COVID-19 In Australia Research Articles

Healthcare Internet of Things system implementations for COVID-19 prevention

BackgroundIn response to the widespread transmission of COVID-19 in Australia, healthcare facilities implemented stringent infection control measures, and mandatory and manual screening procedures were introduced to ensure the safety of patients and healthcare staff. However, these necessary measures resulted in imbalances within the healthcare system, a shortage of front-line workers and impacts on patient experience and wait times. The prioritization of infection control measures shifted resources away from routine care, causing delays in accessing necessary healthcare services.Methods and FindingsTo address these challenges, we developed and implemented an Internet of Things (IoT) Smart Screening eGate solution in partnership with a large metropolitan children’s hospital in Australia. This solution integrated a contactless health self-service web app, thermal camera, and physical barrier to automate the COVID-19 health screening and data recording process. During the 3-month pilot period, we deployed the eGate at multiple entrances to the hospital, and monitored the number of users of the system in different periods. We also used a framework of formative evaluation to classify user design challenges within limited resources and improved the design of the eGate to enhance its effectiveness. Our findings show that the IoT eGate solution improved the efficiency of the screening process and reduced the workload and exposure risks of front-line staff and anyone who required access to the hospital. By automating the screening process, we reduced the need for manual screening and minimized contact between individuals, thus reducing the risk of potentially infected.ConclusionIn conclusion, our pilot study demonstrated the potential of IoT technologies in improving the efficiency and safety of medical facilities during pandemics and provided a series of recommendations for the translation of IoT technologies for medical facilities, including the importance of co-design and collaboration with stakeholders, user-centered design, and ongoing monitoring and evaluation.

Machine-Learning Based Risk Prediction of Outcomes in Patients Hospitalised With COVID-19 in Australia: The AUS-COVID Score

Machine-Learning Based Risk Prediction of Outcomes in Patients Hospitalised With COVID-19 in Australia: The AUS-COVID Score

Defining the correlates of lymphopenia and independent predictors of poor clinical outcome in adults hospitalized with COVID-19 in Australia

Lymphopenia is a common feature of acute COVID-19 and is associated with increased disease severity and 30-day mortality. Here we aim to define the demographic and clinical characteristics that correlate with lymphopenia in COVID-19 and determine if lymphopenia is an independent predictor of poor clinical outcome. We analysed the ENTER-COVID (Epidemiology of hospitalized in-patient admissions following planned introduction of Epidemic SARS-CoV-2 to highly vaccinated COVID-19 naïve population) dataset of adults (N = 811) admitted for COVID-19 treatment in South Australia in a retrospective registry study, categorizing them as (a) lymphopenic (lymphocyte count < 1 × 109/L) or (b) non-lymphopenic at hospital admission. Comorbidities and laboratory parameters were compared between groups. Multiple regression analysis was performed using a linear or logistic model. Intensive care unit (ICU) patients and non-survivors exhibited lower median lymphocyte counts than non-ICU patients and survivors respectively. Univariate analysis revealed that low lymphocyte counts associated with hypertension and correlated with haemoglobin, platelet count and negatively correlated with urea, creatinine, bilirubin, and aspartate aminotransferase (AST). Multivariate analysis identified age, male, haemoglobin, platelet count, diabetes, creatinine, bilirubin, alanine transaminase, c-reactive protein (CRP) and lactate dehydrogenase (LDH) as independent predictors of poor clinical outcome in COVID-19, while lymphopenia did not emerge as a significant predictor.

Estimating the impact of test–trace–isolate–quarantine systems on SARS-CoV-2 transmission in Australia

Background:Australian states and territories used test–trace–isolate–quarantine (TTIQ) systems extensively in their response to the COVID-19 pandemic in 2020-2021. We report on an analysis of Australian case data to estimate the impact of test–trace–isolate–quarantine systems on SARS-CoV-2 transmission. Methods:Our analysis uses a novel mathematical modelling framework and detailed surveillance data on COVID-19 cases including dates of infection and dates of isolation. First, we directly translate an empirical distribution of times from infection to isolation into reductions in potential for onward transmission during periods of relatively low caseloads (tens to hundreds of reported cases per day). We then apply a simulation approach, validated against case data, to assess the impact of case-initiated contact tracing on transmission during a period of relatively higher caseloads and system stress (up to thousands of cases per day). Results:We estimate that under relatively low caseloads in the state of New South Wales (tens of cases per day), TTIQ contributed to a 54% reduction in transmission. Under higher caseloads in the state of Victoria (hundreds of cases per day), TTIQ contributed to a 42% reduction in transmission. Our results also suggest that case-initiated contact tracing can support timely quarantine in times of system stress (thousands of cases per day). Conclusion:Contact tracing systems for COVID-19 in Australia were highly effective and adaptable in supporting the national suppression strategy from 2020–21, prior to the emergence of the Omicron variant in November 2021. TTIQ systems were critical to the maintenance of the strong suppression strategy and were more effective when caseloads were (relatively) low.

Business Interruption Insurance and COVID-19 in Australia

Business Interruption Insurance and COVID-19 in Australia

Excess mortality in residents of aged care facilities during COVID-19 in Australia, 2019-22.

To date, the excess mortality experienced by residential aged care facility (RACF) residents related to COVID-19 has not been estimated in Australia. This study examined (i) the historical mortality trends (2008-09 to 2021-22) and (ii) the excess mortality (2019-20 to 2021-22) of Australian RACF residents. A retrospective population-based study was conducted using the Australian Institute of Health and Welfare's GEN website data (publicly available aged care services information). Non-Aboriginal, older (≥65 years old) RACF residents between 2008-09 and 2021-22 were evaluated. The observed mortality rate was estimated from RACF exits compared with the RACF cohort yearly. Direct standardization was employed to estimate age-standardized mortality rates and 95% CIs. Excess mortality and 95% prediction intervals (PIs) for 2019-20 to 2021-22 were estimated using four negative binomial (NB) and NB generalized additive models and compared. The age-standardized mortality rate in 2018-19 was 23 061/100 000 residents (95% CI, 22 711-23 412). This rate remained similar in 2019-20 (23 023/100 000; 95% CI, 22 674-23 372), decreased in 2020-21 (22 559/100 000; 95% CI, 22 210-22 909) and increased in 2021-22 (24 885/100 000; 95% CI, 24 543-25 227). The mortality rate increase between 2020-21 and 2021-22 was observed in all age and sex groups. All models yielded excess mortality in 2021-22. Using the best-performing model (NB), the excess mortality for 2019-20 was -160 (95% PI, -418 to 98), -958 (95% PI, -1279 to -637) for 2020-21 and 4896 (95% PI, 4503-5288) for 2021-22. In 2021-22, RACF residents, who represented <1% of the population, experienced 21% of the Australian national excess mortality (4896/22886). As Australia adjusts to COVID-19, RACF residents remain a population vulnerable to COVID-19.

Documenting Australian Society: Progress Report on an Initiative of the UNESCO Australian Memory of the World Committee

The topic of Documenting Australian Society has been something of an occasional perennial on ASA Conference programs since the 1990s. Archives and manuscripts published a theme issue on it in 2001. In December 2018, the UNESCO Australian Memory of the World Program organised a national summit on the topic in Canberra. That summit meeting endorsed ‘The Canberra Declaration’ as an action agenda for the documentary heritage sectors and agreed that the UNESCO Memory of the World Program should continue to take carriage of the initiative. Since then, a steering committee has been established, and two seminars/webinars have been organised: the first on Documenting COVID-19 in Australia and the second on Documenting the Experiences of Australian on Welfare. This paper discusses the background and objectives of the initiative, its current status and plans for the future.

Assembling the Crisis of COVID-19 in Australia: A Foucauldian Analysis of Prime Ministerial Press Conferences in March 2020

In this article, I present a Foucauldian analysis of the speeches made by the then Prime Minister of Australia (Mr. Scott Morrison) in March 2020. This analysis sets out to explore the political rationalities that assembled COVID-19 as a particular type of ‘problem’ that warranted unprecedented governmental intervention into the everyday lives of citizens. I believe that the insights provided by such an analysis are relevant to ongoing examination of governing in liberal democracies both during a crisis and afterwards.

Association between pre-existing cardiovascular disease, mortality and cardiovascular outcomes in hospitalised patients with COVID-19.

Pre-existing cardiovascular disease and cardiovascular risk factors are common in patients with COVID-19 and there remain concerns for poorer in-hospital outcomes in this cohort. We aimed to analyse the relationship between pre-existing cardiovascular disease, mortality and cardiovascular outcomes in patients hospitalised with COVID-19 in a prospective, multicentre observational study. This prospective, multicentre observational study included consecutive patients of age ≥18 in their index hospitalisation with laboratory-proven COVID-19 in Australia. Patients with suspected but not laboratory-proven COVID-19 and patients with no available past medical history were excluded. The primary exposure was pre-existing cardiovascular disease, defined as a composite of coronary artery disease, heart failure or cardiomyopathy, atrial fibrillation or flutter, severe valvular disease, peripheral arterial disease and stroke or transient ischaemic attack. The primary outcome was in-hospital mortality. Secondary outcomes were clinical cardiovascular complications (new onset atrial fibrillation or flutter, high-grade atrioventricular block, sustained ventricular tachycardia, new heart failure or cardiomyopathy, pericarditis, myocarditis or myopericarditis, pulmonary embolism and cardiac arrest) and myocardial injury. 1,567 patients (mean age 60.7 (±20.5) years and 837 (53.4%) male) were included. Overall, 398 (25.4%) patients had pre-existing cardiovascular disease, 176 patients (11.2%) died, 75 (5.7%) had clinical cardiovascular complications and 345 (37.8%) had myocardial injury. Patients with pre-existing cardiovascular disease had significantly increased in-hospital mortality (aOR: 1.76 95% CI: 1.21-2.55, p = 0.003) and myocardial injury (aOR: 3.27, 95% CI: 2.23-4.79, p < 0.001). There was no significant association between pre-existing cardiovascular disease and in-hospital clinical cardiovascular complications (aOR: 1.10, 95% CI: 0.58-2.09, p = 0.766). On mediation analysis, the indirect effect and Sobel test were significant (p < 0.001), indicating that the relationship between pre-existing cardiovascular disease and in-hospital mortality was partially mediated by myocardial injury. Apart from age, other cardiovascular risk factors such as diabetes, hypercholesterolemia and hypertension had no significant impact on mortality, clinical cardiovascular complications or myocardial injury. Pre-existing cardiovascular disease is associated with significantly higher mortality in patients hospitalised with COVID-19. This relationship may be partly explained by increased risk of myocardial injury among patients with pre-existing cardiovascular disease which in turn is a marker associated with higher mortality.

Exploring Environmental Factors Associated with Child Wellbeing during COVID-19 in Australia and Germany

The COVID-19 pandemic has had a significant impact on the wellbeing of children and families globally. With extended lockdown periods, early childhood education and school closures, and remote learning, families experienced increased stress and anxiety, financial hardship, and disrupted routines. This paper aims to explore associations between children’s social-emotional wellbeing and environmental factors (including the burden of COVID-19 on the family, early learning experiences in the home and early childhood education, and parent wellbeing and mental health) during COVID-19 in Australia and Germany, two countries that experienced significant lockdown periods. Using a longitudinal online survey design, parents of young children (aged 1–6 years) in Australia (N = 66) and Germany (N = 53) completed surveys on their own wellbeing; their child’s wellbeing; the home learning environment, and their satisfaction with early childhood education and care at two time points in 2020 and 2021. The burden of COVID-19 mitigation measures on families’ everyday lives correlated with child wellbeing outcomes in both the Australian and German cohorts. Findings also provide evidence of potential protective factors of children’s social-emotional wellbeing during stressful events, such as the lockdowns experienced by families in Germany and Australia during the pandemic.

Community-based access to oral antiviral treatments for COVID-19 in Australia

The availability of oral antivirals for SARS-CoV-2 infection reduces the risk of severe, acute illness in people at higher risk for death and hospitalisation.The process for antiviral prescription and dispensing in Australia is outlined using nationwide data.Australia has focused on providing rapid access to antivirals to high-risk people in the community via general practices and community pharmacies. Although the introduction of oral antiviral treatments is an important part of the response to the COVID-19 pandemic, vaccination remains the most effective way of mitigating the risk of developing severe complications of COVID-19, including hospitalisation and death.

Spiritual complexity in Australia: Wellbeing and risks

The turn of the twenty-first century was characterised by ‘spiritual revolution’, with claims that interest in New Age spirituality was eclipsing religion and would continue to do so in the future. Since then, scholars of religion have been more focused on religious diversity and the rise of the non-religious. While interest in spirituality, uptake of spiritual practices, and identification as ‘spiritual but not religious’ have continued to grow, spirituality is typically not taken as seriously as religion, at least in political spheres or by academia. This article examines the history and contemporary dynamics of spiritual complexity in Australia, drawing on the findings of two Australian Research Council–funded studies ‘The Worldviews of Australia’s Generation Z’ and ‘Religious Diversity in Australia’ and on a recent project ‘(Con)spirituality, Science and COVID-19 in Australia’. It argues that it is certainly time for spirituality to be taken more seriously in this country and globally, given spirituality’s concern with personal and planetary wellbeing, and also the potential risks spirituality can pose due to its association with dis/misinformation, neoliberalism, and violence.

The Digital Heritage of the Battle to Contain COVID-19 in Australia and Its Implications for Heritage Studies

One of the major public health measures to manage and contain the outbreak of the COVID-19 pandemic was to engage in systematic contact tracing, which required gastronomy, community and sporting venues to keep patron registers. Stand-alone and web-based applications, developed by a range of private IT providers, soon replaced pen-and-paper lists. With the introduction of a uniform, state-wide, mandatory data collection system, these private applications became obsolete. Although only active for four months, these applications paved the way for the public acceptance of state-administered collection systems that allowed for an unprecedented, centralized tracking system of the movements of the entire population. This paper discusses the cultural significance of these applications as a game changer in the debate on civil liberties, and addresses the question of how the materiality, or lack thereof, of this digital heritage affects the management of ephemeral smartphone applications, and its preservation for future generations.

Racially minoritized people’s experiences of racism during COVID-19 in Australia: A qualitative study

ObjectiveDrawing from a broader study exploring how New South Wales community members from racially minoritized backgrounds experienced living through a pandemic, this paper reports specifically on experiences of racism during the COVID-19 pandemic in 2020. MethodsUsing an in-depth, qualitative interpretive approach, 11 semi-structured interviews and one focus group hosting three participants (n=14) were held via an online videoconferencing platform from September to December 2020. Inductive thematic analysis was undertaken using QRS NVivo as a data management tool. ResultsRacism was heightened during the pandemic and experienced in various ways by racially minoritized peoples in New South Wales. All participants in this research cited experiences of racism that impacted their wellbeing during COVID-19. These experiences are represented by the following four themes: experiencing racism is common; how racisms are experienced; increased fear of racism during COVID-19; and ways of coping with racisms. ConclusionsRacism was heightened during the pandemic and generated fear and anxiety that prevented racially minoritized peoples from participating in everyday life. Implications for Public HealthMessaging from broader public platforms must be harnessed to stop the spread of moral panic so that during times of pandemic, public health strategies need only confirmation, not creation.

Liminality and insecurity: A qualitative study of young adults’ vulnerabilities during the first twelve months of COVID-19 in Australia

COVID-19 has disrupted the normative social order, particularly for young adults. Their deteriorating mental health over 2020 has been associated with the economic and social conditions during the COVID-19 lockdowns. We conducted 19 semi-structured interviews with young adults aged 8 and 29 most of whom lived in Victoria, Australia. The interviews explored participants' experiences and responses to COVID-19, covering areas such as disrupted everyday practices and future plans, impacts on their physical and mental health, and interactions with community and services. Young adults were concerned about loss of social connectedness, their mental health and the complex interplay of issues such as employment, income, education and housing. They developed routines to protect their physical and mental health while in lockdown and some made the most of new opportunities. However, the pandemic may have had a profound effect by disrupting some young adults’ plans for the future, thus contributing to a sense of ontological insecurity.

Family Bonds with Pets and Mental Health during COVID-19 in Australia: A Complex Picture

The COVID-19 pandemic has drawn attention to the health-promoting features of human-animal relationships, particularly for families with children. Despite this, the World Health Organization's (1986) Ottawa Charter remains human-centric. Given the reciprocal health impacts of human-animal relationships, this paper aims to (i) describe perceived pet-related benefits, worries, and family activities; and to (ii) examine differences in perceived benefits, worries, and activities for parents and children with and without clinical mental health symptoms. We recruited 1034 Australian parents with a child < 18 years and a cat or dog via a national online survey between July and October 2020. Most parents reported their pet was helpful for their own (78%) and their child's mental health (80%). Adjusted logistic regression revealed parents with clinical psychological distress were 2.5 times more likely to be worried about their pet's care, well-being, and behaviour (OR = 2.56, p < 0.001). Clinically anxious children were almost twice as likely to live in a family who engages frequently in pet-related activities (e.g., cooked treats, taught tricks, OR = 1.82, p < 0.01). Mental health and perceived benefits of having a pet were not strongly associated. Data support re-framing the Ottawa Charter to encompass human-animal relationships, which is an often-neglected aspect of a socioecological approach to health.

A health impact assessment of gender inequities associated with psychological distress during COVID19 in Australia’s most locked down state—Victoria

BackgroundSince March 2020, when the COVID19 pandemic hit Australia, Victoria has been in lockdown six times for 264 days, making it the world’s longest cumulative locked-down city. This Health Impact Assessment evaluated gender disparities, especially women’s mental health, represented by increased levels of psychological distress during the lockdowns.MethodsA desk-based, retrospective Health Impact Assessment was undertaken to explore the health impacts of the lockdown public health directive with an equity focus, on the Victorian population, through reviewing available qualitative and quantitative published studies and grey literature.ResultsFindings from the assessment suggest the lockdown policies generated and perpetuated avoidable inequities harming mental health demonstrated through increased psychological distress, particularly for women, through psychosocial determinants.ConclusionOngoing research is needed to elucidate these inequities further. Governments implementing policies to suppress and mitigate COVID19 need to consider how to reduce harmful consequences of these strategies to avoid further generating inequities towards vulnerable groups within the population and increasing inequalities in the broader society.

Decentralised point-of-care testing for acute, chronic and infectious disease – benefits and challenges

The COVID-19 pandemic has reinforced Australia’s need for diagnostic testing frameworks that are well-prepared, well-resourced, responsive, appropriately governed, scalable, interdisciplinary and collaborative.1 Point-of-care (POC) technologies offer diagnostic solutions capable of delivering individual, community and public health benefits in settings where: a) laboratory testing is not available, b) rapid turn-around time is needed, c) high loss to follow-up occurs in high-risk populations with standard of care cascades and/or d) disease transmission rates exceed laboratory response capacity. Key translational research derived from collaborative point-of-care testing networks for a) diabetes management (238 remote health services; 3,233 operators; 172,069 HbA1c and 51,379 urine albumin:creatinine ratio tests), b) acute care (106 remote health services; 2,279 operators; 32,950 blood gas, 32,689 cardiac troponin, 46,418 urea/electrolytes, 48,193 international normalised ratio tests), c) hepatitis C virus (HCV) (41 sites; 110 operators; 5,733 HCV tests; 4,978 RNA, 755 antibody), d) syphilis screening (156 sites; 1,412 operators), e) chlamydia, gonorrhea or trichomonas (51 sites; 795 operators; >50,000 tests) or f) COVID-19 (101 remote health services, 733 operators, 72,624 tests) will be used to highlight operational, clinical, public health, and economic benefits of POC testing. Challenges associated with scale-up and accreditation pathways for decentralised POC testing will be discussed. Reference 1. Revised Testing Framework for COVID-19 in Australia, March 2022 Version 2.1. Communicable Disease Network Australia and Public Health Laboratory Network.

Aussie blokes and high maintenance girls: how the old became new again on dating apps in COVID-19 in Australia

Dating apps saw increased usage during the COVID-19 lockdown in Australia – both of new users, and of activity. Using Bumble and Tinder, two of the largest dating apps in the Australian market, we examine the ways in which gender scripts were reinforced and/or subverted on dating apps during the COVID-19 lockdown. Dating apps offer a potential space for negotiation of gender scripts and challenges to heteronormativity, particularly during a period like COVID-19, where media discourse reported a shift in normative constraints because of liberation from physical social spaces. So how did it play out in practice? How did the inability to meet in person affect the ways in which users conformed to or subverted normative binaristic gender scripts? We explore this question drawing on interviews and focus groups conducted with dating app users during the COVID-19 lockdown. We discuss how and whether participants mobilised heteronormative gender specific cultural codifiers to present themselves on app, and whether this was encouraged by Bumble and Tinder architecture. We also discuss how and if ‘traditional’ gender scripts were adhered to in the navigation of new matches and relationships, and the particularities of this in Australian culture. This includes the (re)emergence of stereotypical presentation ideals such as the ‘high-maintenance girl’ and the locally specific ‘Aussie bloke’, and an apparent increased desire for the ontological security provided by monogamous romantic relationships.

Nutrition care processes across hospitalisation in critically ill patients with COVID-19 in Australia: A multicentre prospective observational study

BackgroundThe COVID-19 pandemic highlighted major challenges with usual nutrition care processes, leading to reports of malnutrition and nutrition-related issues in these patients. ObjectiveThe objective of this study was to describe nutrition-related service delivery practices across hospitalisation in critically ill patients with COVID-19 admitted to Australian intensive care units (ICUs) in the initial pandemic phase. MethodsThis was a multicentre (nine site) observational study in Australia, linked with a national registry of critically ill patients with COVID-19. Adult patients with COVID-19 who were discharged to an acute ward following ICU admission were included over a 12-month period. Data are presented as n (%), median (interquartile range [IQR]), and odds ratio (OR [95% confidence interval {CI}]). ResultsA total of 103 patients were included. Oral nutrition was the most common mode of nutrition (93 [93%]). In the ICU, there were 53 (52%) patients seen by a dietitian (median 4 [2–8] occasions) and malnutrition screening occurred in 51 (50%) patients most commonly with the malnutrition screening tool (50 [98%]). The odds of receiving a higher malnutrition screening tool score increased by 36% for every screening in the ICU (1st to 4th, OR: 1.39 [95% CI: 1.05–1.77] p = 0.018) (indicating increasing risk of malnutrition). On the ward, 51 (50.5%) patients were seen by a dietitian (median time to consult: 44 [22.5–75] hours post ICU discharge). The odds of dietetic consult increased by 39% every week while on the ward (OR: 1.39 [1.03–1.89], p = 0.034). Patients who received mechanical ventilation (MV) were more likely to receive dietetic input than those who never received MV. ConclusionsDuring the initial phases of the COVID-19 pandemic in Australia, approximately half of the patients included were seen by a dietitian. An increased number of malnutrition screens were associated with a higher risk score in the ICU and likelihood of dietetic consult increased if patients received MV and as length of ward stay increased.