Vicki Sentas, UNSW; Leanne Weber, University of Canberra, and Louise Boon-Kuo, University of SydneyWith rolling lockdowns now part of how Australians live in the pandemic age, important questions arise about corresponding changes in policing. Constantly changing public health orders bring not only confusion but expansive police authority to enforce many new criminal offences.
On one view, using the police to protect public health by stopping the spread of the virus appears a logical step. But, in practice, do public health objectives always take precedence over existing enforcement approaches?
The recent deployment of 100 additional officers and mounted police to south-west Sydney call to mind the same concerns expressed by the Victorian Ombudsman that the policing and lockdown of public housing tower blocks in 2020 were partly informed by “incorrect and potentially stereotypical assumptions” about residents.
Reports of unfair police actions revise age-old questions about the role and function of the police in enforcing social inequalities and its punitive effects.
How is COVID being policed?
Select data we obtained from New South Wales Police indicate that from March 15 to June 15 2020, the most common police action was to search those stopped. Although the public health relevance of conducting a search is unclear, police searched 45% of all people stopped for a COVID-related incident.
We also know COVID policing has affected some communities more than others. In Victoria, a parliamentary inquiry found people in lower socioeconomic areas were twice as likely to be fined as those in higher socioeconomic areas.
Our research in NSW found Aboriginal or Torres Strait Islander peoples comprised 9% of the stop incidents in which Indigenous or non-Indigenous status was recorded. Aboriginal and Torres Strait Islander people were even more disproportionately subject to coercive police powers following a stop, making up 15% of arrests and 10% of people searched.
Whatever the precise level of over-representation, these findings are consistent with the broader, long-standing experience of the over-policing of Aboriginal and Torres Strait Islander peoples.
Considering Aboriginal and Torres Strait Islander peoples comprise around 3% of the population, these data alone show disproportionate use of search and arrest powers. They also support concerns that the pandemic has intensified the policing of Aboriginal and Torres Strait Islander peoples.
COVID policing appears to rely on longstanding criminalisation strategies at odds with public health. An old-school public order approach of stop and search, and fines, undermines public health because of the social harms of criminal justice contact.
Most obviously, increased police contact through personal searches could increase the risk of transmission. And, as we explain elsewhere, questions remain about their lawful basis.
How could COVID be policed?
The social and economic costs of the pandemic have greater impacts on precarious and low-wage workers and marginalised people. It is even more critical that policing does not amplify those inequalities by prioritising punishment over keeping people safe.
The Australian approach isn’t the only possibility. Heavy reliance on enforcement contrasts, for example, with the United Kingdom, where the policing of COVID-19 measures early in the pandemic was independently assessed by policing experts as “taking place at the margins”. These experts pointed out that people are more likely to comply with rules where they regard them as morally right and reflecting social norms, rather than because they fear fines and other sanctions.
Instead of prosecuting individuals for non-compliance with frequently changing laws, a better approach would be to provide financial assistance and accessible information, particularly for disadvantaged groups.
A community-focused, public health approach would move away from coercive policing and emphasise co-developed community resources on COVID restrictions and their purpose.
A small group of NSW Police officers recently joined forces with a community organisation to hand out free masks and hand sanitiser to residents in hard-hit areas of western Sydney. But this has not been a system-wide approach, and is unlikely to erase the memory of mounted police patrols enforcing the lockdown in the same area.
It is too early to say what the lasting changes in policing may be. Will additional powers granted to police persist beyond the emergency in some other form? Will states continue to revert to border control to protect against future, non-biological risks? Will technology-driven population surveillance become more prominent?
This all remains to be seen. But it is certain that mass vaccination would shrink the need for state policing of COVID altogether.
Denis Muller, The University of MelbourneElements within News Corporation are now fighting among themselves over how its platforms should position themselves in response to the worsening COVID crisis in New South Wales.
This has become clear with the decision by the editor of News Corp’s Daily Telegraph, Ben English, to ditch Alan Jones as a columnist.
Over the past few weeks, as the coronavirus outbreak got inexorably worse, the Telegraph ran a series of characteristically shrill columns by Jones attacking mask-wearing, lockdowns and NSW Premier Gladys Berejiklian.
Yet Jones also promotes these opinions on News Corp’s Sky News, where his Sky-at-Night slot is undisturbed. Indeed, Jones makes a virtue of this, telling The Sydney Morning Herald:
Have a look at Sky News YouTube, Sky News Facebook and Alan Jones Facebook and you can see. The same column that I write for the Tele goes up on my Facebook page.
On July 29, the Telegraph also took the opportunity provided by an outburst against Jones by the NSW health minister, Brad Hazzard, to distance itself from its former columnist, referring to him as a “Sky News host”.
At The Australian on July 30, Jones’s opinions were confined to rugby union.
Trying to read the entrails of what goes on in News Corp is akin to Kremlinology, but this is the second piece of evidence in the past couple of weeks that the Telegraph is executing a delicate pivot.
A decision to switch to an overt anti-Coalition position would be well above the editor’s pay grade. However, a couple of weeks ago, the Telegraph’s editor-at-large, Matthew Benns, wrote a curious critique of Scott Morrison’s handling of vaccination and quarantine, written as if by the Morrison family dog. It contained quite a lot of nipping at Morrison’s heels.
It has continued to report the growing COVID crisis straight, publishing pictures of a strained-looking Berejiklian but refraining from attacking her in commentary.
Putting all this together, the Telegraph seems to be positioning itself as champion of an heroic people, contingently tolerant of Berejiklian, intolerant of attacks on her policies, restless with Morrison, yet anxious not to damage the Liberal Party politically.
The degree of difficulty involved in staying upright while executing this manoeuvre is considerable.
Meanwhile at Sky, Jones goes on as before, and Peta Credlin resorts to some very dodgy logic in an attempt to show that the performance of the Labor government in Victoria is still clearly inferior to the performance of the Coalition government in New South Wales.
Her proposition is that the 172 cases of the Delta strain reported on July 28 was nothing like as bad as the 700 cases a day at the height of the Victorian crisis last year, even though, she said, Delta was three times more infectious than last year’s strain.
This, she said, should cause people in NSW to “take heart”.
So a snapshot one-point reading of a curve that is still rising steeply – the case numbers on July 29 were 239 – is compared with the peak of a separate outbreak of a strain that Credlin says was three times less infectious.
If the people of New South Wales take heart from that, they are really grasping at straws.
Credlin does not attack Berejiklian, masks or lockdowns as Jones does, and she carries a torch for the Coalition while also trying to boost morale in Sydney.
Andrew Bolt threads his way through this maze by attacking politicians who he says have “smeared” the people who took part in the anti-lockdown marches on July 25. At the same time he remains uncharacteristically agnostic on whether lockdowns are right.
Last year Bolt was calling lockdowns an over-reaction. It evidently makes a difference when it is your side of politics doing the locking down.
As Australia enters a pre-election phase, it matters what the Murdoch media do. Its newspapers represent about two-thirds of the nation’s metropolitan daily circulation, with monopolies in Brisbane, Adelaide and Hobart. In August, Sky News will re-enter free-to-air television via several Southern Cross Austereo regional channels, which it claims will give it an audience of seven million.
What the Telegraph does is particularly important because it is Murdoch’s main populist political attack dog in Australia. It circulates widely in western Sydney, where there are several marginal seats.
Reading the entrails is an inexact science, to put it mildly, but there is a public-interest reason for trying.
Deborah Williamson, The Peter Doherty Institute for Infection and Immunity and Sharon Lewin, The Peter Doherty Institute for Infection and ImmunitySince the start of the pandemic, COVID-19 testing in Australia has been performed using highly sensitive PCR (polymerase chain reaction) tests.
But this conventional model of testing, which involves swabbing by a health-care professional and transporting samples to a laboratory for analysis, has important bottlenecks. Recent reports indicate people have been waiting several hours just to have a swab taken.
With the current COVID outbreaks in Australia, there’s been a renewed focus on alternative testing methods to PCR — in particular rapid antigen testing.
New South Wales this week announced it would begin using rapid antigen tests in schools to allow year 12 students to return to the classroom safely, as well as in essential workplaces.
So what are rapid antigen tests, are they effective, and what role should they play in Australia’s response to COVID-19?
What are antigen tests?
Antigen tests detect protein on the surface of SARS-CoV-2 (the virus that causes COVID-19) directly from a sample taken with a swab inserted into the nose.
Because antigen tests do not amplify parts of the virus’ genetic code, they are less sensitive than PCR tests.
The main advantages of antigen tests over PCR tests include their lower cost and their speed. Most antigen tests are designed to be used at the point of care, with results available in about 15 minutes. They cost roughly A$5 to A$20 per test.
How effective are they?
In countries such as the United Kingdom and United States, antigen tests have been used widely to complement PCR testing during the pandemic.
So far, the strongest published evidence to support the use of antigen tests is in symptomatic people within the first few days of their symptoms starting, when the amount of virus in nasal secretions is highest.
In other words, antigen tests are most accurate when the viral load is highest and when a person is likely to be most infectious. If an antigen test is taken either too early or too late in the course of infection, it may not detect the virus.
There are conflicting data on the performance of antigen tests in people without symptoms. A Cochrane review looking at results across several studies found the sensitivity of antigen tests (the likelihood of a positive result if someone is infected with the virus) was between 40% and 74% in people without symptoms. So a fair proportion of people tested may receive a negative test when they really have the virus.
With this in mind, compared to a “one-off” antigen test, repeated antigen testing (for example, daily) may improve the detection of virus, particularly in people who don’t have symptoms, or when there’s a low level of disease in the community.
Importantly, “real-world” overseas studies looking at antigen testing have varied widely in the types of tests it was compared with, the populations tested, and how much disease was circulating in the community at the time of the study.
This means it’s very hard to extrapolate information from overseas directly to Australia.
We need to trial rapid antigen testing in Australia to get reliable local information
The Therapeutics Goods Administration has so far approved 20 rapid antigen tests for use in Australia.
But antigen tests can only be supplied to accredited laboratories, medical practitioners, health-care professionals working in residential and aged-care facilities, or health departments. The commercial supply of COVID-19 antigen kits for self-testing at home is prohibited.
One way we could properly evaluate the use of antigen tests in Australia is through a series of clinical trials.
These could include trials of returning travellers undertaking daily self-testing in home quarantine, or repeated testing of groups of workers in potentially high-risk workplaces (for example, food distribution centres, construction sites or aged care).
Lessons from HIV
A precedent for community-based self-testing for an infectious disease in Australia is HIV. There were initially concerns the antibody test used for home HIV testing was not sensitive enough, and not as good as the gold standard laboratory test. There were also concerns people wouldn’t know how to deal with a positive test.
But the implementation of HIV self-testing over the past couple of years has been broadly successful. Education campaigns help people understand the limitations of the test, while there are effective processes in place to support people who return a positive result.
Although COVID-19 and HIV are very different diseases, the HIV experience offers useful lessons on how to implement home testing for a high-impact disease in a low-prevalence setting, while ensuring testing is accessible and convenient for all, including marginalised groups.
It’s not perfect, but it could be useful
One fundamental proviso for the use of widespread antigen testing is that we have to be prepared to accept a degree of risk. We know these tests are less sensitive than the current diagnostic “gold standard”, meaning it’s almost certain they will miss some cases of COVID-19.
PCR testing undoubtedly underpins our high-quality laboratory response to COVID-19 in Australia. But our capacity to sustain PCR testing at the level we will eventually need for communities to function normally and for international borders to reopen is uncertain.
We urgently need pragmatic real-world trials of new testing strategies to help us understand how best to return to a “COVID-normal” life.
Deborah Williamson, Professor of Microbiology, The Peter Doherty Institute for Infection and Immunity and Sharon Lewin, Director, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital and Consultant Physician, Department of Infectious Diseases, Alfred Hospital and Monash University, The Peter Doherty Institute for Infection and Immunity
Danielle Marie Muscat, University of Sydney; Julie Ayre, University of Sydney; Kirsten McCaffery, University of Sydney, and Olivia Mac, University of SydneyAs Sydney’s COVID-19 outbreak continues to grow, the message has shifted to urgently “get the jab”. And people’s motivation to get vaccinated is increasing.
But with ever-changing advice, many people are confused about which vaccine they’re eligible for and where to get an appointment.
Our recent review, which has been accepted for publication in the Medical Journal of Australia, shows information for the public about COVID vaccines is too complex to read, understand and act upon. It’s even more complex than other COVID public health advice, such as for physical distancing or masks.
Then there’s the results of our recent survey, which has yet to be peer reviewed, of where people from culturally and linguistically diverse (CALD) communities get their COVID information from. This finds a huge diversity of sources, beyond official government websites. So we need to tailor communications to these communities via channels people actually use.
Taken together, our research shows we are still missing clear and consistent communication about COVID vaccines all Australians can understand and act on.
No wonder people are confused
We looked at publically available COVID-19 information from government websites from Australia (federal and three states), the United Kingdom, New Zealand, and three international public health agencies (including the World Health Organization).
Most public information was above the recommended reading level for the general population (8th grade).
In Australia, information was commonly written at postgraduate level. This means it is too difficult for people with average reading ability to understand. It’s likely even harder for the 9 million Australians who have lower health literacy.
Vaccination information from the federal government website was the only Australian material to adequately outline the action or steps readers needed to take to get vaccinated. Websites from all three states (New South Wales, Queensland, Victoria) we reviewed did not.
This means there has been little progress nationally or internationally in terms of improving the readability of written COVID-19 information since April 2020.
Culturally and linguistically diverse Australians
Our review does not begin to capture the additional limitations of COVID-19 communications for CALD communities.
People from CALD backgrounds form a significant and growing share of Australia’s population. For instance, 43% of the population of southwest Sydney (one of the focuses of the current COVID-19 outbreak) was born overseas; up to 71% in certain local government areas speak a language other than English at home.
Yet, translated information and communications about COVID-19 have been sparse, intermittent and not all has been appropriate. The original source materials in English are too complex, official translators are not used, and/or translations are not reviewed to make sure the information makes sense.
There has been some progress
We’ve had some progress this week. Press briefings, crucially important for keeping up-to-date about new rules and regulations, have only in the past few days been made available in any other language than English.
Similarly, the online vaccination eligibility checker has only just been translated into 15 other languages. However, the online vaccine clinic finder, which you reach at end of the vaccine eligibility checker, remains only in English.
More positively, a COVID-19 vaccination glossary (with clear descriptions of complex vaccine terms) is now available in 29 languages.
But more work is needed
However, more work is needed to ensure COVID information is “distributed widely” to CALD communities via the most appropriate channels, as recommended in the Australian government’s own plan.
Our recent survey of over 700 CALD community members in Greater Western Sydney showed just over half (about 54%) of participants used official government sources to find out about COVID-19. However, this varied greatly between language groups, reaching as low as 29% for some.
Social media (52%), family and friends (33%), and community sources (26%) were also common pathways for seeking out information about COVID. Many sought in-language communication from overseas. For some of these groups, official sources appear less accessible or useful.
So work is clearly needed to distribute tailored communications via channels people actually use.
What actually works?
We know how to communicate public health messages clearly for diverse communities. We can:
- use everyday words for all public health communication
- test readability levels of written documents
- check the “actionability” of instructions (whether there are clear instructions of what to do next)
- use pictures, icons or animations.
We know it is possible to successfully implement these strategies. Our review identified 12 “easy-to-read” materials written at a lower reading grade that were easier to understand.
However, these were rare, difficult to find on official websites and often poorly signposted. For instance, some were on pages labelled for “people with disability”.
We need concerted action to ensure materials such as these become the “rule” rather than the exception. Plain language and in-language information simply cannot be an afterthought or “optional extra” if we are to achieve the 80% or higher vaccination rates needed to end lockdowns and return to some semblance of normal.
Danielle Marie Muscat, Post-Doctoral Research Fellow, University of Sydney; Julie Ayre, Post Doctoral Research Fellow, University of Sydney; Kirsten McCaffery, NHMRC Principal Research Fellow, University of Sydney, and Olivia Mac, Research fellow, University of Sydney
The Census of Population and Housing is held every five years in Australia — and counts every person and household in Australia. But this is the first time the count will be held during a global pandemic amid lockdowns and rising health and economic impacts of COVID-19.
Census data are crucial to what we know about Australia: who lives here, and how and where people live. Data from census informs vital services and infrastructure including, education, healthcare, transport, and welfare.
August 10 is the official census date, but things will be done a little differently in 2021. This year, Australia’s 10 million households will receive census login information or hard copy forms in the mail from next week.
The Australian Bureau of Statistics is encouraging people to complete the census as soon as they receive their instructions, if they know where they’ll be on August 10. In previous years you had to fill in your form on census night.
The 2016 ‘fail’
Australia’s last census was associated with great controversy stemming from the “digital-first” strategy (where the majority of Australians would do the census online for the first time) and bureau plans to keep names and addresses for up to four years, to boost anonymous links with other data.
Then came #censusfail.
Distributed denial of service attacks on census night saw the online questionnaire platform shut down and remain offline for nearly two days.
While data quality was not compromised, it was nevertheless a huge embarrassment for the bureau and the Turnbull government.
What’s changed in terms of set-up?
Lessons have since been learned and these are seen in preparations for Census 2021.
The new window to complete the census, rather than a one-night burst, will help ease online bottlenecks and external threats. It will also reduce pressure on the many Australians in lockdown, juggling paid work and home schooling.
Neighbourhoods won’t be graced by an army of census workers, this time, either. The bureau is expecting the overwhelming majority of people to complete the census online, with reminders sent out by mail.
So the digital-first strategy that caused such a stir in 2016 was an important trial run for the contactless conditions necessary during a pandemic. Some other countries have postponed their national census programs (like Scotland) and even risked COVID-19 exposure by going ahead regardless (like Indonesia). But Australia’s preparations will enable a vital undertaking to continue safely.
What’s changed in terms of the questions?
According to the bureau, this year will include the “first significant changes to the information collected in the census since 2006”. (Funding cuts since the 2001 have previously prohibited questionnaire refreshes.)
2021 will see new questions about long-term health conditions and defence force service. Sex beyond the binary of male/female will be also collected for the first time for all. These new additions to census have been made possible by the removal of the household internet connection question.
Improvements have also been made to better capture language and ancestry of First Nations Australians.
Census questions still have some way to go to better reflect contemporary Australia. But any changes to the census need to be understood by all.
What will we get out of Census 2021?
The census has the power to say much about a nation and how populations are changing. While there will be no specific questions on COVID-19, the data will provide valuable insights into the impacts of the coronavirus on Australians. With the 2016 data now five years old, more up-to-date information is needed to make plans for the future.
With so many people in Australia in lockdown, the census will gauge the economic and social impacts of COVID-19 in a way no other data undertaking has been able to achieve yet. Individuals, communities and economic activities affected by COVID-19 will be reflected.
Census 2021 is no ordinary population survey – it will lay the foundation for Australia’s post-pandemic future by informing the nation’s social and economic recovery, including measuring the success of the vaccination rollout through improved population data. It’s more important than ever that we get this census right.
Results from Census 2021 will become available from June next year.
The future of the census
A number of countries, such as The Netherlands, have moved away from traditional census taking. Instead opting for data compilation performed using routine government data collected through administrative interactions. Like Medicare and Centrelink data being compiled by government for your census submission.
The Australian Statistician David Gruen, has foreshadowed such a possibility for Australia. The United Kingdom is also thinking about it. This approach is a concern as it excludes individuals and communities from a vital participatory undertaking, and the data quality suffers as people can no longer self-report information.
In its current form, census data is accessible, and contributed to, by all. Australia’s census data enable everyone from researchers, to policymakers, to ordinary individuals the power to hold government to account.
It belongs to all of us.
Hannah Dahlen, Western Sydney UniversityHaving a baby brings enough stress and uncertainty without having to deal with a pandemic. Added to that is the difficult decision to have a recently developed vaccine or not.
But some are unclear if they should get vaccinated. Our survey (still ongoing) of 519 women who had a baby 12 months ago asked their intention to be vaccinated. We found 62% said they would, 12% wouldn’t and 26% were unsure, mainly due to fears over safety during pregnancy and breastfeeding.
Increasingly, international evidence supports the safety of COVID vaccines for pregnant women and demonstrates it is effective at preventing severe disease. Here’s what it says so far.
What does the new advice say?
The peak medical body for Australian obstetricians and gynaecologists recently updated its advice in a joint statement with the Australian Technical Advisory Group on Immunisation (ATAGI), the government’s vaccine advisory group.
The two groups recommend:
pregnant women are routinely offered Pfizer mRNA vaccine (Cominarty) at any stage of pregnancy […] because the risk of severe outcomes from COVID-19 is significantly higher for pregnant women and their unborn baby.
There are also other benefits. During pregnancy, antibodies that pass through the umbilical cord may offer protection to the baby. We don’t know how long this protection lasts.
Why the change?
The main reason the advice has changed is new data from recently published studies.
A study from the United States of 827 pregnant women who had mRNA vaccines such as Pfizer, mostly in their third trimester, found no safety concerns.
The rates of miscarriage (12.6%), stillbirth (one baby), preterm birth (9.4%) small babies (3.2%) and abnormalities in the baby (2.2%) were similar to what would be expected in an unvaccinated group of women.
This study is still under way and includes nearly 4,000 pregnant women in total, many of whom were yet to give birth when this paper was published.
In July, a paper from Israel looked at 7,530 pregnant women who were vaccinated and 7,530 unvaccinated pregnant women.
Rates of COVID were higher among unvaccinated pregnant women (202) than vaccinated pregnant women (118).
Of the pregnant women who were vaccinated, 68 reported possible vaccine-related side effects, such as headache, body aches, pain at the injection site, but none were severe or prolonged or different to non-pregnant people. There was no difference in any other pregnancy outcomes.
What about clinical trials?
The studies above looked at what was happening in real world data, rather than testing the vaccine in trials, where people don’t know if they got the vaccine or a placebo (disguised as a vaccine).
Pregnant women are often excluded from vaccine trials. This is because vaccinating pregnant women has the potential to affect both mother and baby, and testing medications on them rightly makes us nervous.
But while animal studies of COVID vaccines show no fertility or pregnancy effects, we need more than mouse models to test safety and efficacy in humans. Calls are therefore growing for pregnant women to be involved in trials.
One such trial of Pfizer involving pregnant women is currently under way but only started in February this year so data won’t be available yet.
Real world data from the UK and US
In the UK, the professional bodies for midwives, obstetricians and gynaecologists have expressed concern about the effect easing restrictions will have on pregnant women.
One in ten pregnant women admitted to hospital with COVID symptoms in the UK go to intensive care. These women are more likely to have a baby born early (preterm), develop high blood pressure, need a caesarean during labour and become very ill, particularly after 28 weeks.
More than 100 pregnant women have been admitted to hospital in the UK in the past couple of weeks with COVID; none had received both doses of the vaccine and five had one dose.
Meanwhile in the US, more than 130,000 pregnant women have received a COVID vaccine to date, and the data so far is reassuring. Side effects such as getting a sore arm or headache or feeling tired are common but don’t appear to affect the pregnancy.
What else do pregnant women need to know?
The Pfizer vaccine is recommended in Australia for pregnant women and doesn’t contain live coronavirus or additional ingredients harmful to pregnant women.
It’s now one of three vaccines offered in pregnancy, along with the whooping cough (pertussis) and influenza vaccines.
Pregnant women are higher risk of becoming very unwell with COVID-19 if they:
- have underlying medical issues such as high blood pressure, diabetes, asthma, heart disease, immune problems
- are overweight
- are over 35 years of age
- in their final trimester.
So getting vaccinated before 28 weeks will offer protection for mother and baby in the riskiest time.
If you are pregnant, keep in mind no vaccine is 100% effective, so it’s important to continue social distancing, wearing masks when needed, and keeping up good hand hygiene.
The decision to get vaccinated as a pregnant woman is not an easy one. The decision should be the woman’s and that decision should be informed and free of pressure or misinformation.