I was quoted in yesterday’s Herald in a piece about people whose COVID vaccination records have gone missing. I’ve been whingeing about this to anyone who’ll listen for the past few months. For a while, it seemed like the easiest thing would be to get another vacination. It’s good to hear that I’m not alone.
The issue seems to have been that the Immunisation Register doesn’t like hyphens or apostrophes in people’s names (seriously). Even if this only affects one percent of people, that’s 60,000 in NSW alone.
Anyway, the story was tweeted by Bill Shorten, which is a pretty good sign I’ve made a mistake by complaining about it.
The curfew and further COVID control measures that were announced today have had me thinking about how a narrow approach to what constitutes evidence can exacerbate health inequalities.
As Prof Catherine Bennett points out, reducing the reproduction rate of the Delta variant to 1.2-1.3 has itself been a major achievement.
Prof Catherine Bennett is always worth listening to. Reducing the transmission rate for Delta from 6-7 to 1.2 is a major achievement.
However the control measures are hard to live with, and because the virus spreads based on inequalities this targeted approach perpetuates them… https://t.co/AiP4XDBbTh
However, because COVID spreads based on inequalities – insecure work, where people live, housing conditions, inability to isolate – a targeted approach based on epidemiological data alone can lead to interventions that reinforce inequities. Interventions like curfews, limiting people to one hour outside the home, and increased policing are unlikely to have an influence on COVID transmission. If anything, they’re only likely to lead to increased criminal justice engagement and charges. They’re also not based on public health evidence.
Because these measures are only being imposed in the poorer parts of Sydney where COVID is circulating most, they’re entrenching determinants of health inequity.
Eighteen months ago, when I was still trying to figure what COVID was all about, I wrote:
There is likely to be a social gradient in transmission, i.e. the poor are more likely to get COVID-19, at least at first. This is a concern that some have already flagged in the U.S.
If there is a social gradient in the disease, there needs to be a social gradient in our response. The most affected locations and communities should be the focus of the health system’s initial response (we can’t just assume this will be the case). If antiviral therapies are found to be effective, or if a vaccine is eventually developed, consideration should be given to deploying them to poorer areas first.
Thanks to Cate Carrigan and Croakey for the chance to chat about COVID and compliance theatre in Western Sydney – and what might make a difference.
“The thing that gives me hope is that if you look at the numbers, they really peaked in Fairfield a month ago and have come down. This is because of the huge efforts by community groups there,” says Harris-Roxas.
The Assyrian, Lebanese, Sudanese and Syrian communities are providing material assistance and information to their networks, using Zoom and social media, he says.
The value of these community ties has been evident in the strong response to the vaccine clinic set up by the Lebanese Muslim Association at Lakemba in south west Sydney.
Saying “open a window to reduce COVID risks” makes sense unless there’s bushfire smoke and poor air quality.
As NSW ponders how schools can reopen safely after the current COVID lockdown, A/Prof Donna Green and I estimate that a $50 million investment can reduce not only COVID risks but also bushfire smoke and asthma risks as well – and needs to be tackled urgently.
The smell of hazard reduction burn smoke in Sydney this week is an unwelcome reminder the bushfire season is almost upon us, and with it, the torment of having to breathe toxic air.
Even before the last of the 2019–20 Black Summer smoke dissipated, another deadly reminder of the importance of access to safe air arrived. COVID forced many of us to take a crash course in how to avoid respiratory viruses.
One of the most effective ways to reduce indoor COVID transmission is to open windows. Maximising outdoor air coming inside, known as the air exchange rate, is a good way to reduce transmission risk.
But opening windows during the bushfire season can let toxic smoke in, changing the risk calculation.
Keeping windows closed and re-circulating air through standard aircon systems can cool the air, but doesn’t remove smoke or viruses.
So how can schools reduce exposure to COVID and bushfire smoke simultaneously?
This dilemma has a solution we can implement immediately. We’ve calculated about A$50 million would provide all NSW primary and secondary school classrooms, and other shared spaces within schools, with High-Efficiency Particulate Air (HEPA) grade air purifiers.
This initial outlay pales compared to the roughly A$220 million-a-day cost of Sydney’s lockdown.
The added benefit of installing air purifiers with HEPA filters is they can help reduce the risk of asthma attacks too.
Air purifiers with HEPA filters can remove over 99% of tiny particles
Most people catch COVID by inhaling it from shared air, and COVID particles often linger in the air in indoor spaces. Simple and relatively cheap air purifiers with HEPA filters have been shown to clear potentially infectious aerosols quickly and effectively.
HEPA air purifiers work by mechanical filtration — they force air through a fine mesh which traps particles. Off-the-shelf air purifers with HEPA filters can remove more than 99.97% of all particle sizes down to 0.30-1.0 microns (one millionth of a metre).
This means they can help filter airborne viruses, bacteria, and tiny particles known as “particulate matter” from bushfire or hazard reduction burn smoke. They can’t completely eliminate COVID transmission, but they can help reduce the risk especially when used with other best practices like wearing masks and other public health measures.
These calculations assume each NSW primary and secondary school student, of which there are approximately 706,000 and 534,000, respectively, are grouped in classes of 25 and 20 pupils, respectively.
Each of these classrooms would require an air purifier designed to work in a standard classroom of approximately 60 square metres. We’ve allowed for each of the 3,100 schools in NSW to have six extra units to include shared spaces such as the library or resource room, staff room and administration area.
Approximately 73,500 units would be needed in NSW. We’ve applied a bulk buy discount of 30% on a currently available, high-quality HEPA air purifier retailing for A$1,000 to arrive at our estimate.
Of course, this doesn’t only affect NSW — schools across the nation would likely benefit from this approach.
Because these units are already available for purchase online and can ship via existing delivery services, the logistics are neither complicated nor expensive.
Installation of the units can be carried out in minutes, and one of the only concerns is the need to ensure proper PPE when changing the filter.
Unfortunately, upgrading existing aircon systems in schools by incorporating higher-grade HEPA filters is slow, expensive and not always technically possible.
In combination with other risk-reduction strategies, air purifiers could be an affordable way to reduce the risk of unmitigated COVID spread between unvaccinated students and staff, and the inevitable spread between, and within, these children’s households.
This approach would buy time until vaccines are approved and rolled out for Australian children. This is unlikely to occur before mid-2022 at the earliest.
There are multiple other benefits too
An added benefit is that for future years, these air purifiers might be able to reduce asthma attacks triggered by smoke from the inevitable, and increasingly intense, bushfire season. That’s because for many people, asthma can be triggered by the small particles in smoke which, once inhaled, can go into the lungs causing inflammation.
Their tiny size means some of them can enter the blood stream and affect our lungs, heart and immune systems.
One in ten Australian children suffer from asthma, so keeping hazard reduction burn and bushfire smoke out of schools is a top priority.
Using HEPA filters will likely result in health savings associated with reduced asthma attacks from avoided smoke inhalation, and a lower burden from COVID cases stemming from school-based transmission. This will place less pressure on NSW’s overwhelmed health system.
It’s hard to comprehend why we haven’t raced to take such an effective no-regrets strategy.
It’s one strategy of many
Installing air purifiers with HEPA filters throughout the entire school system might be one of the most important, and cost effective, ways to improve the health and safety for millions of families in NSW, and around Australia.
We also need to deploy a range of strategies to reduce the risk to school children and staff of exposure to airborne viruses, as well as smoke and other air pollutants.
We know we also need to:
promote outdoor sports over indoors
stagger outside playground access times
move non-essential person-to-person interactions online (for example parent-teacher meetings)
perform rigorous daily checks for symptomatic children
constantly encourage people with even the most minor symptoms to stay home and get tested
mandate masks in schools and on public transport
stagger drop off and pick up times where possible.
It was a real privilege to speak with First Dog on the Moon about how things are going in South Western Sydney during this lockdown, which informed some of this fantastic cartoon.
We hate Covid but we hate it even more when politicians try to police their way out of a public health crisis, by First Dog on the Moon (2021)
I was wondering about the Australia 2020 Summit tonight, prompted by seeing former Prime Minister Rudd on television talking about the Ruby Princess. For those who don’t remember, it was a sort of festival of ideas convened by the still-new Gillard-Rudd government in 2008. It was supposed to shape a long-term strategy for Australia’s future, one that was sadly never realised.
If I’m honest I imagined that the report would be full of naïve assumptions and misguided aspirations (much like Mr Rudd’s comments this evening). The horrors of the summer bushfires and the global COVID-19 pandemic mean we’re living in a world I didn’t imagine even a year ago, even though I’ve been worried about climate change, biodiversity loss, and water scarcity for a while. It must have been inconceivable twelve years ago.
Instead I was surprised by how many of the ideas remain relevant and, by and large, unaddressed. The topics in the table of contents should be part of any long-term strategy we’d develop today, albeit with much greater urgency about climate change.
An example of the ideas captured in the report, this from page 385.
There are even some of my pet topics in the report, like health impact assessments, which I’d entirely forgotten.
A call for health impact statements of all new policies and an audit of the impacts of taxation on healthy, from page 155 in the report.
I won’t attempt to summarise the report. It’s 399 pages, and quite densely packed with ideas. It’s definitely worth reading if you have a chance.
Mostly, I’m left with a sense of sadness about how we’ve wasted the last twelve years. I hope the crisis we face due to COVID-19 forces us to reconsider our direction as a society, and the renewed urgency for a long-term strategy for Australia’s future.
Workers waiting to use the ‘inhalatorium’ at the Kodak Australasia Pty Ltd factory in Abbotsford, 1919. The inhalatorium was thought to protect workers from being infected with the influenza during the 1919 Spanish flu epidemic. A zinc sulphate solution was steamed onto the worker’s faces to ‘disinfect’ the workers’ throats and air passages. Staff were given this treatment twice a day for four minutes at a time. Source: Museums Victoria Photographer: Unknown Credit: Courtesy of Kodak Australasia Pty. Ltd. Terms of use: Public Domain
The poor came down with influenza first and were overall most affected, while the rich with less exposure in the first wave tended to have higher morbidity in the second wave. This finding is concurrent with prior studies documenting that the poor had the highest 1918 pandemic mortality. Although this study could not tease out the mechanisms for the SES crossover in morbidity, results suggest that preparedness plans should consider how (non‐)pharmaceutical interventions can hinder socioeconomic morbidity disparities in future pandemics. Surprisingly however, social inequalities in pandemic outcomes do not form part of the discussion in international preparedness plans for pandemic influenza. This is not conducive to achieving the international goals of eradicating poverty, reducing social inequalities and ensuring good health for all by 2030.
Source:
My knowledge about the 1918-1919 influenza pandemic is woeful. I was prompted to learn more by this diagram from the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19), which describes COVID-19 as similarly transmissible to the H1N1 influenza in 1918-1919. I’ve been reading a few articles, keeping an eye out for potential lessons for our looming COVID-19 pandemic.
If there is a social gradient in the disease, there needs to be a social gradient in our response. The most affected locations and communities should be the focus of the health system’s initial response (we can’t just assume this will be the case). If antiviral therapies are found to be effective, or if a vaccine is eventually developed, consideration should be given to deploying them to poorer areas first .
Air pollution may increase the impact of the pandemic (important given the recent bushfires and poor air quality in Australia).
We’re much better placed to respond now than health systems were in 1918. Things like intensive care units and protective equipment simply didn’t exist then .
The economic impacts of the pandemic will likely have health consequences that dwarf those of the virus itself.
The social impacts of the 1918 pandemic were far-reaching, but also still seem to be poorly understood. “What if” questions abound but are unanswerable. For example, the Indian independence movement was strengthened by the British mishandling of its influenza response in India. Would independence have happened in the same way without the pandemic?
It’s similarly difficult for us to imagine what COVID-19’s far-reaching future social consequences will be.
I’ll keep reading. Your suggestions about good sources are welcome.
Wilson, Nick, Osman D Mansoor, and Michael G Baker. “The First Analytic Evidence for Socio-Economic Gradients in 1918 Pandemic Influenza Mortality Rates for New Zealand.” New Zealand Medical Journal 131, no. 1486 (2018): 5.
Mamelund, Svenn-Erik. “1918 Pandemic Morbidity: The First Wave Hits the Poor, the Second Wave Hits the Rich.” Influenza and Other Respiratory Viruses 12, no. 3 (2018): 307–13. https://doi.org/10.1111/irv.12541.
Jester, Barbara J., Timothy M. Uyeki, Anita Patel, Lisa Koonin, and Daniel B. Jernigan. “100 Years of Medical Countermeasures and Pandemic Influenza Preparedness.” American Journal of Public Health 108, no. 11 (2018): 1469–72. https://doi.org/10.2105/AJPH.2018.304586.
Clay, Karen, Joshua Lewis, and Edson Severnini. “Pollution, Infectious Disease, and Mortality: Evidence from the 1918 Spanish Influenza Pandemic.” The Journal of Economic History 78, no. 4 (December 2018): 1179–1209. https://doi.org/10.1017/S002205071800058X.
Jester, Barbara, Timothy M. Uyeki, Daniel B. Jernigan, and Terrence M. Tumpey. “Historical and Clinical Aspects of the 1918 H1N1 Pandemic in the United States.” Virology 527 (January 15, 2019): 32–37. https://doi.org/10.1016/j.virol.2018.10.019.
Cristina, Juan, Raquel Pollero, and Adela Pellegrino. “The 1918 Influenza Pandemic in Montevideo: The Southernmost Capital City in the Americas.” Influenza and Other Respiratory Viruses 13, no. 3 (2019): 219–25. https://doi.org/10.1111/irv.12619.
