Coronavirus support packages will reshape the future economy, and that presents an opportunity



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Ilan Noy, Te Herenga Waka — Victoria University of Wellington

Governments across the world have rolled out extensive financial packages to support individuals, businesses and large corporations affected by the COVID-19 pandemic.

Equally, central banks have decreased their lending rates to almost zero, and have announced extensive and previously untested direct lending to private corporations and financial companies.

In many wealthy countries, the support packages are record-breaking in their size and scope, such as the US$2.2 trillion stimulus package for the US economy.

The US and Australian stimulus packages each represent about 10% of GDP. New Zealand’s program is about 5% of GDP, but each country is experiencing the economic shock differently, has different existing safety nets and priorities, and different mechanisms to deliver this assistance.

These support packages will play a significant role in shaping our world for many years, and we should not allow the clear emergency of the situation to stop us questioning their design.




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Goals for financial support

Our work on economic recovery following natural hazards and disasters defines a set of build-back-better goals, and how they should be assessed.

This kind of thinking applies equally to our current predicament. We argue that globally, the purpose of COVID-19 stimulus packages should be threefold, and we should assess them against these three goals:

  1. make sure people’s basic needs are satisfied

  2. make it possible for the economy to spring back into action once the necessary social distancing measures are relaxed

  3. use these funds to create positive change, and rebuild areas we previously neglected (in many countries, this will mean investing in public health systems).




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To achieve the first goal of making sure people can meet their basic needs, many high-income countries – including the US, Greece, the UK and France – are either providing direct payments to all citizens (as in the US) or targeted support to those who lost income or jobs.

These payments are sometimes a fixed proportion of each recipient’s previous income, up to a cap (as in the UK), or are identical for everyone who has lost income (as in New Zealand).

From an economic perspective, it is clearly more efficient to provide support only to the people who really need it – those who have lost income and would not be able to support themselves and their dependants.

But these programs are also shaped by politics and ethics, and different countries chose different ways to distribute this assistance, not always based on need.

Restarting economies

Even better are programs that provide the wage subsidies through existing employers, such as Germany’s famed Kurzarbeit program (which translates to “work with shorter hours”) which was implemented during the 2008 global financial crisis.

New Zealand’s wage subsidy package is a similar program. It supports businesses to continue paying their staff even if they are unable to work.

Details of payments to businesses are posted online, to make sure employers comply and transfer these funds to their employees. This initiative was trialled after the 2011 Christchurch earthquake.




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A similar support was also implemented in Australia.

Generally, wage subsidies allow for continued employment of individuals who would otherwise be let go, and they will also assist in achieving the second goal of resuming economic activity once restrictions are relaxed.

Such programs have been shown to be effective in Germany and New Zealand in ameliorating unexpected shocks.

While employees need support, directly or indirectly, it is also important that small and medium-sized businesses are propped up so they are ready to forge ahead once it is possible to do so. They should receive grants and subsidised loans to pay their costs, other than wages. Otherwise many businesses will fail, and the recovery will be slow and hard.

Global impacts

Whether large corporations need to receive support depends partly on the longer-term importance of their sector. It is easier to justify support for national airlines, which are an important linchpin in many countries’ global ties, than to support fossil fuel producers, for example.

Nor are there many reasons why taxpayers (present and future) should bail out wealthy individual owners of large businesses, when these businesses could be restructured in bankruptcy proceedings that should not lead to their shutdown.

But the COVID-19 pandemic has impacts well beyond individual countries and their economies and may require global support mechanisms.

Most low- and middle-income countries have either not yet announced any assistance or their packages are less than 1% of GDP. They typically cannot afford more with their existing debt levels.

It is therefore incumbent on high-income countries that can afford larger fiscal support packages to help countries that cannot. But so far only a handful of high-income countries, including Finland and Norway, have provided such support.

The international institutions supported by the rich world, such as the International Monetary Fund (IMF) and the World Bank, should pull out all the stops and lend enough, and at concessionary rates, to low-income countries so they can, at the very least, provide for their people’s basic needs.

Without that support, the virus will continue to spread in low-income countries and defeat the draconian social distancing measures that almost every country is implementing now.

Finally, it is important that we scrutinise these programs carefully now, rather than only once the public health emergency has passed and they have been entrenched. The sums involved are incredibly large and we will be remiss if we mis-spend what we are now borrowing from our children and grandchildren.

* Stay in touch with The Conversation’s coverage from New Zealand experts by signing up for our weekly newsletter – delivered to you each Wednesday morning.The Conversation

Ilan Noy, Professor and Chair in the Economics of Disasters, Te Herenga Waka — Victoria University of Wellington

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

A coronavirus spike may put ICU beds in short supply. But that doesn’t mean the elderly shouldn’t get them



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Paul Komesaroff, Monash University; George Skowronski, and Ian Kerridge, University of Sydney

Although recent encouraging news suggests the rate of new coronavirus cases in Australia is slowing, our medical facilities could still be overwhelmed at some point.

One modelling study has suggested that, if public health measures are not observed or do not work, demand for the existing 2,200 intensive care unit (ICU) beds in Australia will be exceeded within a few weeks. More optimistic views of our achievable ICU capacity would merely delay this event for a few weeks.

Critical shortages of ICU beds and other medical resources overseas have resulted in large numbers of deaths. In these countries there have been vigorous debates about which of many eligible patients should be given access to care facilities in short supply.

This discussion is now underway in Australia.

For many clinicians, the question of who has access to limited ICU beds presents disturbing challenges, especially in view of a widely disseminated proposal that has gained particular support in Italy. This bases decisions about who is granted access to ICU beds on calculations of the future years of life that could potentially be achieved through treatment (or, in some proposals, “quality adjusted” years of life).

This would deny access to people above a certain age as well as to people with disabilities and certain medical conditions.




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What is a person worth?

This approach is deeply problematic.

It has taken many years for us to move away from judging the value or worth of a person by their age, race, sexual preference, physical ability, religion or other personal characteristics.

The worst outrages of the 20th century resulted directly from such approaches, which were often claimed at the time to be supported by “ethical” justifications.

Decisions should not be made based on calculations about how many years a person has to live.
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There has also never been a public discussion, and certainly there is no agreement, about whether the “ethical value” of a person can be calculated mathematically on the basis of the total number of years he or she might live.




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The alternative, which has been developed and routinely employed in hospitals around Australia for years, applies a process of rigorous discussion about the potential benefits and burdens of treatments proposed for every individual patient, taking into account all relevant clinical features and whether acute problems can be overcome.

It entails a detailed analysis of technical issues and results. It involves open discussion with the patient, medical carers, family members, and expert ICU staff, about medical, social, emotional and ethical issues.

It embraces flexibility and a readiness to adapt and change protocols with changing circumstances. It takes into account the specific circumstances of individual patients’ lives, including their personal preferences and religious and cultural beliefs.

It leaves aside personal characteristics not relevant to the medical decision at hand, such as race, gender, sexual preference and ethnicity.

Age can be relevant

This is not to say that age can never be a relevant consideration. Indeed, in some conditions, advanced age is closely linked with the likelihood of a poorer response to a treatment.

Sometimes this is because increasing age is directly linked to age-related diseases that reduce the likelihood of a successful outcome from treatment, such as certain types of cancer.

Sometimes age can be a factor but it’s more of a signifier of other considerations.
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At other times, for reasons that are much less clear, age itself appears to predict poor outcomes of treatment, leading to its inclusion in many scoring systems for predicting outcomes of treatment, including in intensive care and cancer care.

In both cases it is valid that age be taken into account in decision-making. It is also possible that age may be relevant to more philosophical considerations, for example, whether older people consider themselves to have already lived a “fair innings” or whether young people should be given the opportunity to live a life and gain their potential.




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While these may also be relevant considerations, and be accepted by many, including sometimes by older people themselves, they are much less clear and much more contested, and require ongoing debate.

The key point is that, even in these cases, age is never taken as a defining quality or characteristic of a person but rather as a potential signifier of other relevant characteristics or risk factors. Its relevance is linked to what it implies for the particular person, not to an assumption that old people have diminished value and are less worthy of treatment.

In extreme settings, time and resource constraints may add greatly to pressures on the decision-making process but the same principles still apply. In fact, it is exactly in these contexts that it is most important to resist resorting to criteria that are not founded on evidence or valid ethical arguments.

How do we respond?

The ethical strength of a society is revealed in how it responds to serious challenges. If we have values worth defending, this is the time to fight for them.

Most of us do not want to move to a society based on the arbitrary imposition of measures that discriminate against people on the basis of ethically or medically irrelevant personal characteristics.

Future generations will judge us on how we respond to this crisis and whether we have been able to defend our core values. This is the time, perhaps more than any other, when we have to keep our ethical nerve.




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The Conversation


Paul Komesaroff, Professor of Medicine, Monash University; George Skowronski, Research Affiliate, Sydney Health Ethics, School of Public Health, University of Sydney, and Ian Kerridge, Professor of Bioethics & Medicine, Sydney Health Ethics, Haematologist/BMT Physician, Royal North Shore Hospital and Director, Praxis Australia, University of Sydney

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

How do viruses mutate and jump species? And why are ‘spillovers’ becoming more common?



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Steve Wylie, Murdoch University

Viruses are little more than parasitic fragments of RNA or DNA. Despite this, they are astonishingly abundant in number and genetic diversity. We don’t know how many virus species there are, but there could be trillions.

Past viral epidemics have influenced the evolution of all life. In fact, about 8% of the human genome consists of retrovirus fragments. These genetic “fossils” are leftover from viral epidemics our ancestors survived.

COVID-19 reminds us of the devastating impact viruses can have, not only on humans, but also animals and crops. Now for the first time, the disease has been confirmed in a tiger at New York’s Bronx Zoo, believed to have been infected by an employee. Six other tigers and lions were also reported as “showing symptoms”.

According to the BBC, conservation experts think COVID-19 could also threaten animals such as wild gorillas, chimps and orangutans.

While virologists are intensely interested in how viruses mutate and transmit between species – and understand this process to an extent – many gaps in knowledge remain.

Skilled in their craft

Most viruses are specialists. They establish long associations with preferred host species. In these relationships, the virus may not induce disease symptoms. In fact, the virus and host may benefit each other in symbiosis.

Occasionally, viruses will “emerge” or “spillover” from their original host to a new host. When this happens, the risk of disease increases. Most infectious diseases that affect humans and our food supply are the result of spillovers from wild organisms.

The new coronavirus (SARS-CoV-2) that emerged from Wuhan in November isn’t actually “new”. The virus evolved over a long period, probably millions of years, in other species where it still exists. We know the virus has close relatives in Chinese rufous horseshoe bats, intermediate horseshoe bats, and pangolins – which are considered a delicacy in China.

Smuggled pangolins are killed for their scales to be used in traditional Chinese medicine. They are suspected to be the world’s most-trafficked mammal, apart from humans.
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Past coronaviruses, including the severe acute respiratory syndrome coronavirus (SARS-CoV), have jumped from bats to humans via an intermediary mammal. Some experts propose Malayan pangolins provided SARS-CoV-2 this link.




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Although the original host of the SARS-CoV-2 virus hasn’t been identified, we needn’t be surprised if the creature appears perfectly healthy. Many other coronaviruses exist naturally in wild mammal and bird populations around the world.

Where do they keep coming from?

Human activity drives the emergence of new pathogenic (disease-causing) viruses. As we push back the boundaries of the last wild places on Earth – felling the bush for farms and plantations – viruses from wildlife interact with crops, farm animals and people.

Species that evolved separately are now mixing. Global markets allow the free trade of live animals (including their eggs, semen and meat), vegetables, flowers, bulbs and seeds – and viruses come along for the ride.




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Humans are also warming the climate. This allows certain species to expand their geographical range into zones that were previously too cold to inhabit. As a result, many viruses are meeting new hosts for the first time.

How do they make the jump?

Virus spillover is a complex process and not fully understood. In nature, most viruses are confined to particular hosts because of specific protein “lock and key” interactions. These are needed for successful replication, movement within the host, and transmission between hosts.

For a virus to infect a new host, some or all protein “keys” may need to be modified. These modifications, called “mutations”, can occur within the old host, the new one, or both.

For instance, a virus can jump from host A to host B, but it won’t replicate well or transmit between individuals unless multiple protein keys mutate either simultaneously, or consecutively. The low probability of this happening makes spillovers uncommon.

To better understand how spillovers occur, imagine a virus is a short story printed on a piece of paper. The story describes:

  1. how to live in a specific cell type, inside a specific host
  2. how to move to the cell next door
  3. how to transmit to a new individual of the same species.

The short story also has instructions on how to make a virus photocopying machine. This machine, an enzyme called a polymerase, is supposed to churn out endless identical copies of the story. However, the polymerase occasionally makes mistakes.

It may miss a word, or add a new word or phrase to the story, subtly changing it. These changed virus stories are called “mutants”. Very occasionally, a mutant story will describe how the virus can live inside a totally new host species. If the mutant and this new host meet, a spillover can happen.

We can’t predict virus spillovers to humans, so developing vaccines preemptively isn’t an option. There has been ongoing discussions of a “universal flu vaccine” which would provide immunity against all influenza virus mutants. But so far this hasn’t been possible.

Let wildlife be wildlife

Despite how many viruses exist, relatively few threaten us, and the plants and animals we rely on.

Nonetheless, some creatures are especially dangerous on this front. For instance, coronaviruses, Ebola and Marburg viruses, Hendra and Nipah viruses, rabies-like lyssaviruses, and mumps/measles-like paramyxoviruses all originate from bats.

Given the enormous number of viruses that exist, and our willingness to provide them global transport, future spillovers are inevitable. We can reduce the chances of this by practising better virus surveillance in hospitals and on farms.

We should also recognise wildlife, not only for its intrinsic value, but as a potential source of disease-causing viruses. So let’s maintain a “social distance” and leave wildlife in the wild.The Conversation

Steve Wylie, Adjunct Associate Professor, Murdoch University

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

Coronavirus Update: International


General

China

Iran

Japan

USA

United Kingdom

Italy

Germany

Masking power in the age of contagion: the two faces of China in the wake of coronavirus



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Haiqing Yu, RMIT University and Michael Keane, Curtin University

China has gradually emerged out of its shadow of despair as the epicentre where the coronavirus pandemic started. Now, there is face saving required – as well as agenda-setting in the global power play.

China played a decisive role in combating the invisible enemy. Chinese officials and academics are taking this opportunity to rescript the narrative and place China as the new world leader.

In the quest for this leadership, China seems to be playing the game of “white face” (friendly face) and “red face” (hostile face). Similar to the Western concept of good cop/bad cop, white face and red face uses seemingly opposing actions to achieve a singular goal.

The red face is Zhao Lijian, a Chinese foreign ministry spokesman who suggested the virus originated in the US and was brought to Wuhan by American soldiers.

The white face is providing medical supplies to countries now battling the pandemic, gestures of goodwill described as “mask diplomacy” or “medical diplomacy”.

By understanding the context for these donations, we can understand a lot about how China embeds symbolism within its soft power diplomacy.

Guarding life

Chinese people have a long history of wearing masks as protection from disease, chemical warfare, pollution, and severe weather. As early as the 13th century, court servants would cover their noses and mouths with a silk cloth when bringing food to the emperor.

As China increasingly encountered foreign powers through Treaty Ports at the turn of the 20th century, disease control became a critical concern. Despite the long legacy of traditional medicine, China was seen as an unhygienic place by the Western occupiers of these ports.

China’s opening to the West in 1978 led to a greater awareness of hygiene. The Chinese word for hygiene weisheng (literally “guarding life”) was incorporated by health reformers in numerous applications, from wooden disposable chopsticks to toilet paper.

In China, not wearing masks in the current health crisis is seen as unhygienic, irresponsible, and even transgressive. Punitive measures are taken by authorities, with non-mask-wearers publicly shamed and humiliated on Chinese social media.

In the West, masks have been widely viewed with suspicion. The official advice from Australian health authorities is if you are not sick, don’t wear masks.

This has lead to anxiety and discontent among Chinese Australians, frustrated by what they see as bad advice. The general public attitude toward mask wearers compounds the problem as Chinese Australians are unfairly targeted with racist slurs.




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International diplomacy

At the height of the Wuhan outbreak, government, private companies and individual citizens in Japan donated thousands of masks. But more significant than the masks was the symbolism. Emblazoned on cargo boxes from the Japan Youth Development Association were Chinese characters reading “Lands apart, sky shared”, a line from an ancient Chinese poem.

A month later, the Jack Ma Foundation reciprocated with a large donation of masks to Japan, with a quote from the same poem: “Stretching before you and me are the same mountain ranges; let’s face the same wind and rain together.”

Millions of masks and thousands of testing kits are being sent overseas, coordinated and endorsed by Chinese government organisations and taking place at the government-to-government level; by the private sector through companies and charity foundations; and by individuals helping their overseas friends.

Mask diplomacy is part of China’s new dual level power play: aiding to foreign countries to regain face and demonstrate its role as a responsible global power; and sharing conspiracy theories about the origins of the virus to attack the opponent.




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China is being aided in this messaging by inefficiency of the US in handling the crisis. By finger pointing at the US, some say China is hoping to “distract from domestic government incompetence.”

This effort to rewrite the virus narrative through mask diplomacy is a strategic gambit to claim the moral high ground and assert international power.

Changing faces

Perhaps a clue to what is now unfolding comes from the world of theatre.

In Chinese Sichuan opera, the performer magically changes masks. A skilled performer can accomplish ten mask changes in 20 seconds. This is one of the great accomplishments of Chinese culture, part of its soft power arsenal. The term used in Chinese, bianlian (literally “changing face”), however, is also a synonym for suddenly turning hostile.

China may have dodged a bullet. But if the pandemic spirals further out of control, China will have a lot more work to do to deliver its charm offensive.

The next few months will be crucial. Much of the global leadership in this global warfare will depend on the US, with its own president appearing to change face at any moment.

Power in the age of global contagion requires more than the dual faces of white and red. The world needs healing, and so the Chinese government will need to carefully moderate its propaganda. Triumphalism over the success of its own military-style control strategies and finger pointing at others may evoke blowback in the theatre of geopolitics.The Conversation

Haiqing Yu, Associate Professor, School of Media and Communication, RMIT University and Michael Keane, Professor of Chinese Digital Media and Culture, Curtin University

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

What can you use a telehealth consult for and when should you physically visit your GP?



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Brett Montgomery, University of Western Australia

As of this week, everyone with a Medicare card is eligible for Medicare-funded telehealth. That means you can have a consultation with your GP, psychologist and other health providers via video or phone, rather than going in.

This should help with social distancing – a core weapon in our community’s fight to contain this epidemic.

Some but not all health care can safely be shifted online. But it can be difficult to know when it’s OK to skip the in-person visit. Here are some pointers to get you going.




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What you can do via telehealth

There’s a saying in medicine that “history is 80% of diagnosis”. By “history”, we mean the things our patients tell us; fortunately, video and telephone connections convey your voices and stories well.

So for issues where doctors and patients mainly need to speak, and where the risk of serious illness is low, telehealth consults are a good option. Evidence backs this up, finding fairly satisfied doctors and patients – and sometimes even cost or time savings.



The Conversation, CC BY-ND

I’m most comfortable using telehealth with patients I know well, and when we are managing long-standing health issues. For example:

  • routine chronic disease management, especially where the condition is fairly stable – for example conditions such as diabetes, high cholesterol or high blood pressure

  • writing repeat prescriptions for medicines used in long-term illnesses – like the examples above, or tablets for contraception, stomach acid or chronic pain

  • exploring mental health issues

  • discussing diet and physical activity

  • writing referral letters.

Some conditions can also be monitored remotely. In particular, many patients with high blood pressure can safely measure this using a machine at home. This is recommended in blood pressure guidelines, as it’s actually more reliable than clinic readings.

But home blood pressure monitoring won’t be a solution for everyone. It needs careful technique, and also enough money to buy a machine.




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Some simple short-term illnesses might also be managed via telehealth, as long as the risk of anything serious going on seems low. Examples could include straightforward urinary tract or upper respiratory tract infections.

But there is a worrisome overlap in symptoms between common viral infections and the early symptoms of COVID-19. Guidelines are being written to help GPs assess, over telehealth, who needs to simply isolate, who needs testing, and who needs to go to hospital.

What you need to see a doctor for

Sometimes a physical examination is important. There are all sorts of presentations in which I might need to listen to your heart or lungs, or feel your abdomen, or take your temperature if you don’t have a thermometer at home. This is especially the case when symptoms are new.

Photographs are tricky. I can’t expect patients to be able to describe or photograph a changing skin lesion well enough for me to make decisions. (Often these are benign, but I’d hate to miss a skin cancer.)




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There are procedures that can’t be done via telehealth. Excising skin lesions, taking swabs and smears, inserting long-acting contraceptive devices, giving injections – these simply don’t happen “virtually”.

Particularly important right now are flu vaccinations: while these offer no protection against coronavirus, they may stop the dangerous “double whammy” of getting influenza and coronavirus together.

You’ll need to go in for your flu shot.
Shutterstock



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What you might need to put off

Some routine checkups and screening tests, in low-risk people without symptoms, might simply best be put off until this pandemic settles. But it’s hard to generalise. If in doubt, ask a doctor who knows you well.

Bookings, prescriptions and blood tests

When booking an appointment, don’t simply book a face-to-face appointment out of habit. Hopefully reception staff will offer the telehealth option, but this is all new, and it can’t hurt for you to raise the idea too.

When GPs aren’t sure whether telehealth is appropriate, we can begin with a telehealth conversation, then swap to a traditional consultation if needed.

Prescriptions and blood test or imaging referrals are currently awkward via telehealth. I can mail non-urgent prescriptions and requests to patients, pharmacies or other providers.

For urgent prescriptions, we’re using a messy combination of phone calls, faxes or emails to get instructions to pharmacists quickly, and then mailing the originals.

Fingers crossed, there will soon be reforms allowing purely digital prescribing.

Just an interim measure for the pandemic?

Medicare has previously been very strict about only funding GP consultations when they happen face-to-face. The shift to funding telehealth has been forced by the coronavirus pandemic; so far the government is promising telehealth funding to late September.

Like patients, not all practices are ready for video consultations. Webcams, like facemasks and hand sanitiser, are hard to find. And we’re still learning which video services tick all the boxes for function and privacy.

Doctors, like patients, are still working out how to consult via telehealth.
Shutterstock

At a better time in history, we’d confine telehealth consultations to the obviously safe consultations, and do all the other ones face-to-face.
But we currently need to balance the risks of forgoing some physical examination and procedures against the risks of potential exposure to coronavirus.

Research evidence on telehealth isn’t much help, because it wasn’t done in the coronavirus era. Instead, we need to be as safe and wise as we can, and learn as we go.

I hope we’ll be able to lay the foundation for telehealth not just as an emergency measure, but as an enduring feature of general practice – complementing rather than replacing face-to-face consultations.




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The Conversation


Brett Montgomery, Senior Lecturer in General Practice, University of Western Australia

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

Thanks to coronavirus, Scott Morrison will become a significant prime minister


Paul Strangio, Monash University

One of Australia’s preeminent historians, Stuart Macintyre, once observed of John Curtin, the Labor Party leader revered for navigating this nation through the dangers of the second world war, that he

would have made a timid and mediocre prime minister in peacetime; in war he assumed duties no one else could discharge. The occasion found the man.

Scott Morrison is no John Curtin. Yet, because of his incumbency coinciding with what is the most perilous peacetime challenge the country has faced in living memory, Morrison now seems destined to be a significant Australian prime minister.

Remember this is the “accidental” prime minister, who obtained the office almost by default after Liberal Party conservatives botched their assault on Malcolm Turnbull’s leadership in August 2018. He then miraculously survived the May 2019 election largely courtesy of Bill Shorten’s chronic unpopularity and Labor’s poorly calculated campaign.




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Fresh from that victory, Morrison’s government spent the following months frittering away the public’s goodwill. It appeared bereft of a discernible policy program, was divided over climate policy, and tainted by the scandal over its pre-election pork-barrelling of community sport funding grants.

Then there was Morrison’s mishandling of the summer bushfires calamity. Put together, it was a record that had the hallmarks of him joining the ranks of the beleaguered set of post-John Howard prime ministers who have each struggled to leave a substantial imprint on the nation.

But now that unflattering history seems like it dates from another age. In the new all-encompassing COVID-19 reality, Morrison has recovered if not the public’s trust, at least its ear, as he has presided over a series of momentous health and economic related responses to the pandemic – the latest among them the gargantuan $130 billion “JobKeeper” payment. The pace and scale of these actions arguably even puts in the shade the policy pyrotechnics of the famed first fortnight of Gough Whitlam’s government in December 1972.

Timing, in short, can be everything in politics.

It has long been recognised that crises present both an opportunity and a danger for leaders. As Macintyre’s observation suggests, Curtin’s reputation – he is commonly lauded as Australia’s greatest prime minister – sprang from a fortuitous congruence between the challenges he met during 1941-45 and his own leadership repertoire.

On the other hand, James Scullin, another Labor leader who was ostensibly equally gifted as Curtin, had his prime ministership broken by the crisis of the Great Depression. Powerless to arrest the country’s descent into economic freefall, Scullin is typically ranked at the bottom of the heap of Australia’s national leaders.




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In other words, while Morrison’s prime ministership seems fated to have an import that was unimaginable only weeks ago, this is no guarantee that it will be remembered as a success. How skilfully his government manages the crisis and the recovery phase will be the true test. It will be months, perhaps even years, before we will be able to fully measure whether Morrison was the appropriate leader for this time.

The political science literature suggests that in a crisis a leader has to perform at least three essential tasks. The first is to authoritatively interpret the causes, dynamics and consequences of the unfolding crisis. The second is to mobilise and coordinate and, where required, recalibrate existing governing systems to facilitate an appropriate response. Thirdly, it must persuasively explain the crisis to the public and the nature of the government’s actions.

Against these benchmarks, the jury is still out regarding Morrison’s response to the COVID-19 emergency. At least initially, and to be fair in common with most of his counterparts internationally, Morrison appeared slow to fathom the gravity of the threat. There are legitimate questions about whether his government’s actions were sufficiently expeditious and proportionate.

In terms of tweaking governing systems, a “national cabinet” (COAG by another name) has been established as the key decision-making forum for dealing with the crisis, and an advisory network of health bureaucrats and medical experts created.

There are also reports of a heavy reliance on treasury officials, the government seeking counsel from an informal group of business leaders, and the prime minister has also brought on board the former Rudd government minister and ACTU chief, Greg Combet, to provide a conduit to the trade union movement. Indeed, it has been striking to note how willingly Morrison has leaned on public service advice in all this. It is a sharp contrast with a prime minister who had hitherto spoken disdainfully of the “Canberra bubble” and also a far cry from his government’s bloody-minded reluctance to heed expert opinion on climate change.

When it comes to public communication, Morrison early on sent out too many mixed messages. He resorted to hectoring rather than informing and calming. But those tendencies have been less evident in recent days, and he appears to be doing much better than during the bushfires crisis when he lost control of the narrative at the beginning and never recovered it.




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There will be other things that will help determine Morrison’s effectiveness in dealing with the current crisis, not least his own psychological resilience and the robustness of the personal support network that he has around him. For most of us, the relentless pressures that Morrison and other leaders internationally are enduring at this time are nigh on unthinkable. Part of the legend of the naturally pensive Curtin is that, worn down by the tribulations of governing during war, he literally worried himself into an early grave.

There will also be a question of how Morrison readapts once the worst of the crisis is behind us. Like what happened to Kevin Rudd following the Global Financial Crisis, a potential danger for the future harmony of Morrison’s government is that he will have become habituated to small-circle decision making.

“Events, dear boy, events”, is what the British post-war prime minister, Howard Macmillan, is reputed to have replied when asked by a journalist what he feared most as a leader. Yet unanticipated events can make as well as break a leader. Morrison is currently finding that out – as are we, anxiously looking on.The Conversation

Paul Strangio, Associate Professor of Politics, Monash University

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

Using nursing assistants to fill coronavirus gaps brings risks if they’re not up to the job



Shutterstock/Have a nice day Photo

Nicole Blay, Western Sydney University; Christine Duffield, University of Technology Sydney, and Michael Roche, University of Technology Sydney

The number of people going to hospital with the coronavirus is expected to rise, putting a strain on our health and aged care services and their workforce.

Australian undergraduate student nurses and those health workers here on visas from overseas are being encouraged to work as nursing assistants during this COVID-19 pandemic.

This is in keeping with the worldwide trend of employing more nursing assistants in health and aged care services.




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But questions remain about the differences in training of nursing assistants compared to regulated nurses (registered and enrolled nurses) and the tasks they are able to undertake.

An unregulated workforce

As nursing assistants are unregulated, their training and clinical practice is not controlled by professional bodies or governments.

Training is certainly recommended, but it is not compulsory, and content between training organisations can be different. Therefore, nursing assistants working in hospitals and residential aged care facilities may have completed an on-line course, a Certificate III qualification, completed one year of undergraduate nursing studies or have a nursing qualification from overseas. They may have had no training at all.

Visa holders can work as a nursing assistant while their overseas nursing qualifications are being assessed by the Nursing and Midwifery Board of Australia.

It is these last two examples, undergraduate nursing students in Australia or overseas trained nurses, that the Prime Minister Scott Morrison recommends organisations seek to recruit.

What a nursing assistant can do

Nursing assistants can work under the supervision of a registered or enrolled nurse to help provide basic nursing care such as showering, hair, skin and mouth care. They can assist with activities essential for daily living including helping people with dressing and feeding.

They may also perform simple wound dressings, transport stable patients or residents between beds or wards, and undertake nursing observations such as pulse, temperature and respiratory rates.

Using student nurses and current visa holders seems like a potential solution to a possible staffing crisis. But is it?

For student nurses, there is considerable variation in the course structure offered by universities, who each write their own curricula within the boundaries of the Australian Nursing and Midwifery Accreditation Council.

This means not all students will have had the same clinical experience or completed the same content by a given point in their course. Therefore they may not have equivalent knowledge or skills before working as a nursing assistant.

Patients at risk?

This variation may be a problem and there is a lot of evidence that a higher number of unregulated nurses and a lower number of regulated nurses increases the risk of patient infections and other adverse events in hospitals) and the aged care sector.

For example, nursing people with an infectious disease requires scrupulous attention to detail and meticulous use of Personal Protective Equipment (PPE) to prevent further spread.

There are correct ways to apply and remove a mask and gown. A tiny slip-up can put the wearer and others at risk of contamination.

Working as nursing assistants can provide undergraduate students with valuable clinical experience. Our recent research shows most nursing activities performed by nursing assistants are those personal care activities described above.

But we found around one-third of tasks they performed require a higher level of skill and knowledge and should therefore be performed by regulated nurses.

This may explain why the rate of adverse events increases with more unregulated nurses. With the projected increase in patients who may need intensive care, experienced qualified nurses who can work without supervision will be needed.

Can retired nurses help?

Some have recommended recruiting retired nurses to help staff intensive care units. Again, this is fraught with problems.

Working nurses are ageing – the average age is about 45 – with two out of five aged 50 and over. So most retired nurses are likely in their 60s or older.




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The two age groups – the over 50s and the over 60s – are precisely those at risk of a severe response to the coronavirus, which could make staffing shortages and the demand for beds much worse.

Perhaps a more effective and sustainable solution would be to use Australian Defence Force nurses who are all regulated, presumably fit and who have been prepared to deal with emerging crises at short notice.

Australia is clearly going to need innovative ways to ease pressure on the health workforce over the coming months. If we’re going to recruit student nurses and current visa holders, we need to make sure all have been trained and assessed to the same standard.The Conversation

Nicole Blay, Research Fellow – workforce, Western Sydney University; Christine Duffield, Professor, Nursing and Health Services Management, Faculty of Health, University of Technology Sydney, and Michael Roche, Associate Professor Mental Health Drug and Alcohol Nursing, University of Technology Sydney

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