Should we vaccinate all returned travellers in hotel quarantine? It’s no magic fix but it could reduce risks


Catherine Bennett, Deakin UniversityThis week, a returned traveller who was quarantining in South Australia seems to have been infected with the virus during his stay, before testing positive once returning to Melbourne. It’s the latest in a long line of hotel quarantine leaks in Australia.

And in this week’s federal budget, the government has committed to welcoming back over 17,000 Australians stranded overseas over the next year, which will likely place more pressure on our hotel quarantine system.

In light of the seemingly continued spillover of hotel quarantine infections into the community, one researcher raised an intriguing possibility online: should we vaccinate all arrivals on day one of their stay in hotel quarantine?

There may be reasonably high vaccination rates among our arrivals already. But, if not, it’s definitely something worth thinking about.

In my view, overseas travellers should be considered equivalent to frontline workers, as they traverse the routes into Australia and cross through border quarantine. Therefore, they could be included in phase 1a of the vaccine rollout alongside these frontline workers.

It’s complex and there’s a lot to take into account, and vaccinating all arrivals won’t be the magic fix to our hotel quarantine troubles. But it might take the edge off some of the transmission risks.

You only have to prevent one case, which could have otherwise led to community spread and lockdown, for such a scheme to pay for itself many times over.

Here’s how it could work.

Vaccinating all arrivals could reduce infection risk

There are a number of potential ways this strategy could reduce infection risk, by:

  • preventing severe illness in people already infected
  • reducing the chance returnees will pass the virus on if they are infected, or become infected
  • protecting them from infection should they be exposed to the virus while in quarantine.

A Public Health England study found that a case who has had a single dose of either the Pfizer or AstraZeneca vaccine is up to 50% less likely to pass the virus on to their close household contacts.

However, when the researchers looked more closely at the timing, they found the full 40-50% reduction in transmission risk only occurred when the case received their first dose five or six weeks before becoming infected. In fact Pfizer didn’t reduce the transmission risk cases posed to others unless the first dose was given at least 14 days before the case became infected. In other words, giving returned travellers a dose of Pfizer while in quarantine might be too late to protect others.




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In saying that, the same study shows AstraZeneca’s vaccine does appear to at least partly reduce the transmission potential of cases even when the dose is given on the same day that person was infected.

In those who’ve received the AstraZeneca vaccine on day zero of their infection, the chance of them transmitting the virus to their close contacts over the ten days or so they’re infectious was on average roughly 20% lower than positive cases who weren’t vaccinated.

Getting the AstraZeneca vaccine when exposed to the virus, or soon after, might therefore marginally protect the wider population if, for example, a traveller contracts the virus late in quarantine and it isn’t picked up in day 12 testing and is released from quarantine.

Both Pfizer and AstraZeneca do provide partial protection from infection within 12 days of the first dose. While this is too late for those already infected, it might still provide some protection from infection for those exposed to the virus in the later stages of their stay in quarantine.

Both vaccines also appear to reduce the risk of subsequently dying from COVID-19 with an 80% reduction in deaths reported in the UK. Some in this study were infected within seven days of their first vaccine dose, but we do not know how this effectiveness against deaths changes with time since vaccination from this report.

Nevertheless, there might be some additional value in offering vaccines to both slightly reduce transmission rates and mitigate against serious illness and death in people who do become infected.

One challenge is that AstraZeneca has more to offer in reducing transmission risk in the first critical two weeks after receiving the first jab, but Australia currently doesn’t advise it for people under 50. Pfizer is in limited supply and our vaccine rollout phase 1a and 1b recipients haven’t all been fully vaccinated yet. The relative risks and benefits of reallocating some of our vaccine supply and delivery must be carefully thought through.

Many of those arriving in Australia will likely have opted for vaccination before travel, if available to them, even if just to increase their chances of testing negative and being allowed to board their flights home. Many are arriving from countries that began their vaccination programs months before Australia.

How many returnees are already vaccinated?

The number of positive cases in hotel quarantine has grown month on month, from 160 in February to 469 in April.

New South Wales provides the most detailed information on returned travellers. Its latest surveillance report on about 21,000 returnees shows 180, or 0.8%, tested positive to COVID-19. About 75% of these positive cases tested positive by day two, suggesting they were exposed before arriving in Australia or in transit.




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The report does include information on how many arrivals have been vaccinated since March 1. Of the 302 positive cases reported to the start of May, 20 had been vaccinated, with six fully vaccinated (two doses at least two weeks prior) and 14 partially vaccinated. Although, those considered “fully vaccinated” might not have been two weeks post-vaccine at the time they actually contracted the virus.

We haven’t been provided the overall vaccination rates for returnees across Australian hotel quarantine, so we can’t yet work out what percentage of arrivals are vaccinated. But if this is quite low, it strengthens the argument for offering vaccines to travellers on arrival.The Conversation

Catherine Bennett, Chair in Epidemiology, Deakin University

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

5 tips for ventilation to reduce COVID risk at home and work



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Mary-Louise McLaws, UNSW

As many of us return to the office, and congregate indoors over dinner and drinks during the summer holidays, we need to think about ventilation to minimise the indoor spread of COVID-19.

SARS-CoV-2, the virus that causes COVID, is spread mostly by larger particles called droplets, but also by smaller particles called aerosols, and by touch from contaminated surfaces.

Aerosol particles are lighter than droplet-sized particles, and can be suspended in the air for longer. The suspension and therefore transmission of aerosols is facilitated by poor ventilation.

Increasing ventilation indoors, with fresh outdoor air, is a key method of dispersing viral particles. Ventilation can reduce the risk that just one COVID-positive person (who might not yet know they’re infectious) will infect others.

There are some simple measures you can take, both at home and at work, to improve ventilation over the holiday period and beyond.




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1. Open windows and doors

The best strategy at home and at work is simply to open windows and doors.

If you’re having friends and family over for a meal, or your office Christmas party, consider moving tables and chairs closer to open windows and open up a door to create a through breeze.

Or, if weather permits, eat outside.

2. Set your air conditioner to pull fresh air from outside

Air conditioners can help, but they must be on the right setting.

At work or home you don’t want to recirculate indoor air, as this just fans the same air around the room (but now colder or warmer).

Instead, always make sure your air conditioner is set to bring in 100% fresh air from outside. There are settings in offices that allow the system to increase air change per hour, meaning it can reduce the time it takes for all the air inside the room to be completely replaced with outside fresh air.

A person using a remote for their air conditioner
Aircons can help ventilate rooms, but only if they’re inserting fresh air from outside, rather than recirculating indoor air.
Shutterstock

But the direction of the airflow is also important. For example, airflow from an air conditioner (that was recirculating air rather than pulling it from outside) was implicated in spreading the virus to a number of diners at tables downstream in a restaurant in China.

Offices welcoming back staff should prepare their air conditioners by having their engineers service the system to pull in fresh air faster than the pre-COVID setting (which may have been around 40 litres per second per person) at no less than 60 litres per second, per person.

In hospitals, aged-care facilities and hotel quarantine, qualified engineers should be brought in to assess the adequacy of the air conditioner’s airflow. This is particularly crucial for any “hot zones” accommodating people who are COVID-positive.

The World Health Organisation recommends hot zones have 12 airflow changes per hour (that’s 80 litres per second per person), meaning the air is totally replaced 12 times every 60 minutes. This is the gold standard for ventilation, and can be very hard to achieve in many buildings.




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Many of our buildings are poorly ventilated, and that adds to COVID risks


3. Use fans

Guidelines released last week by the US Centers for Disease Control and Prevention recommend placing fans near open windows to enhance airflow. The recommendation is to keep fans on at all times when a room is occupied, for example at restaurants.

As with aircons, fans can be dangerous if they push the air directly from one person to another, and one is infectious. You should place the fan so it increases the flow of fresh air into the room, and shouldn’t be placed so the air moves from the room towards the open window or open door.

4. Don’t bother with HEPA filters at home

High-efficiency particulate air (HEPA) filters have been marketed as a way to reduce the concentration of SARS-CoV-2 particles in the air.

Their effectiveness is dependent on the airflow capacity of the unit, the configuration of the room, the number of people in the room, and the position of the filter in the room.

But there’s no evidence to suggest a portable HEPA filter unit will help in your home. So don’t rush out and buy one for Christmas.

They may be effective in some areas of health care, such as a COVID ward in a hospital or in aged care homes, particularly when used in negative-pressure rooms. The combination of the HEPA filter and negative air pressure reduces the risk of aerosol particles escaping into the corridor.

5. In public transport, taxis and Ubers

COVID outbreaks have been traced back to exposure on public transport. For example, a young man in Hunan Province, China, travelled on two buses and infected multiple people who were sitting in different areas of the buses. A study of this cluster was carried out by Chinese researchers, who put forward one theory regarding air flow:

The closed windows with running ventilation on the buses could have created an ideal environment for aerosol transmission […] the ventilation inlets were aligned above the windows on both sides, and the exhaust fan was in the front, possibly creating an airflow carrying aerosols containing the viral particles from the rear to the middle and front of the vehicle.

The study’s authors recommend all windows be open on public transport to help disperse viral particles. If you’re on a tram or a bus, you should open them if you can.

However, on some forms of public transport it might be impossible, like trains. In these instances, you should wear a mask.

Likewise, it’s ideal to have the windows down in Ubers and taxis. But if you can’t or don’t want to, turn on the air conditioner and have it pull fresh air from outside. And still wear a mask!The Conversation

Mary-Louise McLaws, Professor of Epidemiology Healthcare Infection and Infectious Diseases Control, UNSW

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

How to reduce COVID-19 risk at the beach or the pool


Brett Mitchell, University of Newcastle and Philip Russo, Monash University

Australians are emerging from winter and, where possible, enjoying trips to beaches and public pools. Beach-side picnics, barbecues and get-togethers are back on the cards for many of us.

While daily COVID-19 case numbers have been looking promising in most places lately, we are still very much in a pandemic; your spring and summertime social activities might look a little different this year.

Here’s how to stay safe if you’re planning a trip to the beach or public pool.




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A person swims laps in a pool.
Your spring and summertime social activities might look a little different his year.
Shutterstock

The three golden rules

Outdoor activities are associated with reduced COVID-19 transmission risk compared to indoor activities. That said, whatever your plans, the three golden rules still apply: stay home if you are sick, keep up the hand hygiene and maintain physical distancing from others.

If you’re sick, you shouldn’t be socialising at all. You should be getting a COVID-19 test and self-isolating while you wait for results. Even outdoors, one sick person can spread COVID-19 to a large number of people.

Going to the beach

Firstly, pick a quieter beach. The extra time it takes to research and travel to a more secluded beach may be a hassle, but it’s less risky than going to a crowded beach (and often nicer, too).

Consider driving or cycling to the beach (if possible) rather than taking public transport. If you do use public transport, pick an off-peak time of day and wear a mask — avoid rush hour.

When you arrive, put your towels down in a spot on the sand at least 1.5m away from others — more is better, if you can. You should still swim between the flags, but you don’t need to be sitting close to other people.

An aerial shot of an ocean pool.
Pick a quieter swim spot or go at a less busy time.
Shutterstock

When swimming between the flags, it might feel crowded in the water during busy times or at busy beaches. If you are in that situation, think about reducing the time spent in the water — go in for five minutes, then come out for a bit, then go back in for another five, so you are not having prolonged contact next to another person.

If you see someone expelling mucus into a wave, try to avoid that wave and person if you can.

Remember to stay COVID-safe if you’re at a cafe for a post-swim snack or ice-block. Don’t bunch up in lines close to other people and maintain physical distance from others if you are sitting down for a meal.

In the past, it might have felt normal to share a plate of hot chips with mates or even offer a friend a sip of your drink — but we don’t do that anymore. If you’re having a beach-side picnic, make sure you’re not sharing utensils, double-dipping in the hummus or sticking your fingers into a shared bowl of olives.

Of course, all these general principles also apply to other outdoor swimming locations, such as rivers and dams.

Going to the pool

The ocean is probably less risky than going to the pool, because there’s more movement of water and a high level of dilution.

So you need to approach public pools with a degree of caution.

But if you have no choice, are living away from the coast and want a swim, it’s probably fine to go to an outdoor pool — especially if you are living in an area with a low level of community transmission. You can find out community transmission rates in your area from your state health department website.

Outdoor pools are less risky than indoor pools because of increased air flow. Confined spaces are associated with increased risk of COVID-19 transmission.

An outdoor pool in Sydney.
Outdoor pools are less risky than indoor pools,
Shutterstock

Choose the right time to go a pool. Transmission risk decreases with fewer people, so try to go at less busy times. In the morning, the pool water has likely had time to be well-filtered and well-chlorinated overnight and not many people have swum in it yet that day.

Chlorine kills coronavirus. The CDC says it is

not aware of any scientific reports of the virus that causes COVID-19 spreading to people through the water in pools, hot tubs, or water playgrounds […] including saltwater pools.

The risk of transmission, albeit potentially low, would also depend on how chlorinated the pool is and how long any coronavirus that may be in the water is exposed to chlorine before coming into contact with another person.

Theoretically, if someone is carrying the virus and some mucus goes out of their mouth and into the pool, there might be a certain period of time before any virus in that mucus is inactivated by the chlorine. If it gets to you before that inactivation happens, then it is possibly a bit more risky.

People swim at a pool in Sydney.
Whatever you have planned this summer, think about the local risks and what you can do to reduce them.
Shutterstock

Avoiding the change-rooms is another way to reduce risk, as these rooms are often in a confined space. Being careful to maintain physical distancing in the pool, poolside and at the cafe are also important measures.

In general, it should be fine to take the kids to the pool but, if there was a degree of community transmission in your area, perhaps reconsider. There is growing evidence kids are less susceptible to COVID-19 compared to adults but it doesn’t necessarily mean they are not transmitting it.

Whatever you have planned this summer, think about the local risks and what you can do to reduce them.




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The Conversation


Brett Mitchell, Professor of Nursing, University of Newcastle and Philip Russo, Associate Professor, Director Cabrini Monash University Department of Nursing Research, Monash University

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

How setting aside some ‘worry time’ can help reduce anxiety over COVID-19 lockdowns



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Dougal Sutherland, Te Herenga Waka — Victoria University of Wellington

Many New Zealanders will be feeling anxious, disappointed and even angry about the return of COVID-19 in the community.

Many of us prefer to suppress these emotions because they are unpleasant or we may feel under-equipped to manage them. But if left unrecognised and unchecked, they will drive our behaviour.

We may act without thinking clearly and rush to the supermarket to stock up. We may lash out verbally or physically at those we see as threatening us. Or we may fall too easily for social media posts that give us a sense of relief, even if we’re not sure about their accuracy.

Times of heightened anxiety are fertile breeding grounds for conspiracy theories, especially among those with low levels of trust in the government.

Anxiety and anger are normal reactions during uncertain times. We experience these emotions when we feel under threat, but the simple act of acknowledging them can ease their intensity.

Recognising your emotional reaction

Research New Zealand has been conducting regular polls of New Zealanders since the first lockdown in March and April. Results show heightened levels of concern about health, losing a job and the economy in general. The most recent poll also shows New Zealanders were worried about a new outbreak.

A heightened level of worry keeps us in a state of “flight or fight” — the evolutionary system that drives our response to fear. But if we pause to notice what we’re feeling, even correctly labelling our emotional state can reduce the intensity of these feelings.

The regular practice of mindfulness, best described as deliberately paying attention to the present moment, has been shown to help reduce the reactivity of our flight or fight system. Physical activity helps to dampen our physiological symptoms of anxiety, and diaphragmatic or belly breathing is a simple but effective means of doing this.




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Once we’ve gained some measure of regulation of our emotional state, we are better able to engage our prefrontal cortex in planning, reasoning and decision making. Noticing what we are thinking and saying to ourselves is a first step and a core part of cognitive-behavioural therapy, which has a strong evidence base in the treatment of stress and anxiety.

If we say to ourselves that this is “disastrous” or “unmanageable”, we may feel increasingly emotionally overwhelmed. If we think that “someone has exposed us to infection”, we may feel quite angry toward that person. In contrast, if we recognise that this style of thinking is not helpful, we may be able to adopt a more balanced view of the situation.

Managing your anxiety

Anxiety wakes you up in the middle of the night as your brain churns over and over. It’s important to recognise what our brains are doing in these instances. They are trying to remind us not to forget about something we perceive as a threat.

This makes sense from an adaptive point of view. Being alert to perceived danger can ultimately keep us alive. But it can also bring with it a sense of loss of control.




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Having a “prescribed worry time” can be an antidote to this loss of control. Setting aside a set time of day to deliberately focus on your worries can both reduce our avoidance of unwelcome emotions and send our brains the message that we won’t forget about this “danger” – so our brains don’t need to keep reminding us of it so much.

Within this worry time, focusing our thinking on what is within our ability to control, rather than on what is outside our sphere of influence, can also reduce levels of anxiety and helplessness.

Ultimately, while our emotional reactions to the return of lockdown are normal and nothing to be afraid of, it can be comforting and motivating to remember that we’ve done this before and can do it again. And we may even learn some tips for coping under stress that are useful for the rest of our lives.The Conversation

Dougal Sutherland, Clinical Psychologist, Te Herenga Waka — Victoria University of Wellington

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

Stimulus that retrofits housing can reduce energy bills and inequity too



Nicola Willand, Author provided

Nicola Willand, RMIT University; Bhavna Middha, RMIT University; Emma Baker, University of Adelaide; Ralph Horne, RMIT University, and Trivess Moore, RMIT University

Stay-at-home orders and the economic crisis have increased the burden of energy costs on lower-income Australians. Poor housing quality and unequal access to home energy efficiency are hurting our most vulnerable households. With the next stage of the national recovery program expected to include cash grants for home renovation, now is the time to turn to housing retrofits that support health and well-being as well as boost jobs.

Staying at home during the COVID-19 pandemic increases households’ energy consumption and costs. As one in ten Australians might lose their jobs, the pandemic is adding to the energy hardship of people who were already struggling to pay their bills.




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Access to energy is essential

Cold housing is a known health risk. Lancet research attributes about 7% of Australian deaths to cold weather. Warm housing reduces the risk of airborne infections, as well as providing comfort for working and studying.

Laundry temperatures of 60-90°C are needed to limit the spread of the coronavirus. But this conflicts with common energy-saving advice of washing clothes in cold water. Self-isolation also means heating more and not being able to close off unused rooms.

Low-income households, renters and older people are more likely to live in energy-inefficient dwellings. In fact, most Australian housing has poor energy efficiency.

When people on low incomes live in such housing, they are doubly disadvantaged by the challenges of needing more energy and not being able to afford it. Households with older people, people with chronic illness and children are particularly susceptible to energy stress and poor health outcomes.




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Stop-gap measures

The temporary stop to disconnections in some states recognises that access to electricity and gas is a basic need and essential for health and well-being. This guaranteed energy, and a commitment by Australian Energy Council retailers not to charge penalty fees for late payment, will give affected households some relief.

Even if power bill payments are deferred, households must still eventually repay their mounting debts.
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However, bill payment will only be postponed until the end of July. Much of the expensive heating period will still be ahead of us. And after that households will face the costs of cooling homes in summer.

Energy debts are going to accumulate as a burden to low-income households into the future. Energy retailers might find it ethically difficult to resume disconnections, but customers will have to repay their debts. This will only be possible if their overall financial position improves and/or the cost of their energy decreases.

Income support via energy concessions can ease bill stress. However, taxpayer money may be better spent on providing sustained relief by improving the energy performance of homes. Acknowledging housing as essential infrastructure would enable economic and social progress.




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A lasting solution to energy poverty

A long-term stimulus package for retrofits would be welcome. The focus should be on comprehensive retrofitting to reduce energy demand, thus helping households to repay debt. Comprehensive or “deep retrofits” combine simple activities such as draught proofing with insulating ceilings, floors and walls, upgrading heating and cooling appliances, and installing solar PV systems.

Many retrofits overlook the opportunity to install underfloor insulation when restumping a house.
CSR Bradford/YouTube screenshot

Initial findings of our HEET (Housing Energy Efficiency Transitions) research show simple retrofit measures are cheap and easy to do, and DIYing is popular. However, some opportunities are missed because householders are not aware of what can and should be done. A common example is failing to install underfloor insulation when restumping the house.




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Riding the current wave of home improvements, innovative retrofit initiatives may guide people in their DIY efforts. However, some training for proper DIY installation and the use of skilled tradespeople for technical installations is needed for safety and quality.

Spread retrofitting benefits more widely

Federal and state subsidy schemes already promote retrofitting. But recent research suggests low-income households and renters have benefited less. The one-in-three households that rent their homes should not be missing out.




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Putting people at the centre of retrofitting programs will provide healthier homes and help tackle unemployment. This means providing retrofit assistance to those who need it most and training people in retrofit skills.

Previously, the boom in new housing construction inhibited retrofitting. This might change following the COVID-19 crisis. A long-term retrofit program would be an opportunity to upskill builders and to retrain newly unemployed Australians, particularly the young people who have been most affected by job losses. An expanded retrofit workforce is needed to reach the large number of inefficient homes.

So-called “Green Deals” have already been proposed in Europe, the US and the UK. Green construction stimulus packages in Australia have successfully supported economic recovery before.
The aim should be to spawn a new industry of energy-efficient builders who will continue to contribute to the upgrade and upkeep of Australian housing. This could help cut greenhouse gas emissions, promote public health and improve our resilience to crises.

A nationwide stimulus package to provide healthier and more energy-efficient homes would help the most vulnerable and boost the economy.The Conversation

Nicola Willand, Lecturer, School of Property, Construction and Project Management, RMIT University; Bhavna Middha, Research Fellow, Centre for Urban Research, RMIT University; Emma Baker, Professor of Housing Research, School of Architecture and Built Environment, University of Adelaide; Ralph Horne, Deputy Pro Vice Chancellor, Research & Innovation; Director of UNGC Cities Programme; Professor, RMIT University, and Trivess Moore, Senior Lecturer, School of Property, Construction and Project Management, RMIT University

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

Beyond travel, a trans-Tasman bubble is an opportunity for Australia and NZ to reduce dependence on China



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Hongzhi Gao, Te Herenga Waka — Victoria University of Wellington and Monica Ren, Macquarie University

When it comes to our economic over-reliance on China, New Zealand consumers need look no further than their most popular big box chain, The Warehouse. The familiar “big red shed” sourced about 60% of its home brand stock from China in 2017 – and a further NZ$62 million in products directly through offices in China, India and Bangladesh in 2019.

In Australia, many major chain stores as well as online retail giant kogan.com are in a similar position. Reliant on China for much of what they sell, including exclusive home-brand items, they are part of what has been described as the world’s most China-reliant economy.

The COVID-19 crisis has thrown Australian and New Zealand businesses’ dependence on China into stark relief. With countries reportedly competing with and undercutting each other to secure desperately needed medical supplies from China, many are now waking up to their economic exposure to a single manufacturing giant.

Understandably, discussions about creating a “trans-Tasman bubble” between Australia and New Zealand have focused on kick-starting economic activity in the short term, particularly through tourism. But both countries also need to take a longer-term view of boosting economic activity – including through increased manufacturing and trade integration.




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The statistics support this. In 2018, 20% of global trade in the manufacturing of “intermediate” products (which need further processing before sale) came from China. Chinese manufacturing (including goods made from components made in China) also accounted for:

  • 35% of household goods
  • 46% of hi-tech goods
  • 54% of textiles and apparel
  • 38% of machinery, rubber and plastic
  • 20% of pharmaceuticals and medical goods
  • 42% of chemical products.

Australia and New Zealand are no exception, with China the number one trading partner of both. Australia earned 32.6% of its export income from China in 2019, mostly from natural resource products such as iron ores, coal and natural gas, as well as education and tourism.

Inside a Bunnings store in Australia: many of the shelves would be empty without goods sourced from China.
http://www.shutterstock.com

From New Zealand, 23% of exports (worth NZ$20 billion) went to China in 2019, and much of the country’s manufacturing has moved to China over the past 20 years. The China factor in New Zealand supply chains is also crucial, with a fifth of exports containing Chinese components.

Supply shortages from China

The world is now paying a price for this dependence on China. Since the COVID-19 outbreak in early 2020 there has been volatility in the supply of products ranging from cars and Apple phones to food ingredients and hand sanitiser packaging.

More worryingly, availability of popular over-the-counter painkiller paracetamol was restricted due to Chinese factory closures. This is part of a bigger picture that shows Australia now importing over 90% of medicines and New Zealand importing close to NZ$1.59 billion in pharmaceutical products in 2019. Overall, both countries are extremely vulnerable to major supply chain disruptions of medical products.

For all these reasons, a cooperative trans-Tasman manufacturing strategy should be on the table right now and in any future bilateral trade policy conversations.

The big red shed: New Zealand’s Warehouse chain sources 60% of its products from China.
http://www.shutterstock.com



Read more:
Australia depends less on Chinese trade than some might think


Opportunities for Australia and NZ

Rather than each country focusing on product specialisation or setting industrial priorities in isolation, the two economies need to discuss how best to pool resources, add value and enhance the competitive advantage of strategic industries in the region as a whole.

Currently, trans-Tasman trade primarily involves natural resources and foodstuffs flowing from New Zealand to Australia, with motor vehicles, machinery and mechanical equipment flowing the other way. Manufacturing is skewed towards Australia, but closer regional integration would mean increased flows of capital, components and finished products between the countries. We have seen this already in the primary and service sectors but not much in the manufacturing sector, especially from New Zealand to Australia.

Medical technologies and telecommunications equipment manufacturing (both critical during the pandemic) stand out as potential new areas of economic integration. In that sense, it was heartening to see major medical tech companies such as Res-Med Australia and Fisher & Paykel Healthcare in New Zealand rapidly scale up their production capacities to build respiratory devices, ventilators, and other personal protective equipment products.




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These brands enjoy a global technology edge, smart niche positioning and reputations for innovation. We need more of these inside a trans-Tasman trade and manufacturing bubble.

China still vital but balance is crucial

Key to successful regional integration will be the pooling of research and development (R&D) resources, mutual direct investment, subsidising R&D and manufacturing in emerging markets with profits from another (such as China), and value-adding specialisation in the supply chain. For example, Tait Communication in New Zealand recently invested in a new facility based in one of Australia’s largest science, technology and research centres.

Together, we can make a bigger pie.

None of this means cutting ties with China, which will remain the main importer of primary produce and food products from Australasia for the foreseeable future. And Chinese exports will still be vital. Fisher & Paykel Healthcare sells its products in about 120 countries, for example, but some of its key raw materials suppliers are Chinese.

Getting this dynamic balancing right will be key to Australia and New Zealand prospering in the inevitably uncertain – even divided – post-pandemic global business environment. And you never know, maybe one day we’ll see a “made in Australia and New Zealand” label in the aisles of The Warehouse and Bunnings.The Conversation

Hongzhi Gao, Associate professor, Te Herenga Waka — Victoria University of Wellington and Monica Ren, Lecturer/ Assistant Professor, Macquarie University

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

Fix housing and you’ll reduce risks of coronavirus and other disease in remote Indigenous communities


Nina Lansbury Hall, The University of Queensland; Andrew Redmond, The University of Queensland; Paul Memmott, The University of Queensland, and Samuel Barnes, The University of Queensland

Remote Indigenous communities have taken swift and effective action to quarantine residents against the risks of COVID-19. Under a plan developed by the Aboriginal and Torres Strait Islander Advisory Group, entry to communities is restricted to essential visitors only. This is important, because crowded and malfunctioning housing in remote Indigenous communities heightens the risk of COVID-19 transmission. High rates of chronic disease mean COVID-19 outbreaks in Indigenous communities may cause high death rates.

The “old story” of housing, crowding and health continues to be overlooked. A partnership between the University of Queensland and Anyinginyi Health Aboriginal Corporation, in the Northern Territory’s (NT) Tennant Creek and Barkly region, re-opens this story. A new report from our work together is titled in Warumungu language as Piliyi Papulu Purrukaj-ji – “Good Housing to Prevent Sickness”. It reveals the simplicity of the solution: new housing and budgets for repairs and maintenance can improve human health.




Read more:
Coronavirus will devastate Aboriginal communities if we don’t act now


Infection risks rise in crowded housing

Rates of crowded households are much higher in remote communities (34%) than in urban areas (8%). Our research in the Barkly region, 500km north of Alice Springs, found up to 22 residents in some three-bedroom houses. In one crowded house, a kidney dialysis patient and seven family members had slept in the yard for over a year in order to access clinical care.

Many Indigenous Australians lease social housing because of barriers to individual land ownership in remote Australia. Repairs and maintenance are more expensive in remote areas and our research found waiting periods are long. One resident told us:

Houses [are] inspected two times a year by Department of Housing, but no repairs or maintenance. They inspect and write down faults but don’t fix. They say people will return, but it doesn’t happen.

Better ‘health hardware’ can prevent infections

The growing populations in communities are not matched by increased housing. Crowding is the inevitable result.

Crowded households place extra pressure on “health hardware”, the infrastructure that enables washing of bodies and clothing and other hygiene practices.




Read more:
Homelessness and overcrowding expose us all to coronavirus. Here’s what we can do to stop the spread


We interviewed residents who told us they lacked functioning bathrooms and washing machines and that toilets were blocked. One resident said:

Scabies has come up a lot this year because of lack of water. We’ve been running out of water in the tanks. There’s no electric pump … [so] we are bathing less …

[Also] sewerage is a problem at this house. It’s blocked … The toilet bubbles up and the water goes black and leaks out. We try to keep the kids away.

A lack of health hardware increases the transmission risk of preventable, hygiene-related infectious diseases like COVID-19. Anyinginyi clinicians report skin infections are more common than in urban areas, respiratory infections affect whole families in crowded houses, and they see daily cases of eye infections.

Data that we accessed from the clinic confirmed this situation. The highest infection diagnoses were skin infections (including boils, scabies and school sores), respiratory infections, and ear, nose and throat infections (especially middle ear infection).

These infections can have long-term consequences. Repeated skin sores and throat infections from Group A streptococcal bacteria can contribute to chronic life-threatening conditions such as kidney disease and rheumatic heart disease (RHD). Indigenous NT residents have among the highest rates of RHD in the world, and
Indigenous children in Central Australia have the highest rates of post-infection kidney disease (APSGN).




Read more:
The answer to Indigenous vulnerability to coronavirus: a more equitable public health agenda


Reviving a vision of healthy housing and people

Crowded and unrepaired housing persists, despite the National Indigenous Reform Agreement stating over ten years ago: “Children need to live in accommodation with adequate infrastructure conducive to good hygiene … and free of overcrowding.”

Indigenous housing programs, such as the National Partnership Agreement for Remote Indigenous Housing, have had varied success and sustainability in overcoming crowding and poor housing quality.

It is calculated about 5,500 new houses are required by 2028 to reduce the health impacts of crowding in remote communities. Earlier models still provide guidance for today’s efforts. For example, Whitlam-era efforts supported culturally appropriate housing design, while the ATSIC period of the 1990s introduced Indigenous-led housing management and culturally-specific adaptation of tenancy agreements.

Our report reasserts the call to action for both new housing and regular repairs and maintenance (with adequate budgets) of existing housing in remote communities. The lack of effective treatment or a vaccine for COVID-19 make hygiene and social distancing critical. Yet crowding and faulty home infrastructure make these measures difficult if not impossible.

Indigenous Australians living on remote country urgently need additional and functional housing. This may begin to provide the long-term gains described to us by an experienced Aboriginal health worker:

When … [decades ago] houses were built, I noticed immediately a drop in the scabies … You could see the mental change, could see the difference in families. Kids are healthier and happier. I’ve seen this repeated in other communities once housing was given – the change.


Trisha Narurla Frank contributed to the writing of this article, and other staff from Anyinginyi Health Aboriginal Corporation provided their input and consent for the sharing of these findings.The Conversation

Nina Lansbury Hall, Senior Lecturer, School of Public Health, The University of Queensland; Andrew Redmond, Senior Lecturer, School of Medicine, The University of Queensland; Paul Memmott, Professor, School of Architecture, and Director, Aboriginal Environments Research Centre (AERC), The University of Queensland, and Samuel Barnes, Research Assistant, School of Public Health, The University of Queensland

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

Here’s what you can eat and avoid to reduce your risk of bowel cancer



It’s not certain why, but fibre has protective effects against bowel cancer.
http://www.shutterstock.com

Suzanne Mahady, Monash University

Australia has one of the highest rates of bowel cancer in the world. In 2017, bowel cancer was the second most common cancer in Australia and rates are increasing in people under 50.

Up to 35% of cancers worldwide might be caused by lifestyle factors such as diet and smoking. So how can we go about reducing our risk of bowel cancer?




Read more:
What’s behind the increase in bowel cancer among younger Australians?


What to eat

Based on current evidence, a high fibre diet is important to reduce bowel cancer risk. Fibre can be divided into 2 types: insoluble fibre, which creates a bulky stool that can be easily passed along the bowel; and soluble fibre, which draws in water to keep the stool soft.

Fibre from cereal and wholegrains is an ideal fibre source. Australian guidelines suggest aiming for 30g of fibre per day for adults, but fewer than 20% of Australian adults meet that target.

Wheat bran is one of the richest sources of fibre, and in an Australian trial in people at high risk of bowel cancer, 25g of wheat bran reduced precancerous growths. Wheat bran can be added to cooking, smoothies and your usual cereal.

It’s not clear how fibre may reduce bowel cancer risk but possible mechanisms include reducing the time it takes food to pass through the gut (and therefore exposure to potential carcinogens), or through a beneficial effect on gut bacteria.

Once bowel cancer is diagnosed, a high fibre diet has also been associated with improved survival.

Dairy is ‘probably’ protective against bowel cancer.
from http://www.shutterstock.com



Read more:
Interactive body map: what really gives you cancer?


Milk and dairy products are also thought to reduce bowel cancer risk. The evidence for milk is graded as “probably protective” in current Australian bowel cancer guidelines, with the benefit increasing with higher amounts.

Oily fish may also have some protective elements. In people with hereditary conditions that make them prone to developing lots of precancerous growths (polyps) in the bowel, a trial where one group received a daily supplement of an omega 3 polyunsaturated fatty acid (found in fish oil) and one group received a placebo, found that this supplement was associated with reduced polyp growth. Whether this is also true for people at average risk of bowel cancer, which is most of the population, is unknown.

And while only an observational study (meaning it only shows a correlation, and not that one caused the other), a study of bowel cancer patients showed improved survival was associated with daily consumption of coffee.

What to avoid

It’s best to avoid large quantities of meat. International cancer authorities affirm there is convincing evidence for a relationship between high meat intake and bowel cancer. This includes red meat, derived from mammalian muscle such as beef, veal, lamb, pork and goat, and processed meat such as ham, bacon and sausages.

Processed meats have undergone a preservation technique such as smoking, salting or the addition of chemical preservatives which are associated with the production of compounds that may be carcinogenic.

Evidence also suggests a “dose-response” relationship, with cancer risk rising with increasing meat intake, particularly processed meats. Current Australian guidelines suggest minimising intake of processed meats as much as possible, and eating only moderate amounts of red meat (up to 100g per day).

What else can I do to reduce the risk of bowel cancer?

The key to reducing cancer risk is leading an overall healthy lifestyle. Adequate physical activity and avoiding excess fat around the tummy area is important. Other unhealthy lifestyle behaviours such as eating lots of processed foods have been associated with increased cancer risk.

And for Australians over 50, participating in the National Bowel Cancer Screening program is one of the most effective, and evidence-based ways, to reduce your risk.




Read more:
INTERACTIVE: We mapped cancer rates across Australia – search for your postcode here


The Conversation


Suzanne Mahady, Gastroenterologist & Clinical Epidemiologist, Senior Lecturer, Monash University

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

Are there certain foods you can eat to reduce your risk of Alzheimer’s disease?



Eating healthy foods doesn’t just improve our physical health. It can benefit our mental health, too.
From shutterstock.com

Ralph Martins, Macquarie University

With the rise of fad diets, “superfoods”, and a growing range of dietary supplement choices, it’s sometimes hard to know what to eat.

This can be particularly relevant as we grow older, and are trying to make the best choices to minimise the risk of health problems such as high blood pressure, obesity, type 2 diabetes, and heart (cardiovascular) problems.

We now have evidence these health problems also all affect brain function: they increase nerve degeneration in the brain, leading to a higher risk of Alzheimer’s disease and other brain conditions including vascular dementia and Parkinson’s disease.

We know a healthy diet can protect against conditions like type 2 diabetes, obesity and heart disease. Fortunately, evidence shows that what’s good for the body is generally also good for the brain.




Read more:
People living in rural areas may be at lower risk of Alzheimer’s disease


Oxidative stress

As we age, our metabolism becomes less efficient, and is less able to get rid of compounds generated from what’s called “oxidative stress”.

The body’s normal chemical reactions can sometimes cause chemical damage, or generate side-products known as free radicals – which in turn cause damage to other chemicals in the body.

To neutralise these free radicals, our bodies draw on protective mechanisms, in the form of antioxidants or specific proteins. But as we get older, these systems become less efficient. When your body can no longer neutralise the free radical damage, it’s under oxidative stress.

The toxic compounds generated by oxidative stress steadily build up, slowly damaging the brain and eventually leading to symptoms of Alzheimer’s disease.




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What causes Alzheimer’s disease? What we know, don’t know and suspect


To reduce your risk, you need to reduce oxidative stress and the long-term inflammation it can cause.

Increasing physical activity is important. But here we are focusing on diet, which is our major source of ANTIoxidants.

Foods to add

There are plenty of foods you can include in your diet that will positively influence brain health. These include fresh fruits, seafood, green leafy vegetables, pulses (including beans, lentils and peas), as well as nuts and healthy oils.

Fish

Fish is a good source of complete protein. Importantly, oily fish in particular is rich in omega-3 fatty acids.

Laboratory studies have shown omega-3 fatty acids protect against oxidative stress, and they’ve been found to be lacking in the brains of people with Alzheimer’s disease.

They are essential for memory, learning and cognitive processes, and improve the gut microbiota and function.

Oily fish, like salmon, is high in omega-3 fatty acids, which research shows can benefit our brain health.
From shutterstock.com

Low dietary intake of omega-3 fatty acids, meanwhile, is linked to faster cognitive decline, and the development of preclinical Alzheimer’s disease (changes in the brain that can be seen several years before for onset of symptoms such as memory loss).

Omega-3 fatty acids are generally lacking in western diets, and this has been linked to reduced brain cell health and function.

Fish also provides vitamin D. This is important because a lack of vitamin D has been linked to Alzheimer’s disease, Parkinson’s disease, and vascular dementia (a common form of dementia caused by reduced blood supply to the brain as a result of a series of small strokes).

Berries

Berries are especially high in the antioxidants vitamin C (strawberries), anthocyanins (blueberries, raspberries and blackberries) and resveratrol (blueberries).

In research conducted on mouse brain cells, anthocyanins have been associated with lower toxic Alzheimer’s disease-related protein changes, and reduced signs of oxidative stress and inflammation specifically related to brain cell (neuron) damage. Human studies have shown improvements in brain function and blood flow, and signs of reduced brain inflammation.




Read more:
Six things you can do to reduce your risk of dementia


Red and purple sweet potato

Longevity has been associated with a small number of traditional diets, and one of these is the diet of the Okinawan people of Japan. The starchy staple of their diet is the purple sweet potato – rich in anthocyanin antioxidants.

Studies in mice have shown this potato’s anthocyanins protect against the effects of obesity on blood sugar regulation and cognitive function, and can reduce obesity-induced brain inflammation.

Green vegetables and herbs

The traditional Mediterranean diet has also been studied for its links to longevity and lower risk of Alzheimer’s disease.

Green vegetables and herbs feature prominently in this diet. They are rich sources of antioxidants including vitamins A and C, folate, polyphenols such as apigenin, and the carotenoid xanthophylls (especially if raw). A carotenoid is an orange or red pigment commonly found in carrots.

Green vegetables and herbs provide us with several types of antioxidants.
From shutterstock.com

The antioxidants and anti-inflammatory chemicals in the vegetables are believed to be responsible for slowing Alzheimer’s pathology development, the build up of specific proteins which are toxic to brain cells.

Parsley is rich in apigenin, a powerful antioxidant. It readily crosses the barrier between the blood and the brain (unlike many drugs), where it reduces inflammation and oxidative stress, and helps brain tissue recovery after injury.




Read more:
What is the Mediterranean diet and why is it good for you?


Beetroot

Beetroot is a rich source of folate and polyphenol antioxidants, as well as copper and manganese. In particular, beetroot is rich in betalain pigments, which reduce oxidative stress and have anti-inflammatory properties.

Due to its nitrate content, beetroot can also boost the body’s nitric oxide levels. Nitric oxide relaxes blood vessels resulting in lowered blood pressure, a benefit which has been associated with drinking beetroot juice.

A recent review of clinical studies in older adults also indicated clear benefits of nitrate-rich beetroot juice on the health of our hearts and blood vessels.

Foods to reduce

Equally as important as adding good sources of antioxidants to your diet is minimising foods that are unhealthy: some foods contain damaged fats and proteins, which are major sources of oxidative stress and inflammation.

A high intake of “junk foods” including sweets, soft drinks, refined carbohydrates, processed meats and deep fried foods has been linked to obesity, type 2 diabetes and cardiovascular disease.

Where these conditions are are all risk factors for cognitive decline and Alzheimer’s disease, they should be kept to a minimum to reduce health risks and improve longevity.




Read more:
Health check: can eating certain foods make you smarter?


The Conversation


Ralph Martins, Professor, Department of Biomedical Sciences, Macquarie University

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

Hand sanitisers in public won’t wipe out the flu but they might help reduce its spread



It’s quicker to use hand sanitiser than soap and water, which means people might be more likely to use it.
Shutterstock

Trent Yarwood, The University of Queensland

This year’s flu season is off to an early start, with 144,000 confirmed cases so far in 2019. That’s more than twice as many confirmed cases of the flu than for all of 2018 (58,000), and almost as many as the 2017 horror flu season (251,000).

The number of cases so far this year, including more than 231 deaths nationwide, led the NSW opposition health spokesperson to call for hand sanitisers in public spaces to help slow the spread.




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It’s a bad year for flu, but it’s too early to call it the worst ever – 5 charts on the 2019 season so far


Influenza spreads via droplets from coughing and sneezing, which is why it’s a good idea to catch your cough. But coughing into your hand can leave flu virus on your hands, which is why we recommend coughing into your elbow or sleeve and washing your hands afterwards.

Along with getting vaccinated and staying home if you’re sick, washing your hands is the best defence against getting the flu.

If the government can make this easier by providing hand sanitisers in public places, it may be worth the investment. It won’t solve our flu problem but it might be an important tool in the toolbox of measures to reduce its spread.

What does the research say?

The scientific literature on hand sanitisers isn’t so clear-cut.

A 2019 study in university colleges showed the use of hand hygiene and face masks didn’t protect against flu any better than mask use alone. But unlike some other countries, Australia doesn’t have a strong habit of mask use when people are unwell, so this may not be very helpful to us.

A 2014 study in New Zealand schools showed that providing sanitiser didn’t reduce the rate of absenteeism from school either.

While these studies make it sound like hand sanitiser is not very effective, that’s not the end of the story.

Other studies show a positive effect – a 16% reduction in respiratory illness in one and a 21% reduction in another. For some infections, the evidence is even stronger – for example, gastroenteritis, most of which is also viral.

However, few of these studies showing the benefits of hand sanitisers were done during a large disease outbreak, which means the potential benefit may be even greater.

Not all influenza-like illness is caused by the flu – it can be other viruses as well, so the estimates are a bit rubbery at best. Hand sanitiser trials which look at influenza-like illness or respiratory infections generally are more likely to show benefits than those that just look for influenza – meaning good hand hygiene prevents other infections as well.

If you have the flu, the best place to be is at home.
Tero Vesalainen/Shutterstock

Lessons from hospitals

Although preventing infection in hospitals is not the same as doing it in the community, there are two important lessons from hospital infection control.

First, in hospital hand-hygiene programs, hand sanitiser is more effective than soap-and-water hand-washing, provided your hands aren’t visibly dirty.

This is partly because of the rapid effect of the alcohol, but mostly because it’s much quicker and therefore more likely that staff will use it.




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Health Check: should I use antibacterial hand sanitisers?


The second important point from hand hygiene and other areas of hospital infection control is that introducing a “bundle” of strategies usually reduces healthcare-associated infection rates – even when the individual parts of these bundles don’t show benefits alone.

This could be because the individual effect sizes are too small, or that change in practice highlights a “safety culture”.

Sanitisers can be one of many strategies

Installing hand rub in public areas won’t solve this year’s flu outbreak by itself. But it can be part of a bundle of strategies – as long as the dispensers are kept topped up.

And it’s certainly a safe intervention – despite some desperate hysteria about the safety of hand gels, or the risk of people drinking them, there is little evidence this actually occurs in reality.

Hand sanitiser is also likely to be easier to implement than fixing the much larger social problem of Australians going to work when they’re sick. This may be because of inadequate sick leave, concerns about “letting the team down”, or other logistical problems such as child-care.

Get your flu vaccine – even now it’s still not too late – and get it for your kids as well, for their sake as well as your own.

Remember to stay home if you’re unwell, and always to cough into your sleeve. And don’t forget to clean your hands – even if the government doesn’t end up making it easier for you.




Read more:
The 2019 flu shot isn’t perfect – but it’s still our best defence against influenza


The Conversation


Trent Yarwood, Infectious Diseases Physician, Senior Lecturer, James Cook University and, The University of Queensland

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