In the latest edition of the COVID-19 wrap, public health researcher Alison Barrett reports on human rights failures, research retractions and social media tips, as well as providing an overview of a host of new resources, including about the needs during the pandemic of refugees, young children with disability and people with cancer.
The right to health must guide responses to COVID-19
Puras, D et al, The Lancet, 29 May 2020
The right to health means that health services, goods and facilities are available and accessible (financially, geographically, and non-discriminatorily), culturally appropriate and good quality.
In responding to the COVID-19 pandemic, many countries have experienced challenges in providing adequate healthcare to their people, with shortages of personal protective equipment and testing kits, or structural barriers that have meant more vulnerable populations have not been able to afford access to essential services.
Addressing the social determinants of health, including access to safe drinking water, food, and protection from violence, are essential to addressing human rights to health.
Inequalities in social determinants have resulted in disproportionate risks of COVID-19 to many vulnerable populations.
While public health measures to stay at home are important to minimise the risk of wide-spread COVID-19 infection, it means that vulnerable populations may become more disadvantaged. For example, keeping children home from school may further limit education, especially in countries with limited access to internet and online teaching. As well, staying at home may prevent purchasing of basic needs, and may increase risk of infection if home conditions are overcrowded or lack basic hygiene.
“The right to health recognises international assistance and cooperation as central to the COVID-19 response,” the authors write.
All states that are able to do so should assist by:
- sharing research, knowledge, and medical supplies
- limiting economic sanctions, and
- working together to decrease economic and social impacts of the pandemic.
However, to date, many countries have not provided enough international support to the most vulnerable populations, despite pleas from WHO for global solidarity.
In conclusion, the authors say: “The COVID-19 pandemic has been exacerbated by human rights failures, yet the right to health can provide a framework for assuring that the COVID-19 response serves to realise the right to the highest attainable standard of physical and mental health for all.”
Hydroxychloroquine developments: trials, results and retractions
Two weeks after its publication in The Lancet, one of the largest observational studies to date on the effects of hydroxychloroquine or chloroquine on COVID-19 patients was retracted.
The study, published on 22 May, reported finding that the use of hydroxychloroquine or chloroquine in patients with COVID-19 did not result in any benefits as a treatment for the virus; and was associated with an increased risk of ventricular arrhythmias and in-hospital death with COVID-19.
Hydroxychloroquine and chloroquine have been used to treat malaria for many years; as a result, it is already in production and available to dispense. Many doctors have been prescribing it to treat COVID-19 patients without empirical evidence of its effects on the novel coronavirus.
A French study published in March 2020 motivated the United States to begin stockpiling hydroxychloroquine and President Donald Trump to confirm he was taking the medication as a preventive measure. In Australia, Clive Palmer announced he purchased 32.9 million doses of hydroxychloroquine for Australia’s fight against COVID-19.
As a result of the findings by Mehra and colleagues, the World Health Organization paused the hydroxychloroquine part of their Solidarity Trial; and researchers from the University of Oxford, UK, and Mahidol Oxford Tropical Medicine Research Unit, Thailand, paused their clinical trial on the drug.
Because the study prompted these important clinical trials to temporarily stop, it was widely examined by researchers around the world; and on 28 May, medical professionals and researchers published an open letter to the authors of the study and editor of The Lancet, voicing concerns about the integrity of the data and statistical analysis.
Some of the concerns they expressed were that no ethical approval was reported; the data described from Australia and Africa did not match government records for the study period; and known confounders were not adjusted sufficiently.
They urged the need for rigorous randomised controlled trials to determine the impact of hydroxychloroquine on COVID-19 patients.
The hydroxychloroquine arm of WHO’s Solidarity Trial has since resumed, and a large number of other trials to determine the effects of hydroxychloroquine and/or chloroquine on COVID-19 patients continue. As of 8 June, 212 are registered with clinicaltrials.gov.
In response to concerns about the study by Mehra and colleagues, The Lancet Editors published an expression of concern on 3 June advising readers that the validity of the study was being reviewed. On 5 June, a retraction was published by three of the study’s original authors, stating:
Our independent peer reviewers informed us that Surgisphere [the source of the data] would not transfer the full dataset, client contracts, and the full ISO audit report to their servers for analysis as such transfer would violate client agreements and confidentiality requirements.
As such, our reviewers were not able to conduct an independent and private peer review and therefore notified us of their withdrawal from the peer-review process.”
In the same week, the same authors retracted a study on the effects of ACE inhibitors and angiotensin-receptor blockers (ARBs) on patients with COVID-19, as data for this study was also sourced from Surgisphere.
As a result of this situation, the peer review process has come under question, as has the use of data obtained from third-party’s; and has ultimately caused delays to the valuable studies required to determine the effect of hydroxychloroquine and chloroquine as a therapy for COVID-19.
It is vital for studies to continue until effects can be confirmed, especially as despite safety concerns, countries such as India are continuing to use hydroxychloroquine.
(Also read more on this topic from Associate Professor Lesley Russell in the 9 June edition of The Health Wrap).
Social Media and Emergency Preparedness in Response to Novel Coronavirus
Merchant, RM & Lurie, N, JAMA, 23 Mar 2020
With 2.9 billion individuals using social media regularly, it is an important tool that can be used in response to the COVID-19 pandemic.
Merchant and Lurie provide the following guidelines and suggest that social media during the pandemic can be used to:
Direct people to trusted sources
World Health Organization, Centers for Disease Control and Prevention and many reputable health bodies around the world post regular updates and information across various social media platforms.
Facebook, Google Scholar and Twitter also have been directing users to reliable resources.
Healthcare organisations, influencers, and clinicians can use their social media accounts to direct traffic to these trusted sources of information.
Pitfalls to the widespread use of social media include the massive amount of information being shared, and that some of this information is incorrect or based on rumour.
As a result, it can be hard for people to find reliable information.
Merchant and Lurie suggest that research is needed to understand the origins of misinformation and that coordinated efforts are required to stop its spread from the original source.
When responding to misinformation, Associate Professor Darren Saunders advises avoiding posting direct links to conspiracies or rumours as this enables more people to see this information on their social media feeds. He recommends taking a screen shot of it instead.
Disseminate reliable testing and diagnosis information
Social media can be used to distribute information about COVID-19 testing criteria and where to seek healthcare.
This enables users to do a quick assessment of their symptoms and decide their best course of action. With sharing functions on all social media platforms, users can then share this information with their networks, which may motivate others to do the same.
Enable connectivity and psychological first aid
“Navigating social isolation will be particularly challenging for already disadvantaged populations.”
Social media can be used to not only raise awareness about the needs of these groups during crisis, but also mobilise support and resources in the lack of physical contact, in particular the ‘safety check’ and ‘crisis response’ functions could enable regular status updates in these populations as a means of checking in.
The authors also suggest that psychological first aid could be delivered via chatbots in ways to support recovery during the pandemic when in-person contact is not as readily available.
Advance remote learning
New methods of developing education of healthcare professionals is needed, the authors write. With clinical and laboratory training being impacted by physical distancing measures, social media could be used to facilitate contact among students and support learning.
This may also enable sharing experiences and knowledge with wider audiences.
Not only can research be promptly shared on social media, platforms such as Facebook are also contributing to COVID-19 research.
Through anonymising location data, Facebook can provide information to researchers to help determine how the virus is spreading.
Enable a culture of preparedness
Lessons from the 1918 influenza pandemic demonstrated the importance of understanding how individuals interact and how information spreads. In 1918, information about the pandemic occurred by telephone, mail or person-to person communication. In 2020, we have the access to a wide range of technologies that are capable of spreading information rapidly.
“Integrating social media as an essential tool in preparedness, response, and recovery can influence the response to COVID-19 and future public health threats,” the authors say.
COVID-19 related resources
A list of expressions of concern and retractions of papers about COVID-19.
Lancet Migration: Global collaboration to advance migration health
“People on the move, whether they are economic migrants or forcibly displaced persons such asylum seekers, refugees, and internally displaced persons, should be explicitly included in the responses to the coronavirus disease 2019 pandemic (COVID-19).”
This resource platform has been developed to share knowledge across different regions and emphasise how important it is to include refugees and migrants in the COVID-19 response.
Analysis and Policy Observatory
An open access evidence platform, where public policy research and resources are made accessible.
Some of the COVID-19 reports they’ve collated include:
Travel restrictions had a huge impact on staff of Aboriginal Community Controlled Health Services (ACCHS), many of whom are ‘fly-in fly-out’ and therefore, needed accommodation whilst quarantining, which had a flow-on impact on human resources. This report outlines some of the hidden impacts of COVID-19 restrictions on ACCHS in Western Australia.
This report discusses the impact of COVID-19 measures and policies on Aboriginal and Torres Strait Islanders, in particular to human rights, those in prisons and youth detention centres and regulation of the public health regulations.
A survey conducted by Children and Young People with Disability Australia organisation found there was a lack of information about COVID-19 targeting children and young people with disability. As well, uncertainty about education meant that progress gained by children and young people with disability would be lost. This report describes in detail the key findings of the survey.
This document outlines how Australia’s development efforts will work to address challenges of COVID-19 in the Indo-Pacific region.
A conceptual framework for managing cancer during COVID-19 and future pandemics was developed by Cancer Australia, following principles of Optimal care pathways for people with cancer.
To view more policy and research reports, visit their website here.
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.
See previous editions of the COVID wrap.