Got a child with COVID at home? Here’s how to look after them

Posted on September 8, 2021 by particularkev

Brendan McMullan, UNSW and Philip Britton, University of SydneyThe Delta variant is more infectious and is leading to more COVID-19 cases in children than previous strains.

Many parents are wondering whether Delta is making kids sicker, and how to care for their children if they get COVID.

It can be a nerve-racking time for parents, but there are practical things you can do to make your child more comfortable if they’re ill.

How common is COVID in kids, and how sick do they get?

There have been more than 50,000 confirmed COVID cases in Australia.

Of these, 4,625 cases have been in children aged 0-9, and 6,325 among those aged 10-19 — totalling approximately 20% of all Australian cases.

Symptoms in children are often like those of other viral infections and may include fever, runny nose, sore throat, cough, vomiting, diarrhoea and lethargy.

A small number of children have other symptoms such as tummy pains, chest pain, headache, body aches, breathing difficulties or loss of taste or smell. Up to half of children with COVID may be asymptomatic.

Despite evidence the more-infectious Delta variant is causing more severe illness in young adults, there’s no convincing evidence it has caused more severe illness in children to date.

Most children can be cared for at home. Hospital networks, including children’s hospitals and local networks, are helping parents and carers to support this care at home.

In some cases, children and families may be transferred to special health accommodation to provide safe isolation and care.

How can I best care for my child at home if they get COVID?

Caring for a child with COVID will look similar to the general supportive care for children with other viral infections.

Children should be dressed in appropriate clothing, so they’re comfortable — not sweating or shivering.

Parents and carers should make sure the child drinks lots of fluids. They can also take paracetamol or ibuprofen if they are uncomfortable with pain or fever. These medicines should be administered as directed in the product information or by a health professional.

Warning signs of deterioration include prolonged fever (for more than five days), difficulty breathing or chest pain.

Some children get severe abdominal pain, vomiting and/or diarrhoea. It’s important to encourage these children to frequently drink fluids. It’s a concern if they’re drinking less or passing urine less than half of what they normally would, or if they are excessively sleepy or irritable.

For these or other serious concerns, parents and carers should seek urgent advice from their care team. In an emergency, they should request ambulance assistance, informing the operator the child has COVID.

Don’t some children end up in hospital or intensive care?

Yes, there’s a small risk of severe disease from COVID in children but this is very uncommon, even in children who have medical vulnerabilities.

Children and adolescents can develop inflammatory complications after COVID, though this is rare. Symptoms include persistent fever and rash, among others. These conditions, termed “Multisystem Inflammatory Syndrome in Children (MIS-C)” or “Paediatric Multisystem Inflammatory Syndrome (PIMS-TS)” have been reported mainly in the United States and Europe.

Estimates from the US suggest these occur in around one in 3,000-4,000 cases of COVID in children. There’s only been a handful of cases reported in Australia to date.

Children aged 12-15 in Australia are now eligible for vaccination, and vaccination trials are ongoing for younger children.

Do children get ‘long COVID’?

There has been increasing concern about prolonged symptoms after COVID infection, sometimes called long COVID, even with mild disease.

Fortunately, this is rare in children. In a study of more than 150 children with mild or asymptomatic COVID in Australia, most symptoms resolved in 4-8 weeks and children generally returned to their baseline health within 3-6 months.

What if some people in the home aren’t infected?

The SARS-CoV-2 virus spreads easily from one person to another, particularly in close contact and for those living in the same household as someone who has the virus.

You can reduce the risk of spread by:

keeping more than 1.5m distance where possible
getting the child to use a separate bathroom, if this is available
wearing a mask (for adolescents and older children); younger children and others who cannot wear a mask can be encouraged to observe the other behaviours
covering coughs and sneezes
performing regular hand hygiene with soap and water or hand sanitiser.

Good ventilation is also a factor in reducing transmission, but not everyone can modify this in their living situation.

If someone in the household has COVID, high touch surfaces such as door handles, kitchen bench tops, switches and taps should be regularly cleaned.

Personal household items such as cutlery, dishes and towels should be washed before being shared. Regular household disinfectant is sufficient.

The authors would like to acknowledge Christine Lau, paediatrician, and Nadine Shaw, clinical nurse consultant, Sydney Children’s Hospitals Network, for their contributions to this article.

Brendan McMullan, Conjoint Senior Lecturer, School of Women’s and Children’s Health, UNSW and Philip Britton, Senior lecturer, Child and Adolescent Health, University of Sydney

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

COVID can worsen quickly at home. Here’s when to call an ambulance

Posted on September 6, 2021 by particularkev

David King, The University of QueenslandMost Australians diagnosed with COVID-19 recover at home, rather than in a quarantine facility or hospital. About 10% have required hospital treatment. However, a handful have had worsening symptoms, did not receive emergency care and died at home.

There appear to have been two factors behind such COVID deaths at home: worry about the perceived costs and risks of seeking official health care; and the sudden onset of complications from a worsening infection.

Here’s what to watch out for when symptoms worsen dramatically at home and when to call an ambulance.

What should I look out for?

As a GP I am asked this question often. Patients naturally want guidance on the signs to look out for so they don’t seek help too late or too early. This is called “safety netting”, and is guided by an understanding of the natural history (prognosis) of a disease and its response to treatment. People also seek advice on worrying symptoms to look out for, and specific information on how and when to seek help.

With COVID-19, the natural course of the infection varies. What starts out with cold and flu-like symptoms can lead to breathing difficulties within five days. Not all patients get symptoms that warrant hospital care. But of those who do go to hospital, this generally occurs around 4-8 days after symptoms start.

We know COVID-19 affects the lungs as well as multiple organs, leading them to fail. This includes complications such as pneumonia, liver or kidney failure, heart attacks, stroke, blood clots and nerve damage.

This progress to more severe disease happens as the virus triggers release of inflammatory proteins, called cytokines, flooding the bloodstream and attacking organs.

Some symptoms of these COVID complications include:

shortness of breath
loss of appetite
dizziness
confusion or irritability
persistent pain or pressure in the chest
high temperature (above 38℃).
reduced consciousness (sometimes associated with seizures or strokes)
cold, clammy or pale and mottled skin.

Not everyone feels ‘short of breath’

The main risk factors that predict progression to severe COVID include: symptoms lasting for more than seven days and a breathing rate over 30 per minute. Faster breathing is to compensate for the less-efficient transfer of oxygen to lung blood vessels, due to inflammation and fluid build-up in the airways.

But how diseases progress is rarely straight forward, making it impossible to give definitive lists of “red flag” symptoms to look out for.

Some COVID patients have “happy” or silent hypoxia. This features low levels of oxygen in the blood but there aren’t the usual signs of respiratory distress normally seen with such low oxygen levels, including feeling “short of breath” and faster breathing.

However, these patients can suddenly deteriorate. Faster and deeper breathing are early warning signs of failing lungs.

What to do

If you’ve already been diagnosed with COVID-19 and are concerned about your symptoms, call the phone number you will have been given by your local public health unit, or your health-care provider.

However, for a sudden deterioration, call an ambulance immediately. Tell the operator you have COVID.

If you’re not sure which applies or you can’t get through on the phone for medical advice immediately, call 000 anyway as operators are trained to triage your call.

Being in hospital if you develop severe COVID, with access to the best monitoring and treatments available, will increase your chance of surviving complications of COVID, and recovering well.

However, the likelihood of getting any of these complications if you’re fully vaccinated is very low. So the best way to protect yourself (and never having to think about calling 000 for COVID) is to get vaccinated.

David King, Senior Lecturer in General Practice, The University of Queensland

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

Home quarantine for vaccinated returned travellers is extremely low risk, and won’t damage their mental health

Posted on June 24, 2021 by particularkev

Gregory Dore, UNSWMany thousands of people need to return to Australia, and many at home wish to reunite with partners and family abroad.

A move away from a one-size-fits-all approach to quarantine is a way to make this happen — including home quarantine for vaccinated returnees.

The federal government implemented home quarantine over a short period in March 2020, before switching to mandatory hotel quarantine for returned residents and other incoming passengers.

But the considerably changed circumstances — most importantly, access to effective vaccines — calls for its reintroduction despite caution among politicians and the community.

The low rate of positive cases, and proven effectiveness of further safeguards to limit breaches, make home quarantine a persuasive strategy.

It’s worth remembering people who contract COVID, and their contacts, have successfully self-isolated at home since the pandemic began.

How will we make sure it’s safe?

There are several protective layers which would ensure extremely limited risk of home quarantine for fully vaccinated returned overseas travellers.

The first is requiring a negative COVID test within three days of departure, which is currently a requirement for all returnees.

The second is COVID vaccination. Recent studies indicate full vaccination provides 60-90% infection risk reduction. In cases where fully vaccinated people do get infected, these “breakthrough cases” are less infectious.

It’s also important to test returnees in home quarantine. A positive case would trigger testing of any contacts and may extend self-isolation.

Also, high levels of testing in the broader community can ensure early detection of outbreaks, enabling a rapid public health response to limit spread, if it did leak out of home quarantine.

The risk would be extremely low

Data from hotel quarantine in New South Wales, which takes around half of returned travellers in Australia, suggests home quarantine for fully vaccinated returnees would likely present an extremely low risk.

In 2021, NSW has screened around 4,700 returnees a week, with the proportion of positive cases detected during quarantine averaging around 0.6%.

From March 1, since vaccination has become more accessible, only eight of 406 positive cases were fully vaccinated.

Unfortunately we don’t have the overall data on how many returnees were fully vaccinated, but even if only 10-20%, this would equate to a positive rate of around 6-12 per 10,000 among the vaccinated. This is considerably lower than the overall rate of 66 COVID cases per 10,000 since March 1.

If home quarantine was initially restricted to fully vaccinated returnees from countries with low to moderate caseloads, the rate would be lower again, probably less than five per 10,000.

If NSW increased their quarantine intake by taking an extra 2,500 per week from this population into home quarantine, it would equate to maybe a few positive cases per month, compared to around 120 cases per month in hotel quarantine. As vaccination uptake increases, this capacity could be expanded, with reduced hotel quarantine requirements.

Will people comply?

The enormous desire for stranded Australian residents, overseas partners and family of residents in Australia to return and reunite should ensure a high level of compliance with home quarantine.

Home quarantine has been successfully implemented in other countries with elimination strategies such as Taiwan and Singapore. Taiwan’s system was deployed rapidly and has 99.7% compliance. Singapore uses a grading system to enable lower-risk returnee residents to do seven days in home quarantine, with a negative test required for release on day seven.

Two major reviews of the hotel quarantine system — the Victorian government-commissioned Coate report, and the national review of hotel quarantine — recommended implementing home quarantine with monitoring technology, such as electronic bracelets. Their recommendations were made prior to the approval of vaccines.

Recent data suggests the current hotel quarantine system has harmful effects. Research published in the Medical Journal of Australia in April found mental health issues were responsible for 19% of all emergency department presentations among people in NSW hotel quarantine. It’s highly likely home quarantine would be more beneficial for the mental health of returnees.

What are the barriers?

Issues which would need to be sorted through include:

methods for determining how risky different countries are
how returnees can prove they’ve been vaccinated
how we would test returnees and home-based contacts, and how frequently
and how long home quarantine would be for.

But none of these are insurmountable, and small-scale home quarantine already exists in the ACT.

Health authorities could ensure returnees can collect their own COVID testing samples, for example by doing nasal swabs or collecting saliva themselves. This would reduce contact with health workers.

Home quarantine is undoubtedly being considered by major Australian COVID policy committees, along with other measures to enable a larger number of returnees and to increase the safety of the quarantine system.

Australians’ excessive caution continues to have direct consequences for the well-being of many thousands of stranded Australian residents, together with non-resident partners and family members desperate to return.

It’s time to change this situation and make their human rights a public health priority.

The author would like to thank John Kaldor, Esther Rockett, and Liz Hicks for their input.

Gregory Dore, Scientia Professor, Kirby Institute; Infectious Diseases Physician, St Vincent’s Hospital, Sydney, UNSW

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

As boundaries between work and home vanish, employees need a ‘right to disconnect’

Posted on May 2, 2021 by particularkev

Barbara Pocock, University of South AustraliaIf you have been in a children’s playground recently, you may have seen a distracted parent absorbed in an intense phone conversation, swatting a child away.

Sure, some are ordering tickets for The Wiggles, but most are not — they are working. They might have officially knocked off, be on leave or it might be a weekend. But as surely as if they were in the office, they are at work.

Many of us know that tug of double consciousness: the child’s pressing need pitted against a complex issue on the other end of the phone demanding every neurone we can muster.

You do not have to be a carer to feel this tug. It still finds plenty of people who just want some quiet time, an uninterrupted run, a life beyond work.

It’s the growth of this tug, affecting more and more women and men, which has fuelled the push for a “right to disconnect” from work. This includes a recent significant victory for Victoria Police employees to protect their time away from work.

Availability creep

Our forebears would not recognise the ephemeral way we work today, or the absence of boundaries around it. But powerful new technologies have disrupted last century’s clearer, more stable, predictable limits on the time and place of work.

This is called “availability creep”, where employees feel they need to be available all the time to answer emails, calls or simply deal with their workload.

Sydney CBD skyline with headlights on the freeway. — Australians did even more unpaid overtime during COVID than before the pandemic.
Mick Tsikas/AAP

And that was well before a pandemic that piled revolution upon revolution on the way we work. A 2020 mid-pandemic survey showed Australians were working 5.3 hours of unpaid overtime on average per week, up from 4.6 hours the year before.

These longer hours are often associated with job insecurity. In a labour market like Australia’s, where insecure work is widespread, there are strong incentives to “stay sweet” with the boss and work longer, harder and sometimes for nothing.

Health implications

So, work is now untethered from a workplace or a workday, and our workplace regulation lags well behind. This has serious implications for our mental health, work-life stress, productivity and a fair day’s work for a fair day’s pay.

Of course, flexibility is not all bad. As a researcher collecting evidence for decades about the case for greater flexibility for employees, I see silver linings in a pandemic that achieved almost overnight what decades of data-gathering could not: new ways of working that can suit workers (especially women) and their households.

However, this change has a dark side. Digital work and work-from-home have shown themselves to drive long hours of work, and to pollute rest and family time. Poor sleep, stress, burnout, degraded relationships and distracted carers are part of the collateral damage.

Disconnecting in Australia and internationally

A growing international response attests to the importance of disconnection. And it has now reached our shores.

Last month, Victoria Police’s new Enterprise Bargaining Agreement (EBA) included the “right to disconnect” from work. It directs managers to respect leave and rest days and avoid contacting police officers outside work hours, unless in an emergency or to check on their welfare. The goal is to ensure that police, whose jobs are often stressful, can switch off from work when they knock off and get decent rest and recovery time.

Swimmers at Bondi Beach pool. — There is a growing push to protect employees’ time outside work hours.
Bianca De Marchi/AAP

The “right to disconnect” has taken several forms internationally in recent decades. At individual firm level, some large companies such as Volkswagen, BMW and Daimler now simply stop out-of-hours or holiday emails or calls.

Goldman Sachs has also recently re-stated its far from radical “Saturday rule”, under which junior bankers are not expected to be in the office from 9pm Friday to 9am Sunday.

The French example

Some countries now regulate the right nationally.

Since 2017, French companies employing more than 50 people have been required to engage in an annual negotiation with employee representatives to regulate digital devices to ensure respect for rest, personal life and family leave. If they can’t reach agreement, the employer must draw up a charter to define how employees can disconnect and must train and inform their workers about these strategies.

While enforcement of the French law has attracted criticism (as penalties are weak), it has fostered a national conversation —now reaching other countries like Greece, Spain and Ireland. In early 2021, the European Parliament voted to grant workers the right to refrain from email and calls outside working hours, including when on holidays or leave, as well as protection from adverse actions against those who disconnect.

What’s next for Australia?

The Victoria Police EBA has encouraged a new level of discussion in Australia. The ACTU has backed a right to disconnect, especially for workers in stressful jobs.

Individual businesses will now be examining their obligations to ensure maximum hours of work are adhered to and “reasonable” overtime and on-call work is managed to avoid possible claims for unpaid work.

This week, The Sydney Morning Herald reported that supermarket giant Coles is trying to prevent out-of-hours work.

The consequences for companies can be expensive when digital work is not well managed. In 2018, the French arm of Rentokil was ordered to pay an ex-employee the equivalent of $A92,000 because it required him to leave his phone on to talk to customers and staff.

Beyond fair remuneration, a duty of care to provide a safe and healthy workplace is also implicated in digital work that leaks beyond working hours.

What needs to happen now

Large public sector workplaces are likely to follow Victoria Police’s example. However, EBAs now cover just 15% of workers, so this pathway won’t help most workers, many of whom are instead covered by one of the 100 or so industry or occupational modern awards.

These awards could be amended to include a right to disconnect. But more simply and comprehensively, the National Employment Standards (which apply to all workers regardless of whether covered by an award or an EBA) could be amended to provide an enforceable right to disconnect with consequences for its breach, alongside existing standards of maximum hours of work, flexibility and other minimum rights.

Given many women, low paid, private sector, un-unionised and relatively powerless workers in smaller workplaces have little chance of negotiating or enforcing a right to disconnect, it is vital the right to disconnect applies across the whole workforce.

Barbara Pocock, Emeritus Professor University of South Australia, University of South Australia

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

What matters is the home: review finds most retirees well off, some very badly off

Posted on November 23, 2020 by particularkev

Helen Hodgson, Curtin University

The government’s Retirement Incomes Review paints an encouraging picture of the finances of retired Australians.

Most are at least as well off in retirement as they were while working, and most are more financially satisfied and less financially-stressed than Australians of working age.

But not all. The huge exception is retirees who do not own their own homes.

Whereas very few retired home owners are in poverty, most retired renters are.

Income poverty rates of retirees

Note: Data relates to 2017-18 financial year. Elevated poverty rate defined as 5 percentage points above retiree average.Retirees are where household reference person is aged 65 and over. There is overlap between some categories, for example, early retired and renter categories. Early retired means aged 55-64 and not in the labour force. Housing costs includes the value of both principal and interest components of mortgage repayments.
Source: Analysis of ABS Survey of Income and Housing Confidentialised Unit Record File, 2017-18

So bad is the divide, the review found that even a 40% increase in Commonwealth Rent Assistance (the payment for pensioners) would reduce financial stress among renters by only 1%.

This is because rent assistance is low, covering only about 13% of the cost of renting.

Retirees who own their own homes don’t have to pay rent (and can still get the pension should their wealth be tied up in their home), and have a source of wealth that usually eclipses both their own superannuation and the wealth of renters.

Equivalised household wealth by asset type for retirees

Note: Retirees are defined as households where the reference person is aged 65 or older and is no longer in the labour force. Household wealth has been equivalised using the OECD equivalence scale in order to take account of differences in a household’s size and composition. Values in 2017-18 dollars.
ABS, Retirement Incomes Review

Most people do not regard their home as a retirement asset, a view compounded by rules that exempt it from taxes and the pension assets test.

They are also reluctant to borrow against the value of their home using facilities such as the Pension Loans Scheme, for the same reasons they are reluctant to touch any of the wealth they retire with.

Data provided to the review by a large super fund shows its members typically die with 90% of what they had at retirement.

Most retirees don’t use what they’ve got

Another study finds age pensioners die with about 90% of what they had on retirement.

Partly the reasons are psychological. The review says words such as “investments”, “savings” and “nest eggs” imply the assets aren’t for living on.

Before compulsory super, employer-sponsored schemes usually paid “defined” benefits that could be measured in terms of income per year.

In the new system, designed to break the connection between workers and specific employers, benefits were “accumulated” in funds that could most easily be measured by the amount in them.

It is difficult for most people to see how a lump sum converts into income stream, and even more difficult when it depends on the interaction with the pension.

Another reason retirees hang on to what they had on retirement might be a genuine (if misplaced) concern about the unexpected.

In fact, health and aged care costs are heavily subsidised. Most people’s spending on them doesn’t increase significantly throughout retirement, yet many people seem unaware of how little of their own funds they will need.

Partly this is because of the complexity of the aged care and health care systems and how poorly they are explained.

It’s created two systems

Providing help to retirees who actually need it (mainly renters, many of them single women) and getting people with assets in the form of superannuation, savings and housing to actually use them rather than pass them on in bequests are the two key challenges identified in the report.

They are problems that boosting the rate of compulsory super contributions (as pushed for by the funds and presently leglislated) won’t help with.

They are set to become worse.

Although home ownership rates remain high for people over the age of 65, a growing number of Australians are not entering the housing market.

Over 15 years, the number of Australians over 65 who do not own their home outright is expected to double.

As the amount in super funds grows (boosted by the legislated increase in compulsory contributions, should it take place), Australians with super are going to have even more relative to what they need and even less need to make use of it.

The report makes no recommendations, and doesn’t suggest that the solutions are easy.

Widening the pension asset test to include the home would leave many homeowners worse off and could generate distrust and destabilise the system.

Getting more Australians into home ownership has proved difficult and could never be a solution for all Australians, in any case.

We already have in place rules that require retirees to draw down their super, but often they withdraw the minimum amount permitted and then reinvest much of it in another savings vehicle outside of super.

We’ve created a system where most have enough or more than enough to retire on and others get nothing like enough.

Helen Hodgson, Professor, Curtin Law School and Curtin Business School, Curtin University

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

Strength training is as important as cardio – and you can do it from home during COVID-19

Posted on August 30, 2020 by particularkev

Jason Bennie, University of Southern Queensland; Jane Shakespear-Druery, University of Southern Queensland, and Katrien De Cocker, University of Southern Queensland

We often get bombarded with the message “regular physical activity is the key to good health and well-being”. To most of us, when we hear “physical activity”, we typically think of aerobic exercise such as walking, jogging, and cycling.

But recent evidence suggests muscle-strengthening exercise is very beneficial to our health. In our study, published today, we argue muscle-strengthening exercise deserves to be considered just as important as aerobic exercise.

And the good news is strength training can be done by anyone, anywhere — and you don’t need fancy equipment.

Strength is just as important as cardio

Muscle-strengthening exercise is also known as strength, weight or resistance training, or simply “lifting weights”. It includes the use of weight machines, exercise bands, hand-held weights, or our own body weight (such as push-ups, sit-ups or planking). It’s typically performed at fitness centres and gyms, but can also be done at home.

More than 30 years of clinical research has shown that muscle-strengthening exercise increases muscle mass, strength and bone mineral density. It improves our body’s capacity to clear sugar and fat from the bloodstream, and improves our ability to perform everyday activities such as walking up stairs or getting in and out of a chair. It can also reduce symptoms of depression and anxiety.

In our research, we reviewed the evidence from several large studies and found muscle-strengthening exercise is associated with a reduced risk of early death, diabetes, cardiovascular disease and obesity. Importantly, these health benefits remained evident even after accounting for aerobic exercise and other factors such as age, sex, education, income, body mass index, depression and high blood pressure.

Compared with aerobic exercise like jogging, clinical studies show that muscle-strengthening exercise has greater effects on age-related diseases such as sarcopenia (muscle wasting), cognitive decline and physical function.

This is particularly significant considering we have an ageing population in Australia. Declines in muscle mass and cognitive function are predicted to be among the key 21st-century health challenges.

Most of us don’t even lift — but we should

While the health benefits of muscle-strengthening exercise are clear, the reality is most adults don’t do it, or don’t do it enough. Data from multiple countries show only 10-30% of adults meet the muscle-strengthening exercise guidelines of two or more days per week. Australian adults reported among the lowest levels of strength training in the world.

Our data from more than 1.6 million US adults show nearly twice as many do no muscle-strengthening exercise at all, compared with those who do no aerobic exercise.

The reasons fewer people do strength training than aerobic exercise are complex. In part, it might be because muscle-strengthening exercise has only been included in guidelines for less than a decade, compared with almost 50 years of promoting aerobic exercise. Strength training therefore has been considered by some physical activity and public health scientists as the “forgotten” or “neglected” guideline.

Other factors that may contribute to fewer people doing strength training include the fact it:

involves a basic understanding of specific terminology (sets and repetitions)
often needs access to equipment (resistance bands or barbells)
requires confidence to perform potentially challenging activities (squats, lunges and push-ups)
and risks the fear of judgement or falling foul of social norms (such as a fear of excessive muscle gain, or of getting injured).

Here’s how to get started

Unlike most aerobic exercise, strength training can be done at home. It can also be done without extensive equipment, using our own body weight. This makes it a great form of exercise during the COVID-19 pandemic, when many people are confined to their homes or otherwise restriced in where they can go.

If you are currently doing no muscle-strengthening exercise, getting started, even a little bit, will likely have immediate health benefits. Guidelines recommend exercising all major muscle groups at least twice a week: legs, hips, back, chest, abdomen, shoulders and arms. This could include bodyweight exercises like push-ups, squats or lunges, or using resistance bands or hand-held weights.

Here are some excellent free online resources that provide practical tips on how to start a muscle-strengthening exercise routine:

8 tips for safe and effective strength training (Harvard Medical School)
5 tips to build muscle strength (Harvard Medical School)
Strength training: get stronger, leaner, healthier (Mayo Clinic).

An elderly lady lifting some small weights at home — Muscle-strengthening exercise can be performed by anyone, anywhere. And its health benefits rival, and often exceed, aerobic exercise.
Shutterstock

Governments need to step up

Many people find aerobic exercise difficult, impossible or simply unpleasant. For these people, strength training provides a different way to exercise.

The evidence supporting the health benefits of muscle-strengthening exercise, coupled with its low participation levels, provides a compelling case to promote this type of exercise. But historically, physical activity promotion has generally focused on aerobic exercise.

If governments expect more people to do muscle-strengthening exercise, they need to provide support. One strategy may be to provide affordable access to community fitness centres, home-based equipment and fitness trainers. And media campaigns endorsing muscle-strengthening exercise could also be important for challenging negative stereotypes such as excessive muscle gain. It’s unlikely any of these strategies will be successful individually, so we’ll have to tackle the problem on a few different fronts.

Jason Bennie, Senior Research Fellow, University of Southern Queensland; Jane Shakespear-Druery, Accredited Exercise Physiologist, PhD Candidate, University of Southern Queensland, and Katrien De Cocker, Senior Research Fellow, University of Southern Queensland

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

The ‘hospital in the home’ revolution has been stalled by COVID-19. But it’s still a good idea

Posted on May 18, 2020 by particularkev

Martin Hensher, Deakin University; Bodil Rasmussen, Deakin University, and Maxine Duke, Deakin University

Growing numbers of Australians are choosing to receive their hospital care at home, according to figures published today in the Medical Journal of Australia. In 2017-18, more than half a million days of publicly funded hospital care were delivered at patients’ homes rather than in hospital.

“Hospital in the home” is just what it sounds like – an acute care service that provides care in the home that would otherwise need to be received as an inpatient.

It provides an alternative to hospital admission, or an opportunity for earlier discharge than would otherwise be possible. The research found it is also associated with a lower likelihood of readmission within 28 days (2.3% vs 3.6%) and lower rates of patient deaths (0.3% vs 1.4%), compared with being an inpatient.

While federal government plans to boost hospital in the home have been hampered by COVID-19, home service models may be even more valuable in a post-pandemic world.

A push from government

In November last year, federal health minister Greg Hunt called for a “hospital in the home revolution”.

He told state and territory governments and private health insurers he wanted more care delivered in patients’ homes rather than hospitals, and pledged to make it easier for these services to qualify for funding.

Hunt said his aim was to offer more choice and better clinical outcomes for patients, as well as better efficiency for state and territory health departments and private health funds. He explicitly linked this plan to efforts to curb the spiralling increases in private health insurance premiums, which threaten that industry’s future.

Hospital in the home was on the federal government’s agenda late last year.
Shuttershock

The promised revolution has inevitably been stalled by the COVID-19 pandemic. But the new research provides a timely reminder of the importance and potential of hospital in the home.

How is hospital in the home delivered?

Hospital in the home is already a widespread practice in Australia. Nationwide, more than 595,000 days of hospital in the home care were delivered in 2017-18 for public patients, accounting for more than 5% of acute-care bed days.

Yet in the private sector, fewer than 1% of acute bed days were delivered at home.

In Victoria, hospital in the home services have been funded by the public health system since 1994, and have consistently been affirmed as being safe and appropriate for patients.

Victoria’s hospital in the home program delivered more than 242,000 patient bed days in 2017-18. Monash Health’s hospital in the home service provided care for some 14% of the whole health service’s overnight admissions in June 2019.

There is considerable variation between states and territories, and between individual health services, in how these services are delivered.

Generally, they are staffed by a multidisciplinary mix of nursing, medical and allied health staff. Patients admitted to the program remain under the care of their hospital doctor, and the hospital’s full resources are available to each patient should they need them.

Some of the main activities of hospital in the home include:

administration of intravenous antibiotics for short- and long-term infections
administration of anticoagulants to help prevent blood clots
post-surgical care
complex wound care and management
chemotherapy.

Western Health’s hospital in the home program provides support for people with chronic conditions like heart failure, chronic obstructive pulmonary disease and cancer. Monash Health provides a wide range of care throughout life, from premature babies to aged care.

Why is it a good thing?

For patients, the benefits include increased comfort, less noise, freedom of movement, more palatable food and, crucially, reduced exposure to hospital-acquired infections.

Treating patients in their homes can also improve responsiveness to cultural and socioeconomic needs, and provide support for carers.

Patients and carers alike appreciate the ability to choose an alternative to hospital admission and feel more in control when care is delivered in their own home.

Based on international evidence, it is less clear whether discharging patients early from hospital and treating them at home actually reduces costs. A 2012 meta-analysis suggested it does, but more recent Cochrane reviews concluded the cost benefits are “uncertain”.

Many people prefer to be at home.
Shutterstock

Hospital in the home and COVID-19

Despite having pushed hospital in the home reforms onto the back burner, COVID-19 might paradoxically provide even greater impetus for this type of care model.

In the short term, home treatment can relieve pressure on the acute hospital system. One example is the Victorian government’s support for mental health care delivered to young people via hospital in the home during the pandemic.

Longer term, the rapid boost to telehealth and remote monitoring technology driven by COVID-19 will greatly benefit hospital in the home.

Better integrated and coordinated hospital in the home care can be achieved via an e-enabled care model, supporting self-management activities, remote symptom monitoring, patient reminders and decision support. It’s likely we’ll see far less resistance to these measures following the COVID-19 pandemic.

Patients’ and carers’ perceptions of home hospital care are also likely to have improved as a byproduct of COVID-19, as people avoid visiting hospitals in person if possible. These attitudes may last well beyond the pandemic.

While private health insurers are currently enjoying bumper profits as COVID-19 reduces the amount of member claims, the likely economic downturn in the wake of the pandemic may put insurers and private hospitals under great pressure as members cancel their policies due to unemployment or reduced income. Hospital in the home could prove a useful tool to drive down costs.

Hunt’s promised revolution will require big changes to the regulations that govern private health care, and to insurers’ willingness to demand change from private hospitals. But if we have learned anything from COVID-19, it’s that change can happen fast when it’s really needed.

The authors wish to acknowledge staff at Western Health (Micheal Perrone, Erin Webster, Aneta Lavcanski) and Monash Health (Jennine Harbrow, Helen Richards) for their contribution to this article.

Martin Hensher, Associate Professor of Health Systems Financing & Organisation, Deakin University; Bodil Rasmussen, Professor in Nursing, Deakin University, and Maxine Duke, Emeritus Professor Nursing and Midwifery, Deakin University

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

If more of us work from home after coronavirus we’ll need to rethink city planning

Posted on May 4, 2020 by particularkev

John L Hopkins, Swinburne University of Technology

We have seen an unprecedented rise in the number of people working from home as directed by governments and employers around the world to help stop the spread of COVID-19.

If, as some expect, people are likely to work from home more often after the pandemic, what will this mean for infrastructure planning? Will cities still need all the multibillion-dollar road, public transport, telecommunications and energy projects, including some already in the pipeline?

World’s largest work-from-home experiment

Remote working was steadily on the rise well before COVID-19. But the pandemic suddenly escalated the trend into the “world’s largest work-from-home experiment”. Many people who have had to embrace remote working during the pandemic might not want to return to the office every day once restrictions are lifted.

They might have found some work tasks are actually easier to do at home. Or they (and their employers) might have discovered things that weren’t thought possible to do from home are possible. They might then question why they had to go into the workplace so often in the first place.

But what impact will this have on our cities? After all, many aspects of our cities were designed with commuting, not working from home, in mind.

Stress test for NBN and energy networks

From a telecommunications perspective, the huge increase in people working from home challenges the ways in which our existing networks were designed.

Data from Aussie Broadband show evening peak broadband use has increased 25% during the shutdown. Additional daytime increases are expected due to home schooling with term 2 starting.

Research by the then federal Department of Communications in 2018 estimated the average Australian household would need a maximum download speed of 49Mbps during peak-use times by 2026. If more people work from home after COVID-19, the size and times of peak use might need to be recalculated.

Another factor not modelled by the government research was the potential impact of an increase in uploads. This is a typical requirement for people working from home, as they now send large files via their suburban home networks, rather than their office networks in the city.

Recent research by Octopus Energy in the UK has found domestic energy use patterns have also changed since COVID-19. With more people working from home, domestic energy use in the middle of the day is noticeably higher. Some 30% of customers use an average of 1.5kWh more electricity between 9am and 5pm.

Conversely, data from the US show electricity use in city centres and industrial areas has declined over the same period.

Less commuting means less congestion

Closer to home, new data from HERE Technologies illustrate just how much traffic congestion has eased.

Thursday afternoons from 5-5.15pm are normally the worst time of the week for traffic congestion in Melbourne. Last week the city’s roads recorded the sort of free-flowing traffic usually seen at 9.30am on a Sunday. Just 1.8% of Melbourne’s major roads were congested, a fraction of the usual 19.8% at that time.

All of Australia’s major cities are experiencing similar reductions. Transurban has reported traffic is down 43% on the Melbourne airport toll road, 29% on its Sydney roads and 27% in Queensland.

Passengers are also staying away from public transport in droves. For example, South Australian government statistics for Adelaide show passenger numbers have slumped by 69% for buses, by 74% for trains and by 77% for trams, compared with this time last year.

What does this mean for infrastructure planning?

With these trends in mind, future investment in roads, public transport, energy and telecommunications will need to consider the likelihood of more people working from home.

Prior to COVID-19, Melbourne research found 64% of city workers regularly worked from home, but usually only one day a week, even though 50% of their work could be done anywhere. While the changes we are now seeing are a result of extreme circumstances, it is not inconceivable that, on average, everybody could continue to work from home one extra day per week after the pandemic. Even this would have significant implications for long-term urban planning.

The most recent Australian Census data show 9.2 million people typically commute to work each day. If people worked from home an average of one extra day per week, this would take 1.8 million commuters off the roads and public transport each day.

Many road and public transport projects will be based on forecasts of continuing increases in commuter numbers. If, instead, people work from home more often, this could call into question the need for those projects.

Areas outside city centres would also require more attention, as working from home creates a need for more evenly distributed networks of services for the likes of energy and telecommunications. Interestingly, such a trend could support long-term decentralisation plans, like those outlined in Melbourne’s Metropolitan Planning Strategy. And if such change encourages more people to live away from the big cities, it also could help to make housing more affordable.

John L Hopkins, Innovation Fellow, Swinburne University of Technology

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

Goodbye to the crowded office: how coronavirus will change the way we work together

Posted on May 4, 2020 by particularkev

Rachel Morrison, Auckland University of Technology

As lockdowns are relaxed around the world and people return to their workplaces, the next challenge will be adapting open office spaces to the new normal of strict personal hygiene and physical distancing.

While the merits and disadvantages of open plan and flexible workspaces have long been debated, the risk they posed of allowing dangerous, highly contagious viruses to spread was rarely (if ever) considered.

But co-working spaces are characterised by shared areas and amenities with surfaces that need constant cleaning. Droplets from a single sneeze can travel over 7 metres, and surfaces within pods or booths, designed for privacy, could remain hazardous for days.

Even in countries such as Australia and New Zealand where efforts to “flatten the curve” have been successful and which have relatively easily controlled borders, it’s fair to ask whether communal workspaces might be a thing of the past.

Perhaps – if vigilant measures are in place – some countries can continue to embrace collaborative, flexible, activity-based workplace designs and the cost savings they represent. But this is unlikely to be the case in general in the coming years. Even if some organisations can operate with minimal risk there will be an expectation they provide virus-free workplaces should there be future outbreaks.

Working from home

Worldwide, there will undoubtedly be fewer people in the office – now workers have tried working from home, they may find they like it. And organisations may have little choice but to limit the numbers of workers on-site. Staggered shifts, enforced flexitime, and 24/7 operations may become the norm, along with working remotely.

Video meetings, even within the same workplace, could become the new normal.
from http://www.shutterstock.com

The open plan model has been criticised for everything from lowered productivity, less interpersonal interaction, antisocial behaviour, reduced well-being, too much distraction, a lack of privacy, and making workers feel exposed and monitored.

But it has also been shown to improve cooperation and communication. Whether these innovative spaces are within a large organisation or are communal workspaces where start-ups, freelancers, and contractors can sit together (such as GridAKL in Auckland or The Commons in Sydney), their popularity is undeniable. The sense of community and the ability to share knowledge and ideas are key attractions of co-working.

Riding the shared/flexi-space wave have been companies such as WeWork – popularising communal tables within co-working hubs and providing “pods” for private conversations. But there is now little doubt WeWork will be an early casualty of COVID-19. Already in financial trouble before the pandemic, WeWork will cut more than 1,000 jobs this month.

But what about the thousands of organisations that retooled their densely populated work environments to encourage flexibility, activity-based work, and movement within and between spaces?

James Muir, CEO of sustainability start-up Crunch and Flourish has no doubt using co-working offices in central Auckland has been a positive: “We benefited from the great community at GridAKL,” he says. “And before long we were collaborating with other start-ups on marketing and design as well as getting great advice from more experienced entrepreneurs.”

Shared workspace company WeWork is expected to be another casualty of COVID-19.
from http://www.shutterstock.com

Missing social cues online

Those fortuitous conversations and information exchanges will inevitably become rarer as we avoid the risk of interpersonal contact – and they are almost impossible to mimic online. Personal interaction (even within the office) will be replaced with the already familiar virtual video meeting – or even, as TIME magazine reports, holograms and avatars.

However, communication is more challenging when conducted remotely. We are more persuasive in person, particularly if we know the person. Being on a video call is more draining than a face-to-face chat because workers must concentrate harder to process non-verbal cues such as tone of voice and body language. Anxiety about technology is another barrier, and some find lack of eye contact in virtual meetings (mimicked by staring at the “dot” of your own camera) disquieting.

New norms of hand sanitising, cleaning equipment and wearing masks will emerge. Handshaking or friendly pecks on the cheek may soon be things of the past, as will family photos and mementos on desks, if they prove too difficult to sanitise.

Aside from behaviours, policies, and attitudes, the physical office will need to change. Already, a company in the Netherlands has coined the term the “6 feet office”, aiming to redesign workspaces to help workers maintain social distancing at work.

We may even see the return of the high-walled cubicle, and the introduction of wide corridors and one-way foot traffic, already found in some hospitals. Activity-based work and hot-desks (which oblige people to move throughout the day) could be replaced by assigned desk arrangements where workers sit back to back.

New builds might incorporate touch-free technology such as voice-activated lifts, doors and cabinets, touchless sinks and soap dispensers, improved air venting and UV lights to disinfect surfaces overnight.

In the meantime, will James Muir resume running Crunch and Flourish from his co-working office after the pandemic? “Yes,” he says, “once the risk of any new cases is under control.”

Rachel Morrison, Associate Professor, Auckland University of Technology

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

‘Click for urgent coronavirus update’: how working from home may be exposing us to cybercrime

Posted on March 27, 2020 by particularkev

Craig Valli, Edith Cowan University

Apart from the obvious health and economic impacts, the coronavirus also presents a major opportunity for cybercriminals.

As staff across sectors and university students shift to working and studying from home, large organisations are at increased risk of being targeted. With defences down, companies should go the extra mile to protect their business networks and employees at such a precarious time.

Reports suggest hackers are already exploiting remote workers, luring them into online scams masquerading as important information related to the pandemic.

On Friday, the Australian Competition and Consumer Commission’s Scamwatch reported that since January 1 it had received 94 reports of coronavirus-related scams, and this figure could rise.

As COVID-19 causes a spike in telework, teleheath and online education, cybercriminals have fewer hurdles to jump in gaining access to networks.

High-speed access theft

The National Broadband Network’s infrastructure has afforded many Australians access to higher-speed internet, compared with DSL connections. Unfortunately this also gives cybercriminals high-speed access to Australian homes, letting them rapidly extract personal and financial details from victims.

The shift to working from home means many people are using home computers, instead of more secure corporate-supplied devices. This provides criminals relatively easy access to corporate documents, trade secrets and financial information.

Instead of attacking a corporation’s network, which would likely be secured with advanced cybersecurity countermeasures and tracking, they now simply have to locate and attack the employee’s home network. This means less chance of discovery.

Beware cryptolocker attacks

Cryptolocker-based attacks are an advanced cyberattack that can bypass many traditional countermeasures, including antivirus software. This is because they’re designed and built by advanced cybercriminals.

Most infections from a cryptolocker virus happen when people open unknown attachments, sent in malicious emails.

In some cases, the attack can be traced to nation state actors. One example is the infamous WannaCry cyberattack, which deployed malware (software designed to cause harm) that encrypted computers in more than 150 countries. The hackers, supposedly from North Korea, demanded cryptocurrency in exchange for unlocking them.

If an employee working from home accidentally activates cryptolocker malware while browsing the internet or reading an email, this could first take out the home network, then spread to the corporate network, and to other attached home networks.

This can happen if their device is connected to the workplace network via a Virtual Private Network (VPN). This makes the home device an extension of the corporate network, and the virus can bypass any advanced barriers the corporate network may have.

If devices are attached to a network that has been infected and not completely cleaned, the contaminant can rapidly spread again and again. In fact, a single device that isn’t cleaned properly can cause millions of dollars in damage. This happened during the 2016 Petya and NotPetya malware attack.

Encryption: not a cryptic concept

On the bright side, there are some steps organisations and employees can take to protect their digital assets from opportunistic criminal activity.

Encryption is a key weapon in this fight. This security method protects files and network communications by methodically “scrambling” the contents using an algorithm. The receiving party is given a key to unscramble, or “decrypt”, the information.

With remote work booming, encryption should be enabled for files on hard drives and USB sticks that contain sensitive information.

Enabling encryption on a Windows or Apple device is also simple. And don’t forget to backup your encryption keys when prompted onto a USB drive, and store them in a safe place such as a locked cabinet, or off site.

VPNs help close the loop

A VPN should be used at all times when connected to WiFi, even at home. This tool helps mask your online activity and location, by routing outgoing and incoming data through a secure “virtual tunnel” between your computer and the VPN server.

Existing WiFi access protocols (WEP, WPA, WPA2) are insecure when being used to transmit sensitive data. Without a VPN, cybercriminals can more easily intercept and retrieve data.

VPN is already functional in Windows and Apple devices. Most reputable antivirus internet protection suites incorporate them.

It’s also important that businesses and organisations encourage remote employees to use the best malware and antiviral protections on their home systems, even if this comes at the organisation’s expense.

Backup, backup, backup

People often backup their files on a home computer, personal phone or tablet. There is significant risk in doing this with corporate documents and sensitive digital files.

When working from home, sensitive material can be stored in a location unknown to the organisation. This could be a cloud location (such as iCloud, Google Cloud, or Dropbox), or via backup software the user owns or uses. Files stored in these locations may not protected under Australian laws.

Businesses choosing to save files on the cloud, on an external hard drive or on a home computer need to identify backup regimes that fit the risk profile of their business. Essentially, if you don’t allow files to be saved on a computer’s hard drive at work, and use the cloud exclusively, the same level of protection should apply when working from home.

Appropriate backups must observed by all remote workers, along with standard cybersecurity measures such as firewall, encryption, VPN and antivirus software. Only then can we rely on some level of protection at a time when cybercriminals are desperate to profit.

Craig Valli, Director of ECU Security Research Institute, Edith Cowan University

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

Sharing my thoughts with the world from a Particular Baptist perspective

How common is COVID in kids, and how sick do they get?

How can I best care for my child at home if they get COVID?

Don’t some children end up in hospital or intensive care?

Do children get ‘long COVID’?

What if some people in the home aren’t infected?

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What should I look out for?

Not everyone feels ‘short of breath’

What to do

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How will we make sure it’s safe?

The risk would be extremely low

Will people comply?

What are the barriers?

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Availability creep

Health implications

Disconnecting in Australia and internationally

The French example

What’s next for Australia?

What needs to happen now

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Most retirees don’t use what they’ve got

It’s created two systems

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Strength is just as important as cardio

Most of us don’t even lift — but we should

Here’s how to get started

Governments need to step up

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A push from government

How is hospital in the home delivered?

Why is it a good thing?

Hospital in the home and COVID-19

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World’s largest work-from-home experiment

Stress test for NBN and energy networks

Less commuting means less congestion

What does this mean for infrastructure planning?

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Working from home

Missing social cues online

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High-speed access theft

Beware cryptolocker attacks

Encryption: not a cryptic concept

VPNs help close the loop

Backup, backup, backup

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