Vaccinations need to reach 90% of First Nations adults and teens to protect vulnerable communities

Posted on October 5, 2021 by particularkev

Paul Komesaroff, Monash University; Donna Ah Chee, Indigenous Knowledge; Ian Kerridge, University of Sydney, and John Boffa, Curtin UniversityWhile some Australians are awaiting the nation reopening after lockdowns with hope and optimism, others are approaching it with dread. This is because a blanket lifting of restrictions when the vaccination rate reaches 70% will have devastating effects on Indigenous and other vulnerable populations.

At present, vaccination rates in Indigenous populations are very low. Meanwhile international data show the risk of serious illness and death among First Nations populations from COVID and other diseases is up to four times that of the wider population.

Once restrictions are lifted everyone unvaccinated will be exposed to the virus. The outcomes for Indigenous people may therefore resemble the early effects of British colonialism, when a high proportion of the population died from introduced infections.

Aboriginal and Torres Strait Islander adults and teenagers need vaccination rates of 90-95% among First Nations people to protect their communities.

Additional health challenges

As with many other medical conditions, the effects of COVID-19 are worse among people with lower socioeconomic status and especially among Aboriginal and Torres Strait Islander people.

There are multiple reasons for this, including the greater likelihood of underlying conditions and reduced access to appropriate health care.

We saw a similar situation in 2009, when H1N1 influenza rates among Aboriginal and Torres Strait Islander people were more than five times those of other Australians.

Overseas, COVID-19 has been associated with striking racial disparities, with death rates for African Americans more than triple the rates for Caucasians, and more than 4% for Navajo people (compared to 1.6% for the whole population).

Outcomes for other First Nations groups in the United States and elsewhere are similar.

What’s the current vaccination plan?

On September 9, the New South Wales government announced its intention to lift lockdowns and other public health measures when the state reaches a vaccination target of 70% of the adult population. This equates to a little over 50% of the state’s population.

NSW will reach the 70% target in less than a month in NSW and the nation will reach the target by October 30.

If such a policy were implemented it would have disastrous consequences for Aboriginal and Torres Strait Islander and other vulnerable populations.

Vaccination rates in Aboriginal and Torres Strait Islander communities are lagging badly behind the remainder of the Australian population. In many places in NSW, Western Australia, Queensland and the Northern Territory fewer than 20% are fully vaccinated.

What should happen instead?

Aboriginal organisations have called on state and federal governments to delay any substantial easing of restrictions until vaccination rates among Aboriginal and Torres Strait Islander populations aged 12 years and older reach 90-95%.

The organisations calling for such a target include the National Aboriginal Community Controlled Health Organisation, the Aboriginal Medical Services of the Northern Territory and the Central Australian Aboriginal Congress.

A 90-95% vaccination rate gives about the same level of population coverage for all ages as the 80% target for the entire population. That’s because Aboriginal and Torres Strait Islander communities are younger than the wider population.

Vaccinating 90-95% of the Aboriginal and Torres Strait Islander population will better protect children and other unvaccinated people in First Nations communities from infection.

This will require an immediate, well-resourced and determined effort to lift vaccination rates.

How can this be achieved?

Many Aboriginal community controlled health services are already running urgent vaccination campaigns with existing resources, but more needs to be done.

The Australian government’s announcement this week of A$7.7 million to fast-track vaccinations in 30 priority areas across the country is an important first step.

But the program needs to be expanded to all areas with significant Aboriginal and Torres Strait Islander populations.

Australia’s First Nations vaccination program needs to:

guarantee a sufficient and reliable source of vaccines to Aboriginal and Torres Strait Islander communities
ensure health services have the capacity and the workforce to carry out intensive outreach vaccination programs. This includes culturally knowledgeable Aboriginal and Torres Strait Islander workers able to engage with communities, and clinicians
address vaccine hesitancy. This should start with the recognition there are many reasons for reluctance to be vaccinated.

What are the reasons for vaccine hesitancy?

For some, there is a historical and understandable distrust of the health system.

Others have been confused or made fearful by misinformation spread on social media or through fringe religious groups.

Many others are not fundamentally opposed to vaccination but are adopting a “wait and see” approach.

To overcome this hesitancy we need urgent government support for financial incentives, in the form of food vouchers or other benefits. This has been done for vulnerable groups in other countries.

Non-financial incentives requiring full vaccination for travel, entering pubs, clubs, restaurants, sporting venues and so on need to be flagged now with a commencement date in the near future.

Effective health education in Aboriginal languages developed by local Aboriginal community controlled health services need to be in the media daily.

Don’t leave vulnerable groups behind

All this is achievable but it requires the combined efforts of government working in partnership with Aboriginal community controlled health services.

Until the 90-95% target is met, rigorous restrictions should remain in place. This is consistent with modelling from the Burnet and Doherty institutes, which inform the NSW and national policies about reopening.

As the Burnet Institute told the authors of this article, Australia:

should not move to Phase B and C until vaccination coverage in each jurisdiction’s Aboriginal and Torres Strait Islander communities is as high as, or even higher than, the general community.

Similar considerations undoubtedly apply to some other vulnerable groups in the population.

Australia remains burdened by the legacy of centuries of harm and damage to its First Nations people. We are facing the possibility of a renewed assault on Aboriginal and Torres Strait Islander health.

The difference today is the outcomes are foreseeable and we know what needs to be done to avert them.

Paul Komesaroff, Professor of Medicine, Monash University; Donna Ah Chee, Central Australian Aboriginal Congress, Indigenous Knowledge; Ian Kerridge, Professor of Bioethics & Medicine, Sydney Health Ethics, Haematologist/BMT Physician, Royal North Shore Hospital and Director, Praxis Australia, University of Sydney, and John Boffa, Adjunct Associate Professor, Curtin University

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

Masks, ventilation, vaccination: 3 ways to protect our kids against the Delta variant

Posted on August 28, 2021 by particularkev

Katrina McLean, Bond University and Natasha Yates, Bond UniversityLast year in the COVID-19 pandemic, children were not catching or spreading the virus much. The main focus was on protecting our elderly and vulnerable.

But the Delta strain has changed things. Children around the world are contracting Delta in high numbers and some frontline doctors believe they may also be getting sicker from this strain.

Many parents and schools have concerns about how to best protect children from COVID-19. There’s also the worry children will catch the virus at school and take it back to their families and communities.

While many children are now well-accustomed to washing and sanitising their hands, this is simply not enough to tackle the spread of COVID-19, especially now we know the virus is airborne. We need a whole toolbox of strategies.

There are three key areas to focus on that we believe are evidence-based, easy to implement and will help protect our children: masks, ventilation and vaccination.

1. Masks

In certain Australian states, children aged 12 and above are currently required to wear a mask in public areas (schools included).

Meanwhile, Victoria’s chief health officer Brett Sutton has recommended children aged five and up wear masks in the face of rising Delta transmission among children.

As GPs, parents often ask us if it’s safe for children to wear masks. While we understand concern from parents, we reassure them masks have been found to cause no harm in children over the age of two. When children wear masks it doesn’t affect their breathing or reduce their oxygen levels.

Importantly, when worn properly, masks are effective at reducing the spread of COVID-19, for adults and children alike.

A few quick tips. Fabric masks should be treated like underwear: wash them regularly, ensure they cover everything, and don’t share. These are a better option for the environment.

Label fabric masks like school hats — they will go missing!

Surgical/disposable masks are single use. Like using a tissue to blow your nose, make sure it goes in the bin once used and then wash your hands.

And masks should fit snugly — the less gaps there are the better they will work.

Like anything new, getting used to masks can take time. Children may initially be anxious, especially if their parents are too. Though most kids adapt really quickly (much quicker than adults, in our experience).

While the majority of children will adapt quickly there will be some who have specific and legitimate concerns, for example disabilities and sensory issues. GPs and paediatricians can help work out what the safest approach is for these children.

2. Ventilation

SARS-CoV-2, the virus that causes COVID-19, can float in the air like smoke. If you’re inside in a small enclosed room with other people and the ventilation is poor, it will only be a matter of time before you’re all breathing in each other’s air.

Schools have lots of children inside enclosed classrooms, often for hours, so what can be done?

Ventilation is something schools can and should address. Some simple strategies include:

get outside as often as is practical. Call children into the classroom only once the day has started. Hold some lessons outside the classroom. During breaks and lunch time children should be outside whenever possible too
open doors and windows
set air conditioning or heating systems to bring in as much outdoor air as possible
check the air with carbon dioxide monitors. This is occurring overseas.

Why do we care about CO₂? Well, we breathe in oxygen and breathe out CO₂. In confined spaces with lots of air that has been “breathed out”, monitors will detect higher levels of CO₂.

All that “breathed out” air could be full of viral particles, so if the monitor is measuring high, airflow needs to be improved immediately by opening a door or window.

In stuffy rooms, or rooms that measure high for CO₂ (indicating the ventilation is poor), a longer-term plan to clean the air should be considered. What’s encouraging is that the technology already exists to address this.

Air cleaners, also known as air purifiers, scrubbers, or HEPA filters, can actually help to “clean” the air we breathe. Lots of schools around the world are now actively improving ventilation systems and air quality monitoring.

Improving the air quality in schools may also prevent some of the other colds and flus kids pick up at school, and reduce asthma and allergy symptoms.

3. Vaccination

At this stage in Australia the Pfizer vaccine is recommended for vulnerable children aged 12-15, including those registered on the National Disability Insurance Scheme.

Vaccinations for all children 12 and over are now under way in New Zealand.

New Zealand GP Dr Sarah Hortop shared this photo of her daughters who received their first dose of the Pfizer vaccine recently.
Sarah Hortop, Author provided

Many other countries have been giving vaccines to children for several months now. For example, in the United States, more than one-third of 12 to 15-year-olds are fully vaccinated and nearly 50% have had at least one dose.

We know the vaccines work well in this age group and just like in adults, there is very close monitoring of adverse events from these vaccines in children. It’s reassuring to see very few serious reactions, and even those that are (for example myocarditis — inflammation of the heart) are treatable.

Vaccine trials are under way in children under 12 in the US (for Pfizer and Moderna), and once we have the safety and efficacy data we can start making decisions around vaccinating them too.

Katrina McLean, Assistant Professor, Medicine, Bond University and Natasha Yates, Assistant Professor, General Practice, Bond University

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

At last, health, aged care and quarantine workers get the right masks to protect against airborne coronavirus

Posted on June 25, 2021 by particularkev

C Raina MacIntyre, UNSW; Benjamin Veness, CQUniversity Australia, and Michelle Ananda-Rajah, Monash UniversityAlmost a year ago, in July 2020, our calls for the government to urgently upgrade the guidelines to protect health workers from airborne SARS-CoV-2 fell on deaf ears.

The existing guidelines said health providers working around COVID-19 patients should wear a surgical mask. It restricted use of the more protective P2 or N95 masks, which stop airborne particles getting through, to very limited scenarios. These involved “aerosol-generating procedures”, such as inserting a breathing tube. This was expanded slightly in August 2020 but still left most health workers without access to P2/N95 masks.

More than 4,000 Australian health workers were infected by COVID-19 during the Victorian second wave. Health authorities denied the importance of airborne transmission and blamed clinical staff for “poor habits” and “apathy”. Health workers expressed despair and a sense of abandonment, cataloguing the opposition they faced to get adequate protection against COVID-19.

Last week, 15 months after the COVID-19 pandemic was declared, the Australian guidelines on personal protective equipment (PPE) for health workers, including masks, were finally revised.

What do the new guidelines say?

The new guidelines expand the range of situations in which P2/N95 masks should be available to staff – essentially anywhere where COVID-19-infected people are expected to be – and remove all references to “aerosol-generating procedures”.

This recognises that breathing, speaking, sneezing and coughing all generate aerosols which can accumulate in indoor spaces, posing a higher risk than “aerosol-generating procedures”.

“Fit testing” is an annual procedure that should be done for all workers wearing a P2/N95 mask or higher grade respirator, to ensure air can’t leak around the edges.

But this was previously denied to many Australian health workers.

The new guidelines unequivocally state fit-tested P2/N95 masks are required for all staff managing patients with suspected or confirmed COVID-19. This means health workers can finally receive similar levels of respiratory protection to workers on mining and construction sites.

The new guidelines leave ambiguity around which workplaces are within the scope by stating that health care:

may include hospitals, non-inpatient settings, managed quarantine, residential care facilities, COVID-19 testing clinics, in-home care and other environments where clinical care is provided.

The guidelines also allow employers to decide what comprises a high risk and what doesn’t, allowing more wiggle room to deny workers a P2/N95 mask.

N95 and surgical masks on a table. — N95 masks (top) protect against airborne transmission, while surgical masks (bottom) don’t.
Shutterstock

The guidelines say when a suitable P2/N95 mask can’t be used, a re-usable respirator (powered air purifying respirators, or PAPRs) should be considered.

But the guideline’s claim that a PAPR may not provide any additional protection compared to a “well-sealed” disposable P2/N95 mask, is not accurate. In fact, re-usable respirators such as PAPRs afford a higher level of protection than disposable N95 masks.

The new guidelines should also apply to workers in hotel quarantine – both health care and non-clinical staff. This will help strengthen our biosecurity, as long as they’re interpreted in the most precautionary way.

That means not using the wiggle room that allows workplaces to deem a situation lower risk than it actually is or that their workplace is exempt. When working around a suspected or confirmed COVID-19 case, all workers must be provided with a fit-tested P2/N95 mask. Otherwise they are not protected from inhaling SARS-CoV-2 from the air.

In aged care and health care, where cases linked to quarantine breaches can be amplified and re-seeded to the community, the new guidelines go some way towards better protecting our essential first responders and their patients.

Guidelines miss the mark on ventilation

The guidelines fail to explicitly acknowledge COVID-19 spreads through air but nonetheless recommend the use of airborne precautions for staff.

Airborne particles are usually less than 100 microns in diameter and can accumulate indoors, which means they’re an inhalation risk.

The old guidelines focused on “large droplets”, which were thought to fall quickly to the ground and didn’t pose a risk in breathed air. This was based on debunked theories about airborne versus droplet transmission.

The new guidelines fail to comprehensively address ventilation, which is only mentioned in passing with a reference to separate guidelines for health-care facilities. This may not cover aged care or hotel quarantine.

We must ensure institutions such as hospitals, hotel quarantine facilities, residential care, schools, businesses and public transport have plans to mitigate the airborne risk of COVID-19 and other pandemic viruses through improved ventilation and air filtration.

Australia could follow Germany, which has invested €500 million (A$787 million) in improving ventilation in indoor spaces.

Meanwhile, Belgium is mandating the use of carbon dioxide monitors in public spaces such as restaurants and gyms so customers can assess whether the ventilation is adequate.

Cleaning shared air would add an additional layer of protection beyond vaccination and mask-wearing. Secondary benefits include decreased transmission of other respiratory viruses and improved productivity due to higher attention and concentration levels.

No updated advice on hand-washing

The United States Centers for Disease Control and Prevention (CDC) now acknowledges exposure to SARS-CoV-2 occurs through “very fine respiratory droplets and aerosol particles” and states the risk of transmission through touching surfaces is “low”.

Yet this is not acknowledged in the latest Australian health-care guidelines.

Australians have been repeatedly reminded to wash or sanitise their hands, wipe down surfaces and stand behind near-useless plexiglass barriers.

The promotion of hand hygiene and cleaning surfaces is not based on science, which shows it is the air we breathe that matters most.

Revised public messaging is needed for Australians to understand shared air is the most important risk for COVID-19.

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW; Benjamin Veness, Adjunct Professorial Fellow, CQUniversity Australia, and Michelle Ananda-Rajah, Consultant physician General Medicine & Infectious Diseases, Alfred Health, past MRFF TRIP Fellow, Monash University

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

COVID-19 vaccines could go to children first to protect the elderly

Posted on November 18, 2020 by particularkev

Julian Savulescu, University of Oxford and Margie Danchin, Murdoch Children’s Research Institute

Several COVID-19 vaccines are in late-stage clinical trials. So discussion is turning to who should receive these vaccines first, should they be approved for use. Today, we discuss two options. One is to prioritise the elderly. This article looks at the benefits of vaccinating children first.

The World Health Organisation is discussing how best to allocate and prioritise COVID-19 vaccines when they arrive.

It is focusing on the immediate crisis. To reduce deaths quickly when there are extremely limited vaccine doses available, vaccinating older, more vulnerable people is expected to be the best option, even if the vaccine is relatively poor at protecting them. That is because the elderly are so much more likely to die from the disease.

But as we produce more vaccines, the goal will be returning to normality where we can freely mix without increased risk. If vaccines are not very effective in older adults, we will need many more people to be vaccinated, including children. One possible strategy is to prioritise children.

Why children first?

The risks and benefits of particular COVID-19 vaccination strategies depend on information we don’t yet have. For example, we don’t yet know whether vaccines work or are safe for specific population groups, such as the young or the old.

But it is worth thinking about the ethics of different strategies in advance. In a pandemic, time can save lives.

A COVID-19 vaccine may be less effective in the elderly because their immune systems decline naturally with age, making them perhaps less able to trigger an efficient, protective immune response after vaccination.

We see this with the flu vaccine, which only reduces influenza-like illnesses by around one-third in the over-65s and deaths by around half.

If there are similar results for a COVID-19 vaccine, to return to normality, we may need to also prevent community transmission through vaccinating young people, who generally mount a stronger immune response. This would in turn protect older, more vulnerable people because the virus would be less likely to reach them.

Yes, this is controversial. Children cannot autonomously consent to being vaccinated. Adults, who make these decisions on their behalf, are also likely to benefit from a reduced risk of contracting the virus within their own household, making the decision a possible conflict of interest.

When would this be OK?

We do sometimes make altruistic decisions on behalf of children. Children can be life-saving bone marrow donors for siblings, for example, despite the risks.

We can also apply the idea that we can restrict liberty where there is a risk of harm to others. For instance, if a child is infected with COVID-19, they need to be isolated and quarantined just like adults.

However, vaccination differs from both examples in one key respect. With vaccination, there is unlikely to be a single identified person the child will help, or whom they are uniquely placed to help. Instead, the potential benefits are collective, to the wider public.

If a child lived with a sibling who had an underlying condition that makes them particularly vulnerable to COVID-19, or lived with their grandparents, vaccination might be an easier choice.

Child sitting on grandfather's lap reading together — If a child lived with grandparents, vaccination might be an easier choice.
Shutterstock

Three factors could help us decide

When weighing up whether children should be vaccinated ahead of adults, we can ask:

1. How severe is the threat to public health?

So far, more than a million people have died from COVID-19. There’s also the risk of overwhelming health systems and the additional collateral damage in terms of economic, social, educational and risk of excess non-COVID-19 deaths as a result (for example through suicide, or delayed access to health care). COVID-19 affects everyone in society, including children.

2. Are there alternatives?

If vaccination works well enough in vulnerable people, or there are other strategies to achieve the same effect, such as general adult vaccination, we should use those instead.

3. Is the response proportional to the threat?

As we vaccinate the vulnerable, and the general adult population, even if it is not fully effective, we will reduce the severity of the crisis. We should assess at that stage whether the remaining problem warrants vaccinating children.

Assuming we meet these conditions, we argue prioritising childrens’ vaccination, on a voluntary basis at least, is the right strategy.

How about mandatory vaccinations?

Mandatory vaccination can be justified if voluntary strategies do not achieve herd immunity, or do not achieve it fast enough to protect the vulnerable.

To gauge whether mandatory vaccination is worth it, we might also need to consider how lethal and infectious a virus is.

For instance, smallpox had a death rate of up to 30% (although contagion requires fairly prolonged contact). It was eradicated by 1979 through vaccination, which was mandatory in many countries. With COVID-19, 0.1-0.35% of infections are fatal.

By definition, mandatory vaccination involves some form of coercion. This can include withholding financial benefits or access to early childhood education (No Jab, No Pay or No Jab, No Play in Australia); preventing children from entering school (USA, with specific rules varying by state) to fines (Italy). France even has legal provision for imprisonment for parents who refuse certain vaccines.

Mandatory vaccination (of some kind) could be justified in groups who are at increased personal risk from COVID-19 — such as health-care workers, the elderly, men, or people with other health conditions — if incentives such as increased freedoms, or even payment are not sufficient. For these groups, the vaccine is win-win: it both protects others and the person vaccinated.

And mandatory vaccinations for children?

The situation is more tricky with children. Unless they have underlying health conditions or have a rare but serious inflammatory condition after infection, children are less likely to have severe COVID-19 or die from it.

So the risk of the vaccine itself (as yet unknown) weighs more heavily.

On the other hand, children benefit from grandparent relationships, and other freedoms afforded by a pandemic-free society.

Mandatory vaccination might be justified in children if the following criteria are met:

the vaccine is proven to be very safe for children (including in the long term, as yet unknown), and safer than the effects of the disease
children are significant spreaders of infection (which does not appear to be the case for COVID-19, at least for pre-teens)
there are other non-COVID benefits to children, such as return to normal social and educational life (school), and access to normal health-care services which they otherwise could not have
measures are reasonable and proportionate, for instance, by limiting child care benefits (rather, for instance, than sending parents to prison).

We are certainly not close to meeting these criteria for mandatory vaccination of children against COVID-19 yet, especially as we don’t know how effective and safe candidate vaccines are in different populations.

Julian Savulescu, Visiting Professor in Biomedical Ethics, Murdoch Children’s Research Institute; Distinguished Visiting Professor in Law, University of Melbourne; Uehiro Chair in Practical Ethics, University of Oxford and Margie Danchin, Associate Professor, University of Melbourne, Murdoch Children’s Research Institute

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

Heading back to the office? Here’s how to protect yourself and your colleagues from coronavirus

Posted on June 30, 2020 by particularkev

Lisa Bricknell, CQUniversity Australia and Dale Trott, CQUniversity Australia

One of the most profound ways the COVID-19 pandemic has affected our lives has been in the way we work. For people lucky enough to keep their jobs, and for those of us in professions where it’s possible, working from home has become the new normal.

Australia’s success in “flattening the curve” means restrictions are now being lifted. With this, many employers are bringing their staff back into the office, or at least contemplating doing so.

But as the current outbreaks in Victoria show, it’s dangerous to think we’re now safe from the threat of COVID-19.

So, what do we need to consider as we take those first tentative steps back into the office?

First, how does the virus spread?

While there’s a lot we still don’t know about SARS-CoV-2, the coronavirus that causes COVID-19, we do know it spreads most effectively from person to person in droplet form. Infected people emit these droplets when they sneeze, cough, and even speak.

Those droplets can be transmitted directly through the air — say when an infectious person coughs in the direction of someone else close by — or they can settle on surfaces, where they can remain viable for hours.

The virus enters the body of a non-infected person through contact with mucous membranes in the nose, mouth or eyes and attaches to cells in the upper respiratory tract to establish infection.

Many of us are keen to get back to the office.
Shutterstock

What does this mean for office workers?

In many workplaces, employees share a small office space, work in an open-plan office, or use “hot desks” that are shared between several different employees on different shifts.

Workers in these situations are often required to work for long periods in environments that make it hard to maintain the recommended 4m² distancing rule.

This combination — several hours spent in close contact — increases the risk of COVID-19 transmission. This is illustrated by an outbreak in an open-plan call centre in Seoul, where more than 43% of workers contracted COVID-19 during February and March.

Considerations for employers

First, each employee in a shared office should be able to have at least 4m² to themselves. If this isn’t possible, it would be a good idea to stagger staff or allow them to continue working from home for now.

Second, think about airflow. Small offices often have insufficient airflow to dilute the virus, and, if an infectious person is present, could end up with high concentrations of viral particles over the course of an hour or so.

Conversely, higher rates of airflow combined with poor ventilation can also lead to infection, as droplets can be carried further.

So where possible, increase ventilation and air exchange in open-plan workspaces. Increasing the ratio of fresh air intake to recirculated air can reduce the concentration of virus particles in air conditioned spaces. Even simply opening windows can reduce viral spread.

Ramping up cleaning practices is a must.
Shutterstock

Third, cleaning protocols need to be increased. Where once a twice weekly visit from a contracted cleaner to vacuum the floors, empty the bins and quickly wipe over surfaces was considered sufficient, during COVID-19 you need to ensure a thorough daily clean of all surfaces.

Frequently touched surfaces, such as desks, light switches, door handles, phones, staircase railings, touch screens, keypads, taps and toilets should be given special attention and may require more frequent cleaning.

Fourth, if a worker becomes sick with respiratory symptoms, isolate them from other staff and arrange for them to go home. Advise them to get tested for COVID-19 and not return to work until they have a negative result.

Similarly, reinforce the message, “if you’re sick, get tested and don’t come to work”. Now more than ever, the culture of “soldiering on” while unwell puts others at risk.

Finally, you might also consider asking employees to wear face masks at work. Face masks are unlikely to protect the person wearing them but can limit the disease being spread by coughs and sneezes.

Considerations for employees

First, you should clean equipment like keyboards, phones and mice regularly, and definitely between each user if desks are shared. Simply wipe your desk and equipment with a domestic spray cleaner.

Second, the best protection against the virus is personal hygiene. Washing your hands with soap and water offers excellent protection against SARS-CoV-2. When you can’t wash your hands, use an alcohol-based hand sanitiser instead.

You should wash or sanitise your hands regularly throughout the day, especially any time you touch anything you suspect someone else has recently been in contact with.

Both employers and employees can reduce the risk COVID-19 will spread in an office environment.
Shutterstock

Third, maintain a distance of 1.5m from other people to protect yourself from airborne droplets.

Fourth, practise good respiratory hygiene by coughing and sneezing into a tissue or the crook of your elbow. This prevents viral particles spreading over surfaces and toward people around you.

Lastly, if you have any symptoms, don’t go to work. Get tested as soon as possible and stay at home until you receive the results.

Lisa Bricknell, Senior Lecturer in Environmental Health, CQUniversity Australia and Dale Trott, Lecturer, Environmental Health, CQUniversity Australia

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

Donald Trump is taking hydroxychloroquine to ward off COVID-19. Is that wise?

Posted on May 23, 2020 by particularkev

Teresa G. Carvalho, La Trobe University

The White House’s confirmation that US President Donald Trump has been taking hydroxychloroquine every day for the past two weeks, with his doctor’s blessing, has reignited the controversy over the drug. It has long been used against malaria but has not been approved for COVID-19.

Trump said he has “heard a lot of good stories” about hydroxychloroquine, and incorrectly claimed there is no evidence of harmful side-effects from taking it. His previous claims in March that the drug could be a “game changer” in the pandemic prompted many people, including Australian businessman and politician Clive Palmer, to suggest stockpiling and distribution of the drug to the public.

But the dangers of acting on false or incomplete health information were underlined by the death of an Arizona man in March after inappropriate consumption of the related drug chloroquine. It’s important to know the real science behind the touted health benefits.

How do these medicines work?

Hydroxychloroquine is an analogue of chloroquine, meaning both compounds have similar chemical structures and a similar mode of action against malaria. Both medications are administered orally and have common side-effects such as nausea, diarrhoea and muscle weakness. However, hydroxychloroquine is less toxic, probably because it is easier for the body to metabolise.

Chloroquine and hydroxychloroquine are listed by the World Health Organisation as an essential medicine. Both drugs have been used to treat malaria for more than 70 years, and hydroxychloroquine has also proved effective against auto-immune diseases such as systemic lupus erythematosus and rheumatoid arthritis. The US Food and Drug Administration has approved both chloroquine and hydroxychloroquine for treating malaria, but not for COVID-19.

We don’t know exactly how these drugs work to combat the malaria parasite. But we know chloroquine disrupts the parasite’s digestive enzymes by altering the pH inside the parasite cell, presumably effectively starving it to death.

Malaria parasites and coronaviruses are very different organisms. So how can the same drugs work against both? In lab studies, chloroquine hinders replication of the SARS coronavirus, apparently by changing the pH inside particular parts of human cells where the virus replicates.

This offers a glimmer of hope that these pH changes inside cells could hold the key to thwarting such different types of pathogens.

Is it OK to repurpose drugs like this?

Existing drugs can be extremely valuable in an emergency like a pandemic, because we already know the maximum dose and any potential toxic side-effects. This gives us a useful basis on which to consider using them for a new purpose. Chloroquine is also cheap to manufacture, and has already been widely used in humans.

But we shouldn’t be complacent. There are significant gaps in our understanding of the biology of SARS-CoV-2, which causes COVID-19, because it is a brand new virus. There is a 20% genetic difference between SARS-CoV-2 and the previous SARS coronavirus, meaning we should not assume a drug shown to act against SARS will automatically work for SARS-CoV-2.

Widely used, but with common side effects.
Gary L. Hider/Shutterstock

Even in its primary use against malaria, long-term chloroquine exposure can lead to increased risks such as vision impairment and cardiac arrest. Hydroxychloroquine offers a safer treatment plan with reduced tablet dosages and lessened side-effects. But considering their potentially lethal cardiovascular side-effects, these drugs are especially detrimental to those who are overweight or have pre-existing heart conditions. Despite the urgent need to confront COVID-19, we need to tread carefully when using existing medicines in new ways.

Any medication that has not been thoroughly tested for the disease in question can have seriously toxic side-effects. What’s more, different diseases may require different doses of the same drug. So we would need to ensure any dose that can protect against SARS-CoV-2 would actually be safe to take.

The evidence so far

Although many clinical trials are under way, there is still not enough evidence chloroquine and hydroxychloroquine will be useful against COVID-19. The few trials completed and published so far, despite claiming positive outcomes, have been either small and poorly controlled or lacking in detail.

A recent hydroxychloroquine trial in China showed no significant benefits for COVID-19 patients’ recovery rate. A French hydroxychloroquine trial was similarly discouraging, with eight patients prematurely discontinuing the treatment after heart complications.

The fascination with chloroquine and hydroxychloroquine has also adversely affected other drug trials. Clinical trials of other possible COVID-19 treatments, including HIV drugs and antidepressants, have seen reduced enrolments. Needless to say, in a pandemic we should not be putting all our eggs in one basket.

Then there is the issue of chloroquine hoarding, which not only encourages dangerous self-medication, but also puts malaria patients at greater risk. With malaria transmission season looming in some countries, the anticipated shortage of chloroquine and hydroxychloroquine will severely impact current malaria control efforts.

Overall, despite their tantalising promise as antiviral drugs, there isn’t enough evidence chloroquine and hydroxychloroquine are safe and suitable to use against COVID-19. The current preliminary data need to be backed up by multiple properly designed clinical trials that monitor patients for prolonged periods.

During a pandemic there is immense pressure to find drugs that will work. But despite Trump’s desperation for a miracle cure, the risks of undue haste are severe.

This article was coauthored by Liana Theodoridis, an Honours student in Microbiology at La Trobe University.

Teresa G. Carvalho, Senior Lecturer in Microbiology, La Trobe University

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

Early exposure to infections doesn’t protect against allergies, but getting into nature might

Posted on February 18, 2020 by particularkev

Emily Johnston Flies, University of Tasmania and Philip Weinstein, University of Adelaide

Over the past few decades, allergies and asthma have become common childhood diseases, especially in developed countries. Almost 20% of Australians experience some kind of allergy, whether it’s to food, pollen, dust, housemites, mould or animals.

When people suffer from food allergies, hay fever or asthma, their immune system incorrectly believes the trigger substances are harmful and mounts a defence.

The response can range from mild symptoms, such as sneezing and a blocked nose (in the case of hay fever), to anaphylaxis (from severe food allergies or bee stings) and asthma attacks.

We used to think the rise in allergic conditions was because we weren’t exposed to as many early infections as previous generations. But the science suggests that’s not the case.

However it seems being out in nature, and exposed to diverse (but not disease-causing) bacteria, fungi and other microorganisms may help protect against asthma and allergies.

Remind me, what’s the hygiene hypothesis?

In 1989, researcher David Strachan examined allergy patterns in more than 17,000 children in England. He noticed young siblings in large families were less likely to have hay fever than older siblings or children from small families.

He proposed that these younger siblings were exposed to more childhood illness at a younger age, as more bugs were circulating in these large families and the younger children were less likely to wash their hands and practise good hygiene.

Greater exposure to these childhood infections helped “train” their immune systems not to overreact to harmless things like pollen.

Strachan coined the term “hygiene hypothesis” to explain this phenomenon, and the idea has been appealing to our dirty side ever since.

Yes, it’s a good idea for kids to wash their hands regularly to avoid getting sick.
Wor Sang Jun/Shutterstock

Strachan wasn’t the first to notice exposure to “dirty environments” seemed to prevent allergic disease. A century earlier, in 1873, Charles Blackley noted hay fever was a disease of the “educated class”, and rarely occurred in farmers or people living in less sanitary conditions.

Ditching the hygiene hypothesis

However, Blackley and Strachan were wrong about one important thing: the association between sanitation and allergies is not due to reduced exposure to early childhood infections (or “pathogens”).

Large studies from Denmark, Finland, and the United Kingdom have found no association between the number of viral infections during childhood and allergic disease. In other words, exposure to disease-causing pathogens doesn’t appear to prevent allergies.

In fact, exposure to childhood viral infections, in addition to making a child sick, may contribute to the development of asthma in predisposed children.

Many researchers now argue the term “hygiene hypothesis” is not only inaccurate but potentially dangerous, because it suggests avoiding infection is a bad thing. It’s not.

Good hygiene practices, such as hand washing, are critical for reducing the spread of infectious and potentially deadly diseases such as influenza and the Wuhan coronavirus.

What about ‘good’ exposure to bacteria?

For healthy immune function, we need exposure to a diverse range of bacteria, fungi and other bugs – known as microbes – in the environment that don’t make us sick.

We need exposure to a range of organisms found in nature.
caseyjadew/Shutterstock

Within urban environments, recent research shows people who live closer to green, biodiverse ecosystems tend to be healthier, with less high blood pressure and lower rates of diabetes and premature death, among other things.

More specifically, research has found growing up on a farm or near forests, with exposure to more biodiverse ecosystems, reduces the likelihood of developing asthma and other allergies.

This is potentially because exposure to a diversity of organisms, with a lower proportion of human pathogens, has “trained” the immune system not to overreact to harmless proteins in pollen, peanuts and other allergy triggers.

How can we get more ‘good’ exposure?

We can try to expose children to environments more like the ones in which humans, and our immune systems, evolved.

Most obviously, children need to have exposure to green space. Playing outdoors, having a garden, or living near green space (especially near a diverse range of native flowering plants) is likely to expose them to more diverse microbes and provide greater protection from allergic diseases.

Infants who are breastfed tend to have more diverse gut microbiomes (a larger variety of bacteria, fungi and other microscopic organisms that live in the gut), which makes them less likely to develop allergic diseases in childhood.

Having a varied diet that includes fresh and fermented foods can help cultivate a healthy gut microbiome and reduce allergic disease. As can using antibiotics only when necessary, as they kill off good bacteria as well as the bad.

So keep washing your hands, especially in cities and airports, but don’t be afraid of getting a little dirty in biodiverse environments.

This article was co-authored by Chris Skelly, International Programme Director, Healthy Urban Microbiomes Initiative and Head of Programmes (Research and Intelligence), Public Health Dorset.

Emily Johnston Flies, Postdoctoral Research Fellow (U.Tasmania), University of Tasmania and Philip Weinstein, Professorial Research Fellow, University of Adelaide

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

Bushfire smoke is bad for your eyes, too. Here’s how you can protect them

Posted on January 19, 2020 by particularkev

When the hazardous particles found in bushfire smoke come into contact with our eyes, this can cause inflammation.
From shutterstock.com

Katrina Schmid, Queensland University of Technology and Isabelle Jalbert, UNSW

As we continue to contend with smoke haze in various parts of the country, many Australians may find themselves with watery, burning, irritated or red eyes.

Data from countries with consistently poor air quality suggest there could also be a risk of longer term effects to our eyes, particularly with prolonged exposure to bushfire smoke.

Although P2/N95 masks can protect us from inhaling harmful particles, unfortunately they can’t protect our eyes.

But there are certain things you can do to minimise irritation and the risk of any longer term effects.

Irritation in the short term

The eye’s surface is continuously exposed to the environment, except when our eyes are shut when we sleep.

Bushfire smoke contains dust, fumes (such as carbon monoxide and nitrogen oxides), and tiny particles called PM10 and PM2.5.

When the smoke comes into contact with our eyes, the fumes and small particles dissolve into our tears and coat the eye’s surface. In some people, this can trigger inflammation, and therefore irritation.

The presence of a marker called matrix metalloproteinase-9, or MMP-9, indicates the eye is inflamed.

During periods of poor air quality from bushfires in the United States, MMP-9 was present in the eyes of more people than it ordinarily would be.

Longer term risks

We know very little about how pollution from bushfire smoke might affect our eyes over the longer term, or what damage repeated or chronic exposure might do.

But we do know people who live in areas with high levels of air pollution, such as China, are three to four times more likely to develop dry eye.

Dry eye is a condition where a person doesn’t have enough tears or they are of such poor quality they don’t lubricate and nourish the eye. We need high quality tears to maintain the health of the front surface of the eye and provide clear vision.

For people who already have dry eyes – often older people – poor air quality may increase the damage. The smoke and pollution may cause intense stinging and a feeling of grittiness to the point they can barely open their eyes.

Avoid rubbing your eyes, as this could make the irritation worse.
From shutterstock.com

While dry eye is a result of damage to the surface of the eyes, it’s also possible pollutants entering the blood stream after we breathe them in could affect the blood supply to the eye. This in turn could damage the fine vessels within the eye itself.

Research has suggested high levels of air pollution in Taiwan may increase the risk of age-related macular degeneration, which could be an example of this.

We need more research into the long-term effects on our eyes of prolonged poor air quality, particularly from bushfire smoke. But what we do know suggests it’s possible bushfire smoke could be causing subtle damage to the eyes, even in people without any symptoms.

What can you do to protect your eyes from the smoke?

the best option is to avoid going outside when air quality is at is worst, where possible
wearing sunglasses or glasses when outside if you need them might stop some of the dust carried in the wind from contacting the eye’s surface (but it won’t stop the tiny particles getting in)
avoid wearing contact lenses if possible.

Some tips if your eyes are irritated

flush your eyes as often as you can, with over-the-counter lubricant eye drops if you have some on hand. If not, use sterile saline solution or clean bottled water
if your eyes are itchy, flush them and then place a cool face washer over your closed lids
don’t rub your eyes, as this could make the irritation worse.

If your eyes are red and sore and these steps don’t help, it’s best to see an eye care professional.

Katrina Schmid, Associate Professor, Queensland University of Technology and Isabelle Jalbert, Associate Professor, School of Optometry and Vision Science, UNSW Sydney, UNSW

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

The case of the pirated blueberries: courts flex new muscle to protect plant breeders’ intellectual property

Posted on December 20, 2019 by particularkev

Not all blueberries are the same. A variety called Ridley 1111 is at the centre of an important lawsuit for intellectual property and plants.
Shutterstock

David Jefferson, The University of Queensland

A few weeks ago, the Federal Court of Australia ordered a farmer in New South Wales to pay A$290,000 to a blueberry-producing company because he had grown and sold a proprietary variety of the fruit without permission.

At issue in the blueberry case were questions of intellectual property. Who owns the plant varieties that are commercialised in Australia and other countries? Who can grow them? If you are the owner of a particular variety, how can you prove someone else has grown it without your permission, and what can you do about it?

The case is an important one in an area of law that may affect how we develop new varieties of plants. This type of work is important to address challenges such as food security and climate change adaptation.

Australia’s intellectual property law was changed last February to give courts more options to protect plant breeders’ rights. This case is one of the first to take those revisions into account, which give courts more options to impose sanctions for infringements.

The plant breeders’ rights system works like a patent or trademark for plant varieties: when breeders create a new variety, they can register it and obtain exclusive rights to grow and sell it.

The system is designed to encourage breeders – who may include scientists, companies, or growers themselves – to develop innovative plant varieties. In other words, the possibility of commercial exclusivity functions as a profit incentive.

The case of Ridley 1111

The recent case (Mountain Blue Orchards v. Chellew) was about a blueberry variety named Ridley 1111. It has appealing characteristics for growers and consumers alike: the berries ripen early and have a notable dark blue colour and firmness.

The NSW-based growers Mountain Blue Orchards obtained plant breeders’ rights for Ridley 1111 in September 2010.

This March, Mountain Blue filed a claim before the Federal Court. They alleged that a grower based near Grafton in NSW named Jason Chellew had obtained, grown, and sold Ridley 1111 blueberries without authorisation.

Earlier this month, the Federal Court found in Mountain Blue’s favour. The court ordered Chellew to destroy the infringing plants and pay Mountain Blue A$290,000 in damages. This sum included compensatory damages, additional damages, interest, and litigation costs.

How do you prove someone has pirated your plants?

Establishing infringement for plant varieties is more difficult than for products protected with other kinds of intellectual property.

If someone is using your trademarked brand name, or is selling a widget that you patented, it is relatively straightforward to show infringement by deconstructing these things into their component elements.

In contrast, plants are complex living organisms that change based on human and non-human influences alike.

DNA testing played a role in the Ridley 1111 case, but this alone may not be enough to prove infringement. A protected variety may have only minor genetic differences from other varieties. Likewise, two individual plants of the same variety may have tiny genetic differences due to random mutations.

Furthermore, plant breeders’ rights infringement may occur at a small scale over diffuse areas, making it difficult for rights owners to enforce their rights.

Finally, it is difficult to collect evidence of possible infringement. If plants are grown on private property they can be hard to see, and third parties may be reluctant to help. Rights owners may also be wary of possible adverse business or public image consequences from pursuing a case.

A new kind of damages

Another difficulty in plant breeders’ rights infringement cases relates to the limits of how much impact even a successful case might have.

Until last February, courts could only award damages based on a calculation of the actual loss suffered by the rights owner. It can be difficult to put a number on this loss, which meant that many in the agricultural industry saw plant breeders’ rights infringement as having few practical consequences.

The Ridley 1111 case is a sign that this may be changing, however. It is one of the first the Federal Court has considered since February’s comprehensive amendments to Australian intellectual property law, which now allows judges to award additional damages.

Courts can now consider several factors when setting damages in an infringement case, including how flagrant the infringement is and the need to deter future infringements. This brings plant breeders’ rights into line with other forms of intellectual property law such as patents and trademarks.

The resulting penalties can now be much higher. This could encourage growers to pursue licensing deals with the owners of protected varieties, when in the past they might have risked a lawsuit to save on royalty payments.

However, this assumes growers are aware of the possibility of heightened penalties, and that rights owners can prove that infringement actually occurred.

Encouraging innovation

What effect will these changes have on the ground? It is probably too ambitious to argue that these changes alone will lead to increased innovation in plant breeding, as some industry groups have claimed.

The development of new plant varieties involves significant investments of time and other resources. What’s more, breeding often relies on substantial collaborations between the private sector and public or academic research institutions.

So while the possibility of obtaining additional damages in an infringement action may have some effect, other factors will continue to affect the development of new plant varieties.

These include the ongoing need for governmental support of plant breeding initiatives, the development of effective partnerships between the public and private sectors, and an accurate understanding of the kinds of crops that would be best suited to Australia’s climatic and agronomic peculiarities and to the desires of Australian consumers.

David Jefferson, Research Fellow, The University of Queensland

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

From face masks to air purifiers: what actually works to protect us from bushfire smoke?

Posted on December 17, 2019 by particularkev

Lidia Morawska, Queensland University of Technology

Bushfire smoke has now been blanketing parts of Australia for months. This week the air quality in Sydney reached new lows, reported to be 12 times hazardous levels in some parts of the city on Tuesday.

Beyond being stifling and unpleasant, people are experiencing irritated eyes and breathing difficulties.

Statistics emerging from hospital records show an increase in emergency hospital admissions for a range of diseases from asthma to heart disease and stroke.

We’ll only fully understand the longer term health effects in the weeks and months to come.

When the situation is as bad as it has been in Sydney over the past few days, people stop asking questions about whether air pollution has an impact on health; we know it has. The question on everybody’s mind now is: how can I protect myself and my family?

Does staying indoors help?

Our natural instinct tells us if the conditions outside are bad, we should seek refuge inside. The indoor environment provides some protection against bushfire smoke and outdoor air pollution in general, but the degree of protection depends on the type of building and importantly, its ventilation.

Buildings such as shopping centres, most modern office buildings and hospitals are equipped with heating ventilation and air conditioning (HVAC) systems, which incorporate air filters.

The efficiency of these systems depends on the filter technology and the size of the filtered particles. Smaller particles are generally more difficult to catch and remove, but sophisticated technology can achieve this. It varies, but what we call HEPA (high efficiency particulate air) filters can remove close to 100% of airborne particles.

The particles we’re concerned about in bushfire smoke are ultrafine particles. So these are likely to be removed with HEPA filters, but could get through less sophisticated filters.

Residential homes and apartments are not commonly equipped with HVAC systems. Instead, they’re naturally ventilated, typically by opening the windows. So in residential houses, the indoor concentrations of pollutants are often close to the outdoor concentrations, particularly when the windows are open.

Even if the windows are closed, outdoor pollutants will penetrate indoors if the building is “leaky”, meaning there are cracks the air can get through. This is the case in many old buildings, particularly those built from timber.

Air purifiers

One option to improve the quality of indoor air is to use air purifiers. Air purifiers use a system of internal fans to pull the air through a series of filters that remove airborne particles. The air purifier then circulates the purified air back into the room.

But again, the protection offered by purifiers can range from low to very high. As with filtration systems, the level of protection depends on the type of purifier you have. Those equipped with HEPA filters are much more efficient.

Their effectiveness also depends on the volume of air the purifier services, the setting (one room or several interconnected rooms), the ventilation rate (this is measured by how many times the whole volume of air is exchanged per hour) and how it is set to operate (continuous or intermittent).

To put this in context, operating a purifier equipped with a HEPA filter in a typical bedroom would significantly reduce the concentration of air pollution in the bedroom, most likely to a safe level. However, operating a less efficient purifier in a large, open plan house is not likely to help much.

Face masks

Many people consider face masks to be the best protection against air pollution. But for the most part, they merely provide a false sense of security.

Firstly, a mask is only effective if it’s properly fitted: if the fit is not perfect, most of the small particles, such as those present in the pollution plume from bushfires, will get through.

Secondly, the efficiency of the mask depends on the behaviour of the person wearing it. This includes how long you wear the mask for and how often you take it off. Considering wearing a mask is uncomfortable – particularly when it’s hot – it’s not easy to keep it on all the time.

Industrial style masks are more fitted than simple fabric masks, so can be more effective – but still depend on the wearer’s behaviour. These are not practical to wear all the time.

And if it’s questionable whether a mask will protect an adult, it’s even less likely to protect a small child. A child cannot be expected to tolerate the inconvenience and discomfort of correctly wearing a mask.

In summary, indoors we are protected to some degree from outdoor air pollution, so consider staying inside where possible – particularly if you have an existing health condition.

You might like to wear a mask or invest in an air purifier. These may help to some degree, but are emergency measures that don’t in themselves represent a solution.

While the air quality is likely to improve in Sydney and other affected regions as these fires ease, our changing climate means we can only expect to be in this situation more and more. The only real way forward is to address the climate crisis urgently and decisively.

Lidia Morawska, Professor, Science and Engineering Faculty; Director, International Laboratory for Air Quality and Health (WHO CC for Air Quality and Health); Director – Australia, Australia – China Centre for Air Quality Science and Management (ACC-AQSM), Queensland University of Technology

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

Sharing my thoughts with the world from a Particular Baptist perspective

Additional health challenges

What’s the current vaccination plan?

What should happen instead?

How can this be achieved?

What are the reasons for vaccine hesitancy?

Don’t leave vulnerable groups behind

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1. Masks

2. Ventilation

3. Vaccination

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What do the new guidelines say?

Guidelines miss the mark on ventilation

No updated advice on hand-washing

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Why children first?

When would this be OK?

Three factors could help us decide

How about mandatory vaccinations?

And mandatory vaccinations for children?

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First, how does the virus spread?

What does this mean for office workers?

Considerations for employers

Considerations for employees

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How do these medicines work?

Is it OK to repurpose drugs like this?

The evidence so far

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Remind me, what’s the hygiene hypothesis?

Ditching the hygiene hypothesis

What about ‘good’ exposure to bacteria?

How can we get more ‘good’ exposure?

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Irritation in the short term

Longer term risks

What can you do to protect your eyes from the smoke?

Some tips if your eyes are irritated

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The case of Ridley 1111

How do you prove someone has pirated your plants?

A new kind of damages

Encouraging innovation

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Does staying indoors help?

Air purifiers

Face masks

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