How can the world help India — and where does that help need to go?


Channi Anand/Ap/AAP

Dileep Mavalankar, Public Health Foundation of IndiaIndia is in the grip of an unprecedented second wave of COVID-19.

Official data suggests new cases have crossed 400,000 per day, and the daily death count is around 4,200. But the actual numbers may be significantly higher.

We know the hospital system is stretched beyond its limits and there are dire shortages in the country’s expanded vaccine drive.

Clearly, India is in need of help from beyond its borders. What can other countries do?

Help already pledged

In this moment of crisis, the international community has already stepped in to provide some help.




Read more:
‘Each burning pyre is an unspeakable, screeching horror’ – one researcher on the frontline of India’s COVID crisis


Several countries including the United States, United Kingdom, United Arab Emirates, Russia, Germany, and France have already sent aid such as oxygen and related equipment, ventilators, medicines and ICU equipment. The US has also said it will provide vaccine help, and critical drugs.

Australia has announced it will send ventilators, surgical masks and other personal protective equipment.

How should this help be used?

This aid is all critical. But given the size of India’s population — almost 1.4 billion — more will be needed and even this will not be enough.

Given this, we need to make best use of the incoming aid. India needs to conduct a quick national and state-level needs assessment exercise. Where is help most needed? And where can it be most useful?

Indians in Prayagraj line up for a COVID vaccine.
India’s vaccine program has begun but has been hit by shortages.
Rajesh Kumar Singh/AP/AAP

This should include an assessment of capacities for care and utilisation by each major city and rural area. For instance, there’s a need to evaluate diagnostic and testing capacities and their distribution across the country. An important measure missing at this point is high capacity testing systems which can help increase testing.

The review would also help answer: what are the strengths of the private and NGO sectors and how can they be harnessed? Where exactly are the most vulnerable, and how best can we reach them? Such a review would also help in ensuring that sophisticated machines such as ventilators are not sent to places where they cannot be operated or maintained.

At the same time, there’s a need to look for available internal funds and services that can strengthen India’s efforts.

The importance of vaccines

Given the emerging shortage of vaccines, they will, of course, be the most helpful gift in the long run. Many countries have booked more than they need. Such excess vaccine doses can be offered to India, as it will need millions of doses of imported vaccine to cover its population rapidly.

Besides the very visible gaps in emergency and critical care — such as oxygen and ventilators — technical expertise in epidemiology, biostatistics, data sciences and modelling as well as diagnostic technology would be very useful.




Read more:
COVID crisis in India: why its public health strategy failed


We need help in conducting expert analysis of the situation, prediction modelling by each state and city, and assistance on how to improve systems to record and analyse the huge amount of data that is streaming in.

Sharing knowledge and collaboration in areas such as understanding mutations via gene sequencing, identification of variants of concern, and studying their virulence and transmissibility will also help.

Such efforts are intangible and would fall in the realm of “knowledge aid”, and hence, governments may not be keen to prioritise this. But foreign support could also come in the form of specific funds and grants.

Help must come with no strings attached

In this process, the countries offering the support should not put any conditions or delay the process. Immediate assistance is needed as the peak of the current wave seems to be only a few weeks away.

This support should reach where the most vulnerable get COVID services: public hospitals, healthcare centres run by non-government organisations, and community COVID care centers. The technical help in epidemiology and data sciences should be given to state health departments and major research centres located in cities.

Most importantly, foreign support should strengthen the health system and not be a burden on it.

Only if we are in it together, can we all hope to defeat the virus.The Conversation

Dileep Mavalankar, Vice President western region, Public Health Foundation of India

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

Taking one for the team: 6 ways our cells can die and help fight infectious disease


White blood cells dying.

Georgia Atkin-Smith, La Trobe University and Ivan Poon, La Trobe UniversityWe have all heard of COVID-19, the flu and bacterial infections. But what is actually happening to our cells when we contract these diseases? Many of our body’s cells don’t live to tell the tale. But cell death isn’t necessarily a bad thing — in fact, the death of infected cells can provide a sacrificial mechanism to stop pathogens in their tracks before they can spread through our body.

Over the years, researchers have realised there are many ways for our cells to die. Our genetics contain a comprehensive “licence to die”, with the route to cell death dictated by both the type of the cell and the pathogen. Let’s check some out:

The dancing death

In the time it takes you to read this sentence, ten million cells in your body will have died, through a type of death called apoptosis. This term, coined in 1972 by Australian pathologist John Kerr, comes from the Greek phrase for “leaves falling from a tree”.

Apoptosis is the most common form of cell death, and has also been nicknamed the “dance of death”, because of the extraordinary shape changes exhibited by the cells under a microscope as they sacrifice themselves.

For example, apoptotic cells dying from radiation or infection with influenza A virus (aka, the flu) generate large, bubble-like structures on their surface called blebs, before shooting out long beaded necklace-like protrusions and finally shattering into pieces.

The death of flu-infected cells is suggested to both aid and limit viral spread. Nevertheless, it’s a spectacular event to witness (and an excellent reminder to get your flu shot this winter).

White blood cell blebbing and dying.

Out with a bang

Vaccinia virus is used worldwide to vaccinate against smallpox. In fact, it was the very first vaccine, developed in 1796 by Edward Jenner.

We now also know that vaccinia virus can make our cells more sensitive to a particular type of cell death, caused by a molecule called TNF. This can help prevent the disease spreading by killing off infected cells before the virus has a chance to replicate.

Many of our cells have a roughly spherical or balloon-like shape, encapsulated by a protective layer called the cell membrane. Just like bursting a balloon with a pin, puncture to the cell membrane marks the point of no return.

This process occurs during necroptosis — an explosive type of cell death in which proteins inside the cell punch holes in the membrane. The cell pops and dies, shutting down the machinery needed for viral replication.

The spider web of death

When they aren’t busy haunting our nightmares, spiders can be found weaving silken masterpieces of extraordinary detail and strength. The web of a golden orb weaving spider, for example, is strong enough to entangle small birds.

On a smaller but equally impressive scale, our immune system contains specialised cells called neutrophils that can weave a deadly web of their own and entrap bacteria. Neutrophils gallantly sacrifice themselves in the process of casting their web, in a type of cell death perhaps fittingly called NETosis.

When infected with bacteria such as Streptococcus pneumoniae, which causes pneumonia and meningitis, neutrophils eject a specialised web made from their own DNA. These webs can entangle nearby bacteria to prevent their escape until other immune cell reinforcements arrive to clear the infection. Sometimes, proteins found in these webs can also kill the bacteria – quite an impressive defence mechanism!

Cartoon illustrating different forms of cell death
There are a surprising number of ways cells can lay down their lives for the greater good.
Author provided

The last meal

Just as our bodies are compartmentalised into organs such as the stomach, liver or heart, our individual cells also have specialised compartments. One of the cell’s “stomachs” (a structure called the “autophagosome”) engulfs and digests cellular contents such as damaged molecules through the process of autophagy.

However, in some circumstances, the machinery that drives this Pac-Man-style action can also facilitate the cell’s demise. Coincidentally, the bacteria Helicobacter pylori can infect cells of the human stomach lining, called epithelial cells, which can cause ulcers and gastritis. The cells can respond with a process called autophagic cell death, in which the induction of autophagy causes the cell to die.

A fiery death

Pyromania, derived from the Greek word pyr, meaning fire, is an obsessive desire to set things ablaze. Some of our immune cells also have the ability to self-immolate and cause inflammation as part of our response to infection.

Since its relatively recent discovery in 2001, this type of cell death, called pyroptosis, has become a hot topic (sorry) among cell biologists, and is often facilitated by a molecular complex called the inflammasome.




Read more:
What is autoinflammatory disease, the rare immune condition with waves of fever?


In 2021, understanding pyroptosis is more important than ever, as it has been linked to infection with SARS-CoV-2 infection, the virus that causes COVID-19.

Activation of the factors that cause pyroptosis may help explain the excessive inflammation seen in patients with severe COVID-19. And this could potentially offer a new way to combat the disease.

Overdosing on iron and fat

There’s no doubt the key to a long and healthy life is a balanced diet and exercise. However, sometimes we can’t resist the urge to devour a burger and fries with ice cream for dessert. With enough hard work, we can burn it off again. But for individual cells, overindulging can be fatal.

Too much iron and/or harmful types of fat molecules can cause cells to die by ferroptosis. Cells infected with Mycobacterium tuberculosis, the bacterium that causes TB, can increase their iron content and cause ferrototic cell death! Pass the salad, thanks.




Read more:
Tick, tock… how stress speeds up your chromosomes’ ageing clock


The survival of the human body is a fine balancing act between cell growth and cell death. Understanding our cells’ complex “licence to die” could give us new ways to combat disease.The Conversation

Georgia Atkin-Smith, Research scientist, La Trobe University and Ivan Poon, Associate Professor, Biochemistry, La Trobe University

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

India is facing a terrible crisis. How can Australia respond ethically?


Paul Komesaroff, Monash University; Ian Kerridge, University of Sydney, and Wendy Lipworth, University of SydneyIndia’s COVID-19 crisis has revived a longstanding debate about whether foreign governments should come to the aid of countries facing major economic or humanitarian challenges and, if so, what kind of help they should provide.

There’s a common assumption foreign aid produces undoubted benefits. But there’s actually limited evidence that it does. Increasing data suggests it may perpetuate existing inequities and inefficiencies, enable corruption, and generate adverse cultural and economic effects.

There are serious questions about the underlying causes of India’s crisis. There’s evidence the Modi government repeatedly ignored warnings from public health experts and refused to plan for the predicted increases in need. Instead, it pursued a public discourse of misinformation, promoted fake cures, withheld health data, intimidated journalists, and encouraged super-spreading events.

Government officials also continue to deny the existence of shortages of vaccines and other medicines. These facts suggest there are underlying structural obstacles, which aid contributions would be unlikely to reverse.




Read more:
COVID in India: how the Modi government prioritised politics over public health


But the moral arguments about the obligations humans have to each other are well established. So is the principle that we should come to someone’s aid if they’re in need. We are also bound by mutually beneficial values such as equity, justice, solidarity and altruism. Consequentialist philosophers, who argue the only things that matter are outcomes (rather than principles, obligations or intentions), claim foreign aid generally provides more benefit than harm overall.

Unfortunately, the fact we have a moral obligation to rescue someone from harm provides little or no guidance about what kind of help or assistance is thereby required.

We should enter into discussions, led by the Indian people, about what kinds of support are likely to make a difference.

As imperfect as the outcome may be, Australia might genuinely be able to help in areas such as assisting the development of expertise and infrastructure, and advocating for the relaxation of vaccine patent restrictions.

Here’s how Australia can help

Last week, Australia committed to sending an initial support package of ventilators, oxygen, and personal protective equipment to India.

If we choose to act further, we should do so in a generous and compassionate manner, but also with prudence and circumspection. We should be realistic about the limited options available to us. Aid cannot be given with conditions attached — for example, that it be directed preferentially to those in greatest need.

What’s more, it cannot be contingent on the enforcement of a value system that’s contrary to those presently in authority. Foreign donors have no straightforward right to insist on the abolition of corrupt or counterproductive policies and practices in the countries they’re supporting.

However, there are options available to us that can ensure we actually make a difference — and some of these may appear to undermine our own interests.

Top health officials have suggested wealthy countries, which have contracted to purchase many more vaccine doses than they need, should urgently donate excess vaccines to middle- and lower-income countries such as India. Some people may argue that, because of our present lesser need, Australia could donate its entire stock of available vaccines. However, this wouldn’t likely be of much benefit given the logistical, political and structural impediments described above.

Instead, we should draw on our experience over the past year in developing effective processes for responding to the pandemic. We should offer to provide India with expertise about quarantine measures, hygiene, masks, and vaccine education campaigns. Our experts and policymakers could respectfully advise on appropriate economic and social policies.

What’s more, we could call for the relaxation of patent and other intellectual property restrictions. These have, since the late 1980s, imposed severe limits on the ability of poorer countries to produce vaccines and pharmaceuticals developed in the United States and Europe. Although India is the world’s largest vaccine producer, the current demand obviously exceeds supply.

What vaccines are available are much less likely to find their way to poorer sections of India’s population than wealthier ones. This is partly because of insufficient government support, but is also exacerbated by the refusal of rich countries (including Australia) to allow the relaxation of the strict patent laws that prevent state-of-the-art vaccines being manufactured cheaply and efficiently in developing countries.




Read more:
Over 700 health experts are calling for urgent action to expand global production of COVID vaccines


There’s already a well-tested mechanism for suspending patent restrictions in an emergency, known as the “Doha Declaration”. This was negotiated in 2001 in response to the urgent need for increased access to newly developed HIV medications. This instrument is ready to use and could be implemented rapidly. Australia should announce its unqualified support for the immediate application of the Doha Declaration to COVID vaccine production.

But that’s not all

India’s huge pharmaceutical industry has previously provided vaccines and medicines to developing countries — many of them in Africa — largely funded by the World Health Organization. The Indian crisis has left these countries vulnerable, through no fault of their own.

Rather than merely responding to the crisis in India, largely self-inflicted by its own government, we should also turn our attention to the increasingly urgent needs of those countries that now face their own major emergencies as a consequence.

Regardless of what anyone does, many people will still die. All that’s open to us is to act ethically in accordance with our own values, informed by knowledge about the complexity of the multiple forces at work.The Conversation

Paul Komesaroff, Professor of Medicine, Monash University; Ian Kerridge, Professor of Bioethics & Medicine, Sydney Health Ethics, Haematologist/BMT Physician, Royal North Shore Hospital and Director, Praxis Australia, University of Sydney, and Wendy Lipworth, Senior Research Fellow, Bioethics, University of Sydney

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

A catastrophe looms with PNG’s COVID crisis. Australia needs to respond urgently



from www.shutterstock.com

Brendan Crabb, Burnet Institute and Leanne Robinson, Burnet Institute

The COVID epidemic in Papua New Guinea has significantly accelerated, judging by the available reports of case numbers.

Since its first case was diagnosed 12 months ago, PNG has avoided a large number of reported cases and corresponding deaths. That situation has changed dramatically over the past fortnight. A crisis is now unfolding with alarming speed and the response must quickly match it.

Australia can be proud of its preparations to support PNG and the region in responding to COVID-19, especially its preparations to support vaccination in the region. These include contributing A$80m to COVAX, $523m to the Regional Vaccine Access and Health Security Initiative, and $100m towards a new one billion dose COVID-19 vaccine initiative together with the United States, India and Japan (the “Quad” group of nations).

As good as they are, these plans are unlikely to be fast enough to stop this current surge before enormous damage is done. There’s simply no time to waste in responding.

Why the urgency?

Reported COVID-19 testing rates remain critically low, with just 55,000 taken from an estimated population of nine million people. This means we don’t yet have a precise picture of the scale of the epidemic.

The reported numbers are highly concerning. In the first week of March, 17% of all people who were tested throughout the country were positive to COVID-19, with over 350 newly confirmed cases. This is the highest number of cases in a single week in PNG since the start of the pandemic. Over half of PNG’s 22 provinces reported new COVID-19 cases in that week.




Read more:
‘We didn’t have money or enough food’: how COVID-19 affected Papua New Guinean fishing families


There are other indicators of a potential large scale outbreak, such as reports of increased cases among health-care workers. What’s more, the total number of documented COVID-19 deaths in PNG has nearly doubled in the past fortnight alone.

Low testing rates, combined with reports of high daily case numbers, means there are likely many thousands of current cases in Port Moresby and widespread seeding and spreading of infections throughout the country.

PNG’s hospitals and front-line health-care workers remain particularly vulnerable. With limited public health controls in place and an effective vaccination program yet to be initiated, and with last week’s huge commemoration ceremonies for Grand Chief and former Prime Minister Michael Somare, there’s every chance the current outbreak will continue to grow exponentially for some time yet.

COVID-19 posters in PNG
These posters in PNG’s East New Britain Province help spread COVID-19 public health advice.
Parrotfish Journey / Shutterstock.com

The people of PNG now face dual health emergencies: death and disease from COVID-19 itself, and a likely increase in existing major diseases barely held in check by the nation’s already stretched health system. These indirect effects, such as potential rises in malaria, tuberculosis, HIV, cervical cancer, vaccine-preventable diseases and poor maternal and newborn health, are likely to be even worse than the direct impact of COVID-19.

Australia and PNG’s vital partnership

This health crisis should be reason enough for Australia to respond urgently in support of PNG. But there’s another reason too. High levels of circulating SARS-CoV-2 in the Asia-Pacific region are a recipe for generating mutant coronavirus variants that might spread more readily, evade immunity more easily, and/or cause more serious disease. A regionally coordinated effort to combat COVID-19 will help ensure protection for everyone, including going a long way to help preserve Australia’s own vaccine program.

PNG already has a coordinated national and provincial COVID-19 response and a vaccine technical working group that has begun planning for deployment of the first allocation of vaccines to front-line health-care workers.

Meanwhile, Australia is also playing a crucial role in supporting this effort, contributing generously to the COVAX vaccine access facility and to a A$500 million fund to support COVID vaccination in PNG and the wider Pacific.

However, these plans were developed on the basis there was substantially more time for planning, deployment and phased rollout than the current case numbers would suggest.

What action is needed?

Two considerations are now paramount. First, the response needs to be requested by — and, more importantly, led by — PNG itself. Second, the response needs to reflect the urgency and scale of the unfolding emergency.

This “emergency package” could conceivably involve:

  1. immediate provision of masks in the community, appropriate PPE for health-care workers and increased support for widespread testing

  2. a campaign to counter COVID-19 misinformation, which is rampant, and

  3. a significant ramp-up of vaccination across PNG, with an ambitious target — perhaps a million doses before the end of the year, aimed at the most at-risk groups.

Arguably the most important element of this would be immediate vaccination for health-care workers in the most heavily impacted areas of the country. Ideally, all of PNG’s crucial health-sector workforce should be vaccinated within the next fortnight. Australia could provide around 20,000 vaccine doses for health-care workers without putting a significant dent in its own vaccine supplies, potentially making a profoundly important intervention in the course of the epidemic in PNG.




Read more:
3 ways to vaccinate the world and make sure everyone benefits, rich and poor


This is the moment for dialogue to occur between the two nations, so PNG can ensure Australia’s help with such an immediate and ambitious response.

PNG is Australia’s closest geographical neighbour, and our countries have a deep shared history of mutual support. An out-of-control COVID-19 epidemic in PNG would be a humanitarian and economic disaster for the nation itself, and a grave threat to the health of the region, particularly with shared borders to Solomon Islands in the east and Indonesia to the west.

Given this pandemic expands at an exponential rate, and with new variants of concern arising regularly in regions of high transmission, it’s the speed of a strong response that matters the most. A rapid public health intervention, to be supported and facilitated at the highest levels of government, would go a long way to mitigating what may well become a public health catastrophe.




Read more:
After a year of pain, here’s how the COVID-19 pandemic could play out in 2021 and beyond


The Conversation


Brendan Crabb, Director and CEO, Burnet Institute and Leanne Robinson, Professor, Program Director of Health Security and Head of Vector-borne Diseases & Tropical Public Health, Burnet Institute; Laboratory Head, Walter & Eliza Hall Institute; Adjunct Principal Research Fellow, PNG Institute of Medical Research, Burnet Institute

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

Introducing Edna: the chatbot trained to help patients make a difficult medical decision



Shutterstock

David Ireland, CSIRO; Clara Gaff, Walter and Eliza Hall Institute, and Dana Kai Bradford, CSIRO

Allow us to introduce Edna — Australia’s first “genomics chatbot”.

The opening dialogue of Edna the chatbot.

Edna (short for “electronic-DNA”) helps patients make informed decisions about seeking “additional findings” testing.

Additional findings testing looks for variants in patients’ genes that aren’t relevant to their current health, but may be later on. For example, it can reveal if someone has an above-average chance of developing a hereditary heart condition.

But these tests can have major implications for patients and their families. Thus, individuals deciding whether they want such a test need support — which Edna can provide.

This chatbot was developed by us and our colleagues at the CSIRO and other members of the Melbourne Genomics Health Alliance.

Genomic and genetic testing

A range of medical conditions have underlying genetic causes. Historically, this has been tested with genetic testing, by looking at either a single gene or a panel of genes related to one particular condition.

In genomic testing, however, almost all the genes in a patient’s DNA are analysed using a biological sample (such as blood).

In Australia, genomic testing is done for patients with certain medical conditions, to provide more information about the condition and medical care required.

But genomic data can be analysed further in an additional findings test, to report on potential gene variants responsible for other preventable and/or treatable conditions.

Although available in the United States, additional findings tests are currently beyond immediate medical need in Australia and are only carried out in research settings. That said, conversations have started about them becoming mainstream here, too.

If additional findings tests were offered in Australia, genetic counsellors would have to spend a large proportion of their time helping patients decide whether they want one. This is where chatbots come in.

Edna the chatbot in training

For chatbots to accurately recognise human speech and provide a meaningful response, their “brain” needs to draw on a large body of data.

Many chatbot brains are developed from open source data, but this is inadequate for highly specialised fields. We developed Edna by analysing transcripts of actual counselling sessions that discussed additional findings analysis.

Edna can emulate the flow of a real patient-counsellor session, explaining various conditions, terms, concepts and the key factors patients should consider when making their decision.

For example, it prompts them to consider the personal and familial implications of undergoing an additional findings analysis. As we all share genes with our family, results from genomic testing can lead to serious conversations.

Edna’s database contains myriad details of medical conditions and terminology.

Edna has several other capabilities, such as:

  • knowing when to connect a patient with a genetic counsellor, if needed

  • providing general information covered in most genetic counselling sessions, allowing counsellors more time to focus on patients with complex needs

  • collecting a patient’s family history

  • detecting various forms of common language, such as “nan” instead of “grandmother” and “heart attack” instead of “myocardial infarct” (the medical term for heart attack)

  • recognising certain temporal markers. For instance, if a patient says “my mother died around Anzac Day two years ago”, Edna will know their mother died around April 25, 2018.

Edna asks about the medical conditions of a patient’s family members.

Edna is currently undergoing a feasibility trial with patients who have already had additional findings analysis done in a research setting, as well as genetic counsellors and students.




Read more:
Aristotle and the chatbot: how ancient rules of logic could make artificial intelligence more human


The Eliza Effect and other hurdles

Past research has suggested people prefer chatbots that interact with empathy and sympathy, rather than unemotionally giving advice. This is called the “Eliza effect” — named after the first ever chatbot. Eliza was able to elicit an emotional response from humans.

Edna is quite advanced on this front. It can detect negative sentiment and even some forms of sarcasm. Still, this isn’t the same as true empathy.

Chatbots can’t yet match genetic counsellors’ ability to detect and respond to emotional cues. And “sentiment analysis” remains a significant challenge in natural language processing.

Edna can identify when a user likely needs to be connected to a real counsellor.

Since Edna provides generic information, it can’t discuss the implications of a future or previous genomic test for a specific patient. It also can’t link the patient with a support group, or provide expert medical advice.

Still, Edna represents a significant move towards a digital health solution that could take some pressure off genetic counsellors.




Read more:
The future of chatbots is more than just small-talk


Providing more genomic healthcare

Edna’s main advantage is accessibility. It can support people living remotely, or who are otherwise unable to attend face-to-face genetic counselling.

It can also be accessed at a patient’s home, where family members may be present. They can then share in the information provided and engage Edna themselves, potentially improving the chances of an accurate history capture.

As a digital interface, Edna is almost endlessly modifiable. It can be updated continuously with data compiled during interactions with patients — whether this be information on new topics, or a new way to respond to a question.

A larger-scale patient trial is planned for the near future.The Conversation

David Ireland, Senior Research Scientist at the Australian E-Health Research Centre., CSIRO; Clara Gaff, Executive Director, Melbourne Genomics Health Alliance, Walter and Eliza Hall Institute, and Dana Kai Bradford, Principal Research Scientist, Australian eHealth Research Centre, CSIRO

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

Are the kids alright? Social isolation can take a toll, but play can help



Shutterstock

Pasi Sahlberg, UNSW and Sharon Goldfeld, Murdoch Children’s Research Institute

Many parents are worried the disruptions of COVID lockdowns and school closures may affect their children’s mental health and development.

In the Royal Children’s Hospital’s National Child Health Poll in June 2020, more than one-third of parents reported the pandemic has had negative consequences on their children’s mental health. Almost half of parents said the pandemic had also been harmful to their own mental health.

Many parents spent at least some months this year supporting their children to learn from home (and still are, in Victoria). This already substantial challenge was complicated by children not being able to go out and play with other children. In Victoria, such restrictions are still in place, although some have been relaxed and playgrounds are open.

Still, it’s fair to say that across the country, some children are not socially engaging with their peers in the same way they did before. This is not only detrimental to children’s learning but also their physical and mental health. It is understandable if parents are worried.

What social isolation means for kids

In June 2020, in the context of COVID-19, a group of researchers in the UK reviewed 80 studies to find how social isolation and loneliness could impact the mental health of previously healthy children. They found social isolation increased the risk of depression and possibly anxiety, and these effects could last several years.




Read more:
How to help young children regulate their emotions and behaviours during the pandemic


The review also concluded loneliness puts children’s well-being at risk of these things long after the social isolation period is over.

The impact of social isolation may be particularly significant for children with special educational needs, when support provided at school to them is interrupted.

Other children – perhaps those living in medium and high-density housing with limited access to outdoor play space – may also be particularly vulnerable to the effects of social isolation.

Father and son racing a toy train on a track.
Playing with your kids can help them feel less lonely.
Shutterstock

Some parents with only one child have also voiced concerns about loneliness.

It is difficult to substitute what real human interaction with peers means to a child. Active engagement in creative play alone or physical activity with parents can be helpful for children who miss the company of their friends.

The power of play

What could possibly fix this situation? The answer is: help children play.

The benefits of regular play are many and they are well documented in research. Paediatricians say play improves children’s language skills, early maths knowledge, peer relations, social and physical development and learning how to get new skills.

When children can’t play for any reason, anxiety and toxic stress can harm the healthy development of social behaviours.




Read more:
Let them play! Kids need freedom from play restrictions to develop


During the pandemic, play can be an effective tonic for stress and can encourage the development of positive behaviours.

When children play together, play effects become even more powerful. Experts say social play can help children develop skills in cooperation, communication, negotiation, conflict resolution and empathy.

In social play, children can rehearse and role play real-world situations safely. Through play, they make sense of the world and process change. Parents playing with their children help children play better with their peers.

Group of kids playing
When children play together, the benefits of normal play are enhanced.
Shutterstock

Now is the time to stress the importance of play. A survey done by the Gonski Institute in 2019 showed four out of five Australians believe today’s children are under pressure to grow up too quickly. More than 70% think the lifelong benefits children gained from play, such as creativity and empathy, are mostly ignored today.

Research from previous pandemics shows we need well-planned and coordinated solutions to potentially long-term emotional issues. We can embrace the role of play to mitigate the losses children have experienced while living through a pandemic.

What can parents do?

Children need both guided indoor play and free play ourdoors. Playing with family members at home, or with friends at school, are good for social play.

Digital devices can provide children a way to play together with their friends when they can’t meet with them. But the benefits of play are more long-lasting through social play in person.

Parks, green spaces and quiet streets are suitable for outdoor play. Natural environments both soothe and stimulate children, while connecting them to their environment and community. So here are four things you can do to encourage play.

1. Make time for play

The most important thing you can do is to make time every day for your children to play. Take play time seriously and show your children you value it for the benefit of their well-being, health and learning.

2. Set clear guidelines to technology use at home

It is important to talk with your children about safe and responsible use of digital media and technology. This may require agreeing to put some limits to the use of screens at home, and encourage children to actively engage with friends by playing interactive games when using digital devices.




Read more:
Child’s play in the time of COVID: screen games are still ‘real’ play


3. Go out whenever possible

A recent review of nearly 200 studies found “green time” — time in parks, nature reserves and woods — appeared to be associated with favourable psychological outcomes, while high levels of screen time appeared to be associated with unfavourable psychological outcomes.

Parks and playgrounds are open now in Victoria, while in other states they have been for some time.

So find fun outdoor exploratory activities for your children, and where possible bring other kids along.

4. Be a role model of all of the above

Children often mimic their parents. The best way to ensure children grow up healthy and happy is to be a role model to them. More play, and enough quality time outdoors with children is good for your own health and happiness, too.


For more see the Raising Children Network and the Gonski Institute.The Conversation

Pasi Sahlberg, Professor of Education Policy, UNSW and Sharon Goldfeld, Director, Center for Community Child Health Royal Children’s Hospital; Professor, Department of Paediatrics, University of Melbourne; Theme Director Population Health, Murdoch Children’s Research Institute

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

Exposure to common colds might give some people a head start in fighting COVID-19



Shutterstock

Larisa Labzin, The University of Queensland and Stefan Emming, The University of Queensland

Could we have some immunity to SARS-CoV-2, the virus that causes COVID-19, without ever having been exposed to it?

Some new studies found people who were never symptomatic, exposed to, or tested positive for COVID-19 have immune cells that can recognise and possibly kill virus-infected cells.

How is this possible? And what does it mean for our fight against COVID-19?

Many common colds are coronaviruses

There are seven known coronaviruses that can infect humans. Three can cause severe respiratory symptoms: SARS-CoV-2, SARS-CoV-1 (which caused the 2002-04 SARS outbreak), and MERS-CoV (which was first identified in 2012).

The other four cause relatively mild colds, and are known as the common cold coronaviruses. It’s hard to find an exact figure, but one estimate suggests up to 30% of all common colds are caused by these coronaviruses, and up to 90% of us will have some antibodies against them in our blood. Like the other viruses that cause common colds (such as rhinoviruses), they show a strong seasonality, with a wave of coronavirus infections each winter.

Immunity to these common cold coronaviruses is not very long–lasting, so we get re-infected with them all the time. We don’t know yet if our immunity to SARS-CoV-2 will also wane over time, and whether that means we could get re-infected.

A TEM image of cells under the microscope of a coronavirus disease that infects birds
Coronaviruses are a family of RNA viruses that infect humans and other animals. They are named after their crown-like spikes, derived from ‘corona’ in Latin which means ‘crown’.
CDC/Unsplash



Read more:
Immunity to COVID-19 may not last. This threatens a vaccine and herd immunity


What did new studies find?

What these new studies did was expose some people’s blood to SARS-CoV-2. These blood samples were taken specifically from “healthy donors” – people who have never been confirmed to have coronavirus, or from whom blood was collected years before SARS-CoV-2 emerged.

Depending on the study, between 20 and 50% of these people were found to have immune cells (called T cells) that could recognise SARS-CoV-2. This is unexpected, as usually specific T cells are only present after infection with the virus.

There are two possible explanations. Either those “healthy donors” were mildly infected with SARS-CoV-2 and didn’t show symptoms or develop antibodies, but they did develop a T cell response. Or, in the case of samples taken before the disease emerged, it means these T cells can recognise multiple coronaviruses, including common colds and SARS-CoV-2.

More than just antibodies

When we get infected with a virus like SARS-CoV-2, our immune system responds in a range of ways. It generates antibodies, which can neutralise the virus to stop it entering our cells. These antibodies are specific to the virus, and thus can be used to test whether we’ve had the virus before.

But besides antibodies, we have a host of other immune weapons in our arsenal for fighting off viruses.

T cells are specialised immune cells that have lots of functions (including helping us make antibodies) but are best known for being able to recognise and kill virus-infected cells. This is really important, because if the virus has evaded antibodies and managed to get into the cells, it can start replicating. Eliminating the infected cell is one of the most efficient ways to stop the infection.

A human T cell
T cells can recognise fragments of virus across different coronaviruses, which could help our body fight COVID-19 infection.
NIAID/Wikimedia Commons



Read more:
Antibody tests: to get a grip on coronavirus, we need to know who’s already had it


T cells are master detectives

How do T cells know which of our body’s cells are infected with a virus? Because they can recognise small but specific snippets of viral proteins that our cells “present” on their surface. These viral snippets on the infected cell surface act like a beacon for the T cells to recognise and eliminate the virus-infected cells. Like antibodies, after the infection is cleared, we keep some of those T cells around in case we get reinfected with the same virus.

The small bits of virus presented on the infected cell’s surface can come from all parts of the virus, including the ones from inside the virus, which tend to be very similar across the different coronaviruses. That means a T cell that recognises a viral protein fragment from one type of coronavirus could potentially recognise the same fragment of viral protein that comes from a different coronavirus.

For example, if a virus was like a car, the antibody might recognise and bind to the outside, and it would only recognise a certain colour, year, and type of car.

But the T cell could recognise the specific bits, like the engine. So if the same engine was in loads of different cars, even though you might have really different cars, as long as it’s a petrol engine the T cell would recognise it. So it’s possible some of our T cells that were formed during a common cold infection are recognising SARS-CoV-2 and helping our immune system have a headstart for fighting SARS-CoV-2.

So these T cells can be cross protective — they work against different coronaviruses — and they can be very longlasting. In patients who recovered from SARS-CoV-1, specific T cells were still detectable up to 11 years later. This T cell memory could protect us from developing severe COVID-19, and could possibly explain why some people get so sick with COVID-19 while other people do not.

It’s not all rosy

While T cells represent another measure of whether people have been infected or not, we can’t use them as a quick diagnostic tool because detecting virus-specific T cells is far more slow, laborious and difficult than detecting antibodies.

We also don’t know yet what this pre-existing T cell immunity means for immune protection. We don’t even know whether the specific T cells generated during SARS-CoV-2 infection will be enough to protect us from COVID-19, and how important they are compared with the antibody responses.

Therefore, the most successful vaccines will likely induce both protective antibody and T cell responses to SARS-CoV-2.




Read more:
Vaccine progress report: the projects bidding to win the race for a COVID-19 vaccine


The Conversation


Larisa Labzin, Research Fellow, Institute for Molecular Bioscience, The University of Queensland and Stefan Emming, Postdoctoral Research Fellow, Institute for Molecular Bioscience, The University of Queensland

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

Multiple sclerosis drug may help treat COVID-19 and lead to faster recovery



Vadim Zakharishchev/Shutterstock

Nial Wheate, University of Sydney and Elise Schubert, University of Sydney

What do multiple sclerosis (MS) and the novel coronavirus have in common? Until this week, not much, but a recent clinical trial has shown a reformulation of a drug used to treat MS can potentially also be used to help patients infected with COVID-19.

SNG001 is an inhaled form of a drug called interferon-beta under development by the UK pharmaceutical company Synairgen. Interferon is normally prescribed for the treatment of symptoms relating to relapsing-remitting MS.

But the clinical trial, Synairgen found that when SNG001 was given to patients with COVID-19, it stopped the development of more severe symptoms, accelerated their recovery, and allowed them to leave hospital earlier.




Read more:
Vaccine progress report: the projects bidding to win the race for a COVID-19 vaccine


Like other clinical trials for COVID-19 treatments, the results still need to be thoroughly checked before SNG001 is included as a standard treatment for coronavirus. The drug’s key risks (potential for severe depression) also need to be weighed against the potential benefits.

How does it work?

MS is a condition of the central nervous system. The nerve impulses between the brain and spinal cord get blocked or mixed up. It happens because the body’s immune system attacks the protective layers around nerve fibres. The result is a loss of muscle control and balance.

In contrast, COVID-19 is a viral infection that affects a patient’s ability to breathe due to inflammation putting pressure on their lungs.

What both diseases have in common is the activation of the body’s immune response, so a drug that modulates the immune system for one can potentially work for the other.

Interferon-beta (interferon), a naturally occurring protein in the body, is used as an immunotherapy drug to combat relapsing-remitting MS by reducing inflammation and easing the symptoms of the disease.

Scientists at Synairgen hypothesised it could also treat COVID-19 through initiating the body’s antiviral response and potentially reducing inflammation on the lungs.

It is believed some at-risk patient groups cannot produce interferon as effectively as other people, reducing their ability to fight the virus and resulting in more severe symptoms.

So giving those patients interferon, in theory, should help them fight the virus, alleviate their symptoms, and improve survival rates.

Take a breath

For the treatment of MS, interferon is given as a weekly injection into muscle tissue.

The SNG001 drug developed by Synairgen contains the same interferon therapy used for MS, but formulated as an inhaled product.

Originally, the company was developing SNG001 as a treatment for a different type of lung condition called chronic obstructive pulomary diease (COPD), but it saw the direct potential for COVID-19 as well.

Instead of an injection, SNG001 is given to patients via a nebuliser, a machine that transforms a water solution of interferon into a fine mist that can be breathed in by patients through a face mask.

Promising results, so far

Between March and May this year, Synairgen sponsored a clinical trial at University Hospital Southampton to test SNG001 for COVID-19 patients. Those eligible for the trial only needed to have mild symptoms of COVID-19.

Other clinical trials conducted in the past for different drugs, such as remdesivir and dexamethasone, required patients to be hospitalised before they were eligible for drug treatment.

In total, 101 patients in a hospital setting were enrolled in the SNG001 trial and were given the drug daily for 14 days. Compared with a placebo, those given SNG001 had a 79% lower risk of developing severe disease.

Patients given the drug were also twice as likely to recover from their infection and were discharged earlier from hospital than those given the placebo.

Before SNG001 becomes standard care for COVID-19 treatment the results of the clinical trial need to be checked by independent scientists.

In the past, trial results for hydroxychloroquine did not stand up to scrutiny after they were announced and the results were subsequently retracted by the research team.

The risks and benefits

If the latest results are shown to be reliable, before doctors decide to make SNG001 a part of the standard treatment for hospitalised COVID-19 patients they will need to weigh its benefits against the potential risks.

One of the most important side effects of the drugs is that it can induce depression.

As a result, interferon is used with caution in patients with pre-existing depression or who have suicidal thoughts. These conditions may already be heightened by the pandemic if a potential patient for the drug has lost their job or they are not dealing well with the isolation of social distancing.

This means doctors would need to undertake a comprehensive mental health screen of all patients they consider for SNG001 treatment.




Read more:
Immunity to COVID-19 may not last. This threatens a vaccine and herd immunity


Other side effects relevant to interferon are that it can worsen seizure disorders or heart failures. So again, it needs to be used with caution in these patient groups.

The results of the SNG001 trial are very promising and potentially give us a treatment to prevent those people mildly infected with COVID-19 from developing more severe symptoms and needing hospitalisation.

But the results need to be checked by independent scientists first, and the drug’s benefits need to be weighed against its risk, as the ability to induce severe depression could cause a wave of mental health problems that make matters worse rather than better.The Conversation

Nial Wheate, Associate Professor | Program Director, Undergraduate Pharmacy, University of Sydney and Elise Schubert, Pharmacist and PhD Candidate, University of Sydney

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

7 tips to help kids feeling anxious about going back to school


Veja/Shutterstock

Mandie Shean, Edith Cowan University

As COVID-19 lockdown measures are lifted, some children may experience social anxiety about the prospect of returning to school.

People with social anxiety may fear embarrassment or the expectation to perform in social situations, or worry exceedingly about people judging you poorly.

In certain situations, people with anxiety may find their heart beats quicker as adrenalin is released into their blood stream, more oxygen flows to the blood and brain, and even digestion may slow down.




Read more:
Don’t want to send the kids back to school? Why not try unschooling at home?


These are helpful responses if you need to run away or fight danger. But social situations are generally not life threatening, and these physical symptoms can interfere with socialising.

People with social anxiety may fear looking silly, being judged, laughed at or being the focus of attention. For anyone, such experiences might be unwelcome but for those with social anxiety they pose an unacceptable threat.

Social anxiety in Australian children

One Australian report found that about 6.9% of children and adolescents surveyed have a diagnosed anxiety disorder, 4.3% experience separation anxiety and 2.3% a social phobia.

Social phobia (social anxiety) is more common in adolescents, whereas separation anxiety (intense anxiety over leaving caregivers, such as parents) is more prevalent in children.

These figures only account for those who have a diagnosis of anxiety. They do not include undiagnosed young people who experience high stress in social situations.

Not all children will be happy to be back in school.
Tom Wang/Shutterstock

Any recent prolonged absence from school may have increased social anxiety, as avoiding what you fear can make your fear become greater.

This is because you do not get to learn that the thing you fear is actually safe. Your beliefs about the threat go unchallenged.

Anxiety can also increase through what pyschologists call reduced tolerance. The more children withdraw from the situations that cause them fear, the less tolerance they have for those situations.

Anxiety can affect education

The educational cost for students with anxiety is considerable.

The research shows students with poor mental health can be between seven to 11 months behind in Year 3, and 1.5 – 2.8 years behind by Year 9.




Read more:
5 reasons it’s safe for kids to go back to school


That’s because these students experience more absences from school, poorer connection to school, lower levels of belonging and less engagement with schoolwork.

7 strategies to help overcome social anxiety

So what can children do to overcome anxiety as they return to school? Here are some useful tips.

  1. deal with some of the physical symptoms. It is hard to think if your body is stressed. Use calming strategies like mindfulness or breathing exercises. Slowing your breathing can reduce symptoms of anxiety, depression, anger and confusion. Useful apps to help you control your breathing include Smiling Mind (iOS and Android) or Breathing Bubbles (Android only).

  2. anxiety increases while using avoidance techniques such as avoiding eye contact, not raising your hand to answer a question, or not attending school. So the most effective way to deal with social anxiety might be to face it. Allow your child to have small experiences of social success – give their opinion to one person, start a conversation with someone they know – so they can learn to feel safe in these social situations.

  3. fear and anxiety are normal and benefit us by helping us to respond efficiently to danger. Rather than read your body as under threat, think about the changes as helpful. Your body is preparing you for action.

  4. while avoiding your fears is not the answer, being fully exposed to them is not the answer either. Providing overwhelming social experiences may lead to overwhelming fear and failure, and may make anxiety sufferers less likely to try again – or at all. Start small and build their courage.

  5. supportive listening and counselling are less effective than facing your fears because these approaches can accommodate the fears. While you want to support your child by providing them with comfort and encouragement – ensure you also encourage them to face the fears that cause the anxiety.

  6. you cannot promise negative things won’t happen. It is possible you will be embarrassed or be judged. Rather than try to avoid these events, try reframing them. Remember that that we all experience negative social feedback, and this does not make you silly or of less value. It makes you normal. Or, rather than see it as embarrassing, maybe it can be funny.

  7. remember it is the “perception” that something is a threat – not the reality. Reasoning with your child to help them see your perspective may not change theirs. This reality only changes with positive real experiences.

Breathing Bubbles in action.

What we think is truth is often revealed as untrue when we face our fears. There is joy in social situations. Keep turning up to them.




Read more:
How not to fall for coronavirus BS: avoid the 7 deadly sins of thought


The Conversation


Mandie Shean, Lecturer, School of Education, Edith Cowan University

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

5 ways nutrition could help your immune system fight off the coronavirus



Shutterstock

Clare Collins, University of Newcastle

The coronavirus presents many uncertainties, and none of us can completely eliminate our risk of getting COVID-19. But one thing we can do is eat as healthily as possible.

If we do catch COVID-19, our immune system is responsible for fighting it. Research shows improving nutrition helps support optimal immune function.

Micronutrients essential to fight infection include vitamins A, B, C, D, and E, and the minerals iron, selenium, and zinc.

Here’s what we know about how these nutrients support our immune system and the foods we can eat to get them.




Read more:
What is a balanced diet anyway?


1. Vitamin A

Vitamin A maintains the structure of the cells in the skin, respiratory tract and gut. This forms a barrier and is your body’s first line of defence. If fighting infection was like a football game, vitamin A would be your forward line.

We also need vitamin A to help make antibodies which neutralise the pathogens that cause infection. This is like assigning more of your team to target an opposition player who has the ball, to prevent them scoring.

Vitamin A is found in oily fish, egg yolks, cheese, tofu, nuts, seeds, whole grains and legumes.

Further, vegetables contain beta-carotene, which your body can convert into vitamin A. Beta-carotene is found in leafy green vegetables and yellow and orange vegetables like pumpkin and carrots.

2. B vitamins

B vitamins, particularly B6, B9 and B12, contribute to your body’s first response once it has recognised a pathogen.

They do this by influencing the production and activity of “natural killer” cells. Natural killer cells work by causing infected cells to “implode”, a process called apoptosis.

At a football match, this role would be like security guards intercepting wayward spectators trying to run onto the field and disrupt play.

Fish is a good source of vitamin B6.
Shutterstock

B6 is found in cereals, legumes, green leafy vegetables, fruit, nuts, fish, chicken and meat.

B9 (folate) is abundant in green leafy vegetables, legumes, nuts and seeds and is added to commercial bread-making flour.

B12 (cyanocobalamin) is found in animal products, including eggs, meat and dairy, and also in fortified soy milk (check the nutrition information panel).

3. Vitamins C and E

When your body is fighting an infection, it experiences what’s called oxidative stress. Oxidative stress leads to the production of free radicals which can pierce cell walls, causing the contents to leak into tissues and exacerbating inflammation.

Vitamin C and vitamin E help protect cells from oxidative stress.




Read more:
Coronavirus: it’s time to debunk claims that vitamin C could cure it


Vitamin C also helps clean up this cellular mess by producing specialised cells to mount an immune response, including neutrophils, lymphocytes and phagocytes.

So the role of vitamin C here is a bit like cleaning up the football ground after the game.

Good sources of vitamin C include oranges, lemons, limes, berries, kiwifruit, broccoli, tomatoes and capsicum.

Vitamin E is found in nuts, green leafy vegetables and vegetables oils.

4. Vitamin D

Some immune cells need vitamin D to help destroy pathogens that cause infection.

Although sun exposure allows the body to produce vitamin D, food sources including eggs, fish and some milks and margarine brands may be fortified with Vitamin D (meaning extra has been added).

Most people need just a few minutes outdoors most days.

People with vitamin D deficiency may need supplements. A review of 25 studies found vitamin D supplements can help protect against acute respiratory infections, particularly among people who are deficient.

5. Iron, zinc, selenium

We need iron, zinc and selenium for immune cell growth, among other functions.

Iron helps kill pathogens by increasing the number of free radicals that can destroy them. It also regulates enzyme reactions essential for immune cells to recognise and target pathogens.

Whole grain foods contain a variety of important nutrients.
Shutterstock

Zinc helps maintain the integrity of the skin and mucous membranes. Zinc and selenium also act as an antioxidant, helping mop up some of the damage caused by oxidative stress.

Iron is found in meat, chicken and fish. Vegetarian sources include legumes, whole grains and iron-fortified breakfast cereals.

Zinc is found in oysters and other seafood, meat, chicken, dried beans and nuts.

Nuts (especially Brazil nuts), meat, cereals and mushrooms are good food sources of selenium.




Read more:
Health Check: should I take vitamin C or other supplements for my cold?


Putting it all together

It’s true some supermarkets are out of certain products at the moment. But as much as possible, focus on eating a variety of foods within each of the basic food groups to boost your intake of vitamins and minerals.

While vitamin and mineral supplements are not recommended for the general population, there are some exceptions.

Pregnant women, some people with chronic health conditions, and people with conditions that mean they can’t eat properly or are on very restrictive diets, may need specific supplements. Talk to your doctor, Accredited Practising Dietitian or pharmacist.




Read more:
Social distancing: What it is and why it’s the best tool we have to fight the coronavirus


And beyond diet, there are other measures you can take to stay as healthy as possible in the face of coronavirus.

Stop smoking to improve your lung’s ability to fight infection, perform moderate intensity exercise like brisk walking, get enough sleep, practise social distancing and wash your hands with soap regularly.The Conversation

Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle

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