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The latest COVID booster will soon be available. Should I get one? Am I eligible?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/nathan-bartlett-1198187">Nathan Bartlett</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Australia’s <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">Therapeutic Goods Administration</a> (TGA) has recently approved a new COVID booster. The shot was developed by Pfizer and targets <a href="https://www.sbs.com.au/news/article/what-to-know-about-the-new-covid-19-vaccine-approved-in-australia/z7ev2u8qn">the JN.1 sub-variant</a> of Omicron. This is now <a href="https://theconversation.com/new-covid-vaccines-may-be-coming-to-australia-heres-what-to-know-about-the-jn-1-shots-237652">the fifth iteration</a> of the COVID vaccines, which have been updated regularly to keep up with the rapidly evolving virus, SARS-CoV-2. But nearly five years into the pandemic, you may be wondering, why do we need yet another type of COVID booster? And do we still need to be getting boosters at all? Here’s what to consider. <h2>Targeting the spike protein</h2> Pfizer’s JN.1 booster (and Moderna’s, though the TGA has <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">not approved</a> this one at this stage) is based on mRNA technology. This technology instructs our cells to produce a specific protein – in this case SARS-CoV-2’s spike, a protein on the surface of the virus that allows it to attach to our cells. This helps the immune system produce antibodies that recognise the spike protein and interfere with the virus getting into our cells. In response to our strengthened immune responses from vaccinations and previous infections (called immune pressure), SARS-CoV-2 has continued to evolve over the course of the pandemic, modifying the shape of its spike protein so our antibodies become less effective. Most recently we’ve faced a soup of Omicron sub-variants, including JN.1. Since JN.1 was first detected <a href="https://www.gavi.org/vaccineswork/seven-things-you-need-know-about-jn1-covid-19-variant">in August 2023</a>, this Omicron sub-variant has spawned a variety of further sub-variants, such as KP.2 (known as FLiRT), KP.3 (<a href="https://theconversation.com/from-flirt-to-fluqe-what-to-know-about-the-latest-covid-variants-on-the-rise-234073">known as FLuQE</a>) and <a href="https://theconversation.com/xec-is-now-in-australia-heres-what-we-know-about-this-hybrid-covid-variant-239292">XEC</a>. The spike protein is made up of <a href="https://www.nature.com/articles/s41401-020-0485-4">1,273 amino acids</a>, a bit like molecular building blocks. Mutations to <a href="https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1228128/full">the spike protein</a> change individual amino acids. Certain amino acids are important for allowing neutralising antibodies to bind to the spike protein. This means changes can give the virus an edge over earlier variants, helping it evade our immune response. Scientists keep updating the COVID vaccines in an effort to keep up with these changes. The better matched the vaccine “spike” is to the spike protein on the surface of the virus trying to infect you, the better protection you’re likely to get. <h2>So who should get vaccinated, and when?</h2> Updating vaccines to deal with mutating viruses is not a new concept. It has been happening for the flu vaccine since <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination">around 1950</a>. We’ve become accustomed to getting the annual flu vaccine in the lead-up to the winter cold and flu season. But, unlike influenza, COVID has not settled into this annual seasonal cycle. The frequency of COVID waves of infection has been fluctuating, with new waves emerging periodically. COVID is also <a href="https://academic.oup.com/jtm/article/29/8/taac108/6731971">more transmissible</a> than the flu, which presents another challenge. While numbers vary, a conservative estimate of the reproduction number (R0 – how many people will one person will go on to infect) for JN.1 is 5. Compare this to seasonal flu with an R0 of <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-480">about 1.3</a>. In other words, COVID could be four times more transmissible than flu. Add to this immunity from a COVID vaccination (or a previous infection) <a href="https://www.nature.com/articles/d41586-023-00124-y">begins to wane</a> in the months afterwards. So an annual COVID booster is not considered enough for some more vulnerable people. <iframe id="gOYwk" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/gOYwk/2/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> For adults <a href="https://www.health.gov.au/our-work/covid-19-vaccines/getting-your-vaccination">aged 65 to 74</a>, a booster is recommended every 12 months, but they’re eligible every six months. For adults over 75, a shot is recommended every six months. Adults aged 18 to 64 are eligible every 12 months, unless they have a severe immune deficiency. Many conditions can cause immunodeficiency, including genetic disorders, infections, cancer, autoimmune diseases, diabetes and lung disease, as well as having received an organ transplant. For this group, it’s recommended they receive a shot every 12 months, but they’re eligible every six. <h2>Making sense of the advice</h2> A vaccine that targets JN.1 should provide good protection against the Omicron sub-variants likely to be circulating in the coming months. A few things need to happen before the JN.1 shots become available, such as the Australian Technical Advisory Group on Immunisation providing guidance to the government. But we can reasonably expect they might be rolled out <a href="https://www.sbs.com.au/news/article/what-to-know-about-the-new-covid-19-vaccine-approved-in-australia/z7ev2u8qn">within the next month or so</a>. If they hit doctors’ offices and pharmacies before Christmas and you’re due for a booster, the holiday period might be added impetus to go and get one, especially if you’re planning to attend lots of family and social gatherings over summer. In the meantime, the <a href="https://theconversation.com/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">XBB.1.5 vaccines</a> remain available. Although they’re targeted at an earlier Omicron sub-variant, they should still offer some protection. While young, healthy people might like to wait for the updated boosters, for those who are vulnerable and due for a vaccination, whether or not to hold out may be something to weigh up with your doctor. The advice on COVID boosters in Australia, with stronger wording (“recommended” versus “eligible”) used for more vulnerable groups, reflects what we know about COVID. People <a href="https://academic.oup.com/ageing/article/49/6/901/5862042">who are older</a> and medically vulnerable are more likely to become very unwell with the virus. For young, healthy people who may be wondering, “do I need a COVID booster at all?”, having one annually is sensible. Although you’re less likely to get very sick from COVID, it’s possible. And, importantly, vaccines also reduce the risk of <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(24)00082-1/fulltext">developing long COVID</a>. While COVID vaccines do a very good job of protecting against severe disease, they don’t necessarily stop you becoming infected. Evidence on whether they reduce transmission <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116597">has been mixed</a>, and <a href="https://pubmed.ncbi.nlm.nih.gov/38820077/">changed over time</a>. We’ve come to appreciate that vaccination is not going to free us of COVID. But it’s still our best defence against severe illness.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239594/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nathan-bartlett-1198187">Nathan Bartlett</a>, Professor, School of Biomedical Sciences and Pharmacy, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-latest-covid-booster-will-soon-be-available-should-i-get-one-am-i-eligible-239594">original article</a>. </div>

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Can you die from long COVID? The answer is not so simple

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/rose-shiqi-luo-1477061">Rose (Shiqi) Luo</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/catherine-itsiopoulos-14246">Catherine Itsiopoulos</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/kate-anderson-1412897">Kate Anderson</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/magdalena-plebanski-1063786">Magdalena Plebanski</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/zhen-zheng-1321031">Zhen Zheng</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Nearly five years into the pandemic, COVID is feeling less central to our daily lives. But the virus, SARS-CoV-2, is still around, and for many people the effects of an infection can be long-lasting. When symptoms persist for more than three months after the initial COVID infection, this is generally referred to as <a href="https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition">long COVID</a>. In September, Grammy-winning Brazilian musician <a href="https://www.abc.net.au/news/2024-09-07/brazilian-musician-sergio-mendez-dies-at-83/104323360">Sérgio Mendes</a> died aged 83 after reportedly having long COVID. <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-july-2023">Australian data</a> show 196 deaths were due to the long-term effects of COVID from the beginning of the pandemic up to the end of July 2023. In the United States, the Centers for Disease Control and Prevention reported 3,544 <a href="https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20221214.htm">long-COVID-related deaths</a> from the start of the pandemic up to the end of June 2022. The symptoms of <a href="https://www.healthdirect.gov.au/long-covid">long COVID</a> – such as fatigue, shortness of breath and “brain fog” – can be debilitating. But can you die from long COVID? The answer is not so simple. <h2>How could long COVID lead to death?</h2> There’s still a lot we don’t understand about what causes long COVID. A popular theory is that “zombie” <a href="https://www.pnas.org/doi/full/10.1073/pnas.2300644120">virus fragments</a> may linger in the body and cause inflammation even after the virus has gone, resulting in long-term health problems. Recent research suggests a reservoir of <a href="https://www.sciencedirect.com/science/article/abs/pii/S1198743X24004324?via%3Dihub">SARS-CoV-2 proteins</a> in the blood might explain why some people experience ongoing symptoms. We know a serious COVID infection can damage <a href="https://covid19.nih.gov/news-and-stories/long-term-effects-sars-cov-2-organs-and-energy#:%7E:text=What%20you%20need%20to%20know,main%20source%20of%20this%20damage">multiple organs</a>. For example, severe COVID can lead to <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19">permanent lung dysfunction</a>, persistent heart inflammation, neurological damage and long-term kidney disease. These issues can in some cases lead to death, either immediately or months or years down the track. But is death beyond the acute phase of infection from one of these causes the direct result of COVID, long COVID, or something else? Whether long COVID can directly cause death continues to be a topic of debate. Of the <a href="https://www.cdc.gov/nchs/data/vsrr/vsrr025.pdf">3,544 deaths</a> related to long COVID in the US up to June 2022, the most commonly recorded underlying cause was COVID itself (67.5%). This could mean they died as a result of one of the long-term effects of a COVID infection, such as those mentioned above. COVID infection was followed by heart disease (8.6%), cancer (2.9%), Alzheimer’s disease (2.7%), lung disease (2.5%), diabetes (2%) and stroke (1.8%). Adults aged 75–84 had the highest rate of death related to long COVID (28.8%). These findings suggest many of these people died “with” long COVID, rather than from the condition. In other words, long COVID may not be a direct driver of death, but rather a contributor, likely exacerbating existing conditions. <h2>‘Cause of death’ is difficult to define</h2> Long COVID is a relatively recent phenomenon, so mortality data for people with this condition are limited. However, we can draw some insights from the experiences of people with post-viral conditions that have been studied for longer, such as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). Like long COVID, <a href="https://bmjopen.bmj.com/content/12/5/e058128">ME/CFS</a> is a complex condition which can have significant and varied effects on a person’s physical fitness, nutritional status, social engagement, mental health and quality of life. Some research indicates people with ME/CFS are at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218818/">increased risk</a> of dying from causes including heart conditions, infections and suicide, that may be triggered or compounded by the debilitating nature of the syndrome. So what is the emerging data on long COVID telling us about the potential increased risk of death? Research from 2023 has suggested adults in the US with long COVID were at <a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802095">greater risk</a> of developing heart disease, stroke, lung disease and asthma. Research has also found <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9721155/">long COVID</a> is associated with a higher risk of <a href="https://www.tandfonline.com/doi/full/10.1080/21642850.2022.2164498#abstract">suicidal ideation</a> (thinking about or planning suicide). This may reflect common symptoms and consequences of long COVID such as sleep problems, fatigue, chronic pain and emotional distress. But long COVID is more likely to occur in people who have <a href="https://www.aihw.gov.au/reports/covid-19/long-covid-in-australia-a-review-of-the-literature/summary">existing health conditions</a>. This makes it challenging to accurately determine how much long COVID contributes to a person’s death. Research has long revealed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302107/">reliability issues</a> in cause-of-death reporting, particularly for people with chronic illness. <h2>So what can we conclude?</h2> Ultimately, long COVID is a <a href="https://www.health.gov.au/topics/chronic-conditions/about-chronic-conditions">chronic condition</a> that can significantly affect quality of life, mental wellbeing and overall health. While long COVID is not usually immediately or directly life-threatening, it’s possible it could exacerbate existing conditions, and play a role in a person’s death in this way. Importantly, many people with long COVID around the world lack access to appropriate support. We need to develop <a href="https://www.mja.com.au/journal/2024/221/9/persistent-symptoms-after-covid-19-australian-stratified-random-health-survey">models of care</a> for the optimal management of people with long COVID with a focus on multidisciplinary care. Dr Natalie Jovanovski, Vice Chancellor’s Senior Research Fellow in the School of Health and Biomedical Sciences at RMIT University, contributed to this article.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239184/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rose-shiqi-luo-1477061">Rose (Shiqi) Luo</a>, Postdoctoral Research Fellow, School of Health and Biomedical Sciences, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/catherine-itsiopoulos-14246">Catherine Itsiopoulos</a>, Professor and Dean, School of Health and Biomedical Sciences, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/kate-anderson-1412897">Kate Anderson</a>, Vice Chancellor's Senior Research Fellow, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/magdalena-plebanski-1063786">Magdalena Plebanski</a>, Professor of Immunology, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/zhen-zheng-1321031">Zhen Zheng</a>, Associate Professor, STEM | Health and Biomedical Sciences, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/can-you-die-from-long-covid-the-answer-is-not-so-simple-239184">original article</a>. </div>

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Lessons for the next pandemic: where did Australia go right and wrong in responding to COVID?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/adrian-esterman-1022994">Adrian Esterman</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a>; <a href="https://theconversation.com/profiles/guzyal-hill-575966">Guzyal Hill</a>, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a>; <a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/kim-m-caudwell-1258935">Kim M Caudwell</a>, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a>; <a href="https://theconversation.com/profiles/michael-toole-18259">Michael Toole</a>, <a href="https://theconversation.com/institutions/burnet-institute-992">Burnet Institute</a>; <a href="https://theconversation.com/profiles/steven-mcgloughlin-1246135">Steven McGloughlin</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/tari-turner-7922">Tari Turner</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> With COVID still classified as <a href="https://www.who.int/europe/emergencies/situations/covid-19">an ongoing pandemic</a>, it’s difficult to contemplate the next one. But we <a href="https://theconversation.com/what-pathogen-might-spark-the-next-pandemic-how-scientists-are-preparing-for-disease-x-223193">need to be prepared</a>. We’ve seen <a href="https://theconversation.com/why-are-we-seeing-more-pandemics-our-impact-on-the-planet-has-a-lot-to-do-with-it-226827">several pandemics</a> in recent decades and it’s fair to expect we’ll see more. For the final part in a <a href="https://theconversation.com/au/topics/the-next-pandemic-160343">series of articles</a> on the next pandemic, we’ve asked a range of experts what Australia got right and wrong it its response to COVID. Here they share their thoughts on the country’s COVID response – and what we can learn for the next pandemic. <hr /> <h2>Quarantine</h2> The federal government mandated 14 days of quarantine for all international arrivals between March 2020 and November 2021. During that period, <a href="https://www.pmc.gov.au/sites/default/files/resource/download/national-review-of-quarantine.pdf">452,550 people</a> passed through the system. The states and Northern Territory were given <a href="https://quarantineinquiry.archive.royalcommission.vic.gov.au/covid-19-hotel-quarantine-inquiry-final-report-0">just 48 hours</a> to set up their quarantine systems. The states chose hotel quarantine, while the Northern Territory repurposed an old miner’s camp, <a href="https://www.aspistrategist.org.au/darwins-howard-springs-facility-a-model-for-building-national-resilience/">Howard Springs</a>, which had individual cabins with outdoor verandas. The ACT had very few international arrivals, while Tasmania only had hotel quarantine for domestic travellers. During the first 15 months of the program, <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.51240">at least 22 breaches</a> occurred in five states (New South Wales, Victoria, Queensland, Western Australia and South Australia). An inquiry into Victoria’s hotel quarantine <a href="https://au.news.yahoo.com/covid-victorias-devastating-hotel-quarantine-killed-almost-800-people-110450178.html">found</a> the lack of warning and planning to set up the complex system resulted in breaches that caused Victoria’s second COVID wave of 2020, leading to almost 800 deaths. A <a href="https://www.cnet.com/science/features/how-the-delta-variant-breached-australias-covid-fortress/">breach at Sydney airport</a> led to the introduction of the Delta variant into Australia. In the next pandemic, mistakes from COVID need to be avoided. They included failure to protect hotel residents and staff from airborne transmission through ventilation and mask usage. Protocols need to be consistent across the country, such as the type of security staff used, N95 masks for staff and testing frequency. These protocols need to be included in a national pandemic preparedness plan, which is frequently reviewed and tested through simulations. This did not occur with the pre-COVID preparedness plan. Dedicated quarantine centres like Howard Springs already exist in Victoria and Queensland. Ideally, they should be constructed in every jurisdiction. Michael Toole <hr /> <h2>Treatments</h2> Scientists had to move quickly after COVID was discovered to find effective treatments. Many COVID treatments involved repurposing existing drugs designed for other viruses. For example, the HIV drug ritonavir is a key element of <a href="https://theconversation.com/pfizers-pill-is-the-latest-covid-treatment-to-show-promise-here-are-some-more-171589">the antiviral Paxlovid</a>, while remdesivir was originally developed <a href="https://theconversation.com/the-who-has-advised-against-the-use-of-two-antibody-therapies-against-covid-heres-what-that-means-190787">to treat hepatitis C</a>. At the outset of the pandemic, there was a lot of uncertainty about COVID treatment among Australian health professionals. To keep up with the rapidly developing science, the <a href="https://www.monash.edu/medicine/partnerships/our-partnerships/projects/national-clinical-evidence-taskforce">National Clinical Evidence Taskforce</a> was established in March 2020. We were involved in its COVID response with more than 250 clinicians, consumers and researchers. Unusually for evidence-based guidelines, which are often updated only every five years or so, the taskforce’s guidelines were designed to be “living” – updated as new research became available. In April 2020 we released the first guidelines for care of people with COVID, and over the next three years <a href="https://app.magicapp.org/#/guideline/7252">these were updated</a> more than 100 times. While health-care professionals always had access to up-to-date guidance on COVID treatments, this same information was not as accessible for the public. This may partly explain why many people turned to <a href="https://theconversation.com/thinking-of-trying-ivermectin-for-covid-heres-what-can-happen-with-this-controversial-drug-167178">unproven treatments</a>. The taskforce’s benefits could have been increased with funding to help the community understand COVID treatments. COVID drugs faced other obstacles too. For example, changes to the virus itself meant some treatments <a href="https://theconversation.com/from-centaurus-to-xbb-your-handy-guide-to-the-latest-covid-subvariants-and-why-some-are-more-worrying-than-others-192945">became less effective</a> as new variants emerged. Meanwhile, provision of antiviral treatments <a href="https://grattan.edu.au/wp-content/uploads/2024/10/How-we-analysed-COVID-antiviral-uptake-Grattan-Institute.pdf">has not been equitable</a> across the country. COVID drugs have had important, though not game-changing, impacts. Ultimately, effective vaccines played a much greater role in shifting the course of the pandemic. But we might not be so fortunate next time. In any future pandemic it will be crucial to have a clear pathway for rapid, reliable methods to develop and evaluate new treatments, disseminate that research to clinicians, policymakers and the public, and ensure all Australians can access the treatments they need. Steven McGloughlin and Tari Turner, Monash University <hr /> <h2>Vaccine rollout</h2> COVID vaccines were developed <a href="https://theconversation.com/one-of-sciences-greatest-achievements-how-the-rapid-development-of-covid-vaccines-prepares-us-for-future-pandemics-228787">in record time</a>, but rolling them out quickly and seamlessly proved to be a challenge. In Australia, there were several missteps along the way. First, there was poor preparation and execution. Detailed <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/auditor-general-highlights-vaccine-rollout-failures">planning was not finalised</a> until after the rollout had begun. Then the federal government had <a href="https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225">overly ambitious targets</a>. For example, the goal of vaccinating four million people by the end of March 2021 fell drastically short, with less than one-fifth of that number actually vaccinated by that time. There were also <a href="https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225">supply issues</a>, with the European Union blocking some deliveries to Australia. Unfortunately, the government was heavily reliant on <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/auditor-general-highlights-vaccine-rollout-failures">the AstraZeneca vaccine</a>, which was found, in rare cases, to lead to <a href="https://www.health.gov.au/our-work/covid-19-vaccines/advice-for-providers/clinical-guidance/tts">blood clots</a> in younger people. Despite all this, Australia ultimately achieved high vaccination rates. By the end of December 2021, <a href="https://www.health.gov.au/sites/default/files/documents/2021/12/covid-19-vaccine-rollout-update-31-december-2021.pdf">more than 94%</a> of the population aged 16 and over had received at least one dose. This was a significant public health achievement and saved <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299844">thousands of lives</a>. But over the past couple of years, Australia’s initially strong vaccine uptake has been waning. The <a href="https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024.pdf">Australian Technical Advisory Group on Immunisation</a> recommends booster doses for vulnerable groups annually or twice annually. However, only 30% of people aged <a href="https://www.health.gov.au/sites/default/files/2024-09/covid-19-vaccine-rollout-update-13-september-2024.pdf">75 and over</a> (for whom a booster is recommended every six months) have had a booster dose in the past six months. There are several lessons to be learned from the COVID vaccine rollout for any future pandemic, though it’s not entirely clear whether they are being heeded. For example, several manufacturers have developed <a href="https://theconversation.com/new-covid-vaccines-may-be-coming-to-australia-heres-what-to-know-about-the-jn-1-shots-237652">updated COVID vaccines</a> based on the JN.1 subvariant. But <a href="https://www.sbs.com.au/news/article/why-australia-could-miss-out-on-modernas-new-covid-19-vaccine/n5n0iruv1">reports indicate</a> the government will only be purchasing the Pfizer JN.1 booster. This doesn’t seem like the best approach to shore up vaccine supply. Adrian Esterman, University of South Australia <hr /> <h2>Mode of transmission</h2> Nearly five years since SARS-CoV-2 (the virus that causes COVID) first emerged, we now know <a href="https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-covid-19-how-is-it-transmitted">airborne transmission</a> plays a far greater role than we originally thought. In contrast, the risk of SARS-CoV-2 being transmitted via surfaces is <a href="https://theconversation.com/catching-covid-from-surfaces-is-very-unlikely-so-perhaps-we-can-ease-up-on-the-disinfecting-155359">likely to be low</a>, and perhaps effectively non-existent in many situations. Early in the pandemic, the role contaminated surfaces and inanimate objects played in COVID transmission was overestimated. The main reason we got this wrong, at least initially, was that in the absence of any direct experience with SARS-CoV-2, we extrapolated what we believed to be true for other respiratory viruses. This was understandable, but it proved to be inadequate for predicting how SARS-CoV-2 would behave. One of the main consequences of overestimating the role of surface transmission was that it resulted in a lot of unnecessary anxiety and the adoption of what can only be viewed in retrospect as <a href="https://theconversation.com/catching-covid-from-surfaces-is-very-unlikely-so-perhaps-we-can-ease-up-on-the-disinfecting-155359">over-the-top cleaning practices</a>. Remember the teams of people who walked the streets wiping down traffic light poles? How about the concern over reusable coffee cups? Considerable resources that could have been better invested elsewhere were directed towards disinfecting surfaces. This also potentially distracted our focus from other preventive measures that were likely to have been more effective, such as <a href="https://theconversation.com/yes-masks-reduce-the-risk-of-spreading-covid-despite-a-review-saying-they-dont-198992">wearing masks</a>. The focus on surface transmission was amplified by a number of studies published early in the pandemic that documented the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121658/">survival of SARS-CoV-2</a> for long periods on surfaces. However, these were conducted in the lab with little similarity to real-world conditions. In particular, the amounts of virus placed on surfaces were greater than what people would likely encounter outside the lab. This inflated viral survival times and therefore the perception of risk. The emphasis on surface transmission early in the pandemic ultimately proved to be a miscalculation. It highlights the challenges in understanding how a new virus spreads. Hassan Vally, Deakin University <hr /> <h2>National unity</h2> Initially, Commonwealth, state and territory leaders were relatively united in their response to the COVID pandemic. The establishment of the National Cabinet in <a href="https://federation.gov.au/national-cabinet">March 2020</a> indicated a commitment to consensus-based public health policy. Meanwhile, different jurisdictions came together to deliver a <a href="https://www.ato.gov.au/individuals-and-families/financial-difficulties-and-disasters/covid-19/jobkeeper-payment">range of measures</a> aimed at supporting businesses and workers affected by COVID restrictions. But as the pandemic continued, tensions gave way to deeper ideological fractures between jurisdictions <a href="https://link.springer.com/article/10.1186/s12888-024-05834-9">and individuals</a>. The issues of <a href="https://www.unswlawjournal.unsw.edu.au/article/covid-19-vaccine-mandates-a-coercive-but-justified-public-health-necessity">vaccine mandates</a>, <a href="https://www.abc.net.au/news/2022-01-30/wa-premier-mark-mcgowan-reopening-date-decision/100788876">border closures</a> and <a href="https://journals.sagepub.com/doi/pdf/10.1177/00048674211031489">lockdowns</a> all created fragmentation between governments, and among experts. The <a href="https://www.theguardian.com/australia-news/2020/oct/19/daniel-andrews-lashes-josh-frydenberg-over-attack-on-victorias-covid-strategy">blame game began</a> between and within jurisdictions. For example, the politicisation of <a href="https://www.9news.com.au/national/govt-playing-cruise-ship-blame-game-labor/49ad3491-2187-4991-a3a0-1c61145bc2cb">quarantine regulations on cruise ships</a> revealed disunity. School closures, on which the Commonwealth and state and territory governments <a href="https://www.smh.com.au/national/nsw/we-made-the-wrong-decisions-covid-era-mass-school-closures-condemned-20240214-p5f521.html">took different positions</a>, also generated controversy. These and other instances of polarisation undermined the intent of the newly established <a href="https://theconversation.com/with-the-covid-crisis-easing-is-the-national-cabinet-still-fit-for-purpose-202145">National Cabinet</a>. The COVID pandemic showed us that <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4859497">disunity across the country</a> threatens the collective work needed for an effective response in <a href="https://ir.law.fsu.edu/jtlp/vol30/iss1/3/">the face of emergencies</a>. The <a href="https://www.pmc.gov.au/domestic-policy/commonwealth-government-covid-19-response-inquiry">COVID response inquiry</a>, due to release its results soon, will hopefully help us work toward <a href="https://link.springer.com/book/10.1007/978-981-19-3292-2">national uniform legislation</a> that may benefit Australia in the event of <a href="https://link.springer.com/chapter/10.1007/978-981-19-3292-2_10">any future pandemics</a>. This doesn’t necessarily mean identical legislation across the country – this won’t always be appropriate. But a cohesive, long-term approach is crucial to ensure the best outcomes for the Australian federation in its entirety. Guzyal Hill and Kim M Caudwell, Charles Darwin University <hr /> This article is part of a <a href="https://theconversation.com/au/topics/the-next-pandemic-160343">series on the next pandemic</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239819/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/adrian-esterman-1022994">Adrian Esterman</a>, Professor of Biostatistics and Epidemiology, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a>; <a href="https://theconversation.com/profiles/guzyal-hill-575966">Guzyal Hill</a>, Associate Professor, Faculty of Arts and Society, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a>; <a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, Associate Professor, Epidemiology, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/kim-m-caudwell-1258935">Kim M Caudwell</a>, Senior Lecturer - Psychology | Chair, Researchers in Behavioural Addictions, Alcohol and Drugs (BAAD), <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a>; <a href="https://theconversation.com/profiles/michael-toole-18259">Michael Toole</a>, Associate Principal Research Fellow, <a href="https://theconversation.com/institutions/burnet-institute-992">Burnet Institute</a>; <a href="https://theconversation.com/profiles/steven-mcgloughlin-1246135">Steven McGloughlin</a>, Director, Intensive Care Unit, Alfred Health; Professor, Epidemiology and Preventative Medicine, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/tari-turner-7922">Tari Turner</a>, Director, Evidence and Methods, National COVID-19 Clinical Evidence Taskforce; Associate Professor (Research), Cochrane Australia, School of Population Health and Preventive Medicine, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/lessons-for-the-next-pandemic-where-did-australia-go-right-and-wrong-in-responding-to-covid-239819">original article</a>. </div>

Legal

Getting antivirals for COVID too often depends on where you live and how wealthy you are

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Medical experts <a href="https://www.health.gov.au/health-alerts/covid-19/treatments/eligibility">recommend</a> antivirals for people aged 70 and older who get COVID, and for other groups at risk of severe illness and hospitalisation from COVID. But many older Australians have missed out on antivirals after getting sick with COVID. It is yet another way the health system is failing the most vulnerable. <h2>Who missed out?</h2> We <a href="https://grattan.edu.au/wp-content/uploads/2024/10/How-we-analysed-COVID-antiviral-uptake-Grattan-Institute.pdf">analysed</a> COVID antiviral uptake between March 2022 and September 2023. We found some groups were more likely to miss out on antivirals including Indigenous people, people from disadvantaged areas, and people from culturally and linguistically diverse backgrounds. Some of the differences will be due to different rates of infection. But across this 18-month period, many older Australians were infected at least once, and rates of infection were higher in some disadvantaged communities. <h2>How stark are the differences?</h2> Compared to the national average, Indigenous Australians were nearly 25% less likely to get antivirals, older people living in disadvantaged areas were 20% less likely to get them, and people with a culturally or linguistically diverse background were 13% less likely to get a script. People in remote areas were 37% less likely to get antivirals than people living in major cities. People in outer regional areas were 25% less likely. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=329&fit=crop&dpr=1 600w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=329&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=329&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=413&fit=crop&dpr=1 754w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=413&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=413&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Dispensing rates by group. Grattan Institute</figcaption></figure> Even within the same city, the differences are stark. In Sydney, people older than 70 in the affluent eastern suburbs (including Vaucluse, Point Piper and Bondi) were nearly twice as likely to have had an antiviral as those in Fairfield, in Sydney’s south-west. Older people in leafy inner-eastern Melbourne (including Canterbury, Hawthorn and Kew) were 1.8 times more likely to have had an antiviral as those in Brimbank (which includes Sunshine) in the city’s west. <h2>Why are people missing out?</h2> COVID antivirals should be taken when symptoms first appear. While awareness of COVID antivirals is generally strong, people often <a href="https://link.springer.com/article/10.1007/s40121-024-01003-3">don’t realise</a> they would benefit from the medication. They <a href="https://www.phrp.com.au/?p=43363">wait</a> until symptoms get worse and it is too late. Frequent GP visits make a big difference. Our analysis found people 70 and older who see a GP more frequently were much more likely to be dispensed a COVID antiviral. Regular visits give an opportunity for preventive care and patient education. For example, GPs can provide high-risk patients with “COVID treatment plans” as a reminder to get tested and seek treatment as soon as they are unwell. Difficulty seeing a GP could help explain low antiviral use in rural areas. Compared to people in major cities, people in small rural towns have about 35% <a href="https://hwd.health.gov.au/resources/data/gp-primarycare.html">fewer</a> GPs, see their GP about half as often, and are 30% more likely to <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release">report</a> waiting too long for an appointment. Just like for <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">vaccination</a>, a GP’s focus on antivirals probably matters, as does providing care that is accessible to people from different cultural backgrounds. <h2>Care should go those who need it</h2> Since the period we looked at, evidence has emerged that raises <a href="https://url.au.m.mimecastprotect.com/s/FmjFC91ZVBSmBpXpZSEh9CqMtQx?domain=nejm.org">doubts</a> about how effective antivirals are, particularly for people at lower risk of severe illness. That means getting vaccinated is more important than getting antivirals. But all Australians who are eligible for antivirals should have the same chance of getting them. These drugs have cost more than A$1.7 billion, with the vast majority of that money coming from the federal government. While dispensing rates have fallen, more than <a href="http://medicarestatistics.humanservices.gov.au/statistics/do.jsp?_PROGRAM=%2Fstatistics%2Fpbs_item_standard_report&itemlst=%2712910L%27%2C%2712996B%27&ITEMCNT=2&LIST=12910L%2C12996B&VAR=SERVICES&RPT_FMT=6&start_dt=202201&end_dt=202408">30,000</a> packs of COVID antivirals were dispensed in August, costing about $35 million. Such a huge investment shouldn’t be leaving so many people behind. Getting treatment shouldn’t depend on your income, cultural background or where you live. Instead, care should go to those who need it the most. People born overseas have been <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-january-2024#deaths-due-to-covid-19-country-of-birth">40% more likely</a> to die from COVID than those born here. Indigenous Australians have been <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-january-2024#covid-19-mortality-among-aboriginal-and-torres-strait-islander-people">60% more likely</a> to die from COVID than non-Indigenous people. And the most disadvantaged people have been <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-january-2024#deaths-due-to-covid-19-socio-economic-status-seifa-">2.8 times</a> more likely to die from COVID than those in the wealthiest areas. All those at-risk groups have been more likely to miss out on antivirals. It’s not just a problem with antivirals. The same groups are also disproportionately missing out on COVID <a>vaccination</a>, compounding their risk of severe illness. The pattern is repeated for other important preventive health care, such as <a href="https://www.aihw.gov.au/getmedia/54a38a6a-9e3c-4f58-b2f6-cdef977a7d60/aihw-can-155_15sept.pdf?v=20230915162104&inline=true">cancer</a> <a href="https://www.aihw.gov.au/getmedia/27f32443-5206-4189-8775-0c1f55a26bc4/aihw-can-160.pdf?v=20240617095924&inline=true">screening</a>. <h2>A 3-step plan to meet patients’ needs</h2> The federal government should do three things to close these gaps in preventive care. First, the government should make Primary Health Networks (PHNs) responsible for reducing them. PHNs, the regional bodies responsible for improving primary care, should share data with GPs and step in to boost uptake in communities that are missing out. Second, the government should extend its <a href="https://www.health.gov.au/our-work/mymedicare">MyMedicare</a> reforms. MyMedicare gives general practices flexible funding to care for patients who live in residential aged care or who visit hospital frequently. That approach should be <a href="https://grattan.edu.au/report/a-new-medicare-strengthening-general-practice/">expanded</a> to all patients, with more funding for poorer and sicker patients. That will give GP clinics time to advise patients about preventive health, including COVID vaccines and antivirals, before they get sick. Third, team-based pharmacist prescribing should be introduced. Then pharmacists could quickly dispense antivirals for patients if they have a prior agreement with the patient’s GP. It’s an approach that would also <a href="https://theconversation.com/pharmacists-should-be-able-to-work-with-gps-to-prescribe-medicines-for-long-term-conditions-212359">work</a> for medications for chronic diseases, such as cardiovascular disease. COVID antivirals, unlike vaccines, have been <a href="https://theconversation.com/covid-wave-whats-the-latest-on-antiviral-drugs-and-who-is-eligible-in-australia-218423">keeping up</a> with new variants without the need for updates. If a new and more harmful variant emerges, or when a new pandemic hits, governments should have these systems in place to make sure everyone who needs treatment can get it fast. In the meantime, fairer access to care will help close the big and persistent <a href="https://www.aihw.gov.au/getmedia/0cbc6c45-b97a-44f7-ad1f-2517a1f0378c/hiamhbrfhsu.pdf?v=20230605184558&inline=true">gaps</a> in health between different groups of Australians. <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/getting-antivirals-for-covid-too-often-depends-on-where-you-live-and-how-wealthy-you-are-239497">original article</a>. </div>

Caring

I have a stuffy nose, how can I tell if it’s hay fever, COVID or something else?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/deryn-thompson-1449312">Deryn Thompson</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Hay fever (also called allergic rhinitis) affects <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-state-and-territory-findings/latest-release">24%</a> of Australians. <a href="https://www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis/allergic-rhinitis-or-hay-fever">Symptoms</a> include sneezing, a runny nose (which may feel blocked or stuffy) and itchy eyes. People can also experience an itchy nose, throat or ears. But COVID is still <a href="https://theconversation.com/xec-is-now-in-australia-heres-what-we-know-about-this-hybrid-covid-variant-239292">spreading</a>, and <a href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">other viruses</a> can cause cold-like symptoms. So how do you know which one you’ve got? <h2>Remind me, how does hay fever cause symptoms?</h2> <a href="https://www.allergy.org.au/hp/papers/allergic-rhinitis-clinical-update">Hay fever</a> happens when a person has become “sensitised” to an allergen trigger. This means a person’s body is always primed to react to this trigger. Triggers can include allergens in the air (such as pollen from trees, grasses and flowers), mould spores, animals or house dust mites which mostly live in people’s mattresses and bedding, and feed on shed skin. When the body is exposed to the trigger, it produces IgE (immunoglobulin E) antibodies. These cause the release of many of the body’s own chemicals, including histamine, which result in hay fever symptoms. People who have asthma may find their asthma symptoms (cough, wheeze, tight chest or trouble breathing) worsen when exposed to airborne allergens. Spring and sometimes into summer can be the worst time for people with grass, tree or flower allergies. However, animal and house dust mite symptoms usually happen year-round. <h2>What else might be causing my symptoms?</h2> Hay fever does not cause a fever, sore throat, muscle aches and pains, weakness, loss of taste or smell, nor does it cause you to cough up mucus. These symptoms are likely to be caused by a virus, such as COVID, influenza, respiratory syncytial virus (RSV) or a “cold” (often caused by rhinoviruses). These conditions can occur all year round, with some overlap of symptoms: <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=582&fit=crop&dpr=1 600w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=582&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=582&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=731&fit=crop&dpr=1 754w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=731&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=731&fit=crop&dpr=3 2262w" alt="" /></a><figcaption><a class="source" href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">Natasha Yates/The Conversation</a></figcaption></figure> COVID still <a href="https://theconversation.com/xec-is-now-in-australia-heres-what-we-know-about-this-hybrid-covid-variant-239292">surrounds</a> us. <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/health+statistics/surveillance+of+notifiable+conditions/respiratory+infections+dashboard">RSV and influenza</a> rates appear higher than before the COVID pandemic, but it may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10888990/#:%7E:text=Increases%20in%20RSV%20patient%20volume,with%20an%20RSV%20diagnosis%20occurred">due to more testing</a>. So if you have a fever, sore throat, muscle aches/pains, weakness, fatigue, or are coughing up mucus, stay home and avoid mixing with others to limit transmission. People with COVID symptoms can take a rapid antigen test (<a href="https://www.health.gov.au/sites/default/files/2024-04/coronavirus-covid-19-rapid-antigen-tests.pdf">RAT</a>), ideally when <a href="https://www.cochrane.org/CD013705/INFECTN_how-accurate-are-rapid-antigen-tests-diagnosing-covid-19">symptoms start</a>, then isolate until symptoms disappear. <a href="https://www.mja.com.au/journal/2023/219/11/covid-19-rapid-antigen-tests-approved-self-testing-australia-published">One negative RAT alone</a> can’t rule out COVID if symptoms are still present, so test again 24–48 hours after your initial test if symptoms persist. You can now test yourself for COVID, RSV and influenza in a <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">combined RAT</a>. But again, a negative test doesn’t rule out the virus. If your symptoms continue, <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">test again</a> 24–48 hours after the previous test. <h2>If it’s hay fever, how do I treat it?</h2> Treatment involves blocking the body’s histamine release, by taking antihistamine medication which helps reduce the symptoms. Doctors, nurse practitioners and pharmacists can develop a <a href="https://www.allergy.org.au/images/pc/ASCIA_Allergic_Rhinitis_Treatment_Plan_2024.pdf">hay fever care plan</a>. This may include using a nasal spray containing a topical corticosteroid to help reduce the swelling inside the nose, which causes stuffiness or blockage. Nasal sprays need to delivered <a href="https://allergyfacts.org.au/are-you-using-your-nasal-spray-correctly/">using correct technique</a> and used over several weeks to work properly. Often these sprays can also help lessen the itchy eyes of hay fever. Drying bed linen and pyjamas inside during spring can <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-minimisation">lessen symptoms</a>, as can putting a <a href="https://www.nps.org.au/consumers/managing-hay-fever">smear of Vaseline</a> in the nostrils when going outside. Pollen sticks to the Vaseline, and gently blowing your nose later removes it. People with asthma should also have an <a href="https://asthma.org.au/manage-asthma/asthma-action-plan/">asthma plan</a>, created by their doctor or nurse practitioner, explaining how to adjust their asthma reliever and preventer medications in hay fever seasons or on allergen exposure. People with asthma also need to be <a href="https://www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/factsheets/thunderstorm-asthma">alert for thunderstorms</a>, where pollens can burst into tinier particles, be inhaled deeper in the lungs and cause a severe asthma attack, and even death. <h2>What if it’s COVID, RSV or the flu?</h2> Australians aged 70 and over and others with underlying health conditions who test positive for COVID are <a href="https://www.healthdirect.gov.au/covid-19/medications#at-home">eligible for antivirals</a> to reduce their chance of severe illness. Most other people with COVID, RSV and influenza will recover at home with rest, fluids and paracetamol to relieve symptoms. However some groups are at greater risk of serious illness and may require additional treatment or hospitalisation. For <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/respiratory-syncytial-virus.aspx">RSV</a>, this includes premature infants, babies 12 months and younger, children under two who have other medical conditions, adults over 75, people with heart and lung conditions, or health conditions that lessens the immune system response. For influenza, people at <a href="https://www.health.nsw.gov.au/Infectious/Influenza/Pages/at-risk.aspx">higher risk</a> of severe illness are pregnant women, Aboriginal people, people under five or over 65 years, or people with long-term medical conditions, such as kidney, heart, lung or liver disease, diabetes and decreased immunity. If you’re concerned about severe symptoms of COVID, RSV or influenza, consult your doctor or call 000 in an emergency. If your symptoms are mild but persist, and you’re not sure what’s causing them, book an appointment with your doctor or nurse practitioner. Although hay fever season is here, we need to avoid spreading other serious infectious. For more information, you can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria); use the <a href="https://www.healthdirect.gov.au/symptom-checker">online Symptom Checker</a>; or visit <a href="http://healthdirect.gov.au/">healthdirect.gov.au</a> or the <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-minimisation">Australian Society of Clinical Immunology and Allergy</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/240453/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/deryn-thompson-1449312">Deryn Thompson</a>, Eczema and Allergy Nurse; Lecturer, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-have-a-stuffy-nose-how-can-i-tell-if-its-hay-fever-covid-or-something-else-240453">original article</a>. </div>

Body

"No show": Wild reason couple denied refund on flights scheduled during Covid

A Melbourne couple, who had booked flights with Qantas during the state's fifth lockdown, were left furious after they were told they were ineligible for a refund because they were a "no show". Kieran McGregor told news.com.au that he and his partner had originally booked the flights to Darwin for July 18, 2021 through travel giant Expedia. When the number of Covid cases started rising, he moved the flights forward to fly out on the 16th of July, hoping that they would be able to get out before another lockdown, but the day before their flight, Victorian Premier Daniel Andrews announced the state's fifth lockdown. Three years later, McGregor was still stuck between trying to get the refund from Expedia, who said Qantas had the money, and Qantas, who said the travel agent had it. Last year, McGregor contacted Expedia on their X account to try to resolve the issue, but the company said: “We just got off the phone with the airline, and as per advised, the ticket shows suspended on their end due to a no show." “Your ticket is no (sic) eligible for a refund, and has no value as per the airline. We apologize for the inconvenience.” He was "incredulous" when he received the message. “How could I fly if the state of Victoria was in lockdown and I couldn’t move more than 5km from the house?” he told news.com.au. When he contacted Qantas, the airline claimed “the funds will still remain with the agency that you’ve booked with” and to contact them directly for a refund. McGregor told news.com.au the ordeal was “utterly disgraceful” and that he was unaware if the flight went ahead or not. The publication reportedly contacted Expedia and Qantas and on Tuesday morning they finally said that a refund would be issued, but McGregor said he was yet to be contacted. “For flight bookings at Expedia, we generally follow the policies of our travel partners, so any refund is determined by the airline,” an Expedia spokeswoman said. “We have looked into this case with Qantas, and we will be contacting the traveller to process the refund.” While a Qantas spokesman said: “We apologise for the extended delay in resolving this issue and are processing a full refund for their bookings.” It is unclear which company held McGregor's funds, which was reported to be around $2,500. Adam Glezer from Consumer Champion told news.com.au that McGregor came to him recently when he felt he had nowhere else to turn. He said that these situations were quite common. “What Kieran has gone through with Expedia and Qantas is extremely common where the third party says the airline has the money and the airline says the third party has the money. I call it the blame game and there’s only one loser out of it and that’s the customer," he said. “Transparency in these situations is of utmost importance and unfortunately it just doesn’t exist.” Images: news.com.au/ DLeng / Shutterstock.com

Travel Trouble

I feel sick. How do I know if I have the flu, COVID, RSV or something else?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> You wake with a sore throat and realise you are sick. Is this going to be a two-day or a two-week illness? Should you go to a doctor or just go to bed? Most respiratory illnesses have very similar symptoms at the start: sore throat, congested or runny nose, headache, fatigue and fever. This may progress to a dry cough. Best case scenario is that you have “<a href="https://lungfoundation.com.au/wp-content/uploads/2018/09/Factsheet-Common-Cold-Mar2016.pdf">a cold</a>” (which can be any one of hundreds of viruses, most commonly rhinovirus), which is short-lived and self-limiting. But some respiratory illnesses can be much more serious. Here is a brief guide to some important bugs to know about that are circulating this winter, and how to work out which one you have. <h2>Respiratory syncytial virus (RSV)</h2> For most people an RSV infection will feel like “a cold” – annoying, but only lasting a few days. However, for babies, older adults and people with immune issues, it can lead to <a href="https://www.rch.org.au/kidsinfo/fact_sheets/bronchiolitis/">bronchiolitis</a> or pneumonia, and even become life-threatening. RSV isn’t seasonal, which means you are just as likely to get it in summer as in winter. However, it is highly contagious so we noticed it <a href="https://pubmed.ncbi.nlm.nih.gov/32986804">disappearing almost completely</a> during COVID lockdowns. There is now a <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">rapid-antigen test (RAT) for RSV</a> which also checks for influenza and COVID, and is the best way of finding out if RSV is what is causing symptoms. Recently, a preventative immune therapy has become available for high risk babies (<a href="https://www.schn.health.nsw.gov.au/respiratory-syncytial-virus-rsv-monoclonal-antibody-factsheet">nirsevimab</a>) and there are also <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked">vaccines for higher risk adults</a>. Nirsevimab is also available to all babies for free in <a href="https://www.health.wa.gov.au/Articles/N_R/Respiratory-syncytial-virus-RSV-immunisation">Western Australia</a> and <a href="https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/paediatric-rsv-prevention-program">Queensland</a>. But there are no specific treatments. Adults who get it simply have to ride it out (using whatever you need to <a href="https://www.mayoclinic.org/diseases-conditions/common-cold/diagnosis-treatment/drc-20351611">manage symptoms</a>). Babies and higher risk patients need to present to an emergency department if they test positive for RSV and are also looking or feeling very unwell (this might mean rapid shallow breathing, fevers not coming down with paracetamol or ibuprofen, a baby not feeding, mottled-looking skin, or going blue around the mouth). If a patient has developed a bronchiolitis or pneumonia, they may need to be hospitalised. <h2>Influenza</h2> Once you have had the “true flu” (influenza), you will find it frustrating when people call their sniffly cold-like symptoms a “flu”. Influenza infections generally start with a sore throat and headache which quickly turns into high fevers, generalised aches and excessive fatigue. You feel like you have been hit by a truck and may struggle to get out of bed. This can last a week or more, even in people who are generally fit and healthy. Influenza is a major public health issue internationally, with 3–5 million cases of severe illness and <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">290,000 to 650,000 respiratory deaths annually</a>. People who are at <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu">greater risk of complications</a> from influenza include pregnant women, children under five, adults aged 65 and over, First Nations peoples, and people with chronic or immunosuppressive medical conditions. For this reason, annual vaccination is <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommended and funded</a> for vulnerable people. Vaccination is also readily available for <a href="https://www.health.gov.au/topics/immunisation/immunisation-contacts">all Australians who want it</a>, through pharmacies as well as medical clinics, usually at a cost of less than A$30. In <a href="https://www.vaccinate.initiatives.qld.gov.au/what-to-vaccinate-against/influenza#:%7E:text=The%20flu%20vaccine%20is%20free,.qld.gov.au">some states</a>, it’s free for all residents. Influenza is seasonal, with definite peaks in the winter months. This is why vaccines are offered from early autumn. If you think you may have influenza, there are now home-testing RATs: all current influenza RATs are in combination with COVID RATs, as the symptoms overlap. Treatment for most people is to manage symptoms and try to avoid spreading it around. Doctors can also <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">prescribe antivirals</a> to vulnerable patients; these work best if started within 48 hours of symptoms. <h2>COVID</h2> It has been less than five years since COVID-19, caused by SARS-CoV-2, started to spread around the world in pandemic proportions. Although COVID is no longer a <a href="https://www.health.gov.au/news/ahppc-statement-end-of-covid-19-emergency-response">public health emergency</a>, it still causes <a href="https://www.abs.gov.au/articles/deaths-due-covid-19-influenza-and-rsv-australia-2022-may-2024">more deaths than influenza and RSV combined</a>. Unlike RSV and influenza, only those <a href="https://www.health.gov.au/topics/covid-19/protect-yourself-and-others/high-risk-groups">aged over 70</a> are in a high-risk age group for COVID. Other <a href="https://www.cdc.gov/covid/risk-factors/?CDC_AAref_Val=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">factors besides age</a> may put you at higher risk of becoming very unwell when infected by this virus. This includes having other respiratory diseases (such as asthma or chronic obstructive pulmonary disease, also known as COPD), diabetes, cancer, kidney disease, obesity or heart disease. Unlike most respiratory viruses, SARS-CoV-2 tends to set off inflammation beyond the respiratory system. This can involve a range of other organs including the heart, kidneys and blood vessels. Although most people are back to their usual work or study after a week or two, a significant proportion go on to experience extended symptoms such as fatigue, breathlessness, brain fog and mood changes. When these last <a href="https://aci.health.nsw.gov.au/statewide-programs/critical-intelligence-unit/post-acute-sequelae">more than 12 weeks</a>, without any other explanation for symptoms, it’s called <a href="https://www.healthdirect.gov.au/covid-19/post-covid-symptoms-long-covid">long COVID</a>. COVID vaccines can prevent serious illness and have been <a href="https://pubmed.ncbi.nlm.nih.gov/38282394/">monitored</a> for several years now for their safety and effectiveness. Current vaccination recommendations are <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024?language=en">based on age and immune status</a>. It’s worth discussing them with your doctor if you are unsure whether you would benefit or not. <a href="https://www.health.gov.au/topics/covid-19/oral-treatments">Antivirals</a> can treat COVID in higher-risk people who contract it, whether vaccinated or not. Specific advice about what to do if you test positive on a RAT will vary according to your current state guidelines and workplace, however the <a href="https://www.health.gov.au/topics/covid-19/testing-positive">general principles</a> are always: avoid spreading the virus to others, and give yourself time to rest and recover. <hr /> <iframe id="ConNR" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/ConNR/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>What if it’s not one of those?</h2> So you’ve done your combined RSV/flu/COVID RAT and the result is negative. But you still have symptoms. What else could it be? More than 200 different viruses can cause cold and flu symptoms, including rhinovirus (mentioned above), adenovirus and sometimes even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2130424/">undefined pathogens</a>. If an illness progresses to a cough which will not go away, and/or you start coughing up sputum, this could be a bacterial infection, such as pertussis (whooping cough), streptococcus pneumoniae, haemophilus influenzae or moraxella catarrhalis. So it’s worth <a href="https://www.racgp.org.au/getattachment/0a637812-c8f0-45a2-af9c-fa215b64f8e4/attachment.aspx">getting assessed by a GP</a> who may do a chest Xray and/or <a href="https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/M/MCS-sputum">test your sputum</a>, particularly if they suspect pneumonia. You also may also start out with what is clearly a viral infection but then get a secondary bacterial infection later. So if you are getting more unwell over time, it’s worth getting tested, in case antibiotics will help. However, taking antibiotics for a purely viral illness will not only be useless, it can contribute to harmful <a href="https://www.nps.org.au/consumers/antibiotic-resistance-the-facts">antibiotic resistance</a> and give you unwanted side effects.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234266/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">original article</a>. </div>

Body

Andrew O'Keefe clashes with press after bail hearing

Andrew O'Keefe has clashed with reporters outside a courtroom after he was granted bail following an interaction with police where he claims a crack pipe allegedly found in his pocket belonged to someone else. The disgraced former TV host sat quietly in the dock as his lawyer, Sharon Ramsden, applied for his release on bail at Waverley Local Court on Monday morning. Police allege the former Deal or No Deal host returned a positive drug test while driving after he was stopped shortly before midday on Sunday in Sydney’s affluent Bellevue Hill. Officers also allege that the 52-year-old also threatened a man in Point Piper shortly before he was stopped by police. The court was told Mr O’Keefe allegedly confronted the man at the property “potentially as a matter of jealousy” following a “rekindling” with his former partner. After O'Keefe was released on bail, chaos ensued outside Waverley police station as the TV host tried to make a quick exit. O'Keefe was followed by reporters as he stepped out into traffic and walked briskly away as he tried to avoid the camera crews. Footage captured by Channel 10 shows Mr O’Keefe handing a reporter her phone after it is dropped before telling her, “get out of my face”. Mr O’Keefe was ultimately granted bail despite magistrate Jacqueline Milledge telling the 52-year-old there were “a lot of aspects of the police facts that are of concern”. “There is a real concern you were somewhere you shouldn't have been and that drugs might still be a factor in your life, but I'm prepared to give you an opportunity to continue with your treatment,” she said. Mr O’Keefe will return before court next month as he faces a single charge each of intimidation and breach a court order, with police foreshadowing more charges pending forensic examination. Image credits: JOEL CARRETT/EPA-EFE/Shutterstock Editorial

Legal

Stormy seas ahead: Why confidence in the cruise industry has plummeted

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/jennifer-holland-969445">Jennifer Holland</a>, <a href="https://theconversation.com/institutions/university-of-suffolk-3830">University of Suffolk</a> The cruise industry has weathered many storms, including fairly regular brushes with disease. Outbreaks of <a href="https://www.cdc.gov/nceh/vsp/pub/norovirus/norovirus.htm">norovirus</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294517/">H1N1</a> and <a href="https://www.nytimes.com/2019/05/02/world/americas/measles-scientology-cruise-ship.html">measles</a> have all happened in the not too distant past. Despite this, a cruise has traditionally been regarded as a safe holiday – the kind where you don’t have to worry about a thing. COVID-19 has changed this. Cruise ships were a hotbed of transmission during the early stages of the pandemic, particularly the Diamond Princess, which was quarantined for six weeks in Japan in spring 2020. It had over <a href="https://www.bmj.com/content/369/bmj.m1632">700 confirmed cases</a>, and for a period was the world’s <a href="https://www.theguardian.com/world/live/2020/feb/20/coronavirus-live-updates-diamond-princess-cruise-ship-japan-deaths-latest-news-china-infections?page=with:block-5e4ea39f8f0811db2fafb3ec#block-5e4ea39f8f0811db2fafb3ec">leading COVID-19 hotspot</a> after China. Coverage of this and other ships’ outbreaks has taken its toll. <a href="https://www.sciencedirect.com/science/article/pii/S259019822100035X">Research</a> that I conducted with colleagues in Australia shows that the pandemic has changed how people think of cruise holidays. We surveyed over 600 people in the UK and Australia, both cruisers and non-cruisers, to ask them about their willingness to cruise and future travel intentions, to explore how COVID-19 has affected perceptions of travel and cruise risks. Nearly 45% of interviewees had less belief than before the pandemic that cruise lines are transparent and honest about safety or health issues. Respondents were also fearful of going on a cruise, with 47% saying they don’t trust cruise lines to look after them if something goes wrong. This is staggering for an industry that depends on repeat customers. We further found that 67% of people are less willing to cruise as a result of the pandemic, while 69% said they feel less positive about cruising now. What’s most surprising is that even repeat cruisers said they feel nervous about cruising as a result of the pandemic, with this emotion coming up repeatedly in the survey’s open-ended questions. This is a gamechanger. Until now, loyal cruisers have always come back, with previous disease outbreaks having <a href="https://www.sciencedirect.com/science/article/abs/pii/S0261517716300309">little</a> <a href="http://ijbssnet.com/journals/Vol_4_No_7_July_2013/2.pdf">impact</a>. <h2>What went wrong?</h2> When the pandemic began, cruise ships immediately suffered high infection rates among passengers and crew. During the first wave, thousands were <a href="https://www.theguardian.com/world/2020/mar/27/stranded-at-sea-cruise-ships-around-the-world-are-adrift-as-ports-turn-them-away">stranded onboard</a> ships as they were held in quarantine or <a href="https://www.sciencedirect.com/science/article/abs/pii/S0160738320302103?via%3Dihub">refused entry to ports</a> as borders closed. By the end of April 2020, <a href="https://www.miamiherald.com/news/business/tourism-cruises/article241640166.html">over 50 cruise ships</a> had confirmed cases of COVID-19 and at least 65 deaths had occurred among passengers and crew. The story of one ship – the Ruby Princess – gained particular attention. Its passengers were allowed to disembark in Sydney in mid-March, with a number carrying the virus. The ship would go on to be linked to more than <a href="https://www.bbc.co.uk/news/world-australia-53802816">900 COVID-19 cases and 28 deaths</a>. The state of New South Wales later launched a <a href="https://www.dpc.nsw.gov.au/assets/dpc-nsw-gov-au/publications/The-Special-Commission-of-Inquiry-into-the-Ruby-Princess-Listing-1628/Report-of-the-Special-Commission-of-Inquiry-into-the-Ruby-Princess.pdf">public inquiry</a> into the ship’s outbreak and found that the state’s ministry of health made a number of serious errors in allowing passengers to get off. It didn’t take long for cruises to be depicted as <a href="https://www.bloomberg.com/news/articles/2020-03-24/virus-explosion-in-australia-exposes-cruise-ships-hidden-menace">places of danger and infection</a>, particularly in Australia. Lots of information about COVID-19 on cruise ships was published, especially about the <a href="https://cruiseradio.net/the-cruise-ship-story-mainstream-media-got-wrong/">Ruby Princess</a>, grabbing the <a href="https://trends.google.com/trends/explore?date=today%205-y&q=Ruby%20Princess">public’s attention</a>. Undoubtedly, this amplified people’s perceptions of risk around cruise holidays. Our study found that the many stories on COVID-19 also reminded the public of previous illnesses and outbreaks onboard cruise ships. Given the high intensity of media interest in Australia, we weren’t surprised to find that perceived risks were higher there compared with the UK, with willingness to cruise lower. This suggests that there could be regional differences in how difficult it is for the industry to recover after the pandemic. <h2>What happens next?</h2> Most respondents in the study said they would wait until it was safe to cruise again – and there’s probably a long way to go on changing the current perception of cruise ships as giant incubators of disease. It’s doubtful pent-up demand from loyal cruisers will be enough to fill cruise ships to capacity – which is critical for <a href="https://link.springer.com/article/10.1057%2Fs41278-020-00158-3">long-term economic viability</a> – and so <a href="https://theconversation.com/can-the-cruise-industry-really-recover-from-coronavirus-144704">financial uncertainty</a> grows. The pandemic has been <a href="https://cruising.org/-/media/Facts-and-Resources/Cruise-Industry-COVID-19-FAQs_August-13-2020">catastrophic</a> for the industry so far, with financial losses of US$50 billion (£36 billion), 1.17 million job losses, 18 cruise ships sold or scrapped and at least <a href="https://www.maritime-executive.com/article/cmv-becomes-the-third-cruise-line-to-go-out-of-business-in-a-month">three cruise lines stopping trading</a>. Before the pandemic, a new cruise ship was built <a href="https://www.seatrade-cruise.com/news-headlines/golden-age-med-ports-need-prepare-new-generation-large-ships">every 47 days</a>, and off the back of the industry’s robust growth over the past two decades another <a href="https://cruising.org/en-gb/news-and-research/research/2020/december/state-of-the-cruise-industry-outlook-2021">19 ships</a> are due to enter operation in 2021, despite demand very likely to have fallen. To recover, the industry will need to address people’s perceptions of risk, which our research shows have heightened. Risk perception has a <a href="https://journals.sagepub.com/doi/10.1177/004728759803700209">significant influence</a> on holiday decision-making, and it will be even more critical post-COVID. In the wake of the pandemic, would-be cruisers will need to think about health protocols, outbreak prevention plans, onboard sanitation procedures, social distancing measures and health screenings. Also, they’ll need to consider the implications of potential outbreaks during the cruise. These could result in being quarantined in their cabin, needing to access healthcare, or even the cruise being terminated. All of this creates uncertainty, which adds to perceptions of risk. The industry will need to provide reassuring answers on all of these points to entice holidaymakers back onboard. Cruise companies will also need to convince customers that they are trustworthy and accountable, given the concerns about honesty and transparency raised by our research. Overall, the sector has been devastated by the pandemic. Possibly no other area of tourism has been as widely affected. A return to the robust growth enjoyed previously is unlikely for many years, if ever. But for there to be any chance of this happening, the industry must understand how the pandemic has affected people’s perceptions of cruises and address their concerns.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/152146/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jennifer-holland-969445">Jennifer Holland</a>, Lecturer in Tourism, <a href="https://theconversation.com/institutions/university-of-suffolk-3830">University of Suffolk</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/stormy-seas-ahead-confidence-in-the-cruise-industry-has-plummeted-due-to-covid-19-152146">original article</a>. </div>

Cruising

Long COVID puzzle pieces are falling into place – the picture is unsettling

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/ziyad-al-aly-513663">Ziyad Al-Aly</a>, <a href="https://theconversation.com/institutions/washington-university-in-st-louis-732">Washington University in St. Louis</a> Since 2020, the condition known as long COVID-19 has become a <a href="https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/guidance-long-covid-disability/index.html">widespread disability</a> affecting the health and quality of life of millions of people across the globe and costing economies billions of dollars in <a href="https://www.oecd.org/en/publications/the-impacts-of-long-covid-across-oecd-countries_8bd08383-en.html">reduced productivity of employees and an overall drop in the work force</a>. The intense scientific effort that long COVID sparked has resulted in <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22long+covid%22+or+%22pasc%22+or+%22post-acute+sequelae+of+covid-19%22+or+%22postacute+sequelae+of+covid-19%22+or+%22post-acute+sequelae+of+SARS-CoV-2%22+or+%22postacute+sequelae+of+SARS-CoV-2%22+or+%22post+covid+condition%22+or+%22post+covid+conditions%22+or+%E2%80%9Cchronic+covid-19%E2%80%9D+or+%E2%80%9Cpost+covid-19+condition%E2%80%9D+or+%E2%80%9Cpost+covid-19+conditions%E2%80%9D+or+%E2%80%9Cpost-covid+condition%E2%80%9D+or+%E2%80%9Cpost-covid+conditions%E2%80%9D+or+%E2%80%9Clong+covid-19%E2%80%9D+or+%28%22long-term%22+and+%22COVID-19%22%29+or+%28%22longterm%22+and+%22COVID-19%22%29+or+%28%22long-term%22+and+%22SARS-CoV-2%22%29+or+%28%22longterm%22+and+%22SARS-CoV-2%22%29+or+%E2%80%9Cpostcovid+condition%E2%80%9D+or+%E2%80%9Cpostcovid+conditions%E2%80%9D+&sort=date">more than 24,000 scientific publications</a>, making it the most researched health condition in any four years of recorded human history. <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">Long COVID</a> is a term that describes the <a href="https://www.yalemedicine.org/conditions/long-covid-post-covid-conditions-pcc">constellation of long-term health effects</a> caused by infection with the SARS-CoV-2 virus. These range from persistent respiratory symptoms, such as shortness of breath, to debilitating fatigue or brain fog that limits people’s ability to work, and conditions such as heart failure and diabetes, which are known to last a lifetime. I am a physician scientist, and I have been deeply immersed in studying long COVID since the early days of the pandemic. I have testified before the U.S. Senate as an <a href="https://www.help.senate.gov/imo/media/doc/baf4e4e7-b423-6bef-7cb4-1b272df66eb8/Al-Aly%20Testimony.pdf">expert witness on long COVID</a>, have <a href="https://scholar.google.com/citations?hl=en&user=DtuRVcUAAAAJ">published extensively on it</a> and was named as one of <a href="https://time.com/6966812/ziyad-al-aly/">Time’s 100 most influential people in health in 2024</a> for my research in this area. Over the first half of 2024, a <a href="https://www.nationalacademies.org/our-work/long-term-health-effects-stemming-from-covid-19-and-implications-for-the-social-security-administration#sl-three-columns-afa91458-20e0-42ab-9bd6-55e3c8262ecc">flurry of reports</a> and <a href="https://doi.org/10.1056/NEJMoa2403211">scientific papers</a> on long COVID added clarity to this complex condition. These include, in particular, insights into how COVID-19 can still wreak havoc in many organs years after the initial viral infection, as well as emerging evidence on viral persistence and immune dysfunction that last for months or years after initial infection. <h2>How long COVID affects the body</h2> A new study that my colleagues and I published in the New England Journal of Medicine on July 17, 2024, shows that the <a href="https://doi.org/10.1056/NEJMoa2403211">risk of long COVID declined</a> over the course of the pandemic. In 2020, when the ancestral strain of SARS-CoV-2 was dominant and vaccines were not available, about 10.4% of adults who got COVID-19 developed long COVID. By early 2022, when the omicron family of variants predominated, that rate declined to 7.7% among unvaccinated adults and 3.5% of vaccinated adults. In other words, unvaccinated people were more than twice as likely to develop long COVID. While researchers like me do not yet have concrete numbers for the current rate in mid-2024 due to the time it takes for long COVID cases to be reflected in the data, the flow of new patients into long COVID clinics has been on par with 2022. We found that the decline was the result of two key drivers: availability of vaccines and changes in the characteristics of the virus – which made the virus less prone to cause severe acute infections and may have reduced its ability to persist in the human body long enough to cause chronic disease. Despite the decline in risk of developing long COVID, even a 3.5% risk is substantial. New and repeat COVID-19 infections translate into millions of new long COVID cases that add to an already staggering number of people suffering from this condition. Estimates for the first year of the pandemic suggests that at <a href="https://doi.org/10.1038/s41579-023-00896-0">least 65 million people</a> globally have had long COVID. Along with a group of other leading scientists, my team will soon publish updated estimates of the global burden of long COVID and its impact on the global economy through 2023. In addition, a major new report by the National Academies of Sciences Engineering and Medicine details all the <a href="https://nap.nationalacademies.org/catalog/27756/long-term-health-effects-of-covid-19-disability-and-function">health effects that constitute long COVID</a>. The report was commissioned by the Social Security Administration to understand the implications of long COVID on its disability benefits. It concludes that long COVID is a complex chronic condition that can result in more than 200 health effects across multiple body systems. These include new onset or worsening: <ul> <li><a href="https://doi.org/10.1038/s41591-022-01689-3">heart disease</a></li> <li><a href="https://doi.org/10.1038/s41591-022-02001-z">neurologic problems</a> such as <a href="https://theconversation.com/mounting-research-shows-that-covid-19-leaves-its-mark-on-the-brain-including-with-significant-drops-in-iq-scores-224216">cognitive impairment</a>, strokes and <a href="https://my.clevelandclinic.org/health/diseases/6004-dysautonomia">dysautonomia</a>. This is a category of disorders that affect the body’s <a href="https://my.clevelandclinic.org/health/body/23273-autonomic-nervous-system">autonomic nervous system</a> – nerves that regulate most of the body’s vital mechanisms such as blood pressure, heart rate and temperature.</li> <li><a href="https://www.cdc.gov/me-cfs/hcp/clinical-care/treating-the-most-disruptive-symptoms-first-and-preventing-worsening-of-symptoms.html">post-exertional malaise</a>, a state of severe exhaustion that may happen after even minor activity — often leaving the patient unable to function for hours, days or weeks</li> <li><a href="https://doi.org/10.1038/s41467-023-36223-7">gastrointestinal disorders</a></li> <li><a href="https://doi.org/10.1681/ASN.2021060734">kidney disease</a></li> <li>metabolic disorders such as <a href="https://doi.org/10.1016/S2213-8587(22)00044-4">diabetes</a> and <a href="https://doi.org/10.1016/S2213-8587(22)00355-2">hyperlipidemia</a>, or a rise in bad cholesterol</li> <li><a href="https://doi.org/10.1038/s41590-023-01724-6">immune dysfunction</a></li> </ul> Long COVID can affect people across the lifespan from children to older adults and across race and ethnicity and baseline health status. Importantly, <a href="https://doi.org/10.1126/science.adl0867">more than 90% of people with long COVID</a> had mild COVID-19 infections. The National Academies report also concluded that long COVID can result in the inability to return to work or school; poor quality of life; diminished ability to perform activities of daily living; and decreased physical and cognitive function for months or years after the initial infection. The report points out that many health effects of long COVID, such as post-exertional malaise and chronic fatigue, cognitive impairment and autonomic dysfunction, are not currently captured in the <a href="https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm">Social Security Administration’s Listing of Impairments</a>, yet may significantly affect an individual’s ability to participate in work or school. <figure><iframe src="https://www.youtube.com/embed/9kJ5GWb2wzw?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Many people experience long COVID symptoms for years following initial infection.</figcaption></figure> <h2>A long road ahead</h2> What’s more, health problems resulting from COVID-19 can last years after the initial infection. A large study published in early 2024 showed that even people who had a <a href="https://doi.org/10.1038/s41591-024-02987-8">mild SARS-CoV-2 infection still experienced new health problems</a> related to COVID-19 in the third year after the initial infection. Such findings parallel other research showing that the <a href="https://doi.org/10.1016/S1473-3099(24)00171-3">virus persists</a> in various organ systems for months or years after COVID-19 infection. And research is showing that immune responses to the infection are <a href="https://doi.org/10.1126/scitranslmed.adk3295">still evident two to three years</a> after a mild infection. Together, these studies may explain why a SARS-CoV-2 infection years ago could still cause new health problems long after the initial infection. Important progress is also being made in understanding the pathways by which long COVID wreaks havoc on the body. Two preliminary studies <a href="https://doi.org/10.1101/2024.06.18.24309100">from the U.S.</a> and <a href="https://doi.org/10.1101/2024.05.30.596590">the Netherlands</a> show that when researchers transfer auto-antibodies – antibodies generated by a person’s immune system that are directed at their own tissues and organs – from people with long COVID into healthy mice, the animals start to experience long COVID-like symptoms such as muscle weakness and poor balance. These studies suggest that an abnormal immune response thought to be responsible for the generation of these auto-antibodies may underlie long COVID and that <a href="https://doi.org/10.1126/science.zbzipqn">removing these auto-antibodies</a> may hold promise as potential treatments. <h2>An ongoing threat</h2> Despite overwhelming evidence of the wide-ranging risks of COVID-19, a great deal of messaging suggests that it is no longer a threat to the public. Although there is no empirical evidence to back this up, this misinformation has permeated the public narrative. The data, however, tells a different story. <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">COVID-19 infections</a> continue to <a href="https://www.cdc.gov/flu/weekly/index.htm">outnumber flu cases</a> and lead to <a href="https://www.cdc.gov/resp-net/dashboard/index.html">more hospitalization</a> and <a href="https://doi.org/10.1001/jama.2024.7395">death</a> than the flu. COVID-19 also leads to <a href="https://doi.org/10.1016/S1473-3099(23)00684-9">more serious long-term health problems</a>. Trivializing COVID-19 as an inconsequential cold or <a href="https://www.theatlantic.com/health/archive/2024/02/covid-anniversary-flu-isolation-cdc/677588/">equating it with the flu</a> does not align with reality.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/233759/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ziyad-al-aly-513663">Ziyad Al-Aly</a>, Chief of Research and Development, VA St. Louis Health Care System. Clinical Epidemiologist, <a href="https://theconversation.com/institutions/washington-university-in-st-louis-732">Washington University in St. Louis</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/long-covid-puzzle-pieces-are-falling-into-place-the-picture-is-unsettling-233759">original article</a>. </div>

Body

Joe Biden has COVID. Here’s what someone over 80 can expect

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> If US politics leading up to the 2024 presidential election was a Hollywood thriller, it would be a movie full of plot twists and surprises. The latest twist is President Joe Biden has <a href="https://edition.cnn.com/2024/07/17/politics/joe-biden-tests-positive-covid-19/index.html">COVID</a> and is isolating at home. <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2024/07/17/statement-from-press-secretary-karine-jean-pierre-3/">Biden’s doctor says</a> his symptoms are mild and include a runny nose, cough and generally feeling unwell. His temperature, oxygen levels and respiratory rate are said to be normal. Biden, who has <a href="https://www.bbc.com/news/articles/cv2gj8314nqo">been diagnosed</a> with COVID twice before, <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2024/07/17/statement-from-press-secretary-karine-jean-pierre-3/">has received</a> his COVID vaccine and booster shots, and has taken the first dose of the antiviral drug Paxlovid. No doubt, Biden will be receiving the best of medical care. Yet, as much <a href="https://theconversation.com/is-joe-biden-experiencing-cognitive-decline-heres-why-we-shouldnt-speculate-234487">recent media coverage</a> reminds us, he is 81 years old. So let’s look at what it means for an 81-year-old man to have COVID in 2024. Of course, Biden is not just any man, but we’ll come to that later. <h2>Luckily, it’s not 2020</h2> If we were back in 2020, a COVID diagnosis at this age would have been a big deal. This was a time before COVID vaccines, before specific COVID treatments and before we knew as much about COVID as we do today. Back then, being over 80 and being infected with the SARS-CoV-2 virus (the virus that causes COVID) represented a significant threat to your health. It was very clear early in the pandemic that your chances of getting severe disease and dying <a href="https://theconversation.com/why-are-older-people-more-at-risk-of-coronavirus-133770">increased with age</a>. The early data suggested that if you were over 80 and infected, you had about a 15% likelihood of dying from the illness. Also, if you did develop severe disease, we didn’t have a lot in the toolkit to deal with your infection. Remember, former UK Prime Minister Boris Johnson <a href="https://theconversation.com/scott-morrison-has-covid-its-a-big-deal-but-not-how-you-think-178298">ended up in the ICU</a> with his COVID infection in <a href="https://www.theguardian.com/world/2020/apr/17/boris-johnson-and-coronavirus-inside-story-illness">April 2020</a>, despite being 55 at the time. That’s a much younger age than Biden is now. Former US President Donald Trump also had what was understood to be a <a href="https://www.theguardian.com/us-news/2021/feb/11/trump-coronavirus-ventilator-covid-illness">very severe case</a> of COVID in October 2020. He was 74 at the time. <h2>How things have changed</h2> So let’s wind the clock forward to 2024. A lot has happened in four years. COVID is still a disease that needs to be <a href="https://www.cdc.gov/ncird/whats-new/changing-threat-covid-19.html">taken seriously</a>. And for some people with other health conditions (for instance, people with heart disease or diabetes) it poses more of a threat. And of course we know more about the well-publicised <a href="https://theconversation.com/i-have-covid-how-likely-am-i-to-get-long-covid-218808">longer term effects</a> of COVID. But the threat COVID poses to an individual is far less now than it has ever been. <h2>More of us have some immunity</h2> First, <a href="https://www.theguardian.com/world/2022/dec/03/who-estimates-90-of-world-have-some-resistance-to-covid">most people</a> have some immunity to COVID now, whether this has come from vaccination or prior infection, and for many both. The fact that your immune system has had some exposure to the virus is transformative in how you respond to infection. Yes, there’s the ongoing problem of waning immunity over time and the virus mutating meaning you need to have regular booster vaccines. But as your immune system has “seen” the virus before it allows it to respond more effectively. This means the threat posed by infection has fallen drastically. We know Biden has received his booster shots. Boosters have been shown to offer <a href="https://theconversation.com/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">substantial protection</a> against severe illness and death and are particularly important for older age groups. <h2>Now we have antivirals</h2> Second, we also have antiviral medicines, such as Paxlovid, which is effective in reducing the likelihood of severe illness from COVID if taken soon after developing symptoms. In <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2118542">one study</a>, if taken soon after infection, Paxlovid reduced the likelihood of severe illness or death by 89%. So it is <a href="https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/ritonavir-boosted-nirmatrelvir--paxlovid-/">highly recommended</a> for those at higher risk of severe illness. As we know, Biden is taking Paxlovid. Paxlovid has also been associated with rebound symptoms. This is when a person looks to have recovered from infection only to have symptoms reappear. Biden experienced this <a href="https://theconversation.com/why-do-some-people-who-take-paxlovid-for-covid-get-rebound-symptoms-or-test-positive-again-like-president-biden-188002">in 2022</a>. The good news is that even if this occurs in most instances the symptoms associated with the recurrence tend to be mild. <h2>Biden would have the best care</h2> The other factor of course is that Biden would have access to some of the world’s best medical care. If his symptoms were to become more severe or any complications were to develop, you can be assured he would get the best treatment. So is Biden’s diagnosis news? Well of course, given all the speculation about his health. But in terms of COVID being a major threat to Biden’s health, there are no indications it should be.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234999/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, Associate Professor, Epidemiology, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credits: Bonnie Cash/Pool via CNP/Shutterstock Editorial This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/joe-biden-has-covid-heres-what-someone-over-80-can-expect-234999">original article</a>. </div>

Body

Are you up to date with your COVID, flu and other shots? It might depend on who your GP is

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Too many older Australians are <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">missing out</a> on recommended vaccinations for COVID, flu, shingles and pneumococcal that can protect them from serious illness, hospitalisation and even death. A new <a href="https://grattan.edu.au/">Grattan Institute report</a> shows vaccination rates vary widely from GP to GP, highlighting an important place to look for opportunities to boost vaccination. Many people get vaccinated at pharmacies, and those vaccinations are counted in our analysis. But we looked at GPs because they have a unique role overseeing someone’s health care, and an important role promoting vaccination. We found that for some GPs, nine in ten of their older patients were vaccinated for flu. For others, the rate was only four in ten. The differences for shingles and COVID were even bigger. For pneumococcal disease, there was a 13-fold difference in GPs’ patient vaccination rates. While some variation is inevitable, these differences are large, and they result in too many people missing out on recommended vaccines. <h2>Some GPs treat more complex patients</h2> A lot of these differences reflect the fact that GPs see different types of patients. Our research shows older people who aren’t proficient in English are up to 15% less likely to be vaccinated, even after other factors are taken into account. And the problem seems to be getting worse. COVID vaccination rates for people 75 years and older fell to just 36% in May 2024. But rates were even lower – a mere 11% – for people who don’t speak English proficiently, and 15% for those who speak a language other than English at home. Given these results, it’s no surprise that GPs with fewer patients who are vaccinated also have more patients who struggle with English. For GPs with the lowest vaccination rates, one-quarter of their patients aren’t proficient in English. For GPs with the highest vaccination rates, it is only 1%. GPs with fewer vaccinated patients also saw more people who live in rural areas, are poorer, didn’t go to university, and don’t have regular access to a GP, all of which reduce the likelihood of getting vaccinated. Many of these barriers to vaccination are difficult for GPs to overcome. They point to structural problems in our health system, and indeed our society, that go well beyond vaccination. But GPs are also a key part of the puzzle. A <a href="https://www.ijidonline.com/article/S1201-9712(14)01379-4/fulltext">strong</a> <a href="https://www.tandfonline.com/doi/full/10.1080/21645515.2020.1780848">recommendation</a> from a GP can make a big difference to whether a patient gets vaccinated. <a href="https://www.aihw.gov.au/reports/primary-health-care/general-practice-allied-health-primary-care">Nearly all</a> older Australians visit a GP every year. And some GPs have room for improvement. <h2>But GPs seeing similar patients can have very different vaccination rates</h2> We compared GPs whose patients had a similar likelihood of being vaccinated, based on a range of factors including their health, wealth and cultural background. Among the GPs whose patients were least likely to get a flu vaccination, some saw less than 40% of their patients vaccinated, while for others in that group, the rate was over 70%. Among GPs with patients who face few barriers to vaccination, the share of their patients who were vaccinated also varied widely. Even within neighbourhoods, GP patient vaccination rates vary a lot. For example, in Bankstown in Sydney, there was a seven-fold difference in COVID vaccination rates and an 18-fold difference for pneumococcal vaccination. Not everything about clinics and patients can be measured in data, and there will be good reasons for some of these differences. But the results do suggest that some GPs are beating the odds to overcome patient barriers to getting vaccinated, while other GPs could be doing more. That should trigger focused efforts to raise vaccination rates where they are low. <h2>So what should governments do?</h2> A comprehensive national reform agenda is <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">needed to increase adult vaccination</a>. That includes clearer guidance, national advertising campaigns, SMS reminders, and tailored local programs that reach out to communities with very low levels of vaccination. But based on the big differences in GPs’ patient vaccination rates, Australia also needs a three-pronged plan to help GPs lift older Australians’ vaccination rates. First, the way general practice is funded needs to be overhauled, providing more money for the GPs whose patients face higher barriers to vaccination. Today, clinics with patients who are poorer, sicker and who struggle with English tend to get less funding. They should get more, so they can spend more time with patients to explain and promote vaccination. Second, GPs need to be given data, so that they can easily see how their vaccination rates compare to GPs with similar patients. And third, Primary Health Networks – which are responsible for improving primary care in their area – should give clinics with low vaccination rates the help they need. That might include running vaccination sessions, sharing information about best practices that work in similar clinics with higher vaccination rates, or offering translation support. And because pharmacies also play an important role in promoting and providing vaccines, governments should give them data too, showing how their rates compare to other pharmacies in their area, and support to boost vaccination uptake. These measures would go a long way to better protect some of the most vulnerable in our society. Governments have better data than ever before on who is missing out on vaccinations – and other types of health care. They shouldn’t miss the opportunity to target support so that no matter where you live, what your background is, or which GP or pharmacy you go to, you will have the best chance of being protected against disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234175/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, Senior Associate, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/are-you-up-to-date-with-your-covid-flu-and-other-shots-it-might-depend-on-who-your-gp-is-234175">original article</a>. </div>

Body

We finally know why some people got COVID while others didn’t

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/marko-nikolic-1543289">Marko Nikolic</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> and <a href="https://theconversation.com/profiles/kaylee-worlock-1543639">Kaylee Worlock</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> Throughout the pandemic, one of the key questions on everyone’s mind was why some people avoided getting COVID, while others caught the virus multiple times. Through a collaboration between University College London, the Wellcome Sanger Institute and Imperial College London in the UK, we set out to answer this question using the world’s first controlled <a href="https://www.nature.com/articles/s41591-022-01780-9">“challenge trial” for COVID</a> – where volunteers were deliberately exposed to SARS-CoV-2, the virus that causes COVID, so that it could be studied in great detail. Unvaccinated healthy volunteers with no prior history of COVID were exposed – via a nasal spray – to an extremely low dose of the original strain of SARS-CoV-2. The volunteers were then closely monitored in a quarantine unit, with regular tests and samples taken to study their response to the virus in a highly controlled and safe environment. For our <a href="https://www.nature.com/articles/s41586-024-07575-x">recent study</a>, published in Nature, we collected samples from tissue located midway between the nose and the throat as well as blood samples from 16 volunteers. These samples were taken before the participants were exposed to the virus, to give us a baseline measurement, and afterwards at regular intervals. The samples were then processed and analysed using single-cell sequencing technology, which allowed us to extract and sequence the genetic material of individual cells. Using this cutting-edge technology, we could track the evolution of the disease in unprecedented detail, from pre-infection to recovery. To our surprise, we found that, despite all the volunteers being carefully exposed to the exact same dose of the virus in the same manner, not everyone ended up testing positive for COVID. In fact, we were able to divide the volunteers into three distinct infection groups (see illustration). Six out of the 16 volunteers developed typical mild COVID, testing positive for several days with cold-like symptoms. We referred to this group as the “sustained infection group”. Out of the ten volunteers who did not develop a sustained infection, suggesting that they were able to fight off the virus early on, three went on to develop an “intermediate” infection with intermittent single positive viral tests and limited symptoms. We called them the “transient infection group”. The final seven volunteers remained negative on testing and did not develop any symptoms. This was the “abortive infection group”. This is the first confirmation of abortive infections, which were previously <a href="https://www.nature.com/articles/s41586-021-04186-8">unproven</a>. Despite differences in infection outcomes, participants in all groups shared some specific novel immune responses, including in those whose immune systems prevented the infection. When we compared the timings of the cellular response between the three infection groups, we saw distinct patterns. For example, in the transiently infected volunteers where the virus was only briefly detected, we saw a strong and immediate accumulation of immune cells in the nose one day after infection. This contrasted with the sustained infection group, where a more delayed response was seen, starting five days after infection and potentially enabling the virus to take hold in these volunteers. In these people, we were able to identify cells stimulated by a key antiviral defence response in both the nose and the blood. This response, called the “interferon” response, is one of the ways our bodies signal to our immune system to help fight off viruses and other infections. We were surprised to find that this response was detected in the blood before it was detected in the nose, suggesting that the immune response spreads from the nose very quickly. <h2>Protective gene</h2> Lastly, we identified a specific gene called HLA-DQA2, which was expressed (activated to produce a protein) at a much higher level in the volunteers who did not go on to develop a sustained infection and could hence be used as a marker of protection. Therefore, we might be able to use this information and identify those who are probably going to be protected from severe COVID. These findings help us fill in some gaps in our knowledge, painting a much more detailed picture regarding how our bodies react to a new virus, particularly in the first couple of days of an infection, which is crucial. We can use this information to compare our data to other data we are currently generating, specifically where we are “challenging” volunteers to other viruses and more recent strains of COVID. In contrast to our current study, these will mostly include volunteers who have been vaccinated or naturally infected – that is, people who already have immunity. Our study has significant implications for future treatments and vaccine development. By comparing our data to volunteers who have never been exposed to the virus with those who already have immunity, we may be able to identify new ways of inducing protection, while also helping the development of more effective vaccines for future pandemics. In essence, our research is a step towards better preparedness for the next pandemic.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/233063/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/marko-nikolic-1543289">Marko Nikolic</a>, Principal Research Fellow/Honorary consultant Respiratory Medicine, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> and <a href="https://theconversation.com/profiles/kaylee-worlock-1543639">Kaylee Worlock</a>, Postdoc Research Fellow, Molecular and Cellular Biology, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/we-finally-know-why-some-people-got-covid-while-others-didnt-233063">original article</a>. </div>

Body

Tucker Carlson hits back at "stupid" Aussie journalist

The poster boy for conservative America has locked horns with an Aussie journalist in a heated exchange that has gone viral. Tucker Carlson, a former Fox News host in the USA and all round controversial figure, is currently doing the rounds Down Under as a guest of Clive Palmer, and took to the stage to make a speech at the Australian Freedom Conference at the Hyatt Hotel in Canberra on Tuesday. With his signature move being to look for an argument, Carlson found a worthy opponent in AAP Newswire’s Kat Wong, who wasted no time in attempting to get under the 55-year-old’s skin. Wong quizzed Carlson about his controversial immigration views, saying he had “talked” about the “Great Replacement Theory” and how “white Australians, Americans and Europeans” are being replaced by “non-white immigrants”, but Carlson was quick to challenge the question. “Whites are being replaced? I don’t think I said that,” he interjected. “Well, it’s been mentioned on your show 4000 times,” Wong replied. “Really? When did I say that? I said ‘whites’ are being replaced?” he responded. When Wong insisted he had, Carlson challenged her to “cite that”. “I said native-born Americans are being replaced, including blacks,” he continued. “African-Americans have been in the United States, in many cases, for more than 400 years and their concerns are as every bit as real and valid and alive to me as the concerns of white people whose families have been there for 400 years." “I’ve never said that ‘whites’ are being replaced. Not one time and you can’t cite it.” When Wong said “I believe that’s untrue”, Carlson took it up a level. <blockquote class="twitter-tweet"> Meet the Australian media. <a href="https://t.co/IyiEqihPkb">pic.twitter.com/IyiEqihPkb</a> — Tucker Carlson (@TuckerCarlson) <a href="https://twitter.com/TuckerCarlson/status/1806034521369776406?ref_src=twsrc%5Etfw">June 26, 2024</a></blockquote> “We just met, but when our relationship starts with a lie, it makes it tough to be friends,” he said. “You actually can’t cite it because I didn’t say it and I don’t believe it, and I’m telling you that to your face. So, why don’t you just accept me at face value?” Carlson doubled down on his views by calling immigration "immoral", saying governments were negligent by “shifting their concern” to immigrants in order to solve the population growth. “In my view, happy people have children,” he said. “And a functioning economy allows them to do that.” “So you need to fix the economy and fix the culture so the people who want to have kids can,” he continued. “You don’t just go for the quick sugar fix of importing new people. That’s my position and if you think that’s racist, that’s your problem.” Wong replied by saying “I never called you a racist” but it only fired Carlson up more. “But of course, you are suggesting … I must say one of the reasons why people don’t like people like you in the media is that you never say exactly what you mean,” Carlson said. “Your slurs are all by implication. You’re about to tell me the Great Replacement Theory is racist or antisemitic, whatever. I’ve said what I’ve said to you right now like 100 times in public." “I hope to, if I live long enough, to say it 100 more times. I think it’s completely honest and real, not racist or scary. It’s factually true. It’s not a theory, it’s a fact." Carlson then took the fight to the issue of gun control when Wong suggested that it is Americans the same immigration theories that turn to violence and commit mass shootings, to which Carlson quickly rejected as he took aim at Wong. “Oh god, come on,” Carlson said. “How do they get people this stupid in the media? I guess it doesn’t pay well. Look, I’m sorry, I’ve lived among people like you for too long. I don’t mean to call you stupid, maybe you’re just pretending to be." He clarified his stance by saying, "But I’m totally against violence." But Wong wouldn’t stop her line of questioning, asking “Right, so therefore you support gun control?” “What?! I thought it couldn’t get dumber, but it did,” he said. “No, I don’t support disarming law-abiding people so they can’t defend themselves, so the government has a monopoly on violence. I don’t think so." Before leaving the stage, Carlson took a broad swipe at Australian media, saying, "I got here and the country is so unbelievably beautiful, and the people are so cheerful and funny, and cool, and smart. " “I’m like, ‘your media has got to be better than ours. It can’t just be a bunch of castrated robots reading questions from the boss’." “And then it turns out it’s exactly the same. Maybe even a tiny bit dumber.” A lengthy clip of the tense exchange has since gone viral amongst conservative X users, with Sky News Australia host Rita Panahi chiming in on the discourse. “If you are going to show up and make outrageous claims and try to connect Tucker Carlson to mass killers, then I don’t know, perhaps go to the trouble of citing a source, have a direct quote from the man,” Ms Panahi said. “Otherwise, you are going to look like an absolute fool.” Image credits: LUKAS COCH/EPA-EFE/Shutterstock Editorial <p style="box-sizing: inherit; margin: 0px 0px 24px; padding: 0px; border: 0px; font-stretch: inherit; line-height: inherit; font-family: 'Helvetica Neue', HelveticaNeue, Helvetica, Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; font-size: 18px; vertical-align: baseline;">

News

COVID vaccines saved millions of lives – linking them to excess deaths is a mistake

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/paul-hunter-991309">Paul Hunter</a>, <a href="https://theconversation.com/institutions/university-of-east-anglia-1268">University of East Anglia</a> A recent <a href="https://bmjpublichealth.bmj.com/content/2/1/e000282">study</a> has sparked another <a href="https://nypost.com/2024/06/06/us-news/covid-vaccines-may-have-helped-fuel-rise-in-excess-deaths-since-pandemic-study/">round of</a> <a href="https://www.telegraph.co.uk/news/2024/06/04/covid-vaccines-may-have-helped-fuel-rise-in-excess-deaths/">headlines</a> <a href="https://www.gbnews.com/health/covid-vaccine-side-effects-deaths">claiming</a> that COVID vaccines caused excess deaths. This was accompanied by a predictable outpouring of <a href="https://x.com/DrAseemMalhotra/status/1797922073798717524">I-told-you-sos</a> on social media. Excess deaths are a measure of how many more deaths are being recorded in a country over what would have been expected based on historical trends. In the UK, and in many other countries, death rates have been higher during the years 2020 to 2023 than would have been expected based on historic trends from before the pandemic. But that has been known for some time. A couple of years ago I wrote an article for <a href="https://theconversation.com/summer-2022-saw-thousands-of-excess-deaths-in-england-and-wales-heres-why-that-might-be-189351">The Conversation</a> pointing this out and suggesting some reasons. But has anything changed? The authors of the new study, published in BMJ Public Health, used publicly available data from <a href="https://ourworldindata.org/COVID-vaccinations">Our World in Data</a> to determine which countries had “statistically significant” excess deaths – in other words, excess deaths that couldn’t be explained by mere random variation. They studied the years 2020 to 2022 and found that many, but not all, countries did indeed report excess deaths. The authors did not try to explain why these excess deaths occurred, but the suggestion that COVID vaccines could have played a role is clear from their text – and indeed widely interpreted as such by certain newspapers. There is no doubt that a few deaths were associated with <a href="https://journals.sagepub.com/doi/full/10.1177/25166026211053485">the COVID vaccines</a>, but could the vaccination programme explain the large number of excess deaths – 3 million in 47 countries – that have been reported? Based on <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/excessdeathsinenglandandwales/march2020todecember2021">death certificates</a>, during 2020 and 2021 there were more deaths from COVID than estimated excess deaths in the UK. So during the year 2021 when most vaccine doses were administered, there were actually fewer non-COVID deaths than would have been expected. It was only in 2022 that excess deaths <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/deathregistrationsummarystatisticsenglandandwales/2022">exceeded COVID deaths</a>. If the vaccination campaign was contributing to the excess deaths that we have seen in recent years, then we should expect to see more deaths in people who have been vaccinated than in those who have not. The most reliable analysis in this regard was done by the UK’s <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/excessdeathsinenglandandwales/march2020todecember2021">Office for National Statistics (ONS)</a>. In this analysis, the ONS matched death registrations with the vaccine histories of each death recorded. They then calculated “age-standardised death rates” to account for age differences between those vaccinated and those not. What the ONS found was that in all months from April 2021 to May 2023, the death rate <a href="https://www.ons.gov.uk/redir/eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJpbmRleCI6MSwicGFnZVNpemUiOjEwLCJwYWdlIjoxLCJ1cmkiOiIvcGVvcGxlcG9wdWxhdGlvbmFuZGNvbW11bml0eS9iaXJ0aHNkZWF0aHNhbmRtYXJyaWFnZXMvZGVhdGhzL2RhdGFzZXRzL2V4Y2Vzc2RlYXRoc2luZW5nbGFuZGFuZHdhbGVzIiwibGlzdFR5cGUiOiJyZWxhdGVkZGF0YSJ9.Cot-XDe8Rr07paGllBNnVVz1nTqnXfVafn2woA3tk0c">from all causes was higher</a> in the unvaccinated than in people who had been vaccinated at least once. That deaths from all causes were lower in the vaccinated than the unvaccinated should come as no surprise given that COVID was a major cause of death in 2021 and 2022. And there is ample evidence of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492612/">protective effect of vaccines</a> against severe COVID and death. But what is even more convincing is that, even when known COVID deaths were excluded in the ONS report, the death rate in the unvaccinated was still higher, albeit not by very much in more recent months. Some COVID deaths would certainly not have been recognised as such. But, on the other hand, people with chronic conditions, such as diabetes, were a high priority for vaccination. And these people would have been at increased risk of death even before the pandemic. <h2>Possible causes</h2> If the vaccine is not the cause of the excess deaths, what was? The major cause of the excess deaths reported in the first two years of the BMJ Public Health study was deaths from COVID. But by 2022, excess deaths exceeded COVID deaths in many countries. Possible <a href="https://theconversation.com/summer-2022-saw-thousands-of-excess-deaths-in-england-and-wales-heres-why-that-might-be-189351">explanations</a> for these excess deaths include longer-term effects of earlier COVID infections, the return of infections such as influenza that had been suppressed during the COVID control measures, adverse effects of lockdowns on physical and mental health, and delays in the diagnosis of life-threatening infections as health services struggled to cope with the pandemic and its aftermath. We do need to look very carefully at how the pandemic was managed. There is still considerable debate about the effectiveness of different behavioural control measures, such as self-isolation and lockdowns. Even when such interventions were effective at reducing transmission of COVID, what were the harms and were the gains worth the harms? Nevertheless, we can be confident that the excess deaths seen in recent years were not a consequence of the vaccination campaign.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231776/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-hunter-991309">Paul Hunter</a>, Professor of Medicine, <a href="https://theconversation.com/institutions/university-of-east-anglia-1268">University of East Anglia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/covid-vaccines-saved-millions-of-lives-linking-them-to-excess-deaths-is-a-mistake-231776">original article</a>. </div>

Body

Doctors at war

In the annals of military history, the valour and sacrifices of doctors who served alongside soldiers in combat zones often go unrecognised. Yet their stories, as retired colonel Robert Likeman poignantly illustrates in his Australian Doctors at War series, reveal a legacy of courage and commitment that is integral to understanding the full scope of wartime heroism. --- Winston Churchill, in his Sketches on Service During the Indian Frontier Campaign of 1897, wrote, “The spectacle of a doctor in action among soldiers, in equal danger and with equal courage, saving life where others are taking it, allaying pain where all others are causing it, is one which must always seem glorious, whether to God or man”. It is certainly true that doctors in a combat zone share the risks of shot and shell equally with the fighting soldier, but they also experience the added stress of taking responsibility for those wounded and dying on the battlefield, and in situations where the best of treatment cannot be readily given. Glorious or otherwise, the stories of our Australian Army doctors at war remain relatively unrecognised. Doctors have always been among the first to volunteer – in all 1,242 doctors served with the first Australian Imperial Force, careless for their own safety, and 55 of them failed to return. These men represented a significant proportion of the medical workforce in Australia, which by 1937 only reached 5,000. In World War 2, with the introduction of compulsory military service, the number of serving doctors exceeded 2,500. Hardly any of them are still with us today, but their children and grandchildren are our fellow citizens, and in many cases our local doctor may be one of these. It is a legacy not to be dismissed lightly. Those who have served in the Army know that treating the ailments of soldiers and preserving their health occupies much more time than dressing their wounds. In World War 1, fought over the agricultural lands of Europe, infectious diseases such as gas gangrene, tetanus and trench fever were common. In the deserts of World War 2, these were replaced by hepatitis, sandfly fever and eye infections. New Guinea presented a wholly different spectrum of disease, dominated by malaria, scrub typhus and amoebic dysentery. The maintenance of “fighting fitness” was a daily struggle for the doctors. The 2021 Interim Report of the Royal Commission into Defence and Veteran Suicide did not identify medical officers as being particularly at risk of psychological injury as a result of their service in a war zone. But in view of their exposure to mass trauma and death, they might be assumed to have a significant risk of Post Traumatic Stress Disorder, both from the chances of being wounded or killed, and from the guilt associated with the failure to preserve life. Two of the medical officers who served at Gallipoli shot themselves on their return to Egypt, perhaps because they had seen men die who might have been saved with better medical attention. Fourteen other doctors from the 1st Australian Imperial Force are known to have committed suicide after their return to Australia. Close to 3,000 Australian nurses served overseas with the Australian Army Nursing Service in World War 1, but female doctors were not permitted to enlist. A significant number of them however, at least 19, served in the British Army or in voluntary hospitals in Europe. One of them, Phoebe Chapple, was awarded the Military Medal for Bravery. In World War 2, 22 women doctors were commissioned in total – moreso due to the shortage of manpower than from egalitarian principles – though none of them were posted overseas. In recent overseas deployments, women doctors in the Army have quite properly taken their rightful place. The military service and civilian practice of all the Australian doctors who served in both World Wars has been meticulously documented in my six-volume series, Australian Doctors at War, published by Halstead Press. Your relatives may be among them. <img src="https://oversixtydev.blob.core.windows.net/media/2024/06/Robert_Likeman_01.jpg" alt="" width="1280" height="720" /> The Inevitable Hour is the sixth and final volume of my Australian Doctors at War series, covering the period from January 1943 to the disbanding of the Second Australian Imperial Force in April 1947. Even after the Japanese had been driven from Papua and New Guinea, they still retained most of the archipelago. The threat to Australia was great, and despite being a then small nation, the country mobilised quickly to disrupt Japanese holdings in Madang, Wewak and Wau. Overcoming the constant influx of wounded men needing treatment, suffering themselves from afflictions such as hepatitis, dysentery and depression, aggravated by extreme and tropical climates, Australia’s medical officers were under considerable pressure, during the war and in the monumental demobilisation of the 2nd AIF that followed Japanese defeat. ABOUT THE AUTHOR Robert Likeman is a graduate of Oxford University, where he studied Classics, Oriental Languages and Medicine. He is a specialist in obstetrics and gynaecology, in tropical medicine, and in rural and remote medicine. After service in the British Army he migrated to Australia in 1972. He is the author of seven books of military history and two biographies, and co-author of a textbook of obstetrics and gynaecology for doctors practising in developing countries. Images courtesy of Robert Likeman.

Books

How to write creative non-fiction history

Discovering an old photo album from the 1920s, celebrated author and adjunct professor Paul Ashton embarked on a journey to turn historical research into engaging creative non-fiction, blending meticulous evidence with captivating storytelling. Here he shares he insights on the fascinating process. One afternoon my elderly father and niece came to my home for lunch. On their way they had seen something on a council clean up. ‘We thought you might be interested in this,’ said my father handing me a small, brown photo album. I was. The album contained around 100 undated black and white photographs. It became apparent quickly that this was the record of a road trip done in the 1920s or 1930s. A boy, two women and a man had gone on a trip from Sydney up through New England, to Tamworth then to Brisbane and back to Sydney. Shadows in some of the images indicate that they were taken by the man and at least one of the women. The album provided the basis for my first children’s book, Palmer’s Mystery Hikes. One photograph stood out for me. Hundreds of people were gathered somewhere in the bush. In the far left-hand corner in the background was an elevated table covered with a large white tablecloth. With a magnifying glass I could just make out ‘Palmers [something] Hike’. In 1932 Palmer’s men and boys’ department store, in Park Street in Sydney, had established a hiking club to promote the sale of hiking apparel. You bought a ‘mystery’ ticket from New South Wales Railways with which Palmer had an arrangement; turned up at Central Station on Sunday morning; and were taken to a mystery destination. From there you did a ten-mile hike to another station and were then trained back to Sydney. There were five hikes. The third one to the Hawkesbury River attracted over 8,000 people. Turning historical research into believable fiction or creative non-fiction has certain demands. How do you strike a balance between historical research and evidence and the narrative form? This is a big question and will ultimately depend on many things, including the availability of primary and secondary sources and the nature of the particular narrative. But perhaps the most important question is: how do writers use the past to give their work historical dimensions and insights? For me, the most critical element is context. And it’s the thing most missing in much historically based fictional literature. Evoking people, places and periods involves understandings of things such as continuity and change over time, historical process – like colonisation and suburbanisation – ideologies and superstitions. Where appropriate, these should form subtle backgrounds to the narrative. Fiction and creative non-fiction as historical modes of presenting history should also show – not tell. My edited collection, If It’s not True It Should Be (Halstead Press), explores writing history using fictional techniques. As Peter Stanley has written in that book, ‘those who seek to illuminate the past through the imaginative recreation of historical fiction … [are] motivated by the fundamental conviction that what links the fidelity of the historian and the imagination of the historical novelist is that the work of both should be offered and read as if it were true.’ ABOUT THE AUTHOR Paul Ashton is adjunct professor and co-founder of the Australian Centre for Public History at the University of Technology Sydney and adjunct professor at the University of Canberra and Macquarie University. He has authored, co-authored, edited and co-edited over 40 books and is editor of the journal Public History Review. His series of creative non-fiction children’s histories – Accidental Histories – is being published by Halstead Press. Images: Supplied

Books

15,000 squares, 500 hours, 19 months: how I used embroidery to make sense of Australia’s catastrophic fires

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/tracey-clement-1518268">Tracey Clement</a>, <a href="https://theconversation.com/institutions/australian-catholic-university-747">Australian Catholic University</a> I slip the needle through a small loop of black thread, pull it tight and snip. Done. I have just tied off the very last stitch on an embroidered scroll that has taken me more than 500 hours across 19 months to complete. All of my artwork is extremely labour-intensive. But I have to admit, this is a bit excessive, even for me. It’s not surprising that I have been asked more than once “why not just outsource the labour?” and even “what is the point?” I always sigh and think enviously of plumbers. I am 100% sure hardworking tradies are never asked to justify the point of their work. Why do I work so hard? There is no one easy answer, it’s different every time. The labour intensity of my processes adds time into the equation and this both carries meaning and can change the meaning of the work as it goes on (and on and on). I always learn something unexpected. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/590597/original/file-20240426-17-sg7esy.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/590597/original/file-20240426-17-sg7esy.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/590597/original/file-20240426-17-sg7esy.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/590597/original/file-20240426-17-sg7esy.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/590597/original/file-20240426-17-sg7esy.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/590597/original/file-20240426-17-sg7esy.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/590597/original/file-20240426-17-sg7esy.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/590597/original/file-20240426-17-sg7esy.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" alt="A finger points to a knot on the back of a messy abstract embroidery done in black, red, orange and yellow" /></a><figcaption>The last stitch! Tracey Clement</figcaption></figure> I put my little scissors down and, before busting out the bubbles, I snap a picture for Instagram because #selfpromotion, but also because this is news, albeit of a very slow-breaking kind. This is what I’ve learned after stitching for seemingly endless hours: while no news may be good news, “slow news” is even better. My embroidered scroll is titled Impossible Numbers. It started as my attempt to memorialise <a href="https://wwf.org.au/what-we-do/australian-bushfires/in-depth-australian-bushfires">the estimated 3,000,000,000 non-human lives lost</a> in the devastating bushfires of 2019–20, a number impossible to actually comprehend. <h2>Doomscrolling an emergency</h2> During that long and awful summer Sydney was often shrouded in an eerie orange haze. You could smell smoke. Ash fell. But, like many Australians, I experienced the worst of it by <a href="https://dictionary.cambridge.org/dictionary/english/doomscrolling">doomscrolling</a> fast news. I was both horrified and fascinated by images of fires so huge and hot they generated their own weather, by pictures of houses reduced to smoking skeletal outlines that somehow remained standing, by headlines comparing the fires to <a href="https://www.theguardian.com/australia-news/2019/dec/31/mallacoota-fire-mayhem-armageddon-bushfires-rage-victoria-east-gippsland">armageddon</a> and <a href="https://www.theguardian.com/australia-news/2020/oct/30/australia-must-prepare-for-future-shaped-by-extreme-climate-bushfire-royal-commission-report-warns">the apocalypse</a>. This hyperbolic language implies we are locked in a war of good versus evil. Even headlines in the vein of “Firefighters battle blazes” pit us (people) against them (the forces of nature). And in the heat of the moment the language of war feels right. <a href="https://traceyclement.com/2020/04/21/apocalypse-now">I’ve succumbed to it myself</a>. But it is dangerous. This language reinforces the idea we can dominate nature; it frames the fires as a conflict that we can end by winning. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/590572/original/file-20240426-21-7mbf5w.JPG?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/590572/original/file-20240426-21-7mbf5w.JPG?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/590572/original/file-20240426-21-7mbf5w.JPG?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=1432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/590572/original/file-20240426-21-7mbf5w.JPG?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=1432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/590572/original/file-20240426-21-7mbf5w.JPG?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=1432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/590572/original/file-20240426-21-7mbf5w.JPG?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=1800&fit=crop&dpr=1 754w, https://images.theconversation.com/files/590572/original/file-20240426-21-7mbf5w.JPG?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=1800&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/590572/original/file-20240426-21-7mbf5w.JPG?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=1800&fit=crop&dpr=3 2262w" alt="A hand holds a phone taking a picture of a long abstract embroidery in black, red, orange and yellow." /></a><figcaption>Viewing the world through the phone. Tracey Clement</figcaption></figure> I will admit watching a goat-toting woman <a href="https://www.abc.net.au/news/2020-01-03/scott-morrison-got-bushfire-welcome-he-deserved-says-liberal-mp/11838476">berate a sitting prime minister</a> left me with a short-lived, but mildly satisfying, feeling of shared righteous indignation. But mostly doomscrolling just fuelled my sorrow and left me feeling impotent as, inevitably, the fast news cycled on to the next crisis (and the next, and the next). <h2>Slowing it down</h2> In October 2022, I finally stopped trying to process the bushfires, and all their terrifying implications, through the fast-news language of war. I picked up a needle instead. Of course 3,000,000,000 stitches would be too many, even for me, so I decided to stitch a grid of some 15,000 squares, which I filled with innumerable stitches – a nod to the endless stream of pixels that usually deliver our news. I started wanting to honour the 3 billion dead, that impossible number, but after months of stitching I realised I was “writing” a kind of slow-news story. It may sound ridiculous, but this tactic has been used before. The <a href="https://www.bayeuxmuseum.com/en/the-bayeux-tapestry">Bayeux Tapestry</a> is a slow-news story that documents the Norman conquest of England through embroidery. It took years to stitch, and some 950 years later it is still in circulation. As an alternative to doomscrolling easily digestible fast-news stories of good triumphing (or not) over evil, I have created an actual fabric scroll which depicts a stylised firestorm building in intensity until it becomes all-consuming. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/590574/original/file-20240426-16-lk14qm.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/590574/original/file-20240426-16-lk14qm.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/590574/original/file-20240426-16-lk14qm.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=799&fit=crop&dpr=1 600w, https://images.theconversation.com/files/590574/original/file-20240426-16-lk14qm.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=799&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/590574/original/file-20240426-16-lk14qm.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=799&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/590574/original/file-20240426-16-lk14qm.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=1004&fit=crop&dpr=1 754w, https://images.theconversation.com/files/590574/original/file-20240426-16-lk14qm.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=1004&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/590574/original/file-20240426-16-lk14qm.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=1004&fit=crop&dpr=3 2262w" alt="A middle-aged white woman peeks out from behind a very long abstract embroidery in black, red, orange and yellow." /></a><figcaption>The artist with Impossible Numbers. Tracey Clement</figcaption></figure> Despite mimicking pixels, Impossible Numbers is resolutely handmade. It is too messy, too crude, to be anything else. It is bleedingly obvious (and there was blood) the will of a person is inextricably stitched into this image of devastating fire. Human labour is literally entangled in this artwork; it shows us as part of the picture, part of nature. And this is good news Impossible Numbers doesn’t have a victorious ending, or any ending at all. The scroll is not fully unrolled. There is no end in sight: the story isn’t over, it’s ongoing. In this way it points to the future; a future in which we are not fighting nature. And this is good news too. If you don’t have a spare 500 hours to process the news into slow news, don’t worry. By the time I finally tied my last knot, I found I had transformed my fear and rage into something tangible, something both magnificent and beautiful (if I do say so myself), no longer about me. It is now a slow-news story that is no longer about a particular event; something everyone can share. This is why I do the work. Impossible Numbers is on display as part of <a href="https://www.casulapowerhouse.com/prizes/the-blake-art-prize">The Blake Prize</a> at the Casula Powerhouse, Sydney, until July 7. <hr /> This article is part of <a href="https://theconversation.com/au/topics/making-art-work-126611">Making Art Work</a>, our series on what inspires artists and the process of their work.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227907/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/tracey-clement-1518268">Tracey Clement</a>, Lecturer in Visual Art and McGlade Gallery Director, <a href="https://theconversation.com/institutions/australian-catholic-university-747">Australian Catholic University</a> Image credits: Instagram This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/15-000-squares-500-hours-19-months-how-i-used-embroidery-to-make-sense-of-australias-catastrophic-fires-227907">original article</a>. </div>

Art

AstraZeneca admits to Covid vaccine's deadly side effect

AstraZeneca has admitted that their Covid vaccine carries a very rare but deadly side effect, as "dozens" of class-action lawsuits pile up. The UK pharmaceutical giant could be facing damages of up to $38 million, as lawyers representing complainants whose loved ones who were injured or killed from the jab called the vaccine "defective". Those who received the AstraZeneca Covid-19 vaccine could be susceptible to a rare and potentially blood clotting disorder called thrombosis with thrombocytopenia syndrome, or TTS, in which patients suffer from blood clots as well as a low blood platelet count. While the side effect is rare, recent research from RMIT University and Monash University found Australia’s Covid-19 vaccination rollout likely prevented the death of 17,760 people aged over 50 in New South Wales between August 2021 and July 2022, with some researchers suggesting that AstraZeneca alone helped saved as many as six million lives worldwide, according to the <a title="nypost.com" href="https://nypost.com/2024/04/29/world-news/astrazeneca-cops-to-rare-deadly-side-effect-of-covid-jab-as-lawsuits-mount/">New York Post.</a> AstraZeneca, which is contesting the claims, acknowledged in a February legal document that its vaccine can “in very rare cases,” cause the clotting condition, while also acknowledging that the potential complication was listed as a side effect of the vaccine since its release. So far, 51 cases have been filed in London’s High Court, estimated to be worth around $190 million (GBP100 million) total, according to the UK newspaper<a title="www.telegraph.co.uk" href="https://www.telegraph.co.uk/news/2024/04/28/astrazeneca-admits-covid-vaccine-causes-rare-side-effect/"> The Telegraph</a>. However, thanks to a deal struck between AstraZeneca and the UK government during the worst of the pandemic, the drugmaker has been pre-emptively indemnified against future lawsuits – which means any successful claims for payouts will be born by taxpayers. One of the claimants is father-of-two Jamie Scott, who was left with a permanent brain injury after suffering a clot following receiving the vaccine in April 2021. His wife, Kate, told <a title="www.telegraph.co.uk" href="https://www.telegraph.co.uk/news/2024/04/28/astrazeneca-admits-covid-vaccine-causes-rare-side-effect/">The Telegraph </a>she’s hopeful the company’s admission will accelerate the outcome of their case. “We need an apology, fair compensation for our family and other families who have been affected. We have the truth on our side, and we are not going to give up.” Image credits: Getty Images

Legal

Christina Applegate details bout of Covid and Sapovirus amid MS battle

Christina Applegate has detailed her latest health battle amid her multiple sclerosis (MS). Speaking on her MesSy podcast with co-host Jamie-Lynn Sigler, the actress revealed her rough experience after contracting Covid for the first time, which then turned into long Covid, and to make matters worse, she then contracted Sapovirus from contaminated food. Sapoviruses can cause acute gastroenteritis, and the actress candidly shared that she had been wearing diapers in recent weeks because of how often she has had to go to the bathroom. "I finally got the Covies.. someone real close to me dropped the ball and came home with the stuff and it spread all over the house," she began. "I had one day when I had a headache and chills and I thought I was making it through this." "It turned into long covid and it turned into a chest infection and then my heart was doing weird stuff, where it just speeds up... so I was like mother f--ker!" She then continued, saying that after contracting the virus she was "p---ing out of her a** for a few days". "I was so dizzy. I was so sick. I couldn't eat... Someone else's poop went into my mouth and I ate it." The actress recently revealed that she has 30 lesions on her brain from her MS, a condition where the body's own immune system mistakenly attacks and damages the fatty material around the nerves, which can cause a range of symptoms. It is the most common acquired chronic neurological disease affecting young adults, according to MS Australia. Image: Getty

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How to write creative non-fiction history

15,000 squares, 500 hours, 19 months: how I used embroidery to make sense of Australia’s catastrophic fires

AstraZeneca admits to Covid vaccine's deadly side effect

Christina Applegate details bout of Covid and Sapovirus amid MS battle

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