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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Here we go again — Perth’s snap lockdown raises familiar hotel quarantine questions


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.

Official medical advice warned of health risks Australians stranded in India face


Michelle Grattan, University of CanberraThe official medical advice to the Morrison government recommending “pausing” Australian arrivals from India also contained a blunt warning that those stranded risk serious illness and even death.

Chief Medical Officer Paul Kelly’s advice said: “It is important in any measures we implement that we balance the burden on our quarantine and health systems and the protection of our community with the need to help Australians to get home, including those currently residing in high risk countries”.

Kelly said COVID-19 continued to be “a severe and immediate threat” to health in Australia and India was a high risk country, with a sharp increase recently in the number and proportion of overseas-acquired cases coming from there.

“Each new case identified in quarantine increases the risk of leakage into the Australian community through transmission to quarantine workers or other quarantined returnees and subsequently into the Australian community more broadly,” Kelly wrote in his Friday advice to Health Minister Greg Hunt.

“This quarantine ‘leakage’ presents a significant risk to the Australian community.”

The advice was in relation to the government’s determination under the Biosecurity Act – announced in the early hours of Saturday – which makes it an offence for anyone to enter Australia if they have been in India in the preceding two weeks.

This was to close any loopholes enabling people to arrive via third countries after the government suspended flights from India until at least May 15.

Kelly said in his advice, running to more than three pages, that Australia’s quarantine and health resources to prevent and control COVID from international arrivals were limited.

“Due to the high proportion of positive cases arising from arrivals from India, I consider a pause until 15 May 2021 on arrivals from India to be an effective and proportionate measure to maintain the integrity of Australia’s quarantine system,” he said.

But Kelly was careful to put on record a clear warning about the dangers faced by Australians who could not get home.

“I wish to note the potential consequences for Australian citizens and permanent residents as a result of this pause on flights and entry into Australia.

“These include the risk of serious illness without access to health care, the potential for Australians to be stranded in a transit country, and in a worst-case scenario, deaths.”

However he said “these serious implications can be mitigated through having the restriction only temporarily in place, i.e a pause, and by ensuring there are categories of exemptions.”

Under the law, action taken must be no more restrictive or intrusive than necessary and in place only so long as needed.

The determination will expire on May 15 unless extended.

The exemptions include crews of aircraft and vessels and associated workers, Australian officials, defence personnel and diplomats and family members, foreign diplomats accredited to Australia and family members, and members of an Australian Medical Assistance Team (AUSMAT).

There are more than 9,000 Australian citizens and residents registered in India of whom 650 are considered vulnerable.

The advice pointed out this would be “the first time that such a determination has been used to prevent Australian citizens and permanent residents entering Australia”.

On Monday Kelly was anxious to say he had nothing to do with the penalties that exist for breaching the determination, which include large fines and up to five years prison and have received much negative publicity. His letter did note the penalties the act carries.

Scott Morrison told 2GB the arrangement was aimed at ensuring Australia did not get a third wave of COVID and its quarantine system could remain strong.

He downplayed the sanctions, saying they would be used appropriately and responsibly.

Morrison said people who had been in third countries for 14 days could return home to Australia. “But if they haven’t, then they have to wait those 14 days.”

Asked on the ABC whether the government should vaccinate Australians stranded in India, Kelly said: “It’s certainly worth looking at. I would say, though, that we know that many of the Australians that are in India at the moment, they’re very scattered. So it’s a huge country; being able to get to them would be a challenge”.

Queensland Nationals senator Matt Canavan has condemned the government’s stand, tweeting:The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

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

A balancing act between benefits and risks: making sense of the latest vaccine news


Shutterstock

Hassan Vally, La Trobe UniversityLast night, the federal government announced substantially revised plans for the use of the AstraZeneca vaccine in Australia.

Due to concerns about the vaccine’s possible links to a rare blood-clotting disorder, and following advice from the Australian Technical Advisory Group on Immunisation (ATAGI), the Pfizer vaccine is now preferred for people under 50.

These developments raise questions about how authorities and individuals assess risk, and respond. Let’s try to make some sense of it.




Read more:
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What’s happened?

Reports about rare blood clots possibly associated with the AstraZeneca vaccine have been floating around for a few weeks now.

So why has it taken so long for the government to clarify this relationship and make the recommendations? Authorities haven’t been keeping us in the dark.

When you have a new condition like this, and experts are examining data in real time, it takes a while to understand exactly what’s going on: to develop a clear case definition, to be confident what you’re seeing is a real phenomenon, and importantly, whether it’s likely to be caused by something in particular (in this case, the vaccine). It’s made more difficult when the event is very rare.

After reviewing a wide range of data relating to cases of this rare blood-clotting syndrome predominantly in the United Kingdom and Europe, Australian experts have now reached the threshold of evidence they needed to be satisfied there may well be a causal link between the AstraZeneca vaccine and this condition.

An arm with a bandaid on the upper arm.
The Australian government now recommends the Pfizer vaccine for adults under 50, rather than the AstraZeneca one.
Shutterstock

Understanding risk

It’s important to note every therapeutic agent (a drug or a vaccine, for example) carries the risk of unintended consequences. For most of us, most of the time, this will be minimal. This is a biological reality reflecting the interconnectedness and complexity of the human body.

So like for any other therapeutic agents, there are risks as well as benefits we have to accept in taking COVID vaccines. What we need to do is to weigh up these risks against the benefits.

We make these sorts of calculations every day in all aspects of our lives. When we decide to get in the car, we know there’s a risk associated with driving. But we assess the risks are worth taking as the benefits of getting where we want to go quickly are worth it.

Mostly, we make these calculations without being consciously aware we’re doing it. Sometimes the parameters underlying these calculations are easy to grapple with — but sometimes they’re more nebulous.




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Australia’s bungled COVID vaccine rollout suffers another setback. Here’s how we can get it back on track


Weighing up the risks and benefits of the AstraZeneca vaccine

We know the vaccine offers near-complete protection against severe disease and death from COVID-19.

We also know severe side effects from the vaccine, in particular vaccine induced prothrombotic immune thrombocytopenia (VIPIT, the blood-clotting disorder in question), are extremely rare. But the condition is serious and around 25% of people have died after developing VIPIT.

There are a range of estimates of how often this syndrome occurs. But it’s generally accepted its incidence is about 4-6 cases per million doses of vaccine.

To put it in perspective, this puts the risk in the same order of magnitude to the average risk of dying if you complete a marathon, go scuba diving, or rock climbing.

It’s also important to note that we’ve started to see a pattern in that those who are at higher risk of this syndrome tend to be younger and tend to be women. We don’t have a clear understanding of why this is, but recognising this is really helpful in terms of making decisions about how to mitigate this risk.

Why the balancing act isn’t so easy

Although we have a pretty good understanding of the rate of severe outcomes from COVID-19, since we have over 12 months’ experience now of this illness, context is important. There are different levels of risk depending on where you live and what the rate of transmission in the community is.

While it’s all well and good in some countries to say you’re more likely to get very sick with or die from COVID than experience a complication from the vaccine, in Australia we have next to no COVID, so the risk of adverse outcomes from COVID is much lower. This needs to be factored into the equation.

We also have different strains of the virus, which can vary in how infectious they are and how sick they might make you. This also needs to be added to the mix.

In acknowledging the difficulty in completing these risk-benefit analyses, it’s really helpful to use a visualisation the University of Cambridge has put together based on UK data, which we’ve adapted here, comparing the risks and benefits of the AstraZeneca vaccine.



It depicts the risk of adverse effects from COVID (being in ICU) against adverse outcomes from the vaccine, based on an assumed incidence of COVID in the community of two in 10,000 people. Although the incidence rate in Australia is lower than this, this visual is extremely useful in conveying the nature of the relationship between the risks and benefits of the AstraZeneca vaccine in Australia.

What this visual shows clearly is that the benefits of the vaccine increase the older you are, because the risk of severe disease is higher the older you get.

It also shows that although the risks of side effects from the vaccine are relatively small regardless of age, the gap between risks and benefits narrows the younger you are. This is in part due to the reduced benefit of the vaccine for younger people who are less likely to have severe symptoms from COVID, and in part due to the increased risk of serious side effects, such as blood clots, for younger adults.

This visual clearly communicates the rationale for the changes announced yesterday. Where the risk-benefit becomes marginal, it makes sense to use other vaccines for younger adults — the Pfizer vaccine and possibly the Novavax vaccine down the track. The recommendations are both cautious and sensible.




Read more:
What you need to know to understand risk estimates


The Conversation


Hassan Vally, Associate Professor, La Trobe University

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

Russia’s coronavirus vaccine hasn’t been fully tested. Doling it out risks side effects and false protection



A scientist holding a coronavirus vaccine at the Nikolai Gamaleya National Center of Epidemiology and Microbiology in Moscow, Russia.
Alexander Zemlianichenko Jr/Russian Direct Investment Fund/AP/AAP

Kylie Quinn, RMIT University and Holly Seale, UNSW

On Tuesday, Vladimir Putin announced Russia was the first country to register a vaccine offering “sustainable immunity” against SARS-CoV-2, the virus that causes COVID-19.

Developed by the Gamaleya Research Institute in Moscow, it’s been registered with the Russian Health Ministry and approved for emergency use only.

But there are concerns it will soon be rolled out across the Russian population, far beyond emergency use. This has prompted discussion about the “race” towards a COVID-19 vaccine.

While speed is important, ensuring a vaccine is effective and safe is much more critical. The consequences of doling out a potentially unsafe and ineffective vaccine could be wide-reaching.




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Data about the trials has not been published

The Gamaleya Research Institute announced it registered a SARS-CoV-2 vaccine with the Russian Health Ministry, the local regulatory body that determines which medicines can be used in Russia. This vaccine is called “Sputnik V” and the Institute has indicated it’s approved for emergency use. An emergency use approval generally means a vaccine could be offered to people at very high risk of infection, such as health-care workers, but not the general civilian population.

The Institute had previously registered this vaccine for a Phase I/II trial (to assess safety and immune responses in humans), initially with just 38 people. Senior Russian officials said it induced a strong immune response and no “serious complications” in this trial. This isn’t too surprising, as published data from human clinical trials for other similar vaccines have shown strong immune responses and no serious complications.

However, the data from the trial of Sputnik V has not been published and there is no data that indicates the vaccine would actually protect, as Phase III studies (requiring thousands of volunteers to demonstrate efficacy and detect rare side-effects) haven’t been performed.

The Institute did announce a Phase III trial for Sputnik V will begin on August 12 in Russia and several other countries. However, many scientists (including Russian researchers) expressed concern the vaccine will soon be used in large civilian vaccination campaigns, which wouldn’t usually be the case with an approval for emergency use.

What are the risks

If we go back to the analogy of a “race”, we should stop thinking of vaccine development as the 100-metre sprint. Instead, think of it more like the pentathlon. In the pentathlon, each section the athlete completes contributes to their overall score and cannot be missed. If we try to run this race against COVID-19 without each section, we could end up with a vaccine which has not been properly tested, which could be unsafe and would be unethical. And then we all lose.

The risks of advancing into mass vaccination without proper testing are significant. If a vaccine is released but side-effects emerge, the consequences include both the health impacts and deterioration in trust from our community. If the vaccine does not protect individuals from infection, those who have been vaccinated could falsely believe they are protected.

Our system of methodical series of clinical trials has been designed, oftentimes with hard-won lessons, to avoid oversights and build essential data on safety, immunity and protection with vaccines.

As stated by the US Health and Human Services secretary, Alex Azar:

The point is not to be first with a vaccine. The point is to have a vaccine that is safe and effective for the American people and the people of the world.

Development takes time and we need to be realistic with our timelines and expectations.

Testing a vaccine is rigorous

When countries consider introducing a vaccine, the following information is examined:

  • how safe is the vaccine?

  • how well does the vaccine work?

  • how serious is the disease the vaccine would prevent?

  • how many people would get the disease if we did not have the vaccine?

This information is collected during each phase of the clinical trials (Phase I, II and III), with a particular focus on vaccine safety at each step. Developing this package of information can take years, but there have been cases when timelines were condensed.

For example, testing for an Ebola vaccine was condensed down to five years due to a critical need for a vaccine in the midst of ongoing epidemics. Regardless of this urgency, each clinical trial phase was still completed.

Phase III clinical trials are especially critical to assess safety in a large group of people, because certain rare side effects may not be identified in earlier, smaller trials. For example, if a vaccine-related side effect only occurred in one in every 10,000 people, the trial would have to enrol 60,000 volunteers to detect it.

In general, vaccines are more thoroughly tested than any other medicine. We administer vaccines to healthy people, so safety is the key priority, and we administer vaccines to large numbers of people, so rare side-effects must be identified.

What’s in this vaccine?

This type of vaccine is called a viral vector. With viral vectors, we trick our immune system with a bait-and-switch; we take a harmless virus, modify it so it can’t replicate, and include a target from the surface of the SARS-CoV-2 virus. The vaccine looks like a dangerous virus to the immune system, so the immune response is relatively strong and targeted against SARS-CoV-2, but the virus can’t cause disease.

Sputnik V is unusual because it uses two different viral vectors, one after the other, in what we call a “prime boost”. The first is called Ad26, which is similar to a COVID-19 vaccine being developed by Johnson&Johnson, and the second is called Ad5, which is similar to a COVID-19 vaccine being developed by CanSino Biologics. This prime boost should generate a relatively strong immune response, but we don’t know for sure.

Viral vectors are also a relatively new technology. There have been a number of large clinical trials with viral vectors for HIV, Malaria, Tuberculosis and Ebola, but only one for Ebola has ever been approved for use in the general population.




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The Conversation


Kylie Quinn, Vice-Chancellor’s Research Fellow, School of Health and Biomedical Sciences, RMIT University and Holly Seale, Senior Lecturer, UNSW

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

Attending the G7 in the US carries great diplomatic risks for Australia


Tony Walker, La Trobe University

“What’s in it for us?”

This is the first question Prime Minister Scott Morrison should have asked himself when US President Donald Trump invited him to join an expanded G7 gathering at Camp David in September.

The invitation came directly to Morrison in a phone call from Trump on June 2.

This was a week after the death of George Floyd in Minneapolis. In that week, American misgivings about the direction in which their country was heading crystallised in Black Lives Matter demonstrations across the United States. They are still going.

Not since the civil rights movement and the death of Martin Luther King in the 1960s has the United States witnessed such widespread civil unrest. This is a country divided against itself, with a president who seems unwilling or unable to find the words or actions to address his country’s divisions.

This forms the background to an invitation to Morrison to attend an event that, on the face of it, is not designed to rally Western democracies dealing with the economic fallout from the coronavirus pandemic.

Rather, a G7+ gathering would be aimed at providing an embattled president with a photo opportunity in the middle of what promises to be one of the most bitter presidential election contests in American history.

In other words, Morrison would be a prop in a wider political game.

Trump has also made no secret of his plans to turn an expanded G7 into a vehicle to criticise China as part of a re-election strategy that involves demonising Beijing.

Scott Morrison attended the 2019 G7 Summit in Biarritz, France.
AAP/EPA/Ian Langsdon

There are many reasons to criticise China, but a Camp David pile-on is the last thing Morrison needs to associate himself with given the tenuous state of Sino-Australian relations.




Read more:
Beware the ‘cauldron of paranoia’ as China and the US slide towards a new kind of cold war


There are several risks associated with a Trump-proposed G7+:

  1. giving an impression that such a gathering would be part of a US-inspired containment policy aimed at China in which Australia is a bit player

  2. Australia could become a prop in a divisive American election campaign in which anti-China sentiment is certain to be present

  3. Beijing’s propaganda that Canberra is at Washington’s beck and call may become further entrenched

  4. associating with a president who may be on the cusp of losing an election in any case.

Latest polls show a slump in Trump’s popularity in response to widespread disgust at his responses to nationwide civil rights demonstrations.




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Morrison would be wise to pay attention to criticisms voiced by a clutch of respected American retired generals. These include James Mattis, who resigned as defence secretary after Trump capriciously abandoned Kurdish allies in northern Syria.

The background to a Trump-convened G7+ summit

The gathering would comprise the original G7 members – United States, United Kingdom, Germany, France, Canada, Italy and Japan – plus India, South Korea and Australia.

Trump has indicated he wants Russian leader Vladimir Putin present. G7 founder members, including Canada and the United Kingdom, are opposed to Putin’s presence, given Russia’s exclusion from the then G8 after its annexation of Crimea from Ukraine in 2014.

It should also go without saying that a Russian presence at Camp David would be highly provocative domestically in America on the eve of an election, given sensitivities over alleged Russian interference in the 2016 poll.

All things being equal, there would be legitimate arguments for convening an expanded G7 during a global economic meltdown in the wake of a pandemic.

Such a gathering might also consider shifts in a global power balance occasioned by China’s rise. This is a pressing issue.

However, things are far from equal. Risks outweigh potential rewards.

Given the anti-China bombast emanating from Washington, it would be hard to envisage Camp David arriving at a constructive approach removed from Trump’s crude politicking.

Typical of the sort of rhetoric Trump has indulged in recently is an outburst on May 29 in which he said China had “ripped off” the United States, “raiding our factories” and “gutting” American industry.

Crude attempts by America to promote a G7+ front against China would be particularly awkward for participants like South Korea and Japan.

South Korea is geographically vulnerable to Chinese pressure, given the unstable security environment in which it finds itself on the Korean Peninsula. South Korea’s companies are significant investors in China. Trade between the two countries is strongly in Seoul’s favor.

Japan under Shinzo Abe has been seeking to improve relations with Beijing. Abe would not want those diplomatic efforts to unravel at a Trump-inspired Camp David three-ring circus in which China feels ganged up on.

China’s Xi Jinping had been scheduled to visit Japan this year as part of a warming process. That important mission now looks as if it will be postponed.

Risks for Australia

Like South Korea and Japan, Australia risks giving unnecessary and additional offence to China, to its detriment.

Morrison has already been the recipient of a lesson in Chinese realpolitik in which Australia was made vulnerable by taking the lead in efforts to hold China to account for the coronavirus.




Read more:
China-Australia relations hit new low in spat over handling of coronavirus


The prime minister’s decision to spearhead efforts to convene an independent inquiry into China’s culpability produced a ferocious push-back from Beijing.

Morrison’s wiser course would have been to join like-minded countries in efforts to get to the bottom of the origins of the virus. This would include the respective roles of the World Health Organisation and China itself.

Instead, he blundered into a thicket of international diplomacy. This has drawn reprisals from Beijing in the form of restrictions on imports of Australian commodities accompanied by inflammatory rhetoric directed at Canberra.

Participation in a Camp David pile-on – if that were to happen – would further inflame this rhetoric and might well lead to additional economic reprisals.

An interesting historical footnote to Trump’s invitation to Australia to attend a G7+ is that Australia diplomacy has, in the past, sought membership of the global grouping of like-minded Western democracies.

This was a pet project of former prime minister Malcolm Fraser. He was frustrated, as it turned out, by American opposition on grounds that opening the doors would encourage lobbying by others to be included.

In 1979, Japan advanced Australia’s case.

To be clear, Australia is not being asked on this occasion to join the G7. Along with Japan, South Korea and India, it is being invited to participate.

This is a similar situation to last year when France’s Emmanuel Macron, in his role as convener, invited Morrison to attend the Biarritz G7.

It is also uncertain whether the Camp David event will go ahead at all, given uncertainties that prevail in the world on many different fronts. Will Trump be in a position to convene such a gathering if America remains in turmoil?

Finally, there’s the issue of where an expanded G7 leaves bodies like the G20 and the Asia-Pacific Economic Cooperation (APEC) forum.

In these latest circumstances, in which the world is facing economic and other challenges not witnessed in a generation, it would make sense to convene a G20 – as was done in 2008 to combat the Global Financial Crisis – whose membership includes both China and Russia.

In the end, what’s in it for Australia? Diplomatic risks are emphatically to the downside.The Conversation

Tony Walker, Adjunct Professor, School of Communications, La Trobe University

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

Cities will endure, but urban design must adapt to coronavirus risks and fears



Public spaces must now meet our need to be ‘together but apart’.
Silvia Tavares, Author provided

Silvia Tavares, University of the Sunshine Coast and Nicholas Stevens, University of the Sunshine Coast

The long-term impacts of coronavirus on our cities are difficult to predict, but one thing is certain: cities won’t die. Diseases have been hugely influential in shaping our cities, history shows. Cities represent continuity regardless of crises – they endure, adapt and grow.




Read more:
Cities lead the charge on the coronavirus front lines


Once we can have our old lives back we will likely return to familiar routines and our memories of lockdown and isolation will start to fade. While our lack of memory is arguably a resiliency resource, urban designers and planners have a long-term role in ensuring urban life is healthy. To fight infectious diseases, cities need well-ventilated urban spaces with good access to sunlight.

The design of these spaces, and public open spaces in particular, promotes different levels of sociability. Some spaces congregate community and are highly social. Others may act as urban retreats where people seek peace with their coffee and book.

How urban spaces perform during disease outbreaks now also demands our close attention.

What is urbanity and why does it matter?

Urban spaces are where communities come together. Urban planners and designers strive to generate a sense of belonging that makes people choose certain areas of a city or even a city itself. Urbanity refers to the public life that happens as a result of the exchanges and communication each space enables.

The combination of diversity and density achieve urbanity – it’s a product of diverse social opportunities in close proximity. This is why densifying cities has been a goal for achieving healthy, social and prosperous cities.

However, the risks of COVID-19 transmission have strengthened anti-density discourses. It is worth remembering, then, that ways of fighting disease, such as sanitation, were only possible because of the financial savings and infrastructure efficiencies enabled by denser cities. Density done right is safe. And it permits the human interactions and connections we need – and which we are now missing.

Once COVID-19 is less of a threat we will crave the normality of going back to our old lifestyles as much as possible. The role of urban planners and designers is then to create a background for public life to happen in social and healthy ways.

Learning from other disasters

Following the 2011 earthquake in Christchurch, New Zealand, where the CBD lost some 800 buildings, the community took a very different view of urban spaces. Crowded areas and tall buildings were a source of fear. The common attitude was to avoid density – what if another earthquake hit?




Read more:
Christchurch five years on: have politicians helped or hindered the earthquake recovery?


Urban designers and decision-makers learned that buildings and public spaces had to respond differently. Safe pop-up areas started to emerge. This new normal made some old quiet cafés and public open spaces resilient, while other pop-ups become popular retreat areas. These urban retreat areas were away from streets and tall buildings, and so offered a way of “being there” and being safe.

A park-like retreat space on South Colombo Street, Christchurch.
Silvia Tavares, Author provided

Both the Christchurch earthquake and coronavirus have made people cautious about their safety in the city – because of their proximity to surrounding buildings and to other users of the space, respectively. Christchurch teaches us a lesson about “being together but apart”: cities are not made only of social spaces, and not all residents want the same thing.

People need choice in their use of urban spaces to feel secure and be safe. While larger social spaces are vibrant, support public transport and local economies, urban retreat spaces apply the idea of prospect and refuge: they meet our psychological needs to observe and be part of the public space (prospect) while feeling safe and removed from the scene (refuge).

Post-quake Christchurch showed how the social character and dynamics of urban spaces influenced the people these spaces attracted and how they behaved there.




Read more:
Three years on: getting creative in post-quake Christchurch


Designing spaces with microclimates in mind

Another factor to consider is the influence of urban microclimates on the use and prosperity of public spaces.

The main activity of large urban social spaces is based upon the presence of people, social interaction and cultural exchange. The use and dynamics of these spaces are more predictable and consistent than for urban retreat spaces. Being close to transport or commercial uses often means weather conditions have less impact on social activity and interaction.

Shops along the street add to the local urbanity of Cashel Mall, Christchurch.
Silvia Tavares, Author provided

When looking for peaceful experiences and personal space, however, people tend to choose urban retreat spaces. Here they have less tolerance of adverse conditions. The place itself is the attraction, so the microclimate and personal comfort are more significant factors in its use.

Understanding, harnessing and managing microclimate, sunlight and ventilation is a clear and known approach to fighting disease and to establishing safe and resilient urban spaces. Offering people choice in the ways they interact with their urban environments, while long considered important, is now essential.




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Broad engagement is essential to get it right

Redesigning our urban spaces to reassure users of their safety and provide community choice is not a straightforward process. Designs for the different forms and locations of urban retreat spaces must acknowledge community diversity and optimise microclimate.

While right now we might just want to hold on to all the good things we had pre-coronavirus, the nuances generated by the work of urban planners and designers are likely to make our lives safer. However, our responses cannot simply be reactive interventions such as warning signs, fencing, wider pathways and the like. Such approaches ultimately have implications for equity and quality of life.

We have long had a reactive, piecemeal approach to urban design and development. The current disaster presents an opportunity to establish safe, resilient and healthy urban spaces. It requires meaningful engagement across communities, designers and decision-makers now, before collective amnesia about COVID-19 sets in and we go back to business as usual.The Conversation

Silvia Tavares, Lecturer and Researcher, Urban Design and Town Planning, University of the Sunshine Coast and Nicholas Stevens, Senior Lecturer and Researcher, Land Use Planning & Urban Design, University of the Sunshine Coast

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

How safe is COVIDSafe? What you should know about the app’s issues, and Bluetooth-related risks



Shutterstock

James Jin Kang, Edith Cowan University and Paul Haskell-Dowland, Edith Cowan University

The Australian government’s COVIDSafe app has been up and running for almost a fortnight, with more than five million downloads.

Unfortunately, since its release many users – particularly those with iPhones – have been in the dark about how well the app works.

Digital Transformation Agency head Randall Brugeaud has now admitted the app’s effectiveness on iPhones “deteriorates and the quality of the connection is not as good” when the phone is locked, and the app is running in the background.

There has also been confusion regarding where user data is sent, how it’s stored, and who can access it.

Conflicts with other apps

Using Bluetooth, COVIDSafe collects anonymous IDs from others who are also using the app, assuming you come into range with them (and their smartphone) for a period of at least 15 minutes.

Bluetooth must be kept on at all times (or at least turned on when leaving home). But this setting is specifically advised against by the Office of the Australian Information Commissioner.

It’s likely COVIDSafe isn’t the only app that uses Bluetooth on your phone. So once you’ve enabled Bluetooth, other apps may start using it and collecting information without your knowledge.

Bluetooth is also energy-intensive, and can quickly drain phone batteries, especially if more than one app is using it. For this reason, some may be reluctant to opt in.

There have also been reports of conflicts with specialised medical devices. Diabetes Australia has received reports of users encountering problems using Bluetooth-enabled glucose monitors at the same time as the COVIDSafe app.

If this happens, the current advice from Diabetes Australia is to uninstall COVIDSafe until a solution is found.

Bluetooth can still track your location

Many apps require a Bluetooth connection and can track your location without actually using GPS.

Bluetooth “beacons” are progressively being deployed in public spaces – with one example in Melbourne supporting visually impaired shoppers. Some apps can use these to log locations you have visited or passed through. They can then transfer this information to their servers, often for marketing purposes.

To avoid apps using Bluetooth without your knowledge, you should deny Bluetooth permission for all apps in your phone’s settings, and then grant permissions individually.

If privacy is a priority, you should also read the privacy policy of all apps you download, so you know how they collect and use your information.

Issues with iPhones

The iPhone operating system (iOS), depending on the version, doesn’t allow COVIDSafe to work properly in the background. The only solution is to leave the app running in the foreground. And if your iPhone is locked, COVIDSafe may not be recording all the necessary data.

You can change your settings to stop your iPhone going into sleep mode. But this again will drain your battery more rapidly.

Brugeaud said older models of iPhones would also be less capable of picking up Bluetooth signals via the app.

It’s expected these issues will be fixed following the integration of contact tracing technology developed by Google and Apple, which Brugeaud said would be done within the next few weeks.




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Vulnerabilities to data interception

If a user tests positive for COVID-19 and consents to their data being uploaded, the information is then held by the federal government on an Amazon Web Services server in Australia.

Data from the app is stored on a user’s device and transmitted in an encrypted form to the server. Although it’s technically possible to intercept such communications, the data would still be encrypted and therefore offer little value to an attacker.

The government has said the data won’t be moved offshore or made accessible to US law enforcement. But various entities, including Australia’s Law Council, have said the privacy implications remain murky.

That said, it’s reassuring the Amazon data centre (based in Sydney) has achieved a very high level of security as verified by the Australian Cyber Security Centre.

Can the federal government access the data?

The federal government has said the app’s data will only be made available to state and territory health officials. This has been confirmed in a determination under the Biosecurity Act and is due to be implemented in law.

Federal health minister Greg Hunt said:

Not even a court order during an investigation of an alleged crime would be allowed to be used [to access the data].

Although the determination and proposed legislation clearly define the who and how of access to COVIDSafe data, past history indicates the government may not be best placed to look after our data.

It seems the government has gone to great lengths to promote the security and privacy of COVIDSafe. However, the government commissioned the development of the app, so someone will have the means to obtain the information stored within the system – the “keys” to the vault.

If the government did covertly obtain access to the data, it’s unlikely we would find out.

And while contact information stored on user devices is deleted on a 21-day rolling basis, the Department of Health has said data sent to Amazon’s server will “be destroyed at the end of the pandemic”. It’s unclear how such a date would be determined.

Ultimately, it comes down to trust – something which seems to be in short supply.




Read more:
The COVIDSafe app was just one contact tracing option. These alternatives guarantee more privacy


The Conversation


James Jin Kang, Lecturer, Computig and Security, Edith Cowan University and Paul Haskell-Dowland, Associate Dean (Computing and Security), Edith Cowan 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.




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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.




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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.

Hot and bothered: heat affects all of us, but older people face the highest health risks



Older people’s bodies can’t regulate their temperature as well as younger people’s.
From shutterstock.com

Arnagretta Hunter, Australian National University

Australian summer temperatures have risen by 1.66℃ over the past 20 years. In the past century we’ve seen a significant increase in the number, intensity and duration of heatwaves during our summers.

Heat is the natural hazard associated with the highest mortality in Australia. When heatwaves occur, the death toll routinely reaches into the hundreds. For example, the 2009 heatwave across southeast Australia resulted in close to 500 deaths.

Heat is more likely to endanger the health of people with pre-existing conditions, people who are socially isolated, and people who have limited access to air conditioning. These are often older members of the community.




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How rising temperatures affect our health


Heat affects people of different ages in different ways

Human body temperature is set at 36.8℃, although our normal temperature can vary slightly and may marginally decrease as we age.

Ambient temperatures well below this prompt us to keep ourselves warm, and as the temperature rises we look for ways to keep ourselves cool.

An important mechanism of cooling is perspiration. As sweat evaporates, it cools our skin. However, humid weather impedes our capacity to cool ourselves in this way.

Heat stress occurs when the body can’t cool itself and maintain a healthy temperature. Heat stress can begin at temperatures around 30℃ when the humidity is high, and at temperatures closer to 40℃ in dry heat.




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Babies and young children are highly vulnerable to the heat because of their small size. They can become dehydrated and develop heat stress more quickly than adults.

This is because they absorb heat faster, and often cannot remove themselves from hot environments. So little ones need to be kept cool and well hydrated (with milk for babies and water for small children) during hot periods.

Babies and young children can become dehydrated more quickly than adults.
From shutterstock.com

While young people and adults face lower health risks from the heat, extended periods of hot weather can adversely affect our mood. One recent study pointed to increased intimate partner violence during heatwaves.

This effect appears to be exacerbated when night time temperatures are also high. High overnight temperatures are associated with increased crime rates, decreased productivity and poorer academic results.

But generally, it’s people over 65 who are at highest risk from the heat.

How does heat affect older people’s health?

The ageing body doesn’t cope with sudden stresses as quickly or effectively as a younger body. For example, an elderly person’s skin does not produce sweat and cool the body as efficiently as a younger person’s skin.

Importantly, heat stress can exacerbate existing health conditions common in older people, such as diabetes, kidney disease, and heart disease. Many heat deaths are recorded as heart attacks.

In short, this is because heat requires our hearts to work harder. In very hot conditions, our blood vessels dilate, increasing our heart rate. For people with abnormal heart function, these hot periods can lead to worsening of their heart failure.

With severe, prolonged heat stroke, heart failure can even develop in people without pre-existing heart disease.




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For people with pre-existing kidney disease, dehydration during hot periods can impact their kidney function. So people with kidney disease need to take extra care to stay hydrated during hot periods.

Dehydration can also affect older people’s blood pressure, making falls more likely.

Further, hot weather can affect blood sugar control for people with diabetes. Heat stress can increase blood sugar levels even in people without diabetes, but is most concerning in those with the condition. Poor blood sugar control is associated with many different diabetes complications including increased risk of infections.

Hot weather can indirectly affect health if the heat means not being able to exercise.
From shutterstock.com

Older people with chronic medical problems usually take regular medications. Some medications can hinder the body’s ability to regulate temperature and make people more susceptible to heat stress.

For example, people with heart failure often take diuretic medications to manage symptoms like swelling and shortness of breath. But increasing diuretic medications in hot weather can cause dehydration, worsening heart failure and often affecting the kidneys.

Added to this, heat stress may cause disorientation, confusion and delirium. This risk is more pronounced for older people with cognitive conditions and dementia.

Social factors and exercise

Socioeconomic factors and isolation can magnify the risk of heat exposure among older people. For example, some pensioners may not be able to afford air conditioning at home.

Being part of social networks can help. One person may recognise if another is unwell, increasing the likelihood of their friend getting medical attention.




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Further, extended periods of hot weather can interrupt our exercise routines. This can be particularly problematic for older people who may be using exercise to manage chronic health conditions.

Regular exercise correlates with improved quality of life in many conditions, including heart failure, chronic obstructive pulmonary disease, depression, diabetes, cognitive impairment and osteoporosis.

When our activity is disrupted for weeks at a time it can be hard to regain previous fitness. This can be especially true for older people, as muscle mass is commonly lost as we age. Periods of inactivity accelerate muscle loss, and regaining strength and endurance is often more difficult in this context.




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Australia’s climate is changing. We’re likely to experience longer periods of hot temperatures, with hotter summers and some extraordinarily high temperatures. This will test our health and our health-care systems. Understanding the challenge ahead can help to reduce the risks.

On a practical level, be aware of spending too much time in hot temperatures, stay hydrated, and know where you can access air conditioning – particularly if power fails. Consider vulnerable relatives, friends and neighbours, especially those of advanced age.The Conversation

Arnagretta Hunter, Physician & Cardiologist, The Canberra Hospital; Clinical Senior Lecturer, Australian National University

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

Five ways parents can help their kids take risks – and why it’s good for them



Have real conversations with your kids about what they’re doing, and the potential consequences of their actions.
from shutterstock.com

Linda Newman, University of Newcastle and Nicole Leggett, University of Newcastle

Many parents and educators agree children need to take risks. In one US study, 82% of the 1,400 parents surveyed agreed the benefits of tree-climbing outweighed the potential risk of injury.

Parents cited benefits including perseverance, sharing, empowerment and self-awareness. One parent thought it allowed her son to learn what his whole body was capable of.




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Should I let my kid climb trees? We asked five experts


Taking risks and succeeding can motivate children to seek further achievements. Failing can lead to testing new ideas, and finding personal capabilities and limits. In this way, children can overcome fears and build new skills.

We mentored a group of educators in a research project trialling how to best introduce kids to risk.

Parents identified sharing and collaboration as one benefit of letting kids climb trees.
from shutterstock.com

Parents can use some of the lessons these educators learnt to help their own children take more risks and challenge themselves.

What was the research?

Adamstown Community Early Learning and Preschool (NSW) wanted to conduct research around risky play. “Risky play” is a term which has evolved from a trend to get more children out into nature to experience challenging environments.

Adamstown wanted to find out whether adult intervention to promote safe risk-taking would play a significant role in developing children’s risk competence.

Educators engaged children in conversations about risk, asked prompting questions and helped them assess potential consequences.

The Adamstown research built on 2007 Norwegian research that identified six categories of risky play:

  • play at great heights, where children climb trees or high structures such as climbing frames in a playground

  • play at high speed, such as riding a bike or skateboarding down a steep hill or swinging fast

  • play with harmful tools, like knives or highly supervised power tools to create woodwork

  • play with dangerous elements, such as fire or bodies of water

  • rough and tumble play, where children wrestle or play with impact, such as slamming bodies into large crash mats

  • play where you can “disappear”, where children can feel they’re not being watched by doing things like enclosing themselves in cubbies built of sheets or hiding in bushes (while actually being surreptitiously supervised by an adult).

The educators examined their practices in these areas to see how and whether they were engaging children in risky play, and how children were responding.

Skating down a hill is one way kids can engage in risky play.
from shutterstock.com

Here are five lessons educators learnt that parents can apply at home.

1. Have real conversations with children (don’t just give them instructions)

Adamstown educators found children were more likely to attempt risky play when adults talked to them about planning for, and taking, risks.

Parents can use similar strategies with their children, helping them question what they are doing and why.

Phrases like “be careful” don’t tell children what to do. Instead, say things like

That knife is very sharp. It could cut you and you might bleed. Only hold it by the handle and cut down towards the chopping board.

Equally, praise with meaning, using phrases like

You cut the cake, thinking about how you held the knife and didn’t slip or cut yourself. Well done!

It is important for children to provide insight into their own problem solving. You could ask their thoughts on what might happen if they used the knife incorrectly or what safety measures they could put in place. This will help develop their risk competence.

2. Introduce risk gradually

Allow your children to try new things by slowly increasing the levels of difficulty.

At Adamstown, a process of introducing children to fire spanned nine months. First – on the advice of an early childhood education consultant – they introduced tea-light candles at meal times. This then moved to a small fire bowl in the sandpit, before children were introduced to a large open fire pit.




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The fire pit is now used for many reasons. In winter, children sit around it in a circle and tell stories. Educators show them cooking skills, referencing the ways Australia’s First Nations People cook. The fire pit is also used to create charcoal for art.

Encourage your children to think about risk when they’re in a safe situation.
from shutterstock.com

Children have been made aware of the safe distance they need to keep and about the potential hazard of smoke inhalation.

During the research process, as children were introduced to more risk, there were no more injuries than before and all were minor. There were also no serious incidents such as broken bones, or events requiring immediate medical attention.

3. Assume all your children are competent – regardless of gender

Adamstown educators were surprised to discover that, although they weren’t excluding girls from risky play, the data indicated they challenged and invited participation more often with boys.

Parents may hold intrinsic biases they are not necessarily aware of. So, check yourself to see if you are:

  • allowing boys to be more independent

  • assuming boys are more competent or girls don’t really want to take as many risks

  • dressing girls in clothes that limit their freedom to climb

  • saying different things to boys and girls.

4. Be close-by but allow children to have a sense of autonomy

Children don’t always want to be supervised. Search for opportunities to allow them to feel as if they are alone, or out of sight. Be close-by, but allow them to think they are playing independently.

5. Discuss risk at times that don’t directly involve it

When walking together to the shops, talk about the risks involved in crossing roads, such as fast cars. You can note safe and unsafe situations as well as encouraging your child to notice these as you go about your daily life. This can also be done in relaxed situations like in the bath.

This way, when the time comes for your child to learn a new skill like crossing the road alone, they have already had some opportunity to consider measures to keep themselves safe in a non-stressful situation.

If your child has a fall or other mishap, when everything is settled again, ask your child about why it happened and how they might suggest it could be prevented next time.




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Kids learn valuable life skills through rough-and-tumble play with their dads


This article was written with Kate Higginbottom, Service Director and Nominated Supervisor at Adamstown Community Early Learning and Preschool Centre.

The Adamstown centre was part of a larger research project, in which four Australian early childhood centres in Newcastle took part as practitioner researchers.The Conversation

Linda Newman, Associate Professor, University of Newcastle and Nicole Leggett, Senior Lecturer, University of Newcastle

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