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Readers response: What’s your top travel tip for staying comfortable on long journeys?

When it comes to a long travel day, getting comfortable can often be a mammoth task. We asked our readers to share their favourite tips and tricks to stay comfy on a long haul flight, car ride or train journey, and the response was overwhelming. Here's what they said. Amy Cardino - Long-haul journeys (to me longer than 8hrs), you need to save up or upgrade your ticket if you have mileage benefits, into business class. Ester Cibasek - My own blowup pillow and blanket (long enough to cover my head), noise reducing ear phones and keep my eyes closed so I dose in and out of sleep all the way. Valerie Keily - A neck pillow is essential and an eye shade. Keep hydrated and remember to move around if possible. Di Richardson - Memory neck pillow. Recovery sleeves on my calves. One departure drink then limit alcohol or coffee. Window seat and sleep when possible. Bliss. Anita Thornton - Go business class. Chrissie Martini - Break the journey by staying overnight in a hotel. Takes longer to get there but you practically eliminate jet lag and the worry of DVTs. On the way to Europe, two overnight stops helps me. Lyn Goodman - Keep warm and wear loose fitting clothes. June Debono - Stretch jeans and socks (as well as other clothes of course). Plus, eye shade and ear plugs. Ingrid Plueckhahn - Take a good book, break up the journey with a fave movie, and just get in the zone and relax. It’s just a day! Image credits: Shutterstock

Travel Tips

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>

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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

Incredible reason behind Aussie woman's 5,500km outback ride

Sarah Wheeler has been travelling through the New South Wales outback for the last four and a half months, doing it entirely on horseback. The 26-year-old Aussie plans to ride 5,500 kilometres through outback Queensland and New South Wales to raise awareness about the rare cancer that killed her mum in 2022, a little over a decade after her father passed away. With around four months left on her trip, Wheeler and her two horses, Shifty and Sally, are slowly trekking across some of the most remote and rugged parts of the country in a trip that has never been done before. "I'd always thought about doing something like this throughout my life," Wheeler told Yahoo News. "So after my parents died, I went out and bought two horses and, yeah, set off on a five-and-a-half-thousand-kilometre horse ride to honour and remember, and grieve." Wheeler set off with her horses from her hometown Rowena in western NSW in May, and has since travelled across long stretches of highways, desolate plains and rocky terrain and has now passed the halfway mark. She explained that in recent weeks she has also been trekking on foot and has contact with other people only when she stops in towns for supplies or when she feeds her horses, using a support vehicle. "The car travels 10 kilometres at a time so that I can keep replenishing my horses, with both food and water. Ten kilometres takes me two hours, sometimes a bit longer, and I'm usually in the saddle for six to eight hours a day," she told the publication. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/C89KIgsxb_A/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/C89KIgsxb_A/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Sarah Wheeler - The Outback Long Ride (@_beneaththebrim)</a> </div> </blockquote> "The most challenging thing has probably been the saddles and saddle pads and cleanliness — that's all so important. I have to wash my saddle blankets every second day. Otherwise, things just start happening, like fungus type of stuff." She added that while "this has been one of the hardest things I have ever done", the friendliness and support of locals has been a highlight of her trip. "Everyone's so lovely and inviting and, yeah, I just I didn't think that I was going to see that to this extent," she said. "People want to invite me in and feed me, they just want to help me as much as they can." Remembering her late parents' legacy, Wheeler said she wants everyone to know just how "remarkable" they both were. "They were like everything this world needed and more," she said. "They were very kind and genuine and humble." Wheeler's ride is raising awareness and funds for two key charities: <a href="https://pancare-gi-cancer.raisely.com/sarah-wheeler" target="_blank" rel="noopener">Pancare Foundation</a>, the lead organisation supporting families and funding research for upper gastrointestinal (GI) cancer, which claimed the life of her mother, and A Daughter’s Way, her own charity supporting rural families experiencing grief. Images: Instagram

Domestic Travel

Snakes are waking up. What should you do if you’re bitten? And what if you’re a long way from help?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/hamish-bradley-2217649">Hamish Bradley</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a>; <a href="https://theconversation.com/profiles/alice-richardson-252002">Alice Richardson</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a>, and <a href="https://theconversation.com/profiles/breeanna-spring-1545193">Breeanna Spring</a>, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a> From the creeks that wind through inner city Melbourne to the far outback in Western Australia, snake season is beginning. Over the cooler months snakes have been in state of <a href="https://youtu.be/FjXOzNjZjoU?si=Mc0eeayVk4VU9906">brumation</a>. This is very similar to hibernation and characterised by sluggishness and inactivity. As warmer conditions return both snakes and humans become more active in the outdoors, leading to an increased likelihood of interaction. This may happen when people are hiking, dog-walking or gardening. The risk of being bitten by a snake is exceptionally small, but knowing basic first aid could potentially save your, or another person’s, life. <h2>When a snake bites</h2> Snake bite envenomation (when venom enters the blood stream) is a significant issue in Australia, with <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja17.00094">3,000 cases annually and an average of two deaths</a>. Snake bite should always be <a href="https://stjohnwa.com.au/online-resources/first-aid-information-and-resources/snake-bite">treated</a> as a life-threatening emergency, and if you are bitten in rural or remote Australia, you will often receive an air medical emergency pick up to a regional or metropolitan hospital for advanced care. The effects of snake bites vary, depending on the species of snake and first aid measures undertaken. Australian <a href="https://www.healthdirect.gov.au/snake-bites">standard first aid guidelines</a> include: <ul> <li>calling for help (dialing 000 or activating an emergency beacon)</li> <li>applying a pressure immobilisation bandage</li> <li>resting.</li> </ul> <h2>Why pressure is important</h2> Snake venom is carried within the <a href="https://theconversation.com/what-are-lymph-nodes-and-can-a-massage-really-improve-lymphatic-drainage-209334">lymphatic system</a>. This is a collection of tiny tubes throughout the body that return fluid outside of blood vessels back to the blood stream. Muscles act as a “<a href="https://theconversation.com/pneumatic-compression-therapy-can-it-really-help-olympians-or-you-recover-after-exercise-236228">pump</a>” to help the fluid move through this system. That’s why being still, or immobilisation, is vital to slow the spread of venom. A firm pressure immobilisation bandage, applied as tight as you would for a sprained ankle, will compress these tubes and help limit the venom’s spread. Ideally bandage the entire limb on which the bite occurred and apply a splint to help further with immobilisation. It is very important that the blood supply to the limb is not limited by this bandage. Never attempt to capture or kill the snake for identification. This risks further bites and is not required for specialist care. The decision about when to give antivenom (if any) is based on the geographical location, symptoms, the results of blood tests and discussion with a toxicologist. <h2>The tyranny of distance</h2> People living in rural and remote locations may also have limited access to health care, including access to ambulance services, <a href="https://www.tandfonline.com/doi/full/10.1080/10871209.2020.1769778">snake bite first aid</a> such as bandages and splints, and to antivenom. Availability and the prompt use of antivenom have been identified as <a href="https://www.sciencedirect.com/science/article/pii/S2590171022000558">crucial factors in the effective treatment</a> of snake envenomation – but not studied in detail. Over one year (as a component of a larger three-year study) we collected information on the pre-hospital care and in-flight care with the Royal Flying Doctors Service Western Operations. During this time, 85 people from regional, rural, remote and very remote Western Australia were flown by Royal Flying Doctor Service to hospital for suspected or confirmed snake bites. Reassuringly, only five of these patients (6%) ultimately received a toxicologist’s diagnosis of envenomation. <h2>To move or not to move?</h2> Troublingly, 38 (45%) of the 85 snake bite victims continued to move around and be active following their suspected snake bite. This raises questions about whether people lack knowledge of first-aid guidelines, or whether this is a consequence of being isolated, with limited access to health care. Either way, our as-yet-unpublished research highlights the vulnerability of Australia’s rural and remote people. All patients eventually received a pressure immobilisation bandage, with an average time from bite to application of 38 minutes. Three quarters of the patients made their way to health-care site by foot, or private car, arriving on average 65 minutes after the bite. <h2>What needs to change?</h2> Our results indicate rural and remote Australians need innovative health-care solutions beyond the metropolitan guidelines, particularly when outside ambulance service areas. Basic snake bite first aid education needs to be not only reiterated but also a pragmatic approach is required in these geographically isolated locations. This would involve being vigilant, staying safe and, when isolated, always carrying emergency technology to call for help. <hr /> The authors wish to acknowledge the efforts required through this research project as it continues, including by Fergus Gardiner, Kieran Hennelly, Rochelle Menzies, James Anderson, Alex McMillan and John Fisher. Hamish Bradley is an Aeromedical Retrieval Specialist and Principal Investigator in this project.<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/234365/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hamish-bradley-2217649">Hamish Bradley</a>, Adjunct Lecturer, Anaesthetist and Aeromedical Retrieval Specialist, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a>; <a href="https://theconversation.com/profiles/alice-richardson-252002">Alice Richardson</a>, Associate professor and lead of Statistical Support Network, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a>, and <a href="https://theconversation.com/profiles/breeanna-spring-1545193">Breeanna Spring</a>, PhD student, Molly Wardaguga Institute for First Nations Birth Rights, Faculty of Health, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin 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/snakes-are-waking-up-what-should-you-do-if-youre-bitten-and-what-if-youre-a-long-way-from-help-234365">original article</a>. </div>

Body

Parents under fire for taking their sick toddler on a long-haul flight

A couple has come under fire after documenting their experience online of boarding a long-haul flight with their toddler, despite the child being sick. Alina and her husband were excited to go on their long-awaited holiday to Thailand with their one-year-old son in tow, taking off on their first big family trip. However, shortly before they were set to take off, their child developed a raging fever, and they decided to go on the trip anyway. Taking the experience to social media, Alina said her son’s temperature soared to around 40 degrees, with their little boy’s condition escalating so rapidly that the parents were considering calling off their entire trip. “My husband and I even wanted to cancel the flight,” she confessed in the video, which has received around 1.4 million views. However, after realising they would be out of pocket by several thousands of dollars if they cancelled the trip at such short notice, they decided to take the risk and board the plane. “Our tickets would have been wasted, and the trip that cost us $3,000 would have been wasted,” the mum wrote. "One plus of this flight was that the flight was at night, and the child could sleep and recover.” In the clip, the parents were seen walking their son around the plane, cradling the sick toddler as he cried uncontrollably. Luckily, the parents “managed to bring down the temperature”, but they weren’t convinced their son would keep quiet for the rest of the trip. “We were so worried about how the baby would feel on an eight-hour flight,” she continued, walking the baby up and down the corridors of the airport, trying to calm him down. As they tried to settle the child, they realised that their hopes that he would sleep the whole way were misguided. “The flight turned out to be difficult,” Alina confessed. “The baby kept waking and crying.” In the middle of the night, their son’s fever returned, which forced the parents to “bring the temperature down again” and left them “very worried” about their son’s health. Their baby’s fever took a toll on the parents as well, who complained of feeling “squeezed like a lemon” while trying to keep his temperature down, as Alina recalled, “We took turns looking after the baby so each of us could sleep.” In a later video, the parents defended their choice to take their son on the flight despite his intense fever and blamed it on his teething, not sickness. “Our baby wasn’t sick, he was teething, and that’s why he had a fever,” she said. “If our child had been sick, we would have cancelled everything … I consider myself a wonderful mother.” Despite the mother's clarification of her son's fever, the parents were slammed for even considering taking a sick child on such a long flight. “It’s OK, don’t worry about making anyone else on that flight sick,” a sarcastic comment read. “This is so tremendously selfish, you are appalling for doing this to him and others.” “I was in the same situation,” another parent said. “I lost all bookings, but who cares, my daughter comes first always and forever, no matter the amount of money!” “Trips come and go; your baby’s health is priceless!” read another comment. “Forty degrees is a hospital admission! Not a flight to Thailand!” However, not everyone was as judgmental, with many parents extending their sympathies to the first-time parents, as one person wrote, “You know what’s best for your baby. Everyone will say things. But only you will know when you are in that situation.” “Everyone is a first-time parent,” another defended. “This was a lesson learned. A baby’s health is of utmost importance. No holiday is more important than that. I hope he is OK now.” Image credits: TikTok

Travel Trouble

"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

How long does back pain last? And how can learning about pain increase the chance of recovery?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">have it this year</a>. Chronic pain, of which back pain is the most common, is the world’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">most disabling</a> health problem. Its economic impact <a href="https://www.ncbi.nlm.nih.gov/books/NBK92510/">dwarfs other health conditions</a>. If you get back pain, how long will it take to go away? We scoured the scientific literature to <a href="https://www.cmaj.ca/content/cmaj/196/2/E29.full.pdf">find out</a>. We found data on almost 20,000 people, from 95 different studies and split them into three groups: <ul> <li>acute – those with back pain that started less than six weeks ago</li> <li>subacute – where it started between six and 12 weeks ago</li> <li>chronic – where it started between three months and one year ago.</li> </ul> We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain. Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access. <h2>More pain doesn’t mean a more serious injury</h2> Most acute back pain episodes are <a href="https://www.racgp.org.au/getattachment/75af0cfd-6182-4328-ad23-04ad8618920f/attachment.aspx">not caused</a> by serious injury or disease. There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine. Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system. The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement. The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain. <h2>Reduce your chance of lasting pain</h2> Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain: <ul> <li> understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain </li> <li> reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal. </li> </ul> <h2>How to reduce your pain sensitivity and learn about pain</h2> Learning about “how pain works” provides the most sustainable <a href="https://www.bmj.com/content/376/bmj-2021-067718">improvements in chronic back pain</a>. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want. These programs have been in development for years, but high-quality clinical trials <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">are now emerging</a> and it’s good news: they show most people with chronic back pain improve and many completely recover. But most clinicians aren’t equipped to deliver these effective programs – <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">good pain education</a> is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure. When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">been told it’s all in their head</a>. Community-driven not-for-profit organisations such as <a href="https://www.painrevolution.org/">Pain Revolution</a> are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than <a href="https://www.painrevolution.org/find-a-lpe">80 local pain educators</a> and supported them to bring greater understanding and improved care to their colleagues and community. But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.<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/222513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, Post-doctoral Researcher, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, <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/how-long-does-back-pain-last-and-how-can-learning-about-pain-increase-the-chance-of-recovery-222513">original article</a>. </div>

Body

John Boland’s battle against prostate cancer and the urgent need for reform

John Boland, a 74-year-old retired Navy Reserve Lieutenant Commander, found himself at a crossroads – a place where hope and despair often meet in the lives of those battling life-threatening illnesses like prostate cancer. Diagnosed five years ago, John’s journey has been a relentless fight against a disease that, despite medical advancements, still claims the lives of 10 men in Australia every day. After undergoing surgery and 37 rounds of radiation therapy, John’s battle was far from over. His PSA (Prostate-Specific Antigen) levels, an indicator of prostate cancer activity, were not dropping sufficiently, signalling that the fight was only getting tougher. It was then that John was introduced to a groundbreaking treatment: Lutetium-177 PSMA therapy (LuPSMA), a targeted radionuclide therapy with pinpoint accuracy to attack cancer cells. This innovative treatment offered a glimmer of hope, a chance to strike at the heart of the disease that had disrupted his life. But there was a catch – the cost. Each round of LuPSMA treatment costs $10,000, and while some patients may require up to eight rounds, John’s doctors recommended two based on his response. Even so, the financial burden was immense, forcing John to dip into his superannuation, ultimately spending $60,000 on the treatment that was not covered by insurance. Despite the financial strain, the results were nothing short of miraculous. After just the first round, John’s PSA levels dropped by a staggering 95%. After the second, they fell to nearly zero. The treatment had not only attacked the cancer but had also restored his quality of life, allowing him to once again enjoy the simple pleasures – time with family, daily activities and even golf. It was a victory that brought renewed hope and confidence for the future, a victory that made the $60,000 investment worth every cent. “My case was remarkably successful after the second treatment, which are eight weeks apart, after the scan had no cancer, and my PSA was effective to zero. So it was a reliable result for me and a huge boost, but unfortunately, they're $10,000 a time, and you can require up to eight treatments,” says John. “Fortunately we were able to fund it from our superannuation pension account, the $20,000, but I imagine that a lot of people, they can’t find that $20,000.” But John’s story, while inspiring, also highlights a grim reality: many Australians are not as fortunate. The LuPSMA treatment that worked so well for John remains out of reach for many others due to its prohibitive cost. And this isn’t just an isolated issue; it’s a systemic problem affecting thousands of men across the country. A new report, the <a href="https://www.pcfa.org.au/media/nbennwom/aus-np-1123-80001-amgen-access-gap-report_april-2024-data-final-approved.pdf" target="_blank" rel="noopener">Australian Patient Access Gap Report</a>, has shed light on the alarming delay in the public availability of new medicines in Australia. The report reveals that Australians with life-threatening illnesses are waiting an average of 591 days – more than 18 months – for access to new, potentially life-saving medicines. For some, the wait can be as long as three years. These delays are not just statistics; they represent real people, real lives hanging in the balance. The Prostate Cancer Foundation of Australia (PCFA), the country’s leading organisation in the fight against prostate cancer, is calling for urgent reform. They argue that the current system, which often requires multiple rounds of review before new treatments are approved for public use, is failing Australians. PCFA CEO Anne Savage points out that while 10 men die from prostate cancer every day, the approval process for new treatments drags on, leaving patients like John Boland to fend for themselves – often at great financial and emotional cost. “In almost every instance, Australians are being denied access to new medicines that can extend and save their lives, simply because our approval systems have not kept up with the pace of change,” she says. “In relation to prostate cancer, applications typically undergo two or three rounds of review before achieving a positive recommendation, while 10 men die a day from the disease. It’s simply not good enough.” John’s story serves as a strong call to action. His successful treatment with LuPSMA is a testament to the power of modern medicine, but it also underscores the urgent need for change. No one should have to choose between their life savings and their life; it’s time for Australia to modernise its pharmaceutical benefits scheme, ensuring that all Australians, regardless of their financial situation, have access to the treatments they need. As we move forward, the PCFA is urging Australians to take part in initiatives like <a href="https://www.thelongrun.org.au/" target="_blank" rel="noopener">The Long Run</a> during Prostate Cancer Awareness Month in September, raising awareness and funds to support the fight against this devastating disease. For John Boland, and for the thousands of others who share his struggle, we must work towards a future where no one is left behind in the fight against cancer. Image: Courtesy of John Boland.

Caring

Major update in long-delayed William Tyrrell inquest

Almost 10 years after William Tyrrell went missing, an inquest into his disappearance is finally set to resume. The three-year-old disappeared from his foster grandmother’s home in Kendall on September 12th 2014, in what has become one of Australia’s most notorious missing persons cases. For 18 long months, an inquest before Deputy State Coroner Harriet Grahame examined William’s disappearance and suspected death, before it was adjourned in October 2020. Ms Grahame’s findings were due to be handed down in June 2021, but the inquest was pushed back indefinitely as prosecutors grappled with evidence concerning the missing boy’s foster mother. As the investigation into William's disappearance continues, his body has never been found and his foster parents have persistently denied having any involvement. Now, after three years of delays, a directions hearing at the NSW Coroner’s Court in Western Sydney on Tuesday confirmed a final block of hearings will commence later in the year. Starting the weeks of November 4th and December 16th, witnesses will be recalled to the stand as the inquest is formally recommenced, with the court saying that the witness list and list of issues was set to be finalised within a few days. No one has been charged in the case of William's disappearance and a $1 million reward for information still stands. Image credits: NSW Police

Legal

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

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>

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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>

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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>

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Attempted assassination of Trump: The long history of violence against U.S. presidents

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/thomas-klassen-1171638">Thomas Klassen</a>, <a href="https://theconversation.com/institutions/york-university-canada-1610">York University, Canada</a> Political assassinations in the United States have a long and disturbing history. The <a href="https://apnews.com/article/trump-vp-vance-rubio-7c7ba6b99b5f38d2d840ed95b2fdc3e5">attempted assassination of Donald Trump</a>, who narrowly escaped death when a bullet grazed his right ear while he was speaking at a campaign rally in Pennsylvania on Saturday, highlights the danger of those seeking votes in a country whose constitution guarantees citizens the right to bear arms. Trump joins a not-so-exclusive club of U.S. presidents, former presidents and presidential candidates who have been the target of bullets. Of the 45 people who have served as president, four have been <a href="https://abcnews.go.com/US/wireStory/us-presidents-assassinated-targeted-presidential-candidates-111920908">assassinated while in office</a>. Given the near mythic status of U.S. presidents, and the nation’s superpower role, political assassinations strike at the very heart of the American psyche. <a href="https://www.loc.gov/collections/abraham-lincoln-papers/articles-and-essays/assassination-of-president-abraham-lincoln/">Abraham Lincoln</a>’s killing in 1865 and that of <a href="https://theconversation.com/jfk-assassination-60-years-on-seven-experts-on-what-to-watch-see-and-read-to-understand-the-event-and-its-consequences-216203">John F. Kennedy</a> in 1963 are key moments in the history of the United States. <a href="https://www.history.com/news/the-assassination-of-president-james-a-garfield">James Garfield</a> (1881) and <a href="https://www.history.com/news/the-assassination-of-president-william-mckinley">William McKinley</a> (1901) are less remembered, but their deaths nonetheless rocked the nation at the time. <h2>Secret Service provides protection</h2> It was after McKinley’s assassination that the U.S. Secret Service was given <a href="https://www.secretservice.gov/about/history/150-years#:%7E:text">the job of providing full-time protection to presidents</a>. The last American president to be shot was Ronald Reagan, <a href="https://www.reaganlibrary.gov/permanent-exhibits/assassination-attempt">who was seriously wounded and required emergency surgery in 1981</a>. Reagan was leaving a Washington hotel after giving a speech when gunman John Hinckley Jr. fired shots from a .22-calibre pistol. One of the bullets ricocheted off the president’s limousine and hit him under the left armpit. Reagan spent 12 days in hospital before returning to the White House. Other presidents have been shot at, but luckily, not injured. In 1933, <a href="http://www.fdrlibraryvirtualtour.org/page03-06.asp">a gunman fired five shots at the car of then President-Elect Franklin D. Roosevelt</a>. Roosevelt wasn’t hit but the mayor of Chicago, Anton Cermak, who was speaking to Roosevelt after the newly elected president had made some brief remarks to the public, was injured and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297642/">died 19 days later</a>. <h2>Two attempts in one month</h2> In September of 1975, President Gerald Ford survived <a href="https://www.fordlibrarymuseum.gov/avproj/assassinations.asp">two separate assassination attempts — both by women</a>. The first came on Sept. 5 when Lynette (Squeaky) Fromme, a follower of cult leader Charles Manson, tried to shoot Ford as he was walking through a park in Sacramento, Calif., but her gun misfired and didn’t go off. On Sept. 22, Sara Jane Moore, a woman with ties to left-wing radical groups, got one shot off at Ford as he left a hotel in San Francisco but it missed the president. Presidential candidates have not been exempt from assassination attempts, including most notably Senator <a href="https://www.npr.org/2023/06/05/1179430014/robert-kennedy-rfk-assassination-anniversary">Robert F. Kennedy</a> killed in 1968 and <a href="https://www.wsfa.com/2024/07/14/son-late-alabama-gov-george-wallace-reacts-trump-rally-shooting/">George Wallace</a> shot and left paralyzed in 1972. In 1912, former president Theodore Roosevelt <a href="https://blogs.loc.gov/headlinesandheroes/2019/07/the-pocket-items-that-saved-the-life-of-theodore-roosevelt/">was hit in the chest by a .38-calibre bullet</a> as he was campaigning to regain the White House. But most of the impact of the bullet was absorbed by objects in the chest pocket of Roosevelt’s jacket. Even though he had been shot, Roosevelt went on to make a campaign speech with the bullet still in his chest. <h2>The violence of 1968</h2> Other figures with significant — if unelected — political power have also had their lives cut short by gunfire, most notably <a href="https://theconversation.com/mlks-vision-matters-today-for-the-43-million-americans-living-in-poverty-92380">Martin Luther King Jr.</a> in 1968, just a few months before Bobby Kennedy’s death. In a country with <a href="https://www.washingtonpost.com/news/wonk/wp/2018/06/19/there-are-more-guns-than-people-in-the-united-states-according-to-a-new-study-of-global-firearm-ownership/">more guns than people</a>, and with firearms easily available, it is not surprising that invariably shootings are the preferred means of killing or attempting to kill political office holders. Like Trump, most assassination attempts occur when candidates and politicians are in public spaces with crowds of people nearby. There is a long history of politicians insisting, against the advice of their security advisers, to “press the flesh” in events that jeopardize their safety. Trump was extraordinarily fortunate to escape with only minor injuries.<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/234630/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/thomas-klassen-1171638">Thomas Klassen</a>, Professor, School of Public Policy and Administration, <a href="https://theconversation.com/institutions/york-university-canada-1610">York University, Canada</a> Image credits: Xinhua News Agency/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/attempted-assassination-of-trump-the-long-history-of-violence-against-u-s-presidents-234630">original article</a>. </div>

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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>

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The world’s longest cruises

If you’re looking for your next cruising adventure, there are a multitude of time frames you can pick from for your next holiday. While many cruise-goers tend to opt for just a week or two at sea, there are other voyages that can see you spend months travelling the world. Here are ten of the longest cruise journeys that are available for the most dedicated travellers. Queen Anne - 107 days In 2025, new Cunard ship Queen Anne will embark on her maiden World Voyage which includes her first visit to Australia and New Zealand. The 107-day journey starts with a transatlantic crossing before sailing to destinations in the Americas, Australasia, Asia, the Arabian Gulf and finally the Mediterranean. Crown Princess - 113 days The Crown Princess is set to embark on an epic around the world cruise next year, and you can get on in Australia or New Zealand. From there, the voyage will visit 49 destinations in 28 countries over 113 days, crossing the equator twice, and sailing 33,500 nautical miles. MSC Magnifica - 119 days MSC's World Cruise 2026 lasts 119 days, with options to book the entire round-the-world itinerary for the most dedicated travellers. The trip starts in Italy, and takes in the Mediterranean before heading across the Atlantic to the Caribbean and South America, before it then sails to California before crossing the Pacific for Hawaii, New Zealand and Australia. Seabourn Sojourn - 129 days Seabourn's 2026 World Cruise sets sail on January 6th 2026 from LA, before taking in Hawaii, South Pacific islands, New Zealand, Australia and the Far East and Asia before heading Alaska and concluding in Vancouver, Canada. That's a total of 63 ports in 14 countries with seven overnight stays. Volendam - 133 days Holland America’s lengthy journey, titled Pole to Pole, takes a round trip from Fort Lauderdale in Florida it visits spots as diverse as Costa Rica, Antarctica, Morocco, France and Canada. Crystal Serenity - 135 days Crystal's 2026 World Cruise is an epic 135-day journey travelling to 72 destinations throughout 27 countries. Departing Los Angeles, Crystal Serenity will traverse the waters of the Pacific taking in the Marquesas Islands, Bora Bora, New Zealand and Sydney, as well as travelling to Hong Kong, Mumbai and Dubai. Seven Seas Splendour - 140 days Guests onboard the Regent Seven Seas Cruises will visit 40 countries over six continents, spending 140 nights onboard the luxurious ship. The voyage visits locations such as Panama, Sri Lanka and Spain, visiting 71 ports around the world. Silver Dawn - 149 days Silversea Cruises' Silver Dawn will explore 80 destinations, covering 35 countries on five continents, including 11 overnight stays. Viking Sky - 163 days The cruise ship Viking Sky will sail for an impressive 163 days on its World Voyage II, taking in 34 countries, with 79 guided tours. Ports of note include Rarotonga in the Cook Islands, Darwin Australia, Colombo Sri Lanka, Cape Town, South Africa and the Shetland Islands in Scotland. Oceana Vista - 197 days The 2026 World Odyssey voyage of Vista will circumnavigate the world, visiting over 100 ports across 43 countries. The voyage visits over 80 UNESCO World Heritage sites across 101 destinations, with 11 overnight stays. Image credits: Shutterstock

Cruising

Long-serving ABC star calls it quits

Paul Barry, the veteran host of Media Watch, who has made a career out of poking the media bear, has announced his departure from the ABC show in December. After an illustrious (and occasionally infamous) tenure that would make a soap opera look like a nap, Barry is hanging up his microphone at the ripe age of 72. “I’ve been in the hot seat for 11 years and it’s time to give someone else a go,” Barry remarked, possibly while the hot seat sighed in relief. Indeed, hosting Media Watch is no small feat – it's a bit like riding a roller coaster while simultaneously refereeing a brawl. But Barry has certainly done it with aplomb, panache and a fair amount of flair. His announcement has left viewers with mixed feelings – a blend of gratitude for his unyielding service and a tinge of sadness, akin to the bittersweet end of a beloved TV series. Barry promised to stay with us until December, giving us ample time to stock up on popcorn and enjoy the remaining episodes. "Lots of fun to be had before then," he teased, hinting at some final rounds of media mischief. For those who might be wondering what Barry plans to do next, well, that's still a mystery. Perhaps he'll take up knitting, but knowing him, it’ll likely be with barbed wire. Barry first commandeered Media Watch in 2000 before returning in 2013, making a grand comeback that rivalled any reality TV show. Over the years, he has ruffled enough feathers to fill a sizeable pillow factory. Commercial media outlets, politicians and even his own network – as Media Watch famously runs independently of the ABC – have all been on the receiving end of his sharp critiques. His fearless approach has made him a hero to many and a headache to some. One of Barry’s most memorable moments came in 2013 during a spat with columnist Andrew Bolt. When Bolt provocatively asked Barry to reveal his salary on air, Barry did just that – $191,259, to be precise. It was a jaw-dropping moment that left viewers stunned and Bolt, presumably, a bit flummoxed. In between his stints at Media Watch, Barry has donned many hats – investigative reporter for the Sydney Morning Herald, correspondent for 60 Minutes, and author of several books, including a controversial unauthorised biography of James Packer. His career has been a veritable smorgasbord of journalism, controversy and unflinching honesty. An ABC spokesperson paid tribute to Barry, highlighting his “track record of independent commentary, analysis, and robust discussion about the media industry and its ethics – or lack thereof.” Barry has indeed been the watchdog’s watchdog, never shying away from calling out malpractice, no matter where it reared its head. As the ABC gears up to announce a new host, the shoes left behind are large ones to fill. Barry’s departure marks the end of an era – one filled with wit, grit and an unwavering commitment to holding the media accountable. So, here’s to Paul Barry – the feather-ruffler, the truth-seeker, the man who made us laugh, gasp and, most importantly, think. As he steps down from Media Watch, we wish him the very best in his next adventure, whether that’s taking on new journalistic endeavours or finally perfecting that tricky scarf pattern. Bravo, Mr Barry. You will be missed. Image: Media Watch

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The world’s longest cruises

Long-serving ABC star calls it quits

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