In the latest edition of the COVID-19 wrap, public health researcher Alison Barrett brings you resources from the Campbell Collaboration, global perspectives on healthcare worker infections, the latest news from Aotearoa/New Zealand and more.
Editorial: Fifty Campbell systematic reviews relevant to the policy response to COVID-19
Campbell Editorial Board, 10 August 2020
Due to the time-sensitive and lifesaving decisions governments need to make in response to the COVID-19 pandemic, it is vital that they are being informed by reliable and strong evidence.
The Campbell Collaboration has published a virtual issue of 50 Campbell systematic reviews that can inform governments’ economic and social policies in response to the pandemic.
These include reviews on how to promote handwashing, interventions to improve youth employment and promote wellbeing among children who have been exposed to intimate partner violence, and emergency cash distribution.
Figure: Campbell Collaboration reviews that are relevant to the social and economic response to COVID-19. Image source: The Campbell Collaboration, under Creative Commons license.
Campbell systematic reviews are peer-reviewed and follow a structured process in order to produce rigorous, high-quality assessments of economic and social programs and policies.
The collated systematic reviews can be found here.
COVID-19 Global Trends and Analyses – Victorian healthcare workers, genomic sequencing and second waves
Toole, M, et al., Burnet Institute, August 2020
The most recent publication of the Burnet Institute’s COVID-19 Global Trends and Analyses (7 – 20 August 2020) discusses current global trends and the risk of infection for healthcare workers.
As of 25 August, 2,785 Victorian healthcare workers have been infected with the coronavirus; approximately 70 percent of those were infected at work.
While the exact sources for the infected healthcare workers is unclear, for those working in areas of high infection risk, adequate personal protective equipment (PPE) is vital. Evidence-based methods for donning and doffing PPE, training and best types of PPE are outlined in this analyses.
Other topics discussed in this report:
- Genomic sequencing by The Doherty Institute indicates approximately 90 percent of the current cases in Victoria can be linked back to a family of four quarantined at Rydges Hotel in Melbourne in May; and most of the other cases can be linked to an outbreak of quarantined people at the Stamford Plaza Hotel.
- Most countries in Europe, Hong Kong and Japan are experiencing a second wave and increase in cases.
- Sixty percent of the global cumulative cases of COVID-19 are in United States, Brazil, India, Russia and South Africa.
- While daily cases are very high in India (averaging over 60,000 per day), they are declining in Pakistan and Afghanistan.
- Vietnam reported its first case of community transmission in 99 days and, after no deaths for the first five and a half months of the pandemic, they have now reported 27 deaths from COVID-19.
The Burnet Institute’s Knowledge Hub for COVID-19 regularly publish updates on research, policies and technical reports.
Policy briefs include information about responses to second waves in South Korea and Israel, evidence for face masks and the impact of COVID-19 on people who use methamphetamine in Victoria. 
Change in the incidence of stillbirth and preterm delivery during the COVID-19 pandemic
Khalil, A, et al., JAMA, 10 July 2020
In St George’s University Hospital, London, researchers have found a significantly higher incidence of stillbirths during the COVID-19 pandemic, when compared to a period prior to the pandemic.
Khalil and colleagues compared pregnancy outcomes, including preterm births, caesarean delivery and stillbirth in two time periods, 1 October 2019 to 31 January 2020 and 1 February to 14 June 2020.
No statistically significant differences were found in other pregnancy outcomes; however, stillbirths had increased from 2.38 per 1,000 births in the pre-pandemic period to 9.31 per 1,000 births during the pandemic period.
No indication of SARS-CoV-2 infection was found in post-mortem examinations and while none of the women who had stillbirths experienced symptoms of the virus, universal testing for COVID-19 in pregnant women did not begin in United Kingdom until 28 May 2020. It is unclear if any of the women prior to that may have been asymptomatic, and thus a potential cause for the increase in stillbirths during the pandemic.
The researchers suggest the increase could also be indirectly related to the COVID-19, with pregnant women potentially decreasing visits to their healthcare team for fear of being infected with the virus or overburdening the national health system.
As the study was conducted over a short-time frame, with a small population and information about hospital visits or pregnancy care were not assessed, it is difficult to understand the exact reason for the increase.
However, the results indicate that further, long-term research is required and that it is important for pregnant women to maintain their regular health checks.
Face masks can be devastating for people with hearing loss
Chodosh, J et al., BMJ Editorial, 9 July 2020
With health workers recommended to wear face masks as a preventive measure against SARS-CoV-2, communication in hospital and medical care settings can be a challenge for people with hearing loss who rely on facial expressions and lip movements to communicate.
Chodosh and colleagues briefly outlined some ways that medical staff and healthcare workers can communicate with people with hearing loss while wearing a face mask, highlighting that “innovation is urgently needed to ensure clear communication in medical settings”.
Firstly, it is important to identify if the patient is understanding what is being said by facing the patient, attracting their attention before speaking slowly and determining if they respond, an indication they have heard or not.
Useful tools that may help enable communication include: white boards, writing pads; speech-to-text transcription apps on smartphones; face masks with clear windows that allow the patient to view facial expressions and lip movements and; virtual consultations on video communication platforms such as Zoom, Microsoft Teams, and Google Meet.
However, face masks with clear windows are currently not in mass production and video communication platforms need to improve their real time speech-to-text captioning for people with severe hearing loss- both areas for innovation, the authors suggest.
“Adopting simple strategies can help maximise communication while innovation ramps up,” the authors conclude.
‘We felt we had beaten it’: New Zealand’s race to eliminate the coronavirus again
Lewis, D, Nature News, 14 August 2020
As reported in the last COVID-19 wrap, after 102 days without any community transmission of COVID-19, four cases were reported in Auckland on 11 August.
As of 25 August, this cluster (a group of ten or more confirmed or probable cases that are connected and not from the same household) has increased to 109 cases, and the source of the outbreak is still under investigation.
In this Nature News article, Dyani Lewis spoke to New Zealand (NZ) epidemiologist, Dr Amanda Kvalsvig, about the current outbreak and possible theories about its origins.
As in the early stages of COVID-19 in Aotearoa/New Zealand, the latest public health measures to contain this outbreak have been implemented promptly and decisively by the NZ Government. Residents of the Auckland region are currently in Alert Level Three (people to stay at home except for essential movement) and the rest of the country are at Alert Level Two (with limits on large gatherings and physical distancing).
Kvalsvig advised that face mask wearing is also strongly being recommended; and contacts of the confirmed cases are being traced, tested and isolated if positive.
One of the possible causes for the outbreak being explored is via packaging in a cold storage facility where one of the first people identified in this cluster work.
However, Kvalsvig, along with others including NZ’s Director General of Health Ashley Bloomfield, say it is most likely the outbreak originated via person-to-person contact. And, while it is possible that community transmission has been undetected for some time, at present it is believed the likely origin of the outbreak is through a recent introduction at the border.
Kvalsvig said genomic sequencing was used in the early stages of COVID-19 in New Zealand to “link cases to a known cluster when conventional public health methods hadn’t been able to establish the link,” and will hopefully be useful in determining the source of the current outbreak.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
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