19 lockdown measures — and their outcomes — varied in cities around the world<figure><img src="https://images.theconversation.com/files/472884/original/file-20220706-21-970rb8.jpg?ixlib=rb-1.1.0&rect=32%2C0%2C5375%2C3607&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Toronto, lockdown measures asked residents to remain at home.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>During the COVID-19 pandemic, Chinese cities have repeatedly imposed lockdowns following their <a href="https://www.globaltimes.cn/page/202205/1266838.shtml">central government’s stubborn pursuit of Zero-COVID</a>. But lockdowns weren’t limited to authoritarian regimes such as China. Many democracies also imposed some form of lockdowns to curb the virus transmission. </p>
<p>How effective were they? Was it worth it? And who was the most adversely affected? </p>
<p>These are meaningful questions to reflect on, especially as drastic COVID-19 measures <a href="https://www.theguardian.com/commentisfree/2022/jun/01/covid-pandemic-end-vaccinated-countries-disease">have been lifted as the severity</a> of the <a href="https://doi.org/10.1038/d41586-021-00396-2">virus’s impact has waned</a>.</p>
<p>We’ve been studying the disparate responses to COVID-19 undertaken by three major cities: <a href="https://euc.yorku.ca/research-project/the-city-after-covid-19-comparing-vulnerability-and-urban-governance-in-chicago-toronto-and-johannesburg/">Johannesburg, Toronto and Chicago</a>.</p>
<p>We examined the nature and impact of public health measures on various populations in these cities. We found “lockdown” to be an imprecise description for the range of restrictions put in place. Lockdown meant different things in different places, but regardless of the context, they disproportionately afflicted those who are and the disadvantaged.</p>
<h2>Johannesburg: Traumatic impact</h2>
<p><a href="https://www.gcro.ac.za/outputs/occasional-papers/detail/johannesburg-and-its-epidemics-can-we-learn-from-history/">South Africa’s hard lockdown in 2020</a> — lasting from March 27 to April 30 — was modelled on Wuhan’s. Strictly enforced by the announcement of <a href="https://www.reuters.com/world/africa/safricas-covid-state-disaster-end-midnight-president-ramaphosa-2022-04-04/">a National State of Disaster, which gave government extraordinary powers</a>, it banned all outdoor activities except for essential services. It was a blunt instrument applied uniformly across the country, although patterns of infection varied widely by region and locality. </p>
<p>The lockdown had a devastating impact on the economy, people’s livelihoods and <a href="https://www.statssa.gov.za/?p=15273">food security</a>. On May 1, 2020, South Africa introduced a <a href="https://sacoronavirus.co.za/covid-19-risk-adjusted-strategy/">five-level risk-adjusted strategy</a>. The response remained national in scope, with the <a href="https://www.gtac.gov.za/wp-content/uploads/2022/06/SA-COVID-19-Report_Final_Online.pdf">National Coronavirus Command Council</a> issuing directives to the provincial governments, which manage health care, and local governments, which provide services in distressed communities.</p>
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<a href="https://images.theconversation.com/files/473029/original/file-20220707-18-f598gv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two armed soldiers patrolling a dusty street" src="https://images.theconversation.com/files/473029/original/file-20220707-18-f598gv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473029/original/file-20220707-18-f598gv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473029/original/file-20220707-18-f598gv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473029/original/file-20220707-18-f598gv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473029/original/file-20220707-18-f598gv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473029/original/file-20220707-18-f598gv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473029/original/file-20220707-18-f598gv.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>
<figcaption>
<span class="caption">Soldiers patrol the streets of Soweto, a township in Johannesburg, during a lockdown instated to combat the spread of the coronavirus.</span>
<span class="attribution"><span class="source">(AP Photo/Themba Hadebe)</span></span>
</figcaption>
</figure>
<p>The lockdown may have delayed the first wave by a month or so, but its <a href="https://www.dailymaverick.co.za/article/2021-03-28-its-such-a-botch-sas-vaccine-delays-and-covid-lockdown-proved-deadly-prof-alex-van-den-heever/">economic impact was more traumatic</a> than the impact of the illness. This was especially so for those who did not have the option of <a href="https://cramsurvey.org/wp-content/uploads/2021/05/2.-Benhura-M.-_-Magejo-P.-2021-Who-cannot-work-from-home-in-South-Africa_-Evidence-from-wave-4-of-NIDSCRAM..pdf">home-based work</a>. There was a <a href="https://citylockdowndiaries.wordpress.com/publications/">difference between how the lockdown was experienced</a> by, for example, households in informal settlements and middle-class households in the suburbs. </p>
<p>Social disparity in South Africa, one of the world’s most unequal societies, increased throughout the pandemic. There was a shadow pandemic of violence against women, with South African police reporting a <a href="https://doi.org/10.1007/s40615-021-01146-w">37 per cent increase in gender-based crime</a>. Children in poor communities <a href="https://resep.sun.ac.za/wp-content/uploads/2020/06/Van-der-Berg-Spaull-2020-Counting-the-Cost-COVID-19-Children-and-Schooling-15-June-2020-1.pdf">lost more than a year of schooling</a>, while those from affluent communities moved online. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lockdown-didnt-work-in-south-africa-why-it-shouldnt-happen-again-147682">Lockdown didn't work in South Africa: why it shouldn't happen again</a>
</strong>
</em>
</p>
<hr>
<h2>Toronto: Swift and decisive</h2>
<p>Toronto’s <a href="https://doi.org/10.1080/07078552.2022.2047483">early response to COVID-19</a> was swift and decisive, but not as restrictive as in Johannesburg. <a href="https://doi.org/10.1093/cjres/rsac022">Subject mostly to provincial oversight in public health management</a>, the city <a href="https://toronto.citynews.ca/2021/03/11/timeline-a-year-of-pandemic-life/">closed schools and restaurants, cancelled professional sporting events and restricted most public life</a>, leaving intact only emergency and essential services. </p>
<p>Throughout subsequent waves of surges, Toronto oscillated between opening up and shutting down. This gave the city a reputation of imposing lockdowns that were <a href="https://www.bbc.com/news/world-us-canada-57079577">longer and stricter than most</a>.</p>
<p>The lockdown had <a href="https://doi.org/10.1093/cjres/rsac022">uneven impacts across Toronto</a>. There were <a href="https://www.utoronto.ca/news/researchers-probe-covid-19-s-uneven-impact-racialized-and-immigrant-communities-peel-region">significant differences</a> between rich and poor, office and essential workers, households saddled with caregiving responsibilities and those without. </p>
<p><a href="https://doi.org/10.1177/17579759211038258">Community responses</a> varied across the region as the <a href="https://blackhealthalliance.ca/wp-content/uploads/Perspectives-on-Health-Well-Being-in-Black-Communities-in-Toronto-Experiences-through-COVID-19.pdf">impact of the pandemic intensified</a> in <a href="https://www.wellesleyinstitute.com/wp-content/uploads/2022/03/The-Impact-of-COVID-19-on-Mental-Health-and-Well-being-A-Focus-on-Racialized-Communities-in-the-GTA.pdf">health and economic terms</a>.</p>
<p>There was a visible <a href="https://www.theglobeandmail.com/canada/article-how-the-pandemic-is-highlighting-canadas-class-divide/">class divide</a> in Canada’s urban communities. <a href="https://www.vawlearningnetwork.ca/docs/Systemic-Racism-Covid-19-Backgrounder.pdf">Racialized and lower-income people</a> experienced the lockdown measures as an additional, often existential, burden, while residents in higher-income households experienced temporary inconvenience.</p>
<p>Eventually, restrictive measures were enacted across all three levels of government. These restrictions contributed to the so-called “freedom convoy,” <a href="https://www.theguardian.com/world/2022/feb/20/canadian-police-ottawa-truckers-protest">which occupied parts of Ottawa in protest in 2022</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/anti-vax-protest-or-insurrection-making-sense-of-the-freedom-convoy-protest-176524">Anti-vax protest or insurrection? Making sense of the 'freedom convoy' protest</a>
</strong>
</em>
</p>
<hr>
<h2>Chicago: Softer measures</h2>
<p>Comparatively, Chicago had a soft lockdown. The city issued a stay-at-home order from March 20 to April 30, 2020, but exempted many essential activities, including exercising outdoors and shopping for groceries. It closed restaurants, offices and public schools, <a href="https://www.chicagobusiness.com/crains-content-studio/lessons-learned-private-schools-adopt-best-practices-stay-open-during">but many resource-rich private schools remained open and offered in-person instruction</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473034/original/file-20220707-24-ngb99k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two people stand behind a podium, in the background a graph titled FLATTEN THE CURVE" src="https://images.theconversation.com/files/473034/original/file-20220707-24-ngb99k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473034/original/file-20220707-24-ngb99k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473034/original/file-20220707-24-ngb99k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473034/original/file-20220707-24-ngb99k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473034/original/file-20220707-24-ngb99k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473034/original/file-20220707-24-ngb99k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473034/original/file-20220707-24-ngb99k.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">Chicago Mayor Lori Lightfoot speaks after Illinois Gov. J.B. Pritzker announced a shelter-in-place order to combat the spread of COVID-19 on March 20, 2020.</span>
<span class="attribution"><span class="source">(AP Photo/Charles Rex Arbogast)</span></span>
</figcaption>
</figure>
<p>The stay-at-home order had a devastating impact on the economy (especially the service sector) and on <a href="https://www.npr.org/2020/06/09/869074151/chicago-tackles-covid-19-disparities-in-hard-hit-black-and-latino-neighborhoods">Black and Latino neighbourhoods</a>, where many residents who worked in essential services lived. For higher-income households, the stay-at-home order brought some inconvenience, but many also enjoyed the benefit of working from home — a trend that continued even after the city lifted all restrictions in 2022.</p>
<h2>Weighing the pros and cons</h2>
<p>Our preliminary research suggests that the experience of COVID-19 should at least give authorities pause before introducing lockdowns as a blanket strategy. We accept that they were generally intended to “flatten the curve,” providing time to prepare for the anticipated waves of infection. </p>
<p>The COVID-19 lockdowns were understandable as a public health measure in a time of insecurity and ignorance of the emerging disease threat. But we now know that they most deeply affected the poor and other vulnerable groups, worsening social inequalities. They were often a blunt measures, relying on quickly dated information on virus transmission and implemented at geographic scales that didn’t account for how the disease spread. </p>
<p>The negative impacts of hard lockdowns may have exceeded their benefits. They intensified social conflict, eroded democratic practice and <a href="https://doi.org/10.1080/07078552.2021.2000210">undermined trust in politics and governance</a> at a time when they were most needed. </p>
<p>Lockdowns should be a measure of last resort but, if they are unavoidable in future pandemics, governments must consider more targeted approaches, put in place a support system to cushion the impact on vulnerable citizens and keep democratic ground rules in place.</p><img src="https://counter.theconversation.com/content/184682/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roger Keil receives funding from the Urban Studies Foundation. </span></em></p><p class="fine-print"><em><span>Philip Harrison receives funding from the Urban Studies Foundation.</span></em></p><p class="fine-print"><em><span>Xuefei Ren receives funding from the Urban Studies Foundation. </span></em></p>Examining how COVID-19 lockdowns and stay-at-home orders were implemented in Toronto, Johannesburg and Chicago reveals the impact they had on vulnerable communities.Roger Keil, Professor, Faculty of Environmental and Urban Change, York University, CanadaPhilip Harrison, Professor School of Architecture and Planning, University of the WitwatersrandXuefei Ren, Professor, Sociology and Global Urban Studies, Michigan State UniversityLicensed 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>
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<span class="attribution"><a class="source" href="https://www.aihw.gov.au/">Australia's Health 2022</a></span>
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</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>
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<span class="attribution"><a class="source" href="https://www.aihw.gov.au/">Australia's Health 2022</a></span>
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</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>
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<span class="attribution"><a class="source" href="https://www.aihw.gov.au/">Australia's Health 2022</a></span>
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<p>This may mean it will be even harder to close the gap between the health of First Nations Australians and the rest of the population.</p>
<p>The overall pattern about mental health is mixed, with raw numbers suggesting no statistically significant change in long-term patterns.</p>
<p>However, there were upticks of reported psychological distress in early 2022, and so the underlying pattern may not yet be clear.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-slashed-health-care-use-by-more-than-one-third-across-the-globe-but-the-news-isnt-all-bad-148537">COVID-19 slashed health-care use by more than one-third across the globe. But the news isn't all bad</a>
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<h2>Outcomes have been good so far, but we’re still in the pandemic</h2>
<p>Extended border closures led to <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-022-00807-7">stress on those separated from their families</a>, and so too did the <a href="https://onlinelibrary.wiley.com/doi/10.1111/ajr.12845">state border closures</a>. Overall, however, outcomes from the pandemic have been good so far.</p>
<p>But the Australian Institute of Health and Welfare report was released in the same week the 10,000th Australian COVID death was reported. The ongoing deaths from COVID are barely reported in the media and appear to be ignored by policymakers.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1539931604906549248"}"></div></p>
<p>The previous prime minister <a href="https://7news.com.au/lifestyle/health-wellbeing/scott-morrison-declares-were-not-going-back-to-lockdowns-as-australias-covid-19-cases-surge-to-an-all-time-high-c-5035678">dichotomised potential COVID responses</a> into lockdowns or “living with COVID”. This was never the case. </p>
<p>A more nuanced response – supplementing a drive to increase vaccination rates with mask mandates and density limits when required, and improving ventilation – was always part of the public health response.</p>
<p>Unfortunately, third dose vaccination rates are sitting at <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/covid-19-vaccine-rollout-update-6-july-2022.pdf">around 70% of those eligible</a>, leaving many Australians dangerously exposed to the virus. </p>
<p>There should be a return to the <a href="https://insightplus.mja.com.au/2021/34/vaccination-alone-not-enough-to-control-covid-19/">“vaccine-plus” strategy</a>, where we focus on lifting vaccination rates and implementing other public health measures – such as mask mandates or density limits – where required.</p>
<p>Otherwise we risk all the good work done in 2020 and 2021 being completely negated and more unnecessary deaths occurring, especially among the most disadvantaged.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-covid-hit-disadvantaged-communities-harder-now-long-covid-delivers-them-a-further-blow-183908">First, COVID hit disadvantaged communities harder. Now, long COVID delivers them a further blow</a>
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</p>
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<img src="https://counter.theconversation.com/content/186461/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While COVID has become less deadly, it has disproportionately claimed the lives of older and poorer Australians. Others have missed out on necessary preventative care during the pandemic.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1809262022-06-09T14:13:05Z2022-06-09T14:13:05ZAdapting to life with COVID-19: Lessons our own immune system can teach us about public health information<figure><img src="https://images.theconversation.com/files/467858/original/file-20220608-21-d97uhv.jpg?ixlib=rb-1.1.0&rect=16%2C150%2C3562%2C2317&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">With mask mandates and vaccine requirements lifting, public health information remains crucial so people can weigh their own COVID-19 risks.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span></figcaption></figure><p>The last of Ontario’s COVID-19 mask mandates — which have still been in effect in settings like hospitals and public transit — are scheduled to expire on June 11. While border protocols, such as random testing, have been extended at least until the end of June, long lineups at Toronto’s Pearson International Airport are <a href="https://www.thestar.com/politics/federal/2022/06/07/needless-covid-19-screening-is-causing-canadas-airport-delays-critics-charge-while-ottawa-says-its-following-the-science.html">fuelling calls to lift them</a>.</p>
<p>COVID-19 is still with us, but just as the virus has changed since 2020, so have our personal and public reactions toward it. As personal risk assessment becomes more important with fewer and fewer public health mandates, there are good lessons to be learned from how our immune system works.</p>
<h2>Clear communication</h2>
<p>In immunology, the way a threat — such as a virus — is presented to the immune system matters as much as the threat itself. The same can be said of public health messaging: its effectiveness rests on how it’s presented.</p>
<p>The <a href="https://www.youtube.com/watch?v=LmpuerlbJu0">immune system</a> is a diverse collection of tissues, cells, and molecules that — at its core — specialize in highly co-ordinated communication. Antibodies and T-cells are key in assessing how the immune system responds to a novel virus, like SARS-CoV-2. To recognize and respond to the threat, those cells need specific messages clearly presented in specific ways. This leads to tailored protective actions, including those carried out by antibodies.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/LmpuerlbJu0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An animated look at how the body’s immune system fights infections.</span></figcaption>
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<p>Antibodies act as specialized flags that not only identify viral particles so the immune system can find them, but also block those particles from infecting healthy cells. </p>
<p>Parts of the immune system remain fairly constant, but other parts are adaptive and can be tweaked in response to threats. T-cells and B-cells are highly sensitive to this, and shape adaptive immunity.</p>
<p>To make antibodies, B-cells must be able to recognize a fragment of the virus. A special class of T-cells called helpers must <a href="https://doi.org/10.1038/nri3084">present the virus fragment to the B-cell in a very specific way</a>. This leads to antibody-mediated protection.</p>
<p>Likewise, for a different class of T-cells — called killers — a small piece of the virus needs to be shown in a slightly different way. This specific presentation of the viral fragment is crucial to generating adaptive immunity, which then mobilizes the process of destroying the virus. </p>
<p>This is precisely what vaccines are designed to enable, but in a safe context avoiding actual virus exposure. Successful immune response gives us an army of trained killers that only recognize that one unique virus fragment.</p>
<p>Clearly, <a href="https://www.theatlantic.com/health/archive/2020/08/covid-19-immunity-is-the-pandemics-central-mystery/614956/">details matter</a> to the immune system. Change what that virus fragment looks like (mutate it), and that same trained immune system may let the virus slip by and need more guidance to <a href="https://doi.org/10.1038/s41586-021-04085-y">re-adapt</a>. And it does adapt. Continuously. </p>
<h2>Adapting messages</h2>
<p>The same concept applies in public health messaging and <a href="https://doi.org/10.1057/s41599-020-00645-1">science communication</a>. When the context changes, so should the strategy and the messaging to the public.</p>
<p>Over the course of the pandemic, its context has changed as the virus has changed. The more is learned about the virus, the better the public health messaging can be tailored. If that is done well, it can help minimize the impact of the virus on communities, at least in theory.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/467854/original/file-20220608-24-9xkmys.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man in a suit wearing a face mask and four people with cameras pointed at him, shot from above with light fixture in the foreground" src="https://images.theconversation.com/files/467854/original/file-20220608-24-9xkmys.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467854/original/file-20220608-24-9xkmys.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467854/original/file-20220608-24-9xkmys.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467854/original/file-20220608-24-9xkmys.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467854/original/file-20220608-24-9xkmys.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467854/original/file-20220608-24-9xkmys.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467854/original/file-20220608-24-9xkmys.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"></a>
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<span class="caption">Dr. Kieran Moore, Ontario’s chief medical officer of health, wears a mask as he arrives at Queen’s Park in Toronto in April. He is greeted by media, also wearing masks.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>In early 2020, local viral spread was low and our understanding of transmission was nascent. <a href="https://www.nytimes.com/2021/04/27/science/face-mask-guidelines-timeline.html">Public health advice</a> reflected this. Today, community viral spread is high and we understand its transmission routes. Public messaging should have adapted to this knowledge. Instead, masks and other <a href="https://www.cbc.ca/news/canada/toronto/covid19-ontario-march-9-mask-mandates-1.6378148">protections have been dropped</a>.</p>
<p>Paramount from a public health strategy perspective, we have learned that this virus is <a href="https://doi.org/10.1016/S0140-6736(21)00869-2">mostly spread</a> via <a href="https://doi.org/10.1126/science.abd9149">airborne routes</a>, in the same way that cigarette smoke moves and lingers. Picture it just like that!</p>
<p>But what <a href="https://doi.org/10.1038/d41586-022-00925-7">hasn’t been done well</a> is shaping public understanding of this to inform a strong mental model that can be applied to assess personal and public risk. We know mask <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html">quality matters</a>, with K/N95 as the <a href="https://thetyee.ca/Analysis/2022/01/06/N95-Mask-We-Should-Be-Wearing/">best choice</a>. We know indoor air <a href="https://doi.org/10.1063/5.0057100">ventilation and filtration</a> matters. And we know that vaccines work to train your immune system, <a href="https://doi.org/10.1056/NEJMc2119912">with three</a> or <a href="https://doi.org/10.1056/NEJMc2202542">four doses</a> being ideal in this particular context.</p>
<h2>Adapting to COVID-19</h2>
<p>As the sixth wave waned in Canada, the message was that it was time to try “<a href="https://www.cbc.ca/news/politics/canada-more-sustainable-covid-response-1.6339609">living with COVID-19</a>.”</p>
<p>This shift in messaging has consequences. It accepts that recurrent waves of the virus will circulate, with the accompanying impact on our personal and community health. This includes the unknown impact of emerging subvariants and future novel variants. To minimize those risks, there is a need to not just surrender to living with the virus and hope for a return to normal, but to <a href="https://www.stcatharinesstandard.ca/news/niagara-region/2022/02/11/no-more-hopium-learning-to-live-with-covid-19.html">adapt to living with COVID-19</a>.</p>
<p><a href="https://covid19-sciencetable.ca/ontario-dashboard/">Without accurate testing data</a>, it’s hard to tell the number of cases in the community right now. However, we do know that subvariants of Omicron <a href="https://news.un.org/en/story/2022/04/1116182">BA.4 and BA.5</a> have <a href="https://www.publichealthontario.ca/-/media/Documents/nCoV/voc/covid-19-omicron-risk-assessment.pdf?sc_lang=en">been detected in Canada</a>. </p>
<p>Despite the effectiveness of current vaccines, vaccination will not solve this on its own. More tools are on the way in the form of <a href="https://doi.org/10.1101/2022.02.14.480449">variant-tailored</a>, <a href="https://doi.org/10.1038/d41573-022-00074-6">pan-coronavirus</a> and <a href="https://doi.org/10.1101/2022.01.24.477597">mucosal</a> vaccines (<a href="https://doi.org/10.1016/j.cell.2022.02.005">nasal sprays</a>) and <a href="https://www.canada.ca/en/health-canada/news/2022/01/health-canada-authorizes-paxlovidtm-for-patients-with-mild-to-moderate-covid-19-at-high-risk-of-developing-serious-disease.html">antivirals</a>. </p>
<p>Right now, the virus <a href="https://health-infobase.canada.ca/covid-19/wastewater/">continues to circulate in the community</a>, with too little understanding of where the risk is. COVID-19 and public health protections require a <a href="https://www.forbes.com/sites/carminegallo/2020/12/10/the-virologist-who-created-a-swiss-cheese-metaphor-to-explain-the-pandemic-has-a-message-for-educators/?sh=50c33b376335">layered approach</a>.</p>
<h2>The path back to ‘normal’</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/467856/original/file-20220608-12-uvt0vb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A long line of people with luggage" src="https://images.theconversation.com/files/467856/original/file-20220608-12-uvt0vb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467856/original/file-20220608-12-uvt0vb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467856/original/file-20220608-12-uvt0vb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467856/original/file-20220608-12-uvt0vb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467856/original/file-20220608-12-uvt0vb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467856/original/file-20220608-12-uvt0vb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467856/original/file-20220608-12-uvt0vb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&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">People wait in line to check in at Pearson International Airport in Toronto on May 12. Major delays have affected passengers at security and clearance points.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
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<p>The path back to a sense of normal doesn’t involve ignoring the threat, and letting it pass, hoping the damage will be manageable. Rather, much like the immune system depends on clear communication to adapt, the path back to normal may depend on public education about vaccination, risk mitigation — such as knowing when it’s <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/about-non-medical-masks-face-coverings.html">best to mask</a> and which mask to choose — and policy development to improve <a href="https://www.whitehouse.gov/ostp/news-updates/2022/03/23/lets-clear-the-air-on-covid/">indoor air quality</a>. </p>
<p>Our immune system adapts to a changing virus by showing our T- and B-cells what has mutated in the latest variant. It learns from the most recent and best available evidence, and creates the best-prepared army of precision antibodies and killer cells. We must enable this at the public response level too.</p>
<p>As individuals, we are the B- and T-cells of our community immunity right now. We need clearly presented strategic information to recognize and precisely assess the threat. As the pandemic continues — and yes, it does continue — public and personal behaviour needs to evolve with the changing pandemic context, with <a href="https://www.scienceupfirst.com/share/">clear public health messaging</a> and infrastructure action. </p>
<p>Like the pieces of immune system, we are all in this together, not individually.</p><img src="https://counter.theconversation.com/content/180926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam J. MacNeil receives funding from the Natural Sciences and Engineering Research Council of Canada (NSERC), New Frontiers in Research Fund (NFRF), Canadian Institutes of Health Research (CIHR), Mitacs, Ontario & the Canada Foundation for Innovation (CFI). </span></em></p>To help people make informed decisions about ongoing COVID-19 risks, public health messaging needs to adapt as the pandemic evolves, just as immune systems adapt to new viruses and variants.Adam J. MacNeil, Associate Professor of Immunology, Brock UniversityLicensed 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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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-has-killed-5-600-australians-this-year-and-the-pandemic-isnt-over-ethics-can-shape-our-response-182765">COVID has killed 5,600 Australians this year and the pandemic isn't over. Ethics can shape our response</a>
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<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>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1522441592266964992"}"></div></p>
<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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<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>
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<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>
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</em>
</p>
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<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/1811322022-04-19T14:55:13Z2022-04-19T14:55:13Z‘Living with COVID-19’ must be more than an empty phrase: Individuals need tools to manage BA.2 and future waves<figure><img src="https://images.theconversation.com/files/458247/original/file-20220414-24-xhspoa.JPG?ixlib=rb-1.1.0&rect=18%2C119%2C3300%2C2527&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ontario Chief Medical Officer of Health Kieran Moore arrives to speak at a press conference at Queen’s Park on April 11, 2022. Ontario lifted most COVID-19 restrictions in March.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/-living-with-covid-19--must-be-more-than-an-empty-phrase--individuals-need-tools-to-manage-ba-2-and-future-waves" width="100%" height="400"></iframe>
<p>When Ontario lifted public health protective measures in March, the expectation was that we might see a <a href="https://www.ctvnews.ca/mobile/health/coronavirus/bump-in-covid-19-cases-not-unexpected-as-public-health-measures-lifted-tam-says-1.5825004?cache=/5-things-to-know-for-monday-september-30-2019-1.4616452">small but manageable bump in COVID-19 cases</a>. At the same time, Canadians were being told that it was time to learn to “<a href="https://www.cbc.ca/news/canada/toronto/ontario-covid19-march-8-2022-1.6376793">live with COVID</a>.” </p>
<p>The decision to lift the public health protective measures happened while many countries in Africa, <a href="https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---15-february-2022">Europe and South Asia</a> were going through another Omicron-like surge, caused by one of its subvariants, BA.2. Many of these countries also removed their public health protective measures. In <a href="https://arstechnica.com/science/2022/04/cdc-study-spotlights-utter-failure-of-chinas-covid-zero-policy-in-hong-kong/">Hong Kong</a>, while the restrictions were being removed, BA.2 hit like a tsunami with massive casualties among people age 60 years and over. <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7115e1.htm?s_cid=mm7115e1_w">China</a> was also dealing with an Omicron BA.2 surge. </p>
<p>In Ontario, authorities had hoped the BA.2 wave would somehow pass by. However, instead of the <a href="https://beta.ctvnews.ca/local/toronto/2022/4/5/1_5849600.amp.html">expected small bump in cases</a>, current predictions are at <a href="https://toronto.ctvnews.ca/ontario-likely-seeing-100k-to-120k-new-covid-19-cases-each-day-head-of-science-table-says-1.5851187">100,000 cases per day</a>, which is likely an underestimation due to lack of wider testing. <a href="https://www.cbc.ca/news/canada/toronto/ontario-daily-covid-file-april-5-2022-1.6408672">COVID-19 hospitalizations have surpassed 1,000 in Ontario</a>. </p>
<p>Although Ontario is now better prepared to handle higher cases of <a href="https://news.ontario.ca/en/release/1001411/ontario-continues-to-add-hospital-beds-and-build-up-health-workforce">hospitalization and intensive care admissions</a>, its challenge may now be to handle large absenteeism in health care and other sectors. The recent chaos in <a href="https://www.thetimes.co.uk/article/covid-chaos-at-uk-airports-spreads-to-border-officials-b0h0x5vqm">British airports</a> and at other borders illustrates the potential impact of BA.2.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-its-normal-for-covid-19-vaccine-immunity-to-wane-and-how-booster-shots-can-help-171786">Why it's normal for COVID-19 vaccine immunity to wane, and how booster shots can help</a>
</strong>
</em>
</p>
<hr>
<p>The surge of BA.2 cases in Ontario is related not only to the subvariant’s characteristics, but also to the <a href="https://www.scientificamerican.com/article/vaccines-remain-effective-against-ba-2-but-protection-from-infection-wanes-over-time/">waning of vaccine-induced immune protection</a> against the infection (including in those that had a booster late last year) and, above all, the removal of public health protective measures, such as the mask requirement. </p>
<h2>What do we know about the BA.2 subvariant?</h2>
<figure class="align-right ">
<img alt="A watercolour illustration of a light blue coronavirus with red spikes" src="https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Omicron BA.2 is now the dominant variant worldwide.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>BA.2 is believed to have emerged around the same time as the other Omicron variants. The significance of BA.2 became clear with the release of a <a href="https://en.ssi.dk/-/media/arkiv/subsites/covid19/risikovurderinger/2022/risk-assesment-of-omicron-ba2.pdf?la=en">report from Denmark</a> in late January, indicating that this subvariant is 30 per cent more transmissible than Omicron, but with the same virulence (the potential to cause severe disease). </p>
<p>By early April, the World Health Organization reported that BA.2 was the <a href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20220405_weekly_epi_update_86.pdf?sfvrsn=3f01a460_4&download=true">dominant variant worldwide</a>. A few more Omicron subvariants have already made their debuts, such as BA.1.1, BA.3 <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-who-press-conference-13-April-2022">BA.5</a> and BA2+. Cases of recombination among Omicron subvariants and Delta, such as <a href="https://www.forbes.com/sites/williamhaseltine/2022/04/06/two-more-members-of-the-omicron-family-to-keep-an-eye-on/?sh=5076c6664fea">Omicron XE</a>,<a href="https://nationalpost.com/news/who-says-it-is-analyzing-two-new-omicron-covid-sub-variants">BA.4</a> <a href="https://theconversation.com/deltacron-what-scientists-know-so-far-about-this-new-hybrid-coronavirus-179442">XD</a> and XF, have emerged. </p>
<p>Omicron XE is getting a lot of attention, as its <a href="https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---5-april-2022">transmissibility is 10 per cent greater</a> than that of BA.2 (or approximately 50 per cent more transmissible than the original Omicron variant, BA.1). It was first detected on <a href="https://time.com/6165297/xe-variant-what-to-know/">Jan. 19 in the United Kingdom</a>.</p>
<p>Research awaiting peer review indicates that <a href="https://doi.org/10.1101/2022.02.19.22271112">re-infection by BA.2</a> is low. However, in those who are re-infected with BA.2, one in four had a prior BA.1 infection. The emergence of variants such as Omicron XE, which results from <a href="https://www.forbes.com/sites/williamhaseltine/2022/03/10/a-new-process-of-sars-cov-2-variation-uncovered-intragenomic-recombination/?sh=66b151a3c8cd">recombination of the genomes of Omicron BA.1 and BA.2</a> in addition to new mutations, suggests that wide circulation of BA.2 among BA.1 impacted populations can significantly contribute to the evolution of SARS-CoV-2. The BA.4 subvariant is the result of <a href="https://www.forbes.com/sites/williamhaseltine/2022/03/16/an-omicron-omicron-recombinant-ba4/?sh=7f1065a059b0">recombination</a> between Omicron BA.1 and BA.3. </p>
<p>Reports that have not yet been peer-reviewed indicate that BA.2 has a slightly higher (30 per cent) <a href="https://arxiv.org/pdf/2202.05031.pdf">immune evasion capability</a> (ability to bypass immunity from vaccines or previous infections) and higher <a href="https://doi.org/10.1101/2022.03.26.22272984">viral shedding</a> (release of virus particles by an infected person) than Omicron. These factors could explain its higher transmissibility than Omicron, while the severity and symptoms remain similar to <a href="https://www.theguardian.com/world/2022/apr/07/omicron-variant-does-cause-different-symptoms-from-delta-study-finds?CMP=oth_b-aplnews_d-1">Omicron</a>.</p>
<h2>What does it mean to ‘live with COVID-19?’</h2>
<p>Two years into the pandemic, there’s a lot that experts have learned about SARS-CoV-2. However, humans keep enabling its circulation, <a href="https://theconversation.com/how-new-covid-19-variants-emerge-natural-selection-and-the-evolution-of-sars-cov-2-176030">giving the virus the chance to evolve</a>. We are not in a position to predict the future of this pandemic, just yet. </p>
<p>Since the beginning of the pandemic, the public was asked to listen to the advice of experts and public health officials. Now the public is being told to learn to live with COVID-19. At the same time, <a href="https://www.thewhig.com/news/covid-19-testing-remains-limited-as-sixth-wave-hits-ontario">testing has become limited</a> and little to no <a href="https://globalnews.ca/news/8753953/covid-19-canada-6th-wave-risk-assessment-challenges/">information on daily COVID-19 cases</a> is now provided in some parts of Canada. So, any chance for the public to check the COVID “weather,” get a forecast and prepare for it is diminished. We are now living in a COVID fog.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three people in face masks and shields carrying bags and packages." src="https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.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">Hong Kong Chief Executive Carrie Lam, left, holds a package of coronavirus prevention materials to be delivered to people during an event on April 2, 2022. Hong Kong authorities asked the entire population to voluntarily test themselves for COVID-19 at home for three days in a row.</span>
<span class="attribution"><span class="source">(AP Photo/Kin Cheung)</span></span>
</figcaption>
</figure>
<p>In the summer of 2020, as Ontario was contemplating lifting lockdowns, public health experts looked for key indicators to sustain such measures. A <a href="https://globalhealth.harvard.edu/evidence-roundup-why-positive-test-rates-need-to-fall-below-3/">three per cent positivity rate</a> was considered to be a sufficiently safe community transmission rate to remove the public health protective measures. We are in a better position now with around <a href="https://covid19tracker.ca/vaccinationtracker.html">86 per cent vaccine coverage</a> among those over five years old, and many people have grown accustomed to face masks, so it’s likely that we can handle a higher positivity rate. The question is, how much higher? </p>
<p>The answer would be a useful indicator for the public to make COVID-19 protection choices. This is not about living with a <a href="https://nationalpost.com/opinion/rupa-subramanya-doug-ford-must-resist-covid-zero-zealots">zero-COVID policy</a>. It is about empowering the public with up-to-date information and providing the right tools to weather a COVID-19 storm. Individuals cannot protect themselves on their own, nor should they have to.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-next-with-face-masks-keep-wearing-them-in-public-wear-the-best-mask-available-and-pay-attention-to-fit-177237">What's next with face masks? Keep wearing them in public, wear the best mask available and pay attention to fit</a>
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<p>We do have vaccines, but their protection against infection wanes with time. In addition, it does not seem like <a href="https://www.reuters.com/article/us-health-coronavirus-israel-study-idCAKCN2LY06B">we can boost our way out</a> of this pandemic. We have the antiviral medications, such as <a href="https://covid-vaccine.canada.ca/info/paxlovid-en.html">Paxlovid</a>, but they need to be administered in the early days of an infection. But without testing, how would one know when to take it? </p>
<p>In addition, <a href="https://www.theglobeandmail.com/canada/article-covid-19-antiviral-drug-paxlovid-being-dispensed-at-low-rates-across/">distribution and administration</a> of this medication has hit a wall in Canada. We have the masks that work very well, but the empty phrase “<a href="https://www.ctvnews.ca/health/coronavirus/get-used-to-it-outbreaks-give-americans-taste-of-living-with-virus-1.5854754">living with the virus</a>” has muddled the significance of this simple, and yet protective, measure.</p>
<p>Instead of minimizing or dismissing this new wave of COVID-19, as well as future waves, we need for strategies to deal with new COVID-19 waves in an efficient way. The U.S. <a href="https://www.popsci.com/health/fda-advisors-meet-future-vaccine-strategy/">Food and Drug Administration</a> recently held a meeting to brainstorm new ways to provide sustainable immune protection in the face of an ever-changing SARS-CoV-2 virus. Canada should follow suit. </p>
<p>Governments should follow the science and provide the means to live with virus: information about the emergence of new variants, number of daily cases, access to testing and solutions for longer-lasting immune protection with different vaccine technologies. Then we can all live a healthy life with COVID-19.</p><img src="https://counter.theconversation.com/content/181132/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dasantila Golemi-Kotra 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>Instead of minimizing current or future waves of COVID-19, we need strategies to deal with new variants efficiently. Only then can we live with the virus in a healthy way.Dasantila Golemi-Kotra, Professor, Biology, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772382022-03-10T20:57:37Z2022-03-10T20:57:37ZShould public health measures like masking continue beyond the pandemic? Data on viral infections shows their benefits<figure><img src="https://images.theconversation.com/files/450321/original/file-20220307-84100-jira1v.jpg?ixlib=rb-1.1.0&rect=166%2C98%2C2717%2C1675&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman wears a face mask as she walks by the sculpture ‘The Illuminated Crowd’ on a street in Montréal. Vulnerable people may benefit from measures like face masks even after the COVID-19 pandemic.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span></figcaption></figure><p>Public health measures, such as masking and physical distancing, that have been a high-profile part of the COVID-19 response for the past two years <a href="https://www.cbc.ca/news/canada/edmonton/jason-kenney-copping-alta-covid-restrictions-lift-1.6368297">are now</a> <a href="https://www.cbc.ca/news/canada/toronto/covid19-ontario-march-9-mask-mandates-1.6378148">beginning to lift</a>. However, surprisingly little attention has been paid to the remarkable effects of these measures on other respiratory illnesses that are caused or exacerbated by viral infections.</p>
<p>These effects are a valuable research discovery from the pandemic. It’s a discovery that suggests that selective, non-mandated use of public health measures like masking, physical distancing and hand-washing may have a continued role as we enter the endemic phase of COVID-19. Collectively, these measures are known as non-pharmacologic public health interventions (NPIs).</p>
<h2>Decreases in acute care</h2>
<p>Following the onset of the pandemic in March 2020, many regions around the world reported a dramatic decrease in demand for <a href="https://doi.org/10.1371/journal.pone.0252441">acute health-care services</a>, including urgent care visits to emergency departments and inpatient hospital stays.</p>
<p>Early on, this was likely driven by stringent lockdown measures, patients avoiding health-care settings due to fears of contracting COVID-19 or the perception that hospitals were overwhelmed and unable to accommodate non-emergency cases. </p>
<p>However, as public health measures were relaxed over the following months, there was a rapid rebound in health-care services for conditions such as heart disease and appendicitis. Meanwhile, the decrease persisted for respiratory illnesses attributed to <a href="http://doi.org/10.1007/s11739-022-02932-y">non-COVID-19 viruses</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign above a row of sinks shows an image of a man washing his hands with the message 'Clean hands keep you healthy. Wash your hands with soap and water for at least 20 seconds. Life is better with clean hands.'" src="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.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">Public health measures such as masking, hand-washing and physical distancing are collectively known as non-pharmacologic public health interventions (NPIs).</span>
<span class="attribution"><span class="source">(AP Photo/David Zalubowski)</span></span>
</figcaption>
</figure>
<p>In Canada, the usual annual surge in influenza infections has not occurred during the <a href="https://doi.org/10.1016/j.lana.2021.100015">two winters since the beginning of the pandemic</a>. </p>
<p>Our research group — all front-line health-care workers — analyzed nationwide admissions data. Our analysis revealed that hospital admissions for major respiratory illnesses dropped sharply in the year following the start of the first lockdown. </p>
<p>Specifically, flare-ups of chronic obstructive pulmonary disease (COPD), a severe lung disease related to long-term smoking, and community-acquired non-COVID-19 pneumonia decreased by nearly 40 per cent across Canada <a href="http://doi.org/10.1007/s11739-022-02932-y">following the implementation of NPIs like masking and physical distancing</a>. </p>
<p>These findings were supported by another study of 15,677 patients from nine countries. That study reported a 50 per cent reduction in the hospital admissions for COPD <a href="https://doi.org/10.1371/journal.pone.0255659">following the onset of the pandemic</a>. This is not entirely surprising as <a href="https://doi.org/10.1111/resp.12780">both COPD and non-COVID-19 pneumonia</a> are often triggered by <a href="https://doi.org/10.1007/s10741-017-9614-7">common cold viruses</a>. If you are like most Canadians, you have not caught a cold in nearly two years. </p>
<h2>Impact on vulnerable patients</h2>
<p>So, what’s the big fuss about a few runny noses and colds? While a viral infection such as the common cold or influenza is unlikely to significantly harm a healthy individual, it can be <a href="https://doi.org/10.1503/cmaj.201748">debilitating and sometimes deadly</a> for someone who is <a href="https://dx.doi.org/10.1016%2FS2213-2600(18)30496-X">elderly, immunocompromised or suffering from a lung disease</a>. It can result in the need for acute care in the hospital, or even the ICU in severe cases, and some patients do not survive. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people in masks sitting on a park bench." src="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A viral infection, such as the common cold or influenza, is unlikely to significantly harm a healthy individual, but it can be debilitating and sometimes deadly for someone who is elderly, immunocompromised or living with a lung disease.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
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<p>In Canada, acute and chronic respiratory diseases are the third greatest cause of death, trailing behind only <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/201126/t001b-eng.htm">cancer and heart disease</a>. This also means virally linked respiratory illnesses place a substantial burden on limited health-care resources. </p>
<p>There were several periods during the pandemic when our <a href="https://cmajnews.com/2022/01/11/covid-update-beds-duong-1095984/">health-care systems</a> were <a href="https://www.cbc.ca/news/health/tam-omicron-more-restrictions-better-masks-1.6293347">over capacity</a>, and there was a fear that hospitals would need to <a href="https://www.theglobeandmail.com/canada/article-alberta-preps-critical-care-triage-plan-amid-surge-in-covid-19-cases/">triage resources</a> and deny ICU care to some critically ill patients. </p>
<p>Thankfully, this did not come to pass, and it seems that the likely reason was the significant additional capacity that became available due to hospitalizations avoided for other <a href="http://doi.org/10.1007/s11739-022-02932-y">virally linked respiratory illnesses</a>.</p>
<h2>Ending COVID-19 prevention measures</h2>
<p>As the pandemic drags on, people have become fatigued with ongoing public health restrictions. With <a href="https://ourworldindata.org/covid-vaccinations">vaccination rates in Canada among the highest in the world</a> and expected to reach even higher with the <a href="https://www.canada.ca/en/public-health/services/vaccination-children/making-decisions-5-11-years-age.html">approval of vaccinations for pediatric populations</a>, many are looking forward to a time when NPIs may no longer be needed. </p>
<p>However, before dispensing with the measures entirely, it is important to consider whether their demonstrated benefits warrant continued use. The fact that hospitalizations for non-COVID-19 respiratory illnesses have remained low, despite the relaxation of stringent lockdown measures, suggests that these benefits may be sustained with the use of masking and practices such as frequent hand-washing. </p>
<figure class="align-center ">
<img alt="Close-up image of a red social distancing circle on asphalt, with two shoe-prints and the message 'Please keep 2M distance'" src="https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&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">There is no consensus on which specific NPIs may be most effective in preventing disease spread.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
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</figure>
<p>Even prior to the pandemic, <a href="https://www.asiapacific.ca/publication/great-mask-divide-lessons-asia">public masking was a common practice</a> in many Asian countries. With this now being the norm in Canada as well, continuing these practices may have significant merit and offer protection to the most vulnerable demographics of our society. </p>
<p>This will certainly be challenging given <a href="https://www.reuters.com/world/americas/canadian-cities-brace-more-anti-vaccine-mandate-protests-2022-02-05/">opposition from a vocal minority</a> and the lack of awareness among the general public about the benefits of continuing use of NPIs. Currently, most available evidence is largely observational, as no randomized trials have yet evaluated the efficacy of NPIs for reducing non-COVID-19 viral respiratory illnesses at a population level. </p>
<p>Additionally, there is no consensus on which specific NPIs may be most effective in preventing disease spread. It’s also unknown whether reductions in acute care use have translated into a reduction in mortality rates for specific conditions. </p>
<h2>Future prevention</h2>
<p>These limitations are currently being addressed in a large-scale Albertan study of over 500,000 patients. The preliminary results — which will be published in the proceedings of the 2022 American Thoracic Society International Conference — show that NPIs are an effective strategy for preventing both acute care visits and mortality related to respiratory illnesses. </p>
<p>However, in the interim, public policy-makers should consider this compelling evidence and weigh in on whether the continued use of masking and other NPI measures is warranted, especially for individuals at high-risk for serious illness from viral respiratory infections and those close to them. </p>
<p>Recommendations, policies or, if deemed necessary, mandates can be amended in the future as new evidence emerges. Until then, NPI use, even on an interim basis, may reduce the strain on our health-care system and help protect the most vulnerable members of our society.</p><img src="https://counter.theconversation.com/content/177238/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Decreases in respiratory infections during the pandemic suggest there may be a continued role for the selective, non-mandated use of measures like masks and social distancing even post-COVID-19.Rutvij A. Khanolkar, Medical Student, University of CalgaryEddy S. Lang, Professor, Cumming School of Medicine, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1778242022-03-02T03:00:42Z2022-03-02T03:00:42ZCOVID mask mandates might be largely gone but here are 5 reasons to keep wearing yours<figure><img src="https://images.theconversation.com/files/449132/original/file-20220301-15-osb9z0.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/low-angle-selected-focus-european-people-1704148564">Shutterstock</a></span></figcaption></figure><p>Mask mandates in most indoor settings <a href="https://www.abc.net.au/news/2022-02-25/covid-mask-rules-australian-states-territories/100854564">have been dropped</a> in New South Wales, Victoria and the ACT, with Queensland to follow later this week. </p>
<p>Without a mandate, <a href="https://www.ijidonline.com/article/S1201-9712(21)00274-5/fulltext">mask use tends to drop</a>, so we can expect only a minority of people to be masked in public indoor spaces. </p>
<p>With thousands of cases a day and <a href="https://www.theguardian.com/australia-news/datablog/ng-interactive/2022/feb/21/covid-19-vaccine-rollout-australia-vaccination-rate-progress-how-many-people-vaccinated-percent-tracker-australian-states-number-total-daily-live-data-stats-updates-news-schedule-tracking-chart-percentage-new-cases-today">just over half</a> (57%) of Australians having received a third COVID vaccine dose and children still under-vaccinated, we may see a surge in infections.</p>
<p>While masks are a small inconvenience, they remain vital in preventing SARS-CoV-2, because the virus <a href="https://theconversation.com/the-pressure-is-on-for-australia-to-accept-the-coronavirus-really-can-spread-in-the-air-we-breathe-160641">spreads</a> through the air we breathe. </p>
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Read more:
<a href="https://theconversation.com/the-pressure-is-on-for-australia-to-accept-the-coronavirus-really-can-spread-in-the-air-we-breathe-160641">The pressure is on for Australia to accept the coronavirus really can spread in the air we breathe</a>
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<p>Some people will continue to wear masks to stay safe and achieve a more normal life through the pandemic. Here are five reasons to keep wearing yours.</p>
<h2>1. Masks reduce your chance of getting COVID</h2>
<p>Many studies <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm">have shown</a> masks protect against COVID. While N95 respirators offer the greatest protection, even cloth masks are beneficial. N95s respirators <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm">lower the odds</a> of testing positive to COVID by 83%, compared with 66% for surgical masks and 56% for cloth masks. </p>
<p>The protection when everyone wears a mask is much greater, because it <a href="https://theconversation.com/which-mask-works-best-we-filmed-people-coughing-and-sneezing-to-find-out-143173">reduces the likelihood</a> of well people inhaling the virus and prevents infected people from exhaling the virus into the air. If everyone wears a mask, the viral load in the air is much lower.</p>
<p>When we lose the protection of universal masking, it’s a good idea to wear a <a href="https://www.npr.org/sections/goatsandsoda/2022/02/25/1083046757/coronavirus-faq-im-a-one-way-masker-what-strategy-will-give-me-optimal-protectio">high protection</a> N95 or P2 respirator. </p>
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<em>
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Read more:
<a href="https://theconversation.com/how-to-get-the-most-out-of-your-n95-mask-or-other-respirator-177229">How to get the most out of your N95 mask or other respirator</a>
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<h2>2. You might not know you have COVID</h2>
<p>Transmission of the virus without symptoms is a major driver of spread, and we cannot know who around us is infected. </p>
<p>Infected people may be asymptomatic or may not know they’re infected. This is <a href="https://www.news-medical.net/news/20220103/Very-high-rates-of-asymptomatic-infection-with-Omicron-compared-to-prior-SARS-CoV-2-variants.aspx">especially so</a> for Omicron. </p>
<p>Overall, about one in four infections are <a href="https://bmjopen.bmj.com/content/11/12/e049752.long">asymptomatic</a>. But even people with symptomatic infection are contagious before the symptoms start.</p>
<figure class="align-center ">
<img alt="Business woman wears a mask." src="https://images.theconversation.com/files/449353/original/file-20220301-23-73zihg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/449353/original/file-20220301-23-73zihg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/449353/original/file-20220301-23-73zihg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/449353/original/file-20220301-23-73zihg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/449353/original/file-20220301-23-73zihg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/449353/original/file-20220301-23-73zihg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/449353/original/file-20220301-23-73zihg.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">You might not know you’re infectious.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/virus-mask-asian-woman-travel-wearing-1629206074">Shutterstock</a></span>
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</figure>
<h2>3. Wearing a mask protects others, including those at risk of severe COVID</h2>
<p>Wearing a mask protects others, including those at greatest risk of severe COVID: people with disability, chronic illnesses and <a href="https://www.theatlantic.com/health/archive/2022/02/covid-pandemic-immunocompromised-risk-vaccines/622094/">suppressed immune systems</a>. </p>
<p>COVID disproportionately affects <a href="https://www.sbs.com.au/language/english/covid-19-update-being-a-migrant-increases-risk-of-dying-from-covid-19-in-australia">migrants</a> and people from lower socioeconomic groups who are more likely to work in customer-service roles. If you wear a mask, you’re protecting workers, commuters and others you interact with. </p>
<p>Rates of vaccination also <a href="https://www1.racgp.org.au/ajgp/coronavirus/aboriginal-communities-covid-vaccination">lag</a> among Aboriginal and Torres Strait Islander people, leaving them more vulnerable to COVID in the absence of masks. </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>Masks also protect children who are vulnerable to COVID, with only <a href="https://www.theguardian.com/australia-news/datablog/ng-interactive/2022/feb/21/covid-19-vaccine-rollout-australia-vaccination-rate-progress-how-many-people-vaccinated-percent-tracker-australian-states-number-total-daily-live-data-stats-updates-news-schedule-tracking-chart-percentage-new-cases-today">half of five to 11 year olds</a> partially vaccinated and under-fives not yet eligible for vaccination. </p>
<p>Children who wear masks can also protect their peers. In the United States, the <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7039e1.htm#T1_down">risk of outbreaks</a> was nearly four times higher in schools without mask mandates compared to those with mandates.</p>
<p>Omicron is not the flu or a cold, and has accounted for <a href="https://www.seattletimes.com/seattle-news/health/omicron-wave-accounts-for-more-u-s-deaths-than-delta-surge/">17% more deaths than Delta</a> in the United States. While Omicron generally causes less severe disease than Delta, it has claimed more lives because of vastly higher case numbers.</p>
<p>There is also growing evidence SARS-COV-2 <a href="https://assets.researchsquare.com/files/rs-1139035/v1_covered.pdf?c=1640020576">persists in the body after infection</a>, which may result in long-term heart, lung and brain damage.</p>
<h2>4. Masks protect your colleagues</h2>
<p>Many workplaces are insisting on people returning to face-to-face work, some without providing safe indoor air – and now without mask mandates. </p>
<p>The risk of COVID transmission is <a href="https://theconversation.com/time-to-upgrade-from-cloth-and-surgical-masks-to-respirators-your-questions-answered-174877">greatest when indoors for prolonged periods without adequate airflow</a>. So sitting in an office for eight hours without a mask is a risk, especially if safe indoor air has not been addressed. </p>
<figure class="align-center ">
<img alt="Man in a mask sits at his work desk, next to his female colleagues." src="https://images.theconversation.com/files/449130/original/file-20220301-13-1tuox9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/449130/original/file-20220301-13-1tuox9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/449130/original/file-20220301-13-1tuox9w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/449130/original/file-20220301-13-1tuox9w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/449130/original/file-20220301-13-1tuox9w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/449130/original/file-20220301-13-1tuox9w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/449130/original/file-20220301-13-1tuox9w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=321&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Wearing a mask reduces your risk of contracting COVID from co-workers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/panoramic-group-business-worker-team-wear-1792685398">Shutterstock</a></span>
</figcaption>
</figure>
<p>At the same time as dropping many workplace mask mandates, NSW has <a href="https://www.begadistrictnews.com.au/story/7629871/nsw-virus-compo-burden-of-proof-opposed/?cs=12">moved to remove automatic workers’ compensation</a> for people who catch COVID at work. </p>
<p>This is a double disadvantage for workers returning to workplaces with fewer protections and facing greater obstacles to workers’ compensation should they get infected. </p>
<h2>5. Others might follow your lead</h2>
<p>Being one of the few people wearing a mask when others aren’t, such as in a supermarket, is a daunting prospect for those of us who wish to continue masking. There are <a href="https://www.newstalkzb.co.nz/news/national/covid-19-convoy-protest-mask-wearing-17-year-old-egged-by-aggressive-convoy-protesters/">reports</a> of masked people being abused and bullied.</p>
<p>However a NSW <a href="https://www.smh.com.au/politics/nsw/more-comfortable-with-masks-voters-want-some-covid-restrictions-to-stay-20220225-p59zs4.html">survey showed</a> the majority of people in that state wanted mask mandates to remain. The more we normalise masks and the more we see them, the better protected the community will be.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1497319160354910209"}"></div></p>
<p>As much as we wish it so, the pandemic is not over and new variants will <a href="http://www.businessinsider.com.au/who-warns-of-covid-19-continuation-and-more-dangerous-variants-2022-2?r=US&IR=T">likely emerge</a>. </p>
<p>A layered, multi-pronged strategy which includes vaccines, masks, ventilation, testing and tracing is the best way to protect health, the economy and a resumption of normal activities. </p>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/177824/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre receives funding from NHMRC, MRFF and has consulted for Ascend Performance Materials, Detmold Group and Cleanspace in the last 5 years.</span></em></p>Masks not only reduce your chance of getting COVID, they might stop you unknowingly transmitting the virus to colleagues, people in vulnerable groups or children who are yet to be vaccinated.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/1767502022-02-24T16:36:27Z2022-02-24T16:36:27ZChildren struggle more than adults to recognize masked faces<figure><img src="https://images.theconversation.com/files/447669/original/file-20220221-28422-lavtez.jpg?ixlib=rb-1.1.0&rect=23%2C0%2C5161%2C2487&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Public health measures to curb the spread of COVID-19 require face masks in many settings.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Face perception is one of the most important visual abilities for humans. A quick glance at a person’s face provides us with rich and socially relevant information, including race, age, gender and emotional state. </p>
<p>Humans typically process faces as a unified whole instead of relying on specific facial features like eyes, nose or mouth. Scientists refer to this type of processing as “<a href="https://doi.org/10.1177/0956797611401753">holistic processing</a>,” and believe that it is essential to recognizing faces quickly and accurately. </p>
<p>Our research explores how mask wearing — the new reality imposed by the COVID-19 pandemic — changes how children and adults process and perceive faces.</p>
<h2>Facing difficulties</h2>
<p>Scientists have promoted mask-wearing as <a href="https://doi.org/10.1073/pnas.2014564118">one of the most important and effective tools to reduce COVID-19 transmission</a>. Many governments around the world required face masks in public places, especially when physical distancing is less feasible. Wearing a mask became prevalent in diverse social settings including on public transportation, in schools and at sporting events and concerts. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/masking-in-schools-a-doctor-and-covid-19-researcher-explains-how-it-keeps-children-safe-177239">Masking in schools: A doctor and COVID-19 researcher explains how it keeps children safe</a>
</strong>
</em>
</p>
<hr>
<p>However, because face masks conceal the lower part of the face, <a href="https://doi.org/10.1038/s41598-020-78986-9">our research group was not surprised to find a reduced ability to learn to recognize new faces when they are masked</a>. Notably, we found that when people had difficulty recognizing masked faces, there were changes in how faces were recognized. Masked faces were processed in a less holistic manner, and more in a feature-by-feature way. </p>
<p>Sensitivity to faces appears early in life. In fact, <a href="https://doi.org/10.1111/1467-9280.00179">newborns are already sensitive</a> to the spatial arrangement of a face, and stare more at visual patterns that resemble this organization (two eyes above a nose above a mouth). Despite this early sensitivity, face perception develops slowly, and some studies suggest that this ability is not fully matured even in teenagers. Given that their face processing system is not fully developed, we wondered if children might have even greater difficulties recognizing masked faces compared to adults. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A ridiculously adorable baby looks at their mother" src="https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.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">Infants show signs of facial recognition and are drawn to visual representations of how facial features are organized.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Impaired recognition</h2>
<p>To test this question, <a href="https://doi.org/10.1186/s41235-022-00360-2">we conducted a study using a version of the face recognition test used in adults, but specially designed for children</a>. This test includes increasing levels of difficulty: The child participants are presented with photographs of other children’s faces, and they need to choose which face they had seen during the study phase. To make the test more challenging, the faces are presented from different viewpoints, and external cues, like hair, are removed. </p>
<p>We tested 72 children. Half of them completed the regular version of the test, while the other half completed a “masked” version of the test, where the children in the photographs appeared to be wearing masks. Each child completed the test twice, once with faces presented upright and once with faces presented upside down. </p>
<p>Turning a face upside down stops people from processing the faces in a holistic way because the typical spatial organization of the face (two eyes above a nose above a mouth) is distorted. When we try to recognize faces without masks, we are much worse at doing so when the face is upside down. This is because we are no longer able to rely on our natural holistic processing system and, instead, we rely on a weaker feature-based strategy. </p>
<p>We assumed that if participants were just as poor at recognizing upright faces with masks as they were at recognizing upside-down faces with masks, it would mean that these masked faces are no longer being processed in a holistic way.</p>
<p>The results of the study were clear. First, we found that children were impaired in recognizing masked faces. The group of children who completed the masked version showed a 20 per cent reduction in their test score. This was even worse than what we had originally found in adults (15 per cent reduction), suggesting that children might find it even more difficult to recognize faces with masks than adults. </p>
<p>We also found evidence for a smaller “upside-down” effect for masked faces. This finding indicates that children processed the masked faces in a more feature-to-feature fashion, which might explain some of their difficulty in recognizing masked faces.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A girl wearing a surgical mask hangs upside down in a swing" src="https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.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">It takes us longer to process upside-down faces because features aren’t where they’re supposed to be.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Children’s recognition cues</h2>
<p>These new findings raise a number of important questions that scientists could address in the future. First, do children learn to use other cues to recognize friends and teachers — for example, by relying on people’s voices or movements? Second, would children become better at recognizing masked faces as they gained more experience with such faces? </p>
<p>This seems likely because previous research found that children’s brains are more adaptable and that experience can shape their visual abilities. Third, do difficulties recognizing masked faces affect children’s ability to communicate with others and form meaningful social relationships? </p>
<p>It is important to emphasize again that masks are one of the most effective tools in our effort to reduce the spread of COVID-19 and keep people safe and healthy. Despite the difficulties that adults and children experience with recognition of masked faces, any decisions about mandatory mask wearing should be informed by public health experts. </p>
<p>At the same time, it’s important to understand how masks may change how children perceive faces so that we can determine whether children are better able to adapt to masks, and which cues or strategies help to improve recognition of masked faces.</p><img src="https://counter.theconversation.com/content/176750/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erez Freud receives funding from the Natural Sciences and Engineering Research Council and from the Vision Science to Applications (VISTA) program funded by the Canada First Research Excellence Fund (CFREF, 2016–2023) . </span></em></p><p class="fine-print"><em><span>Shayna Rosenbaum receives funding from the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council (NSERC), and from the Vision Science to Applications (VISTA) program funded by the Canada First Research Excellence Fund (CFREF, 2016–2023) .</span></em></p>We rely on the spatial arrangement of facial features to process faces, and wearing masks interferes with that — especially for children.Erez Freud, Assistant Professor, Psychology, York University, CanadaR. Shayna Rosenbaum, Professor and York Research Chair, Psychology, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1749812022-01-20T13:21:40Z2022-01-20T13:21:40ZWhat makes young people accept help to stay well: a review of interventions in Africa<figure><img src="https://images.theconversation.com/files/441045/original/file-20220117-13-1hzz8rb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young people must be included from the early stages of interventions.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Anyone who has ever tried to convince an adolescent to behave a certain way is likely to be familiar with resistance. So, when offering support to help young people stay healthy, happy and out of difficulty, it’s worth knowing what they are comfortable with. Interventions that young people find acceptable are more likely to work.</p>
<p>But what do they find acceptable? </p>
<p>There isn’t much research about this in low- and middle-income countries, specifically in Africa or beyond the health sector. This is despite the fact that there are <a href="https://www.brookings.edu/research/addressing-youth-unemployment-in-africa-through-industries-without-smokestacks-a-synthesis-on-prospects-constraints-and-policies/">360 million</a> people aged 15-24 on the continent. Many face challenges to their wellbeing. These include low educational attainment, unemployment and poor access to healthcare. </p>
<p>To explore this, we systematically <a href="https://bmjopen.bmj.com/content/11/12/e055160.full">reviewed</a> studies published over the past decade (2010-2020). The research assessed the acceptability of interventions with adolescents and young people aged 10-24 in Africa. </p>
<p>We wanted to know what young people find acceptable in an intervention and why. We included all types of interventions that aimed to improve outcomes outlined in the <a href="https://sdgs.un.org/goals">Sustainable Development Goals</a>. Most were linked to the goal of ensuring healthy lives and promoting wellbeing – HIV testing is one example.</p>
<p>We identified a number of factors that developers of interventions should pay attention to. One recommendation arising from our review is that adolescents and young people be involved early in the design, planning and scale up of interventions.</p>
<h2>Focus of studies</h2>
<p>We found 55 studies evaluating 60 interventions for acceptability. Most of these studies were carried out in southern and east Africa, mainly South Africa and Uganda. </p>
<p>Most focused on HIV or sexual and reproductive health interventions. Based on the way interventions were delivered, 10 interventions could be categorised as HIV or HPV vaccine interventions, 10 as e-health, eight as HIV testing interventions, seven as support group interventions and six as contraceptive interventions. There were also programmes for voluntary medical male circumcision and pre-exposure prophylaxis (PrEP) to reduce the risk of HIV transmission. </p>
<p>Overall, the interventions were well accepted. This could indicate that they were well aligned with young people’s needs and preferences. It is also possible, though, that studies with more positive results are more likely to be published. </p>
<h2>What’s acceptable and what’s not</h2>
<p>The reasons most frequently raised by young people to explain why they found interventions acceptable were: </p>
<ul>
<li><p>ease of use of the product or intervention </p></li>
<li><p>knowledge of the intervention or knowledge provided by the intervention</p></li>
<li><p>the intervention allowing for (greater) autonomy</p></li>
<li><p>feeling supported while participating in the intervention</p></li>
<li><p>feeling assured that their privacy and confidential information would be protected. </p></li>
</ul>
<p>Reasons for “unacceptability” were more diverse. These included: </p>
<ul>
<li><p>conservative views about the intervention or its content (such as contraception)</p></li>
<li><p>intervention costs</p></li>
<li><p>difficult or inequitable access</p></li>
<li><p>fear of pain and side effects (for biomedical interventions, including vaccines)</p></li>
<li><p>stigma (for example around HIV testing)</p></li>
<li><p>distrust (of vaccines, for example)</p></li>
<li><p>lack of knowledge or support.</p></li>
</ul>
<h2>Key aspects and delivery</h2>
<p>Our findings suggest that intervention developers and implementers should pay attention to key aspects of interventions and their delivery that adolescents clearly care a lot about. This must start from the intervention development phase. </p>
<p>They should ensure that adolescents are provided with adequate knowledge, training and resources to properly understand the intervention and feel confident in their ability to use it. </p>
<p>They need to make sure that adolescents have access to sufficient logistical and emotional support while participating. </p>
<p>And, importantly, these young people’s confidential information must be protected. This will protect participants from much-feared stigma and other potential negative social consequences. </p>
<p>Moreover, intervention developers should bear in mind that adolescents value autonomy. And that this has a gender dimension. Autonomy does not only mean being able to choose to participate in or use an intervention. It also means being empowered by the knowledge it may provide and the greater control it may afford young people – particularly young women – in managing high risk situations and unequal relationships.</p>
<p>Given current public health challenges, such as the COVID-19 pandemic, it may also be worth paying particular attention to specific types of interventions. </p>
<p>For example, digital technology is becoming increasingly important to achieve developmental goals in the context of COVID-19. Young people remain the most connected population group to digital platforms. But more than <a href="https://files.eric.ed.gov/fulltext/ED590013.pdf#page=9">60%</a> of young adults in Africa do not have access to the internet. </p>
<p>Findings of our review work show overall high acceptability of e-health interventions. Adolescents highlighted benefits presented by digital technology. These include lower costs compared to in-person interaction. </p>
<p>But there were also concerns. These ranged from connectivity issues, lack of access to mobile phones and other devices, and unintended disclosure of HIV status or other confidential information. These concerns represent challenges for the equitable access, acceptability and effectiveness of e-health programmes. It is therefore important for intervention providers to assess these challenges early on, and to explore ways of increasing access to necessary technologies within the intervention itself or by supporting concurrent initiatives. </p>
<h2>Way forward</h2>
<p>Our findings highlight the importance of strengthening adolescents’ knowledge of interventions and how to interact with them, but also of understanding and engaging with the broader context within which adolescent acceptability is shaped. </p>
<p>One way to achieve this is to involve adolescents and youth early in the design, planning and scale up of interventions and – if possible – at various stages of the intervention life cycle. </p>
<p>It would also be important to engage early on with whoever is central to an intervention being relevant, well-implemented and accepted by adolescents and the broader community. These may include caregivers, partners and peers, teachers and community leaders, who may play an important role in adolescents’ lives.</p>
<p>Lastly, opportunities exist for more acceptability research in important areas for adolescent development beyond health. These include educational outcomes, employment opportunities, access to water and other services, gender equality, protection from violence, social protection and mental health.</p><img src="https://counter.theconversation.com/content/174981/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Adolescents and young people should get involved early in the design, planning and scale up of interventions.Marisa Casale, Extraordinary Professor, University of the Western CapeGenevieve Haupt Ronnie, Research fellow, University of Cape TownOluwaseyi Dolapo Somefun, Postdoctoral fellow, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1744612022-01-08T01:29:14Z2022-01-08T01:29:14ZSupreme Court considers derailing federal vaccine mandates – appears inclined to keep for health workers, but not wider workforce<figure><img src="https://images.theconversation.com/files/439874/original/file-20220107-25-yxou9q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Did justices give oral arguments an icy reception?</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/WashingtonWinterWeather/b94cdea96f4648daab7a9e1f3cc47095/photo?Query=Supreme%20Court&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=43623&currentItemNo=22">AP Photo/J. Scott Applewhite</a></span></figcaption></figure><p><em>Editor’s note: this article was written before the <a href="https://www.marketwatch.com/story/supreme-court-stops-biden-osha-vaccine-mandate-for-u-s-businesses-01642103975">Supreme Court issued orders</a> stopping the mandate for large employers and permitting the mandate for health facilities.</em></p>
<p>Conservative justices on the Supreme Court <a href="https://www.scotusblog.com/2022/01/court-seems-poised-to-block-vaccine-or-test-policy-for-workplaces-but-may-allow-vaccine-mandate-for-health-care-workers/">appeared to signal</a> a belief that the Biden administration may have overreached in ordering private companies to require that staff be vaccinated or subject to regular testing. But a separate requirement that health care workers at institutions receiving federal funds be immunized may be judged to be on firmer legal ground.</p>
<p><a href="https://www.supremecourt.gov/oral_arguments/argument_transcripts/2021/21a240_l537.pdf">Oral arguments</a> over just how far the federal government can go to require employees to get vaccinated came before the Supreme Court on Jan. 7, 2022. The cases, <a href="https://www.supremecourt.gov/orders/courtorders/122221zr2_f20h.pdf">NFIB v. OSHA</a> and <a href="https://www.supremecourt.gov/orders/courtorders/122221zr1_d18e.pdf">Biden v. Missouri</a>, come at a critical time: A surge of COVID-19 cases resulting from the <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/omicron-variant.html#:%7E:text=As%20of%20December%2020%2C%202021,19%20cases%20it%20is%20causing.&text=CDC%20is%20expecting%20a%20surge,surveillance%20and%20potential%20rapid%20spread.">highly contagious omicron variant</a> has put added pressure on workplaces and hospitals across the nation. And arguments took place just days before OSHA’s key mandate is due to come into effect on Jan. 10.</p>
<p>As a <a href="https://isearch.asu.edu/profile/1436144">law expert</a> who has closely followed the treatment of vaccine mandates in the lower courts, I envision a divided court issuing decisions soon. Although oral arguments are not a solid predictor of how the court will rule, justices seemed to be moving toward allowing vaccine requirements for health care workers but curbing federal powers to implement a broader mandate affecting the wider workforce. </p>
<p>The oral arguments in front of the justices related to two vaccine mandates put forward by the Biden administration.</p>
<p>The first, <a href="https://www.osha.gov/coronavirus/ets2">issued by the Occupational Safety and Health Administration</a>, requires that all employees at private businesses with 100 or more staff be vaccinated or submit to regular testing. The OSHA ruling affects more than 80 million American workers.</p>
<p>The second, <a href="https://www.cms.gov/newsroom/press-releases/biden-harris-administration-issues-emergency-regulation-requiring-covid-19-vaccination-health-care">issued by the Centers for Medicare and Medicaid Services</a>, requires that over 10 million health care workers at CMS-funded providers be vaccinated.</p>
<p>Enforcement of both mandates is held up in specific states following decisions in lower courts, and is awaiting final rulings by the Supreme Court. </p>
<h2>How did we get to this point?</h2>
<p>Federal vaccine mandates are seen by <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2021/11/04/fact-sheet-biden-administration-announces-details-of-two-major-vaccination-policies/">the Biden administration as a linchpin</a> in the national strategy to quell the pandemic, which has now taken over 833,000 American lives. </p>
<p>Since their introduction on Nov. 5, 2021, the OSHA and CMS vaccine mandates have faced extensive judicial challenges by mainly Republican states.</p>
<p>Federal appellate courts had different opinions on the legality of OSHA’s mandate, ultimately allowing it to take effect through a <a href="https://www.pbs.org/newshour/politics/federal-appeals-court-allows-biden-employer-vaccine-mandate-to-take-effect">unified decision in the 6th Circuit Court of Appeals</a>. </p>
<p>Lower federal district courts in several states determined that the CMS vaccine requirement should be set aside. Based on multiple appeals, the Supreme Court agreed to hear the cases in two consecutive oral arguments.</p>
<p>The question before the court now is not whether mandates work to get people vaccinated – <a href="https://www.scientificamerican.com/article/vaccine-mandates-are-lawful-effective-and-based-on-rock-solid-science/">we know that they do</a>. Rather, the central question in front of the justices is whether the federal government, as opposed to states, can actually implement them. </p>
<p>States’ abilities to mandate vaccines as a condition of employment, school attendance or admission to certain events are largely unquestioned and have been confirmed in lower-court rulings. Provided exemptions are allowed those who are medically unfit, or religiously opposed in many jurisdictions, state-based vaccine mandates are constitutional. Such was the Supreme Court’s decision in <a href="https://www.oyez.org/cases/1900-1940/197us11">Jacobson v. Massachusetts</a>, which affirmed in 1905 the constitutionality of a local vaccine mandate to counter a smallpox outbreak in Cambridge.</p>
<p>The issue is that not all states approve COVID-19 vaccine mandates. From the onset of the coronavirus pandemic, largely conservative-leaning states, including <a href="https://www.abc15.com/news/vaccine-in-arizona/arizona-governor-doug-ducey-signs-order-banning-government-covid-19-vaccine-mandates">Arizona</a>, <a href="https://www.reuters.com/legal/government/florida-bans-strict-vaccine-mandates-schools-businesses-2021-11-18/">Florida</a> and <a href="https://www.texastribune.org/2021/10/18/texas-covid19-vaccine-mandates-bill/">Texas</a>, prohibited them. Residents could choose to be vaccinated, but no one was going to be forcefully inoculated.</p>
<p>Losing patience with contrary state approaches and a minority of Americans steadfastly refusing vaccination, <a href="https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/09/09/remarks-by-president-biden-on-fighting-the-covid-19-pandemic-3/">President Biden determined in September 2021</a> that federal employees, members of the military and contractors would be required to be vaccinated.</p>
<p>These mandates faced their own judicial challenges. The contractor rule, affecting millions of workers at federally supported enterprises, has been stalled in multiple courts.</p>
<h2>Constitutional questions</h2>
<p>Central to cases in front of the Supreme Court now is the question of whether the federal government has the authority to impose a vaccine mandate on large employers, regardless of the public health benefits.</p>
<p>Justice Elena Kagan, a reliable member of the court’s minority liberal wing, stressed the “extraordinary circumstances” of the pandemic in justifying OSHA’s vaccine mandate. OSHA’s authority to regulate workplace health and safety broadly is beyond debate, observed fellow liberal Justice Sonia Sotomayor.</p>
<p>Other justices diverged. Chief Justice John Roberts expressed reservations over agency-hopping, suggesting the Biden administration sought new legal arguments to vaccinate Americans through multiple agencies’ authorities.</p>
<p>Meanwhile, conservative Justices Neil Gorsuch and Brett Kavanaugh persistently questioned whether Congress had empowered OSHA to impose sweeping national vaccine requirement through “cryptic” or “broad” language contained in the Occupational Safety and Health Act of 1970.</p>
<p>Resolution of these issues will prove pivotal in the court’s forthcoming decision.</p>
<h2>An ‘easier case’</h2>
<p>The legal issues at stake in <a href="https://www.oyez.org/cases/1900-1940/252us416">Biden v. Missouri</a> challenging CMS’ vaccination mandate for health care workers presented an “easier case,” noted Roberts. The reason is simple: In crafting its mandate, CMS relied on a slate of existing legally approved statutory authorities that allow the center to set terms of provider participation in furtherance of patient safety and health.</p>
<p>Hospitals and other providers were largely in favor of CMS’ vaccination mandate. </p>
<p>It was conservative states and localities like Missouri and Kentucky that objected, on grounds that CMS exceeded its conditional spending powers. </p>
<p>Kagan insisted that requiring vaccinations to curb risks to patients and workers in hospitals and other health care settings was logical and consistent with its legal duties.</p>
<p>Opposing counsels and Gorsuch suggested otherwise. They argued that CMS failed to provide adequate notice and and attempted to “commandeer” health care workers in violation of federal statutes and principles of federalism.</p>
<h2>What’s to come?</h2>
<p>With enforcement of the OSHA standard due to start on Jan. 10, 2021, the court may issue a rapid decision, or it could provide a temporary stay. A third option is to simply do nothing and allow the vaccine mandate to take effect.</p>
<p>Justice Stephen Breyer repeatedly questioned how the court could issue a stay under the “public’s interest” at a time when hundreds of thousands of Americans are being infected daily and hospitals are filling to capacity.</p>
<p>Other justices seemed inclined to stall enforcement of OSHA’s standard while mulling over their arguments. </p>
<p>CMS’ rule has a more generous enforcement timeline, allowing more time for health care providers to comply without penalties. Consequently, the court has more time to finalize and issue its decisions regarding its legality.</p>
<h2>Weighing the options</h2>
<p>Could the court restrict the federal government’s capacity to issue vaccination requirements? It is possible.</p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.]</p>
<p>Over the course of the pandemic, the Supreme Court has <a href="https://www.networkforphl.org/resources/covid-19-related-opinions-and-orders-from-the-u-s-supreme-court/">repeatedly struck down</a> public health measures on constitutional grounds. Even if CMS’ vaccine mandate looks likely to stay, the court’s conservative justices’ concerns about overreach of OSHA’s authorities are telling. </p>
<p>Skeptical justices are weighing their concerns of federal overreach against the deadliest public health threat to ever confront the nation.</p><img src="https://counter.theconversation.com/content/174461/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Hodge does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The court appears split over the future of vaccination mandates, with conservative justices skeptical of the Biden administration’s authority to enforce requirements.James Hodge, Professor of Law, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1666482021-08-25T20:05:35Z2021-08-25T20:05:35ZCan’t get your kid to wear a mask? Here are 5 things you can try<figure><img src="https://images.theconversation.com/files/417720/original/file-20210825-16536-1fg70fl.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/family-kids-face-mask-shopping-mall-1632557005">Shutterstock</a></span></figcaption></figure><p>Let’s face it, none of us actually enjoys wearing a mask. And it’s even harder when you’re a parent trying to get your kids masked up, as well as yourself. </p>
<p><a href="https://www.coronavirus.vic.gov.au/face-masks">Victoria</a>, <a href="https://www.nsw.gov.au/covid-19/rules/changes/face-mask-rules">New South Wales</a> and the <a href="https://www.covid19.act.gov.au/stay-safe-and-healthy/protect-yourself#Face-masks">Australian Capital Territory</a> now require everyone over the age of 12 to wear a mask whenever they leave their home, unless they are exercising. This mandate includes in high schools in <a href="https://www.covid19.act.gov.au/stay-safe-and-healthy/protect-yourself#Face-masks">NSW</a> and <a href="https://www.coronavirus.vic.gov.au/face-masks">Victoria</a>. </p>
<p>In parts of <a href="https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/current-status/public-health-directions/restrictions-impacted-areas#when-to-wear-mask-impacted-areas">Queensland</a> and <a href="https://www.covid-19.sa.gov.au/restrictions-and-responsibilities/activities-and-gatherings/current-activity-restrictions">South Australia</a>, children 12 to 17 years also need to wear a face mask if they’re indoors and can’t socially distance. </p>
<p>Children should not wear <a href="https://www.who.int/news-room/q-a-detail/q-a-children-and-masks-related-to-covid-19">masks while exercising</a>. And children under two years old should also not wear masks, as they are a <a href="https://www.healthdirect.gov.au/covid19-restriction-checker/face-masks/nsw">choking and suffocation</a> risk.</p>
<p>Parents can decide if children between the ages of five and 12 should wear a mask. But, the World Health Organization says children <a href="https://www.who.int/news-room/q-a-detail/q-a-children-and-masks-related-to-covid-19">under five years old should not be required to wear masks</a>.</p>
<p>There is <a href="https://www.cambridge.org/core/journals/epidemiology-and-infection/article/why-does-the-spread-of-covid19-vary-greatly-in-different-countries-revealing-the-efficacy-of-face-masks-in-epidemic-prevention/0459AACF859068ED40E2CBCFF67554BD">ample</a> <a href="https://www.pnas.org/content/118/4/e2014564118?fbclid=IwAR0acQLrK5uzFbEsJE5E7lDgkcBVPB7b_2CjhPAy2yG2jDzEJ5H5ekpwVIk">evidence</a> showing masks help keep children and <a href="https://pubmed.ncbi.nlm.nih.gov/33735161/">young people</a> <a href="https://www.unicef.org/coronavirus/covid-19-and-masks-tips-families">safe</a>. Plus, unlike the <a href="https://theconversation.com/under-12s-are-increasingly-catching-covid-19-how-sick-are-they-getting-and-when-will-we-be-able-to-vaccinate-them-165948">earlier stages of the pandemic</a> when kids weren’t contracting or transmitting the virus as much as adults, we are now seeing <a href="https://www.smh.com.au/politics/nsw/as-more-than-200-primary-kids-get-a-covid-diagnosis-in-one-weekend-hazzard-says-it-s-too-early-to-talk-about-school-20210822-p58kwt.html">many cases in children</a> of the Delta variant. Although, thankfully, serious disease among young people is still rare.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/under-12s-are-increasingly-catching-covid-19-how-sick-are-they-getting-and-when-will-we-be-able-to-vaccinate-them-165948">Under-12s are increasingly catching COVID-19. How sick are they getting and when will we be able to vaccinate them?</a>
</strong>
</em>
</p>
<hr>
<p>Here are five things you can do to encourage your kids to wear a mask.</p>
<h2>1. Model wearing one</h2>
<p>One of the best things you can do to encourage your kids to mask up is to <a href="https://healthblog.uofmhealth.org/childrens-health/5-ways-to-get-young-kids-to-wear-face-masks">model mask wearing</a>. Show your child it is OK to wear a mask; it is “normal”. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417731/original/file-20210825-18817-nseepx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mother and daughter listening to music and wearing a mask while waiting for train." src="https://images.theconversation.com/files/417731/original/file-20210825-18817-nseepx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417731/original/file-20210825-18817-nseepx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417731/original/file-20210825-18817-nseepx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417731/original/file-20210825-18817-nseepx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417731/original/file-20210825-18817-nseepx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417731/original/file-20210825-18817-nseepx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417731/original/file-20210825-18817-nseepx.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">Show your child it’s normal, and not scary to wear a mask.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-daugther-enjoy-listening-music-wearing-1804094767">Shutterstock</a></span>
</figcaption>
</figure>
<h2>2. Empathise with their feelings</h2>
<p>If your child is reluctant to wear a mask, you can empathise with their feelings. Nobody likes wearing masks. Children <a href="https://link.springer.com/article/10.1007/s12098-020-03535-1">rely on facial gestures</a> to communicate, and many have sensory issues that can make wearing masks uncomfortable. Reflecting back to your child that you know this is hard for them helps them feel understood.</p>
<p>Find out why they don’t want to wear a mask. It might be they get <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/josh.13033">sore ears or a headache</a>. If so, masks that tie behind the head can be helpful. If it’s fogged glasses, a better fitting mask, or a <a href="https://www.healthline.com/health/how-to-stop-glasses-from-fogging">mask clip</a>, may help. </p>
<p>The internet is full of <a href="https://www.kgun9.com/face-masks-more-comfortable-this-easy-hack/">mask hacks</a> to help make masks more comfortable. Some are as simple as using <a href="https://cooktopcove.com/2020/04/22/7-cool-face-mask-hacks-you-must-know/">hair clips</a> in the loops to extend the length of the mask.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/13-insider-tips-on-how-to-wear-a-mask-without-your-glasses-fogging-up-getting-short-of-breath-or-your-ears-hurting-143001">13 insider tips on how to wear a mask without your glasses fogging up, getting short of breath or your ears hurting</a>
</strong>
</em>
</p>
<hr>
<h2>3. Help them understand the science</h2>
<p>Kids may be more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260829/">willing</a> to wear a mask if they understand why they need to. When children understand why a behaviour is important to their <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242134">health</a>, they <a href="https://www.sciencedirect.com/science/article/abs/pii/S0195670113003010">are more likely to comply</a>. Older children may be interested in the science of mask wearing. </p>
<p>There are many resources — including easy to understand <a href="https://www.youtube.com/watch?v=Y47t9qLc9I4">YouTube videos</a> — that can help. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/qGij_HIguK8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">You could get your kids to watch a video, like this one.</span></figcaption>
</figure>
<p>Remind your kids that doing things they want, like seeing their friends at school, relies on them wearing a mask. </p>
<h2>4. Make it a game</h2>
<p>Younger children may be helped by making the mask wearing a <a href="https://raisingchildren.net.au/guides/coronavirus-covid-19-guide/face-masks-coronavirus-children">bit of a game</a>, which can include making up silly poems about wearing masks. Or you could encourage your child to see themselves as <a href="https://www.youtube.com/watch?v=4KRuP1QGmhU">a superhero protecting others</a> by wearing a mask. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/4KRuP1QGmhU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Younger children can imagine they’re a superhero helping others.</span></figcaption>
</figure>
<p>You could also give your child the chance to choose a mask or <a href="https://masks.primelayers.com/how-to-decorate-blank-face-mask/">decorate their own, turning it into a craft activity</a>. This will make the child comfortable with the mask and give them a sense of ownership over it. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tinker-bell-batman-ben-10-if-your-kids-are-in-character-theyre-more-likely-to-help-around-the-house-139962">Tinker Bell, Batman, Ben 10... if your kids are in character, they're more likely to help around the house</a>
</strong>
</em>
</p>
<hr>
<h2>5. Ask others for help</h2>
<p>Children require good fine motor skills to put on, and keep on, a mask. If you want your child to be wearing a mask at school, you could talk to the teacher, teacher aide or guidance officer to see if they can help. </p>
<p>Teachers can make sure the mask is on properly, and help your child to adjust the mask as needed. </p>
<h2>For children with a disability</h2>
<p>If your child has a <a href="https://raisingchildren.net.au/guides/coronavirus-covid-19-guide/face-masks-coronavirus-children">learning disability</a>, <a href="https://www.urmc.rochester.edu/strong-center-developmental-disabilities/resources/masks-toolkit.aspx">developmental delay</a> or is on the <a href="https://researchautism.org/the-challenge-of-face-masks/">autism spectrum</a>, asking them to wear a mask, and keep it on, may be harder. </p>
<p>Making it a game or making it fun may also work for these children. And there’s evidence that <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/jaba.802">tolerance training</a>, where you gradually expose your child to mask wearing providing praise when the child is able to complete a step, can help. </p>
<p>But it may be impossible to force compliance and it may be dangerous in some circumstances. There are <a href="https://www.nsw.gov.au/covid-19/rules/changes/face-mask-rules">exemptions</a> for people who have any medical condition that makes wearing masks unsuitable. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417733/original/file-20210825-16536-d61dm8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Students in class wearing masks." src="https://images.theconversation.com/files/417733/original/file-20210825-16536-d61dm8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417733/original/file-20210825-16536-d61dm8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417733/original/file-20210825-16536-d61dm8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417733/original/file-20210825-16536-d61dm8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417733/original/file-20210825-16536-d61dm8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417733/original/file-20210825-16536-d61dm8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417733/original/file-20210825-16536-d61dm8.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">You could ask a teacher to help your child wear their mask properly at school.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/children-face-mask-back-school-after-1751409812">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Lastly, ask yourself these questions</h2>
<p>If your child isn’t legally required to wear a mask, but you’re still wondering, ask yourself these questions:</p>
<ul>
<li><p>are there high levels of virus in my community? </p></li>
<li><p>is my child going to be indoors with poor ventilation and lots of people?</p></li>
<li><p>does my child have a medical condition that might make COVID-19 more risky for them or are they going to be around people who have a medical condition that makes them more susceptible to COVID-19? </p></li>
</ul>
<p>If the answers to any of these questions are “yes”, that would lend weight to encouraging mask wearing. </p>
<p>If the answers to any of these questions are “no”, this would lend weight towards not requiring mask wearing.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/children-need-playgrounds-now-more-than-ever-we-can-reduce-covid-risk-and-keep-them-open-166562">Children need playgrounds now, more than ever. We can reduce COVID risk and keep them open</a>
</strong>
</em>
</p>
<hr>
<p>But if your child is under 12, or has a developmental or another kind of disability, it’s also important to consider whether they can put the mask on and take it off safely by themselves, and whether you or someone else can supervise them while they are wearing a mask. If not, it may be better they don’t wear one.</p><img src="https://counter.theconversation.com/content/166648/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One of the best things you can do to encourage your kids to mask up is to model wearing one. There are other things you can try too.Rebecca English, Senior Lecturer in Education, Queensland University of TechnologyKarleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1657002021-08-11T14:58:31Z2021-08-11T14:58:31ZWhy population immunity is not a realistic goal in Africa’s bid to control COVID-19<figure><img src="https://images.theconversation.com/files/415427/original/file-20210810-15-oqn9q2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID-19 vaccination in Africa is speeding up. </span> <span class="attribution"><span class="source">Habimana Thierry/Anadolu Agency via Getty Images</span></span></figcaption></figure><p>In public health, an important goal of vaccination and immunisation is to reach population or herd immunity. This is why the term comes up often in relation to the COVID-19 pandemic. And it helps to be clear about what it means.</p>
<p>Think of a community where some people have been immunised against an infectious disease and others have not. “Herd immunity” or “population immunity” is the protection that at-risk people get indirectly from immunised people. The indirect protection is attained when a certain proportion (threshold) of community members has acquired immunity to the infectious disease. </p>
<p>The threshold for reaching population immunity depends on many factors. One is the effectiveness of the vaccine. Another is how many people get the vaccine. A third is how long the immunity given by the vaccine lasts. </p>
<p>Then there’s the infectiousness of the disease. For example, the population immunity threshold for a highly infectious disease, like measles, is estimated at <a href="https://pubmed.ncbi.nlm.nih.gov/31551070/">95%</a>. Only when 95% of a population is immune from measles will the remaining 5% of the population be protected. </p>
<p>The estimates are highly variable for COVID-19. They range from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151357/">50% to 85%</a>, assuming the effectiveness of the available vaccines is not greatly changed by new SARS-CoV-2 variants. </p>
<p>Vaccine-induced immunity following complete vaccination against measles is long-lived. We don’t know yet how long COVID-19 vaccine-induced immunity lasts. But data is rapidly accumulating.</p>
<p>People acquire immunity either from being infected and recovering, or from being vaccinated, or a combination of the two. There are risks to relying on natural acquired immunity in the case with COVID-19. The outcome of an infection is unpredictable and sometimes fatal. Therefore, the safest and fastest way to attain population immunity is through <a href="https://jamanetwork.com/journals/jama/fullarticle/2772168">vaccination</a>. </p>
<p>Smallpox was eradicated in <a href="https://www.who.int/health-topics/smallpox#tab=tab_1">1980</a> through vaccination-induced population immunity. We no longer need to administer vaccines against smallpox. Ideally, vaccination-induced population immunity can control the COVID-19 pandemic. </p>
<p>But evidence is <a href="https://theconversation.com/covid-study-finds-lower-antibody-activity-against-delta-variant-at-single-dose-but-vaccines-still-work-164351">emerging</a> that the effectiveness of currently available COVID-19 vaccines may be declining, because of continually mutating SARS-COV-2. This has led some <a href="https://theconversation.com/covid-19-herd-immunity-its-not-going-to-happen-so-what-next-165471">experts to caution</a> that we can “forget about herd immunity” and instead, “vaccinate enough people quickly enough”. </p>
<p>It is still worth acknowledging that vaccine rollout is speeding up. But presently, COVID-19 vaccine-induced population immunity appears to be a moving target and unrealistic.</p>
<h2>Population immunity through vaccination</h2>
<p>Sweden’s attempted to attain population immunity through natural infection proved to be highly risky and unattainable. It resulted in a sharp increase in <a href="https://jamanetwork.com/journals/jama/fullarticle/2772167">COVID-19 cases and loss of lives</a>. The country then turned to public health interventions and is now rolling out COVID-19 vaccines. </p>
<p>In contrast, Israel quickly rolled out its vaccination programme in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01018-7/fulltext">December 2020</a> with the Pfizer/BioNTech COVID-19 vaccine. The efficacy of the vaccine is as high as 95% against the original SARS-COV-2. This efficacy is reported to be reduced to around <a href="https://pubmed.ncbi.nlm.nih.gov/34289274/">88%</a> against emerging variants. </p>
<p>At the time of writing, Israel had fully vaccinated <a href="https://ourworldindata.org/covid-vaccinations?country=OWID_WRL">5.39 million individuals, representing 59.6% of the total population</a>. The public health benefits were almost immediate. These included a significantly lower COVID-19 disease burden and a return to the pre-pandemic way of life. </p>
<p>This was unfortunately interrupted by the delta variant. The delta variant is <a href="https://asm.org/Articles/2021/July/How-Dangerous-is-the-Delta-Variant-B-1-617-2">60% more transmissible than the alpha variant</a>. If vaccine coverage in Israel was higher and included younger population groups, the country would likely not be experiencing a resurgence in SARS-CoV-2 infections. </p>
<p>Israel provides valuable lessons on the benefits of vaccinating as many people as quickly as possible – even without attaining population immunity. Evidently, COVID-19 vaccines must be rapidly deployed and have high uptake to save lives and livelihoods. </p>
<h2>Vaccine-induced population immunity in Africa</h2>
<p>Key barriers to achieving population immunity through current vaccination approaches include the inequitable supply of and access to COVID-19 vaccines, and emerging SARS-CoV-2 variants. </p>
<p>African countries are among those facing disproportionate vaccine supply delays and shortages. The Africa Centres for Disease Control and Prevention <a href="https://africacdc.org/covid-19-vaccination/">estimated</a> that by the beginning of August 2021, 3.42% of the continent’s population had received at least one dose of a COVID-19 vaccine. Only 1.46% were fully vaccinated. This is in stark contrast to the <a href="https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/">European region</a>, where 60.9% of the population is estimated to have received at least a single dose. Around 52.5% were fully vaccinated as at 8 August 2021. </p>
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Read more:
<a href="https://theconversation.com/interested-in-vaccine-rollouts-across-africa-heres-a-map-to-guide-you-156802">Interested in vaccine rollouts across Africa? Here's a map to guide you</a>
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<p>The unequal coverage is largely the result of most wealthy countries securing large supplies of vaccines early on – often more than they needed. Some high-income countries are considering giving their populations a third dose of COVID-19 vaccines. This will worsen the access problems for countries in Africa. <a href="https://www.unicef.org/press-releases/we-need-speed-and-simplicity-remove-barriers-acquisition-manufacture-and">Global agencies have called</a> for these high-income countries to share their surplus vaccines rather than “topping up” vaccine-induced immunity with a third dose.</p>
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Read more:
<a href="https://theconversation.com/covid-who-calls-for-moratorium-on-booster-shots-is-it-justifiable-165762">COVID: WHO calls for moratorium on booster shots – is it justifiable?</a>
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<p>Aside from vaccine supply bottlenecks, other <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00097-8/fulltext">logistical and operational barriers</a> exist in the African context. </p>
<p>In some cases, low vaccination rates have been recorded among populations with negative perceptions of the vaccines, brought on by widespread vaccine misinformation and disinformation, as well as limited knowledge about the safety of these vaccines. It’s difficult to quantify the role of misinformation in vaccine uptake given that vaccine demand currently outstrips supply in most African countries. </p>
<p>Still, there is a need for intensive, context-specific, and culturally appropriate community engagement campaigns to improve knowledge about COVID-19 vaccines and address public concerns about these lifesaving interventions. </p>
<p>With the delays in vaccination in Africa, concerns are growing that some variants of the virus could continue to fuel outbreaks of the disease or make the available vaccines less effective.</p>
<p>Under these conditions, attaining population immunity on the continent is unrealistic. The continental goal to <a href="https://news.un.org/en/story/2021/02/1083882">vaccinate at least 20% of the African population by the end of 2021</a> currently appears far off. But still, the only way ahead is improved vaccine access, rapid rollout of the available vaccines and community engagement to encourage uptake. </p>
<h2>Looking ahead</h2>
<p>In general, vaccine-induced population immunity is critical to interrupting the transmission of deadly pathogens and controlling outbreaks and pandemics.</p>
<p>Some community members (young infants) are currently not eligible for COVID-19 vaccination. They will therefore have to depend on the decisions that adults make when offered COVID-19 vaccines.</p>
<p>Authorised COVID-19 vaccines are safe, effective, and integral to global public health efforts aimed at attaining population immunity. </p>
<p>Without equitable access, rapid and high uptake of COVID-19 vaccines worldwide, vaccine-induced population immunity against COVID-19 is merely an illusion. Therefore, vaccination rollout in Africa should be complemented with non-therapeutic interventions: social distancing, wearing face masks, regularly washing and sanitising hands.</p><img src="https://counter.theconversation.com/content/165700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In Africa, it’s more rational to prioritise vaccine access, rapid rollout and community engagement, than pushing the narrative of vaccine-induced population immunity.Edina Amponsah-Dacosta, Postdoctoral Research Fellow, Vaccines for Africa Initiative, University of Cape TownBenjamin Kagina, Senior Research Officer, Vaccines For Africa Initiative, Faculty of Health Sciences, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1654592021-08-09T19:59:00Z2021-08-09T19:59:00ZWhen will Sydney’s lockdown end? Well, it depends who you ask<figure><img src="https://images.theconversation.com/files/414967/original/file-20210806-21-1c38j60.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sydney-nsw-australia-15th-2021-isolated-2008345958">from www.shutterstock.com</a></span></figcaption></figure><p>During the pandemic, infectious disease modelling has come to prominence as never before. A <a href="https://amp.smh.com.au/national/nsw/scientists-split-over-whether-sydney-s-lockdown-is-tight-enough-to-tame-outbreak-20210728-p58dpk.html">plethora of models</a> have been used to guide policy. </p>
<p>The models use computer programs to predict, for example, how COVID outbreaks develop and which public health measures are most likely to contain them, under different future scenarios.</p>
<p>Among the big questions modellers are trying to answer currently is what should Sydney’s strategy be for addressing its current Delta outbreak, to allow release from lockdown while minimising COVID-related deaths.</p>
<p>Different groups of researchers give different predictions. And it’s easy to be bewildered, especially if you’re in lockdown and looking for answers.</p>
<h2>Why do answers vary?</h2>
<p>At their best, infectious disease models should provide a way of integrating all the available information relevant to the problem at hand. This includes the characteristics of the virus circulating, the scope of the epidemic, the history of the outbreak to date, and evidence from clinical trials and other research. </p>
<p>We can then use this to challenge our own ideas about what the best policy response should be and develop a high-level strategy for the future.</p>
<p>Many of the mathematical models that have informed COVID policy across the world have been “mechanistic”. They explicitly represent the population in which the virus is transmitting and so simulate the process of susceptible people becoming infected with the virus through exposure to others. </p>
<p>Although many other mathematical techniques have been used during the pandemic, this approach has the advantage of being able project the outcomes of a wide range of policy responses.</p>
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Read more:
<a href="https://theconversation.com/scientific-modelling-is-steering-our-response-to-coronavirus-but-what-is-scientific-modelling-135938">Scientific modelling is steering our response to coronavirus. But what is scientific modelling?</a>
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<p>This approach also has several limitations. One of the most important is that tiny changes in what you feed into the model can have a huge effect on the output.</p>
<p>Another important consideration is that future projections inevitably represent the expected outcomes under a particular set of policy choices, which are impossible for modellers to predict.</p>
<p>In short, infectious disease epidemics are difficult to predict because their dynamics are volatile and dependent on the policies we choose to implement.</p>
<h2>Let’s look at the Sydney predictions</h2>
<p>Several groups have modelled Sydney’s lockdown recently and have shared their results with the public. These include groups at the <a href="https://burnet.edu.au/news/1465_likely_stage_4_tighter_restriction_levels_will_be_needed_to_control_the_current_delta_variant_outbreak_in_nsw_new_modelling_shows">Burnet Institute</a> and at the <a href="https://www.sydney.edu.au/news-opinion/news/2021/07/30/social-distancing-up-but-still-inadequate-to-control-outbreak.html">universities of Sydney</a> and <a href="https://pursuit.unimelb.edu.au/articles/how-long-till-sydney-gets-out-of-lockdown">Melbourne</a>.</p>
<p><strong>The Burnet model</strong></p>
<p>The Burnet Institute simulates individuals and their characteristics and behaviours (an agent-based model). It can mimic the social networks through which individuals interact in specific settings, fundamental to how the epidemic spreads.</p>
<p>This approach is particularly well-suited to considering interventions that affect groups of people interacting. These include closing specific venues or activities, such as restaurants, gyms, schools or sporting events.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415138/original/file-20210809-21-wtzhqi.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/415138/original/file-20210809-21-wtzhqi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415138/original/file-20210809-21-wtzhqi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415138/original/file-20210809-21-wtzhqi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415138/original/file-20210809-21-wtzhqi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415138/original/file-20210809-21-wtzhqi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415138/original/file-20210809-21-wtzhqi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415138/original/file-20210809-21-wtzhqi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The Burnet Institute’s modelling shows that without the initial stay-at-home orders, the results would have been catastrophic (red line).</span>
<span class="attribution"><a class="source" href="https://theconversation.com/a-tougher-4-week-lockdown-could-save-sydney-months-of-stay-at-home-orders-our-modelling-shows-164483">Burnet Institute</a></span>
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<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>
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<p>This model, <a href="https://burnet.edu.au/news/1465_likely_stage_4_tighter_restriction_levels_will_be_needed_to_control_the_current_delta_variant_outbreak_in_nsw_new_modelling_shows">released July 12</a>, predicted a more stringent lockdown (blue line in the chart above; something like Melbourne’s stage 4 lockdown in 2020) should be enough to drive case numbers in Sydney back down towards low levels (less than five new local cases per day) over several weeks. This would lead to elimination of the virus, allowing lockdown to lift.</p>
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<a href="https://images.theconversation.com/files/411147/original/file-20210714-23-sm3g2c.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/411147/original/file-20210714-23-sm3g2c.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/411147/original/file-20210714-23-sm3g2c.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/411147/original/file-20210714-23-sm3g2c.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/411147/original/file-20210714-23-sm3g2c.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/411147/original/file-20210714-23-sm3g2c.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/411147/original/file-20210714-23-sm3g2c.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/411147/original/file-20210714-23-sm3g2c.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&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"><span class="source">Burnet Institute, July 12</span></span>
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<p><strong>University of Sydney model</strong></p>
<p>The University of Sydney model is also an agent-based model, similar in several ways to the Burnet model. It builds on previous work on modelling influenza in which the researchers constructed a detailed representation of the Australian population using census data.</p>
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<p>Along with their COVID status, the age, gender, residence and workplace of individuals is simulated, along with their commuting patterns. Various interventions are simulated, including isolating contacts of cases in quarantine, and social distancing.</p>
<p>The Sydney model found that unless interactions between people are reduced substantially for several weeks, the epidemic is unlikely to decline rapidly.</p>
<p><strong>University of Melbourne model</strong></p>
<p>The University of Melbourne model represents people or groups of people as agents who move in two-dimensional space, potentially becoming infected as susceptible agents interact with infected ones. </p>
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<p>Because discrete individuals are represented, models like this can be used to define when the last case has recovered and elimination has been achieved.</p>
<p>This model generally had more optimistic findings for Sydney than the other two, with most model runs showing the epidemic dying away within two months if current restrictions or tighter are sustained. Unfortunately, case numbers already seem to be escalating beyond these predictions.</p>
<figure class="align-center ">
<img alt="The University of Melbourne's modelling of Sydney's COVID outbreak" src="https://images.theconversation.com/files/415160/original/file-20210809-17-1a12kvd.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415160/original/file-20210809-17-1a12kvd.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415160/original/file-20210809-17-1a12kvd.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415160/original/file-20210809-17-1a12kvd.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415160/original/file-20210809-17-1a12kvd.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=421&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415160/original/file-20210809-17-1a12kvd.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=421&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415160/original/file-20210809-17-1a12kvd.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=421&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">The University of Melbourne’s modelling suggested Sydney’s COVID outbreak could take until early September to be brought under control.</span>
<span class="attribution"><a class="source" href="https://www.abc.net.au/news/2021-07-20/nsw-lockdown-needs-to-run-to-september-for-delta-cases-to-drop/100307698">Chart: ABC news. Source: University of Melbourne</a></span>
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<h2>The similarities</h2>
<p>Despite some differences in findings, we can take the following messages from these models:</p>
<ul>
<li><p>if there had been no lockdown or if lockdowns were released now, a devastating epidemic would result</p></li>
<li><p>the public health response (including lockdown) is having a major effect in driving down transmission</p></li>
<li><p>with the current response and level of restrictions, at best it will take months to bring the epidemic fully under control</p></li>
<li><p>if restrictions are tightened considerably for at least one to two months, case numbers may decline to the point that elimination could be targeted.</p></li>
</ul>
<h2>Take-home message</h2>
<p>The epidemic in Sydney is at a crossroads, with the only two feasible choices being to go hard towards elimination (as supported by all modelling groups) or to maintain manageable case numbers until vaccination begins to take effect. Current policy choices in NSW appear to prefer the latter. </p>
<p>The next task for modellers should be to simulate this chosen pathway and the length of lockdown it would imply.</p>
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Read more:
<a href="https://theconversation.com/we-cant-rely-solely-on-arbitrary-vaccination-levels-to-end-lockdowns-here-are-7-ways-to-fix-sydneys-outbreak-165658">We can't rely solely on arbitrary vaccination levels to end lockdowns. Here are 7 ways to fix Sydney's outbreak</a>
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<img src="https://counter.theconversation.com/content/165459/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Epidemiological Modelling Unit at the School of Public Health and Preventive Medicine (led by James Trauer) has received funding for COVID-19 research from the NHMRC, the MRFF, the World Health Organization and the Victorian Government Department of Health and Human Services (now the Victorian Department of Health), including to produce epidemic projections during Victoria's second wave in 2020.</span></em></p>Different groups of researchers give different predictions. And it’s easy to be bewildered, especially if you’re in lockdown and looking for answers. Here’s what to make of it all.James Trauer, Associate Professor, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1650732021-07-29T20:00:22Z2021-07-29T20:00:22ZAustralia shouldn’t ‘open up’ before we vaccinate at least 80% of the population. Here’s why<figure><img src="https://images.theconversation.com/files/413261/original/file-20210727-13-rejbhp.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/casual-blond-young-woman-talking-on-1917201809">Shutterstock</a></span></figcaption></figure><p>Earlier this month National Cabinet released a four-phase <a href="https://www.pm.gov.au/media/national-cabinet-statement-6">COVID response plan</a>. It wasn’t so much a plan – it had no dates and no thresholds – but more a back-of-the-napkin thought bubble. It was <a href="https://theconversation.com/australia-has-a-new-four-phase-plan-for-a-return-to-normality-heres-what-we-know-so-far-163804">sensible, but vague</a>.</p>
<p>National Cabinet now faces the hard task of converting vagueness into a real plan. To do this it must answer the question: what proportion of the Australian population needs to be vaccinated before we can open our international borders?</p>
<p>This means allowing stranded Australians to return, letting footloose people travel overseas, and welcoming international tourists and students again. </p>
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Read more:
<a href="https://theconversation.com/australia-has-a-new-four-phase-plan-for-a-return-to-normality-heres-what-we-know-so-far-163804">Australia has a new four-phase plan for a return to normality. Here's what we know so far</a>
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<p>Well qualified experts <a href="https://www.afr.com/policy/health-and-education/the-politicisation-of-pandemic-punditry-20210721-p58brg">differ on the requisite threshold for vaccination</a> partly because there are so many unknowns, such as how quickly the Delta variant of COVID would spread through Australia if we open up, and how effective the different vaccines will prove to be in preventing transmission.</p>
<p>But new <a href="http://grattan.edu.au">Grattan Institute modelling</a> shows it would be dangerous for Australia to open up before at least 80% of the population is vaccinated. </p>
<p>Here’s what we found, and how we came to the 80% figure. Let’s start with the good news.</p>
<h2>Vaccines offer substantial protection</h2>
<p>Both vaccines on offer in Australia – Pfizer and AstraZeneca – are effective at preventing infections from the Delta strain. Two doses of Pfizer <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2108891">offers</a> about 88% protection against infection, while two doses of AstraZeneca offers about 67% protection. </p>
<p>Vaccinated people can still catch COVID, but those that do pass it on to about half as many others compared to the unvaccinated. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/yes-you-can-still-get-covid-after-being-vaccinated-but-youre-unlikely-to-get-as-sick-163870">Yes, you can still get COVID after being vaccinated, but you're unlikely to get as sick</a>
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<p>Evidence from the United Kingdom, Canada, and the European Union – areas with higher vaccination levels than Australia – also suggests both vaccines offer substantial protection against hospitalisation and death from COVID. A vaccinated person is about <a href="https://media.tghn.org/articles/Effectiveness_of_COVID-19_vaccines_against_hospital_admission_with_the_Delta_B._G6gnnqJ.pdf">95% less likely</a> than an unvaccinated person to end up in hospital with COVID.</p>
<p>Now for the bad news.</p>
<h2>The delta strain is far more infectious</h2>
<p>Researchers estimate the Delta variant is <a href="https://jglobalbiosecurity.com/articles/10.31646/gbio.121/">50% to 100% more infectious than the Alpha variant</a>, which itself was more transmissible than the variant that was dominant throughout 2020. </p>
<p>The effective reproduction number, or Reff, tells us how many people one infected person will spread the virus to, taking into account behaviour and public health measures in place designed to reduce transmission, such as masks and physical distancing.</p>
<figure class="align-center ">
<img alt="A masked supermarket check out operator scans products." src="https://images.theconversation.com/files/413509/original/file-20210728-27-147471c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/413509/original/file-20210728-27-147471c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/413509/original/file-20210728-27-147471c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/413509/original/file-20210728-27-147471c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/413509/original/file-20210728-27-147471c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/413509/original/file-20210728-27-147471c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/413509/original/file-20210728-27-147471c.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 Reff changes according to the public health measures in place, such as mask mandates.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cashier-supermarket-staff-medical-protective-mask-1680373474">Shutterstock</a></span>
</figcaption>
</figure>
<p>If the Reff of the Delta variant in Australia is around 6 without vaccination, having 50% vaccination coverage will reduce the Reff to 3.</p>
<p>But the national goal must be to bring the Reff down to below 1, which would mean each person who was infected would infect less than one other person – and the virus would eventually peter out.</p>
<p>The higher the vaccination rate, the lower the effective reproduction number. Each person vaccinated offers a chance of breaking a chain of transmission that might lead to an outbreak. </p>
<p>Not only are vaccinated people less likely to become infected, they are also less likely to pass the virus onto others if they are.</p>
<p><strong>The higher the vaccination rate, the lower the effective reproduction number</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/413513/original/file-20210728-13-1wsg5r1.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/413513/original/file-20210728-13-1wsg5r1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/413513/original/file-20210728-13-1wsg5r1.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=595&fit=crop&dpr=1 600w, https://images.theconversation.com/files/413513/original/file-20210728-13-1wsg5r1.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=595&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/413513/original/file-20210728-13-1wsg5r1.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=595&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/413513/original/file-20210728-13-1wsg5r1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=748&fit=crop&dpr=1 754w, https://images.theconversation.com/files/413513/original/file-20210728-13-1wsg5r1.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=748&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/413513/original/file-20210728-13-1wsg5r1.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=748&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Effective reproduction number (Reff) by population vaccination rate.</span>
<span class="attribution"><span class="source">Grattan Institute</span></span>
</figcaption>
</figure>
<h2>So why do we need 80% of people vaccinated?</h2>
<p><a href="https://github.com/grattan/covidReff">Grattan Institute’s model</a> simulates the spread of COVID within a partially vaccinated population, and helps us peek into the future.</p>
<p>It uses age-based hospitalisation and intensive care unit (ICU) admission rates from more than a year of COVID data from Australian ICU units. It also assumes children under 16 are about one-fifth less likely to get COVID, and children over the age of two are able to be vaccinated.</p>
<p>In most of our simulations, older people have higher rates of vaccination, and no age group has more than 95% vaccine coverage.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-will-we-reach-herd-immunity-here-are-3-reasons-thats-a-hard-question-to-answer-164560">When will we reach herd immunity? Here are 3 reasons that's a hard question to answer</a>
</strong>
</em>
</p>
<hr>
<p>We ran thousands of simulations of different vaccination rates, and different estimates of the Reff. The outcomes for 12 distinct scenarios are shown in the table below. </p>
<p>You can see why we recommend Australia not open up until at least 80% of the population is vaccinated – it is the only scenario where the virus is managed, with hospitalisations and deaths kept down to reasonable levels, even if the Reff is high.</p>
<hr>
<iframe src="https://flo.uri.sh/visualisation/6859968/embed" title="Interactive or visual content" class="flourish-embed-iframe" frameborder="0" scrolling="no" style="width:100%;height:1500px;" sandbox="allow-same-origin allow-forms allow-scripts allow-downloads allow-popups allow-popups-to-escape-sandbox allow-top-navigation-by-user-activation" width="100%" height="400"></iframe>
<div style="width:100%!;margin-top:4px!important;text-align:right!important;"><a class="flourish-credit" href="https://public.flourish.studio/visualisation/6859968/?utm_source=embed&utm_campaign=visualisation/6859968" target="_top"><img alt="Made with Flourish" src="https://public.flourish.studio/resources/made_with_flourish.svg"> </a></div>
<hr>
<h2>Let’s break it down</h2>
<p>Our simulations show that opening up at 50% vaccination rate (scenario 1) is a very bad idea, with many, many thousands of deaths.</p>
<p>Scenarios 2 and 3 are the optimist’s and gambler’s scenarios. If you are lucky and the Reff of Delta in Australia is 4 (with 70% vaccination rate) or 5 (with 75% vaccination rate), deaths and hospitalisations would not rise above moderate levels, and lockdowns could end and the borders could reopen. </p>
<p>But if you gambled on the wrong Reff, our hospitals would be overwhelmed and deaths would be unacceptably high. Opening the borders is a one-shot gamble: if you make the wrong call, the virus will quickly spread and all the good work and hard yards of living through lock-downs over the previous two years will have been wasted.</p>
<p>Public health decision-making is often risk averse, for the best of reasons. The difference in virus spread, hospitalisations and deaths between opening at 75% and at 80% are big, but the wait between the two thresholds may only be a month or two.
This is why we recommend an 80% vaccination rate (scenario 4) as the threshold for opening up. </p>
<p>Even if the Reff of Delta is 6, our hospital system will not be overwhelmed, and deaths will not rise above the number of deaths in a moderate flu season, such as 2010, when there were <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdi4104-f">2,364 flu deaths</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/80-vaccination-wont-get-us-herd-immunity-but-it-could-mean-safely-opening-international-borders-162863">80% vaccination won't get us herd immunity, but it could mean safely opening international borders</a>
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</p>
<hr>
<img src="https://counter.theconversation.com/content/165073/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett has had his first AstraZeneca vaccination.
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. Stephen Duckett has been partially vaccinated with AstraZeneca.</span></em></p><p class="fine-print"><em><span>Will Mackey 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>If we open up the international borders before enough of the population is vaccinated, hospitals could become overwhelmed and deaths would be unacceptably high.Stephen Duckett, Director, Health Program, Grattan InstituteWill Mackey, Senior Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1645862021-07-25T08:04:50Z2021-07-25T08:04:50ZCOVID-19 in children: the South African experience and way forward<figure><img src="https://images.theconversation.com/files/412145/original/file-20210720-25-15016mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">From the outset, communities were concerned about the impact of SARS-CoV-2 on children.</span> <span class="attribution"><span class="source">Roger Sedres/Gallo Images via Getty Images</span></span></figcaption></figure><p>Since its emergence in late 2019, SARS-CoV-2 has caused illness (COVID-19) and death in all countries in the world. The restrictions put in place to reduce the spread of this virus have devastated economies and livelihoods the world over. By the end of June 2021, the World Health Organisation <a href="https://covid19.who.int/">estimated</a> that there had been 180.4 million cases of COVID-19 and 3.9 million associated deaths globally.</p>
<p>From the outset, communities were concerned about the impact of SARS-CoV-2 on children. This was justifiable because many other respiratory viruses such as influenza and respiratory syncytial virus disproportionately affect children. With their immature and developing immune systems children have larger amounts of virus in their respiratory tract and release the virus from there for longer durations. This puts them at the centre of transmission of those viruses – to each other at schools and to adults and siblings at home. It was not surprising that early interventions to delay the spread of COVID-19 included shutting down schools. </p>
<p>But COVID-19 has bucked this trend of affecting children more than adults. </p>
<p>SARS-CoV-2 is known to infect children of all ages, from newborns to older adolescents and teens. But children have <a href="https://bmjpaedsopen.bmj.com/content/4/1/e000722">not been the drivers</a> of the COVID-19 pandemic to date. </p>
<p>This is because children are less likely to: </p>
<ul>
<li><p>be <a href="https://bmjpaedsopen.bmj.com/content/4/1/e000722">infected</a> with the SARS-CoV-2 virus when exposed to it; </p></li>
<li><p>develop <a href="https://bmjpaedsopen.bmj.com/content/5/1/e001063">symptomatic disease</a> when infected;</p></li>
<li><p>be hospitalised or die from COVID-19 when they do develop <a href="https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2779416">severe disease</a> compared to adults; and</p></li>
<li><p><a href="https://www.ingentaconnect.com/content/ocean/aap/2021/00000042/00000001/art00004">transmit</a> the SARS-CoV-2 virus to others. </p></li>
</ul>
<p>Our <a href="https://www.nicd.ac.za/diseases-a-z-index/covid-19/surveillance-reports/monthly-covid-19-in-children/">surveillance data</a> in South Africa indicate that this lower risk of infection, disease, death or transmission experienced by children is age-dependent. Among children, the likelihood of infection, disease or death generally increases with age. Older teens and adolescents are acquiring COVID-19 at rates similar to adults in some instances. This routine surveillance has been in place since the beginning of the COVID-19 pandemic. The aim is to monitor disease trends in children and inform policy around prevention, care and treatment for children. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-south-africas-teachers-brought-to-the-virtual-classroom-during-covid-19-147306">What South Africa's teachers brought to the virtual classroom during COVID-19</a>
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<h2>The South African experience</h2>
<p>By <a href="https://sacoronavirus.co.za/category/daily-cases/page/2/">mid-June 2021</a>, South Africa had conducted 12.3 million tests and detected 1.8 million cases. Children <a href="https://www.nicd.ac.za/wp-content/uploads/2021/07/COVID-19-in-children-surveillance-report_5-JULY-2021.pdf">19 years or younger</a> accounted for 13.4% of tests conducted, 10.2% of new cases reported, 4.2% of COVID-19 associated hospital admissions and 0.7% of COVID-19 associated deaths. This is despite children this age accounting for <a href="http://www.statssa.gov.za/publications/P0302/P03022020.pdf">36.6%</a> of the South African population. </p>
<p>This age group was 3.7 times less likely to test for COVID-19, 5.7 times less likely to test positive for COVID-19, 13.3 times less likely to be admitted to hospital with COVID-19 and 6.7 times less likely to die in hospital once admitted compared to adults older than 19 years. </p>
<p>The data to date has not shown or suggested an association between case or admission rates with the opening and closing of schools in the country. </p>
<p>Given the adverse <a href="https://www.who.int/publications/i/item/considerations-for-school-related-public-health-measures-in-the-context-of-covid-19">social and psychological impacts</a> of closures on schools, it is encouraging to know that schools are not driving the COVID-19 pandemic. They can <a href="https://www.who.int/publications/i/item/considerations-for-school-related-public-health-measures-in-the-context-of-covid-19">safely remain open</a> provided there is implementation of and adherence to non-pharmaceutical interventions for COVID-19 prevention.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-african-countries-can-reform-education-to-get-ahead-after-pandemic-school-closures-163935">How African countries can reform education to get ahead after pandemic school closures</a>
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</em>
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<hr>
<p>Some groups <a href="https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2780706">among children</a> experience <a href="https://www.pediatric.theclinics.com/article/S0031-3955(20)30107-3/fulltext">higher rates of illness</a> and these bear more discussion. </p>
<p>First, the <a href="https://www.nicd.ac.za/wp-content/uploads/2021/07/COVID-19-in-children-surveillance-report_5-JULY-2021.pdf">increased case rates</a> in older teens and adolescents, at rates similar to adults older than 19 years in the third wave, requires monitoring. Since the onset of the third wave to the peak, the fraction of all COVID-19 cases aged 19 years or younger was averaging 14.6% as opposed to around 9% in the first and second waves. Half of the cases were occurring in older teens and adolescents 15-19 years, bringing the case rate in this group on par with adults older than 19 years. </p>
<p>This could have been as a result of: </p>
<ul>
<li>generally <a href="https://www.nicd.ac.za/wp-content/uploads/2021/07/COVID-19-in-children-surveillance-report_5-JULY-2021.pdf">increased testing in children</a> in the third wave. More testing would pick up more cases, including mild or asymptomatic ones. </li>
<li>increased testing in response to cluster outbreaks in schools, leading to more testing among symptomatic or mildly symptomatic children and adolescents</li>
<li>increasing <a href="https://theconversation.com/south-africans-are-keener-to-get-vaccinated-but-many-still-need-to-be-convinced-164350">vaccination rates</a> among adults, leaving younger individuals contributing more cases; and</li>
<li>the <a href="https://theconversation.com/pasha-113-covid-19-the-delta-variant-and-south-africas-vaccination-problems-163748">Delta variant</a> itself – which may have a greater predilection for children, although there is not yet any conclusive data to support this.</li>
</ul>
<p>Second, infants under the age of one have experienced higher hospital admission rates compared to other children, especially after the second wave. In our most <a href="https://www.nicd.ac.za/diseases-a-z-index/covid-19/surveillance-reports/monthly-covid-19-in-children/">recent report</a>, infants made up 2.2% of cases 19 years or younger but contributed 19.3% of the admissions and 31.8% of deaths in this group. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-school-closures-in-south-africa-and-their-impact-on-children-141832">COVID-19 school closures in South Africa and their impact on children</a>
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</em>
</p>
<hr>
<p>It is unclear why these infants are admitted to start with or what the causes of deaths are. Generally infants are much more likely to be admitted with non-COVID-19 conditions compared to older children. There is routine testing of all admissions at many hospitals, so it is possible that many of these admissions are for other reasons, with COVID-19 an incidental finding. More data are needed to investigate reasons for admission in this age group. </p>
<p>Lastly, children with underlying conditions made up 19.3% of children admitted with COVID-19 but 56% of those who died. The most commonly reported underlying conditions among those admitted were chronic respiratory diseases, diabetes, HIV and tuberculosis (active and previous). HIV, diabetes and tuberculosis were common among those who died.</p>
<h2>What about vaccination?</h2>
<p>South African children are not yet <a href="https://www.gov.za/covid-19/vaccine/vaccine">eligible</a> for COVID-19 vaccination and may not be for a while. The <a href="https://theconversation.com/children-teens-and-covid-vaccines-where-is-the-evidence-at-and-when-will-kids-in-australia-be-eligible-160625">reasons for this include</a> the lower risk of disease and the need to prioritise the elderly; limited information on the efficacy and safety of the vaccines in children; and limited number of vaccines which are licensed for use in children.</p>
<p>Some countries in Europe and North America have opened up vaccination to children 12-16 years although coverage in this age group is still low. As more children are vaccinated in these countries, more data on side effects and effectiveness will be collected and many lessons to inform rollout in South Africa will be learnt. </p>
<p>In the South African setting, there is a case for the expedited vaccination of children with underlying conditions and older teens and adolescents based on burden of cases and hospitalisations in these two groups respectively. </p>
<p>Until then the onus is on everyone to ensure vaccination of adults around children to achieve herd immunity, and adherence to non-pharmaceutical intervention to reduce transmission in the community and spillover into schools.</p><img src="https://counter.theconversation.com/content/164586/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cheryl Cohen receives funding from United States Centres for Disease Control and Prevention and Wellcome Trust UK.</span></em></p><p class="fine-print"><em><span>Nicola Chiwandire, Sibongile Walaza, Tendesayi Kufa-Chakezha, and Waasila Jassat 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>Schools are not driving the COVID-19 pandemic and can safely remain open provided people stick to the non-pharmaceutical interventions for COVID-19 prevention.Tendesayi Kufa-Chakezha, Epidemiologist and Public Health Specialist, National Institute for Communicable DiseasesCheryl Cohen, co-head of the Centre for Respiratory Disease and Meningitis, National Institute for Communicable DiseasesSibongile Walaza, Medical Epidemiologist at the National Institute of Communicable Diseases and Lecturer at the School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1553632021-04-18T12:51:44Z2021-04-18T12:51:44ZGovernment-ordered COVID-19 lockdowns are actually unethical, and here’s why<figure><img src="https://images.theconversation.com/files/395314/original/file-20210415-15-13q1xy9.png?ixlib=rb-1.1.0&rect=23%2C23%2C5168%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">To control the spread of COVID-19, various public health measures have been put into effect.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The ongoing coronavirus pandemic has invited government and public health officials to issue <a href="https://ig.ft.com/coronavirus-lockdowns/">lockdowns and stay-at-home orders globally</a>. But these <a href="https://www.aier.org/article/a-comprehensive-case-against-lockdowns-how-dr-ari-joffe-changed-his-mind/">lockdown orders are not justified</a>. Consequently, there is no moral obligation to obey them.</p>
<p>After the SARS and H1N1 epidemics, the Public Health Agency of Canada drafted the <a href="https://www.canada.ca/en/public-health/services/flu-influenza/canadian-pandemic-influenza-preparedness-planning-guidance-health-sector.html">Canadian Pandemic Influenza Preparedness (CPIP)</a> guide. Although the guide was not implemented, it <a href="https://www.canada.ca/en/public-health/services/flu-influenza/canadian-pandemic-influenza-preparedness-planning-guidance-health-sector/table-of-contents.html#a4c">nevertheless maintains that</a>:</p>
<blockquote>
<p>… when considering restrictive measures, it is important to balance respect for autonomy against protection of overall population health. In such situations, the principles of proportionality, reciprocity and flexibility are involved, with a view to safeguarding individual freedom to the extent possible while promoting protection against the health and societal consequences of influenza infection.</p>
</blockquote>
<p>I understand this to mean that justification for state-sanctioned paternalism to promote public health is possible. What provides actual justification, however, depends on the equitable balance of benefits over harms such paternalistic measures are able to achieve. There is a philosophical argument to be made that lockdown measures essentially do not — indeed, cannot — achieve this balance.</p>
<h2>Legitimacy of law</h2>
<p>So, it’s possible for public health measures that limit the scope of rights and liberties to warrant enforcement. But in order for them to actually obtain warrant, measures must: i) be evidentially and demonstrably effective at achieving their aim; ii) have purported benefits that outweigh their foreseeable harms, and iii) be clearly, uniformly, transparently and publicly communicated. These conditions are necessary for limiting — not infringing — <a href="https://doi.org/10.1111/j.1748-720x.2002.tb00384.x">relevant rights and civil liberties</a>. </p>
<p>These conditions have <a href="https://www.tvo.org/article/it-leads-to-mistrust-experts-weigh-in-on-ontarios-covid-19-communications">not been fulfilled with lockdown measures</a>. So, under what conditions is it permissible to disobey the law? What policies would warrant citizens to no longer recognize the legitimacy of state authority?</p>
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<figcaption><span class="caption">In Jan. 2021, lockdowns became enforcable by law in the United Kingdom.</span></figcaption>
</figure>
<p>There is the fact of law and there is the force of law, but neither of these provide the law with legitimacy. This is the condition of the possibility of claims like “an unjust law is no law at all.”</p>
<p>If the law is just, then failure to obey results in one being rightfully subject to the resulting punishment. If, however, the law is unjust, then failure to obey becomes legitimate and one is wrongfully subject to what could only be considered disproportionate sanctions. In this case, the law is incommensurate with the right and the just; it is law, but not lawful.</p>
<p>When it is not possible for a law to obtain justification, it does not have the ability to be legitimate. And when a law cannot obtain legitimacy, disobedience to that law becomes morally warranted.</p>
<h2>Determining justice</h2>
<p>The <a href="https://www.ohchr.org/EN/UDHR/Documents/UDHR_Translations/eng.pdf">Universal Declaration of Human Rights</a> serves to protect and promote fundamental human interests and make provision for the intrinsic values of humans. This is the moral character of rights: they determine the minimum standard of what is morally permissible, prohibited and prescribed in human acts, legislation included. So, for law to be legitimate, it must be predicated on such rights.</p>
<p>Rights involve either claims or privileges. When rights make claims, there is a corresponding duty made upon others to respect the claim being made. Claim rights protect basic human interests from being harmed, such as the security of the person.</p>
<p>When rights involve privileges, others are unable to make claims against you. If you have a privilege, you no longer have a responsibility to respect a claim because a claim can’t be made against you. Privilege rights promote the expression of permissible human interests, such as freedom of belief.</p>
<p>When a law fails to protect claim rights, promote privilege rights or make provision for the actual exercise of either, it is not a just law.</p>
<h2>Lockdowns and compliance</h2>
<p>How do lockdown measures fail to be legitimate and, consequently, fail to demand our obedience?</p>
<p>Consider the right of “the security of the person.” This right makes a claim against others to refrain from inflicting any undue harms, be they physical, psychological or economic without express consent of the agent.</p>
<p>The right to security of the person also safeguards what we are at liberty to do up to the limit of inflicting undue harms on others. Security of the person actually safeguards the citizen against the state inflicting undue harms on them, while simultaneously safeguarding individuals against the harmful exercise of their protected liberties.</p>
<p>No state has the mandate to protect its citizens against harms as such — it simply has the duty to make provisions for safeguarding its citizens against those harms that would impair their ability to act autonomously and with respect for the public good.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-lockdown-worth-the-pain-no-its-a-sledgehammer-and-we-have-better-options-145555">Is lockdown worth the pain? No, it's a sledgehammer and we have better options</a>
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</em>
</p>
<hr>
<p>Lockdown measures have reversed this order by mistaking a claim right for a privilege right: they force individuals to suspend what they are properly at liberty to do in order to protect others from harms they cannot properly be protected from. In the process, lockdown orders demand that people suspend their right to security of the person for the sake of being secured against the very harms this right is meant to safeguard people against. </p>
<p>That there is less <a href="https://www.msn.com/en-us/news/world/swedens-choice-not-to-lockdown-for-covid-wasnt-that-different-from-rest-of-world-says-dr-anders-tegnell/ar-BB1cI1am">evidence for the effectiveness of lockdowns</a> than there is for their <a href="https://nationalpost.com/news/canada/ontario-lockdown-not-supported-by-strong-science-says-former-chief-medical-officer-of-health">ineffectiveness makes matters worse</a>. That the various <a href="https://www.msn.com/en-us/health/medical/who-official-urges-world-leaders-to-stop-using-lockdowns-as-primary-virus-control-method/ar-BB19TBUo">harms of lockdown measures</a> far exceed their purported benefits, even more so.</p>
<p>It is morally permissible to enact a policy wherein <a href="https://www.weforum.org/agenda/2020/04/this-is-the-psychological-side-of-the-covid-19-pandemic-that-were-ignoring/">harms quantitatively outweigh benefits</a> only if the benefits are of such comparative quality that <a href="https://www.cbc.ca/news/business/cfib-survey-1.5882059">failing to promote them would itself constitute a greater harm</a>.</p>
<p>The purported benefits of lockdowns is to safeguard public health. But this is obtained at the expense of the rights and freedoms constituting the public interest, of which public health forms a part.</p>
<p>As I argue elsewhere, <a href="https://www.hilltimes.com/2020/04/27/public-health-the-public-good-and-where-collective-responsibility-lies/243715">no one can be made responsible to secure lesser goods at the expense of greater</a>. Lockdown measures force us to fulfil a responsibility to public health that impairs our responsibility to protect, promote or make provision for other goods of equal or greater value. Lockdowns are, therefore, <a href="https://www.hrw.org/news/2020/04/09/covid-19-and-childrens-rights">orders of magnitude less beneficial than the harms they cause</a>.</p>
<p>The state must proportion its response to COVID-19 to the evidence. The state must also only enlist those strategies that demonstrably and judiciously strike a balance between promoting the public good and protecting public health. The state must clearly, uniformly and transparently communicate these strategies to the public.</p>
<p>The public must be viewed as collaborators in the execution of these strategies and not variables to be controlled for their own good. The state must end lockdown orders.</p>
<p>Otherwise, civil disobedience to them appears morally warranted.</p><img src="https://counter.theconversation.com/content/155363/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Sikkema 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>Different levels of governments have ordered physical distancing measures of varying degrees, but are they truly lawful?James Sikkema, Assistant Professor, Philosophy, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1565512021-03-23T12:33:02Z2021-03-23T12:33:02ZPeople gave up on flu pandemic measures a century ago when they tired of them – and paid a price<figure><img src="https://images.theconversation.com/files/391004/original/file-20210322-21-1ubeke9.jpg?ixlib=rb-1.1.0&rect=0%2C517%2C2700%2C1669&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Armistice Day celebrations on Nov. 11, 1918, worried public health experts as people crowded together in cities across the U.S.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/ArmisticeDay1918/4a5c7026339b41feabd1d798f98af262/photo?boardId=d7f2514f50804466b15dfb81ed00d9cd&st=boards&mediaType=audio,photo,video,graphic&sortBy=&dateRange=Anytime&totalCount=36&currentItemNo=0">AP Photo </a></span></figcaption></figure><p>Picture the United States struggling to deal with a deadly pandemic.</p>
<p>State and local officials enact a slate of social-distancing measures, gathering bans, closure orders and mask mandates in an effort to stem the tide of cases and deaths.</p>
<p>The public responds with widespread compliance mixed with more than a hint of grumbling, pushback and even outright defiance. As the days turn into weeks turn into months, the strictures become harder to tolerate.</p>
<p><a href="https://quod.lib.umich.edu/f/flu/7520flu.0016.257/1/--protest-is-made?rgn=full+text;view=image;q1=Protest+is+Made+by+Theater+Men">Theater and dance hall owners complain</a> about their financial losses.</p>
<p><a href="https://quod.lib.umich.edu/f/flu/9660flu.0001.669/1/--wants-churches-open?rgn=full+text;view=image;q1=Wants+churches+open">Clergy bemoan church closures</a> while offices, factories and in some cases even saloons are allowed to remain open.</p>
<p><a href="https://quod.lib.umich.edu/f/flu/1240flu.0006.421/1/--clash-over-school-order-due-monday?rgn=full+text;view=image;q1=Clash+Over+School+Order+Due+Monday">Officials argue whether children are safer in classrooms</a> or at home.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="men with a streetcar" src="https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=823&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=823&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=823&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1034&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1034&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1034&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">No mask, no service on streetcar in 1918.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/precautions-taken-during-spanish-influenza-epidemic-would-news-photo/1223011380">Universal History Archive/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<p><a href="https://quod.lib.umich.edu/f/flu/1320flu.0009.231/1/--new-cases-of-influenza-at-low-record?rgn=full+text;view=image;q1=New+Cases+of+Influenza+at+Low+Record">Many citizens refuse to don face masks while in public</a>, some complaining that they’re uncomfortable and others arguing that the government has no right to <a href="https://theconversation.com/mask-resistance-during-a-pandemic-isnt-new-in-1918-many-americans-were-slackers-141687">infringe on their civil liberties</a>.</p>
<p>As familiar as it all may sound in 2021, these are real descriptions of the U.S. during the deadly 1918 influenza pandemic. <a href="https://scholar.google.com/citations?user=gzhca9MAAAAJ&hl=en&oi=sra">In my research as a historian of medicine</a>, I’ve seen again and again the many ways our current pandemic has mirrored the one experienced by our forebears a century ago.</p>
<p>As the COVID-19 pandemic enters its second year, many people want to know when life will go back to how it was before the coronavirus. History, of course, isn’t an exact template for what the future holds. But the way Americans emerged from the earlier pandemic could suggest what post-pandemic life will be like this time around.</p>
<h2>Sick and tired, ready for pandemic’s end</h2>
<p>Like COVID-19, the 1918 influenza pandemic hit hard and fast, going from a handful of reported cases in a few cities to a nationwide outbreak within a few weeks. Many communities issued several rounds of various closure orders – corresponding to the ebbs and flows of their epidemics – in an attempt to keep the disease in check.</p>
<p><a href="https://doi.org/10.1001/jama.298.6.644">These social-distancing orders worked</a> to reduce cases and deaths. Just as today, however, they often proved difficult to maintain. By the late autumn, just weeks after the social-distancing orders went into effect, the pandemic seemed to be coming to an end as the number of new infections declined.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="masked typist at work" src="https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=470&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=470&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=470&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=590&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=590&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=590&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 were ready to be done with masks as soon as it looked like the flu was receding.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/typist-wears-mask-while-working-at-her-office-desk-during-news-photo/108882651?adppopup=true">PhotoQuest/Archive Photos via Getty Images</a></span>
</figcaption>
</figure>
<p>People clamored to return to their normal lives. Businesses pressed officials to be allowed to reopen. Believing the pandemic was over, state and local authorities began rescinding public health edicts. The nation turned its efforts to addressing the devastation influenza had wrought.</p>
<p>For the friends, families and co-workers of the <a href="https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html">hundreds of thousands of Americans who had died</a>, post-pandemic life was filled with sadness and grief. Many of those still recovering from their bouts with the malady required support and care as they recuperated.</p>
<p>At a time when there was no federal or state safety net, charitable organizations sprang into action to provide resources for families who had lost their breadwinners, or <a href="https://quod.lib.umich.edu/f/flu/07z0flu.0000.070/1/--caring-for-little-ones-left-orphans?page=root;rgn=full+text;size=150;view=image;q1=orphan">to take in the countless children left orphaned</a> by the disease.</p>
<p>For the vast majority of Americans, though, life after the pandemic seemed to be a headlong rush to normalcy. Starved for weeks of their nights on the town, sporting events, religious services, classroom interactions and family gatherings, many were eager to return to their old lives.</p>
<p>Taking their cues from officials who had – somewhat prematurely – declared an end to the pandemic, Americans overwhelmingly hurried to return to their pre-pandemic routines. <a href="https://quod.lib.umich.edu/f/flu/7900flu.0004.097/1/--big-increase-in-flu-feared-as-result-of-packed-city-streets?rgn=full+text;view=image;q1=Big+Increase+in+Flu+Feared+as+Result+of+Packed+City+Streets">They packed into movie theaters</a> and dance halls, crowded in stores and shops, and gathered with friends and family.</p>
<p><iframe id="VfjzK" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/VfjzK/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Officials had warned the nation that cases and deaths likely would continue for months to come. The burden of public health, however, now rested not on policy but <a href="https://quod.lib.umich.edu/f/flu/2770flu.0007.772/1/--measures-taken-to-again-combat-epidemic-of-flu?page=root;rgn=full+text;size=150;view=image;q1=Measures+Taken+to+Again+Combat+Epidemic+of+Flu">rather on individual responsibility</a>.</p>
<p>Predictably, the pandemic wore on, stretching into a third deadly wave that lasted through the spring of 1919, with a fourth wave hitting in the winter of 1920. Some officials blamed the resurgence on careless Americans. <a href="https://quod.lib.umich.edu/f/flu/6090flu.0000.906/1/--anxious-rumors-about-recurrence-of-influenza-not-sustained?page=root;rgn=full+text;size=150;view=image;q1=Anxious+Rumors+about+Recurrence+of+Influenza+Not+Sustained+by+Facts">Others downplayed the new cases</a> or turned their attention to more routine public health matters, including other diseases, restaurant inspections and sanitation. </p>
<p>Despite the persistence of the pandemic, influenza quickly became old news. Once a regular feature of front pages, reportage rapidly dwindled to small, sporadic clippings buried in the backs of the nation’s newspapers. The nation carried on, inured to the toll the pandemic had taken and the deaths yet to come. People were largely unwilling to return to socially and economically disruptive public health measures.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="masked barber shaves a customer" src="https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">No matter the era, aspects of daily life go on even during a pandemic.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-an-unspecified-barbershop-a-man-receives-a-shave-from-a-news-photo/1219167388">Chicago History Museum/Archive Photos via Getty Images</a></span>
</figcaption>
</figure>
<h2>It’s hard to hang in there</h2>
<p>Our predecessors might be forgiven for not staying the course longer. First, the nation was eager <a href="https://chroniclingamerica.loc.gov/lccn/sn83030193/1918-11-07/ed-1/seq-1/#words=Ended+end+End+War+war+Peace+peace">to celebrate</a> the recent <a href="https://chroniclingamerica.loc.gov/lccn/sn83030214/1918-11-11/ed-1/seq-1/#words=over+end+surrendered+Over+war+ENDED+War+armistice+SURRENDERED+End+surrender+WAR+Armistice">end of World War I</a>, an event that perhaps loomed larger in the lives of Americans than even the pandemic.</p>
<p>Second, death from disease was a much larger part of life in the early 20th century, and scourges such as diphtheria, measles, tuberculosis, typhoid, whooping cough, scarlet fever and pneumonia each routinely <a href="https://www.cdc.gov/nchs/data/vsushistorical/mortstatsh_1918.pdf">killed tens of thousands of Americans every year</a>. Moreover, neither the cause nor the epidemiology of influenza was well understood, and many experts remained unconvinced that social distancing measures had any measurable impact.</p>
<p>Finally, there were no effective flu vaccines to rescue the world from the ravages of the disease. In fact, the influenza virus would not be <a href="https://www.cdc.gov/flu/pandemic-resources/pandemic-timeline-1930-and-beyond.htm">discovered for another 15 years, and a safe and effective vaccine</a> was not available for the general population until 1945. Given the limited information they had and the tools at their disposal, Americans perhaps endured the public health restrictions for as long as they reasonably could.</p>
<p><iframe id="wEFff" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/wEFff/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>A century later, and a year into the COVID-19 pandemic, it is understandable that people now are all too eager to return to their old lives. The end of this pandemic inevitably will come, as it has with <a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">every previous one humankind has experienced</a>.</p>
<p>If we have anything to learn from the history of the 1918 influenza pandemic, as well as our experience thus far with COVID-19, however, it is that a premature return to pre-pandemic life risks more cases and more deaths.</p>
<p>And today’s Americans have significant advantages over those of a century ago. We have a much better understanding of virology and epidemiology. We know that <a href="https://www.sciencedaily.com/releases/2020/09/200910110824.htm">social distancing</a> and <a href="https://doi.org/10.1038/d41586-020-02801-8">masking work to help save lives</a>. Most critically, we have multiple safe and effective vaccines that are being deployed, with <a href="https://www.nytimes.com/live/2021/03/18/world/covid-19-coronavirus/us-vaccine-pace-eligible">the pace of vaccinations increasingly weekly</a>.</p>
<p>Sticking with all these coronavirus-fighting factors or easing off on them could mean the difference between a <a href="https://www.statnews.com/2021/03/20/rising-covid19-cases-in-some-states-highlight-precarious-position/">new disease surge</a> and a quicker end to the pandemic. COVID-19 is much more transmissible than influenza, and <a href="https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html">several troubling SARS-CoV-2 variants are already spreading</a> around the globe. The deadly third wave of influenza in 1919 shows what can happen when people prematurely relax their guard.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/156551/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J. Alexander Navarro does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Americans were tired of social distancing and mask-wearing. At the first hint the virus was receding, people pushed to get life back to normal. Unfortunately another surge of the disease followed.J. Alexander Navarro, Assistant Director of the Center for the History of Medicine, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1508192020-12-11T16:49:55Z2020-12-11T16:49:55ZMasks and mandates: How individual rights and government regulation are both necessary for a free society<figure><img src="https://images.theconversation.com/files/373708/original/file-20201208-23-t491lr.jpg?ixlib=rb-1.1.0&rect=18%2C25%2C4130%2C2502&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Residents line up in their cars in late November at a food distribution site in Clermont, Florida, where many are hungry because of the pandemic. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/volunteers-direct-traffic-as-residents-line-up-in-their-news-photo/1229725644?adppopup=true">Paul Hennessy/SOPA Images/LightRocket via Getty Images</a></span></figcaption></figure><p>I’ve been thinking a lot, recently, about the tension between demanding “individual rights” – in the sense of deciding whether or not to wear a mask – and calling for more action on the part of our government to protect us from the coronavirus pandemic. </p>
<p><a href="https://theconversation.com/profiles/martha-ackelsberg-519759">I’m a political theorist</a>, which means I study how communities are organized, how power is exercised and how people relate to one another in and between communities. I’ve realized – through talking to friends, and thinking about the protests against COVID-19-related restrictions that have taken place around the country – that many people do not understand that individual rights and state power are not really opposites. </p>
<p>The laws and policies that governments enact set the framework for the exercise of our rights. So, inaction on the part of government does not necessarily empower citizens. It can, effectively, take away our power, leaving us less able to act to address our needs.</p>
<h2>‘War of all against all’</h2>
<p><a href="https://www.archives.gov/founding-docs/declaration-transcript">The Founders stated in the Declaration of Independence</a> that “governments are instituted among Men … to secure their rights … to life, liberty, and the pursuit of happiness.” </p>
<p>Those goals cannot be pursued individually without governments to help create the conditions necessary for collective life. As Thomas Hobbes recognized almost four centuries ago, if everyone just does what they please, no one can trust anyone. We end up with chaos, uncertainty and a “<a href="https://plato.stanford.edu/entries/hobbes-moral/">war of all against all</a>.” </p>
<p>Rights become worthless.</p>
<p>This paradox – of the need for government to enable the effective pursuit of individual aims – is particularly extreme in the situation of COVID-19 and its attendant economic crisis. Amid a rampaging pandemic, people have rights to do many things, but are they really free to exercise them? </p>
<figure class="align-center ">
<img alt="A bus in West Reading, PA, with the message 'No Masks No Ride' displayed on its digital sign." src="https://images.theconversation.com/files/373709/original/file-20201208-15-12vsgsz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373709/original/file-20201208-15-12vsgsz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373709/original/file-20201208-15-12vsgsz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373709/original/file-20201208-15-12vsgsz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373709/original/file-20201208-15-12vsgsz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373709/original/file-20201208-15-12vsgsz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373709/original/file-20201208-15-12vsgsz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A bus reminds people ‘No Masks No Ride’ in September 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/bus-with-the-message-no-masks-no-ride-displayed-on-its-news-photo/1272483926?adppopup=true">Ben Hasty/MediaNews Group/Reading Eagle via Getty Images</a></span>
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<p>It may not feel like you can enjoy the benefits of your individual rights when you have to be engaged in a continuous process of risk-assessment: Is it safe to leave my house? To go to work? To send my child to school? To visit my loved ones?</p>
<p>Even more, people confront those questions from very different perspectives: <a href="https://www.thenationshealth.org/content/50/6/1.1">“Essential” workers</a> have had to make decisions about whether to go to work and risk disease or death, or to stay home to protect themselves and their families and risk hunger and homelessness. <a href="https://doi.org/10.1056/NEJMp2024046">Those who are unsafe in their homes</a>, because they live with <a href="https://theconversation.com/intimate-partner-violence-has-increased-during-pandemic-emerging-evidence-suggests-148326">abusive parents or partners</a> must choose between the danger of staying in and the dangers of leaving. Even those who work remotely <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-whats-safe-to-do-in-the-new-normal">make an assessment of risk every time they leave home</a>, especially now that infections have surged, given the absence of clear, shared norms about social distancing, mask-wearing and other precautions against the spread of disease.</p>
<h2>Collective framework</h2>
<p>Each person experiences these as personal choices, however, because federal and state governments have <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/state-data-and-policy-actions-to-address-coronavirus/">failed to provide a truly collective framework</a> within which people can be safer. </p>
<p>People may know, for example, that if everyone wore a mask in the presence of others, maintained social distance and avoided large crowds, <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/need-to-know.html">it would be relatively safe</a> to be out in public. But that <a href="https://doi.org/10.1056/NEJMp2006740">goal cannot be achieved by voluntary individual actions alone</a>, since the benefits are achieved only when most or all of us participate. </p>
<p>The only way to assure that everyone will be wearing a mask — understood as an act of community and collective care, an action taken to protect others, as well as ourselves — is for the government to require mask-wearing because it is needed for the protection of life. </p>
<p>It’s well accepted that governments can <a href="https://www.nerdwallet.com/article/insurance/minimum-car-insurance-requirements">mandate that drivers must have insurance</a> if they are to be allowed to register and drive a car, or that <a href="https://www.ncsl.org/research/health/immunizations-policy-issues-overview.aspx">all children be vaccinated before they can attend school</a>. These requirements are justified out of the recognition that our individual actions (or inactions) affect others as well as ourselves.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373711/original/file-20201208-14-1qe7i2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Maine Independent Sen. Angus King sets up a sign describing a bipartisan proposal for a Covid-19 relief bill on Capitol Hill." src="https://images.theconversation.com/files/373711/original/file-20201208-14-1qe7i2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373711/original/file-20201208-14-1qe7i2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373711/original/file-20201208-14-1qe7i2d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373711/original/file-20201208-14-1qe7i2d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373711/original/file-20201208-14-1qe7i2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373711/original/file-20201208-14-1qe7i2d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373711/original/file-20201208-14-1qe7i2d.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">Maine Independent Sen. Angus King sets up a sign describing a bipartisan proposal for a COVID-19 relief bill on Capitol Hill on December 1, 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sen-angus-king-sets-up-a-sign-alongside-a-bipartisan-group-news-photo/1288861346?adppopup=true">Tasos Katopodis/Getty Images</a></span>
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<p>Of course — and here is where questions about individual rights come up against the need for government policy — in the absence of government economic support for individuals and families, for example, <a href="https://coronavirus.jhu.edu/from-our-experts/the-unequal-cost-of-social-distancing">the costs of actions taken to protect others fall unequally</a>. </p>
<p>If businesses close to slow the spread of disease, they protect both workers and consumers. But without government aid, they and their workers are the ones who <a href="https://www.washingtonpost.com/business/2020/05/12/small-business-used-define-americas-economy-pandemic-could-end-that-forever/">bear the financial burdens of these actions</a> as individuals.</p>
<h2>Interdependence and mutual responsibility</h2>
<p>That is why <a href="https://www.npr.org/2020/03/26/821457551/whats-inside-the-senate-s-2-trillion-coronavirus-aid-package">the CARES Act</a>, which provided income for those who lost jobs and loans or grants to those who kept their workers on payroll, was critical. </p>
<p>It was government policy that recognized that collective caring behavior cannot be sustained without communal support. The CARES Act articulated, through a series of government programs, the idea that no one should be forced to be a martyr — say, to lose their livelihood — for the benefit of others.</p>
<p>Government policy of this sort (such as <a href="https://www.npr.org/2020/12/11/945339594/discussions-drag-on-for-another-coronavirus-relief-bill">the relief bills now being considered by Congress</a>) aims to ensure that those who forego work to protect others — or go to work to protect others, like essential workers — will not have to pay a personal price. </p>
<p>The ability to exercise the rights to work, to shop or to go to school depends upon having a relatively safe public space in which to operate. In turn, that requires all of us to attend to the rights and safety of others, as well as of ourselves. </p>
<p>Government is the means by which such attending — caring — is expressed and accomplished. It is only when people can count on others to be concerned for one another that they can truly be free to act, and exercise their rights, in the public arena.</p><img src="https://counter.theconversation.com/content/150819/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am not now receiving any funding; but I have, in the past, held a National Defense Education Act fellowship for graduate study, and research fellowships from Smith College, the American Association of University Women, the Mellon Foundation, the Danforth Foundation. I have also served on review panels for the National Science Foundation (for which I receive a small stipend).</span></em></p>The absence of effective government policy doesn’t make citizens free. It takes away their power, leaving them less able to act to address their needs. That’s especially clear during the pandemic.Martha Ackelsberg, William R. Kenan, Jr. Professor of Government, emerita, Smith CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/914472018-02-19T17:21:48Z2018-02-19T17:21:48ZIt’s poverty, not individual choice, that is driving extraordinary obesity levels<figure><img src="https://images.theconversation.com/files/206256/original/file-20180213-44657-1d5r96h.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/man-overweight-symbolic-photo-beer-belly-623414777?src=LkZ-VVZgvyvrT0wshwYfaQ-1-1">Sharomka/Shutterstock.com</a></span></figcaption></figure><p>The “obesity epidemic” deserves much more serious attention than it is getting. It is, after all, thought to be killing nearly <a href="http://easo.org/education-portal/obesity-facts-figures/">3m people</a> a year worldwide. It is putting huge pressure on health services, yet the public policy response in developed countries such as the US and UK is pitiful, largely confined to finger-wagging at children’s sugary treats.</p>
<p>The story that has not been getting out is that there is a clear and extraordinary correlation between obesity and social inequality. Obesity is invariably presented as a diet issue for nutritionists, whereas social inequality is deemed the domain of sociologists and economists. Put another way, even as the inequality gap becomes <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/6871/1871208.pdf">more and more obvious</a> there’s been a medicalisation of a social problem. Yet obesity is not just a matter for nutritionists: rather, it is a product of social inequality and requires a collective social response.</p>
<p>This failure to face up to the underlying causes of obesity is all the more striking as issues of social inequality and justice are dominating the news agenda. Despite vast increases in total wealth in the world today, the health issue remains a marker for a general political problem about inequality in society, even in the most affluent societies.</p>
<p>The tragedy is that obesity is usually treated as a problem and responsibility of individuals or families – not as a social problem like, say, low-educational achievement or delinquency. And so the solutions are pitched at that individual or family level.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"949798142228090881"}"></div></p>
<p>And yet the statistics point remorselessly towards obesity being a symptom with an underlying social cause. That should completely change the approach to dealing with it. But so far, it hasn’t.</p>
<h2>Vital statistics</h2>
<p>Take the US. Here, the most “obese” state, <a href="http://healthyamericans.org/reports/stateofobesity2017/release.php?stateid=AR">Arkansas</a>, is also the fourth poorest state overall, whereas the poorest state, <a href="http://healthyamericans.org/reports/stateofobesity2017/release.php?stateid=MS">Mississippi</a>, is also the third most overweight. </p>
<p>The picture in the nation’s second poorest state, New Mexico, is less clear because here it is complicated by another factor: ethnicity. <a href="http://healthyamericans.org/reports/stateofobesity2017/release.php?stateid=NM">New Mexico</a> has “only” the 33rd highest adult obesity rate – apparently bucking the trend. Yet even in “The Land of Enchantment”, the correlation of wealth and health still leaves its unmistakable fingerprint. Here, the adult obesity rate is 34.4% among black adults, 31.3% among Latino adults and a comparatively sprightly 23.9% among white adults, again reflecting wealth distribution. </p>
<p>Recall that in terms of relative income, a <a href="https://prosperitynow.org/files/PDFs/road_to_zero_wealth.pdf">2017 study</a> found that it would take 228 years for the average black family to reach the same level of wealth that white families have today, while for Latino families, it would take 84 years. Meanwhile, colour correlates to poor health and reduced life expectancy.</p>
<p><a href="http://digital.nhs.uk/catalogue/PUB22269">Recent studies</a> in England also illustrate this link between obesity and income. As you can see in the interactive graph below (toggle the options to see how they compare), of the ten worst areas in terms of overweight or obese children, half are also in the worst ten for child poverty. England’s most obese council, Brent, is also its ninth poorest, whereas England’s wealthiest council, Richmond, despite being a neighbouring council in London, is one of the sprightliest, with a relatively low rate of obesity. And England’s poorest council? Another London borough, Newham, is also the eighth most affected by childhood obesity.</p>
<iframe src="https://datawrapper.dwcdn.net/hYGrG/3/" scrolling="no" frameborder="0" allowtransparency="true" width="100%" height="500"></iframe>
<p>In its way, these figures are as disgraceful an indictment of social priorities and inequality as the 19th-century mortality levels due to epidemics of rickets or typhoid. And the solutions needed are every bit as collective rather than individual.</p>
<h2>Victorian parallels</h2>
<p>Imagine that the Victorians had tried to tackle typhoid by advising everyone to live in the countryside near clean wells, rather than by building sewers and water treatment plants. Today’s response to an epidemic that kills so many people around the world that it has become the <a href="http://easo.org/education-portal/obesity-facts-figures/">fifth leading cause</a> of early death, is just as unrealistic.</p>
<p>In the early years of the 19th century, the industrial towns of the West were characterised by overcrowding, poor housing, bad water and disease. Epidemics, even in the modern cities of New York and London, were – it was assumed – a part of life. The fact that they caused significantly greater suffering in the poorer, slum neighbourhoods only contributed to the blasé responses of city leaders. Epidemics were interpreted as punishments for moral turpitude – in much the same way that today’s illnesses linked to being overweight are. It was only very slowly that such attitudes – deeply rooted in religious notions of individual guilt – <a href="https://jhupbooks.press.jhu.edu/content/great-stink-paris-and-nineteenth-century-struggle-against-filth-and-germs">gave way</a> to public health measures.</p>
<p>But then this was an era before the mechanisms for the transmission of diseases was understood, indeed in an era before even the idea of germs as tiny, invisible life-forms was fully accepted. And so it seemed only reasonable to middle-class New Yorkers that diseases like cholera would hit working-class neighbourhoods the hardest. It was seen as proof of their moral depravity.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206743/original/file-20180216-131003-3ffksv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206743/original/file-20180216-131003-3ffksv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=407&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206743/original/file-20180216-131003-3ffksv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=407&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206743/original/file-20180216-131003-3ffksv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=407&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206743/original/file-20180216-131003-3ffksv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=512&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206743/original/file-20180216-131003-3ffksv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=512&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206743/original/file-20180216-131003-3ffksv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=512&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hand bill from the New York City Board of Health, 1832.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Cholera_outbreaks_and_pandemics#/media/File:Cholera_395.1.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Meanwhile, businesses fought against public sanitation proposals fearing increased costs – in much the same way that the food industry <a href="https://www.npr.org/sections/thesalt/2013/02/26/172969363/how-the-food-industry-manipulates-taste-buds-with-salt-sugar-fat">resists or subverts public health initiatives</a> as the investigative journalist, Michael Moss, in particular has detailed. And like today, the business interest was often backed by politicians. The hazards back then were not ambiguous things such as sugary soda drinks or ready meals, but rotting animal carcasses and mountains of refuse. Yet the opposition to change was similar – every improvement had to be fought for.</p>
<p>So what are the factors that push poorer people towards unhealthy eating? Food and health policy expert Martin Caraher <a href="https://www.euractiv.com/section/economy-jobs/interview/professor-there-is-a-link-between-poverty-and-unhealthy-diets/">has explained</a> that food choices are massively influenced by factors such as income, knowledge and skills. Others <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464955/">have highlighted</a> the fact that eating well invariably involves more food preparation time. Yet such explanations don’t fit many cases, indeed seem dangerously retrospective. What is sure is that you cannot deal with the obesity epidemic by taxing popular snacks, anymore than you could deal with rocketing suicide rates by taxing sales of rope.</p>
<p>The point is that we need to collectively tackle the places where obesity germs breed – in stressed communities characterised by insecure and erratic employment, inadequate education, stress, depression and a lack of social cohesion. That this requires an enormous shift in public priorities is only to be expected – but the consequences of not acting are far worse.</p><img src="https://counter.theconversation.com/content/91447/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Martin Cohen 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 statistics point remorselessly towards obesity being a symptom with an underlying social cause. That should completely change the approach to dealing with it.Martin Cohen, Visiting Research Fellow in Philosophy, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/775262017-06-14T10:32:52Z2017-06-14T10:32:52ZThe social barriers to an active society are being ignored<figure><img src="https://images.theconversation.com/files/172924/original/file-20170608-32392-4qrt5q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Out and about.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/three-young-women-runners-sports-autumn-502255993?src=uNpqMQ-JabCZ79os_6Wpzw-1-9">Shutterstock</a></span></figcaption></figure><p>Warmer weather and longer days can herald feelings of renewed energy and a sense of new beginnings. This year the seasonal change in Britain was pre-empted by a series of official nudges encouraging people to put extra spring into their steps. Move more, sit less and ensure you spend time every day being physically active, goes the advice. </p>
<p>Momentum began to build in late February as women and girls were called to action by the return of Sport England’s <a href="https://www.sportengland.org/news-and-features/news/2017/february/24/this-girl-can-returns-to-our-screens/">This Girl Can</a> campaign. April was the month for <a href="http://www.rafapana.org/index.php/en/world-day-of-p-a">World Physical Activity Day</a>, while May featured <a href="http://moveweek.eu">#MoveWeek</a>. </p>
<p>These initiatives certainly help raise awareness of the role that regular physical activity plays in preventing illness and promoting good health. And it is an important message. <a href="https://www.sportengland.org/research/about-our-research/active-people-survey/">Current UK figures</a> indicate that 33% of men and 45% of women are not active enough to achieve health benefits. Physical inactivity costs the National Health Service in England more than <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/524234/Physical_inactivity_costs_to_CCGs.pdf">£450m a year</a> – a figure projected to increase unless changes are made. </p>
<p>But the simplicity of exhorting people to “be more active” belies how complicated it can be to put this into practice. Increasing physical activity requires individuals to do things differently. It means changing how they spend their work and leisure time, and their habitual patterns of moving or being still as they go about their daily lives. </p>
<p>Can individuals alone make the changes that are required? Public health campaigns imply that they can, focusing on how to live a healthier, more active life. But do the roots of inactivity really lie only in the behaviour, decisions and motivations of individuals? Or are there wider factors which need to be recognised and addressed? </p>
<p><a href="https://doi.org/10.1177/1363459317695630">Plenty of evidence</a> suggests that external influences are also important, and there is mileage in ensuring that these elements are integrated into addressing individual behaviour. </p>
<p>Consider, for example, the challenge of raising physical activity levels among older people. This is a priority for public health given the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/bulletins/nationalpopulationprojections/2015-10-29">predicted 89.3% increase</a> in the numbers of older adults to 9.9m in the UK by 2039. According to Sport England, <a href="https://www.sportengland.org/media/11498/active-lives-survey-yr-1-report.pdf">54% of those aged 75 and above</a> are doing less than 30 minutes of physical activity a week. </p>
<p>Recognising the everyday situations of older people helps to explain why becoming more active involves more than individuals simply choosing to behave differently. Many face substantial constraints such as poor health, with <a href="https://www.ageuk.org.uk/Documents/EN-GB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true">AgeUK</a> reporting that 40% of all people aged 65 and above have a longstanding limiting illness, while one in three will die with a form of dementia. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/172971/original/file-20170608-32402-1ei82d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/172971/original/file-20170608-32402-1ei82d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/172971/original/file-20170608-32402-1ei82d2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/172971/original/file-20170608-32402-1ei82d2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/172971/original/file-20170608-32402-1ei82d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/172971/original/file-20170608-32402-1ei82d2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/172971/original/file-20170608-32402-1ei82d2.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">From Ageing: the bigger picture photo challenge.</span>
<span class="attribution"><a class="source" href="https://www.photocrowd.com/photo-competitions/ageing-bigger-picture-documentary-photo-contest-374/overview/">Willem Kuijpers/Photocrowd.com/britishgerontology.org</a></span>
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</figure>
<p>On top of this, <a href="https://www.ageuk.org.uk/Documents/EN-GB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true">data on health inequalities</a> alerts us to other challenges that affect large numbers of older people. Nearly a million people report having to cut back on food shopping to cover the cost of utility bills. Around 25,000 can die of the cold each year, while 2.9m feel they have no one to turn to for help and support. All of these reflect broader social, political and economic inequalities that are beyond any individual’s control.</p>
<p>Living in poverty, insecurity and social isolation can undermine well-being and reduce a person’s capacity to be proactive and engage in healthy activities. But these obstacles are by no means confined to older people. Across all age groups, physical activity is lowest among those in lower income neighbourhoods. </p>
<p>Among them are those experiencing poverty, unemployment, lone parenting, and being part of a marginalised group. If physical activity policy is to be effective, it needs to recognise these circumstances and their impact on inactivity. </p>
<h2>Taking a step back</h2>
<p>Fortunately, we have the tools to do this. There is a long tradition of scientific inquiry that recognises how individuals interact with social networks, structures and processes. <a href="http://dx.doi.org/10.1080/09581596.2014.980396">“Theories of practice”</a> and <a href="http://dx.doi.org/10.1080/2159676X.2013.819374">social ecological models</a>, for instance, recognise the impact that families, communities, organisations, policies and wider structural factors have on an individual’s daily life. </p>
<p>Adopting this wider perspective allows physical activity policy and guidance to be refocused. Recommendations should reflect the fact that individuals are indeed just that – unique in their characteristics, biographies and everyday circumstances. Generic messages instructing people to “be more active” are just the starting point. They need to be followed up by comprehensive, evidence-based analysis that identifies the constraining factors that limit people’s opportunities and capacity for being active in their everyday lives.</p>
<p>This means that interventions to encourage people to move more also need to recognise the wider social context. Local knowledge can be invaluable here, especially when it includes consultation with inactive people themselves. This ensures that specific needs are identified and constraints addressed. It brings a new, more empathetic tone to public health messaging, acknowledging that becoming active can be difficult and offering support rather than chastisement.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/172972/original/file-20170608-32325-1yuqr8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/172972/original/file-20170608-32325-1yuqr8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/172972/original/file-20170608-32325-1yuqr8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/172972/original/file-20170608-32325-1yuqr8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/172972/original/file-20170608-32325-1yuqr8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/172972/original/file-20170608-32325-1yuqr8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/172972/original/file-20170608-32325-1yuqr8r.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">
<figcaption>
<span class="caption">From Ageing: the bigger picture photo challenge.</span>
<span class="attribution"><a class="source" href="https://www.photocrowd.com/contests/374-ageing-bigger-picture/winners/">Bogdan Zarkowski/Photocrowd.com/britishgerontology.org</a></span>
</figcaption>
</figure>
<p>Inactivity is a perennial public health problem. To tackle it most effectively, the expert community of policymakers, practitioners and researchers need to pause and take a step back. Looking at the problems that surround the problem will allow a better informed approach to supporting people’s capacity to get physical – whether it’s warm outside or not.</p><img src="https://counter.theconversation.com/content/77526/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cassandra Phoenix receives funding from the Economic and Social Research Council, the National Institute for Health Research and the Thomas Pocklington Trust. </span></em></p><p class="fine-print"><em><span>Tess Kay receives funding from the Economic and Social Research Council, Macmillan Cancer Support, Sport England and
Public Health England.</span></em></p>Poverty, insecurity and social isolation have a major impact on public health.Cassandra Phoenix, Reader, Department for Health (Physical Culture, Sport & Health Group), University of BathTess Kay, Professor of Sport and Social Sciences, Brunel University LondonLicensed as Creative Commons – attribution, no derivatives.