Tuberculosis, the forgotten pandemic relying on a 100-year-old vaccine

Posted on August 11, 2021 by particularkev

Justin Denholm, Melbourne HealthBy some estimates, 2 billion people are now infected worldwide, and in 2019, around 1.4 million people died from it.

It’s a pandemic infection, spread through the air — but it’s not COVID. It’s tuberculosis (or TB). Yet we’re not in lockdown for it. And we’re not queuing up for a vaccine.

Some people call TB “the forgotten pandemic”. But our knowledge of one pandemic is helping us manage the other.

They’re similar in some ways …

TB is caused by the bacterium Mycobacterium tuberculosis. And COVID is caused by SARS-CoV-2, a virus. They’re quite different microorganisms. But it’s easy for them to overlap in people’s minds.

Both TB and COVID are infectious diseases that generally affect the lungs. Both are passed between people mainly by aerosols, when infected people cough, sing or otherwise release them into the surrounding air.

Mycoplasma tuberculosis — TB is caused by *Mycobacterium tuberculosis*.
from www.shutterstock.com

So some of the things we’re used to doing for COVID-19 – like wearing masks and good ventilation – also work for preventing the spread of TB.

However, there are some important differences between them, which mean our public health responses can look quite different.

… but not in others

We are all so familiar with COVID. So when I’m talking with people about TB, I’ve started highlighting three key differences between the infections.

1. TB is less infectious

TB is much less infectious. While COVID (especially strains like the Delta variant) may be transmitted after brief or “fleeting” contact, this is rare for TB.

As a rule of thumb, TB programs around the world often suggest you need to be in close contact with an infectious person for more than eight hours before that risk builds up to the point where you need to be tested for it.

This means people are more likely to spread the infection within their household or immediate family rather than at the shops.

2. TB symptoms take longer to show up

With TB, the “window” between being exposed and becoming unwell, known as the incubation period, is much longer.

Infections can stay dormant (or “latent”) in the body for many months or years before people become unwell. But almost everyone who becomes unwell with COVID has been infected within the past two weeks.

We don’t ask contacts of TB to isolate at home as we can’t predict when they might become unwell. It certainly wouldn’t be ethical or realistic to isolate people for months or years, just in case. Fortunately, people who have dormant TB cannot pass infection on to others in the meantime.

3. We have TB treatments to help curb the spread

As we’re uncertain about how long it takes between someone becoming infected and becoming unwell with TB, you’d think that would be a big problem.

But we have effective treatments to give people with dormant TB. These help prevent them developing active disease.

These treatments, particularly antibiotics such as isoniazid or rifampicin, can greatly reduce the risk of contacts becoming sick.

For COVID, we don’t yet have any treatments for people who are infected but who are not showing symptoms (known as post-exposure treatments) to minimise the chance of them spreading the virus.

Some have been tried, but so far none have convincingly been shown to be effective.

How about vaccines?

Perhaps the biggest difference in our response to these pandemics is we have a variety of effective vaccines against COVID.

For TB, we are relying on a 100-year-old vaccine, known as BCG (short for Bacille Calmette-Guerin), which is still one of the most widely used vaccines globally.

While it protects young children from the most severe forms of TB, the vaccine seems to give much less protection for adults.

The BCG vaccine, unlike COVID vaccines, is a live vaccine, meaning it contains live (but weakened) bacteria. So it can’t be given safely to people with immune suppressing conditions, like HIV, because they could get infected from it. This means its use is limited in some people who most need protection.

TB vaccine may protect against COVID

Perhaps the BCG vaccine and COVID will come full circle. The BRACE trial, launched from Melbourne’s Murdoch Children’s Research Institute, is studying whether the BCG vaccine might protect against COVID infection.

This investigation has been prompted by a long history of research showing the vaccine also improves our immune responses to other conditions such as viral infections.

We don’t know yet whether this will work, as the study is ongoing. Almost 7,000 health-care workers around the world at risk of COVID exposure have been recruited to the trial.

Whether or not BCG turns out to prevent COVID, there’s no question we need new and more effective vaccines for TB.

While we have an increasing number of potential vaccine candidates, right now there is still no alternative to our 100-year-old BCG.

The massive amount of activity globally in developing COVID vaccines has also stimulated calls for greater efforts and funding to develop new TB vaccines.

We hope these will lead to more effective and safer options, and be powerful tools for eliminating TB. Let’s hope we’re not left waiting another 100 years.

Justin Denholm, Associate Professor, Melbourne Health

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

Australia’s handling of the pandemic ranked more accountable than most, but not perfect

Posted on June 26, 2021 by particularkev

Miranda Stewart, The University of Melbourne and Teck Chi Wong, Crawford School of Public Policy, Australian National UniversityGovernments worldwide spent more than US$14 trillion fighting the health and economic effects of the coronavirus in 2020, much of it very quickly.

Among other things the timing of budgets was changed, procedural requirements bypassed, parliaments not consulted, and information not released.

In a new study comparing 120 countries, Australia was found to be one of only four countries — along with Norway, Peru and the Philippines — whose processes were assessed as having “adequate” accountability.

The International Budget Partnership study found that almost three-quarters of the countries studied (87 out of 120) failed to manage their immediate financial response in a transparent and accountable manner.

Almost two-thirds failed to provide transparency in procurement, half bypassed their parliaments, and only a quarter published expedited audit reports.

No countries were judged as having had “substantive” accountability.

Australia’s accountability practices included delivering an Economic and Fiscal Update in place of its postponed May budget and establishing an opposition-chaired Senate select committee to monitor its responses to the pandemic.

Despite the parliament only meeting intermittently early in the pandemic, the select committee and other parliamentary committees continued to hold public hearings virtually to fill the accountability gap.

Nevertheless, the Senate select committee faced difficulties in gaining access to the government’s underlying modelling of its response packages.

Adequate, if not substantive, accountability

As well, the Australian National Audit Office failed to get an increase in funding to deal with the extra work necessitated by the government’s responses to the pandemic. Instead, its funding was cut in the October budget.

And the Morrison government failed to publish an analysis of the gender impact of its responses, something that became problematic as it emerged women had been disproportionately affected by the pandemic.

The global study was completed in January 2021, with Australia’s accountability practices examined by the Australian National University’s Tax and Transfer Policy Institute.

Since then, there have been welcome developments.

The May 2021 budget reversed the budget cuts to the Audit Office by allocating an extra A$61.5 million over four years, enabling it to take on more staff to conduct more post-pandemic performance audits.

And the long-absent women’s budget statement returned to the official budget papers.

It’s too early to know whether these changes will make a lasting difference.

Much will depend on how the content of the women’s budget statement and funding of the audit office develop.

A lasting difference would give Australia a chance to be assessed next time as “substantively” accountable.

Miranda Stewart, Professor, The University of Melbourne and Teck Chi Wong, Research Assistant at the Tax and Transfer Policy Institute, Crawford School of Public Policy, Australian National University

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

No, OCD in a pandemic doesn’t necessarily get worse with all that extra hand washing

Posted on April 29, 2021 by particularkev

Carey Wilson, The University of Melbourne and Thibault Renoir, Florey Institute of Neuroscience and Mental HealthAt the beginning of the COVID-19 pandemic, we were concerned infection control measures such as extra hand washing and social distancing might compound the distress of people living with obsessive-compulsive disorder (OCD).

Early anecdotal evidence and case studies reported an apparent increase in OCD relapse rates and symptom severity.

But a year on, we’re learning this is not necessarily the case, and research is giving us a more nuanced understanding of what it’s like to have OCD during a pandemic.

What is OCD?

OCD is a common and disabling condition, affecting roughly 1.2% of Australians.

It’s characterised by obsessions (repetitive intrusive thoughts) and compulsions (physical actions or mental rituals) that attempt to quell these preoccupations.

There are several subtypes of OCD, including:

contamination: characterised by obsessions and compulsions centred around washing, cleaning and concerns around personal hygiene and health
overresponsibility: encompassing pathological doubt, concerns over unintentional harm to others or oneself, and persistent urges to check things
symmetry: obsessions about things feeling “just right” (for example, uniform and/or symmetrical), resulting in ritualistic behaviours including counting and ordering
taboo: characterised by unwanted intrusive thoughts that are often violent, sexual or religious in nature.

Although we don’t fully understand what causes OCD, research points to abnormal activity of specific brain networks, including a network called the cortico-striatal-thalamo-cortical loop.

This network connects key emotional, cognitive and motor hubs in the brain, and it’s particularly important for higher-order cognitive tasks such as thinking flexibly.

No, people with OCD aren’t ‘quirky’

There are several prevailing stereotypes about what it means to live with OCD, such as a belief people with the disorder are just a bit quirky, overly particular, “neat freaks” or “germ-phobic”.

Such ideas are frequently promulgated in popular culture. For example, in 2018 Khloe Kardashian promoted her “KHLO-C-D” branding for an online miniseries in which she gave tips on home organisation and cleanliness. The campaign was widely criticised.

While contamination fears and an affinity for symmetry are better recognised in the community (perhaps owing to portrayals in TV and film), the “taboo” and “overresponsibility” dimensions of OCD are far less understood and are therefore subject to higher levels of stigma.

Are we all OCD now?

The global response to COVID-19 has blurred the line between pathological behaviours and adaptive health and safety measures.

Behaviours that were previously linked to psychiatric illnesses, such as repetitive washing and sanitising rituals, are now encouraged (at least to some extent) by health authorities.

While infection control directives such as social distancing and hand hygiene play an essential role in our fight against the virus, they take a psychological toll too.

The pandemic has had a profound effect on mental health due to increased stress and lifestyle changes. Indeed, scientists have recently proposed a condition called “COVID-19 stress syndrome”. Some of the symptoms significantly overlap with anxiety disorders and OCD.

While we don’t all have OCD now, it’s unquestionable our collective behaviour has changed in ways that make the distinction between “normal” and “pathological” much more complex.

In this light, the International College of Obsessive–Compulsive Spectrum Disorders has highlighted the unique challenges the pandemic poses for accurately diagnosing OCD.

Living with OCD in a pandemic

Having a pre-existing mental health condition appears to be the single most influential predictor of high stress levels during COVID-19.

However, recent evidence from well-controlled studies doesn’t find compelling evidence that people with OCD have been affected by COVID-19 to a greater extent than those with other psychological conditions (such as depression or general anxiety).

One study published in January compared OCD severity in a large group before and during the pandemic. It found the stress induced by COVID-19 increased measures of mental distress across all OCD symptom dimensions (not only those directly related to a public health crisis).

The authors suggested the increase in OCD symptom severity was likely a “non-specific stress-related response”. In other words, it’s the general stress of the pandemic that has worsened OCD in some cases; not the increased focus on infection control.

A woman sitting on the couch, appears pensive or unhappy. — Having a pre-existing mental health condition is the biggest risk factor for having high stress levels during the pandemic.
Shutterstock

Another recent study found the pandemic didn’t lessen the benefits of treatment in a large outpatient group with OCD in India.

Interestingly, the researchers from this study also found prior incomplete disease remission (cases of OCD that persisted even with treatment) and general stress were the best predictors of OCD relapse during the pandemic, rather than “COVID-specific” stress, per se.

After the pandemic

These findings don’t suggest there’s a specific vulnerability to COVID-related stress for people with OCD.

But it’s worth noting cognitive inflexibility, a symptom often seen in OCD, may make it more difficult for people with the disorder to “unlearn” temporary public health directives.

So it’s important we continue to monitor the effects of COVID-related stress on OCD and similar disorders, particularly as we slowly transition from the pandemic.

There’s much we can learn from the study of OCD during COVID-19. Most notably, it appears an “intuitive” understanding of the disorder doesn’t sufficiently capture the breadth of individual OCD experiences.

A deeper understanding of the variability of OCD presentations, and a move away from stereotyped perceptions, may encourage more people to openly discuss their own OCD experience and seek treatment.

Need support?

If you live in Australia, call Lifeline (13 11 14), Kids Helpline (1800 551 800) or BeyondBlue (1800 512 348). Alternatively, “OCD STOP!” is a free online program designed to help you better understand and manage OCD.

If you simply want to learn more about OCD, online resources are available at SANE Australia and Beyond Blue.

Carey Wilson, PhD Candidate, The University of Melbourne and Thibault Renoir, Head of Genes Environment and Behaviour Laboratory, Florey Institute of Neuroscience and Mental Health

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

Will Vaccines End the Coronavirus Pandemic?

Posted on March 28, 2021 by particularkev

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

Posted on March 13, 2021 by particularkev

Michael Toole, Burnet Institute

One year ago today, the World Health Organization (WHO) declared COVID-19 a pandemic, the first caused by a coronavirus.

As we enter year two of the pandemic, let’s remind ourselves of some sobering statistics. So far, there have been more than 117.4 million confirmed cases of COVID-19 around the world; more than 2.6 million people have died. A total of 221 countries and territories have been affected. Some 12 of the 14 countries and territories reporting no cases are small Pacific or Atlantic islands.

Whether the race to end the pandemic will be a sprint or a marathon remains to be seen, as does the extent of the gap between rich and poor contestants. However, as vaccines roll out across the world, it seems we are collectively just out of the starting blocks.

Here are the challenges we face over the next 12 months if we are to ever begin to reduce COVID-19 to a sporadic or endemic disease.

Vaccines are like walking on the Moon

Developing safe and effective vaccines in such a short time frame was a mission as ambitious, and with as many potential pitfalls, as walking on the Moon.

Miraculously, 12 months since a pandemic was declared, eight vaccines against SARS-CoV-2, the virus that causes COVID-19, have been approved by at least one country. A ninth, Novavax, is very promising. So far, more than 312 million people have been vaccinated with at least one dose.

While most high-income countries will have vaccinated their populations by early 2022, 85 poor countries will have to wait until 2023.

This implies the world won’t be back to normal travel, trade and supply chains until 2024 unless rich countries take actions — such as waiving vaccine patents, diversifying production of vaccines and supporting vaccine delivery — to help poor countries catch up.

The vaccines have been shown to be safe and effective in preventing symptomatic and severe COVID-19. However, we need to continue to study the vaccines after being rolled out (conducting so-called post-implementation studies) in 2021 and beyond. This is to determine how long protection lasts, whether we need booster doses, how well vaccines work in children and the impact of vaccines on viral transmission.

What should make us feel optimistic is that in countries that rolled out the vaccines early, such as the UK and Israel, there are signs the rate of new infections is in decline.

What are the potential barriers to overcome?

One of the most salutary lessons we have learnt in the pandemic’s first year is how dangerous it is to let COVID-19 transmission go unchecked. The result is the emergence of more transmissible variants that escape our immune responses, high rates of excess mortality and a stalled economy.

Until we achieve high levels of population immunity via vaccination, in 2021 we must maintain individual and societal measures, such as masks, physical distancing, and hand hygiene; improve indoor ventilation; and strengthen outbreak responses — testing, contact tracing and isolation.

Office workers wearing masks, one santising hands — In 2021, we still need to wear masks, physically distance, clean our hands, and improve indoor ventilation.
from www.shutterstock.com

However, there are already signs of complacency and much misinformation to counter, especially for vaccine uptake. So we must continue to address both these barriers.

The outcomes of even momentary complacency are evident as global numbers of new cases once again increase after a steady two month decline. This recent uptick reflects surges in many European countries, such as Italy, and Latin American countries like Brazil and Cuba. New infections in Papua New Guinea have also risen alarmingly in the past few weeks.

Some fundamental questions also remain unanswered. We don’t know how long either natural or vaccine-induced immunity will last. However, encouraging news from the US reveals 92-98% of COVID-19 survivors had adequate immune protection six to eight months after infection. In 2021, we will continue to learn more about how long natural and vaccine-induced immunity lasts.

New variants may be the greatest threat

The longer the coronavirus circulates widely, the higher the risk of more variants of concern emerging. We are aware of B.1.1.7 (the variant first detected in the UK), B.1.351 (South Africa), and P.1 (Brazil).

But other variants have been identified. These include B.1.427, which is now the dominant, more infectious, strain in California and one identified recently in New York, named B.1.526.

Variants may transmit more readily than the original Wuhan strain of the virus and may lead to more cases. Some variants may also be resistant to vaccines, as has already been demonstrated with the B.1.351 strain. We will continue to learn more about the impact of variants on disease and vaccines in 2021 and beyond.

A year from now

Given so many unknowns, how the world will be in March 2022 would be an educated guess. However, what is increasingly clear is there will be no “mission accomplished” moment. We are at a crossroads with two end games.

In the most likely scenario, rich countries will return to their new normal. Businesses and schools will reopen and internal travel will resume. Travel corridors will be established between countries with low transmission and high vaccine coverage. This might be between Singapore and Taiwan, between Australia and Vietnam, and maybe between all four, and more countries.

In low- and middle-income countries, there may be a reduction in severe cases, freeing them to rehabilitate health services that have suffered in the past 12 months. These include maternal, newborn, and child health services, including reproductive health; tuberculosis, HIV and malaria programs; and nutrition. However, reviving these services will need rich countries to commit generous and sustained aid.

The second scenario, which sadly is unlikely to occur, is unprecedented global cooperation with a focus on science and solidarity to halt transmission everywhere.

This is a fragile moment in modern world history. But, in record time, we have developed effective tools to eventually control this pandemic. The path to a post-COVID-19 future can perhaps now be characterised as a hurdle race but one that presents severe handicaps to the world’s poorest nations. As an international community, we have the capacity to make it a level playing field.

Michael Toole, Professor of International Health, Burnet Institute

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

Government rejects Royal Commission’s claim of no aged care plan, as commission set to grill regulator

Posted on August 13, 2020 by particularkev

Michelle Grattan, University of Canberra

The federal government has clashed with the Royal Commission into Aged Care, strongly rejecting the claim by senior counsel assisting the inquiry Peter Rozen that it had no specific COVID-19 plan for the sector.

Aged Care Minister Richard Colbeck told a news conference: “We have had a plan to deal with COVID-19 in residential aged care, going right back to the beginnings of our preparations.

“We’ve been engaged with the sector since late January, and continuously working with the sector to ensure they have all the information they require and the support that they need in the circumstance that they might have an outbreak of COVID-19.”

Acting chief medical officer Paul Kelly said: “We have been planning for our aged population as a vulnerable group since the beginning of our planning in relation to COVID-19”. And there had been “very strong communication with the sector throughout,” he said.

Rozen, in a Monday statement at the opening of this week’s hearings on COVID in the aged care sector, said while much was done to prepare the health sector more generally for the pandemic, “neither the Commonwealth Department of Health nor the aged care regulator developed a COVID-19 plan specifically for the aged care sector”.

The sector had been underprepared, he said.

Asked whether the government’s plan had failed, Colbeck admitted there had been “some circumstances where things haven’t gone as we would like”, saying “the circumstance at St Basil’s [in Melbourne] is one, where we didn’t get it all right”.

On Wednesday the commission will take evidence from Janet Anderson, head of the Commonwealth regulator, the Aged Care Quality and Safety Commission, which Rozen said “did not have an appropriate aged care sector COVID-19 response plan”.

The government has left Anderson out to dry, after it was belatedly discovered her body was told of an outbreak at St Basil’s two days after a staffer was diagnosed, but it failed to pass on the information.

Quizzed about this, Colbeck said under the protocols, “the Commonwealth should have been advised of the outbreak on 9 July by either the Victorian health department or St Basil’s management or both. Instead it was formally informed on July 14.”

But he was also critical of the Quality and Safety Commission which was informed of the outbreak when it was speaking to the home as part of a survey about preparedness and infection control.

“The disappointing thing, from my perspective, is that the information that was gleaned … about a positive outbreak wasn’t passed on to anyone else,” Colbeck said.

“There was an assumption made … that information had already been passed on. It wasn’t.

“The gap in the supply chain, or the information chain, has now been closed. … There should not have been a hole in our systems. That’s been rectified appropriately, as it should have been.”

Michelle Grattan, Professorial Fellow, University of Canberra

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

Australians highly confident of government’s handling of coronavirus and economic recovery: new research

Posted on July 22, 2020 by particularkev

Mark Evans, University of Canberra

Australians have exhibited high levels of trust in federal government during the coronavirus pandemic, a marked shift from most people’s views of government before the crisis began, new research shows.

Australians are also putting their trust in government at far higher rates than people in three other countries badly affected by the virus – the US, Italy and the UK.

The findings, published today in a new report, “Is Australia still the lucky country?”, are part of a broader comparative research collaboration between the Democracy 2025 initiative at the Museum of Australian Democracy and the TrustGov Project at the University of Southampton in the UK.

The research involved surveys of adults aged between 18 and 75 in all four countries in June to gauge whether public attitudes toward democratic institutions and practices had changed during the pandemic. We also asked about people’s compliance with coronavirus restrictions and their resilience to meet the challenge of the post-pandemic recovery.

The main proposition behind our research is that public trust is critical in times like this. Without it, the changes to public behaviour necessary to contain the spread of infection are slower and more resource-intensive.

Levels of trust higher for most institutions

Australians are now exhibiting much higher levels of political trust in federal government (from 25% in 2019 to 54% in our survey), and the Australian public service (from 38% in 2018 to 54% in our survey).

Compared to the other three countries in our research, Australia’s trust in government also comes out on top. In the UK, only 41% of participants had high trust in government, while in Italy it was at 40% and the US just 34%.

Confidence in key institutions

Percentage who say they have ‘a great deal’ or ‘quite a lot’ of confidence. (Note: the survey collect data on the Australian parliament as it didn’t convene during the period of data collection.)
Democracy 2025/TrustGov survey; Author provided

Australians also have high levels of confidence in institutions related to defence and law and order, such as the army (78%), police (75%) and the courts (55%). Levels of trust are also high in the health services (77%), cultural institutions (70%) and universities (61%). Notably, Australians exhibit high levels of trust in scientists and experts (77%).

These figures were comparable with the other countries in the survey, with the notable exception of Americans’ confidence in the health services, which stood at just 48%.

Although Australians continue to have low levels of trust in social media (from 20% in 2018 to 19% in our survey), confidence is gaining in other forms of news dissemination, such as TV (from 32% in 2018 to 39%), radio (from 38% in 2018 to 41%) and newspapers (from 29% in 2018 to 37%).

Public trust in various media, scientists and experts

How does Morrison compare with Trump and other leaders?

Prime Minister Scott Morrison is perceived to be performing strongly in his management of the crisis by a significant majority of Australians (69%).

Indeed, he possesses the strongest performance measures in comparison with Italy (52% had high confidence in Prime Minister Giuseppe Conte), the UK (37% for Prime Minister Boris Johnson) and the US (35% for President Donald Trump).

Morrison also scores highly when it comes to listening to experts, with 73% of Australians saying he does, compared to just 33% of Americans believing Trump does.

Public perceptions of leadership

Percentage of respondents in four countries who ‘agree’ or ‘strongly agree’ with statements about how their leader is handling COVID-19.
Democracy 2025/TrustGov survey; Author provided

Interestingly, Morrison’s approval numbers are also far higher than the state premiers in Australia. Only 37% of our respondents on average think their state premier or chief minister is “handling the coronavirus situation well”. Tasmanians (52%) and Western Australians (49%) had the highest confidence in their leaders’ handling of the crisis.

This suggests that in Australia, the politics of national unity (the “rally around the flag” phenomenon) is strong in times of crisis, whereas people tend to view the leaders of states or territories as acting in their own self-interest.

Perceptions of the quality of state and territory leadership

Compliance and resilience

Our findings also showed most Australians were complying with the key government measures to combat COVID-19, but were marginally less compliant than their counterparts in the UK. (Australians are relatively equal with Italians and Americans.)

Among the states and territories, Victorians have been the most compliant with anti-COVID-19 measures, while the ACT, Tasmania and the Northern Territory were the least compliant. This is in line with the low levels of reported cases in these jurisdictions and by the lower public perception of the risk of infection.

When it comes to resilience to meet the challenges of the post-pandemic recovery, we considered confidence in social, economic and political factors.

Although a majority of Australians (60%) expect COVID-19 to have a “high” or “very high” level of financial threat for them and their families, they are less worried than their counterparts in Italy, the UK and US about the threat COVID-19 poses “to the country” (33%), “to them personally” (19%), or “to their job or business” (29%).

Perceptions of the level of threat posed by COVID-19

Percentage of respondents who agree or strongly agree with the statements about the economic threat posed by coronavirus.
Democracy 2025/TrustGov survey; Author provided.

About half of all Australians believe the economy will get worse in the next year (this is slightly higher than in the US but much lower than in the UK and Italy). In Australia, women, young people, Labor voters and those on lower incomes with lower levels of qualifications are the most pessimistic on all confidence measures.

However, Australians remain highly confident the country will bounce back from COVID-19, with most believing Australia is “more resilient than most other countries” (72%).

Perceptions of Australian resilience

We also assessed whether views about how democracy works should change as a result of the pandemic. An overwhelming majority of people said they wanted politicians to be more honest and fair (87%), be more decisive but accountable for their actions (82%) and be more collaborative and less adversarial (82%).

Staying lucky

Australia has been lucky in terms of its relative geographical isolation from international air passenger traffic during the pandemic.

But Australia has also benefited from effective governance – facilitated by strong political bipartisanship from Labor – and by atypical coordination of state and federal governments via the National Cabinet.

The big question now is whether Morrison can sustain strong levels of public trust in the recovery period.

There are two positive lessons to be drawn from the government’s management of COVID-19 in this regard.

First, the Australian people expects their governments to continue to listen to the experts, as reflected in the high regard that Australians have for evidence-based decision-making observed in the survey.

Second, the focus on collaboration and bipartisanship has played well with an Australian public fed up with adversarial politics.

The critical insight then is clear: Australia needs to embrace this new style of politics – one that is cleaner, collaborative and evidence-based – to drive post-COVID-19 recovery and remain a lucky country.

Mark Evans, Professor of Governance and Director of Democracy 2025 – bridging the trust divide at Old Parliament House, University of Canberra

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

Alert but not alarmed: what to make of new H1N1 swine flu with ‘pandemic potential’ found in China

Posted on July 4, 2020 by particularkev

Ian M. Mackay, The University of Queensland

Researchers have found a new strain of flu virus with “pandemic potential” in China that can jump from pigs to humans, triggering a suite of worrying headlines.

It’s excellent this virus has been found early, and raising the alarm quickly allows virologists to swing into action developing new specific tests for this particular flu virus.

But it’s important to understand that, as yet, there is no evidence of human-to-human transmission of this particular virus. And while antibody tests found swine workers in China have had it in the past, there’s no evidence yet that it’s particularly deadly.

What we know so far

China has a wonderful influenza surveillance system across all its provinces. They keep track of bird, human and swine flus because, as the researchers note in their paper, “systematic surveillance of influenza viruses in pigs is essential for early warning and preparedness for the next potential pandemic.”

In their influenza virus surveillance of pigs from 2011 to 2018, the researchers found what they called “a recently emerged genotype 4 (G4) reassortant Eurasian avian-like (EA) H1N1 virus.” In their paper, they call the virus G4 EA H1N1. It has been ticking over since 2013 and became the majority swine H1N1 virus in China in 2018.

In plain English, they discovered a new flu that’s a mix of our human H1N1 flu and an avian-based flu.

What’s interesting is antibody tests picked up that workers handling swine in these areas have been infected. Among those workers they tested, about 10% (35 people out of 338 tested) showed signs of having had the new G4 EA H1N1 virus in the past. People aged between 18 to 35 years old seemed more likely to have had it.

Of note, though, was that a small percentage of general household blood samples from people who were expected to have had little pig contact were also antibody positive (meaning they had the virus in the past).

Importantly, the researchers found no evidence yet of human-to-human transmission. They did find “efficient infectivity and aerosol transmission in ferrets” – meaning there’s evidence the new virus can spread by aerosol droplets from ferret to ferret (which we often use as surrogates for humans in flu studies). G4-infected ferrets became sick, lost weight and acquired lung damage, just like those infected with one of our seasonal human H1N1 flu strains.

They also found the virus can infect human airway cells. Most humans don’t already have antibodies to the G4 viruses meaning most people’s immune systems don’t have the necessary tools to prevent disease if they get infected by a G4 virus.

In summary, this virus has been around a few years, we know it can jump from pigs to humans and it ticks all the boxes to be what infectious disease scholars call a PPP — a potential pandemic pathogen.

If a human does get this new G4 EA H1N1 virus, how severe is it?

We don’t have much evidence to work with yet but it’s likely people who got these infections in the past didn’t find it too memorable. There’s not a huge amount of detail in the new paper but of the people the researchers sampled, none died from this virus.

There’s no sign this new virus has taken off or spread in the regions of China where it was found. China has excellent virus surveillance systems and right now we don’t need to panic.

The World Health Organisation has said it is keeping a close eye on these developments and “it also highlights that we cannot let down our guard on influenza”.

What’s next?

People in my field — infectious disease research — are alert but not alarmed. New strains of flu do pop up from time to time and we need to be ready to respond when they do, watching carefully for signs of human-to-human transmission.

As far as I can tell, the specific tests we use for influenza in humans won’t identify this new G4 EA H1N1 virus, so we should design new tests and have them ready. Our general flu A screening test should work though.

In other words, we can tell if someone has what’s called “Influenza A” (one kind of flu virus we usually see in flu season) but that’s a catch-all term, and there are many strains of flu within that category. We don’t yet have a customised test to detect this new particular strain of flu identified in China. But we can make one quickly.

Being prepared at the laboratory level if we see strange upticks in influenza is essential and underscores the importance of pandemic planning, ongoing virus surveillance and comprehensive public health policies.

And as with all flus, our best defences are meticulous hand washing and keeping physical distance from others if you, or they, are at all unwell.

Ian M. Mackay, Adjunct assistant professor, The University of Queensland

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

The next once-a-century pandemic is coming sooner than you think – but COVID-19 can help us get ready

Posted on June 15, 2020 by particularkev

David Murdoch, University of Otago

COVID-19 is being referred to as a “once in a century event” – but the next pandemic is likely to hit sooner than you think.

In the next few decades, we will likely see other pandemics. We can predict that with reasonable confidence because of the recent increased frequency of major epidemics (such as SARS and Ebola), and because of social and environmental changes driven by humans that may have contributed to COVID-19’s emergence.

A COVID-19-type pandemic had long been predicted, but scientists’ warnings weren’t heeded. Right now, while we have the full attention of politicians and other key decision-makers, we need to start rethinking our approaches to future preparedness internationally and within our own nations. That includes countries like New Zealand, where – despite getting its active COVID-19 cases down to zero in June 2020 – big challenges remain.

We can’t say we weren’t warned

Less than five years ago, I was one of about 100 global experts invited to a World Health Organization (WHO) meeting in Geneva, prompted by the then ongoing Ebola outbreak in West Africa.

Then, as now, WHO was criticised for its response to the outbreak. The December 2015 meeting was meant to improve international collaboration and preparation for future epidemics and other infectious disease risks.

The very last presentation was from Dr David Nabarro, then the United Nations Special Envoy on Ebola (and now a Special Envoy on COVID-19).

In the wake of the Ebola outbreak, politicians were more focused on public health than ever before. Nabarro urged us to show greater leadership and capture that interest, before political and public attention moved on. He stressed the importance of trust, respect, transparent communication, and working with nature.

Yet five years later, we’re still talking about inadequate funding for pandemic preparedness; delays in adopting preventive measures; failure to develop surge capacity in health systems, laboratories and supply chain logistics; and reduced infectious disease expertise.

But there are signs that some lessons may have been learned. For example, countries most affected by SARS (such as Taiwan and Singapore) have tended to respond more quickly and decisively to COVID-19 than other countries.

Primed and ready, vaccine developers have progressed at enormous pace, with several COVID-19 vaccine candidates already undergoing clinical trials. The volume and pace of sharing scientific information about COVID-19 has been unprecedented.

We’ve also seen a number of rapid reports urging us to learn from this pandemic and past epidemics to protect us from future events – especially by taking an holistic “One Health” approach. This brings together expertise across human health, animal health and the environment.

For instance, last month the Lancet One Health Commission called for more transdisciplinary collaboration to solve complex health challenges. Similarly, the World Wide Fund for Nature’s March 2020 report on The Loss of Nature and Rise of Pandemics highlighted the likely animal origin of COVID-19, and how intimately connected the health of humans is to animal and environmental health.

What New Zealand can learn from COVID-19

As well as working more effectively together internationally, each country will need its own strategy. So what should we be doing to protect New Zealand from future infectious diseases threats?

Our health system has, for the most part, responded well to COVID-19. Our research institutions and universities have engaged quickly and effectively to provide scientific support for the public health response.

Yet we can and must still do better. Our expertise and systems are not always well joined up – vital for coordinated and timely responses to challenges like COVID-19.

We allow scientists to work in silos, despite obvious overlapping interests and skill sets. Of particular importance for tackling infectious diseases is the need to break down artificial barriers between human, animal and environmental health.

This approach makes particular sense in New Zealand. We are an island nation vulnerable to introduced infectious diseases, and economically dependent on agriculture and the physical environment. But we’re also home to an existing indigenous Māori worldview and knowledge system that emphasises interconnectivity between humans, animals and the environment.

University-led efforts, such as One Health Aotearoa, have brought together professionals and researchers from different disciplines. But more investment is needed to get even better value from such collaborations.

We need to strengthen capability in such areas as epidemiology, modelling and outbreak management, and build pandemic plans that are flexible enough to respond to all eventualities. New Zealand has a Centre of Research Excellence in plant biosecurity – but not in animal biosecurity or infectious diseases.

We also need to better integrate science and research into the health system, a key feature of the New Zealand Health Research Strategy 2017-2027. This requires a culture change so research is regarded as business as usual for district health boards, providing the science needed to inform policy, preparedness and best practice.

Crucially, we need a new generation of scientists and professionals who are systems thinkers and comfortable working with multiple disciplines and across the human-animal-environment interface.

And we need the kind of leadership Nabarro called for: science-informed and forward-looking, rather than reactive.

We have seen good leadership based on science in the highest levels of New Zealand’s government in response to COVID-19.

We now need to see this at all levels of health, research and politics to get us out of this pandemic in the best shape possible – and be better prepared for our next pandemic.

David Murdoch, Dean and Head of Campus, University of Otago

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

China: The Beginning of the Pandemic in Wuhan

Posted on April 13, 2020 by particularkev

Random Thoughts

Sharing my thoughts with the world from a Particular Baptist perspective

Tag Archives: pandemic

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The next once-a-century pandemic is coming sooner than you think – but COVID-19 can help us get ready

We can’t say we weren’t warned

What New Zealand can learn from COVID-19

China: The Beginning of the Pandemic in Wuhan

Sharing my thoughts with the world from a Particular Baptist perspective

They’re similar in some ways …

… but not in others

How about vaccines?

TB vaccine may protect against COVID

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Adequate, if not substantive, accountability

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What is OCD?

No, people with OCD aren’t ‘quirky’

Are we all OCD now?

Living with OCD in a pandemic

After the pandemic

Need support?

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Vaccines are like walking on the Moon

What are the potential barriers to overcome?

New variants may be the greatest threat

A year from now

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Levels of trust higher for most institutions

How does Morrison compare with Trump and other leaders?

Compliance and resilience

Staying lucky

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What we know so far

If a human does get this new G4 EA H1N1 virus, how severe is it?

What’s next?

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We can’t say we weren’t warned

What New Zealand can learn from COVID-19

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