Why some people don’t want to take a COVID-19 test


Jane Williams, University of Sydney and Bridget Haire, UNSW

Last week, outgoing chief medical officer Brendan Murphy announced all returned travellers would be tested for COVID-19 before and after quarantine.

Some were surprised testing was not already required. Others were outraged some 30% of returned travellers in hotel quarantine in Victoria had declined to be tested.

This week, Victorian premier Daniel Andrews said more than 900 people in two Melbourne “hotspots” had declined door-to-door testing.

Again, there was outrage. People refusing COVID-19 tests were labelled selfish and rude.

A positive test result, together with contact tracing, gives public health authorities important information about the spread of SARS-CoV-2, the coronavirus that causes COVID-19, in a community.

So why might people at higher risk of a positive result be reluctant testers? And what can we do to improve testing rates?

The many reasons why

Reluctance to be tested for COVID-19 is not unique to returned travellers in hotel quarantine or people living in “hotspot” suburbs.

In the week ending June 28, FluTracking, a voluntary online surveillance system, reported only 46% of people with a fever and cough had gone for a COVID-19 test.

That can be for a variety of reasons.

A medical test result is not a neutral piece of information. People may refuse medical testing (if they have symptoms) or screening (if no symptoms) of any type because they want to avoid the consequences of a positive result.

Alternatively, they might want to avoid the perceived burden of the test procedure itself.

Reasons may relate to potentially losing money or work

Many reasons for avoiding testing are likely to be structural: a casualised workforce means fewer workers with sick leave and a higher burden associated with having to isolate while waiting for test results. After a COVID-19 test in NSW, for instance, this can take 24-72 hours.

Then there’s the issue of precarious work. If people can’t attend work, either waiting at home for test results or recovering from sickness, they may lose their job altogether.




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In the case of hotel quarantine, a positive result on day ten will mean a longer stay in isolation. Hotel quarantine is not an easy experience for many, particularly if quarantining alone.

An extension of time at a point where the end is in sight may be a very difficult proposition to stomach, such that avoiding testing is a preferable option.

Another structural issue is whether governments have done enough to reach linguistically diverse communities with public health advice, which Victoria’s chief health officer Brett Sutton recently admitted may be an issue.

Through no fault of their own, may people who don’t speak English as a first language, in Victoria or elsewhere, may not be getting COVID-19 health advice about symptoms, isolation or testing many of us take for granted.




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People might fear the procedure or live with past traumas

Reasons may be personal and include fear of the test procedure itself (or fear it will hurt their children), distrust in government or public health systems, and worry about the extent of public health department scrutiny a positive result will bring.

People may also feel unprepared and cautious in the case of door-knocking testing campaigns.

We can’t dismiss these concerns as paranoid. Fears of invasive procedures are associated with past trauma, such as sexual abuse.

People who have experienced discrimination and marginalisation may also be less likely to trust governments and health systems.

COVID-19 can also lead to social stigma, including blame and ostracism, even after recovery.

As with any health-related decision, people usually consider, consciously or not, whether benefits outweigh harms. If the benefit of a test is assumed to be low, particularly if symptoms are light or absent, the balance may tip to harms related to discomfort, lost income or diminished freedoms.

Should we force people to get tested?

Although federal and state laws can compel certain people to undergo testing under limited circumstances, acting chief medical officer Paul Kelly said it was “a last resort”.

Forcing a person to undergo a test contravenes that person’s right to bodily integrity. This is the right to make decisions about what happens to your own body, without outside coercion.

It also involves medical personnel having to override their professional responsibility to obtain voluntary and informed consent.

Some states have indicated they will introduce punishments for refusing testing. They include an extension of hotel quarantine and the potential for fines for people not willing to participate in community testing.




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Forced testing will backfire

We don’t think forced testing is the way to go. A heavy-handed approach can create an antagonistic and mistrustful relationship with public health institutions.

The current situation is not the only infectious disease emergency we will face. Removing barriers to participating in public health activities, in the immediate and long term, will enable people to comply with and help build trusted institutions. This is likely to create an enduring public good.

Victoria is trying to make testing easier. It is offering a test that takes a saliva sample rather than a nasal swab, which is widely perceived to be unpleasant.




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Explainer: what’s the new coronavirus saliva test, and how does it work?


This may encourage parents to have their children tested. The test is less sensitive, however, so the gains in increased uptake may be lost in a larger number of false negatives (people who have the virus but test negative).

Ultimately, we need to understand why people refuse testing, and to refine public health approaches to testing that support individuals to make decisions in the public interest.The Conversation

Jane Williams, Researcher at the Centre for Values, Ethics and the Law in Medicine (VELiM), University of Sydney and Bridget Haire, Postdoctoral Research Fellow, Kirby Institute, UNSW

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

Explainer: what’s the new coronavirus saliva test, and how does it work?


Deborah Williamson, The Peter Doherty Institute for Infection and Immunity; Allen Cheng, Monash University, and Sharon Lewin, The Peter Doherty Institute for Infection and Immunity

A cornerstone of containing the COVID-19 pandemic is widespread testing to identify cases and prevent new outbreaks emerging. This strategy is known as “test, trace and isolate”.

The standard test so far has been the swab test, in which a swab goes up your nose and to the back of your throat.

But an alternative method of specimen collection, using saliva, is being evaluated in Victoria and other parts of the world. It may have some benefits, even though it’s not as accurate.




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Saliva testing can reduce risks for health workers

The gold standard for detecting SARS-CoV-2 (the coronavirus that causes COVID-19) is a polymerase chain reaction (PCR). This tests for the genetic material of the virus, and is performed most commonly on a swab taken from the nose and throat, or from sputum (mucus from the lungs) in unwell patients.

In Australia, more than 2.5 million of these tests have been carried out since the start of the pandemic, contributing significantly to the control of the virus.

Although a nasal and throat swab is the preferred specimen for detecting the virus, PCR testing on saliva has recently been suggested as an alternative method. Several studies demonstrate the feasibility of this approach, including one conducted at the Doherty Institute (where the lead author of this article works). It used the existing PCR test, but examined saliva instead of nasal samples.




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The use of saliva has several advantages:

  • it is easier and less uncomfortable to take saliva than a swab

  • it may reduce the risk to health-care workers if they do not need to collect the sample

  • it reduces the consumption of personal protective equipment (PPE) and swabs. This is particularly important in settings where these might be in short supply.

But it’s not as sensitive

However, a recent meta-analysis (not yet peer-reviewed) has shown detection from saliva is less sensitive than a nasal swab, with a lower concentration of virus in saliva compared to swabs. It’s important to remember, though, this data is preliminary and must be treated with caution.

Nonetheless, this means saliva testing is likely to miss some cases of COVID-19. This was also shown in our recent study, which compared saliva and nasal swabs in more than 600 adults presenting to a COVID-19 screening clinic.

Of 39 people who tested positive via nasal swab, 87% were positive on saliva. The amount of virus was less in saliva than in the nasal swab. This most likely explains why testing saliva missed the virus in the other 13% of cases.

The laboratory test itself is the same as the PCR tests conducted on nasal swabs, just using saliva as an alternative specimen type. However, Australian laboratories operate under strict quality frameworks. To use saliva as a diagnostic specimen, each laboratory must verify saliva specimens are acceptably accurate when compared to swabs. This is done by testing a bank of known positive and negative saliva specimens and comparing the results with swabs taken from the same patients.

When could saliva testing be used?

In theory, there are several settings where saliva testing could play a role in the diagnosis of COVID-19. These may include:

  • places with limited staff to collect swabs or where high numbers of tests are required

  • settings where swabs and PPE may be in critically short supply

  • some children and other people for whom a nasal swab is difficult.

The use of saliva testing at a population level has not been done anywhere in the world. However, a pilot study is under way in the United Kingdom to test 14,000 health workers. The US Food and Drug Administration recently issued an emergency approval for a diagnostic test that involves home-collected saliva samples.

In Australia, the Victorian government is also piloting the collection of saliva in limited circumstances, alongside traditional swabbing approaches. This is to evaluate whether saliva collection is a useful approach to further expanding the considerable swab-based community testing occurring in response to the current outbreaks in Melbourne.




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A saliva test may be better than no test at all

Undoubtedly, saliva testing is less sensitive than a nasal swab for COVID-19 detection. But in the midst of a public health crisis, there is a strong argument that, in some instances, a test with moderately reduced sensitivity is better than no test at all.

The use of laboratory testing in these huge volumes as a public health strategy has not been tried for previous infectious diseases outbreaks. This has required a scaling up of laboratory capacity far beyond its usual purpose of diagnosing infection for clinical care. In the current absence of a vaccine, widespread testing for COVID-19 is likely to occur for the foreseeable future, with periods of intense testing required to respond to local outbreaks that will inevitably arise.

In addition to swab-free specimens like saliva, testing innovations include self-collected swabs (which has also been tested in Australia), and the use of batch testing of specimens. These approaches could complement established testing methods and may provide additional back-up for population-level screening to ensure testing is readily available to all who need it.


This article is supported by the Judith Neilson Institute for Journalism and Ideas.The Conversation

Deborah Williamson, Professor of Microbiology, The Peter Doherty Institute for Infection and Immunity; Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash University, and Sharon Lewin, Director, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital and Consultant Physician, Department of Infectious Diseases, Alfred Hospital and Monash University, The Peter Doherty Institute for Infection and Immunity

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

Hospital beds and coronavirus test centres are needed fast. Here’s an Australian-designed solution


Deborah Ascher Barnstone, University of Technology Sydney

Two of the most pressing needs worldwide in the coronavirus pandemic are for more hospital beds and testing centres. No country in the world has enough hospital beds or intensive-care unit (ICU) beds for a pandemic. Even the best prepared, like Germany with 33.9 ICU beds per 100,000 citizens, does not have enough.

Most countries have locked down to buy time by flattening the infection curve so fewer patients will present to hospital at once. They hope to use the time to boost hospital capacity.




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But the design challenge is significant. We need structures that can be quickly and easily assembled, are inexpensive and meet technical requirements. Architects have always worked on such challenges – the Living Shelter is one recent example.

Here in Australia a consortium is working to develop two designs, one for hospital intensive care units and one for COVID-19 testing centres, that can be used across the country and overseas. By using recycled shipping containers as the core structure, the price of the buildings will be less than a third of the cost of conventional designs.

In both building types, the container doubles as structure and packaging. This means the designs are self-contained and easy to distribute anywhere in the world. All the building parts, technical equipment, cabinets and other fit-out materials pack into the container.

The design of the testing centre is based on a shipping container, which doubles as the packaging for transport.
Author provided

Douglas Abdiel, the director of charitable foundation P&G Purpose, and architect Robert Barnstone are working together on the design and delivery of these hospital units and testing centres.

Barnstone specialises in disaster relief architecture. He has developed designs for emergency housing for the International Red Cross and rapid deployment schools for countries afflicted by disaster. This experience gave Barnstone invaluable insights into the economics and potential construction systems for the hospital units and testing centres.




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What are the key requirements?

Any disaster relief architecture must consider several critical design aspects:

  • buildings need to be as cheap as possible so limited funds can be stretched to help as many people as possible

  • the structure should be lightweight and easy to assemble because professional builders might not be available for construction

  • the structure needs to be weatherproof and insulated for variable climates

  • medical functions require running water, electricity, air exchange to bring fresh air into the container, and air conditioning to control the temperature inside.

The mechanical services needed in a medical facility are highly specialised and expensive. This makes it particularly challenging to design. Ideally, the structure should be lasting, so money invested in relief efforts is not wasted.

Emergency structures should also be designed for easy packaging and shipping. Standard dimensions of shipping containers, freight costs and delivery logistics must be considered.




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So how do the two building designs work?

The two proposals for intensive care units and testing facilities use modified shipping containers as the supporting structure. You can see the full designs and specifications here.

The hospital structure is simply a large shed that houses ICU bays. A nurses’ station is located in the centre.

The testing centre is a drive-by place to conduct COVID-19 tests and either process them when a fast test is available or store them for shipping to laboratories.

Used shipping containers are cheap and easy to find. They are made from a steel frame with corrugated steel panelling, which makes them very strong.

Both schemes use prefabricated panels for exterior and interior walls. Window units will be integrated into panels. These come in standard sizes that easily pop into place.

The two design approaches do have differences, however.

The front entry of the rapid deployment hospital annexe.

The hospital uses a full-length 12-metre container. The shipping container acts as the structural and spatial core of the hospital building.

When unpacked, the container sits in the middle of the hospital and supports long-span steel trusses and the roof. It houses office and storage space.

Inside the hospital annexe the container houses the nurses’ annexe and supports the building trusses and roof.

The prefabricated panels form both the outside walls and interior partitions. End walls are made of transparent glass to allow natural light into the interior.

Interior bays for patients are also prefabricated. These line the exterior walls, leaving space for hospital staff to circulate between the ICU bays and central container.

In contrast, the testing centre is a single-unit building made from a half-length six-metre container. A large overhanging canopy covers the roof and front deck to protect against sun and rain.

A water storage tank rests on the roof underneath the canopy. A generator sits on one side. There is a scrub sink and changing area outside, with a curtain that allows for privacy and a bin to dispose of protective equipment.

The exterior of the testing centre has a changing area and sink.

The container doors support storage cabinets for test kits on their inside wall. These doors can swing open so they are flush with the front facade. In this position, the cabinets face the front deck for easy access by nurses and doctors.

The front deck of the testing centre showing storage cabinets.

The interior has ample storage and office furniture.

The testing centre office.

Construction of the prototype test centre was due to begin on April 15. To date, the team has raised A$30,000 to support the effort but needs $20,000 more. At A$3,125 per square metre, compared with about A$10,000 per square metre for usual construction, these solutions are affordable and can be produced and delivered very quickly.The Conversation

Deborah Ascher Barnstone, Professor, Course Director Undergraduate Studies, School of Architecture, University of Technology Sydney

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

Antibody tests: to get a grip on coronavirus, we need to know who’s already had it


Larisa Labzin, The University of Queensland

With much of society now effectively in lockdown, how will we know when it’s safe to resume something like normality?

It will largely depend on being able to say who is safe from contracting the coronavirus, officially named SARS-CoV-2, which causes the disease called COVID-19, and who still needs to stay out of harm’s way. A blood test to detect who has antibodies against the virus would be a crucial aid.

An antibody test – which would identify those whose immune systems have already encountered the virus, as opposed to current tests that reveal the presence of the virus itself – will be an important part of efforts to track the true extent of the outbreak.

This is because the antibody test will be able to determine whether someone has been infected with virus, even if they haven’t shown symptoms.




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When we get infected with the novel coronavirus (SARS-CoV-2), one of the ways our immune system fights the virus is by making antibodies. These small molecules bind specifically to SARS-CoV-2 (and not other viruses or bacteria), and combat the infection, mainly by preventing the virus from entering our cells.

Even after we’ve cleared a particular virus infection, these antibodies stay in our bloodstream, ready to protect us if we encounter the same virus again. This is the principle behind vaccination.

Because antibodies are specific to a particular virus, that means if we can detect SARS-CoV-2 specific antibodies in someone’s blood, we know that person has already been infected with the coronavirus.

Scientists in the United States and Europe have already developed specific antibody tests for SARS-CoV-2. Laboratory tests show that only antibodies from SARS-CoV-2 patients will bind to SARS-CoV-2 (and not to the 2003 SARS virus, for example). This tells us the test is specific.

Testing times

Antibody tests are different from the current testing kits used at COVID-19 clinics, which reveal the presence of the virus itself (by detecting its genetic material), rather than our antibodies against it.

That is useful for determining whether someone is currently infected, but cannot spot people who have already fought off the virus. In contrast, the antibody tests won’t be able to detect if someone is newly infected with SARS-CoV-2, as it takes our immune system a week or more to make antibodies. So we still need to do the existing tests to accurately diagnose a current infection.

Many companies have developed rapid test kits for detecting anti-SARS-CoV-2 antibodies. The UK is already rolling out 3.5 million antibody tests, while Australia has ordered 1.5 million antibody tests to determine whether patients showing symptoms of fever and cough are infected.

What still needs to be tested is how specific those kits are. It’s vital that these antibody test kits are only able to detect antibodies against SARS-CoV-2, and not other coronaviruses or even viruses of other types. Otherwise, people might think they are protected against SARS-CoV-2 when in fact they aren’t.

Additionally, because the onset of symptoms may appear within 2-14 days after exposure, a person might test negative to the antibody test but actually be infected. So we really still need to use the two tests together to accurately diagnose patients with COVID-19.

A new test developed by NSW Health Pathology will also be able to determine whether the antibodies in the blood are able to kill the virus. These kinds of tests will help clinicians and scientists measure exactly how soon after infection we develop antibodies, what levels are needed to be protective, and how long these antibodies stay in our body.

This will also help scientists track the spread of the virus and know if someone is going to be immune to reinfection with SARS-CoV-2.

Rapid response

These antibody tests have been developed much more rapidly than vaccines, which are still many months away. This is because the antibody tests are done outside the body, using just a small blood sample, perhaps just a pinprick.

In contrast, a vaccine needs to be injected into the body, so it has to be tested for safety as well as effectiveness.

For a vaccine, we first need to understand how the immune response to the virus itself works, because essentially a vaccine is trying to trick the immune system into thinking it’s seen the virus before so it makes protective antibodies. Then, we need to thoroughly test any candidate vaccine to ensure it doesn’t make people ill. This means we probably won’t see any vaccines for at least 12 months.

The new antibody tests will also help guide vaccine development. By measuring antibody levels in infected and recovered patients, we’ll have a much better idea of the levels of protective antibodies a vaccine needs to elicit.




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While we wait for a vaccine, the new antibody tests will give scientists, doctors and public health officials much more information about who gets infected, who has already been infected and recovered, and how protected we are against reinfection.

But there is still a long way to go before we can test people’s blood for antibodies against SARS-CoV-2 and confidently say it is safe for people to go back to work or into the community without getting sick.

Ultimately it is up to our community leaders and public health officials to decide when it is safe for us to resume normal life.The Conversation

Larisa Labzin, Research Fellow, Institute for Molecular Bioscience, The University of Queensland

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

Who can get tested for coronavirus?


Hassan Vally, La Trobe University

To control the spread of COVID-19 we need to identify as many people with the virus as possible. If we know who has it, we can isolate them so they can’t infect others and quarantine their close contacts in case they’ve already been infected.

But some experts are concerned we’re not testing enough. Because of restrictions on who can be tested, they argue, we’re only seeing the tip of the iceberg. Beneath the surface, the virus could be spreading much more than we think.




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


The federal government recently expanded its testing guidelines and now allows states and territories to set their own rules for testing. But before we get to what they say, let’s look at the symptoms.

What are the symptoms of COVID-19?

Colds, influenza and COVID-19 are all respiratory illnesses and share many of the same symptoms.

For COVID-19, the most common symptoms are fever and a dry cough. Other symptoms might include fatigue, the production of phlegm, shortness of breath, a sore throat and a headache.

But some people experience no, or mild, symptoms.


The Conversation, CC BY-ND

What is Australia’s testing criteria?

Across Australia, if you develop a respiratory illness, with or without a fever, you can be tested for coronavirus if you:

  • have returned from overseas in the past 14 days or spent time on a cruise ship

  • have been in close contact with a confirmed COVID-19 case in the past 14 days

  • have severe community-acquired pneumonia and there is no clear cause.




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If you have a fever or a respiratory illness, you can be tested (and in some cases, must be tested), if you:

  • work in health care, aged care or other residential care sectors

  • have spent time in a location with elevated levels of community transmission

  • have spent time at a “high-risk” location where there are two or more linked cases of COVID-19. This could be an aged care facility, a remote Aboriginal community, a correctional facility, a boarding school, or a military base with live-in accommodation.

Who else can get tested?

Australians in all states and territories can get tested if they meet the criteria above, but some states have expanded their criteria.

In Western Australia, if you have fever of 38℃ and over and have signs of a respiratory infection, you may be tested.

In New South Wales, GPs have discretion to test anyone who has symptoms of COVID-19. People who identify as Aboriginal in rural and remote communities may also be tested, as can people who live in communities with local transmission.

South Australia has had a cluster of cases among airport baggage handlers. Therefore, anyone who has symptoms of COVID-19 and has been at the airport in the past 14 days, including the carpark or terminal, should also present.

Queensland will offer testing for people who have symptoms consistent with COVID-19 and live in a Aboriginal or Torres Strait Islander communities, as Indigenous Australians are more vulnerable to COVID-19.




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Victoria has introduced random testing at screening centres, testing every fifth person who presents. This should provide a snapshot of the spread of the virus among a broader section of the community.

The ACT, Northern Territory and Tasmania are following the national guidelines and haven’t included any other groups or situations in which someone can be tested.

So what if you think you have COVID-19?

If you think you have symptoms of COVID-19, call your your GP and advise them of your symptoms and other relevant details, such as travel or contact with a known case.

If you don’t have a usual GP or want to discuss your concerns, call the National Coronavirus Helpline on 1800 020 080. You will be given information on where the closest COVID-19 testing clinic is and detailed advice on whether you should be tested.

If you’re asked to come to a COVID-19 clinic, you’ll need to take precautions. These include driving yourself if possible, wearing a mask if you have one, staying at least 1.5 metres from other people and coughing or sneezing into your elbow.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.

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


C Raina MacIntyre, UNSW

As the World Health Organisation keeps reminding health officials around the world, in order to get COVID-19 under control, we must “test, test, test”.

Along with tracing contacts of cases, travel bans and social distancing, testing is one of the four key planks in our pandemic response to SARS-CoV2, the virus that causes COVID-19.

Widespread testing has been the key to reducing transmission in South Korea, which was able to use only limited lockdowns because it tested at a mass scale.




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Both South Korea and Japan tested people at high risk who didn’t have symptoms. On the Diamond Princess ship, for example, which was quarantined for two weeks in the port of Yokohama, Japanese testers found 634 people were infected and of these, 328 had no symptoms.

In the United States, asymptomatic spread has likely driven the silent growth of an epidemic that was only realised when the health system began overloading. We’ve seen the same in Italy and Spain, which also restrict testing.

Australia’s federal government has expanded the testing criteria beyond just returned travellers and those with close contact with an infected person.

But testing remains restricted to people with symptoms and doesn’t go far enough. Like South Korea, we should also be testing people without symptoms who are in high risk groups, such as close contacts, evacuees from cruise ships, and health workers who request a test.

How do we test for coronavirus?

There are two kinds of laboratory tests. One is a PCR (polymerase chain reaction) test, which detects fragments of the virus RNA in the sputum (phlegm), throat, nose or other body fluid.

The other is a blood test for antibodies to the virus. This can identify people who have been exposed to the virus and produced antibodies, whose swab may be negative.

Currently only PCR tests are widely available, but blood tests (serology) should be available soon.

PCR tests have some shortcomings. Throat swabs in particular can give you a false negative, so it may be necessary to repeat the test in someone who seems to have COVID-19. A nasal swab or sputum (phleghm) specimen is more likely to be positive in an infected person.

The PCR tests will only be transiently positive, while the serology remains positive once you have been infected. Blood tests are less likely to miss infected people, including children and young people. However, a blood test doesn’t tell you if someone is infectious at that time. PCR and serology can be used together for optimal results.




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Rapid, point-of-care tests which use a swab and have results available in 45 minutes are especially useful in outbreaks in closed settings such as aged care facilities or prisons. These aren’t yet available in Australia.

The government has ordered 1.5 million rapid tests which use blood. But it takes five days for a patient to develop antibodies and become positive to that kind of test. Only a PCR-based test can give an early diagnosis.

Chest CT scans were also used in China for rapid diagnosis because of the problem with PCR being negative.

Australian testing guidelines

The current Australian guidelines, which were expanded yesterday (March 25), restrict testing to people with a fever or respiratory illness who:

  • have been in contact with a known COVID-19 case

  • are return travellers including on cruise ships

  • are in a high-risk setting where at least two COVID-19 cases have been confirmed, such as an aged care facility, prison, boarding school, detention centre, Indigenous community or military base

  • are being hospitalised with pneumonia or a respiratory illness of unknown cause

  • have illness clinically consistent with COVID-19 in a geographically localised area with elevated risk of community transmission, as defined by health authorities

  • are health care workers, aged or residential care workers.

While these guidelines have expanded the testing criteria, they still restrict testing to people with symptoms.

Why more people should be tested

Australia has a high rate of testing compared to many other countries, and a low positive rate.

But we don’t have data on silent transmission that could be bubbling under the surface when infected people don’t have any symptoms or have very mild illness.

On February 14, the Spanish health minister laughed and told the Spanish people there was no COVID-19 in Spain:

Six weeks later the country has around 40,000 cases and a health system in collapse.

Who we should test

To make social distancing measures successful, they must be accompanied by a broadened testing criteria to ensure every new case can be identified rapidly.




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We should be testing people without symptoms who fall into the groups outlined in the current Australian guidelines, so that we do not miss asymptomatic cases in high risk groups.

This would include asymptomatic people who are: close contacts of people with COVID-19; evacuees from cruise ships; health or aged care workers who request a test; as well as asymptomatic people in closed outbreak settings (aged care centre, prison, boarding school, detention centre, Indigenous community or military base).

We also need to scale up capacity

Social distancing measures also need to be accompanied by scaled-up testing capabilities including:

  • expanded capacity for PCR (swab) testing

  • the ability to repeat testing (at least three tests) for suspected cases when the initial PCR (swab) test is negative

  • drive-through testing sites to make testing accessible and safer for infection control

  • increased capacity for Australian laboratories to conduct blood tests at mass scale

  • continued investment and development of rapid point of care and commercial serological tests.

If we cannot procure or make enough tests, we could ask South Korea for help as the United States is doing.

It is essential we can identify all cases before we take the foot off the brakes of lockdowns.




Read more:
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The Conversation


C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW

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

The coronavirus outbreak is the biggest crisis ever to hit international education


Christopher Ziguras, RMIT University and Ly Tran, Deakin University

The coronavirus outbreak may be the biggest disruption to international student flows in history.

There are more than 100,000 students stuck in China who had intended to study in Australia this year. As each day passes, it becomes more unlikely they will arrive in time for the start of the academic year.

Of course international affairs are bound to sometimes interfere with the more than 5.3 million students studying outside their home country, all over the world.

After the September 11 attacks in 2001, the United States closed its borders temporarily and tightened student visa restrictions, particularly for students from the Middle East. Thousands were forced to choose different study destinations in the following years.

In 2018, Saudi Arabia’s government instructed all its citizens studying in Canada to return home, in protest at the Canadian foreign minister’s call to release women’s rights activists held in Saudi jails.

A significant proportion of the 12,000 or so Saudi students in Canada left to continue their studies elsewhere, before the Saudi government quietly softened its stance.

So we have seen calamities before, but never on this scale. There are a few reasons for this.

Why this is worse than before

The current temporary migration of students from China to Australia represents one of the largest education flows the world has ever seen. Federal education department data show there were more than 212,000 Chinese international students in Australia by the end of 2019.


Screenshot/Department of Education

This accounts for 28% of Australia’s total international student population. Globally, there are only two study routes that involve larger numbers of students. The world’s largest student flow is from China to the United States and the second largest is from India to the US.

It’s also difficult to imagine a worse time for this epidemic to happen for students heading to the southern hemisphere than January to February, at the end of our long summer break.

Many Chinese students had returned home for the summer and others were preparing to start their studies at the end of February.

By comparison, the SARS epidemic in 2003 didn’t significantly dent international student enrolments in Australia because it peaked around April-May 2003, well after students had started the academic year.




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Ending in July that year, the SARS outbreak infected fewer than half the number of people than have already contracted coronavirus. Even during the SARS outbreak Australia didn’t implement bans on those travelling from affected countries.

What will the impact be?

This crisis hits hard for many Chinese students, an integral component of our campus communities. It not only causes disruptions to their study, accommodation, part-time employment and life plans, but also their mental well-being.

A humane, supportive and respectful response from the university communities is vital at this stage.

Australia has never experienced such a sudden drop in student numbers.

The reduced enrolments will have profound impacts on class sizes and the teaching workforce, particularly at masters level in universities with the highest proportions of students from China. Around 46% of Chinese students are studying a postgraduate masters by coursework. If classes are too small, universities will have to cancel them.

And the effects don’t end there. Tourism, accommodation providers, restaurants and retailers who cater to international students will be hit hard too.

Chinese students contributed A$12 billion to the Australian economy in 2019, so whatever happens from this point, the financial impact will be significant. The cost of the drop in enrolments in semester one may well amount to several billion dollars.

The newly-formed Global Reputation Taskforce by Australia’s Council for International Education has commissioned some rapid response research to promote more informed discussion about the implications and impacts of the crisis.




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What attracts Chinese students to Aussie universities?


If the epidemic is contained quickly, some of the 100,000 students stuck in China will be able to start their studies in semester one, and the rest could delay until mid-year. But there might still be longer-term effects.

Australia has a world-class higher education system and the world is closely watching how we manage this crisis as it unfolds.

Prospective students in China will be particularly focused on Australia’s response as they weigh future study options.

The world is watching

Such a fast-moving crisis presents a range of challenges for those in universities, colleges (such as English language schools) and schools who are trying to communicate with thousands of worried students who can’t enter the country.

Australian universities are scrambling to consider a wide range of responses. These include:

  • delivering courses online
  • providing intensive courses and summer or winter courses
  • arrangements around semester commencement
  • fee refund and deferral
  • provision of clear and updated information
  • support structures for starting and continuing Chinese students, including extended academic and welfare support, counselling, special helplines, and coronavirus-specific information guidelines
  • support with visa issues, accommodation and employment arrangements.

A coordinated approach involving different stakeholders who are providing different supports for Chinese students is an urgent priority. This includes education providers, government, city councils, international student associations, student groups and professional organisations.




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This outbreak further raises awareness within the international education sector of the need for risk management and crisis response strategies to ensure sustainability.

Most importantly, we need to ensure we remain focused on the human consequences of this tragedy first. Headlines focusing on lost revenues at a time like this are offensive to international students and everyone involved in international education.The Conversation

Christopher Ziguras, Professor of Global Studies, RMIT University and Ly Tran, ARC Future Fellow, Deakin University

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

Partner or customer? Why China is Scott Morrison’s biggest foreign policy test



Scott Morrison is relatively inexperienced on foreign policy, but he’s certain to be tested by China in his first full term in office.
Mick Tsikas/AAP

Euan Graham, La Trobe University

The 2019 federal election, unlike previous campaigns, did not feature a dedicated debate on foreign affairs or defence. The conventional cynicism – that there are no votes in foreign policy – does not adequately explain this. It seems Prime Minister Scott Morrison and Labor leader Bill Shorten reached a shabby consensus that foreign and security policy questions were uniformly too hot to handle.

Foreign affairs is in fact among the most important challenges facing the Morrison government. The simple reason: the status quo that has served Australia so well in the past couple of decades is fast coming to an end.

Australia has uniquely avoided recession among the developed economies because it has surfed a once-in-a-generation wave of Chinese demand for commodities. Australia’s security has also been assured through its longstanding alliance with the US, while its military commitments have been kept largely at arm’s length in the Middle East and Afghanistan.




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However, as Asia-Pacific scholar Nick Bisley has commented, Australia now finds itself caught between two different forms of revisionism: the strategic revisionism of Xi Jinping’s China and the economic revisionism of Donald Trump’s United States.

Trump’s trade wars and protectionist policies are likely to be a continuing point of friction with Australia, which remains heavily reliant on Asian markets (not only China) for trade.

But China is the most important external challenge Australia faces. It’s so all-encompassing that it transcends traditional foreign, trade and defence policy silos, and includes a significant domestic dimension in terms of political interference, as well.

Even though Morrison has already served the better part of a year in office, it’s hard to be sure of his convictions on China. With his mandate secured, he now has both the opportunity and obligation to show his true colours.

Caught between a rock and a hard place

In theory, the Coalition’s election victory should mean continuity in foreign policy, as signalled by Morrison’s decision to retain Marise Payne as foreign minister.

When China was – belatedly – raised during the campaign, Morrison repeated a well-worn mantra about not having to “pick sides” between the United States and China. The former he characterised as Australia’s “friend”, labelling China as a “customer”. While this description no doubt raised eyebrows in Beijing, Morrison was arguing Canberra could “stand by” both.

The Morrison administration has generally sought to position Australia somewhere in between its chief ally and its chief customer. His reticence thus far to make waves with the country’s number one customer may be borne of a desire to maintain Canberra’s room for manoeuvre as a middle power, though this is getting steadily harder.

Australia could find itself in an awkward position if the rift between China and the US deepens.
Roman Pilipey/EPA

If the prime minister truly believes Australia can play an intermediary role, few in Canberra’s foreign policy and defence circles would agree. To do so would only expose Australia to heightened risk, precipitating the kind of invidious strategic choices that Morrison wishes to avoid.

It also plays into the Chinese Communist Party’s objective of sowing discord between the US and its Pacific allies.




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In his first major foreign policy test, Morrison needs to stick to the script


If Morrison is privately more attuned to the strategic risks China poses – and after nine months of intelligence briefings he should be – then he has a duty to prepare the public for the likelihood of tougher times ahead. Should Australia-China relations take a darker turn, it may prove difficult for the government to persuade the public to back a significant adjustment in national security policy, including increased defence spending.

Moreover, there are risks to publicly framing US-China strategic competition as a destabilising factor for Australia’s security. Australians could judge the prospect of entrapment in a confrontational US policy towards China as potentially more threatening to Australia’s security than Beijing’s deliberate challenge to the “rules-based order” in the region.

This could undermine public support for Australia’s alliance with the US, which remains the bedrock of our security.

Stepping up in the Pacific

The Pacific is where the strategic interests of China and Australia clash most directly. Morrison’s most important security policy decision thus far, announced at last year’s APEC summit, was to establish a joint naval base with the US and Papua New Guinea at Lombrum on Manus Island. This was partly aimed at denying the location to China, as well as establishing a forward ADF presence in the Pacific.

It is also notable that Morrison will visit the Solomon Islands on his first post-election overseas trip. China is inevitably part of the subtext here, as Prime Minister Manasseh Sogavare is reported to be swaying towards switching allegiances from Taiwan to Beijing – yet another sign of China’s growing influence in the region.

Of course, there is more than geopolitics to the Pacific region and Morrison must be careful to demonstrate empathy and humility, given Australia’s patchy engagement with the region and the Coalition’s ambivalence on climate change – a major grievance for most Pacific nations.

Morrison’s appointment of Alex Hawke as both minister of international development and Pacific and assistant defence minister provides easy ammunition to critics, who will charge that the government’s Pacific “step up” is narrowly conceived through a geopolitical lens.

But Morrison appears to take the step up seriously, and a commitment to reversing the relative decline in Australia’s influence in its immediate neighbourhood (note: not “backyard”). A volatile political situation in PNG further demands a close watch on the Pacific.

Chinese President Xi Jinping has made Australia nervous by courting Pacific leaders like PNG’s Peter O’Neill.
Mick Tsikas/AAP

Other key alliances to shore up

Elsewhere in the neighbourhood, Morrison has fallen on his feet now that friendly incumbents in Indonesia and India – President Joko “Jokowi” Widodo and Prime Minister Narendra Modi – were also returned in recent elections, making it easier for continuity to be maintained.

Morrison was quick off the mark to congratulate Jokowi on Twitter, who promptly replied that Australia is one of Indonesia’s “greatest allies.”

By pulling off an unlikely election victory, Morrison is in the fortunate position of being the first prime minister for some time who is not looking immediately over his or her shoulder for political assassins within their party.

Morrison also has more bandwidth to devote to foreign issues than any leader since Kevin Rudd. He is disadvantaged, however, by his relative inexperience and the thinness of his front bench. That places a special burden on whoever will be advising Morrison on international security – a role sure to take on greater importance in his administration – to provide the counsel he needs and to wrangle the bureaucracy into line. For there will be no shortage of challenges ahead.The Conversation

Euan Graham, Executive Director, La Trobe Asia, La Trobe University

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

India destroys its own satellite with a test missile, still says space is for peace


Bin Li, University of Newcastle

On March 27, India announced it had successfully conducted an anti-satellite (ASAT) missile test, called “Mission Shakti”. After the United States, Russia and China, India is now the fourth country in the world to have demonstrated this capability.

The destroyed satellite was one of India’s own. But the test has caused concerns about the space debris generated, which potentially threatens the operation of functional satellites.

There are also political and legal implications. The test’s success may be a plus for Prime Minister Narendra Modi, who is now trying to win his second term in the upcoming election.




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But the test can be viewed as a loss for global security, as nations and regulatory bodies struggle to maintain a view of space as a neutral and conflict-free arena in the face of escalating technological capabilities.

According to the official press release, India destroyed its own satellite by using technology known as “kinetic kill”. This particular technology is usually termed as “hit-to-kill”.

A kinetic kill missile is not equipped with an explosive warhead. Simply put, what India did was to launch the missile, hit the target satellite and destroy it with energy purely generated by the high speed of the missile interceptor. This technology is only one of many with ASAT capabilities, and is the one used by China in its 2007 ASAT test.

Power and strength

Since the first satellite was launched in 1957 (the Soviet Union’s Sputnik), space has become – and will continue to be – a frontier where big powers enhance their presence by launching and operating their own satellites.

There are currently 1,957 satellites orbiting Earth. They provide crucial economic, civil and scientific benefits to the world, from generating income to a wide range of services such as navigation, communication, weather forecasts and disaster relief.

The tricky thing about satellites is that they can also be used for military and national security purposes, while still serving the civil end: one good example is GPS.

So it’s not surprising big powers are keen to develop their ASAT capabilities. The name of India’s test, Shakti, means “power, strength, capability” in Hindi.

Danger of space debris

A direct consequence of ASAT is that it creates space debris when the original satellite breaks apart. Space debris consists of pieces of non-functional spacecraft, and can vary in size from tiny paint flecks to an entire “dead” satellite. Space debris orbits from hundreds to thousands of kilometres above Earth.

The presence of space debris increases the likelihood of operational satellites being damaged.

Although India downplayed the potential for danger by arguing that its test was conducted in the lower atmosphere, this perhaps did not take into account the creation of pieces smaller than 5-10 cm in diameter.

In addition, given the potential self-sustaining nature of space debris, it’s possible the amount of space debris caused by India’s ASAT will actually increase due to the collision.

Aside from the quantity, the speed of space debris is another worrying factor. Space junk can travel at up to 10km per second in lower Earth orbit (where India intercepted its satellite), so even very small particles pose a realistic threat to space missions such as human spaceflight and robotic refuelling missions.

Regulatory catch-up

As we’re seeing clearly now in social media, when technology moves fast the law can struggle to keep up, and this leads to regulatory absence. This is also true of international space law.

Five fundamental global space treaties were created 35-52 years ago:

  • Outer Space Treaty (1967) – governs the activities of the states in exploration and use of outer space
  • Rescue Agreement (1968) – relates to the rescue and return of astronauts, and return of launched objects
  • Liability Convention (1972) – governs damage caused by space objects
  • Registration Convention (1967) – relates to registration of objects in space
  • Moon Agreement (1984) – governs the activities of states on the Moon and other celestial bodies.



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These were written when there were only a handful of spacefaring nations, and space technologies were not as sophisticated as they are now.

Although these treaties are binding legal documents, they leave many of today’s issues unregulated. For example, in terms of military space activities, the Outer Space Treaty only prohibits the deployment of weapons of mass destruction in space, not conventional weapons (including ballistic missiles, like the one used by India in Mission Shakti).

In addition, the treaty endorses that outer space shall be used exclusively for peaceful purposes. However, the issue is how to interpret the term “peaceful purposes”. India claimed, after its ASAT test:

we have always maintained that space must be used only for peaceful purposes.

When terms such as “peaceful” seem to be open to interpretation, it’s time to update laws and regulations that govern how we use space.

New approaches, soft laws

Several international efforts aim to address the issues posed by new scenarios in space, including the development of military space technologies.

For example, McGill University in Canada has led the MILAMOS project, with the hope of clarifying the fundamental rules applicable to the military use of outer space.




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A similar initiative, the Woomera Manual, has been undertaken by Adelaide Law School in Australia.

Though commendable, both projects will lead to publications of “soft laws”, which will have no legally binding force on governments.

The UN needs to work much harder to attend to space security issues – the Disarmament Commission and Committee on the Peaceful Uses of Outer Space can be encouraged to collaborate on the issues regarding space weapons.

It is in everyone’s best interests to keep space safe and peaceful.The Conversation

Bin Li, Lecturer, University of Newcastle

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

In his first major foreign policy test, Morrison needs to stick to the script



File 20181113 194500 179zyor.jpg?ixlib=rb 1.1
After a positive start, Morrison’s relations with his Indonesian counterpart, Joko Widodo, cooled off after he suggested moving the Australian embassy in Israel to Jerusalem.
Lukas Coch/AAP

Susan Harris Rimmer, Griffith University

Attending a global leaders summit might look easy – all interesting shirts, family-style photos and unusual handshakes – but these occasions can prove extremely difficult for leaders who focus solely on domestic politics or brand new leaders with uncertain electoral prospects.

Prime Minister Scott Morrison is both.

Morrison faces a busy week of foreign policy tests in his first big moment on the global stage. He first travels to Singapore for the ASEAN and East Asia Summit, then hosts Japanese Prime Minister Shinzo Abe’s historic visit to Darwin before jetting off for the APEC Summit in Papua New Guinea on the weekend. This power week will be followed by the G20 Leaders Summit in Buenos Aires at the end of month.

This week, Morrison will have his first meetings with Chinese President Xi Jinping, US Vice President Mike Pence and Russian President Vladimir Putin, in addition to new (but not so new) Malaysian PM Mahathir Mohamad and Chinese Premier Li Keqiang.




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So what can we expect from Morrison’s debut summit season and in particular his meetings with Xi?

Pundits have been speculating whether Morrison might try to use the August leadership spill and appointment of new Foreign Minister Marise Payne as a way of pressing the reset button on relations with China.

Payne’s recent visit to Beijing was viewed by both parties as a success, so Morrison should have a more pleasant meeting with Xi than former Prime Minister Malcolm Turnbull might have.

Payne’s visit to China was the first by an Australian foreign minister since Julie Bishop’s trip in 2016.
Thomas Peter/EPA

But Morrison’s first months in office show a leader who speaks without due care to the reactions of foreign governments – floating the idea of shifting the Australian embassy in Israel from Tel Aviv to Jerusalem is the most glaring example – and a leader with little political capital to spare.

He needs to stick to the script this week.

Danger signs

Morrison has already courted controversy on foreign policy in a short period of time. He skipped the UN General Assembly in September. He also missed the Pacific Islands Forum in Nauru, forcing Payne to reassure Pacific neighbours that he wasn’t “snubbing” them.

Morrison did go straight to Jakarta in his first overseas trip as leader to meet with President Joko Widodo and sign the Comprehensive Economic Partnership Agreement with Indonesia.

But he was then accused of playing “straight from Trump’s songbook” when he mused about moving Australia’s embassy in Israel to Jerusalem without consulting diplomats or generals beforehand. It was widely seen as a crude attempt to win the Jewish vote in the Wentworth by-election.

One downfall of Australian leaders is they can sometimes look parochial and small-town while on the big stage. For example, then-Prime Minister Tony Abbott made a cringeworthy speech to G20 leaders in Brisbane in 2014 about GP co-payments and stopping the boats. Opposition leader Bill Shorten described it as “weird and graceless”.

In his case, Morrison failed to realise the negative reception his embassy musings would receive in Indonesia. Now, his meetings with Widodo are likely to be frosty, with no plans to sign the free-trade agreement by the end of the year.

Morrison’s meetings with Xi, Putin and Modi

In his recent headland speech, Morrison seemed to adopt a Malcolm Turnbull-style line on taking a middle path with the US and China, noting that a confrontation between the two powers:

risks unimagined damage to economic growth and the global order. Damage where no-one benefits. Lose-lose.

Nevertheless, the speech was strong on values, many of which China does not share.

It is also not clear how Xi will view the recent Pacific push from Morrison, though he seemed to offer the possibility for partnership in the region.

Morrison’s meeting with Putin at the East Asia Summit will likewise be interesting to watch. This is Putin’s first time at the summit, but by no means his first rodeo. His presence is perhaps indicative of Russia’s intention to pivot more attention towards the Indo-Pacific region, taking advantage of Trump’s absence.




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In yet another foreign policy stumble, Abbott once famously vowed to “shirtfront” Putin over the downing of Malaysian Airlines flight MH17. Putin enjoys such displays of toxic masculinity; hopefully, Morrison can restrain himself.

Australia wants to enhance its partnership with India, so we should see Morrison make a beeline for Prime Minister Narendra Modi at the ASEAN meeting, hoping for one of Modi’s signature hugs.

Before meeting Modi, Morrison will hopefully have carefully read the India Economic Strategy to 2035, authored by the former high commissioner to India and head of DFAT, Peter Varghese.

Modi got a hug of his own from Abbott during his high-profile visit to Australia in 2014.
Tracey Nearmy/AAP

Our Pacific family

Last week, Morrison made perhaps his most important foreign policy speech – a major strategic announcement on the Pacific. He said Australia would open five new embassies and launch an infrastructure bank in the region to the tune of A$2 billion, and declared the Pacific “our patch”:

This is our part of the world. This is where we have special responsibilities. We always have, we always will. We have their back, and they have ours. We are more than partners by choice. We are connected as members of a Pacific family.

The announcement came after he signed a deal for a joint naval base in Papua New Guinea. Both this and the infrastructure bank were seen as ways of countering Chinese influence in the Pacific, but Morrison did refrain from using any anti-China rhetoric.




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This is noteworthy. Tess Newton Cain has pointed out that Australia often misses the right tone of respect and partnership in its announcements to the region.

But despite this new push for Pacific engagement, Australia is still seen as weak on climate policy – a hugely important issue to Pacific leaders. This could result in difficult conversations for Morrison at APEC, as PNG has invited many Pacific nations to attend for the first time.

Sit down, be humble

Even if Morrison puts his best foot forward to overcome his poor start on foreign policy, he will still have difficulty standing out in the crowd.

Even leaders require some political capital to stand out in those big rooms.

The churn in Australian prime ministers means that some foreign leaders may not consider it worth the time or energy to build a relationship of personal trust with Morrison if they view him more like a caretaker. Former Foreign Minister Julie Bishop had spent 10 years building up this diplomatic trust and stability in her various roles, but that was severed abruptly.

My advice to Morrison? Stay humble and listen. Read the briefs, listen to the diplomats and do everything Payne and DFAT Secretary Frances Adamson say to do, to the letter.The Conversation

Susan Harris Rimmer, Australian Research Council Future Fellow, Griffith Law School, Griffith University

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