Public health milestones through the years
Vaccination, Testing, Clean Air: COVID Hasn't Gone Away – Here's Where Australia Needs To Do Better
In May 2023 the World Health Organization (WHO) declared COVID was no longer a public health emergency of international concern. For many, this signalled the pandemic was over.
But the virus continues to infect millions of people globally and the WHO recognises COVID as an ongoing pandemic.
In Australia, more than 50,000 infections have been reported so far in 2024. And this is likely to be a significant underestimate, as we are testing much less than we used to. As of February 1 there were 287 outbreaks in residential aged care homes, and people are still dying from the virus.
Although we've come a long way since earlier in the pandemic, as we enter its fifth year, COVID continues to have negative effects on individuals, health services and society at large.
To reduce the impact on health services and the community, the Australasian College for Infection Prevention and Control, of which we are on the board of directors, is calling for ongoing infection prevention and control strategies in Australia. These include supporting people to access vaccination and testing, and cleaner air in shared indoor spaces.
VaccinationCOVID vaccination reduces severe illness and can in turn reduce pressure on the health system. But, to reap the greatest benefits, a high proportion of the population must be vaccinated and receive regular booster doses.
Boosters are important as we know immunity wanes over time, both after infection and vaccination. Also, because COVID continues to evolve, vaccines are updated to keep up with circulating strains.
Current advice from the Australian Technical Advisory Group on Immunisation (ATAGI) indicates adults over 75 should receive a routine booster, and adults 65 to 74 should consider doing so. Younger people are only eligible if they have an increased risk of severe COVID, for example due to a particular medical condition.
There's also no recommendation that people at greater occupational risk of catching COVID, such as health-care workers, childcare workers or emergency and essential services workers receive another vaccination at this stage.
Read more: It's 4 years since the first COVID case in Australia. Here's how our pandemic experiences have changed over time
Yet broadening eligibility could help in several ways. For example, having a high proportion of the population unvaccinated or undervaccinated may increase opportunities for the virus to mutate and for new variants to develop.
Also, although older people are generally at greatest risk from a COVID infection, COVID in younger age groups can still in some cases cause severe and potentially long-term illness (and we know vaccination reduces the risk of long COVID).
We believe the current advice provided by the Australian government is out of date. There needs to be a review of ATAGI advice to allow booster access for more people, as is offered in other countries, such as the United States.
Younger people are no longer routinely offered COVID boosters in Australia. Supamotionstock.Com/ShutterstockEven among those who are eligible, uptake is poor. Recent figures show only 16.6% of people aged between 65 and 74 have received a booster dose in the past six months.
As such, in tandem with updated guidelines, there should be focused promotion of COVID boosters to all vulnerable people, as well as nation-wide promotion of free access to vaccinations for the wider population.
The Australian government has recognised the need for a strong vaccination program as a means to minimise levels of severe COVID and death. So securing and delivering an ongoing supply of up-to-date vaccinations is paramount.
TestingWhile testing is encouraged if you have COVID symptoms, there's no requirement or incentive to test or report positive results. This poses two problems: under-reporting of COVID cases, and people not knowing they have COVID (and therefore not knowing they might transmit it).
In New South Wales for example, laboratory confirmed cases are trending downwards while wastewater testing suggests COVID prevalence remains high.
Reinstating easy access to rapid antigen and PCR testing would enable people to better manage their illness, and provide a clearer picture for health authorities.
Read more: Should we still be using RATs to test for COVID? 4 key questions answered
VentilationCOVID is airborne and evidence shows clean air is key to minimising its spread.
In September 2023 the Australasian Health Infrastructure Alliance released guidance on pandemic preparedness. This document calls for the design of any new health-care building to take minimising the risk of infection transmission into account.
There are examples where investment in building design to minimise infectious disease transmission has had positive results. But guidance documents lack the legal clout needed to drive true change, and these examples are the exception. COVID still spreads in our hospitals and aged care facilities.
New health-care facilities should be built with ventilation in mind. Spotmatik Ltd/ShutterstockInfection prevention and control specialists should play a key role in designing health-care facilities and residential aged care homes. Strategies to optimise ventilation in buildings must involve early consultation with qualified ventilation specialists who can address requirements such as the air exchange rate relative to the size of the building and number of expected occupants.
Mandating this would ensure we build facilities which minimise the transmission of most respiratory infections – not just COVID.
Other thingsSupport for communities to engage in key prevention strategies such as promoting the use of surgical masks or preferably P2/N95 respirators and staying home when unwell is important. Employers have a responsibility to enable access to paid sick leave, especially for those working with vulnerable communities and in health care.
Hand hygiene, although a foundation of infection prevention and control, appears to have less of a role in controlling COVID transmission. So we need to spend less time thinking washing our hands will protect us from COVID, and more time on what the evidence actually shows will help us ride this stage of the pandemic.
We also need new research initiatives such as large-scale clinical trials to prevent and treat long COVID, and more funding for the development of new vaccines and antiviral drugs as new variants arise.
Coronavirus: How An Aged Care Crisis Seized 'ill-prepared' Australia
By Lucy MartinBBC News
Victoria has now seen almost 100 outbreaks in aged care homes"I grew up in a war; I'm not dying in a pandemic."
Margaret Alcock sheltered from bombs during the Blitz, crossed an ocean to live in Australia, and was evacuated to safety during last season's bushfires.
The 89-year-old - who is my nanna - used stoicism and black humour to cope during those times. It's the same now with Covid-19.
"I do sometimes wonder how on Earth I've ended up here with coronavirus around me," she tells me over the phone from New South Wales (NSW).
"But I've seen worse things happen, and I don't worry about it."
When the coronavirus reached Australia in January, my family assumed that my grandparents - both of whom live in aged care homes - were in the safest place possible.
Five months on, the sector has seen scores of outbreaks and 156 of Australia's 247 virus deaths. This includes 12 of the 15 announced on Wednesday - Australia's deadliest day yet.
In a deepening crisis, some providers have been accused of failing to protect society's most vulnerable members. State and federal governments are also facing questions.
The author with her nanna, Margaret AlcockMore than 180,000 people live in Australia's residential aged care homes, which are managed by not-for-profit groups, private companies and government organisations.
Many of these facilities were quick to impose their own lockdowns. Some went beyond the government's official advice by banning visitors, halting activities and confining people to their rooms.
Margaret has been relatively lucky. Though visitors were forbidden for a while, residents at her home in regional NSW can move around freely.
But my other grandma - aged 87 and also named Margaret - has not left her care home in Melbourne, Victoria, since March. And in the past month, Melbourne has seen infections surge.
Grandma is confined to her room with the exception of short walks down the corridor. She sits in her armchair and eats meals alone.
Despite this, she has only praise for staff at her home who are working under extraordinary pressure. Grandma has upped her word search game and plays "hallway bingo", where residents sit in doorways as a staff member walks up and down shouting numbers.
"The lockdown is hard but I've accepted that it's for my own welfare," she says.
"I don't go to bed worrying about it. It's hard not being able to see my family but just because they're not here doesn't mean they don't love me."
Margaret Martin is locked down in Melbourne, where infections are surgingThe company that runs her home says it has a comprehensive infection plan, a full stock of personal protective equipment (PPE) and strict hygiene measures.
But across the two states, many families have been left heartbroken because lockdowns in other facilities have failed to prevent the virus spreading.
'We didn't pay attention to overseas'It's not hard to understand why aged care homes are so vulnerable to this virus.
They have elderly populations with underlying conditions, limited medical facilities and a pool of employees who sometimes work across multiple sites, increasing the risk of spread.
In February, harrowing stories began to emerge about the "silent massacre" of Europe's care home residents.
It should have been obvious that Australia was at risk of a similar situation, according to Professor Joe Ibrahim, who is head of health law and ageing research unit at Monash University.
"Australia's response was inadequate, underprepared and none of it should have been a surprise," he said.
Melbourne's 'state of disaster'"People use the word 'inevitable' but that's not right because it gives the impression there was nothing we could do. We didn't acknowledge the real risk that Covid-19 [posed] to aged care and we didn't pay attention to what was happening overseas."
On 3 March, an employee of the Dorothy Henderson Lodge in Sydney tested positive for Covid-19. By the time that outbreak was declared over in May, 21 residents and staff had been infected and six had died.
Another Sydney facility - Newmarch House - decided to quarantine infected people in their rooms rather than send them to hospital, despite struggling with staff shortages and a lack of PPE. Nineteen residents died and dozens more were infected.
Relatives of residents at Newmarch House protested over their treatment in AprilThose cases raised many questions but so far there are few answers. Now it's happening again.
The state of Victoria is experiencing a new outbreak in both the wider community and care homes. Currently close to 1,200 active cases are linked to 97 separate aged care outbreaks there.
Prof Ibrahim says lockdowns alone were never enough to keep the virus out. "We didn't have clear policies or a command structure in place [for when a case did occur]," he said.
"The federal government is responsible for aged care but the public health authorities in each state are responsible for outbreaks, so there was confusion about who steps in and when. There was also confusion about whether to provide care [for Covid-19 patients] in the homes or in hospitals."
Opposition leader Anthony Albanese has also called for wide-ranging scrutiny, saying this week: "Why weren't the lessons learned from Newmarch, which occurred months ago in New South Wales?"
A new control centre has been set up in Melbourne with both state and federal agencies working together to manage the crisis in Victoria.
Prof Ibrahim would like to see a national centre set up to assess every care home in Australia.
"That way we'd be clear about which places are at risk and where to aim resources," he said. "The response must be swift and definitive - there can be no equivocation."
The Australian Defence Force has been called in to help stem the outbreakA government inquiry has been set up to investigate the sector's response. It has heard accounts of staff shortages, lack of training and personal protective equipment and delays in accepting help from health authorities.
But the Australian Medical Association has called for the greater scrutiny of a royal commission - the top form of public inquiry. Its Victorian president, Julian Rait, told Nine newspapers the crisis was a "foreseeable tragedy".
For now, it's inevitable more elderly Victorians will die, according to Australia's Health Department secretary Brendan Murphy.
My loved ones are lucky - their care homes remain free of coronavirus. While Margaret Martin remains in strict lockdown, Margaret Alcock is being allowed visitors once again. My mum visited on Saturday to put rollers in her hair.
They laughed, they hugged, they bickered, and, just for a moment, they forgot about Covid-19.
Nanna thinks getting the virus would probably be the end of her, but she's not going down easily.
"I was chased by a lot of geese when I was younger so I doubt coronavirus is going to get me."
Covid Outbreak At BlueCare Capricorn Aged Care Facility, Yeppoon
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