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The Health Wrap: concerns about COVID complacency and confusion, plus “interesting” times in the United States and United Kingdom

Introduction by Croakey: An emerging wave of COVID-19 infections has prompted a new bout of messaging from health authorities, although the advice and emphasis varies between jurisdictions.

Please contribute to this Croakey Twitter thread sharing news and analysis on COVID communications – how the federal, state and territory governments are responding (or not) to the new wave of infections, and whether the public is receiving clear, consistent messaging (or not).

In her latest column, Adjunct Associate Professor Lesley Russell gives a sobering overview of COVID management, and reports on new pandemic recommendations that emphasise the importance of clear communications and “public health messages that build and enhance individual and community trust”.

As we watch the United States midterm elections unfold, Russell also brings timely reports on health news from the US, as well as the United Kingdom – and some enticing photos from a long walk on Noongar Country.


Lesley Russell writes:

Amid warnings from experts that COVID-19 infections are on the rise again in Australia and new variants are circulating, it’s sobering – or maybe scary is a better word – to see the lack of attention politicians are paying to the ongoing pandemic.

Moreover, it’s becoming increasingly difficult to access up-to-date information to track infections, hospitalisations, deaths and vaccinations.

Mandatory reporting of positive rapid antigen test (RAT) results ceased in Victoria and New South Wales in October, and all jurisdictions are updating reports less often and in more aggregated ways. As I write, the most recent data available on the Federal Department of Health website is from 25 October and deaths are now given as a rolling seven-day average.

An article on the ABC News website summarises the current situation well, ‘Australians warned of ‘another COVID wave’ as sub-variants take hold’.

How prepared is Australia for another possible wave of new infections? My sense is that little has been done at either the federal or state and territory levels to prepare for this possibility, and that “pandemic fatigue” has set in – both figuratively and literally.

Yet the costs to the economy, the healthcare system, families and individuals continue: in the week ending November 4, just for New South Wales, there were 809 people in hospital, 17 people in intensive care, and 24 COVID-related deaths.

Little or nothing is currently being done to urge people to get vaccinated and there is much confusion among the public and the medical profession about the availability of the newly-approved Moderna bi-valent vaccine and who is eligible for a fifth vaccine dose.

It appears that the lack of public information about the bivalent vaccine may be due to a lack of supply. An article in the RACGP Newsletter indicates that the 15 million doses promised by former Health Minister Greg Hunt will not be delivered in 2022.

The vaccine situation in Australia is currently a neglected mess. The Federal Government is yet to secure updated mRNA vaccine doses for 2023 and into the future, despite the warnings from the recent Halton review of an “anticipated shortfall”.  Some vaccines are going to waste, especially Novavax.

Department of Health data show that, as of 26 October, 20.05 million Australians aged 16 and over have had at least one dose of vaccine, 19.97 million have had two doses, 14.26 million have had three doses, and 4.99 million have had four or more doses.

It is good to see that 96.1 percent of aged care residents have now had three or more doses but concerning that only 76.3 percent of NDIS participants have had three doses. Even more worrying is the fact that only 56 percent of eligible Aboriginal and Torres Strait Islander people have had three or more doses.

Since the pandemic began, 10,383,000 cases of COVID-19 have been reported and there have been 15,678 deaths (it’s telling that it’s easier to get this information from the New York Times website than from the Department of Health).

However, an article just published by the National Centre for Immunisation Research and Surveillance reports that serological surveys show that actual infection rates are higher.

At least two-thirds of Australians, including children and adolescents, have had COVID-19. These findings come from two national serosurveys (current to the end of August 2022), one in children and adolescents and the other in adults.

The children and adolescents survey found at least 64 percent of 0–19 year-olds in Australia had been infected with SARS-CoV-2. In unvaccinated children aged 1–4 years, approximately 8 out of 10 had evidence of past infection.

The adults survey found at least two-thirds of the adult population had been infected with SARS-CoV-2, with approximately 20 percent of these since the previous survey in June 2022.

As Dr Gideon Meyerowitz-Katz and Professor Greg Dore state in their recent opinion piece in the Sydney Morning Herald, “It’s possible that COVID-19 will continue to be one of the biggest public health issues for a long time to come.”

Watch the video with Dr Kerry Chant.
Watch the video with Professor Brett Sutton.


Global roadmap for ending the pandemic

It’s an easy segue from the topic above to some international efforts to address the pandemic. Perhaps Australia can learn from these?

A large, multidisciplinary panel of 386 experts from over 100 countries has just published a roadmap for ending the pandemic in Nature.  This includes 41 consensus statements and 57 recommendations, broken down into six primary categories (communication, health systems, vaccination, prevention, treatment and care, and pandemic inequities). It took 14 months to develop.

The panel largely focused on trust in governments, the consequences of misinformation, and the dissemination of large volumes of new COVID-related information. It noted that “governments themselves may be a source of misinformation”.

To tackle these issues, the panel called for improved collaboration between community leaders, scientific experts, and public health officials “to develop public health messages that build and enhance individual and community trust.”

They encourage public health officials to use “clear, direct, culturally responsive messaging that is free of unnecessary scientific jargon” as a way to address misinformation and develop trust.

In addition, the panelists called for more attention to be paid to the disproportionate effects of COVID-19 on vulnerable populations, emphasising the need for high-income countries to fund equitable access to vaccines and treatments for lower-income countries.

In an editorial in StatNews, several of the participants wrote that, at times, they had wondered if the effort was worth it, as “it seems like most of the world’s political leaders are already rushing to declare victory over COVID-19″.There are a number of other international roadmaps out there, including this: An equitable roadmap for ending the COVID-19 pandemic.

Australian researchers, led by Professor Jeffrey Braithwaite, have looked at 40 national health systems (including Australia) to identify common national factors associated with effective pandemic responses.  Understanding these is central to informing future pandemic planning.

Their study investigated the relationships between national governments’ initial capacity to respond, their level of early response stringency, scope of COVID-19 testing, and the associated public health consequences. This work was done for data from early 2020 – so Australia rates highly.

Australia fell into a cluster that included South Korea, Iceland and Taiwan. These countries implemented relatively early stringency measures and a broad approach to testing. These actions were associated with a change in the disease outcome trajectory. By the end of April 2020, the curve for new cases had flattened in this cluster, and these national health systems reported the lowest rate of COVID-19 deaths.

In what the authors describe as a “counter-intuitive” finding, there was no association between pre-pandemic governments’ inherent capacity to respond and actual response.

They suggest that other factors such as the political landscape, effectiveness of pandemic leadership, willingness to listen to medical science and capacity to learn fast and early were more important than capacity to respond.


Health news from the United Kingdom

It would not be an overstatement to say that United Kingdom politics is currently a mess. And that means there are major consequences for the healthcare system – already under strain from endless “reforms” and the pandemic.

Under the brief tenure of Liz Truss as Prime Minister, Therese Coffey was appointed Health Secretary. There were concerns about the appropriateness of this choice, given her record on issues like smoking and obesity (and it should be noted that Truss is also a long-standing sceptic about tobacco control).

Since her election in 2010, Coffey has voted against measures to restrict smoking, including a ban on smoking in public spaces, the outlawing of smoking in cars with children and plain packaging for cigarettes.  As Health Secretary, she indicated that that the Government’s long-awaited tobacco control plan did not align with her priorities for health and might never see the light of day.

Coffey also scrapped the government’s long-promised white paper on health inequalities.  This paper, meant to appear last spring, was a key part of then-Prime Minister Boris Johnson’s commitment to address the 19-year gap in life expectancy between the rich and poor and the stark inequalities in health exposed by the pandemic.

Public health has struggled to get the attention is needs in the United Kingdom. I have previously written about changes in the public health agencies. See for example The Health Wrap editions from 23 June 2020 and from 15 September 2020.

My guess is that public health advocates breathed a sigh of relief when, on the appointment of Rishi Sunak as Prime Minister, Coffey was shuffled off to the Environment, Food and Rural Affairs portfolio where she is already in strife.

The chair of the Office for Environmental Protection has told Coffey that the possibility of taking formal enforcement action against the government over multiple missed targets, including those on water quality and halting the decline in nature, was being kept under active review.

The new Secretary of Health and Social Care is Steve Barclay, who served in the same position during the last few weeks of Boris Johnson’s government and was a junior health minister for 11 months in 2018. He comes with an unpleasant reputation as a bully, a micro-manager of the wrong things and has been described as “NHS leadership’s worst nightmare.”

Aside from the toll the pandemic is continuing to take in the NHS, it is also in the middle of major structural reforms. On 1 July across England, 42 new Integrated Care Boards (ICBs) became statutory bodies, part of the most far-reaching NHS reforms for at least a decade.

This approach sweeps away much of the pro-competition framework that has been the basis of the NHS for decades. It is supported by many NHS leaders, but it will require a huge effort to achieve the aim of a more collaborative and integrated health and care system.

A recent report from the National Audit Office has warned that the new integrated care systems will struggle to deliver long term improvements in people’s health amid “extreme” funding and staffing pressures in the NHS and social care.

The report states that for the new system to succeed, ministers must tackle workforce shortages, ensure sustainable NHS finances, and coordinate measures across government to tackle wider determinants of ill health. It said that the government has made “little progress” on action to tackle matters beyond clinical healthcare that contribute to poor health.

It appears that the upcoming “autumn budget” will not cut health spending, but cabinet ministers have been told there would be a “program of reform” for under-performing trusts. Jeremy Hunt, the chancellor and a former health secretary, has warned the government expects the NHS and Department of Health and Social Care to find “new efficiencies”.


Health news from the United States

After condemning British politics, what can I say about politics in the United States? One thing is certain – there will be changes (and almost certainly not for the better) after the midterm elections on 8 November.

I think Republicans are almost certain to take the House with a swing in the 20-30 seat range. The Senate is still a toss-up with races in Georgia, Arizona, Pennsylvania and Nevada too close to call. With lots of Republicans who believe Trump won in 2020 on the ballot, arguments over final counts could continue for weeks.

If President Biden is to have any change of continuing to govern, then Democratic control of the Senate is essential. I fully expect a Republican-controlled House to launch into impeachment proceedings against Biden, current House Speaker Nancy Pelosi, and other high-profile Democrats.

The recent ruling by the US Supreme Court (SCOTUS) that abolished with federal right to abortion will be a driver in getting out the vote.

Now it also appears that the conservative majority on the Court will vote to over-ride affirmative action for college admissions – something SCOTUS has twice upheld in the past.

A ban on race-conscious college admissions will have a huge impact on the ability of people of colour to get higher education. Organisations like the Association of American Medical Colleges and the American Medical Association fear that such a decision could have ripple effects on medical schools and ultimately on patient care.

In an amicus brief, 46 health organisations urged the high court not to do anything that would “disrupt” the current admission processes of health professional schools. They argue that when it comes to educating physicians and other healthcare professionals, diversity is a “medical imperative” that “literally saves lives.”

Meanwhile in Texas, a judge has ruled that the requirement that health insurance must cover preexposure prophylaxis (PrEP), medication for HIV prevention violates the religious rights of Christian businesses which provide health insurance for their employees’.

This case is certain to eventually end up in the US Supreme Court, like other similar cases that relate to the requirement imposed by the Affordable Care Act (Obamacare) that all health insurance must cover all preventive services recommended by the US Preventive Services Taskforce (USPST) without cost-sharing.

This case also argues that the experts who sit on the USPST are not appointed in accordance with the Appointments Clause of the US Constitution (ie a presidential appointment, approved by the Senate).

So you can see where this is potentially leading – to the undermining not just of health insurance cover for preventive services but to the politicisation of the expert body that makes the decisions about what should be covered.

You can read more in a briefing paper from the Kaiser Family Foundation here.

Finally, there’s a disturbing report that – even as Americans behave as though the pandemic is over – Republican candidates on the campaign trail are using every opportunity to argue that scientific institutions have amassed too much power.

Republican candidates have pumped nearly US$46 million into COVID-related campaign ads lambasting Democrats for school shutdowns, business closures and mask mandates. Calls to investigate, jail and even kill Dr Anthony Fauci have become regular campaign rallying cries.

This political messaging is playing out at a time of deeply partisan skepticism of figures like Fauci and federal agencies such as the Centers for Disease Control and Prevention. While more than half of Democrats say they trust public health officials, just 15 percent of Republicans say the same.

Read the StatNews article


In case you missed it

What Covid Has Taught the World about Ethics – a perspectives piece in The New England Journal of Medicine from Ezekiel Emanuel et al.

New modelling reveals Australians’ true financial stress. UnitingCare Australia and the Australian National University Centre for Social Research and Methods have released new research that provides a more comprehensive measure of financial wellbeing in Australian households.

At the same time, the Foodbank Hunger Report 2022 highlights the dreadful impact the cost of living is having on the ability of a large swathe of Australians to afford food and to eat healthily.

The remarkable Australian desert archeologist Mike Smith died last month. He worked at  Puritjarra, after Lake Mungo, the most important archaeological site in the Australian desert. Thanks to Smith’s’s enduring commitment, it is one of the most carefully documented and dated sites in Australia. Puritjarra deepened the chronology of human history in the centre of the continent from 10,000 to 35,000 years.

You can read about Mike Smith’s fascinating work here.

A paper by Australian researchers looks at how allied health notes are used for patient care and clinical decision-making by other members of the healthcare team. It concludes that: “Improving both the relationship between the various health professions and interpretation of other professions’ documented clinical information may reduce the frequency of communication errors, thereby improving patient care.”

The Climate Council has released a new report ahead of the COP27 meeting in Egypt. G’Day COP27: Australia’s Global Climate Reset.

Also follow Croakey’s series that launched this week: #HealthyCOP27, which aims to put a strong focus on health and Indigenous knowledges during COP27. On Twitter follow #HealthyCOP27 and also this Twitter list.

(Croakey acknowledges and thanks the Lord Mayor’s Charitable Foundation for funding the #HealthyCOP27 series, and Adjunct Professor Janine Mohamed and the Lowitja Institute for partnering with Croakey Health Media on the project.)


The best of Croakey

This Croakey article, Hold the front page! And don’t mention the climate crisis…, recently highlighted the lack of page-one coverage of the climate crisis across metropolitan newspapers. It’s great to see regional newspapers have launched a special climate series, as tweeted by Saffron Howden.

However, as advocated by the global media collaboration Covering Climate Now, coverage of climate needs to be integrated prominently into every newsroom beat, including politics, the arts, transport, sport, real estate, and so on.


The good news story

Since 2017, Jess Wade, a research fellow at Imperial College in London, has written more than 1,750 Wikipedia pages for female and minority scientists and engineers whose accomplishments were not documented on the site.

Just 19 percent of English Wikipedia biographies are of women, according to WikiProject Women in Red, a group dedicated to addressing Wikipedia’s gender gap.

In 2019, with a colleague, Wade had an opinion piece in the Washington Post outlining why it matters that women in science are given greater visibility and acknowledgement.

You can follow her on Twitter @jesswade – make sure to read this story about how she fought back (and won) when Wikipedia editors removed her biography of an African American woman, a nuclear chemist, who is recognised as the first Black woman to be involved with the discovery of a chemical element.


A week on the Cape to Cape track

And lastly – an indulgence from me. If you follow me on Twitter then you will know that partner Bruce and I have recently finished walking the coastal track from Cape Naturaliste to Cape Leeuwin in south-western Western Australia. We covered 135 km in seven days, often walking along the pristine beaches.

This is Noongar Country and it’s spectacularly beautiful, especially at this time of year – masses of wildflowers, tall kauri forests, breaching whales and frolicking dolphins, seabirds and wedge tail eagles and (mostly) fine weather.

If you are not big long-distance walkers there are plenty of opportunities to explore the Cape to Cape for shorter day walks.

In two weeks we head to New Zealand to do the Queen Charlotte Track (me for the second time) – so stay tuned for more Russell / Wolpe hiking (and eating) adventures.


Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.

Previous editions of The Health Wrap can be read here.

 

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