Cardiac arrests in young people — what causes them and can they be prevented or treated? A heart expert explains

Wolfgang Rattay/AP/AAP

Jessica Orchard, University of SydneyOn June 12, 16,000 spectators at Copenhagen’s Parken Stadium and millions of viewers around the world watched in shock as Danish midfielder Christian Eriksen’s heart stopped.

Late in the first half of Denmark’s opening game of the Euro 2020 soccer tournament against Finland, the 29 year-old was running just after a throw-in and suddenly collapsed. It appears he suffered a sudden cardiac arrest.

Fortunately, he was quickly attended to by a medical team with full resuscitation equipment, who administered CPR and successfully used a defibrillator. Erikson survived and has been fitted with an implantable cardiac defibrillator. This is a small device which is connected to the heart and fitted under the skin. If a dangerously abnormal rhythm is detected, it will deliver an electric shock to the heart to try to restore a normal rhythm.

So how often do cardiac arrests happen in young people? What are the risk factors, and can they be prevented?

Cardiac arrests during sport are extremely rare. If you’re playing sport next weekend, you should go ahead in the knowledge it’s almost certain not to happen. The benefits of exercise far outweigh the risks.

But because events like this do happen, albeit very rarely, we need public venues to have good emergency plans to improve survival, including the widespread availability of defibrillators.

There have been some recent improvements in this regard in Australia. For example, defibrillators are now installed in all Coles and Woolworths stores nationally, and there are several programs to support rollout of defibrillators and emergency action plans to community sports clubs. But there’s still room for improvement.

Am I at risk? How often does this happen?

Sudden death from cardiac arrest in a young person is a very rare but tragic outcome. The baseline risk in Australia for people under 35 is 1.3 per 100,000 people per year, with 15% occurring either during or immediately after exercise.

Across all ages, there are 20,000 sudden cardiac arrests in Australia that occur out of hospital every year, and sadly only 10% of people survive.

It’s also worth remembering a cardiac arrest isn’t exactly the same thing as a heart attack. A heart attack occurs when one of the coronary arteries is blocked, stopping blood supply to part of the heart. A cardiac arrest is when the heart stops pumping blood around the body, and can occur due to a heart attack or another cause.

The major causes of cardiac arrest depend on age. In people over 35, the vast majority are caused by coronary artery disease, where arteries supplying blood to the heart are blocked or damaged.

In people aged under 35, there’s no single major cause of cardiac arrest. Some of the conditions that can cause cardiac arrest in young people include:

• a condition where the heart muscle becomes too thick, called “hypertrophic cardiomyopathy”
• other conditions of the heart muscle that make it harder for the heart to work properly (called “cardiomyopathies”)
• a condition called “Long QT syndrome” which can cause a dangerously erratic heartbeat
• “Brugada syndrome”, which is a heart rhythm disorder.

However, 40% of sudden cardiac deaths in young people remain unexplained even after autopsy.

Is cardiac screening the answer?

Cardiac screening in young people looks for certain heart abnormalities that haven’t yet been detected. It’s common for elite and professional athletes in Australia and internationally, and is mandatory for young athletes in some countries, for example Italy and Israel.

This screening usually includes a “12-lead electrocardiogram” or ECG, which is a painless test that involves putting some sticky dots on the body and recording the electrical activity of the heart over a ten second period.

However, ECG screening cannot detect all of the conditions which can cause sudden cardiac arrests. This is because some conditions don’t show ECG abnormalities before a cardiac arrest.

Eriksen’s condition was likely in that category, because we know he had regular heart screenings while at Tottenham and these hadn’t shown any problems.

Medicare in Australia funds heart health checks for people who are middle aged or older, but not in younger people. This is similar to most countries. Other than in professional athletes and those with a family history, most professional bodies don’t recommend widespread screening of younger people because the risk of cardiac arrests is so low overall.

How else can we prevent sudden cardiac death? Defibrillators and data

The best strategy for preventing sudden cardiac death at any age is having defibrillators widely available. A defibrillator is a device that can analyse the heart’s rhythm and deliver an electric shock if needed. This can shock the heart back into a normal rhythm.

While they obviously can’t stop the cardiac arrest happening in the first place, they are crucial to survival once they do happen. Early access to a defibrillator can improve survival to almost 90%.

However, access needs to be very quick, ideally within 2-5 minutes, as we know the chances of survival drop by 10% for every minute of delay before defibrillation.

We also need as many as people as possible to be regularly trained to provide CPR.

Fabrice Muamba, a former midfielder for the Bolton Wanderers soccer team in the UK, was lucky to survive after he collapsed and his heart stopped on the field during a 2012 FA cup quarter-final.

Muamba, who recovered after he received CPR and 26 defibrillator shocks, last week voiced his support for defibrillators to be a legal requirement in public places in the UK. Ideally, Australia could also introduce a similar requirement to have defibrillators in public venues, supported by widespread CPR training (including how to use a defibrillator) to improve survival rates from out of hospital cardiac arrests.

In addition to defibrillators and CPR training, venues such as schools and sporting stadiums need to have good cardiac emergency plans so they can respond efficiently and effectively if someone’s heart stops.

Some of the conditions that are diagnosable prior to a cardiac arrest run in families, such as “Long QT syndrome”. So, it’s important to seek medical advice for anyone with a family member who has had cardiac arrest under the age of 40.

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Importantly, anyone who has any worrying symptoms should seek medical advice, especially fainting or collapse during exercise.

Finally, research projects such as the Australian End Unexplained Cardiac Death (EndUCD) registry are urgently needed to identify the underlying causes of cardiac death in young people so we can prevent deaths from sudden cardiac arrest.

Jessica Orchard, Postdoctoral Fellow, Centenary Institute; and Adjunct Senior Lecturer, University of Sydney

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

What is drink spiking? How can you know if it’s happened to you, and how can it be prevented?

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Nicole Lee, Curtin University and Jarryd Bartle, RMIT UniversityRecent media reports suggest drink spiking at pubs and clubs may be on the rise.

“Drink spiking” is when someone puts alcohol or other drugs into another person’s drink without their knowledge.

It can include:

• putting alcohol into a non-alcoholic drink
• adding extra alcohol to an alcoholic drink
• slipping prescription or illegal drugs into an alcoholic or non-alcholic drink.

Alcohol is actually the drug most commonly used in drink spiking.

The use of other drugs, such as benzodiazepines (like Rohypnol), GHB or ketamine is relatively rare.

These drugs are colourless and odourless so they are less easily detected. They cause drowsiness, and can cause “blackouts” and memory loss at high doses.

Perpetrators may spike victims’ drinks to commit sexual assault. But according to the data, the most common type of drink spiking is to “prank” someone or some other non-criminal motive.

So how can you know if your drink has been spiked, and as a society, how can we prevent it?

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How often does it happen?

We don’t have very good data on how often drink spiking occurs. It’s often not reported to police because victims can’t remember what has happened.

If a perpetrator sexually assaults someone after spiking their drink, there are many complex reasons why victims may not want to report to police.

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One study, published in 2004, estimated there were about 3,000 to 4,000 suspected drink spiking incidents a year in Australia. It estimated less than 15% of incidents were reported to police.

It found four out of five victims were women. About half were under 24 years old and around one-third aged 25-34. Two-thirds of the suspected incidents occurred in licensed venues like pubs and clubs.

According to an Australian study from 2006, around 3% of adult sexual assault cases occurred after perpetrators intentionally drugged victims outside of their knowledge.

It’s crucial to note that sexual assault is a moral and legal violation, whether or not the victim was intoxicated and whether or not the victim became intoxicated voluntarily.

How can you know if it’s happened to you?

Some of the warning signs your drink might have been spiked include:

• feeling lightheaded, or like you might faint
• feeling quite sick or very tired
• feeling drunk despite only having a very small amount of alcohol
• passing out
• feeling uncomfortable and confused when you wake up, with blanks in your memory about what happened the previous night.

If you think your drink has been spiked, you should ask someone you trust to get you to a safe place, or talk to venue staff or security if you’re at a licensed venue. If you feel very unwell you should seek medical attention.

If you believe your drink has been spiked or you have been sexually assaulted, seeking prompt medical attention can assist in subsequent criminal prosecution. Medical staff can perform a blood test for traces of drugs in your system.

How can drink spiking be prevented?

Most drink spiking occurs at licensed venues like pubs and clubs. Licensees and people who serve alcohol have a responsibility to provide a safe environment for patrons, and have an important role to play in preventing drink spiking.

This includes having clear procedures in place to ensure staff understand the signs of drink spiking, including with alcohol.

Preventing drink spiking is a collective responsibility, not something to be shouldered by potential victims.

Licensees can take responsible steps including:

• removing unattended glasses
• reporting suspicious behaviour
• declining customer requests to add extra alcohol to a person’s drink
• supplying water taps instead of large water jugs
• promoting responsible consumption of alcohol, including discouraging rapid drinking
• being aware of “red flag” drink requests, such as repeated shots, or double or triple shots, or adding vodka to beer or wine.

Bartenders should be wary of ‘red flag’ drinks requests like people asking for double or triple shots.
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A few simple precautions everyone can take to reduce the risk of drink spiking include:

• have your drink close to you, keep an eye on it and don’t leave it unattended
• avoid sharing beverages with other people
• purchase or pour your drinks yourself
• if you’re offered a drink by someone you don’t know well, go to the bar with them and watch the bartender pour your drink
• if you think your drink tastes weird, pour it out
• keep an eye on your friends and their beverages too.

What are the consequences for drink spiking in Australia?

It’s a criminal offence to spike someone’s drink with alcohol or other drugs without their consent in all states and territories.

In some jurisdictions, there are specific drink and food spiking laws. For example, in Victoria, the punishment is up to two years imprisonment.

In other jurisdictions, such as Tasmania, drink spiking comes under broader offences such as “administering any poison or other noxious thing with intent to injure or annoy”.

Spiking someone’s drink with an intent to commit a serious criminal offence, such as sexual assault, usually comes with very severe penalties. For example, this carries a penalty of up to 14 years imprisonment in Queensland.

There are some ambiguities in the criminal law. For example, some laws aren’t clear about whether drink spiking with alcohol is an offence.

However, in all states and territories, if someone is substantially intoxicated with alcohol or other drugs it’s good evidence they aren’t able to give consent to sex. Sex with a substantially intoxicated person who’s unable to consent may constitute rape or another sexual assault offence.

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Getting help

In an emergency, call triple zero (000) or the nearest police station.

For information about sexual assault, or for counselling or referral, call 1800RESPECT (1800 737 732).

If you’ve been a victim of drink spiking and want to talk to someone, the following confidential services can help:

– Beyond Blue: 1300 22 4636

– Kids Helpline (5-25 year olds): 1800 55 1800

– National Alcohol and other Drug Hotline: 1800 250 015.

Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin University and Jarryd Bartle, Sessional Lecturer, RMIT University

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

Eliminating most homelessness is achievable. It starts with prevention and ‘housing first’

Angela Spinney, Swinburne University of Technology

The stereotype of a homeless person – those living in tents or sleeping in parks or doorways – is just the visible tip of the much larger crisis of homelessness in Australia.

For every one of about 8,000 “rough sleepers” there about 14 others staying in temporary accommodation or with others in severely crowded dwellings. That’s a total of more than 116,000 homeless Australians, according to Australian Bureau of Statistics census data.

About 60% are under the age of 35, though the number of homeless aged 55 and older has been steadily increasing. About a quarter are women and children fleeing domestic violence.

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The causes of homelessness are complex. The sterotype is that it involves mental illness and substance addiction. But the more common denominators are poverty, unemployment and a lack of affordable adequate housing.

Whatever the cause, research by myself and colleagues for the Australian Housing and Urban Research Institute proposes a path forward to reduce, and even eliminate, homelessness in Australia.

To do so requires moving away from treating the problem in an uncoordinated manner at the point of crisis and investing in an integrated system that prioritises prevention, fast rehousing and an adequate supply of affordable long-term housing.

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A historical legacy

Australia’s existing approach to dealing with homelessness is the legacy of a response originating in the 19th century, long before the advent of the modern welfare state, relying on charitable institutions to pick up the pieces of an economic system failing to care for the most vulnerable.

This has resulted in a somewhat chaotic system of small-scale and often disconnected services that are funded to only put a band-aid on the problem. It is mainly oriented towards crisis responses, with limited resources devoted to responding to homelessness once it has occurred, often only providing temporary relief from homelessness.

Federal, state and territory governments provide about A$250 million a year in funding to the 1,500 not-for-profit “specialist homelessness services” – organisations such as Launch Housing and Vincent Care – to provide support services and short-term accommodation in refuges, hostels, motels and caravan parks.

But this is insufficient to achieve the aim of even providing temporary accommodation to all those in need. Homeless services turn away almost 60% of those who ask for help. People instead have to rely on the kindness of family and friends, or sleep in their cars or on the street, while they wait to receive assistance. There is no statutory duty to provide assistance to homeless people in Australia.

The status quo is an expensive and unsatisfactory approach. We can do much better.

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Housing comes first

An emerging trend internationally is to reorient homelessness service systems away from a largely crisis response and towards prevention and long-term solutions.

The key is a “Housing First” approach, investing resources into first getting people into long-term accommodation, and then providing support to address the reasons they found themselves homeless in the first place.

Once housing is secured, relevant support workers can then support clients with particular needs, from preparing for employment, drug and alcohol rehabilitation, negotiating the legal system arising from domestic and family violence, and psychiatric or psychological counselling.

Evidence to the superiority of the “Housing First” approach comes from Norway. Over the past 12 years the number of homeless Norwegians has fallen by more than 35%. This compares with Australia’s approach, which in the past 20 years has managed to only marginally reduce the number of rough sleepers while other categories of homelessness have continued to rise.

We need an integrated strategy

A clear deficiency in Australia’s approach to homelessness has been the lack of any integrated national strategy and leadership. This means funding arrangements in states and territories are piecemeal and inadequate.

The first step in moving to a “Housing First” approach is coordinated federal and state funding for an adequate supply of affordable and social housing.

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Australian Bureau of Statistics, Author provided

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As we outline in our new report Ending homelessness in Australia: A redesigned homelessness service system, an integrated national strategy would also include an enhanced role for universal welfare services such as primary health services, schools and colleges to assist people at risk of homelessness.

They would have a duty to prevent homelessness when possible, assisting clients to maintain their existing housing or to access new housing. Where this is not possible, they would refer clients to specialist housing services for assistance finding crisis accommodation, and then long-term housing.

In this system, providing crisis accommodation would be the solution of last resort.

That affordable housing is the first step in solving homelessness may seem startlingly obvious. But, counterintuitively, that’s not the premise of how the current system works.

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We cannot stress enough how much an adequate planned supply of long-term affordable and social housing that is appropriate, secure and safe is vital to any successful attempt to end homelessness.

Angela Spinney, Lecturer/Research Fellow in Housing and Urban Studies, Swinburne University of Technology

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

We could be doing more to prevent vision loss for people with diabetes

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Clare Villalba, Queensland University of Technology; Anjali Jaiprakash, Queensland University of Technology, and Anthony Russell, The University of Queensland

Diabetes-related vision loss is the leading cause of blindness for working-aged Australians. Yet it’s almost entirely preventable.

A recent Australian study found only half of people with diabetes get the recommended annual eye checks.

We could be doing things better.

One of many complications

Around 1.7 million Australians have diabetes. Aboriginal and Torres Strait Islander people are three times more likely to develop diabetes than non-Indigenous Australians.

Diabetes occurs when glucose (sugar) in your blood is not converted into energy, so its level becomes too high. Blood glucose is our main source of energy and mostly comes from the food we eat.

Diabetes can be managed, for example through lifestyle modifications, medication, or insulin. Diabetes management will be a different experience for each person, and depend on the type of diabetes they have.

But the central aim is keeping blood sugar levels within a healthy range. When they’re not, people with diabetes are at higher risk of complications, which can affect all parts of the body.

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The most common complication of diabetes — globally and for Australians — is eye disease.

Diabetes-related eye disease affects more than one in three people with diabetes. When left undiagnosed and untreated, it can cause vision loss and blindness.

What causes it?

Diabetes-related eye disease can occur when there is damage to the blood vessels on the retina, a thin layer at the back of the eye. This damage limits oxygen and other nutrients reaching the eye.

We need a healthy retina to be able to see.

Diabetes-related eye disease can occur when the blood vessels at the back of the eye become damaged.
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The chance of developing diabetes-related eye disease is higher for some people, including those who have high blood pressure, high cholesterol, or who have had diabetes for many years.

Worryingly, the study we mentioned above found people who had been living with diabetes for ten or more years were even less likely to get regular eye checks. Almost 80% of people in this group didn’t have the recommended annual eye check.

Prevention and treatment

When diabetes-related eye disease becomes more advanced, it can cause blurred or distorted vision and blindness. But we can prevent most diabetes-related vision loss before it reaches this stage.

Special cameras allow us to look at the retina and see if irregular spots or blood vessels are developing.

At this early stage the disease has no impact on a person’s vision. Once we detect it, we can provide timely treatment with laser therapy or injections.

But without regular eye checks, we might not know until it’s too late.

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We have made progress

Strong social impact work from the government, not-for-profits and local health services is already preventing diabetes-related eye disease from developing into vision loss and blindness in many people.

2020 Australian of the Year, ophthalmologist James Muecke, cofounded the not-for-profit Sight For All and has brought attention to the issue of preventable vision loss for people with diabetes.

The federal government is investing in a national diabetes eye screening program, as well as primary health-care technology and training to embed retinal care in 105 existing health services across Australia. But national programs can put a blanket solution over the population.

When one Aboriginal and Torres Strait Islander health-care service introduced cameras in 2008, they screened 93% of regular clients with diabetes for eye disease — a significant improvement on 16% the previous year. But we found these rates subsequently declined and by 2016, only 22% had an eye check.

We can see just having the technology in primary care is not enough. Ongoing quality improvement is integral to a successful service in the long term.

About 1.7 million Australians have diabetes.
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What else can we do?

In the case of diabetes-related eye disease, the science supporting early detection is advancing every day. But it’s not reaching those who need it the most, including Aboriginal and Torres Strait Islander people.

Having the technology, policy or medicine alone is not sufficient. We need to unlock the potential of communities, empowering everyone to have joint responsibility.

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A model of person-centred eye care would involve:

• making screening and treatment easy to access for people with diabetes. This means addressing physical barriers, such as distance and cost, but also cultural, emotional and social barriers that might stop people from getting their eyes checked

• thinking about the screening experience, including:

  • before: how will we motivate people to get their eyes checked, especially if they’re not experiencing any problems with their vision?
  • during: how can eye checks be streamlined with regular diabetes care, and how can we make the process as seamless as possible for patients?
  • after: how do we ensure they come back every year?

• considering the experience of the diverse teams providing this care, including keeping staff well equipped, trained and motivated

• investing in researching, developing and testing the non-medical components of eye care services. For example, the reminder system, the workflow of each eye check, and how the results are delivered to patients.

We must pursue ongoing improvement of eye care that involves and empowers people with diabetes, their health teams and communities to develop services, systems, new technology and policies that meet their needs.

There is potential for us to prevent blindness in more people with diabetes.

Clare Villalba, Service Designer and Researcher (PhD), Queensland University of Technology; Anjali Jaiprakash, Senior Research Fellow and Deputy Director, Centre for Biomedical Technologies, Queensland University of Technology, and Anthony Russell, Associate Professor, Faculty of Medicine, The University of Queensland

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

We can’t ignore mental illness prevention in a COVID-19 world

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Stephen Carbone, University of Melbourne

Despite the incremental easing of Victoria’s restrictions, it’s clear the journey towards COVID-normal is far slower than many people had hoped.

Australians – particularly Victorians – have shown remarkable resilience, but many are suffering emotionally.

The mental health impacts of COVID-19

During the early days of the pandemic, surveys showed a sharp increase in symptoms of anxiety and depression across Australia. These difficulties continued into mid-August. More than 40% of Australians aged 18 years and older feel high levels of anxiety, and around one in six report depressive symptoms.

To target this, federal and state governments have increased telephone, online and face-to-face mental health supports. While this is vital, more needs to be done to prevent people suffering severe mental health problems in the first place.

Over 40% of Australians aged 18 years and older feel high levels of anxiety, and around 1 in 6 report depressive symptoms.
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Prevention is better than cure

There’s good evidence we can prevent many cases of depression, anxiety and substance abuse. But Australia doesn’t have a mental health prevention plan or policy, and government funding for prevention is just 1% of the total mental health budget.

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The Fifth National Mental Health and Suicide Prevention Plan, the government’s key mental health blueprint, focuses on improving mental health-care services and suicide prevention, but not on preventing the mental health conditions that are a major risk factor for suicide.

What about illness prevention?

Last month the federal government released a consultation paper on its proposed National Preventive Health Strategy, setting out what the strategy will aim to achieve and how it might be done.

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The document’s exciting because it focuses on health promotion and illness prevention, acknowledging we can’t improve the health of the Australian community through health-care measures alone.

But unfortunately, the proposed strategy’s fundamentally focused on physical health issues. In its 20 pages, the consultation paper only mentions mental health three times.

Government funding for prevention is just 1% of the total mental health budget. The National Preventive Health Strategy provides an opportunity to shed light on prevention measures for mental health conditions.
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The same principles outlined in the strategy to prevent conditions such as diabetes also apply to preventing mental health conditions such as depression. To prevent either, we need to minimise risk factors and increase protective factors linked to the condition, before it occurs. But some adaptation would be needed for the plan to address both physical and mental health.

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What prevention measures should be added?

A focus on physical activity, healthy eating, and non-smoking will help to promote good mental health as well as physical health.

Unemployment, a risk factor for a number of mental health conditions, is on the rise due to COVID-19.
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To prevent mental health issues we should focus on building people’s health literacy and self-care skills through public information campaigns and online learning programs. Supportive social environments can be encouraged by parenting programs, and school and workplace mental health promotion initiatives.

Local communities could also be mobilised to take positive action on local issues that contribute to poor health and mental health through place-based strategies. Place-based strategies aim to tackle issues existing at a neighbourhood level, such as social isolation and poor housing.

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Services could be reoriented towards prevention. Primary care professionals might provide advice on self-care and use social prescribing to address stress and enhance social supports. Social prescribing involves medical professionals linking patients to non-medical supports. For example, they may provide an “exercise prescription” or “art prescription”.

Finally, appropriate public policy solutions, such as JobSeeker and JobKeeper, that tackle the social and economic determinants of ill-health are needed.

Social factors matter too

Research also points to a strong link between mental health conditions and experience of childhood adversity, family violence, loneliness, racism, homophobia and transphobia. Workplace stressors, financial stress, unemployment and homelessness are also risk factors.

Many of these issues are on the increase because of COVID-19, so to safeguard mental health we need to tackle them and their impact. This will require the use of evidence-based preventive programs outlined above – many of which already exist but are not being implemented well or to sufficient scale. It will also require public policies to soften the economic blow and ease financial stress.

Targeting these issues will not only help to prevent mental health conditions, but physical health conditions as well.

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While better access to mental health-care services is important, it can’t solve all the mental health challenges posed by COVID-19. We also need to strengthen the factors that buffer people against stress, and tackle the underlying factors that contribute to poor mental health.

Whether we create a National Preventive Mental Health Plan, or embed mental health in the current National Preventive Health Strategy, one thing’s for sure: continuing to ignore the prevention of mental health conditions is not an option in a COVID-19 world.

Stephen Carbone, Honorary, School for Population and Global Health, University of Melbourne

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

Now we’re in lockdown, how can we get out? 4 scenarios to prevent a second wave

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James Trauer, Monash University; Ben J Marais, University of Sydney, and Emma McBryde, James Cook University

Australia is effectively in lockdown. Public gatherings of more than two people are banned and people are only permitted to leave home for a limited set of reasons.

The recent tough measures appear to be having some effect and the daily growth rate of new cases is now slowing.

Although this is an encouraging indication we may be starting to reverse the epidemic, we need now to start thinking about if, when and how we relax our current aggressive control measures.

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What are our options for coming out of lockdown?

Achieving control buys time and allows us to learn more about the virus and the successes and failures of other countries.

But until an effective vaccine arrives, the majority of the population will still lack immunity to COVID-19. This is essentially identical to the position we were in when the first imported cases of the coronavirus arrived in Australia.

While there has been debate about the speed at which restrictions have been introduced, there has been less discussion about how and when these measures can be relaxed without causing another spike in infections.

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The Guardian, CC BY

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We outline four broad options available for coming out of lockdown once we have gained initial control:

• option 1: we could relax lockdown measures completely, prioritising a return to normal social and economic freedoms over suppressing infection

• option 2: we could limit community transmission and ensure case rates remain very low until a vaccine is developed

• option 3: we could push to completely eradicate the virus and avoid rebound when social distancing measures are relaxed, as long as borders remain closed

• option 4: we could relax some measures and allow infection to continue in a very controlled manner, while protecting the vulnerable.

Each of these four approaches is associated with huge risks.

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The lockdown trap

The first option would see a resurgence of the virus, with similar consequences to those of an unchecked epidemic.

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Sources: Victoria, NSW, Queensland, SA, NT, WA, Tasmania, ACT

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The second option involves keeping case numbers to a trickle until a vaccine arrives – squashing the curve to a flat line but not eliminating transmission completely. This appears to be the path we are now pursuing, but it is not yet clear whether we will be able to reopen businesses, restaurants and even schools while still allowing low-level transmission to continue.

If we continue this path, we should recognise that some form of lockdown is likely. We could gradually release the brakes, but any suggestion of an upswing would be met with renewed suppression efforts. We could continually be putting out spot-fires and intermittently returning to strict lockdown until a vaccine arrives.

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The third option involves an attempt to completely eradicate all circulating virus. Although we may be able to return to our previous lives, we would remain highly vulnerable to recurrence through importation if we were to reopen our borders.

If we were to pursue this path, extensive public engagement would be essential. We would need to remain in lockdown for many weeks after the last case has been reported and the rationale for pushing through towards eradication needs to be communicated clearly.

It is unclear if this is the strategy pursued by China, but its promising case numbers demonstrate the value of strict and prolonged lockdown. The rebound risk of this strategy will only be tested once strict lockdown measures are released.

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Herd immunity

The fourth option may include carefully controlled transmission of the SARS-CoV-2 virus in select low-risk groups, which is an extremely dangerous path.

However, the almost complete absence of mortality in children and young adults may allow us to consider ways by which we can increase population-wide immunity, while protecting the vulnerable to avoid the huge rates of death seen in the elderly.

The term “herd immunity” has generated considerable controversy since the start of this pandemic. But ensuring a significant proportion of the population develop natural immunity to the virus – in a controlled manner – could be the only way to slow its spread while returning to our previous lifestyles, in the absence of an effective vaccine.

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Coronavirus: can herd immunity really protect us?

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We still need to understand better the risks posed to young people from natural infection, as well as the strength and duration of natural immunity. But current indications are the disease is relatively benign in healthy, young people and that they do acquire immunity. This very distinctive pattern may provide a key to coming out of lockdown while minimising risks – if an effective vaccine fails to materialise in the near future.

This option would need to be carefully controlled to ensure the virus cannot spread to the elderly and the vulnerable. How this could be achieved remains to be considered, but could involve the creation of environments in which transmission can be carefully facilitated among healthy young volunteers, without any risk of spread to the general community.

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To get on top of the coronavirus, we also need to test people without symptoms

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Natural immunity in a substantial proportion of the younger generation would allow those individuals to get on with their lives without putting others at risk. It would also slow any recurrent outbreaks that may occur once lockdown restrictions are relaxed.

Although there are no easy answers, we need to actively debate our exit strategy now, and collect the necessary information to guide our decision making. We may have to consider different solutions in different environments, but with an overarching strategy that is nationally coordinated.

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Read more:
Coronavirus: can herd immunity really protect us?

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James Trauer, Senior Research Fellow, Monash University; Ben J Marais, Professor in Paediatrics and Child Health, University of Sydney, and Emma McBryde, Professor of Infectious Disease and Epidemiology, James Cook University

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

The public has a vital role to play in preventing future cyber attacks

Numerous cyber attacks in recent years have targeted common household devices, such as routers.
Shutterstock

Sandeep Gopalan, Deakin University

Up to 400 Australian organisations may have been snared in a massive hacking incident detailed today. The attack, allegedly engineered by the Russian government, targeted millions of government and private sector machines globally via devices such as routers, switches, and firewalls.

This follows a cyber attack orchestrated by Iranian hackers revealed last month, which targeted Australian universities.

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Explainer: how internet routers work and why you should keep them secure

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A joint warning by the US and UK governments stated that the purpose of the most recent attack was to:

… support espionage, extract intellectual property, maintain persistent access to victim networks, and potentially lay a foundation for future offensive operations.

The Russians’ modus operandi was to target end-of-life devices and those without encryption or authentication, thereby compromising routers and network infrastructure. In doing so, they secured legitimate credentials from individuals and organisations with weak password protections in order to take control of the infrastructure.

Cyber attacks are key to modern conflict

This is not the first instance of Russian aggression.

The US city of Atlanta last month was crippled by a cyber attack and many of its systems are yet to recover – including the court system. In that case, attackers used the SamSam ransomware, which also uses network infrastructure to infiltrate IT systems, and demanded a ransom payment in Bitcoin.

Baltimore was hit by a cyber attack on March 28 that disrupted its emergency 911 calling system. Russian hackers are suspected to have taken down the French TV station TV5Monde in 2015. The US Department of State was hacked in 2015 – and Ukraine’s power grid and military infrastructure were also compromised in separate attacks in 2015 and 2017.

But Russia is not alone in committing these attacks.

In December 2017, North Korean hackers were blamed for the WannaCry attack that infected over 300,000 computers in 150 countries, affecting hospitals and banks. The UK’s National Health Service was particularly bruised and patients had to be turned away from surgical procedures and appointments.

Iran has conducted cyber attacks against numerous targets in the US, Israel, UAE, and other countries. In turn, Iran was subjected to a cyber attack on April 7 that saw computer screens display the US flag with the warning “don’t mess with our elections”.

Prosecuting hackers is ineffective

The US government has launched prosecutions against hackers – most recently against nine Iranians for the cyber attacks on universities. However, prosecutions are of limited efficacy when hackers are beyond the reach of US law enforcement and unlikely to be surrendered by their home countries.

As I have written previously, countries such as Australia and the US cannot watch passively as rogue states conduct cyber attacks against targets within our jurisdiction.

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Is counter-attack justified against a state-sponsored cyber attack? It’s a legal grey area

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Strong countermeasures must be taken in self defence against the perpetrators wherever they are located. If necessary, self defence must be preemptive – any potential perpetrators must be crippled before they are able to launch strikes on organisations here.

Reactive measures are a weak deterrent, and our response should include a first strike cyber attack option where there is credible intelligence about imminent attacks. Notably, the UK has threatened to use conventional military strikes against cyber attacks. This may be an overreaction at this time.

Educating the public is essential

Numerous cyber attacks in recent years – including the current attack – have targeted common household devices, such as routers. As a result, the security of public infrastructure relies to some extent on the security practices of everyday Australians.

So, what role should the government play in ensuring Australians are securing their devices?

Unfortunately, cybersecurity isn’t as simple as administering an annual flu shot. It’s not feasible for the government to issue cybersecurity software to residents since security patches are likely to be out-of-date before the next attack.

But the government should play a role in educating the public about cyber attacks and securing public internet services.

The city of New York has provided a free app to all residents called NYC Secure that is aimed at educating people. It is also adding another layer of security to its free wifi services to protect users from downloading malicious software or accessing phishing websites. And the city of Jonesboro, Georgia is putting up a firewall to secure its services.

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Artificial intelligence cyber attacks are coming – but what does that mean?

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Australian city administrations must adopt similar strategies alongside a sustained public education effort. A vigilant public is a necessary component in our collective security strategy against cyber attacks.

This cannot be achieved without significant investment. In addition to education campaigns, private organisations – banks, universities, online sellers, large employers – must be leveraged into ensuring their constituents do not enable attacks through end-of-life devices, unsupported software, poor password protection policies and lack of encryption.

Governments must also prioritise investment in their own IT and human resources infrastructure. Public sector IT talent has always lagged the private sector due to pay imbalances, and other structural reasons.

It is difficult for governments to attain parity of technical capabilities with Russian or North Korean hackers in the short term. The only solution is a strong partnership – in research, detection tools, and counter-response strategies – with the private sector.

The Atlanta attack illustrates the perils of inaction – an audit report shows the city was warned months in advance but did nothing. Australian cities must not make the same mistake.

Sandeep Gopalan, Pro Vice-Chancellor (Academic Innovation) & Professor of Law, Deakin University

This article was originally published on The Conversation. Read the original article.

New, More Dangerous Hindu Extremist Groups Emerge in India

Christians concerned as rightwing factions splinter to form militant outfits.

PUNE, India, October 29 (CDN) — After more than a decade of severe persecution, India’s Christian minority is growing increasingly concerned over the mushrooming of newer and deadlier Hindu extremist groups.

Gone are the days when Christians had to watch out only for the Vishwa Hindu Parishad (World Hindu Council) and its youth wing, Bajrang Dal, which are closely linked with the most influential Hindu extremist umbrella organization, the Rashtriya Swayamsevak Sangh (RSS). With voter support faltering for the RSS’s political wing, the Bharatiya Janata Party (BJP), moderate and extremist sections within the Hindu nationalist movement are blaming each other, and militant splinter groups have emerged.

Claiming to be breakaway factions of the RSS, new groups with even more extreme ideology are surfacing. The Abhinav Bharat (Pride of India), the Rashtriya Jagran Manch (National Revival Forum), the Sri Ram Sene (Army of god Rama), the Hindu Dharam Sena (Army for Hindu Religion) and the Sanatan Sanstha (Eternal Organization) have launched numerous violent attacks on Christian and Muslim minorities.

The Sri Ram Sene was one of the most active groups that launched a series of attacks on Christians and their property in and around Mangalore city in the southern state of Karnataka in August-September 2008, according to a report, “The Ugly Face of Sangh Parivar,” published by the People’s Union of Civil Liberties (PUCL), in March 2009. In Jabalpur city in the central state of Madhya Pradesh, suspected extremists from the Abhinav Bharat attacked the Rhema Gospel Church on Sept. 28, according to the Global Council of Indian Christians. They had earlier attacked Pastor Sam Oommen and his family in the same city on Aug. 3.

The Hindu Dharam Sena has become especially terrifying for Christians in Jabalpur. Between 2006 and 2008, Jabalpur was plagued by at least three anti-Christian attacks every month, according to The Caravan magazine. In the western state of Gujarat and other parts of the country, the Rashtriya Jagran Manch has also violently attacked Christians, according to news website Counter Currents.

At an ecumenical meeting held in New Delhi on Saturday (Oct. 24), the secretary general of the Catholic Bishops’ Conference of India, Archbishop Stanislaus Fernandes, said the rise of fundamentalism was “seriously worrying” the church in India. The meeting was held to discuss prospects for immediate enactment of federal legislation to counter religious extremism with the proposed Communal Violence (Prevention, Control and Rehabilitation of Victims) Bill.

RSS ‘Too Mild’

The new groups, formed mostly by former members of RSS-connected outfits, find the Hindu nationalist conglomerate too “mild” to be able to create a nation with Hindu supremacy.

The Sri Ram Sene, mainly active in south India, was started by Pramod Muthalik after he was expelled in 2007 from the Bajrang Dal, one of the most radical groups in the RSS family, for being an extremist, according to the daily newspaper DNA. The Hindu Dharam Sena was started by Yogesh Agarwal, former worker of the Dharam Jagran Vibhag (Religion Revival Department) of the RSS, also in 2007, as he felt “the RSS did not believe in violence,” according to The Caravan. He had earlier launched the Dharam Sena, an offshoot of the RSS, in Madhya Pradesh and neighboring Chhattisgarh state in 2006.

The founding members of the Abhinav Bharat, which was started in Pune in 2006, also believe that the RSS is not militant enough. Outlook magazine notes that its members were planning to kill top leaders of the RSS for their inability to implement Hindu extremist ideology. The Rashtriya Jagran Manch, also a breakaway group of the RSS founded in 2007, has close links with the Abhinav Bharat.

Based out of Goa, a western state with a substantial number of Christians, the Sanatan Sanstha provides the ideological base for Hindu militant groups. It has close links with the Sri Ram Sene and publishes a periodical, Sanatan Prabhat, which occasionally spews hate against Christians.

Media reports warn of tensions due to the recent spurt in activity of the splinter groups.

“The hardliners are now getting into more extreme activities,” The Times of India daily quoted V.N. Deshmukh, former joint director of India’s Intelligence Bureau, as saying on Oct. 21.

The most extremist sections are disillusioned with the way the RSS is functioning, said Mumbai-based Irfan Engineer, Director of the Institute of Peace and Conflict Studies. Most RSS cadres were mobilized with an ideology that called for elimination of minorities, mainly Muslims and Christians, he told Compass, adding that many of them were highly disappointed with the way the movement was being led.

He said the BJP was restricted when it led a coalition government at the federal level from 1998 to 2004, keeping it from effectively working towards a Hindu nation. A majority of the BJP’s allies in the National Democratic Alliance were not Hindu nationalists.

“One section of the [Hindu nationalist] movement believes in acquiring state power by participating in parliamentary democracy, and the other wants to create a Hindu nation by violent means,” Engineer said.

It is believed that the divide within the RSS family may deepen even further.

Analysts believe that Hindu nationalism is losing relevance in national politics, as was evident in the two successive defeats of the BJP in the 2004 and 2009 general elections. Consequently, the RSS and the BJP may distance themselves from the hard-line ideology or make it sound more inclusive and less militant.

After this year’s elections, the RSS increasingly has begun to talk about the threat China poses to India and the need for development in rural areas, instead of its pet issues like Islamist terrorism and Christian conversions. This has disappointed sections of the highly charged cadres even more, and the splintering may accelerate.

For the next few years, “we will see more new names and new faces but with the same ideology and inspiration,” said Anwar Rajan, secretary of the PUCL in Pune.

Whether the new groups truly have no connection with the RSS is not fully known – that appearance may be an RSS strategy to evade legal action, said Dr. Asghar Ali Engineer, chairman of the Centre for Study of Society and Secularism in Mumbai.

He said relations between the RSS and the new groups can be compared with the ones between Maoist (extreme Marxist) rebels and the Communist Party of India-Marxist (CPI-M) in India. While the CPI-M distances itself from Maoist violence, it speaks for the rebels whenever security forces crack down on them.

At base, the newer rightwing groups surely have the sympathy of the RSS, said Pune-based S.M. Mushrif, former Inspector General of Police in Maharashtra, who has been observing Hindu extremist groups for years.

Report from Compass Direct News 

BANGLADESH: MUSLIM VILLAGERS BEAT EVANGELISTS IN SOUTHEAST

Nearly four months later, Christian worker still suffering nerve damage.

FULGAZI, Bangladesh, June 1 (Compass Direct News) – Nearly four months after Muslim villagers in this southeastern Bangladesh sub-district furiously beat two evangelists for showing the “Jesus Film,” one of the Christians is still receiving treatment for nerve damage to his hip.

Christian Life Bangladesh (CLB) worker Edward Biswas, 32, was admitted to Alabakth Physiotherapy Centre on May 5. Dr. Mohammad Saifuddin Julfikar told Compass that injuries Biswas sustained from the Feb. 8 attack in Feni district, some 150 kilometers (93 miles) southeast of Dhaka, had led to neurological complications in his hip.

“His hip joint was displaced, and one bone in the hip was fractured,” Julfikar said.

Biswas told Compass that he and 21-year-old Dolonmoy Tripura first showed the film on Feb. 7 in a home in Chandpur village, where they also taught the more than 200 poor and mostly illiterate viewers about the dangers of arsenic in water, mother-and-child health care and AIDS prevention. United Nations Children’s Fund reports say more than 30 million people are exposed to high levels of arsenic in water in Bangladesh and India.

Azad Mia of the same village requested they show the film at his house the following day. They went to his home the evening of Feb. 8, but because one of Mia’s family members was ill they were unable to screen the film. As they returned home, Biswas said, some villagers told them to show the film at their home; the two evangelists suspected a trap.

“At first they tried to sweet-talk us into going to their house,” Biswas said. “On our refusal to show the film, they tried to force us to go. I smelled a rat and again refused to go. Later they forcefully took us deep inside the village.”

About 20 people gathered and began beating them, he said.

“Some of the elders of the village told them to release us, but they were adamant to see the movie,” Biswas said. “They took us to a schoolyard, where we showed the ‘Jesus Film’ under tremendous compulsion. After showing 20 minutes of the first reel of the film, Muslim villagers again started beating us as we were lying on the ground. They punched and kicked us.”

While 15 to 20 Muslims struck them, approximately 200 others present for the screening looked on, he said. The villagers also beat a Muslim who had transported the CLB workers about the village on a three-wheel rickshaw for the showing of the film.

The assailants also destroyed the film projector, generator, microphone and the four reels of the film, Biswas said.

“Several days after the beating, I came to know from some villagers that a family had become Christian around 10 years ago in the neighboring village, “Biswas said. “All the villagers were angry, and they evicted that family from the village.”

The attack was pre-planned, with the showing of the film seen as a legitimate pretext for beating them, he said. They also threatened Daud Mia, a Muslim villager who had allowed them to show the film in his house the previous day, said Biswas.

CLB Area Supervisor Gabriel Das took Biswas and Tripura to a local doctor for treatment. CLB Chairman Sunil Adhikary expressed concern about freedom of religion and the rights of minorities provided in the country’s constitution.

“The beating was a flagrant violation of our rights,” said Adhikary. “They showed the film, but they did not force anyone to be converted. We forgave the attackers and showed them the love of our God.”

Since 2003 at least three CLB workers in Bangladesh have been killed – likely by Islamic extremists, say police and local officials – and several hundred have been injured.

In April Prime Minister Sheikh Hasina Wazed spoke about freedom of religion, democratic governance and equal opportunity in Bangladesh with Gerard Valin, vice-admiral of the French Navy and commander of the French Joint Forces in the Indian Ocean, who was visiting the country. Hasina told the commander that Bangladesh would protect religious freedom for all faith groups, as well as ensure freedom of expression for all minorities.

Report from Compass Direct News