The first Indigenous COVID death reminds us of the outsized risk NSW communities face

The second wave of COVID-19 in New South Wales brings concerns about vaccination rates in Aboriginal and Torres Strait Islander people.
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Kalinda Griffiths, UNSWOn Sunday, New South Wales saw four more deaths from COVID-19. One of them was a man from Dubbo who was in his 50s and unvaccinated. It was the first COVID-19 death of a First Nations person in Australia.

Aboriginal communities in remote areas have been pleading with the government for help with medical resourcing and food for families. It was recently found there were pleas for protection against COVID in Wilcannia, with Aboriginal health organisation Maari Ma Aboriginal Health contacting Ken Wyatt about this back in March last year.

There has been some progress in the nation’s vaccination rates with a little over 32% of the eligible population over the age of 12 now vaccinated. However, the second wave of COVID-19 in New South Wales highlights concerns for the unvaccinated and those with multiple risk factors. This includes Aboriginal and Torres Strait Islander people.

New South Wales is now in day 76 of their most recent outbreak with cases reaching over 20,000.

Aboriginal and Torres Strait Islander people were identified as a priority group early in the vaccine rollout, yet they still have lower vaccination rates than the NSW population.

Almost 12% of Aboriginal and Torres Strait Islander people are fully vaccinated in NSW compared to almost 30% of the non-Indigenous population.

Aboriginal and Torres Strait Islander people at risk

It’s well known Aboriginal and Torres Strait Islander people experience higher rates of disease than non-Indigenous people. Aboriginal and Torres Strait Islander people in New South Wales experience two or more health conditions at a rate that is over two and half times greater than non-Indigenous people.

In addition, there is increased risk of spread in families, as larger family groups often live together in regional and remote communities.

These risks, along with extreme yet ignored service gaps in regional and remote areas, mean our Indigenous community is facing severe risk of death and disease from the COVID-19 pandemic.

Children and young people under the age of 20 account for a little over 20% of Australia’s case numbers, with all children aged 12 to 15 now recommended to get the Pfizer vaccine.

Pre-existing conditions such as asthma, gastrointestinal disease, diabetes/prediabetes, as well as children who are immunocompromised and preterm, have been found to be predictors of severe COVID-19 disease.

This is of great concern to Aboriginal communities, considering Aboriginal children are up to two times more likely to be hospitalised for respiratory conditions than non-Indigenous children.

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We need better data

The gaps in COVID-19 publicly available data are concerning, especially data specific to Aboriginal and Torres Strait Islander peoples.

There is currently no information on vaccination rates for children over the age of 12 in out-of-home care. In 2018 there were 45,800 children in out-of-home care. About 40% of these children are Aboriginal and Torres Strait Islander.

There is also little to no data available on the number of Aboriginal and Torres Strait Islander people tested for COVID, as well as issues with the accuracy of Indigenous status in the reporting of the case numbers.

Despite the daily high case numbers, this week the New South Wales government announced restrictions in the state will be relaxed across selected local government areas for those people who are fully vaccinated.

While the risk for those people who are vaccinated is relatively low, greater activity could still increase the spread of COVID-19 across the state, putting people in Aboriginal communities at greater risk.

Knowing exactly who is vaccinated and who is at greatest risk will be of the utmost importance as restrictions start to ease.

How the public can help

The increasing case numbers and resultant lockdowns across NSW local government areas have seen Aboriginal communities having limited access to health care and basic necessities due to limitations in the supply of regional and remote supermarkets. A number of First Nations people have rallied together to support their communities.

This has included pages that have been set up for:

• emergency food packs across western NSW
• support for Wilcannia community
• fresh fruit and veggies in Wilcannia
• a volunteer group to assist in coordinating water and food support in Wilcannia nd provides opportunities for people to volunteer.
• an interstate fundraiser from Lullas Children and Family Centre to supply Aboriginal kids with educational toys, games and other items

People can donate or contact the volunteer group to get involved.

Where to next?

As the Delta variant makes its way across Australia, all people need access to vaccines. This means increasing government resources and health system efforts in Aboriginal and Torres Strait Islander communities as well as ensuring all Indigenous people have multiple access points to the vaccines.

This could include door-to-door vaccinations in Aboriginal and Torres Strait Islander communities, pop-up vaccination clinics in regional and remote local government areas as well as school-based vaccinations.

With the expected mRNA vaccine supplies to be sufficient for the entire Australian population in the coming months, the biggest next step is ensuring their distribution is prioritised to those who need it the most.

This requires moving beyond the rhetoric and supporting health services, particularly Aboriginal Community Controlled Organisations, to do the work.

Kalinda Griffiths, Scientia lecturer, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What’s Australia’s first local Pfizer-style COVID vaccine? And when might it be in our arms? An mRNA expert explains

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Archa Fox, The University of Western AustraliaAustralia has struggled to get enough Pfizer doses to meet Australians’ growing demand for COVID-19 vaccinations.

Australia has been producing doses of AstraZeneca since March, but this vaccine is no longer recommended for those aged under 60 because of the small but serious risk of clotting.

Now a research team at Monash University, led by Professor of Pharmaceutical Biology Colin Pouton, hopes to develop a new mRNA vaccine, which works by the same principles as the Pfizer vaccine, and could be manufactured locally.

So how would the vaccine work? What hurdles do the researchers need to overcome to make it a reality? And when could it become available?

It’s based on existing technology

Before COVID, the researchers were developing mRNA vaccines against a variety of viruses and diseases, and testing the technology in mice. After the pandemic hit, they pivoted their skills and technology and started work on an mRNA vaccine against COVID-19.

The vaccine is an mRNA vaccine, like the ones by Pfizer and Moderna. These vaccines prompt your body to produce the virus’ spike protein, to which your immune system makes antibodies against.

But the Monash mRNA vaccine is a little bit different, as it directs our cells to only make a small part of the spike protein, the “receptor binding domain”, which is the most important part allowing the virus to enter our cells.

The receptor binding domain, or tip of the spike protein, is also the part that’s quickly mutating to form the different variants of concern. Directly targeting this part makes sense to get the most variant-specific response.

How do mRNA vaccines work again?

MRNA vaccines work as instructions, telling our cells to make certain proteins. If these proteins are foreign to our bodies, our immune system will recognise them and mount an immune response. Over time, immune memory is developed, meaning when we encounter the virus, our immune system will clear it.

The researchers began modelling the vaccine off the original strain of the virus, first discovered in Wuhan. But they’ve since adjusted their sequence to model the shot off the Beta variant, first discovered in South Africa. This adjustment was made partly because the neutralising antibodies from patients infected with the Wuhan strain are least effective against the Beta variant.

Our current crop of approved COVID vaccines protect well against the Alpha variant, first found in the United Kingdom, and the Delta variant, first discovered in India. But because the Beta variant is good at evading immunity from vaccines, it’s more likely than most other variants to surge when vaccine protection begins to wane.

For these reasons, there’s a stronger clinical need for Beta variant vaccines.

This quick adjustment of the sequence demonstrates how flexible the mRNA technology is. It’s easy to change the sequence of the vaccine to adapt to new variants of the virus that have emerged, and might emerge in future. This ability to quickly change the sequence is similar for DNA vaccines like AstraZeneca, but harder for traditional and protein-based vaccines.

As with all other mRNA vaccines, the RNA will be broken down in the body over the course of a day or so. The vaccine doesn’t stay in your body over the long term. You gain immunity as your immune system learns how to respond to the short burst of proteins your body makes. When you get the second dose of mRNA vaccine, the immune memory is reinforced.

The group has tested this vaccine in mice, and says its results are really promising.

Based on these pre-clinical results, the Victorian government has given the project A$5 million. The money has come out of a A$50 million research fund earmarked to support local mRNA vaccine development.

The A$5 million will help pay for a manufacturer in Europe to make a sufficient amount of the mRNA for the phase 1 trials. This material will then be shipped via ultra-cold storage to Australia, and a local company is going to package the RNA into “lipid nanoparticles” which allows the mRNA to get into human cells.

What are the next steps?

Phase 1 trials to check the vaccine is safe in humans will begin in October or November this year, and will initially include 150 volunteers.

If the vaccine passes this trial, it will move to phase 2 and 3 trials which require tens of thousands of participants. The primary aim of these later stage trials will be to see if the vaccine can reduce the severity of COVID-19 disease, while also checking it’s still safe.

These later stage trials are quicker to complete if conducted in areas with (unfortunately) high community transmission. One reason we saw Pfizer and Moderna’s vaccines approved so quickly was because trials took place in countries where the virus was rampant. If and when this vaccine goes to phase 2 and 3 trials, Australia will hopefully not be in a situation with widespread transmission. So the team may need to involve international partners and recruit participants overseas.

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However, there may also be alternative metrics to measure how well a vaccine is working. Researchers can look at study volunteers’ blood to see how many, and the type of, antibodies they’re producing. This could work as a proxy for measuring efficacy. But it’s not clear if Australia’s drug regulator, the Therapeutic Goods Administration, would approve the vaccine without the traditional exposure model.

The team will also compare their mRNA vaccine directly with Pfizer, in a side-by-side comparison, to see how stable it is and how well it elicits antibodies against the virus.

So when can we get it into our arms? It’s uncertain how long the full suite of trials will take, but probably not for a couple of years. It’s possible the vaccine will not make it past phase 1 or 2 trials, although with the similarity in methodology to the Pfizer and Moderna vaccines, both of which are safe, this is less likely.

Why we need Australian-made vaccines

This is an important step in developing Australia’s sovereign capacity for mRNA vaccine production, and for the newly developing Australian RNA biotechnology sector as a whole. It’s likely we’ll need booster shots for some years to come, so we need to develop local manufacturing capability.

I sincerely hope it’s successful, but even if it’s not, it’s creating a pipeline for onshore mRNA vaccine development.

What’s more, mRNA vaccines are the new gold standard and the next generation vaccine technology. It’s likely we’ll see more pandemics and novel viruses in future, so that adds to the argument for having local mRNA vaccine capacity.

We don’t know how much the federal government paid for the Pfizer and Moderna vaccines, but it’s likely to have been much more costly than making it here. If we can make it ourselves more cheaply, we’re at a real advantage.

Archa Fox, Associate Professor and ARC Future Fellow, The University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Healing the urban-rural divide: Why a ‘locals-first’ approach doesn’t work in a pandemic

DARREN ENGLAND/AAP

Timothy Baker, Deakin University; Emma Tumilty, Deakin University, and Kristy Hess, Deakin University

Toilet paper and ventilators may be unlikely bedfellows, but they serve as powerful symbols of the growing tensions between urban and rural regions in Australia and elsewhere amid the COVID-19 pandemic.

Last month, the media reported dozens of frenetic “supermarket swoops” across the nation. Busloads of city residents converged on rural grocery stores to fill their trolleys with supplies, leaving the shelves bare for local shoppers.

As a result, supermarket managers and security guards stepped in to be custodians of the local, refusing access to those who did not look familiar.

It is important to note that “local” is a powerful cultural idea. Local shoppers don’t legally have a right to toilet paper in this instance, but there is a moral perception they should have first dibs based on their need for essential services and in the interests of social order.

No ‘locals only’ option for hospitals

The toilet paper fiasco serves as an analogy for a much graver issue as the pandemic spreads around the world.

What happens if overwhelmed city hospitals hoard the staff and resources needed to manage COVID-19, leaving rural areas to fend for themselves? Rural areas of the United States are already confronting this reality.

To compound the problem, many people have been eager to escape crowded cities like Sydney, London, New York and San Francisco for the imagined safety of the countryside. This places strain on rural healthcare providers, making it difficult to prepare for and utilise already stretched resources.

Small town health services cannot plaster “locals only” posters on their doors or allow only “familiar faces” access to lifesaving equipment.

As rural professionals in medicine, ethics and media/cultural studies, we bring an interdisciplinary perspective to the issue of local resourcing and implications for the urban-rural divide.

We understand that in a pandemic, urban health care workers would also feel a need to protect and ensure supplies at their local hospitals first. But the equity of urban-rural resourcing during the COVID-19 crisis warrants more attention.

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Big media focus on urban problems

Urban areas in Australia already have almost three times as many hospital specialists per capita as outer regional areas and many times more critical care specialists.

Our regional health systems are struggling. Many hospitals rely on fly-in-fly-out emergency, anaesthetic and intensive care doctors. These doctors (often from city hospitals on short-term contracts to fill gaps in the local roster) are now limited by quarantine restrictions. They also want to stay near their metropolitan hospitals in case they are needed.

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There’s a concern that a capital city’s rush for resources could also leave patients in rural hospitals without medical necessities, similar to the panic buying of supermarket goods that has left some remote Indigenous communities without basic food and hygiene necessities.

Yet, these issues have not been discussed enough. Big media tends to focus on the impact of this health crisis on major metropolitan areas where more people live.

How we can more equitably share resources

We need a better strategy for rural-urban resource allocation during the crisis.

Nobel Prize-winning economist Amartya Sen suggests solutions may have to be tailored to specific contexts (like rural and urban settings) to be effective and ensure everyone’s health is of equal value. Drawing on his “capability approach”, we need to allocate resources in a way that is community-centred, equity-focused and puts an emphasis on deliberative democratic processes.

To hash out solutions, stakeholders in rural and urban hospitals should gather around a “virtual” table to discuss their differing needs. Government organisations and medical colleges have already begun this process.

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Effective resource allocation could impact who gets critical care treatment. Centralising resources is a proven lifesaver in normal times when transport is secure, but pandemics threaten to overwhelm our ability to move rural patients to hospitals in big cities. Transport could be delayed by days or even cease for a time.

Accessibility of life-saving equipment becomes key. We need to increase the capacity of transport services to get rural patients to cities when need be and ensure there is enough staff and equipment in regional areas to treat as many patients as possible locally.

The long-term benefits of better urban-rural cooperation

An unexpected upside to COVID-19 may be an increased sharing of knowledge and ideas between rural and urban communities.

Regional Australia has many general practitioners with anaesthetic skills, for instance. They are experienced in short-term ventilation for operations. These doctors can become “accidental intensivists”, meaning they could take care of critically ill patients, with preparatory online courses and real-time video support from urban specialists (who get to remain in their urban communities).

Urban doctors may also benefit from interacting with rural doctors who are already experts in making do with fewer resources. This kind of digital interaction could be useful long after the crisis has abated, too.

Civil wars have been fought over access to resources many times in the past. There is no reason to broaden the urban-rural divide in a war against a virus that has no borders.

Timothy Baker, Associate Professor and Director, Centre for Rural Emergency Medicine, Deakin University; Emma Tumilty, Lecturer, Deakin University, and Kristy Hess, Associate Professor (Communication), Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

First locally-transmitted COVID-19 cases in Australia, as Attorney-General warns drastic legal powers could be used

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Michelle Grattan, University of Canberra

The coronavirus has moved to a new stage in Australia, with the first two cases of local transmission of the disease.

The NSW government announced a 53-year-old Sydney health worker – who had not recently travelled abroad – had been diagnosed. The other case is the 41-year-old sister of an Iranian man who had arrived in Australia on Saturday. The woman had not travelled to Iran.

Other cases in Australia – now more than 30 – have been people who have come from abroad. These include the third new case announced in NSW on Monday, a man in his 30s, who had recently travelled from Iran.

There has been one death in Australia, a 78-year-old man who had been evacuated from the Diamond Princess cruise ship.

Health authorities have anticipated the spread of the virus locally, with plans being ramped up to deal with that.

Efforts were being made on Monday to track down passengers who sat near travellers from Iran who have been diagnosed with the virus. There is now a ban on the entry of foreigners coming from Iran.

News of the local transmission comes amid the expectation the Reserve Bank will cut interest rates on Tuesday as the virus scare hits the economy, and panic buying of items such as toilet paper.

Hand sanitisers have been a runaway sales item. The share price of Zoono, a company that makes them, has jumped 70% in under a week.

On Friday the futures market rated the probably of a Tuesday rate cut at just 18%. On Monday it was rating the probability at 100%, with some economists even speculating about the possibility of the cut being double the usual 0.25%.

The Australian share market fell by 0.77%, after a 10% fall in what was the worst week since the global financial financial crisis.

NSW Health Minister Brad Hazzard said it was time for people to “give each other a pat on the back” rather than shaking hands. He also suggested a degree of caution when kissing.

In parliament, the government took a series of questions on the virus and its fallout. Attorney-General Christian Porter said it was important for Australians to understand the use of certain powers may become necessary in the months ahead.

Notably among these were changes made in 2015 to the Biosecurity Act, which replaced the Quarantine Act.

COVID-19 had been listed as a human disease for the purposes of this act in January.

“That has a number of very important consequences for Australia and Australians in what will no doubt be challenging months going ahead,” Porter said.

“There are two broad ranges of powers that people may well experience for the first time.

“There is the ability of the government to impose – always based on medical advice, but nevertheless impose – a human biosecurity control order on person or persons who have been exposed to the disease.

“It could require any Australian to give information about people that they’ve contacted or had contact with so that we can trace transmission pathways. It will also mean that Australians could be directed to remain at a particular place or indeed undergo decontamination.”

“Secondly, a very important power that may be experienced for the first time—and that we will be monitoring very carefully—is the declaration of a human health response zone, ” he said.

This was done with the Diamond Princess.

“But it’s very important to understand, going forward, that that is a power that can be used for either localised disease outbreaks in Australia or indeed to restrict individuals from attending places where a large number of people may otherwise choose to gather, such as shopping centres, schools or work.

“These are challenging times going forward, and these will be some of the first times that these important powers may be used,” Porter said.

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Cricket: The Ashes – First Test (Day 1)

Australian Politics: 21 July 2013

The new hardline regime concerning asylum seekers has been implemented with the first boat arriving since the announcement of the changes by Kevin Rudd and Labor. The Coalition is supporting some of the changes, which for Labor should be an alarm bell, meaning it has gone too far to the right.

For more visit:
http://www.theaustralian.com.au/national-affairs/first-asylum-boat-arrives-under-rudds-hardline-png-solution/story-fn59niix-1226682406568

The link below is to an article that looks at some of the divergent interest parties contesting this year’s federal election.

For more visit:
http://www.easternriverinachronicle.com.au/story/1650949/something-for-everyone-how-niche-parties-are-taking-over-australias-political-landscape/

Australia: The First Family

The link below is to an article that takes a look at the Rudd family.

For more visit:
http://www.smh.com.au/national/meet-the-rudds-where-politics-is-a-family-affair-20130719-2q9uo.html

Article: First ‘Gay’ Bible Released

The link below is to an article reporting on the release of the first ‘gay’ Bible – I guess it was bound to happen sooner or later in this age of Bibles for everything and every occasion.

For more visit:
http://www.christianpost.com/news/recently-released-queen-james-purports-to-be-first-ever-gay-bible-86627/

Article: The Voice Australia – Latest News

Keen to know what is happening with the three runners-up from the first season of The Voice Australia? The link below is to an article that reports on the news for Darren Percival, Sarah De Bono and Rachael Leahcar.

For more visit:
http://www.dailytelegraph.com.au/entertainment/insider/the-voice-runners-up-darren-percival-sarah-de-bono-and-rachel-leahcar-will-also-have-record-deals/story-e6frewt9-1226406377829

Video: Rachael Leahcar’s First Appearance on The Voice (Australia)

Rachael Leahcar Sings ‘La Vie En Rose’

Sadly I couldn’t embed this video here, which is disappointing. Click on the link and really enjoy a great performance that tugs at the heart.

http://www.dailymotion.com/embed/video/xq94c8
The Voice Australia: Rachael Leahcar sings La…