COVID in Wilcannia: a national disgrace we all saw coming

Originally published on theconversation.com
The town of Wilcannia in the far outback of New South Wales on the banks of the Darling river. shutterstock

The COVID-19 crisis in Wilcannia demonstrates how entrenched neglect, combined with a global pandemic, have created a perfect storm impacting the most marginalised people in society.

The treatment of the Barkindji people of Wilcannia is appalling by anyone’s standards and should be unacceptable to every Australian. The stories flooding out of Wilcannia of mistreatment of Aboriginal people should make every person stand up and demand immediate action.

The government needs to take immediate action to address the conditions in which the people in Wilcannia are forced to live, and by providing vaccinations immediately to all those who want to be vaccinated.



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Not enough healthcare, too much police involvement

As part of my research, I spoke to community members over the phone to listen to their experiences of this breakout. Here are just a few stories told to me by the people of Wilcannia:

a young mother who was made to sit outside a hospital on a cold night, before being sent home due to under-resourcing

a woman who had police arrive on her doorstep to inform her she had tested positive to COVID-19, and they must take her to the isolation unit. There was no phone call from NSW Health, just police arriving to take her to isolation. Her elderly mother, who is on dialysis, was taken to another town

Aboriginal people with mental illness or disorders, who require regular treatment and medication, being picked up in police vans and taken to the hospital because they “may” have COVID-19. The people of Wilcannia told me they were told this is because police vans are “easier” to clean.

The police or the defence force themselves cannot be blamed. They are doing all they can to assist, much of which NSW Health should be resourced to do. Without the police and the defence force, Wilcannia would be in a much worse situation. However, we need a health and community response, not a law and order response.

Reports have surfaced Aboriginal people in Wilcannia are being fined up to $5,000 for leaving home to get food. Some of the people being fined are already living on meagre incomes and having to pay those fines will cause significant distress and further financial problems, further entrenching disadvantage.

Neglect of Aboriginal people has led us here

Overcrowded and poor-quality housing already results in poor health outcomes. The effects of overcrowded and poor quality housing during a viral pandemic cannot be overstated.

Aboriginal people have been isolating in tents during cold desert nights to try to protect their families. They do not choose to live in overcrowded and poor-quality housing; that is all that is available.

NSW Health have since supplied 30 motor homes for people diagnosed with COVID so they can isolate away from their families.



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The situation in Wilcannia did not just happen overnight, nor was it unforeseen. The neglect of Aboriginal people by current and successive governments has led us to this point.

Furthermore, Aboriginal health services predicted last year that if COVID-19 entered Aboriginal communities, it would be disastrous. Instead of governments taking responsibility for their failures, some have blamed the people suffering the consequences of their failure.

For example, the government demonised the family and community who attended a funeral, making false statements and allegations, despite the funeral occurring before restrictions and lockdowns outside of the Greater Sydney Region. Those who made negative statements about the funeral attendance have expressed regret, but it’s too little too late.



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Aboriginal people were classified as 1B priority for the vaccines, but in many places, the vaccines were simply not available. This was either because services on the ground did not have the capacity to deliver or there just were not enough vaccines. Many Aboriginal people across the state of NSW have reported long waiting lists to get vaccinated.

It must also be noted that those Aboriginal people wary of vaccines have good reason, based in over 200 years of history, not to trust what the government says.

However, we do not need to go back that far to understand this crisis. We only need to look at the government’s failure to secure enough (timely) vaccines for these vulnerable communities.

What has to happen now?

The government firstly must address the immediate needs of the community, by ensuring adequate and appropriate housing for people to isolate in, tents and motor homes are not appropriate in this situation. Vaccinations must be urgently administered and everyone who wants to be vaccinated must be able to do so without a waiting list.

More doctors and nurses need to be sent to regional areas affected by the virus. Social workers must also be sent to ensure people have access to adequate and appropriate health care, food and accommodation as well as programs to allow people to deal with issues worsened by the pandemic and to maintain mental and cultural well-being during times of isolation and lock down.

Susan Green receives funding from ARC research funding. She is affiliated with CSU as an academic, AASW, as the Aboriginal and Torres Strait Islander Board member and Visual Dreaming as a board member.

Overlooked and undervalued, New Zealand’s community caregivers have become the ‘invisible’ essential workers

Originally published on theconversation.com

Shutterstock

As Auckland enters it’s fifth week in level 4 lockdown and the rest of New Zealand stays at level 2, spare a thought for the nation’s invisible network of essential community support workers.

They are the people caring for those who, through age or disability, cannot work or leave their homes, cannot independently care for themselves, and who in many cases have underlying mental health and cognitive problems.

While other front-line essential workers are rightly recognised for their service, it’s important we also remember those less obvious workers who put their own health and well-being at risk to care for and support some of our most vulnerable citizens.

Often these community workers receive little support themselves. And while the stress on hospital staff, supermarket workers and even political leaders has been acknowledged, this other essential group has largely gone unnoticed.

As one community worker told us when reflecting on being overlooked as essential workers and the potential impact this could have on their own well-being:

At the start, the government kind of didn’t even really consider us as health workers, did they?

Community care workers struggled for even basic protective equipment due to unclear official guidelines.
Shutterstock

Struggle for pay and PPE

In our ongoing research, we have so far heard from over 75 community support workers nationwide about their well-being during the COVID-19 pandemic.

They are employed mostly by private companies (some not-for-profit) contracted to a variety of government agencies, including the Ministry of Health, ACC and district health boards.



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Our preliminary findings show these workers struggled to gain recognition throughout the first national lockdown in 2020. Furthermore, they struggled to be paid and to receive even the most basic personal protective equipment (PPE) provided by their employers:

Our employers were so slack, not recognising that we needed [PPE]. But they were following Ministry of Health guidelines and so it was government […] it was the World Health Organization — it was everybody.

What was wrong with people to think that we could go out there and do our jobs without PPE? And then why do we have to have such a battle for it? Because it was actually hard enough doing the job without having all of that as well.

This very real struggle underscored a wider battle by community care workers to be appreciated for their work — or even to be “seen”. As one support worker noted:

In comparison with nurses, who are angels, caregivers are just ignored […] it’s like a little underworld where, all over your city, women, mostly in uniforms in little cars, are getting in and out of the cars and going into houses and doing things that nobody has any idea about.

Working in isolation

Despite working with people in the most vulnerable situations, support workers spoke of being turned away or facing public backlash when trying to use essential worker queues at supermarkets.

And yet these support workers are undeniably essential. In many ways they are the “glue” in the health system, as another told us:

One thing I want to make sure that you understand is that we look after [everyone from] medically fragile children to palliative [cases]. We look after all of them — anybody that wants to remain in the community, then has a health issue, we look after them.



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Even during the best of (non-pandemic) times, these workers operate in isolation. The majority hardly ever see a co-worker, and almost never see a manager in person. Communication is via impersonal emails, phone apps or call centres.

But during lockdowns, support workers are the only people isolated clients see — they step in as communicators and carers. In effect they become like family. They have to deal – alone – with the confusion and anxiety of their clients. Their own well-being and mental health often come second:

I felt unsupported in regards to dealing with these [client] behaviours at the time, because there were no people on the ground. They were all working from home, so they were all on a phone. So, in some cases, my biggest “PPE” would have been having someone there, and it wasn’t there. I had someone on a phone.



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‘I would have just loved a phone call’

As with other healthcare workers, coping is a strategy built up over time by community support workers:

It’s like, right, suck it up and just, you know, dry those tears and put on that smile and be your bouncy self again […] I’ve had to learn.

But unlike other healthcare workers, such as those at COVID testing and vaccination stations and hospitals, community support workers don’t have a team around them for support:

We just had days and days where we didn’t hear anything from our employer and we felt really alone and vulnerable. And, of course, when we went into lockdown and everything, we didn’t feel supported at all.

It was very frightening. We had to go out there as essential workers and, oh God, it was stressful.

Asked what might improve their well-being, a common refrain has been that employers and society in general pay attention and care more:

Somehow showing how you’re valued […] It would be nice just to have a “you’re doing well” or something.

I would have just loved a phone call, just to check if I’m coping or not.

This project is funded by the Health Research Council’s ‘Wellbeing of Essential Workers during Covid-19: Community Support Workers’, in partnership with the E tū and PSA Unions. The findings here represent the views of the authors, not the funder and not necessarily the research partners.

Amber Nicholson receives funding from the Health Research Council.

Fiona Hurd receives funding from the Health Research Council.

Why nuclear submarines are a smart military move for Australia — and could deter China further

Originally published on theconversation.com

The Morrison government has decided it’s best for Australia to accelerate the production of a more capable, integrated, nuclear-powered submarine platform with the US and the UK.

This will more tightly enmesh Australia into the US orbit. Technologically and militarily, it means if the US goes into a conflict in the Indo-Pacific region, it would be much more difficult for Australia not to be directly and almost automatically involved.

The other side of argument is this is a good thing because it will at least incrementally add to the deterrence against China.

Chinese strategists and leaders will have to weigh up the risk and presumably be less likely to decide that crossing the threshold of war is something they are prepared to do. The hope is that added deterrence will make the stakes higher for the Chinese and the prospects of success lower.

How do nuclear submarines differ from conventional ones?

In recent years, the Australian government and Department of Defence have been placing greater emphasis on longer-range military capabilities, particularly with the Defence Strategic Update in 2020.

This includes the acquisition of missiles, as well as space and cyber capabilities. Nuclear-powered submarines now leapfrog our existing naval capabilities.



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The benefit of nuclear submarines is you don’t have to snorkel: they allow you to stay submerged and be stealthier for longer. The conventionally powered (diesel/electric) submarine does not have the same range without exposing itself to detection by surfacing.

This potentially will transform the ability of the Australian Defence Force to operate at range around Australia and beyond, and operate more closely in an integrated way with the US and UK.

Our previous A$90 billion deal with the French company DCNS to build up to 12 submarines was always less connected with the US and UK.

The French ironically had nuclear propulsion in their Barracuda submarine, and had we gone with that option when we signed the deal in 2016, they could have said, “OK, let’s replicate what we do and give that to you”. Had we done that, we would be well on the way to our first one.

But we said we wanted the propulsion to be conventional. That delayed the French program, so they now have cause to be irritated over this new deal.

The question is how quickly these new submarines will become available, because the French-designed ones were decades away from being operational.

This new deal potentially would see Australia able to lease British and/or American submarines on an interim basis to develop Australian expertise with nuclear propulsion, or at least operate with them and have Australian crew on board to learn the ropes.

But we do not have the capability in Australia at the moment to operate and maintain nuclear submarines. There’s a whole infrastructure that’s missing.

This means we either have to spend an enormous amount of money to develop it, or subcontract it to the UK or US, which makes us beholden to them and subject to their domestic, political dynamics.

Where did things go wrong?

We’ve fumbled the ball in our handling of our future submarine capability over the last decade and a half. We should have made a decision on a new submarine design a long time ago — one that was feasible — and locked it in.

We bypassed a couple of other options, including an upgrade of our current Collins-class submarine — a newer, snazzier, more capable version of what we already know.

Instead, we went for a radical new design that even the French had never built before. Anything with cutting-edge technology is going to incur delays and cost overruns. And that’s exactly what we faced.

A Barracuda submarine under construction in France. DCNS, a French company, had been chosen to design 12 diesel-electric, Shortfin Barracuda submarines for Australia in 2016.
Thibault Camus/AP

In the meantime, the clouds have gotten darker in our region and the need to acquire new, capable submarines has become all the more pressing and important.

The combination of those factors has driven a hard-nosed re-evaluation of our previous half-baked decisions on our future submarine requirements.

Interestingly, in defence industry circles there is emerging a strong sense of approval that Australia is now going with a known quantity — a reliable, technological platform that is more integrated with the US and hopefully can become operational much sooner.

How will this build up Australia’s defence industry?

The details remain sketchy but it appears the initial plan will be to subcontract the development of the submarines to the US or UK.

But if Australia is to be self-reliant, which I believe the government recognises the need for, then much of this technology will have to be transferred to Australia — at least to allow for maintenance.

No doubt, aspects of the fit-out are not directly linked to insider knowledge on nuclear propulsion secrets, so there will be a considerable portion of the work that could be done in Australia. But that will incur delays and additional costs.

Australia’s circumstances are more turbulent and the prospect of the American alliance coming to the rescue is more precarious than ever. The irony is that to be more self-reliant, there’s a need to double down on US technology and US capabilities. They are the world leaders and they have the industrial capacity to quickly provide the technology.

One of the things Defence Minister Peter Dutton went to Washington to do was to persuade the US to share technology. This AUKUS arrangement talks about developing a technology industrial basis and supply lines — this means the US and UK are appear prepared to invest in Australia’s ability to sustain it.



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How will China likely react?

That’s the million dollar question: does this make us safer? There’s no question we will get strong and sharp-edged criticism from Beijing, where the Chinese government will see it in conspiratorial terms.

But Chinese rhetoric doesn’t need be taken at face value. This is largely for domestic purposes and about influencing and shaping opinion in a way that’s consistent with China’s perceived interests.

In the past few years, China has become more assertive in its rhetoric, matching its military buildup, which most security pundits now say is about seeking to intimidate potential adversaries so they’ll just back down.

One of China’s new nuclear-powered submarines, the Long March 10.
Mark Schiefelbein/AP

So, does a more capable AUKUS coalition, with Australia in the middle, deter or aggravate China?

It’s fair to say there is growing consensus we need to do more to deter Chinese actions in the region. Deterrence requires credible capabilities. This new alliance is consistent with that line of reasoning.

We have put our eggs in the US security basket for the past 70 years — and this new coalition puts more eggs in that basket. The hope is collaborating with the UK and US will improve our ability to defend ourselves. But submarines are only really useful if you find yourself contemplating having to use them.

Short of such circumstances, some deft diplomacy and regional engagement is key. Australia’s Foreign Policy White Paper of 2017 spoke of investing in regional security ties. For this policy change to enhance security, it needs to be coupled with much greater efforts aimed at bolstering security and stability alongside our neighbours in Southeast Asia and the Pacific.

John Blaxland 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.

Vaccinations need to reach 90% of First Nations adults and teens to protect vulnerable communities

Originally published on theconversation.com

While some Australians are awaiting the nation reopening after lockdowns with hope and optimism, others are approaching it with dread. This is because a blanket lifting of restrictions when the vaccination rate reaches 70% will have devastating effects on Indigenous and other vulnerable populations.

At present, vaccination rates in Indigenous populations are very low. Meanwhile international data show the risk of serious illness and death among First Nations populations from COVID and other diseases is up to four times that of the wider population.

Once restrictions are lifted everyone unvaccinated will be exposed to the virus. The outcomes for Indigenous people may therefore resemble the early effects of British colonialism, when a high proportion of the population died from introduced infections.

Aboriginal and Torres Strait Islander adults and teenagers need vaccination rates of 90-95% among First Nations people to protect their communities.



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Additional health challenges

As with many other medical conditions, the effects of COVID-19 are worse among people with lower socioeconomic status and especially among Aboriginal and Torres Strait Islander people.

There are multiple reasons for this, including the greater likelihood of underlying conditions and reduced access to appropriate health care.

We saw a similar situation in 2009, when H1N1 influenza rates among Aboriginal and Torres Strait Islander people were more than five times those of other Australians.

Overseas, COVID-19 has been associated with striking racial disparities, with death rates for African Americans more than triple the rates for Caucasians, and more than 4% for Navajo people (compared to 1.6% for the whole population).

Outcomes for other First Nations groups in the United States and elsewhere are similar.

What’s the current vaccination plan?

On September 9, the New South Wales government announced its intention to lift lockdowns and other public health measures when the state reaches a vaccination target of 70% of the adult population. This equates to a little over 50% of the state’s population.

NSW will reach the 70% target in less than a month in NSW and the nation will reach the target by October 30.



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If such a policy were implemented it would have disastrous consequences for Aboriginal and Torres Strait Islander and other vulnerable populations.

Vaccination rates in Aboriginal and Torres Strait Islander communities are lagging badly behind the remainder of the Australian population. In many places in NSW, Western Australia, Queensland and the Northern Territory fewer than 20% are fully vaccinated.

What should happen instead?

Aboriginal organisations have called on state and federal governments to delay any substantial easing of restrictions until vaccination rates among Aboriginal and Torres Strait Islander populations aged 12 years and older reach 90-95%.

The organisations calling for such a target include the National Aboriginal Community Controlled Health Organisation, the Aboriginal Medical Services of the Northern Territory and the Central Australian Aboriginal Congress.

A 90-95% vaccination rate gives about the same level of population coverage for all ages as the 80% target for the entire population. That’s because Aboriginal and Torres Strait Islander communities are younger than the wider population.

Vaccinating 90-95% of the Aboriginal and Torres Strait Islander population will better protect children and other unvaccinated people in First Nations communities from infection.

This will require an immediate, well-resourced and determined effort to lift vaccination rates.



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How can this be achieved?

Many Aboriginal community controlled health services are already running urgent vaccination campaigns with existing resources, but more needs to be done.

The Australian government’s announcement this week of A$7.7 million to fast-track vaccinations in 30 priority areas across the country is an important first step.

But the program needs to be expanded to all areas with significant Aboriginal and Torres Strait Islander populations.

Australia’s First Nations vaccination program needs to:

guarantee a sufficient and reliable source of vaccines to Aboriginal and Torres Strait Islander communities

ensure health services have the capacity and the workforce to carry out intensive outreach vaccination programs. This includes culturally knowledgeable Aboriginal and Torres Strait Islander workers able to engage with communities, and clinicians

address vaccine hesitancy. This should start with the recognition there are many reasons for reluctance to be vaccinated.

What are the reasons for vaccine hesitancy?

For some, there is a historical and understandable distrust of the health system.

Others have been confused or made fearful by misinformation spread on social media or through fringe religious groups.

Many others are not fundamentally opposed to vaccination but are adopting a “wait and see” approach.

To overcome this hesitancy we need urgent government support for financial incentives, in the form of food vouchers or other benefits. This has been done for vulnerable groups in other countries.

Non-financial incentives requiring full vaccination for travel, entering pubs, clubs, restaurants, sporting venues and so on need to be flagged now with a commencement date in the near future.

Effective health education in Aboriginal languages developed by local Aboriginal community controlled health services need to be in the media daily.

Don’t leave vulnerable groups behind

All this is achievable but it requires the combined efforts of government working in partnership with Aboriginal community controlled health services.

Until the 90-95% target is met, rigorous restrictions should remain in place. This is consistent with modelling from the Burnet and Doherty institutes, which inform the NSW and national policies about reopening.

As the Burnet Institute told the authors of this article, Australia:

should not move to Phase B and C until vaccination coverage in each jurisdiction’s Aboriginal and Torres Strait Islander communities is as high as, or even higher than, the general community.

Similar considerations undoubtedly apply to some other vulnerable groups in the population.

Australia remains burdened by the legacy of centuries of harm and damage to its First Nations people. We are facing the possibility of a renewed assault on Aboriginal and Torres Strait Islander health.

The difference today is the outcomes are foreseeable and we know what needs to be done to avert them.

I am a member of the Australian Labor Party

Donna Ah Chee, Ian Kerridge, and Paul Komesaroff 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.

Australia to build nuclear submarines in a new partnership with the US and UK

Originally published on theconversation.com
original AAP/EPA/Oliver Contreras

Australia will build a fleet of nuclear submarines as part of a new security partnership with the United States and United Kingdom, dubbed AUKUS.

The dramatic move is a response to the growing threat of China and will be seen as provocative by that country.

In a early morning address at Parliament House, part of a three way virtual appearances with US President Joe Biden and UK Prime Minister Boris Johnson, Prime Minister Scott Morrison said Australia, the US and the UK had “always seen the world through a similar lens.”

“Our world is becoming more complex, especially here in our region, the Indo-Pacific.

“This affects us all. The future of the Indo-Pacific will impact all our futures. To meet these challenges, to help deliver the security and stability our region needs, we must now take our partnership to a new level.”

The submarines will be built in Adelaide, in cooperation with the UK and US.

Morrison stressed “Australia is not seeking to acquire nuclear weapons or establish a civil nuclear capability”.

Labor is yet to respond but sources said the plan presented no problem in terms of the ALP platform.

There will be an 18-month long effort by the three countries to develop the best plan to deliver the new capability. In doing this, expertise from the US and the UK will be used.

In a statement Morrison, Biden, and Johnson said: “Through AUKUS, our governments will strengthen the ability of each to support our security and defence interests, building on our longstanding and ongoing bilateral ties.

“We will promote deeper information and technology sharing. We will foster deeper integration of security and defence-related science, technology, industrial bases, and supply chains. And in particular, we will significantly deepen cooperation on a range of security and defence capabilities.”

The leaders said : “The endeavour we launch today will help sustain peace and stability in the Indo-Pacific region.”

American nuclear-powered submarines visit Australia.

Currently, Australia has a contract with the French for conventionally powered submarines. This has been controversial because of the long lead time and escalating costs.

Senate crossbencher Rex Patrick, a former submariner, said the decision on nuclear submarines should come under rigorous parliamentary scrutiny.

“I’ve been a strong critic of the French submarine deal.The delays and cost overruns are huge and unacceptable. But we have to be careful we don’t move from one massive procurement disaster into something else that hasn’t been thought through properly.”

Patrick said that “acquiring, operating and maintaining a nuclear submarine fleet without a domestic nuclear power industry is a challenge that must not be underestimated.”

Michelle Grattan 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.

You’re much less likely to get long COVID if you’ve been vaccinated

Originally published on theconversation.com

Increasing COVID-19 vaccination rates as quickly as possible is currently a major focus for Australia.

Doing so has clear benefits in reducing new infections and preventing severe disease, hospitalisation and death.

One question which is frequently asked is – does COVID vaccination prevent you from getting long COVID?

Here’s what the science says so far.

How many people get long COVID?

There has been much international debate as to the definition of long COVID, how common it is, and how long it may last.

Studies examining the frequency of long COVID range from anywhere to over 80% in hospitalised patients with severe initial illness, to as low as 2-3% in one large app-based study of largely young healthy people in the United Kingdom.

A recent review of 45 studies and almost 10,000 people suggested almost 75% of them reported at least one persistent symptom at 12 or more weeks after COVID infection.

Many of these studies are highly dependent on the choice of people studied, and whether they required a definite confirmation by positive swab testing.

The Australian ADAPT study (led by myself and other colleagues from St Vincent’s Hospital, Sydney), enrolled people who’d had confirmed positive PCR tests, as well as a mix of hospitalised people and those who didn’t go to hospital. It found around one-third of people had persistent symptoms at an average of two to three months after infection.

The most common symptoms were persistent fatigue, shortness of breath and chest tightness, although a variety of other symptoms were also reported. These findings are in keeping with most of the evolving research which documents a wide variety of long COVID symptoms.

One review published in August involving 15 studies and more than 47,000 people detailed up to 55 separate symptoms involving all body systems and organs. The five most common were fatigue, shortness of breath, palpitations, brain fog and loss of smell.

The diverse nature of long COVID symptoms makes a clear definition difficult. The World Health Organization is currently attempting to achieve a consensus agreement from its members. Expect to see further tweaks to this definition as it evolves.



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Yes, vaccination does reduce the risk of long COVID

Vaccination doesn’t prevent all COVID infections. “Breakthrough” infections in fully vaccinated people have been estimated to occur in a small proportion of people.

Breakthrough infections are more likely to have few or no symptoms, and are associated with lower levels of the SARS-CoV-2 virus.



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Is this important in preventing long COVID? The answer is probably yes.

Currently our understanding of what causes or predicts long COVID is limited, not least because it’s probably a “catch all” definition for several different conditions with underlying causes.

In most studies, there were two main predictors of getting long COVID.

One was the severity of the initial illness, and the second being female sex.

The first of these is very likely to be impacted by vaccination and a recent study published in The Lancet medical journal gives weight to this argument. It looked at symptoms reported after vaccination among users of the COVID Symptom Study app in the UK.

More than 1.2 million users of the app reported at least one vaccine dose and around 900,000 had two doses. A small proportion, less than 1%, of each of these groups subsequently developed COVID infection and tracked their symptoms.

The study found vaccinated people had a much-reduced risk of being hospitalised or having multiple symptoms in the first week of infection.

Importantly, the likelihood of having a long duration of symptoms (over 28 days) was approximately halved.

This would clearly be expected to translate into a lesser number of people with long COVID at 12 weeks and beyond, although data confirming this is presently lacking.

So, vaccination has benefit in limiting both severe acute COVID infection and long COVID.

A word of caution though – long COVID appears to have a variety of triggers and many people suffering this condition didn’t have an initial severe illness. Long COVID also appears to be more common in females and this association remains unexplained.



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If the virus does trigger a long-lasting abnormal immune response in some people, it’s too soon to understand whether this can still occur after breakthrough infection post-vaccination.

Further research is urgently needed to understand the reasons for long COVID and direct potential treatments.

In the meantime, the likely effect of vaccination in reducing the risk of long COVID is yet another reason for us to roll up our sleeves.

Gail Matthews is affiliated with The Kirby Institute, UNSW and St Vincent’s Hospital, Sydney.
The ADAPT study is supported by funding from The Curran Foundation and the St Vincents Clinic Foundation.
Gail Matthews is a member of the Australian National COVID-19 Evidence Taskforce

Christian Porter’s ministerial future on the line as Morrison seeks advice on ‘blind trust’

Originally published on theconversation.com

Christian Porter’s ministerial future is again on the line, with Scott Morrison seeking advice on whether his receiving money for his legal bills from a “blind trust” breaches the ministerial standards code.

Morrison discussed the arrangement, which has attracted a storm of controversy, with Porter on Wednesday.

On Tuesday Porter updated his parliamentary register of interests to reveal a “part contribution” to his legal bills for his (now settled) defamation case against the ABC from “a blind trust known as the Legal Services Trust”.

“As a potential beneficiary I have no access to information about the conduct and funding of the trust,” he said in the update.

The defamation action followed the ABC reporting a historical rape allegation against an unnamed cabinet minister. Porter, attorney-general at the time, later identified himself as the minister and strongly denied the allegation.

He was subsequently moved from attorney-general to the industry ministry.

A spokesperson for Morrison said late Wednesday: “The Prime Minister is taking this matter seriously and has discussed the matter with the minister today.

“The Prime Minister is seeking advice from his department on any implications for the Ministerial Standards and any actions the minister must take to ensure that he meets the Standards.”

The advice will come from the secretary of the Prime Minister’s department, Phil Gaetjens, and Stephanie Foster, deputy secretary for governance.

If Porter is not meeting the ministerial standard one course would be for him to return the money.

Earlier on Wednesday, former prime minister Malcolm Turnbull said he was “staggered that Porter thought he could get away with it and I will be even more staggered if the prime minister allows this to stand.

“It is a shocking affront to transparency,” Turnbull told the ABC.

“Basically what Porter is saying is that it is okay for an Australian cabinet minister, a former attorney-general – not just of Australia, but of Western Australia – to take a large donation, a large gift to himself, without disclosing who the donor was and apparently without him knowing who the donor was either. It is so wrong.”

Turnbull said it was “like saying ‘my legal fees were paid by a guy in a mask who dropped off a chaff bag full of cash’”.

Opposition leader Anthony Albanese ridiculed the proposition that Porter didn’t know the identity of his benefactors.

“The idea that he doesn’t know, that just somehow out there random people are discovering this trust, finding out for themselves where to put the money and depositing the money with no knowledge to him, is, quite frankly, just unbelievable and absurd,” Albanese said.

Albanese said this was “yet another reason why we need a national anti-corruption commission.

“If there was a national anti-corruption commission, it’d be up this like a rat up a drainpipe.”

Shadow attorney-general Mark Dreyfus said the PM seeking advice was “another farcical ‘inquiry’ by Scott Morrison’s right-hand man” which “follows yet another outrageous scandal in Mr Morrison’s government”.

Treasurer Josh Frydenberg defended Porter, telling Sky that he “has disclosed in accordance with the requirements of parliamentarians on their register of interest”.

“The point about Christian Porter’s legal defence is that he did not use taxpayers’ money, and that is very important,” Frydenberg said.

Michelle Grattan 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.

Beyond AOC’s ‘Tax the Rich’ dress: 5 acts of fashion provocation that changed history

Originally published on theconversation.com

NDZ/STAR MAX/IPx

Democratic congresswoman Alexandria Ocasio-Cortez has ignited both controversy and celebration after wearing a gown to the Met Gala emblazoned in red graffiti text with the statement “Tax the Rich”.

Appearing as a guest of the Metropolitan Museum of Art at the annual fund raiser, (for which tickets cost tens of thousand dollars), the left-wing politician wore a custom gown by fashion brand Brother Vellies, bringing with her the label’s founder, the young Black designer and activist Aurora James.

Using fashion as a tool to address wider social concerns has, in fact, long been a strategy for people seeking to make change — including wearing these clothes in spaces of influence.

From 19th century Suffragettes who pounded the streets in heels, ultra-feminine dress and large “picture” hats to refute claims that they were unwomanly, to patriot textiles in the second world war, to Indigenous Australian street clothes and accessories by a brand such as Dizzy Couture today, dress has historically conveyed political messages, creating “looks” for generations of change agents.

Here are 5 clothing acts as provocations that changed history.

1. George Washington’s suit

Houdon’s sculpture of Washington.
Wikimedia Commons, CC BY

The founders of the American Revolution wished to break with the old codes of European aristocracy. Much of the world still had “sumptuary laws”: legal edicts that regulated the types, materials and amounts of cloth, colours, jewellery and accessories permitted to various social groups.

In North America, the formal clothing codes of the old regime were actively resisted: men were not expected to wear the expensive and colourful embroidered silks typically worn to European courts. Their imported fabrics were considered bad for local economies, and their elite air at odds with the idea that all men might now be (relatively) equal.

President elect George Washington was sculpted by Houdon in the late 18th century with a button missing from his waistcoat. This was a deliberate gesture to show his actions were more important than his appearance. He also wore plain, home-spun American woollen cloth for his inauguration instead of the expected silk or velvet. This was a firm demonstration of North American independence and perhaps the first American “business casual”.

2. The Abolitionist handbag

Abolitionist bag full of anti-slavery pamphlets.
©Victoria and Albert Museum, London, CC BY-NC

Since the late 18th century, a range of objects from jewellery to printed dishes were produced to critique the Slave Trade.

British Quakers had advocated for Abolition in 1783. The Female Society for Birmingham (originally the Ladies Society for the Relief of Negro Slaves, the first such group) mobilised their anti-slavery followers with handbags printed with images and slogans designed to gain support for the Abolitionist movement.

The silk drawstring bags, made by women in sewing circles, were presented to prominent figures such as George IV and Princess Victoria. The bags contained newspaper articles and tracts supportive of Abolition.

The Slavery Abolition Act, which provided for the immediate abolition of slavery in most of the British Empire was passed ten years later, in 1833. A similar Act was ratified in the USA only in 1865.

3. No feather hats

Feather fan circa 1902.
Te Papa, CC BY-NC-ND

The ostrich and exotic bird industry was massive in the 19th century: as well as plumes, women wore whole bodies of birds as accessories, such as hummingbird earrings.

The ostrich plume “double fluff” industry was centred on South Africa, where the feathers were worth more than gold. They were exported to rooms in London and New York where exhausted young girls finished and dyed them for retail.

In 1914 a massive “feather crash” saw the raw material become close to worthless. Young women interested in the growing national park and conservation movements objected to the trade on ecological grounds. They simply stopped wearing the fashion, starting a global “anti-plumage” movement.

The women involved with the Massachusetts Audubon Society were so successful that their lobbying led to the first US federal conservation legislation, The Lacey Act (1900). Taxidermied birds, feather boas and birds as earrings became largely unfashionable and were rarely seen again in women’s fashion.

4. The ACT UP T-shirt


“Act Up Oral History Project”, CC BY-NC-SA

The AIDS crisis of the 1980s-90s saw the mobilisation of a unique blend of activism born from the women’s, Hispanic, Black power and 1970s gay movements. ACT UP New York determined that only anger and civil disobedience would focus the attention of government and big pharma on the plight of mainly gay men’s health.

A series of extraordinary “zaps” or site-specific protests, often theatrical, was engineered. ACT UP’s membership included skilled figures from advertising and design who created unified and stylish T-shirts, posters and banners. The designs were clean, slick and looked just like good advertising.

As Sarah Schulman recently demonstrated in her 20 year history of ACT UP, the bold T-shirt designs both created optimum impact for ACT UP’s protests on the TV news and a new pro-gay identity. Worn with Doc Marten shoes, leather jackets, clean and tight jeans or denim shorts, ACT UP established the look of gay urban men for a generation.

Government bodies and large drug companies were shamed by the public protests into adopting better and more rational health messaging, conducting better funded and more equitable drug trials and selling cheaper retrovirals.

5. When Katharine met Maggie

In 1984, designer Katharine Hamnett wore a t-shirt that read, “58% DONT WANT PERSHING” (a reference to nuclear missiles) to a high profile fashion evening attended by conservative Prime Minister Margaret Thatcher.

Hamnett made her T-shirt the night before, recognising the opportunity she had, and hid it under her coat upon entry. Its graphic format owes a debt to both 1970s Punk and ACT UP. She later recalled of the widely photographed encounter with Thatcher:

She looked down and said, “You seem to be wearing a rather strong message on your T-shirt”, then she bent down to read it and let out a squawk, like a chicken.

Social change needs its visual forms. Fashion is one of them. Fashion is a brilliant communicator of new ideas. That we are reading about AOC’s clothing “controversy” shows she fully understands fashion’s power.

Peter McNeil 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.

Australia’s yellow international arrival cards are getting a COVID-era digital makeover. Here are 5 key questions

Originally published on theconversation.com
shutterstock

As Australia prepares to lift the ban on international travel, the federal government has awarded Irish-based IT multinational Accenture a A$75 million contract to develop a Digital Passenger Declaration (DPD) system.

These new digital passes, announced this week, will replace two current documents: the physical incoming passenger cards filled in by all international arrivals to Australia, and the online COVID-19 Australian Travel Declaration, which details travellers’ COVID vaccination status.

With international travel restrictions set to be lifted for vaccinated Australians once the nation reaches 80% vaccination, it is not yet clear whether unvaccinated foreign travellers will be allowed into Australia once the international border opens, or whether unvaccinated Australians will be allowed to travel overseas and return.

It is also not yet clear how the new system will interact with the COVID “vaccine passports” the government has pledged to make available to Australians from next month, allowing them to prove their vaccination status using either a digital or printed document.

The federal government says the new DPD system will also be able to share details of international travellers’ health and vaccination status with state and territory health authorities.

And Stuart Robert, the federal minister responsible for digital data policy, said the program could be extended in future to cover visas, import permits, licences, registrations and other government-issued documents.

While many of the details remain to be confirmed, the announcement prompts a range of questions about how the new digital passenger declarations will work in practice.

Is the new document a ‘vaccine passport’?

Travellers arriving in Australia, both Australian and foreign nationals, have previously been required to fill in a physical declaration card.

Not really — it’s more than that, because it also replaces the yellow arrival cards that will be familiar to anyone who has travelled to Australia on an international flight in recent years.

Besides this, the system will also allow passengers to digitally upload their COVID vaccination certificate. It’s not yet clear whether this will be the same document as the “vaccine passports” set to be issued by the federal government from next month.

The vaccine passports can be shown to immigration officials in other countries, whereas the information in the DPD is purely for collection by Australian officials. It’s also not clear what documents foreign arrivals will be able to use to declare their COVID vaccination status to Australian authorities via the DPD system.



Read more:
Vaccine passports are coming to Australia. How will they work and what will you need them for?

How will privacy and security concerns be addressed?

Arriving travellers completing an incoming passenger card disclose lots of personal information, such as their full name, passport number, intended address in Australia, and declarations relating to customs and quarantine.

The new proposed DPD system will capture all these details, as well as the traveller’s COVID vaccination status. This raises several questions about how these data will be collected, transmitted, stored, accessed and shared.

A digital-based system comes with increased cybersecurity risks, and cyber criminals will doubtless be on the lookout for any vulnerability. There will also need to be clear policies detailing which federal, state and territory agencies are granted access to the data.

Will it be mandatory for overseas arrivals to declare their vaccination status, and will they be refused entry if they can’t prove they have been vaccinated? We don’t know yet.

Will authorities determine who needs to quarantine based on their vaccination status? Will Australia implement a traffic-light system, similar to other nations such as the United Kingdom, to identify which countries pose their biggest risk from unvaccinated travellers?

It is also unclear whether the system will be offered in languages besides English, and whether alternatives will be provided to those with accessibility needs or who lack access to a digital device.

How will travellers’ vaccination status be verified?

Recently, federal trade minister Dan Tehan told ABC radio the government is working with the International Civil Aviation Organisation on a QR-based system that would allow Australian vaccine certificates to be internationally recognised.

However, it is unclear at this stage whether the new DPD system will use the same system to verify the vaccination status of Australians returning home, and whether it will be able to verify foreign travellers’ vaccination status without further checks.

At the same time, Qantas is investigating ways to integrate yet another system, the IATA Travel Pass, into its own app. This system, developed by the International Air Transport Association and already used by airlines in several countries, allows passengers to securely store and present their COVID vaccination certificate, and to find information on testing and vaccine requirements for their journey.

IATA Travel Pass.
IATA

Why isn’t there a globally unified approach?

European Union residents can already use the EU Digital COVID Certificate app to travel freely between member nations, and to other participating countries such as Norway. The app uses a QR code signed with a digital signature to ensure authenticity without needing to collect extra personal details from the holder.

EU Digital Certificate app.

New York state, meanwhile, has adopted a blockchain-based app called Excelsior Pass, which provides digital proof of COVID vaccination or negative test results. It works by searching the state’s health department records, using special cryptographic signatures to ensure COVID certificates and health data are genuine.

For the time being at least, international passengers will likely need to use several different apps to prove their vaccination status in various parts of the world. There are obvious issues with this beyond simple inconvenience, such as data and privacy protection.

Will the system discriminate unfairly?

My research shows that the absence of a unified approach to COVID-19 contact-tracing apps was the main driver behind their failures worldwide. Similar problems are now arising with the rapid proliferation of national and international COVID certificates, travel passes and vaccine passports.

One issue is compatibility. The Excelsior Pass app, for instance, only works on devices running Apple iOS version 13 or later, or Android version 7 or later.

But more importantly, people should have the right to prove their vaccination status without needing to carry a smart phone. Even in a rich country like Australia, only about 80% of the population owns a smart phone, and the rate is lower in developing nations. A system that relies solely on apps would disproportionately deny freedom of movement to poorer people.

Other issues go beyond the choice of technology involved. Legislation will be needed to ensure people with a valid reason for not having been vaccinated do not face discrimination as Australia and the world gradually open up their borders.

Mahmoud Elkhodr 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.

Victoria has announced extra funds for counselling, but it’s unlikely to improve our mental health

Originally published on theconversation.com

Shutterstock

Yesterday, Victorian Minister for Mental Health James Merlino announced additional funding of $22 million for mental health support in response to the COVID-19 pandemic.

The centrepiece of this announcement was $13.3 million for 20 “pop-up community mental health services” with “around 90 dedicated clinicians providing 93,000 additional hours of well-being checks and counselling”.

This announcement is a small step towards overcoming some of the deficiencies in mental health service provision which were identified by the Royal Commission into Victoria’s Mental Health System. So it’s not surprising the new funding has been welcomed by mental health advocates.

However, is it likely to make a difference to the effects the pandemic is having on mental health?

Victoria’s mental health has worsened during the pandemic

Early in the pandemic, mental health experts warned there was likely to be a worsening of mental health and perhaps even an increase in suicide.

They called for increased resources for treatment and prevention of mental health problems to reduce this impact. The predictions of worse mental health have proved to be correct.

Fortunately, however, there has been no increase in suicide.

Recent compilations of data by the Australian Institute of Health and Welfare and the Australian Bureau of Statistics have shown depression and anxiety symptoms increased in Australia early in the pandemic, but then decreased back towards pre-pandemic levels.

However, in Victoria, which has been the state most affected by lockdowns, the prevalence of a high level of psychological distress remains much greater than in the rest of Australia (27% versus 18%).

Demand for services is also up

The Australian Institute of Health and Welfare data also show demand for mental health services has increased substantially.

Victorians have received a much higher rate of mental health services funded under Medicare since the start of the pandemic. Some of this increase was facilitated by the introduction of telehealth services, which weren’t previously available.

There have also been increased calls by Victorians to support services provided by Lifeline (up 37% from 2019 to 2020), Kids Helpline (up 27%) and Beyond Blue (up 65%).



Read more:
Lockdowns don’t get easier the more we have them. Melbourne, here are 6 tips to help you cope

Will the additional services make a difference?

Given Victorians’ increasing demand for mental health support, the additional services will be welcomed by people who are on waiting lists and by hard-pressed clinicians.

However, it’s unlikely they will make an impact on the worsening of mental health seen during the pandemic. The reason for expecting no reduction in prevalence is that in recent decades Australia has had substantial increases in the provision of mental health services, but this has had no measurable impact on people’s mental health.

Rather, prevalence remained stable for the two decades leading up to the pandemic.

Australia isn’t unique in this regard. In other high-income countries where the mental health of the population has been monitored over many years, no reduction in prevalence has been found with increases in treatment.

Why are more services unlikely to have an impact?

One of the reasons increasing services has had no measurable impact is they’re often of poor quality.

In Australia, most people with depression or anxiety disorders who seek help do not receive minimally adequate treatment. In many cases, the treatment isn’t evidence-based and the number of sessions received is too few to be effective.

Providing more funding for services has increased the number of people with milder problems receiving help. But the people with severe and recurring mental illnesses who are most in need are still not getting adequate help.

Another reason services are unlikely to have a measurable impact is they don’t generally deal with the risk factors that underlie the worsening of mental health during the pandemic.

Important risk factors are loneliness due to social isolation, financial stress, and juggling the demands of childcare and homeschooling while working from home.

I have argued previously that income and employment support are more important in addressing the mental health impact of the pandemic than mental health services.



Read more:
The government will spend $48 million to safeguard mental health. Extending JobKeeper would safeguard it even more

While governments can take action to ameliorate these risk factors, the major impact is likely to come with the easing of lockdowns and consequent resumption of social contact, schooling and work.

These benefits require greater vaccination coverage and provide an important motivation for achieving this goal.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Anthony Jorm receives funding from the National Health and Medical Research Council. He is a Chief Investigator on the Centre for Research Excellence on Childhood Adversity and Mental Health. He is Chair of the Scientific Advisory Committee of Prevention United, Member of the Board of Mental Health First Aid International, a member of the Alliance for Prevention of Mental Disorders and a member of the Association for Psychological Science.