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1200 children to undergo testing after child abuse charges laid

Warning: This article contains details of alleged child sexual abuse which may be distressing to some readers. More than 1,200 children are being urged to undergo precautionary health screening after a former childcare worker was charged with more than 70 offences relating to alleged child sexual abuse at a centre in Melbourne’s south-west. Joshua Dale Brown, 26, from Point Cook, has been charged over alleged sexual offences against eight children – aged between five months and two years – at the Creative Garden Early Learning Centre in Point Cook, where he worked between April 2022 and January 2023. Victoria Police revealed Brown has worked at 20 childcare centres between 2017 and 2025, with investigations ongoing and additional allegations, including one involving a centre in Essendon, being pursued. Deputy Commissioner Wendy Steendam said the case is “incredibly distressing”, describing the allegations as confronting and involving “some of our most vulnerable people in our community”. The charges laid against Brown include sexual penetration of a child, producing child abuse material, and recklessly contaminating goods to cause alarm or anxiety. Detectives from the Sexual Crimes Squad began investigating in May after they allegedly uncovered child abuse material and executed a search warrant at Brown’s Point Cook home. He had not previously been known to police and held a valid Working with Children Check at the time of his employment. Police said the families of the eight alleged victims were notified last week. “As you can imagine, this was deeply distressing for the families to hear,” said Acting Commander Janet Stevenson, adding that not all centres where Brown worked are believed to be connected to the alleged offences. In a coordinated response, Victoria Police and the Department of Health have contacted more than 2,600 families whose children may have been at centres during Brown’s employment. About 1,200 children have been recommended for infectious disease testing “out of an abundance of caution”, authorities said. Chief Health Officer Dr Christian McGrath said while the public health risk is low, the testing was being recommended due to a potential exposure risk during the relevant period. “We do understand this is another distressing element to the situation and we’re taking this approach as a precaution,” Dr McGrath said, assuring families that any infections could be treated with antibiotics and that there is no broader risk to the public. Letters sent to families on Tuesday stated: “At this stage, there is no evidence to suggest that your child has been offended against. If this changes, you will be contacted directly by Victoria Police.” Support lines staffed by professionals have been established, and the government has promised free testing and assistance for affected families. G8 Education, the operator of the Point Cook centre, said it was “extremely distressed” by the allegations and is fully cooperating with authorities. In a statement, the company said all legally required employment and background checks were carried out during Brown’s employment. “G8 Education has no tolerance for any behaviour that compromises the safety or wellbeing of children,” the company said. Brown has been remanded in custody and is scheduled to appear at Melbourne Magistrates Court in September. The investigation remains ongoing. Images: ABC News / Supplied

Caring

Unusual use of nicotine patches or gum to fight brain fog

<div class="theconversation-article-body"> Some people with long COVID are turning to an unlikely remedy: nicotine gum and patches. Though typically used to quit smoking, nicotine is now being explored as a possible way to ease symptoms such as brain fog and fatigue. One such case, detailed in a recent <a href="https://slate.com/technology/2025/06/nicotine-gum-patch-cigarettes-cognitive-benefits-research.html">article in Slate</a>, describes a woman who found significant relief from debilitating brain fog after trying low-dose nicotine gum. Her experience, while anecdotal, aligns with findings from a small but interesting study from Germany. The <a href="https://bioelecmed.biomedcentral.com/articles/10.1186/s42234-023-00104-7">study</a> involved four participants suffering from symptoms related to long COVID. The researcher administered low-dose nicotine patches once daily and noticed marked improvements in the participants’ symptoms. Tiredness, weakness, shortness of breath and trouble with exercise rapidly improved – by day six at the latest. For those who had lost their sense of taste or smell, it took longer, but these senses came back fully within 16 days. Although it’s not possible to draw definitive conclusions on cause and effect from such a small study, the results could pave the way for larger studies. While some people slowly recover from COVID, others remain unwell for years, especially those who became sick before vaccines were available. Between <a href="https://www.ox.ac.uk/news/2024-08-01-new-study-highlights-scale-and-impact-long-covid">3% and 5%</a> of people continue to experience symptoms months, and sometimes even years, after the initial infection. In the UK, long COVID affects around <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/4august2022">2.8% of the population</a>. Brain fog and other neurological symptoms of long COVID are thought to result from a combination of factors – including inflammation, reduced oxygen to the brain, vascular damage and disruption to the <a href="https://www.cidrap.umn.edu/covid-19/researchers-identify-mechanism-behind-brain-fog-long-covid">blood-brain barrier</a>. Research continues as there is still a lot we don’t know about this condition. The researcher in the German study thinks that long COVID symptoms, such as fatigue, brain fog and mood changes, might partly be due to problems with a brain chemical called acetylcholine, a neurotransmitter. This chemical is important for many functions in the body, including memory, attention and regulating mood. Normally, acetylcholine works by attaching to special “docking sites” on cells called nicotinic acetylcholine receptors, which help send signals in the brain and nervous system. But the COVID virus may interfere with these receptors, either by blocking them or disrupting how they work. When this happens, the brain may not be able to send signals properly, which could contribute to the mental and physical symptoms seen in long COVID. So why would nicotine potentially be useful? Nicotine binds to the same receptors and might help restore normal signalling, but the idea that it displaces the virus directly is still speculative. Nicotine is available in different forms, such as patches, gum, lozenges and sprays. Using nicotine through the skin, for example, with a patch, keeps the amount in the blood steady without big spikes. Because of this, people in the study didn’t seem to develop a dependence on it. Chewing nicotine gum or using a lozenge can cause spikes in nicotine levels, since the nicotine is absorbed gradually through the lining of the mouth. But unlike a patch, which delivers a steady dose, the user has more control over how much nicotine they take in when using gum or lozenges. There are mixed <a href="https://pubmed.ncbi.nlm.nih.gov/33899218/">results</a> on the effectiveness of nicotine on cognitive functions such as memory and concentration. But most <a href="https://pubmed.ncbi.nlm.nih.gov/36736944/">studies</a> agree that it can enhance attention. Larger studies are needed to gauge the effectiveness of nicotine specifically for long COVID symptoms. <h2>Not without risks</h2> Despite its benefits, nicotine is <a href="https://www.verywellmind.com/nicotine-addiction-101-2825018">not without risks</a>. Even in gum or patch form, it can cause side-effects like nausea, dizziness, increased heart rate and higher blood pressure. Some of these stimulant effects on heart rate may be useful for people with long COVID symptoms such as exercise intolerance. But this needs to be closely monitored. Long-term use may also affect heart health. For non-smokers, the risk of developing a nicotine dependency is a serious concern. So are there any options to treat long COVID symptoms? There are some <a href="https://www.sciencedirect.com/science/article/pii/S2667257X22001000">studies</a> looking at guanfacine in combination with N-acetylcysteine, which have shown improvement in brain fog in small groups of people. There has been at least <a href="https://clinicaltrials.gov/study/NCT02720445">one clinical trial</a> exploring nicotine for mild cognitive impairment in older adults, though not in the context of long COVID. Given that anecdotal reports and small studies continue to draw attention, it is likely that targeted trials are in development. The main <a href="https://www.nhsinform.scot/long-term-effects-of-covid-19-long-covid/signs-and-symptoms/long-covid-brain-fog/">recommendations</a> by experts are to implement lifestyle measures. Slowly increasing exercise, having a healthy diet, avoiding alcohol, drugs and smoking, sleeping enough, practising mindfulness and doing things that stimulate the brain are all thought to help brain fog. For those grappling with long COVID or persistent brain fog, the idea of using nicotine patches or gum might be tempting. But experts caution against self-medicating with nicotine. The lack of standardised dosing and the potential for addiction and unknown long-term effects make it a risky experiment. While nicotine isn’t a cure and may carry real risks, its potential to ease long COVID symptoms warrants careful study. For now, those battling brain fog should approach it with caution – and always under medical supervision. What’s clear, though, is the urgent need for more research into safe, effective treatments for the lingering effects of COVID.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/259093/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> By <a href="https://theconversation.com/profiles/dipa-kamdar-1485027">Dipa Kamdar</a>, Senior Lecturer in Pharmacy Practice, <a href="https://theconversation.com/institutions/kingston-university-949">Kingston University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/some-people-are-turning-to-nicotine-gum-and-patches-to-treat-long-covid-brain-fog-259093">original article</a>. Image: Wikimedia Commons </div>

Body

How old are you really? Are the latest ‘biological age’ tests all they’re cracked up to be?

<div class="theconversation-article-body"> We all like to imagine we’re ageing well. Now a simple blood or saliva test promises to tell us by measuring our “<a href="https://www.si.com/soccer/cristiano-ronaldo-shocking-biological-age">biological age</a>”. And then, as many have done, we can <a href="https://nypost.com/2024/07/25/entertainment/khloe-kardashian-40-learns-her-biological-age-is-28/">share</a> how “young” we really are on social media, along with our secrets to success. While chronological age is how long you have been alive, <a href="https://www.medicalnewstoday.com/articles/chronological-aging">measures of biological age</a> aim to indicate how old your body actually is, purporting to measure “wear and tear” at a molecular level. <blockquote class="twitter-tweet"> Cristiano Ronaldo is biologically 29 years old! 😱 CR7’s WHOOP stats put his body at 12 years younger than his actual age! 💪 Cristiano’s dedication to his health and longevity is second to none 👏 (Via <a href="https://twitter.com/Cristiano?ref_src=twsrc%5Etfw">@cristiano</a>/<a href="https://twitter.com/WHOOP?ref_src=twsrc%5Etfw">@WHOOP</a>) <a href="https://t.co/PwKqc77031">pic.twitter.com/PwKqc77031</a> — DAZN Football (@DAZNFootball) <a href="https://twitter.com/DAZNFootball/status/1925894821203321009?ref_src=twsrc%5Etfw">May 23, 2025</a></blockquote> The appeal of these tests is undeniable. Health-conscious consumers may see their results as reinforcing their anti-ageing efforts, or a way to show their journey to better health is paying off. But how good are these tests? Do they actually offer useful insights? Or are they just clever marketing dressed up to look like science? <h2>How do these tests work?</h2> Over time, the chemical processes that allow our body to function, known as our “metabolic activity”, lead to damage and a decline in the activity of our cells, tissues and organs. Biological age tests aim to capture some of these changes, offering a snapshot of how well, or how poorly, we are <a href="https://www.aginganddisease.org/EN/10.14336/AD.2022.1107">ageing on a cellular level</a>. Our DNA is also affected by the ageing process. In particular, chemical tags (methyl groups) attach to our DNA and affect gene expression. These changes occur in predictable ways with age and environmental exposures, in a process called methylation. Research studies have used “epigenetic clocks”, which measure the methylation of our genes, to estimate biological age. By analysing methylation levels at specific sites in the genome from participant samples, researchers apply predictive models to estimate the cumulative wear and tear on the body. <h2>What does the research say about their use?</h2> Although the science is rapidly evolving, the evidence underpinning the use of epigenetic clocks to measure biological ageing in research studies is <a href="https://pubmed.ncbi.nlm.nih.gov/39743988/">strong</a>. Studies have shown epigenetic biological age estimation is a <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC5940111/">better predictor</a> of the risk of death and ageing-related diseases than chronological age. Epigenetic clocks also have been found to <a href="https://www.sciencedirect.com/science/article/pii/S1279770725001277?dgcid=rss_sd_all">correlate strongly</a> with lifestyle and environmental exposures, such as smoking status and diet quality. In addition, they have been found to be able to <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8484046/">predict</a> the risk of conditions such as cardiovascular disease, which can lead to heart attacks and strokes. Taken together, a growing body of research indicates that at a population level, epigenetic clocks are robust measures of biological ageing and are strongly linked to the risk of <a href="https://www.aginganddisease.org/EN/10.14336/AD.2022.1107">disease and death</a> <h2>But how good are these tests for individuals?</h2> While these tests are valuable when studying populations in research settings, using epigenetic clocks to measure the biological age of individuals is a different matter and requires scrutiny. For testing at an individual level, perhaps the most important consideration is the “signal to noise ratio” (or precision) of these tests. This is the question of whether a single sample from an individual may yield widely differing results. A <a href="https://www.nature.com/articles/s43587-022-00248-2">study from 2022</a> found samples deviated by up to nine years. So an identical sample from a 40-year-old may indicate a biological age of as low as 35 years (a cause for celebration) or as high as 44 years (a cause of anxiety). While there have been significant improvements in these tests over the years, there is considerable <a href="https://www.nature.com/articles/s43587-022-00248-2">variability</a> in the precision of these tests between commercial providers. So depending on who you send your sample to, your estimated biological age may vary considerably. <blockquote class="twitter-tweet"> Khloé Kardashian, 40, learns her biological age after confessing bad eating habits <a href="https://t.co/vlipIl9Im2">https://t.co/vlipIl9Im2</a> <a href="https://t.co/s1zRdpht0K">pic.twitter.com/s1zRdpht0K</a> — New York Post (@nypost) <a href="https://twitter.com/nypost/status/1816322940532650399?ref_src=twsrc%5Etfw">July 25, 2024</a></blockquote> Another limitation is there is currently no standardisation of methods for this testing. Commercial providers perform these tests in <a href="https://www.livescience.com/health/ageing/new-biological-aging-test-predicts-your-odds-of-dying-within-the-next-12-months">different ways</a> and have different algorithms for estimating biological age from the data. As you would expect for commercial operators, providers don’t disclose their methods. So it’s difficult to compare companies and determine who provides the most accurate results – and what you’re getting for your money. A third limitation is that while epigenetic clocks correlate well with ageing, they are simply a “<a href="https://frontlinegenomics.com/opinion-direct-to-consumer-epigenetic-tests-are-not-getting-enough-scrutiny/#:%7E:text=Companies%20claim%20that%20epigenetic%20variants,in%20the%20usual%20DTC%20scrutiny">proxy</a>” and are not a diagnostic tool. In other words, they may provide a general indication of ageing at a cellular level. But they don’t offer any specific insights about what the issue may be if someone is found to be “ageing faster” than they would like, or what they’re doing right if they are “ageing well”. So regardless of the result of your test, all you’re likely to get from the commercial provider of an epigenetic test is generic advice about what the science says is healthy behaviour. <h2>Are they worth it? Or what should I do instead?</h2> While companies offering these tests may have good intentions, remember their ultimate goal is to sell you these tests and make a profit. And at a cost of around A$500, they’re not cheap. While the idea of using these tests as a personalised health tool has potential, it is clear that <a href="https://www.theguardian.com/science/2022/jun/13/biological-age-startups-why">we are not there yet</a>. For this to become a reality, tests will need to become more reproducible, standardised across providers, and validated through long-term studies that link changes in biological age to specific behaviours. So while one-off tests of biological age make for impressive social media posts, for most people they represent a significant cost and offer limited real value. The good news is we already know what we need to do to increase our chances of living longer and healthier lives. These <a href="https://theconversation.com/you-cant-reverse-the-ageing-process-but-these-5-things-can-help-you-live-longer-214580">include</a>: <ul> <li>improving our diet</li> <li>increasing physical activity</li> <li>getting enough <a href="https://academic.oup.com/sleep/article/47/1/zsad253/7280269">sleep</a></li> <li>quitting smoking</li> <li><a href="https://theconversation.com/how-much-stress-is-too-much-a-psychiatrist-explains-the-links-between-toxic-stress-and-poor-health-and-how-to-get-help-222245">reducing stress</a></li> <li>prioritising social connection.</li> </ul> We don’t need to know our biological age in order to implement changes in our lives right now to improve our health. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/257710/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" />By <a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, Associate Professor, Epidemiology, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-old-are-you-really-are-the-latest-biological-age-tests-all-theyre-cracked-up-to-be-257710">original article</a>. Image: Pexels / Cottonbro Studio </div>

Body

What is a blood cholesterol ratio? And what should yours be?

<div class="theconversation-article-body"> Have you had a blood test to check your cholesterol level? These check the different blood fat components: <ul> <li>total cholesterol</li> <li>LDL (low-density lipoprotein), which is sometimes called “bad cholesterol”</li> <li>HDL (high-density lipoprotein), which is sometimes called “good cholesterol”</li> <li>triglycerides.</li> </ul> Your clinician then compares your test results to normal ranges – and may use ratios to compare different types of cholesterol. <iframe id="8KC9s" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/8KC9s/6/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> High blood cholesterol is a major risk factor for cardiovascular disease. This is a broad term that includes disease of blood vessels throughout the body, arteries in the heart (known as coronary heart disease), heart failure, heart valve conditions, arrhythmia and stroke. So what does cholesterol do? And what does it mean to have a healthy cholesterol ratio? <h2>What are blood fats?</h2> Cholesterol is a waxy type of fat made in the liver and gut, with a small amount of pre-formed cholesterol coming from food. Cholesterol is found in all cell membranes, contributing to their structure and function. Your body <a href="https://www.ncbi.nlm.nih.gov/books/NBK513326/">uses cholesterol to make</a> vitamin D, bile acid, and hormones, including oestrogen, testosterone, cortisol and aldosterone. When there is too much cholesterol in your blood, it gets deposited into artery walls, making them hard and narrow. This process is called <a href="https://en.wikipedia.org/wiki/Atherosclerosis">atherosclerosis</a>. Cholesterol is <a href="https://www.ncbi.nlm.nih.gov/books/NBK513326/">packaged with</a> <a href="https://en.wikipedia.org/wiki/Triglyceride">triglycerides</a> (the most common type of fat in the body) and specific <a href="https://en.wikipedia.org/wiki/Apolipoprotein">“apo” proteins</a> into “lipo-proteins” as a package called “very-low-density” lipoproteins (VLDLs). These are transported via the blood to body tissue in a form called low-density lipoprotein (LDL) cholesterol. Excess cholesterol can be transported back to the liver by high-density lipoprotein, the HDL, for removal from circulation. Another less talked about blood fat is Lipoprotein-a, or Lp(a). This is determined by your genetics and <a href="https://www.victorchang.edu.au/heart-disease/high-cholesterol">not influenced by lifestyle factors</a>. About one in five (<a href="https://www1.racgp.org.au/ajgp/2021/may/lipid-management-and-implications-for-australian-g">20%</a>) of Australians are carriers. Having a high Lp(a) level is an independent cardiovascular disease risk factor. <h2>Knowing your numbers</h2> Your blood fat levels <a href="https://www.heartfoundation.org.au/your-heart/high-blood-cholesterol">are affected by</a> both modifiable factors: <ul> <li>dietary intake</li> <li>physical activity</li> <li>alcohol</li> <li>smoking</li> <li>weight status.</li> </ul> And non-modifiable factors: <ul> <li>age</li> <li>sex</li> <li>family history.</li> </ul> <iframe id="S7Xp4" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/S7Xp4/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <h2>What are cholesterol ratios?</h2> Cholesterol ratios are sometimes used to provide more detail on the balance between different types of blood fats and to evaluate risk of developing heart disease. Commonly used ratios include: <h2>1. Total cholesterol to HDL ratio</h2> This ratio is used in Australia to <a href="https://www.cvdcheck.org.au/calculator">assess risk of heart disease</a>. It’s calculated by dividing your total cholesterol number by your HDL (good) cholesterol number. A higher ratio (<a href="https://www.medicalnewstoday.com/articles/cholesterol-ratio-calculator#how-to-calculate">greater than 5</a>) is associated with a higher risk of heart disease, whereas a lower ratio is associated with a lower risk of heart disease. A <a href="https://pubmed.ncbi.nlm.nih.gov/36589799/">study</a> of 32,000 Americans over eight years found adults who had either very high, or very low, total cholesterol/HDL ratios were at 26% and 18% greater risk of death from any cause during the study period. Those with a ratio of greater than 4.2 had a 13% higher risk of death from heart disease than those with a ratio lower than 4.2. <h2>2. Non-HDL cholesterol to HDL cholesterol ratio (NHHR)</h2> Non-HDL cholesterol is the total cholesterol minus HDL. Non-HDL cholesterol includes all blood fats such as LDL, triglycerides, Lp(a) and others. This ratio is abbreviated as NHHR. This ratio has been used more recently because it compares the ratio of “bad” blood fats that can contribute to atherosclerosis (hardening and narrowing of the arteries) to “good” or anti-atherogenic blood fats (HDL). Non-HDL cholesterol is a <a href="https://pubmed.ncbi.nlm.nih.gov/31170997/">stronger predictor of cardiovascular disease risk</a> than LDL alone, while <a href="https://pubmed.ncbi.nlm.nih.gov/37228232/">HDL is associated with</a> lower cardiovascular disease risk. Because this ratio removes the “good” cholesterol from the non-HDL part of the ratio, it is not penalising those people who have really high amounts of “good” HDL that make up their total cholesterol, which the first ratio does. Research has suggested this ratio may be a stronger <a href="https://pubmed.ncbi.nlm.nih.gov/39949279/">predictor of atherosclerosis in women than men</a>, however more research is needed. Another <a href="https://pubmed.ncbi.nlm.nih.gov/39415313">study</a> followed more than 10,000 adults with type 2 diabetes from the United States and Canada for about five years. The researchers found that for each unit increase in the ratio, there was around a 12% increased risk of having a heart attack, stroke or death. They identified a risk threshold of 6.28 or above, after adjusting for other risk factors. Anyone with a ratio greater than this is at very high risk and would require management to lower their risk of heart disease. <h2>3. LDL-to-HDL cholesterol ratio</h2> LDL/HDL is calculated by dividing your LDL cholesterol number by the HDL number. This gives a ratio of “bad” to “good” cholesterol. A lower ratio (<a href="https://www.medicalnewstoday.com/articles/cholesterol-ratio-calculator#how-to-calculate">ideal is less than 2.0</a>) is associated with a lower risk of heart disease. While there is lesser focus on LDL/HDL, these ratios have been shown to be predictors of occurrence and <a href="https://pubmed.ncbi.nlm.nih.gov/35843962/">severity of heart attacks</a> in patients presenting with chest pain. If you’re worried about your cholesterol levels or cardiovascular disease risk factors and are aged 45 and over (or over 30 for First Nations people), consider seeing your GP for a Medicare-rebated <a href="https://www.heartfoundation.org.au/your-heart/heart-health-checks">Heart Health Check</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/253126/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> By <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> and <a href="https://theconversation.com/profiles/erin-clarke-1314081">Erin Clarke</a>, Postdoctoral Researcher, Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-a-blood-cholesterol-ratio-and-what-should-yours-be-253126">original article</a>. Image: Everlabs </div>

Caring

A new COVID variant is on the rise: what you need to know

<div class="theconversation-article-body"> More than five years since COVID was <a href="https://www.who.int/europe/emergencies/situations/covid-19">declared a pandemic</a>, we’re still facing the regular emergence of new variants of the virus, SARS-CoV-2. The latest variant on the rise is LP.8.1. It’s <a href="https://www.health.gov.au/resources/collections/australian-respiratory-surveillance-reports-2025">increasing in Australia</a>, making up close to <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/respiratory-surveillance-20250322.pdf">one in five COVID cases</a> in New South Wales. Elsewhere it’s become even more dominant, comprising at least three in five cases <a href="https://inews.co.uk/news/health/lp-covid-variant-cases-future-waves-3598768">in the United Kingdom</a>, for example. So what is LP.8.1? And is it cause for concern? Let’s look at what we know so far. <h2>An offshoot of Omicron</h2> LP.8.1 was first <a href="https://www.who.int/publications/m/item/risk-evaluation-for-sars-cov-2-variant-under-monitoring-lp81">detected in July 2024</a>. It’s a descendant of Omicron, specifically of KP.1.1.3, which is descended from <a href="https://theconversation.com/the-emergence-of-jn-1-is-an-evolutionary-step-change-in-the-covid-pandemic-why-is-this-significant-220285">JN.1</a>, a subvariant that caused large waves of COVID infections around the world in late 2023 and early 2024. The <a href="https://www.who.int/activities/tracking-SARS-CoV-2-variants">World Health Organization</a> (WHO) designated LP.8.1 as a <a href="https://www.who.int/publications/m/item/risk-evaluation-for-sars-cov-2-variant-under-monitoring-lp81">variant under monitoring</a> in January. This was in response to its significant growth globally, and reflects that it has genetic changes which may allow the virus to spread more easily and pose a greater risk to human health. Specifically, LP.8.1 has mutations at six locations in its spike protein, the protein which allows SARS-CoV-2 to attach to our cells. One of these mutations, V445R, is thought to allow this variant to spread more easily relative to other circulating variants. V445R has been shown to increase binding to human lung cells in <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00015-5/fulltext">laboratory studies</a>. <figure class="align-center "><img src="https://images.theconversation.com/files/658901/original/file-20250401-56-eywcgb.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/658901/original/file-20250401-56-eywcgb.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=468&fit=crop&dpr=1 600w, https://images.theconversation.com/files/658901/original/file-20250401-56-eywcgb.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=468&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/658901/original/file-20250401-56-eywcgb.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=468&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/658901/original/file-20250401-56-eywcgb.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=588&fit=crop&dpr=1 754w, https://images.theconversation.com/files/658901/original/file-20250401-56-eywcgb.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=588&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/658901/original/file-20250401-56-eywcgb.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=588&fit=crop&dpr=3 2262w" alt="A chart showing the distribution of different COVID variants in different colours." /><figcaption>The proportion of COVID cases caused by LP.8.1 has been rising in New South Wales. <a class="source" href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/respiratory-surveillance-20250322.pdf">NSW Health</a></figcaption></figure> Notably, the symptoms of LP.8.1 don’t appear <a href="https://www.who.int/publications/m/item/risk-evaluation-for-sars-cov-2-variant-under-monitoring-lp81">to be any more severe</a> than other circulating strains. And the WHO has evaluated the additional public health risk LP.8.1 poses at a global level to be low. What’s more, LP.8.1 remains a variant under monitoring, rather than a variant of interest or a variant of concern. In other words, these changes to the virus with LP.8.1 are small, and not likely to make a big difference to the trajectory of the pandemic. <h2>That doesn’t mean cases won’t rise</h2> COVID as a whole is still a major national and international health concern. So far this year there have been close to <a href="https://www.health.gov.au/resources/collections/australian-respiratory-surveillance-reports-2025">45,000 new cases recorded in Australia</a>, while around <a href="https://covidlive.com.au/report/daily-hospitalised/aus">260 people are currently in hospital</a> with the virus. Because many people are no longer testing or reporting their infections, the real number of cases is probably far higher. In <a href="https://www.health.gov.au/resources/collections/australian-respiratory-surveillance-reports-2025">Australia</a>, LP.8.1 has become the <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/respiratory-surveillance-20250322.pdf">third most dominant strain in NSW</a> (behind <a href="https://theconversation.com/xec-is-now-in-australia-heres-what-we-know-about-this-hybrid-covid-variant-239292">XEC</a> and KP.3). It <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/respiratory-surveillance-20250322.pdf">has been growing</a> over the past couple of months and this trend looks set to continue. This is not to say it’s not growing similarly in other states and territories, however NSW Health publishes <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Pages/reports.aspx">weekly respiratory surveillance</a> with a breakdown of different COVID variants in the state. Sequences of LP.8.1 in the <a href="https://gisaid.org/">GISAID database</a>, used to track the prevalence of variants around the world, increased from <a href="https://www.who.int/publications/m/item/risk-evaluation-for-sars-cov-2-variant-under-monitoring-lp81">around 3%</a> at the end of 2024 to 38% of global sequences as of <a href="https://x.com/Mike_Honey_/status/1905816340331728914">mid March</a>. In some countries it’s climbed particularly high. In the United States LP.8.1 is responsible for <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">55% of cases</a>. In <a href="https://inews.co.uk/news/health/lp-covid-variant-cases-future-waves-3598768">the UK</a>, where LP.8.1 is making up at least 60% of cases, scientists fear <a href="https://inews.co.uk/news/science/new-covid-wave-cases-hospitalisations-3611459?srsltid=AfmBOor_V7pQrPMPhUYQA2KCZgRfsI_CpxTwIRiHDFJHIJhq2kbAmD42">it may be driving a new wave</a>. <h2>Will COVID vaccines work against LP.8.1?</h2> Current COVID vaccines, including the most recently available <a href="https://theconversation.com/new-covid-vaccines-may-be-coming-to-australia-heres-what-to-know-about-the-jn-1-shots-237652">JN.1 shots</a>, are still expected to <a href="https://www.who.int/publications/m/item/risk-evaluation-for-sars-cov-2-variant-under-monitoring-lp81">offer good protection</a> against symptomatic and severe disease with LP.8.1. Nonetheless, due to its designation as a variant under monitoring, WHO member countries will continue to study the behaviour <a href="https://www.who.int/publications/m/item/risk-evaluation-for-sars-cov-2-variant-under-monitoring-lp81">of the LP.8.1 variant</a>, including any potential capacity to evade our immunity. While there’s no cause for panic due to LP.8.1 variant at this stage, COVID can still be a severe disease for some. Continued vigilance and vaccination, particularly <a href="https://www.health.gov.au/our-work/covid-19-vaccines/getting-your-vaccination">for medically vulnerable groups</a>, is essential in minimising the impact of the disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/253237/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> By <a href="https://theconversation.com/profiles/thomas-jeffries-1511629">Thomas Jeffries</a>, Senior Lecturer in Microbiology, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/a-new-covid-variant-is-on-the-rise-heres-what-to-know-about-lp-8-1-253237">original article</a>. Image: Shutterstock </div>

Caring

"Game changer": Aussie women welcome new early-detection cancer test

Australian women will soon have access to a revolutionary blood test designed to aid in the early detection of breast cancer. The innovative test, known as BREASTEST plus™, was developed by BCAL Diagnostics and is set to complement traditional breast cancer screening methods such as mammograms and ultrasounds. BCAL Diagnostics chair Jayne Shaw <a href="https://7news.com.au/news/public-health/australian-first-blood-test-to-help-early-detection-of-breast-cancer-comes-to-sydney-before-nationwide-rollout-c-18153750" target="_blank" rel="noopener">revealed to 7NEWS</a> that the development of the test had taken 15 years, describing it as a "game changer" for women worldwide. “The breast test is a game changer for all women everywhere because it’s a blood test to detect breast cancer alongside other diagnostic tools like ultrasound and a mammogram,” Shaw said. She pointed out that a similar blood test for prostate cancer, which has been available since 1989, has significantly improved clinical outcomes for men. “Early diagnosis for all cancers will lead to improved survivability rates, and it was only inevitable that a blood test would be developed to diagnose breast cancer earlier,” she added. One of the major advantages of the new blood test is its ability to detect breast cancer in women with high breast density. Around 40-50% of Australian women undergoing screening have high breast density, which can obscure abnormalities on mammograms and make diagnosis more difficult. With the ability to identify breast cancer markers, the blood test will provide a valuable additional tool for detecting cancers that might otherwise go unnoticed. Breast Cancer Network Australia director Vicki Durston welcomed the new test, especially for its potential to improve the reporting of high breast density cases, where cancers are often missed. “Breast Cancer Network Australia has long been calling for the uplift in the breast density statement nationally to see standardised reporting across the country,” Durston said. She also noted that while high breast density is just one of many risk factors, the new test represents an innovative step forward in improving early detection and treatment. Breast cancer remains the most commonly diagnosed cancer among Australian women, accounting for approximately 28% of all new cancer cases. In 2024 alone, around 21,194 people were diagnosed with breast cancer in Australia, including 20,973 women and 221 men. However, survival rates have improved dramatically, with Australia’s peak breast cancer body reporting that the five-year survival rate has risen from 78% in 1994 to 92% in 2020, with many people living long and healthy lives beyond this period. While the test currently comes at an out-of-pocket cost, there is hope that the Australian government will eventually provide subsidies under Medicare to make it more accessible. The first tests will be available at the <a href="https://www.sydneybreastclinic.com.au/" target="_blank" rel="noopener">Sydney Breast Clinic</a> starting Thursday, followed by a rollout in Melbourne, with plans to expand nationwide by the end of the year. Images: Shutterstock / 7NEWS

Body

I’m avoiding a hearing test because I don’t want chunky hearing aids. What are my options?

<div class="theconversation-article-body"><a href="https://www.health.gov.au/hearing-health/resources/publications/one-in-six-australians-experience-hearing-loss-poster-0?language=en">One in six Australians</a> have hearing loss and, for most adults, hearing starts to decline from <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0107720">middle age onwards</a>. Many of us, however, hesitate to seek help or testing for our hearing. Perhaps you’re afraid you’ll be told to wear hearing aids, and envision the large and bulky hearing aids you might have seen on your grandparents decades ago. In fact, hearing aids have changed a lot since then. They’re often now very small; some are barely noticeable. And hearing aids aren’t the only option available for people experiencing hearing loss. <h2>Why you shouldn’t ignore hearing loss</h2> Acquired hearing loss can have a serious impact on our life. It is <a href="https://journals.sagepub.com/doi/10.1177/2331216517734088">associated</a> with or can <a href="https://pubmed.ncbi.nlm.nih.gov/29222544/">contribute</a> to: <ul> <li>social isolation</li> <li>loneliness</li> <li>not being able to work as much, or at all</li> <li>memory problems</li> <li>trouble thinking clearly</li> <li>conditions such as dementia.</li> </ul> Hearing loss has also been associated with depression, anxiety and stress. A <a href="https://academic.oup.com/gerontologist/article-abstract/60/3/e137/5369884?redirectedFrom=fulltext">systematic review and meta-analysis</a> found adults with hearing loss are 1.5 times more likely to experience depression than those without hearing loss. A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768374">large population study</a> in the US found self-reported hearing loss was associated with: <ul> <li>higher levels of psychological distress</li> <li>increased use of antidepressant and anti-anxiety medications, and</li> <li>greater utilisation of mental health services.</li> </ul> The good news is that doing something about your hearing loss can help you live a <a href="https://pubmed.ncbi.nlm.nih.gov/36385406/">happier</a> and <a href="https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00232-5/fulltext">longer</a> life. <h2>So why don’t people get their hearing checked?</h2> <a href="https://pubmed.ncbi.nlm.nih.gov/17927921/">Research</a> has found adults with hearing loss typically wait ten years to seek help for their hearing. Less than a quarter of those who need hearing aids actually go ahead with them. Hearing declines slowly, so people may perceive their hearing difficulties <a href="https://www.tandfonline.com/doi/full/10.3109/14992027.2013.839888">aren’t concerning</a>. They may feel they’re now used to not being able to hear properly, without fully appreciating the impact it’s having on their life. Some people harbour <a href="https://www.tandfonline.com/doi/full/10.3109/14992027.2013.839888">negative attitudes to hearing aids</a> or don’t think they’ll actually help. Others may have overheard their <a href="https://www.tandfonline.com/doi/full/10.3109/14992027.2013.839888">partner, family or friends</a> say negative things or make jokes about hearing aids, which can put people off getting their hearing checked. <a href="https://www.tandfonline.com/doi/full/10.1080/14992027.2023.2293651">Stigma</a> can play a big part. People often associate hearing loss with <a href="https://www.tandfonline.com/doi/full/10.1080/14992027.2024.2353862">negative stereotypes</a> such as ageing, weakness and “being different”. Our recent <a href="https://www.tandfonline.com/doi/full/10.1080/14992027.2024.2446480">research</a> found that around one in four people never tell anyone about their hearing loss because of experiences of stigma. Adults with hearing loss who experience stigma and choose not to disclose their hearing loss were also likely not to go ahead with hearing aids, we found. <h2>What are my options for helping my hearing?</h2> The first step in helping your hearing is to have a hearing check with a hearing care professional such as an an audiologist. You can also speak to your GP. If you’ve got hearing loss, hearing aids aren’t the only option. Others include: <ul> <li>other assistive listening devices (such as amplified phones, personal amplifiers and TV headphones)</li> <li>doing a short course or program (such as the <a href="https://shrs.uq.edu.au/active-communication-education-ace">Active Communication Education program</a> developed via University of Queensland researchers) aimed at giving you strategies to manage your hearing, for instance, in noisy environments</li> <li>monitoring your hearing with regular checkups</li> <li>strategies for protecting your hearing in future (such as wearing earplugs or earmuffs in loud environments, and not having headphone speakers too loud)</li> <li>a cochlear implant (if hearing loss is severe)</li> </ul> Hearing care professionals should take a <a href="https://www.tandfonline.com/doi/full/10.1080/14992027.2023.2190864">holistic approach</a> to hearing rehabilitation. That means coming up with individualised solutions based on your preferences and circumstances. <h2>What are modern hearing aids like?</h2> If you do need hearing aids, it’s worth knowing there are several different types. All modern hearing aids are extremely small and discrete. Some sit behind your ear, while others sit within your ear. Some look the same as air pods. Some are even completely invisible. These hearing aids are custom fitted to sit deep within your ear canal and contain no external tubes and wires. Some types of hearing aids are more expensive than others, but even the basic styles are discrete. In Australia, children and many adults are eligible for <a href="https://www.health.gov.au/our-work/hearing-services-program/accessing/eligibility">free or subsidised hearing services</a> and many health funds offer hearing aid rebates as part of their extras cover. Despite being small, modern hearing aids have advanced technology including the ability to: <ul> <li>reduce background noise</li> <li>direct microphones to where sound is coming from (directional microphones)</li> <li>use Bluetooth so you can hear audio from your phone, TV and other devices directly in your hearing aids.</li> </ul> When used with a smartphone, some hearing aids can even track your health, detect if you have fallen, and translate languages in real time. <h2>What should I do next?</h2> If you think you might be having hearing difficulties or are curious about the status of your hearing, then it’s a good idea to get a hearing check. The earlier you do something about your hearing, the greater the likelihood that you can prevent further hearing decline and reduce other health risks. And rest assured, there’s a suitable option for everyone.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/250925/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> By <a href="https://theconversation.com/profiles/katie-ekberg-1534998">Katie Ekberg</a>, Senior Lecturer, College of Nursing and Health Sciences, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/barbra-timmer-1199057">Barbra Timmer</a>, Senior Lecturer and Researcher in Audiology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/im-avoiding-a-hearing-test-because-i-dont-want-chunky-hearing-aids-what-are-my-options-250925">original article</a>. Image: Getty </div>

Hearing

5 years since COVID was declared a pandemic – how prepared are we for the next one?

<div class="theconversation-article-body"> On March 11 2020, as COVID continued to spread rapidly around the globe, the <a href="https://www.who.int/europe/emergencies/situations/covid-19">World Health Organization</a> (WHO) officially declared a pandemic. More than <a href="https://data.who.int/dashboards/covid19/deaths">7 million people</a> have since died from COVID. The virus, and the public health measures enacted to control it, have had far-reaching effects on societies around the world. Five years on, the virus continues to circulate. But, thanks to vaccines and <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10425195/">immunity acquired from infections</a>, hospitalisations and deaths due to COVID are vastly less frequent <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/latest-release">than in previous years</a>. Meanwhile, <a href="https://www.aihw.gov.au/reports/covid-19/long-covid-in-australia-a-review-of-the-literature/summary">long COVID</a> continues to have a major impact on people’s lives. Estimates suggest more than <a href="https://www.nature.com/articles/s41591-024-03173-6">400 million people</a> around the world have had or are currently living with long COVID. At this point, Australia and the world must take the lessons of COVID – in areas from surveillance, to outbreak response, to vaccines and therapeutics – to be better prepared for the next pandemic. <h2>Some areas we went right – and wrong</h2> Our diagnostic laboratories across Australia were well prepared. Laboratories at the Doherty Institute diagnosed the first case of COVID in Australia and were the first to <a href="https://www.mja.com.au/journal/2020/212/10/isolation-and-rapid-sharing-2019-novel-coronavirus-sars-cov-2-first-patient">isolate and share the virus</a> globally in early 2020. At the same time, a national public health response was quickly put in place. This involved <a href="https://academic.oup.com/cid/article/73/3/e808/6044730?login=false">measures such as</a> closing borders, setting up testing centres, and limiting gatherings. But there are several areas where we could have mobilised more effectively. During the early stages of the pandemic, there were, at times, challenges with sharing data as well as biological samples and the ingredients for COVID tests between the different states and territories. For example, there are currently restrictions in place that limit sharing of virus strains between states and territories. But when a new strain emerges, many laboratories need access to it to evaluate their testing capabilities. One recommendation from an <a href="https://www.pmc.gov.au/domestic-policy/commonwealth-government-covid-19-response-inquiry">independent 2024 review</a> of the federal government’s COVID response was an Australian Centre for Disease Control. An interim version was launched in early 2024 and the Australian government is investing <a href="https://www.health.gov.au/news/2517m-to-establish-an-independent-australian-centre-for-disease-control-cdc#:%7E:text=The%20Australian%20Government%20is%20investing,for%20Disease%20Control%20(CDC).">A$251.7 million</a> in this important initiative. The goal for the new centre for disease control will be to provide independent technical advice on infectious diseases to government. It will also facilitate rapid integration of data from all states and territories leading to a more unified response. At the start of a pandemic, we need to understand everything about the new virus and at great speed. This needs systems in place in “peace time”, ready to be mobilised in “war time”. Back in 2020, we had protocols ready for <a href="https://www.nature.com/articles/s41591-020-0819-2">hospitalised patients</a> and <a href="https://www.remapcap.org/">intensive care units</a> to collect specimens and also start new clinical trials. But we were not prepared on many other fronts, for example to collect samples or study how COVID was transmitted in the community or in different key groups. Every day counts at the start of a pandemic. <h2>Harnessing medical technologies</h2> Relatively recent technological advances in both diagnostics (RAT tests) and vaccine development (the use of <a href="https://www.genome.gov/genetics-glossary/Messenger-RNA-mRNA">messenger RNA</a>, which gives our body genetic instructions to fight COVID) have put us in a strong position to be at the cutting edge in any pandemic response. Moderna, one of the two companies that pioneered the mRNA vaccines, has established its <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/world-leading-moderna-vaccine-facility-opens-in-victoria">Asia-Pacific headquarters in Melbourne</a>. CSL, which made the AstraZeneca COVID vaccines in Australia and manufactures several other vaccines, has now incorporated <a href="https://www.aumanufacturing.com.au/csls-mrna-covid-19-vaccine-approved-for-sale-in-japan">mRNA in its repertoire</a>. This capability means Australians could have immediate access to mRNA vaccines in the event of another pandemic. We could also potentially manufacture these vaccines for low- and middle-income countries in our region. But what if we can’t make an effective vaccine to fight a future pandemic? This is a situation we must be prepared for, as we’ve seen with infections such as HIV, where after 40 years of trying and billions of dollars spent, <a href="https://www.sciencenews.org/article/aids-hiv-vaccine-anniversary-immunity-antibodies">we still don’t have a vaccine</a>. In such a situation, we will need to rely on antiviral drugs. The way we currently make antiviral drugs takes significantly longer to develop than vaccines. And although we have some <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8069527/">broad spectrum antiviral drugs</a>, the most potent antivirals are very specific – meaning one drug treats <a href="https://retrovirology.biomedcentral.com/articles/10.1186/s12977-022-00608-1">only one type of virus</a>. To be better prepared for future pandemics, many groups around the world are working on developing a library of drugs that work against whole <a href="https://theconversation.com/what-pathogen-might-spark-the-next-pandemic-how-scientists-are-preparing-for-disease-x-223193">families of viruses</a> that could cause the next pandemic. Another approach is to develop totally new technologies that are fully tested for one virus, but can be easily adapted to a new virus. This approach could allow more rapid deployment, as the details of safety and dosing would already be understood. This is one of the major goals of the recently launched <a href="https://www.doherty.edu.au/cumming-global-centre-for-pandemic-therapeutics">Cumming Global Centre for Pandemic Therapeutics</a> based at the Doherty Institute. These ambitious efforts will require global collaboration, sharing resources and engagement of the private sector. Once we have a vaccine or drug that works, we need agreed systems in place to ensure widespread equitable access. We fell seriously short of this goal with COVID. Some <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9878283/">low- and middle-income</a> countries received vaccines months or years later than high income countries. For treatments, <a href="https://www.citizen.org/article/paxlovid-procured-supply-vs-health-need-in-low-and-middle-income-countries-through-the-end-of-2022/">antivirals such as Paxlovid</a> were never available in many countries. This is one goal of an agreement led by the WHO, called the “<a href="https://www.who.int/news-room/questions-and-answers/item/pandemic-prevention--preparedness-and-response-accord">pandemic accord</a>”, to have member states agree on pandemic prevention, preparedness and response. But after years of discussion, there remains no binding agreement. <h2>Preparing for the next pandemic</h2> As COVID was (partly due to advances in technology) the most intensively studied pandemic in human history, we have a unique resource in the record of what happened to inform our response to any future pandemic. And this is likely a matter of when, not if. New infectious disease outbreaks have continued to emerge over the past five years, including mpox, which was declared a public health emergency of international concern in July 2022 and again in <a href="https://www.health.gov.au/diseases/monkeypox-mpox">August 2024</a>. Right now, there’s an outbreak of a new viral disease in <a href="https://www.aljazeera.com/news/2025/2/27/mystery-disease-kills-more-than-50-in-drc-what-we-know-so-far">the Congo</a>, the origins of which have still <a href="https://www.science.org/content/article/mysterious-congo-outbreak-likely-linked-contaminated-water-researchers-say">not been identified</a>. We know bats, thought to be <a href="https://www.nature.com/articles/s41586-020-2012-7?rel=outbound">the source</a> of the coronavirus behind the COVID pandemic, carry an enormous spectrum of viruses that potentially threaten us. But new pandemics can also arise through mosquitoes and close contact with other animals. Pandemics are global, not national, problems. We are at a pivotal time where countries including Australia must step up their commitments to this global effort. This will need politicians to rely on the evidence and lessons learned from COVID as well as private and public investment. Unfortunately, five years down the track, we still have a long way to go to be prepared for the next pandemic.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/245362/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Written by <a href="https://theconversation.com/profiles/sharon-lewin-131968">Sharon Lewin</a>, Melbourne Laureate Professor, University of Melbourne; Director, <a href="https://theconversation.com/institutions/the-peter-doherty-institute-for-infection-and-immunity-2255">The Peter Doherty Institute for Infection and Immunity</a> and <a href="https://theconversation.com/profiles/peter-c-doherty-169">Peter C. Doherty</a>, Laureate Professor Emeritus, <a href="https://theconversation.com/institutions/the-peter-doherty-institute-for-infection-and-immunity-2255">The Peter Doherty Institute for Infection and Immunity</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/5-years-since-covid-was-declared-a-pandemic-were-still-poorly-prepared-for-the-next-one-245362">original article</a>. Image: <a class="source" style="font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Open Sans', 'Helvetica Neue', sans-serif; text-align: center;" href="https://unsplash.com/photos/white-and-black-printer-paper-OBmBHmrc3pw">Anastasiia Chepinska/Unsplash</a> </div>

Caring

The heart research that could save fit and healthy Australians

Leading scientists at the <a title="https://www.hri.org.au" href="https://www.hri.org.au/" data-outlook-id="7561b6b0-1679-4cf1-aedd-c178db738113">Heart Research Institute</a> (HRI) are close to uncovering a new biomarker to identify people at risk of heart disease with a simple blood test, after a “good” gene was identified that causes the heart to enlarge with exercise. The world first discovery was led by one of Australia’s foremost heart scientists, Professor Julie McMullen, who is now leading HRI’s Heart Muscle Group to focus on developing new ways to prevent and treat heart attack and heart failure. “Our goal is to reproduce the actions of the ‘good’ genes in the diseased heart by mimicking the beneficial effects of exercise in a failing heart. We then use that information to develop new drugs to reduce the risk of heart disease or heart failure,” Prof McMullen said. One person has a heart attack in Australia every 10 minutes, while one Australian dies from cardiovascular disease every 12 minutes. “Heart disease can happen to any of us. With increasing rates of obesity and type two diabetes, people are being affected by heart conditions at a much younger age, which can progress to heart attack and heart failure,” Prof McMullen said. “Current drugs are not very effective for improving heart function and quality of life, so it is important that we identify new therapies for patients with heart disease and heart failure.” A simple blood test could have helped someone like Warren Williams, who was a fit and healthy tri-athelete when he discovered he had atrial fibrillation. The Sydney father had to be fitted with a pacemaker, only to still suffer a massive cardiac arrest years later while on a run. “Doctors told me I should be dead, they said I shouldn’t have lived through it,” he said. "Somehow I miraculously survived, probably due to my fitness, but that we will never know. I was told I wouldn’t be able to run again, ride a bike, sing on stage, and possibly not even work again." The father is now on a mission to spread awareness about regular heart check-ups, especially for those people who feel fit and healthy. "Atrial Fibrillation affects people in many different ways - for some, everyday life and function becomes quite difficult, whereas in others, like myself, it can be a silent underlying condition with potentially life-threatening outcomes." Scientists are hoping to find the gift of research in their Santa stocking this festive season as HRI launches a targeted <a title="https://www.hri.org.au/donate-christmas-appeal" href="https://www.hri.org.au/donate-christmas-appeal" data-outlook-id="69ee70de-a228-4c82-9fb7-4efd2bcfa0b0">Christmas Appeal</a> to help Prof McMullen’s team ramp up their work to the next phase. “We know this biomarker is there and we are close to finding it, but it comes down to researchers getting time in the lab,” Prof McMullen said. “By donating, individuals can fund essential laboratory resources and high-tech equipment, accelerating the availability of life-changing treatments for those in need, said Prof McMullen. Image credits: Shutterstock

Body

NSW Government refunds millions of Covid fines

Millions of dollars in fines dished out for breaches of Covid restrictions in NSW are set to be refunded, while close to 24,000 penalty notices will be officially erased. The announcement of the statewide refund by the NSW Fines Administration Commissioner on Tuesday came after legal advice cast doubt on the legal validity of the penalties handed out during Covid lockdowns. In total, more than $5.5 million will be handed back to those who have made either a full or partial payment towards paying off a Covid fine. Those in line for money, or with outstanding penalties, will be contacted by Revenue NSW within days. “Following representations made to the Commissioner of Police and myself concerning the validity of COVID-19 penalty notices, I have decided to exercise my statutory authority and withdraw these notices,” Fine Administration Commissioner Scott Johnston said. “Revenue NSW will be reaching out to all affected customers to support them through the finalisation of their matters.” At the height of the pandemic, the state government claimed they introduced the public health orders to "protect the community". Some fines have already been withdrawn, as in 2022 the Commissioner withdrew about 36,000 penalty notices tied to Covid-related offences because the information on them “made it difficult” for recipients to understand their offence. The remaining 23,539 penalty notices were believed to have provided a clearer explanation and were not withdrawn, but after further legal advice and consideration, it was considered “appropriate” to withdraw them too. Image credits: Xinhua News Agency/Shutterstock Editorial

Legal

The latest COVID booster will soon be available. Should I get one? Am I eligible?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/nathan-bartlett-1198187">Nathan Bartlett</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Australia’s <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">Therapeutic Goods Administration</a> (TGA) has recently approved a new COVID booster. The shot was developed by Pfizer and targets <a href="https://www.sbs.com.au/news/article/what-to-know-about-the-new-covid-19-vaccine-approved-in-australia/z7ev2u8qn">the JN.1 sub-variant</a> of Omicron. This is now <a href="https://theconversation.com/new-covid-vaccines-may-be-coming-to-australia-heres-what-to-know-about-the-jn-1-shots-237652">the fifth iteration</a> of the COVID vaccines, which have been updated regularly to keep up with the rapidly evolving virus, SARS-CoV-2. But nearly five years into the pandemic, you may be wondering, why do we need yet another type of COVID booster? And do we still need to be getting boosters at all? Here’s what to consider. <h2>Targeting the spike protein</h2> Pfizer’s JN.1 booster (and Moderna’s, though the TGA has <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">not approved</a> this one at this stage) is based on mRNA technology. This technology instructs our cells to produce a specific protein – in this case SARS-CoV-2’s spike, a protein on the surface of the virus that allows it to attach to our cells. This helps the immune system produce antibodies that recognise the spike protein and interfere with the virus getting into our cells. In response to our strengthened immune responses from vaccinations and previous infections (called immune pressure), SARS-CoV-2 has continued to evolve over the course of the pandemic, modifying the shape of its spike protein so our antibodies become less effective. Most recently we’ve faced a soup of Omicron sub-variants, including JN.1. Since JN.1 was first detected <a href="https://www.gavi.org/vaccineswork/seven-things-you-need-know-about-jn1-covid-19-variant">in August 2023</a>, this Omicron sub-variant has spawned a variety of further sub-variants, such as KP.2 (known as FLiRT), KP.3 (<a href="https://theconversation.com/from-flirt-to-fluqe-what-to-know-about-the-latest-covid-variants-on-the-rise-234073">known as FLuQE</a>) and <a href="https://theconversation.com/xec-is-now-in-australia-heres-what-we-know-about-this-hybrid-covid-variant-239292">XEC</a>. The spike protein is made up of <a href="https://www.nature.com/articles/s41401-020-0485-4">1,273 amino acids</a>, a bit like molecular building blocks. Mutations to <a href="https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1228128/full">the spike protein</a> change individual amino acids. Certain amino acids are important for allowing neutralising antibodies to bind to the spike protein. This means changes can give the virus an edge over earlier variants, helping it evade our immune response. Scientists keep updating the COVID vaccines in an effort to keep up with these changes. The better matched the vaccine “spike” is to the spike protein on the surface of the virus trying to infect you, the better protection you’re likely to get. <h2>So who should get vaccinated, and when?</h2> Updating vaccines to deal with mutating viruses is not a new concept. It has been happening for the flu vaccine since <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination">around 1950</a>. We’ve become accustomed to getting the annual flu vaccine in the lead-up to the winter cold and flu season. But, unlike influenza, COVID has not settled into this annual seasonal cycle. The frequency of COVID waves of infection has been fluctuating, with new waves emerging periodically. COVID is also <a href="https://academic.oup.com/jtm/article/29/8/taac108/6731971">more transmissible</a> than the flu, which presents another challenge. While numbers vary, a conservative estimate of the reproduction number (R0 – how many people will one person will go on to infect) for JN.1 is 5. Compare this to seasonal flu with an R0 of <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-480">about 1.3</a>. In other words, COVID could be four times more transmissible than flu. Add to this immunity from a COVID vaccination (or a previous infection) <a href="https://www.nature.com/articles/d41586-023-00124-y">begins to wane</a> in the months afterwards. So an annual COVID booster is not considered enough for some more vulnerable people. <iframe id="gOYwk" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/gOYwk/2/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> For adults <a href="https://www.health.gov.au/our-work/covid-19-vaccines/getting-your-vaccination">aged 65 to 74</a>, a booster is recommended every 12 months, but they’re eligible every six months. For adults over 75, a shot is recommended every six months. Adults aged 18 to 64 are eligible every 12 months, unless they have a severe immune deficiency. Many conditions can cause immunodeficiency, including genetic disorders, infections, cancer, autoimmune diseases, diabetes and lung disease, as well as having received an organ transplant. For this group, it’s recommended they receive a shot every 12 months, but they’re eligible every six. <h2>Making sense of the advice</h2> A vaccine that targets JN.1 should provide good protection against the Omicron sub-variants likely to be circulating in the coming months. A few things need to happen before the JN.1 shots become available, such as the Australian Technical Advisory Group on Immunisation providing guidance to the government. But we can reasonably expect they might be rolled out <a href="https://www.sbs.com.au/news/article/what-to-know-about-the-new-covid-19-vaccine-approved-in-australia/z7ev2u8qn">within the next month or so</a>. If they hit doctors’ offices and pharmacies before Christmas and you’re due for a booster, the holiday period might be added impetus to go and get one, especially if you’re planning to attend lots of family and social gatherings over summer. In the meantime, the <a href="https://theconversation.com/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">XBB.1.5 vaccines</a> remain available. Although they’re targeted at an earlier Omicron sub-variant, they should still offer some protection. While young, healthy people might like to wait for the updated boosters, for those who are vulnerable and due for a vaccination, whether or not to hold out may be something to weigh up with your doctor. The advice on COVID boosters in Australia, with stronger wording (“recommended” versus “eligible”) used for more vulnerable groups, reflects what we know about COVID. People <a href="https://academic.oup.com/ageing/article/49/6/901/5862042">who are older</a> and medically vulnerable are more likely to become very unwell with the virus. For young, healthy people who may be wondering, “do I need a COVID booster at all?”, having one annually is sensible. Although you’re less likely to get very sick from COVID, it’s possible. And, importantly, vaccines also reduce the risk of <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(24)00082-1/fulltext">developing long COVID</a>. While COVID vaccines do a very good job of protecting against severe disease, they don’t necessarily stop you becoming infected. Evidence on whether they reduce transmission <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116597">has been mixed</a>, and <a href="https://pubmed.ncbi.nlm.nih.gov/38820077/">changed over time</a>. We’ve come to appreciate that vaccination is not going to free us of COVID. But it’s still our best defence against severe illness.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239594/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nathan-bartlett-1198187">Nathan Bartlett</a>, Professor, School of Biomedical Sciences and Pharmacy, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-latest-covid-booster-will-soon-be-available-should-i-get-one-am-i-eligible-239594">original article</a>. </div>

Body

Can you die from long COVID? The answer is not so simple

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/rose-shiqi-luo-1477061">Rose (Shiqi) Luo</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/catherine-itsiopoulos-14246">Catherine Itsiopoulos</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/kate-anderson-1412897">Kate Anderson</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/magdalena-plebanski-1063786">Magdalena Plebanski</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/zhen-zheng-1321031">Zhen Zheng</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Nearly five years into the pandemic, COVID is feeling less central to our daily lives. But the virus, SARS-CoV-2, is still around, and for many people the effects of an infection can be long-lasting. When symptoms persist for more than three months after the initial COVID infection, this is generally referred to as <a href="https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition">long COVID</a>. In September, Grammy-winning Brazilian musician <a href="https://www.abc.net.au/news/2024-09-07/brazilian-musician-sergio-mendez-dies-at-83/104323360">Sérgio Mendes</a> died aged 83 after reportedly having long COVID. <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-july-2023">Australian data</a> show 196 deaths were due to the long-term effects of COVID from the beginning of the pandemic up to the end of July 2023. In the United States, the Centers for Disease Control and Prevention reported 3,544 <a href="https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20221214.htm">long-COVID-related deaths</a> from the start of the pandemic up to the end of June 2022. The symptoms of <a href="https://www.healthdirect.gov.au/long-covid">long COVID</a> – such as fatigue, shortness of breath and “brain fog” – can be debilitating. But can you die from long COVID? The answer is not so simple. <h2>How could long COVID lead to death?</h2> There’s still a lot we don’t understand about what causes long COVID. A popular theory is that “zombie” <a href="https://www.pnas.org/doi/full/10.1073/pnas.2300644120">virus fragments</a> may linger in the body and cause inflammation even after the virus has gone, resulting in long-term health problems. Recent research suggests a reservoir of <a href="https://www.sciencedirect.com/science/article/abs/pii/S1198743X24004324?via%3Dihub">SARS-CoV-2 proteins</a> in the blood might explain why some people experience ongoing symptoms. We know a serious COVID infection can damage <a href="https://covid19.nih.gov/news-and-stories/long-term-effects-sars-cov-2-organs-and-energy#:%7E:text=What%20you%20need%20to%20know,main%20source%20of%20this%20damage">multiple organs</a>. For example, severe COVID can lead to <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19">permanent lung dysfunction</a>, persistent heart inflammation, neurological damage and long-term kidney disease. These issues can in some cases lead to death, either immediately or months or years down the track. But is death beyond the acute phase of infection from one of these causes the direct result of COVID, long COVID, or something else? Whether long COVID can directly cause death continues to be a topic of debate. Of the <a href="https://www.cdc.gov/nchs/data/vsrr/vsrr025.pdf">3,544 deaths</a> related to long COVID in the US up to June 2022, the most commonly recorded underlying cause was COVID itself (67.5%). This could mean they died as a result of one of the long-term effects of a COVID infection, such as those mentioned above. COVID infection was followed by heart disease (8.6%), cancer (2.9%), Alzheimer’s disease (2.7%), lung disease (2.5%), diabetes (2%) and stroke (1.8%). Adults aged 75–84 had the highest rate of death related to long COVID (28.8%). These findings suggest many of these people died “with” long COVID, rather than from the condition. In other words, long COVID may not be a direct driver of death, but rather a contributor, likely exacerbating existing conditions. <h2>‘Cause of death’ is difficult to define</h2> Long COVID is a relatively recent phenomenon, so mortality data for people with this condition are limited. However, we can draw some insights from the experiences of people with post-viral conditions that have been studied for longer, such as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). Like long COVID, <a href="https://bmjopen.bmj.com/content/12/5/e058128">ME/CFS</a> is a complex condition which can have significant and varied effects on a person’s physical fitness, nutritional status, social engagement, mental health and quality of life. Some research indicates people with ME/CFS are at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218818/">increased risk</a> of dying from causes including heart conditions, infections and suicide, that may be triggered or compounded by the debilitating nature of the syndrome. So what is the emerging data on long COVID telling us about the potential increased risk of death? Research from 2023 has suggested adults in the US with long COVID were at <a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802095">greater risk</a> of developing heart disease, stroke, lung disease and asthma. Research has also found <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9721155/">long COVID</a> is associated with a higher risk of <a href="https://www.tandfonline.com/doi/full/10.1080/21642850.2022.2164498#abstract">suicidal ideation</a> (thinking about or planning suicide). This may reflect common symptoms and consequences of long COVID such as sleep problems, fatigue, chronic pain and emotional distress. But long COVID is more likely to occur in people who have <a href="https://www.aihw.gov.au/reports/covid-19/long-covid-in-australia-a-review-of-the-literature/summary">existing health conditions</a>. This makes it challenging to accurately determine how much long COVID contributes to a person’s death. Research has long revealed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302107/">reliability issues</a> in cause-of-death reporting, particularly for people with chronic illness. <h2>So what can we conclude?</h2> Ultimately, long COVID is a <a href="https://www.health.gov.au/topics/chronic-conditions/about-chronic-conditions">chronic condition</a> that can significantly affect quality of life, mental wellbeing and overall health. While long COVID is not usually immediately or directly life-threatening, it’s possible it could exacerbate existing conditions, and play a role in a person’s death in this way. Importantly, many people with long COVID around the world lack access to appropriate support. We need to develop <a href="https://www.mja.com.au/journal/2024/221/9/persistent-symptoms-after-covid-19-australian-stratified-random-health-survey">models of care</a> for the optimal management of people with long COVID with a focus on multidisciplinary care. Dr Natalie Jovanovski, Vice Chancellor’s Senior Research Fellow in the School of Health and Biomedical Sciences at RMIT University, contributed to this article.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239184/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rose-shiqi-luo-1477061">Rose (Shiqi) Luo</a>, Postdoctoral Research Fellow, School of Health and Biomedical Sciences, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/catherine-itsiopoulos-14246">Catherine Itsiopoulos</a>, Professor and Dean, School of Health and Biomedical Sciences, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/kate-anderson-1412897">Kate Anderson</a>, Vice Chancellor's Senior Research Fellow, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/magdalena-plebanski-1063786">Magdalena Plebanski</a>, Professor of Immunology, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/zhen-zheng-1321031">Zhen Zheng</a>, Associate Professor, STEM | Health and Biomedical Sciences, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/can-you-die-from-long-covid-the-answer-is-not-so-simple-239184">original article</a>. </div>

Body

New “corpse disposal” theory tested in William Tyrrell inquest

A police theory that William Tyrrell's foster mother unlawfully disposed of the child's body after he died of an accident is set to be put before the court in an inquest into Tyrrell's disappearance. On Monday, counsel assisting Gerard Craddock SC reopened the inquest for a fifth round of evidence, saying the focus would be on the viability of the theory that William's body was purposefully disposed of. Police have alleged that after the then three-year-old died on the Kendall property on the mid-north NSW coast in September 2014, the foster mum might have loaded his body into her mother’s Mazda before driving down the road to dispose of his remains. Deputy NSW coroner Harriet Grahame heard in court that it was only then that she may have called triple zero to report the child missing. “Police assert that she must have quickly resolved that if the accidental death were to be discovered, she might lose (her other foster child),” Craddock said. Tyrrell's foster mother has long denied having any involvement with William's disappearance. Later in the inquest, evidence is set to be given from a truck driver who drove past where the foster mother allegedly disposed of the body at the time. The inquest into William’s disappearance began in March 2019 but was adjourned in October 2020. No one has been charged and a $1 million reward for information stands. Image credits: NSW Police

Legal

From eye exams to blood tests and surgery: how doctors use light to diagnose disease

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/matthew-griffith-1539353">Matthew Griffith</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> You’re not feeling well. You’ve had a pounding headache all week, dizzy spells and have vomited up your past few meals. You visit your GP to get some answers and sit while they shine a light in your eyes, order a blood test and request some medical imaging. Everything your GP just did relies on light. These are just some of the optical technologies that have had an enormous impact in how we diagnose disease. <h2>1. On-the-spot tests</h2> Point-of-care diagnostics allow doctors to test patients on the spot and get answers in minutes, rather than sending samples to a lab for analysis. The “flashlight” your GP uses to view the inside of your eye (known as an <a href="https://medlineplus.gov/ency/article/003881.htm">ophthalmoscope</a>) is a great example. This allows doctors to detect abnormal blood flow in the eye, deformations of the cornea (the outermost clear layer of the eye), or swollen optical discs (a round section at the back of the eye where the nerve link to the brain begins). Swollen discs are a sign of elevated pressure inside your head (or in the worst case, a brain tumour) that could be <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/increased-intracranial-pressure-icp-headache">causing your headaches</a>. The invention of <a href="https://openmedscience.com/lighting-the-way-in-healthcare-the-transformative-role-of-lasers-in-medicine/">lasers and LEDs</a> has enabled many other miniaturised technologies to be provided at the bedside or clinic rather than in the lab. <a href="https://theconversation.com/whats-a-pulse-oximeter-should-i-buy-one-to-monitor-covid-at-home-174457">Pulse oximetry</a> is a famous example, where a clip attached to your finger reports how well your blood is oxygenated. It does this by <a href="https://www.howequipmentworks.com/pulse_oximeter/">measuring</a> the different responses of oxygenated and de-oxygenated blood to different colours of light. Pulse oximetry is used at hospitals (and <a href="https://theconversation.com/whats-a-pulse-oximeter-should-i-buy-one-to-monitor-covid-at-home-174457">sometimes at home</a>) to monitor your respiratory and heart health. In hospitals, it is also a valuable tool for detecting <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60107-X/fulltext">heart defects in babies</a>. <h2>2. Looking at molecules</h2> Now, back to that blood test. Analysing a small amount of your blood can diagnose <a href="https://theconversation.com/blood-tests-and-diagnosing-illness-what-can-blood-tell-us-about-whats-happening-in-our-body-80327">many different diseases</a>. A machine called an automated “full blood count analyser” tests for general markers of your health. This machine directs focused beams of light through blood samples held in small glass tubes. It counts the number of blood cells, determines their specific type, and reports the level of haemoglobin (the protein in red blood cells that distributes oxygen around your body). In minutes, this machine can provide a <a href="https://www.nuffieldhealth.com/article/inside-the-pathology-lab-what-happens-to-my-blood">snapshot</a> of your overall health. For more specific disease markers, blood serum is separated from the heavier cells by spinning in a rotating instrument called a centrifuge. The serum is then exposed to special chemical stains and enzyme assays that change colour depending on whether specific molecules, which may be the sign of a disease, are present. These colour changes can’t be detected with the naked eye. However, a light beam from an instrument called a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476943/#R88">spectrometer</a> can detect tiny amounts of these substances in the blood and determine if the biomarkers for diseases are present, and at what levels. <h2>3. Medical imaging</h2> Let’s re-visit those medical images your GP ordered. The development of fibre-optic technology, made famous for transforming high-speed digital communications (such as the NBN), allows light to get inside the body. The result? High-resolution optical imaging. A common example is an <a href="https://www.medicalnewstoday.com/articles/153737#risks-and-side-effects">endoscope</a>, where fibres with a tiny camera on the end are inserted into the body’s natural openings (such as your mouth or anus) to examine your gut or respiratory tracts. Surgeons can insert the same technology through tiny cuts to view the inside of the body on a video screen during <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553337/">laparoscopic surgery</a> (also known as keyhole surgery) to diagnose and treat disease. <h2>How about the future?</h2> Progress in nanotechnology and a better understanding of the interactions of light with our tissues are leading to new light-based tools to help diagnose disease. These include: <ul> <li> <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/advs.201903441">nanomaterials</a> (materials on an extremely small scale, many thousands of times smaller than the width of a human hair). These are being used in next-generation sensors and new diagnostic tests </li> <li> <a href="https://www.nature.com/articles/s41587-019-0045-y">wearable optical biosensors</a> the size of your fingernail can be included in devices such as watches, contact lenses or finger wraps. These devices allow non-invasive measurements of sweat, tears and saliva, in real time </li> <li> AI tools to analyse how blood serum scatters infrared light. This has allowed researchers to build a <a href="https://www.advancedsciencenews.com/powerful-diagnostic-approach-uses-light-to-detect-virtually-all-forms-of-cancer/">comprehensive database</a> of scatter patterns to detect <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/aisy.202300006">any cancer</a> </li> <li> a type of non-invasive imaging called <a href="https://www.ncbi.nlm.nih.gov/books/NBK554044/">optical coherence tomography</a> for more detailed imaging of the eye, heart and skin </li> <li> fibre optic technology to deliver a tiny microscope into the body on the <a href="https://www.uwa.edu.au/projects/microscope-in-a-needle">tip of a needle</a>. </li> </ul> So the next time you’re at the GP and they perform (or order) some tests, chances are that at least one of those tests depend on light to help diagnose disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231379/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/matthew-griffith-1539353">Matthew Griffith</a>, Associate Professor and ARC Future Fellow and Director, UniSA Microscopy and Microanalysis Facilities, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/from-eye-exams-to-blood-tests-and-surgery-how-doctors-use-light-to-diagnose-disease-231379">original article</a>. </div>

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Lessons for the next pandemic: where did Australia go right and wrong in responding to COVID?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/adrian-esterman-1022994">Adrian Esterman</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a>; <a href="https://theconversation.com/profiles/guzyal-hill-575966">Guzyal Hill</a>, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a>; <a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/kim-m-caudwell-1258935">Kim M Caudwell</a>, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a>; <a href="https://theconversation.com/profiles/michael-toole-18259">Michael Toole</a>, <a href="https://theconversation.com/institutions/burnet-institute-992">Burnet Institute</a>; <a href="https://theconversation.com/profiles/steven-mcgloughlin-1246135">Steven McGloughlin</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/tari-turner-7922">Tari Turner</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> With COVID still classified as <a href="https://www.who.int/europe/emergencies/situations/covid-19">an ongoing pandemic</a>, it’s difficult to contemplate the next one. But we <a href="https://theconversation.com/what-pathogen-might-spark-the-next-pandemic-how-scientists-are-preparing-for-disease-x-223193">need to be prepared</a>. We’ve seen <a href="https://theconversation.com/why-are-we-seeing-more-pandemics-our-impact-on-the-planet-has-a-lot-to-do-with-it-226827">several pandemics</a> in recent decades and it’s fair to expect we’ll see more. For the final part in a <a href="https://theconversation.com/au/topics/the-next-pandemic-160343">series of articles</a> on the next pandemic, we’ve asked a range of experts what Australia got right and wrong it its response to COVID. Here they share their thoughts on the country’s COVID response – and what we can learn for the next pandemic. <hr /> <h2>Quarantine</h2> The federal government mandated 14 days of quarantine for all international arrivals between March 2020 and November 2021. During that period, <a href="https://www.pmc.gov.au/sites/default/files/resource/download/national-review-of-quarantine.pdf">452,550 people</a> passed through the system. The states and Northern Territory were given <a href="https://quarantineinquiry.archive.royalcommission.vic.gov.au/covid-19-hotel-quarantine-inquiry-final-report-0">just 48 hours</a> to set up their quarantine systems. The states chose hotel quarantine, while the Northern Territory repurposed an old miner’s camp, <a href="https://www.aspistrategist.org.au/darwins-howard-springs-facility-a-model-for-building-national-resilience/">Howard Springs</a>, which had individual cabins with outdoor verandas. The ACT had very few international arrivals, while Tasmania only had hotel quarantine for domestic travellers. During the first 15 months of the program, <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.51240">at least 22 breaches</a> occurred in five states (New South Wales, Victoria, Queensland, Western Australia and South Australia). An inquiry into Victoria’s hotel quarantine <a href="https://au.news.yahoo.com/covid-victorias-devastating-hotel-quarantine-killed-almost-800-people-110450178.html">found</a> the lack of warning and planning to set up the complex system resulted in breaches that caused Victoria’s second COVID wave of 2020, leading to almost 800 deaths. A <a href="https://www.cnet.com/science/features/how-the-delta-variant-breached-australias-covid-fortress/">breach at Sydney airport</a> led to the introduction of the Delta variant into Australia. In the next pandemic, mistakes from COVID need to be avoided. They included failure to protect hotel residents and staff from airborne transmission through ventilation and mask usage. Protocols need to be consistent across the country, such as the type of security staff used, N95 masks for staff and testing frequency. These protocols need to be included in a national pandemic preparedness plan, which is frequently reviewed and tested through simulations. This did not occur with the pre-COVID preparedness plan. Dedicated quarantine centres like Howard Springs already exist in Victoria and Queensland. Ideally, they should be constructed in every jurisdiction. Michael Toole <hr /> <h2>Treatments</h2> Scientists had to move quickly after COVID was discovered to find effective treatments. Many COVID treatments involved repurposing existing drugs designed for other viruses. For example, the HIV drug ritonavir is a key element of <a href="https://theconversation.com/pfizers-pill-is-the-latest-covid-treatment-to-show-promise-here-are-some-more-171589">the antiviral Paxlovid</a>, while remdesivir was originally developed <a href="https://theconversation.com/the-who-has-advised-against-the-use-of-two-antibody-therapies-against-covid-heres-what-that-means-190787">to treat hepatitis C</a>. At the outset of the pandemic, there was a lot of uncertainty about COVID treatment among Australian health professionals. To keep up with the rapidly developing science, the <a href="https://www.monash.edu/medicine/partnerships/our-partnerships/projects/national-clinical-evidence-taskforce">National Clinical Evidence Taskforce</a> was established in March 2020. We were involved in its COVID response with more than 250 clinicians, consumers and researchers. Unusually for evidence-based guidelines, which are often updated only every five years or so, the taskforce’s guidelines were designed to be “living” – updated as new research became available. In April 2020 we released the first guidelines for care of people with COVID, and over the next three years <a href="https://app.magicapp.org/#/guideline/7252">these were updated</a> more than 100 times. While health-care professionals always had access to up-to-date guidance on COVID treatments, this same information was not as accessible for the public. This may partly explain why many people turned to <a href="https://theconversation.com/thinking-of-trying-ivermectin-for-covid-heres-what-can-happen-with-this-controversial-drug-167178">unproven treatments</a>. The taskforce’s benefits could have been increased with funding to help the community understand COVID treatments. COVID drugs faced other obstacles too. For example, changes to the virus itself meant some treatments <a href="https://theconversation.com/from-centaurus-to-xbb-your-handy-guide-to-the-latest-covid-subvariants-and-why-some-are-more-worrying-than-others-192945">became less effective</a> as new variants emerged. Meanwhile, provision of antiviral treatments <a href="https://grattan.edu.au/wp-content/uploads/2024/10/How-we-analysed-COVID-antiviral-uptake-Grattan-Institute.pdf">has not been equitable</a> across the country. COVID drugs have had important, though not game-changing, impacts. Ultimately, effective vaccines played a much greater role in shifting the course of the pandemic. But we might not be so fortunate next time. In any future pandemic it will be crucial to have a clear pathway for rapid, reliable methods to develop and evaluate new treatments, disseminate that research to clinicians, policymakers and the public, and ensure all Australians can access the treatments they need. Steven McGloughlin and Tari Turner, Monash University <hr /> <h2>Vaccine rollout</h2> COVID vaccines were developed <a href="https://theconversation.com/one-of-sciences-greatest-achievements-how-the-rapid-development-of-covid-vaccines-prepares-us-for-future-pandemics-228787">in record time</a>, but rolling them out quickly and seamlessly proved to be a challenge. In Australia, there were several missteps along the way. First, there was poor preparation and execution. Detailed <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/auditor-general-highlights-vaccine-rollout-failures">planning was not finalised</a> until after the rollout had begun. Then the federal government had <a href="https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225">overly ambitious targets</a>. For example, the goal of vaccinating four million people by the end of March 2021 fell drastically short, with less than one-fifth of that number actually vaccinated by that time. There were also <a href="https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225">supply issues</a>, with the European Union blocking some deliveries to Australia. Unfortunately, the government was heavily reliant on <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/auditor-general-highlights-vaccine-rollout-failures">the AstraZeneca vaccine</a>, which was found, in rare cases, to lead to <a href="https://www.health.gov.au/our-work/covid-19-vaccines/advice-for-providers/clinical-guidance/tts">blood clots</a> in younger people. Despite all this, Australia ultimately achieved high vaccination rates. By the end of December 2021, <a href="https://www.health.gov.au/sites/default/files/documents/2021/12/covid-19-vaccine-rollout-update-31-december-2021.pdf">more than 94%</a> of the population aged 16 and over had received at least one dose. This was a significant public health achievement and saved <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299844">thousands of lives</a>. But over the past couple of years, Australia’s initially strong vaccine uptake has been waning. The <a href="https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024.pdf">Australian Technical Advisory Group on Immunisation</a> recommends booster doses for vulnerable groups annually or twice annually. However, only 30% of people aged <a href="https://www.health.gov.au/sites/default/files/2024-09/covid-19-vaccine-rollout-update-13-september-2024.pdf">75 and over</a> (for whom a booster is recommended every six months) have had a booster dose in the past six months. There are several lessons to be learned from the COVID vaccine rollout for any future pandemic, though it’s not entirely clear whether they are being heeded. For example, several manufacturers have developed <a href="https://theconversation.com/new-covid-vaccines-may-be-coming-to-australia-heres-what-to-know-about-the-jn-1-shots-237652">updated COVID vaccines</a> based on the JN.1 subvariant. But <a href="https://www.sbs.com.au/news/article/why-australia-could-miss-out-on-modernas-new-covid-19-vaccine/n5n0iruv1">reports indicate</a> the government will only be purchasing the Pfizer JN.1 booster. This doesn’t seem like the best approach to shore up vaccine supply. Adrian Esterman, University of South Australia <hr /> <h2>Mode of transmission</h2> Nearly five years since SARS-CoV-2 (the virus that causes COVID) first emerged, we now know <a href="https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-covid-19-how-is-it-transmitted">airborne transmission</a> plays a far greater role than we originally thought. In contrast, the risk of SARS-CoV-2 being transmitted via surfaces is <a href="https://theconversation.com/catching-covid-from-surfaces-is-very-unlikely-so-perhaps-we-can-ease-up-on-the-disinfecting-155359">likely to be low</a>, and perhaps effectively non-existent in many situations. Early in the pandemic, the role contaminated surfaces and inanimate objects played in COVID transmission was overestimated. The main reason we got this wrong, at least initially, was that in the absence of any direct experience with SARS-CoV-2, we extrapolated what we believed to be true for other respiratory viruses. This was understandable, but it proved to be inadequate for predicting how SARS-CoV-2 would behave. One of the main consequences of overestimating the role of surface transmission was that it resulted in a lot of unnecessary anxiety and the adoption of what can only be viewed in retrospect as <a href="https://theconversation.com/catching-covid-from-surfaces-is-very-unlikely-so-perhaps-we-can-ease-up-on-the-disinfecting-155359">over-the-top cleaning practices</a>. Remember the teams of people who walked the streets wiping down traffic light poles? How about the concern over reusable coffee cups? Considerable resources that could have been better invested elsewhere were directed towards disinfecting surfaces. This also potentially distracted our focus from other preventive measures that were likely to have been more effective, such as <a href="https://theconversation.com/yes-masks-reduce-the-risk-of-spreading-covid-despite-a-review-saying-they-dont-198992">wearing masks</a>. The focus on surface transmission was amplified by a number of studies published early in the pandemic that documented the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121658/">survival of SARS-CoV-2</a> for long periods on surfaces. However, these were conducted in the lab with little similarity to real-world conditions. In particular, the amounts of virus placed on surfaces were greater than what people would likely encounter outside the lab. This inflated viral survival times and therefore the perception of risk. The emphasis on surface transmission early in the pandemic ultimately proved to be a miscalculation. It highlights the challenges in understanding how a new virus spreads. Hassan Vally, Deakin University <hr /> <h2>National unity</h2> Initially, Commonwealth, state and territory leaders were relatively united in their response to the COVID pandemic. The establishment of the National Cabinet in <a href="https://federation.gov.au/national-cabinet">March 2020</a> indicated a commitment to consensus-based public health policy. Meanwhile, different jurisdictions came together to deliver a <a href="https://www.ato.gov.au/individuals-and-families/financial-difficulties-and-disasters/covid-19/jobkeeper-payment">range of measures</a> aimed at supporting businesses and workers affected by COVID restrictions. But as the pandemic continued, tensions gave way to deeper ideological fractures between jurisdictions <a href="https://link.springer.com/article/10.1186/s12888-024-05834-9">and individuals</a>. The issues of <a href="https://www.unswlawjournal.unsw.edu.au/article/covid-19-vaccine-mandates-a-coercive-but-justified-public-health-necessity">vaccine mandates</a>, <a href="https://www.abc.net.au/news/2022-01-30/wa-premier-mark-mcgowan-reopening-date-decision/100788876">border closures</a> and <a href="https://journals.sagepub.com/doi/pdf/10.1177/00048674211031489">lockdowns</a> all created fragmentation between governments, and among experts. The <a href="https://www.theguardian.com/australia-news/2020/oct/19/daniel-andrews-lashes-josh-frydenberg-over-attack-on-victorias-covid-strategy">blame game began</a> between and within jurisdictions. For example, the politicisation of <a href="https://www.9news.com.au/national/govt-playing-cruise-ship-blame-game-labor/49ad3491-2187-4991-a3a0-1c61145bc2cb">quarantine regulations on cruise ships</a> revealed disunity. School closures, on which the Commonwealth and state and territory governments <a href="https://www.smh.com.au/national/nsw/we-made-the-wrong-decisions-covid-era-mass-school-closures-condemned-20240214-p5f521.html">took different positions</a>, also generated controversy. These and other instances of polarisation undermined the intent of the newly established <a href="https://theconversation.com/with-the-covid-crisis-easing-is-the-national-cabinet-still-fit-for-purpose-202145">National Cabinet</a>. The COVID pandemic showed us that <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4859497">disunity across the country</a> threatens the collective work needed for an effective response in <a href="https://ir.law.fsu.edu/jtlp/vol30/iss1/3/">the face of emergencies</a>. The <a href="https://www.pmc.gov.au/domestic-policy/commonwealth-government-covid-19-response-inquiry">COVID response inquiry</a>, due to release its results soon, will hopefully help us work toward <a href="https://link.springer.com/book/10.1007/978-981-19-3292-2">national uniform legislation</a> that may benefit Australia in the event of <a href="https://link.springer.com/chapter/10.1007/978-981-19-3292-2_10">any future pandemics</a>. This doesn’t necessarily mean identical legislation across the country – this won’t always be appropriate. But a cohesive, long-term approach is crucial to ensure the best outcomes for the Australian federation in its entirety. Guzyal Hill and Kim M Caudwell, Charles Darwin University <hr /> This article is part of a <a href="https://theconversation.com/au/topics/the-next-pandemic-160343">series on the next pandemic</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239819/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/adrian-esterman-1022994">Adrian Esterman</a>, Professor of Biostatistics and Epidemiology, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a>; <a href="https://theconversation.com/profiles/guzyal-hill-575966">Guzyal Hill</a>, Associate Professor, Faculty of Arts and Society, <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a>; <a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, Associate Professor, Epidemiology, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>; <a href="https://theconversation.com/profiles/kim-m-caudwell-1258935">Kim M Caudwell</a>, Senior Lecturer - Psychology | Chair, Researchers in Behavioural Addictions, Alcohol and Drugs (BAAD), <a href="https://theconversation.com/institutions/charles-darwin-university-1066">Charles Darwin University</a>; <a href="https://theconversation.com/profiles/michael-toole-18259">Michael Toole</a>, Associate Principal Research Fellow, <a href="https://theconversation.com/institutions/burnet-institute-992">Burnet Institute</a>; <a href="https://theconversation.com/profiles/steven-mcgloughlin-1246135">Steven McGloughlin</a>, Director, Intensive Care Unit, Alfred Health; Professor, Epidemiology and Preventative Medicine, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/tari-turner-7922">Tari Turner</a>, Director, Evidence and Methods, National COVID-19 Clinical Evidence Taskforce; Associate Professor (Research), Cochrane Australia, School of Population Health and Preventive Medicine, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/lessons-for-the-next-pandemic-where-did-australia-go-right-and-wrong-in-responding-to-covid-239819">original article</a>. </div>

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Getting antivirals for COVID too often depends on where you live and how wealthy you are

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Medical experts <a href="https://www.health.gov.au/health-alerts/covid-19/treatments/eligibility">recommend</a> antivirals for people aged 70 and older who get COVID, and for other groups at risk of severe illness and hospitalisation from COVID. But many older Australians have missed out on antivirals after getting sick with COVID. It is yet another way the health system is failing the most vulnerable. <h2>Who missed out?</h2> We <a href="https://grattan.edu.au/wp-content/uploads/2024/10/How-we-analysed-COVID-antiviral-uptake-Grattan-Institute.pdf">analysed</a> COVID antiviral uptake between March 2022 and September 2023. We found some groups were more likely to miss out on antivirals including Indigenous people, people from disadvantaged areas, and people from culturally and linguistically diverse backgrounds. Some of the differences will be due to different rates of infection. But across this 18-month period, many older Australians were infected at least once, and rates of infection were higher in some disadvantaged communities. <h2>How stark are the differences?</h2> Compared to the national average, Indigenous Australians were nearly 25% less likely to get antivirals, older people living in disadvantaged areas were 20% less likely to get them, and people with a culturally or linguistically diverse background were 13% less likely to get a script. People in remote areas were 37% less likely to get antivirals than people living in major cities. People in outer regional areas were 25% less likely. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=329&fit=crop&dpr=1 600w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=329&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=329&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=413&fit=crop&dpr=1 754w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=413&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/620627/original/file-20240920-20-yc7sq5.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=413&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Dispensing rates by group. Grattan Institute</figcaption></figure> Even within the same city, the differences are stark. In Sydney, people older than 70 in the affluent eastern suburbs (including Vaucluse, Point Piper and Bondi) were nearly twice as likely to have had an antiviral as those in Fairfield, in Sydney’s south-west. Older people in leafy inner-eastern Melbourne (including Canterbury, Hawthorn and Kew) were 1.8 times more likely to have had an antiviral as those in Brimbank (which includes Sunshine) in the city’s west. <h2>Why are people missing out?</h2> COVID antivirals should be taken when symptoms first appear. While awareness of COVID antivirals is generally strong, people often <a href="https://link.springer.com/article/10.1007/s40121-024-01003-3">don’t realise</a> they would benefit from the medication. They <a href="https://www.phrp.com.au/?p=43363">wait</a> until symptoms get worse and it is too late. Frequent GP visits make a big difference. Our analysis found people 70 and older who see a GP more frequently were much more likely to be dispensed a COVID antiviral. Regular visits give an opportunity for preventive care and patient education. For example, GPs can provide high-risk patients with “COVID treatment plans” as a reminder to get tested and seek treatment as soon as they are unwell. Difficulty seeing a GP could help explain low antiviral use in rural areas. Compared to people in major cities, people in small rural towns have about 35% <a href="https://hwd.health.gov.au/resources/data/gp-primarycare.html">fewer</a> GPs, see their GP about half as often, and are 30% more likely to <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release">report</a> waiting too long for an appointment. Just like for <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">vaccination</a>, a GP’s focus on antivirals probably matters, as does providing care that is accessible to people from different cultural backgrounds. <h2>Care should go those who need it</h2> Since the period we looked at, evidence has emerged that raises <a href="https://url.au.m.mimecastprotect.com/s/FmjFC91ZVBSmBpXpZSEh9CqMtQx?domain=nejm.org">doubts</a> about how effective antivirals are, particularly for people at lower risk of severe illness. That means getting vaccinated is more important than getting antivirals. But all Australians who are eligible for antivirals should have the same chance of getting them. These drugs have cost more than A$1.7 billion, with the vast majority of that money coming from the federal government. While dispensing rates have fallen, more than <a href="http://medicarestatistics.humanservices.gov.au/statistics/do.jsp?_PROGRAM=%2Fstatistics%2Fpbs_item_standard_report&itemlst=%2712910L%27%2C%2712996B%27&ITEMCNT=2&LIST=12910L%2C12996B&VAR=SERVICES&RPT_FMT=6&start_dt=202201&end_dt=202408">30,000</a> packs of COVID antivirals were dispensed in August, costing about $35 million. Such a huge investment shouldn’t be leaving so many people behind. Getting treatment shouldn’t depend on your income, cultural background or where you live. Instead, care should go to those who need it the most. People born overseas have been <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-january-2024#deaths-due-to-covid-19-country-of-birth">40% more likely</a> to die from COVID than those born here. Indigenous Australians have been <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-january-2024#covid-19-mortality-among-aboriginal-and-torres-strait-islander-people">60% more likely</a> to die from COVID than non-Indigenous people. And the most disadvantaged people have been <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-31-january-2024#deaths-due-to-covid-19-socio-economic-status-seifa-">2.8 times</a> more likely to die from COVID than those in the wealthiest areas. All those at-risk groups have been more likely to miss out on antivirals. It’s not just a problem with antivirals. The same groups are also disproportionately missing out on COVID <a>vaccination</a>, compounding their risk of severe illness. The pattern is repeated for other important preventive health care, such as <a href="https://www.aihw.gov.au/getmedia/54a38a6a-9e3c-4f58-b2f6-cdef977a7d60/aihw-can-155_15sept.pdf?v=20230915162104&inline=true">cancer</a> <a href="https://www.aihw.gov.au/getmedia/27f32443-5206-4189-8775-0c1f55a26bc4/aihw-can-160.pdf?v=20240617095924&inline=true">screening</a>. <h2>A 3-step plan to meet patients’ needs</h2> The federal government should do three things to close these gaps in preventive care. First, the government should make Primary Health Networks (PHNs) responsible for reducing them. PHNs, the regional bodies responsible for improving primary care, should share data with GPs and step in to boost uptake in communities that are missing out. Second, the government should extend its <a href="https://www.health.gov.au/our-work/mymedicare">MyMedicare</a> reforms. MyMedicare gives general practices flexible funding to care for patients who live in residential aged care or who visit hospital frequently. That approach should be <a href="https://grattan.edu.au/report/a-new-medicare-strengthening-general-practice/">expanded</a> to all patients, with more funding for poorer and sicker patients. That will give GP clinics time to advise patients about preventive health, including COVID vaccines and antivirals, before they get sick. Third, team-based pharmacist prescribing should be introduced. Then pharmacists could quickly dispense antivirals for patients if they have a prior agreement with the patient’s GP. It’s an approach that would also <a href="https://theconversation.com/pharmacists-should-be-able-to-work-with-gps-to-prescribe-medicines-for-long-term-conditions-212359">work</a> for medications for chronic diseases, such as cardiovascular disease. COVID antivirals, unlike vaccines, have been <a href="https://theconversation.com/covid-wave-whats-the-latest-on-antiviral-drugs-and-who-is-eligible-in-australia-218423">keeping up</a> with new variants without the need for updates. If a new and more harmful variant emerges, or when a new pandemic hits, governments should have these systems in place to make sure everyone who needs treatment can get it fast. In the meantime, fairer access to care will help close the big and persistent <a href="https://www.aihw.gov.au/getmedia/0cbc6c45-b97a-44f7-ad1f-2517a1f0378c/hiamhbrfhsu.pdf?v=20230605184558&inline=true">gaps</a> in health between different groups of Australians. <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/getting-antivirals-for-covid-too-often-depends-on-where-you-live-and-how-wealthy-you-are-239497">original article</a>. </div>

Caring

I have a stuffy nose, how can I tell if it’s hay fever, COVID or something else?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/deryn-thompson-1449312">Deryn Thompson</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Hay fever (also called allergic rhinitis) affects <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-state-and-territory-findings/latest-release">24%</a> of Australians. <a href="https://www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis/allergic-rhinitis-or-hay-fever">Symptoms</a> include sneezing, a runny nose (which may feel blocked or stuffy) and itchy eyes. People can also experience an itchy nose, throat or ears. But COVID is still <a href="https://theconversation.com/xec-is-now-in-australia-heres-what-we-know-about-this-hybrid-covid-variant-239292">spreading</a>, and <a href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">other viruses</a> can cause cold-like symptoms. So how do you know which one you’ve got? <h2>Remind me, how does hay fever cause symptoms?</h2> <a href="https://www.allergy.org.au/hp/papers/allergic-rhinitis-clinical-update">Hay fever</a> happens when a person has become “sensitised” to an allergen trigger. This means a person’s body is always primed to react to this trigger. Triggers can include allergens in the air (such as pollen from trees, grasses and flowers), mould spores, animals or house dust mites which mostly live in people’s mattresses and bedding, and feed on shed skin. When the body is exposed to the trigger, it produces IgE (immunoglobulin E) antibodies. These cause the release of many of the body’s own chemicals, including histamine, which result in hay fever symptoms. People who have asthma may find their asthma symptoms (cough, wheeze, tight chest or trouble breathing) worsen when exposed to airborne allergens. Spring and sometimes into summer can be the worst time for people with grass, tree or flower allergies. However, animal and house dust mite symptoms usually happen year-round. <h2>What else might be causing my symptoms?</h2> Hay fever does not cause a fever, sore throat, muscle aches and pains, weakness, loss of taste or smell, nor does it cause you to cough up mucus. These symptoms are likely to be caused by a virus, such as COVID, influenza, respiratory syncytial virus (RSV) or a “cold” (often caused by rhinoviruses). These conditions can occur all year round, with some overlap of symptoms: <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=582&fit=crop&dpr=1 600w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=582&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=582&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=731&fit=crop&dpr=1 754w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=731&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=731&fit=crop&dpr=3 2262w" alt="" /></a><figcaption><a class="source" href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">Natasha Yates/The Conversation</a></figcaption></figure> COVID still <a href="https://theconversation.com/xec-is-now-in-australia-heres-what-we-know-about-this-hybrid-covid-variant-239292">surrounds</a> us. <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/health+statistics/surveillance+of+notifiable+conditions/respiratory+infections+dashboard">RSV and influenza</a> rates appear higher than before the COVID pandemic, but it may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10888990/#:%7E:text=Increases%20in%20RSV%20patient%20volume,with%20an%20RSV%20diagnosis%20occurred">due to more testing</a>. So if you have a fever, sore throat, muscle aches/pains, weakness, fatigue, or are coughing up mucus, stay home and avoid mixing with others to limit transmission. People with COVID symptoms can take a rapid antigen test (<a href="https://www.health.gov.au/sites/default/files/2024-04/coronavirus-covid-19-rapid-antigen-tests.pdf">RAT</a>), ideally when <a href="https://www.cochrane.org/CD013705/INFECTN_how-accurate-are-rapid-antigen-tests-diagnosing-covid-19">symptoms start</a>, then isolate until symptoms disappear. <a href="https://www.mja.com.au/journal/2023/219/11/covid-19-rapid-antigen-tests-approved-self-testing-australia-published">One negative RAT alone</a> can’t rule out COVID if symptoms are still present, so test again 24–48 hours after your initial test if symptoms persist. You can now test yourself for COVID, RSV and influenza in a <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">combined RAT</a>. But again, a negative test doesn’t rule out the virus. If your symptoms continue, <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">test again</a> 24–48 hours after the previous test. <h2>If it’s hay fever, how do I treat it?</h2> Treatment involves blocking the body’s histamine release, by taking antihistamine medication which helps reduce the symptoms. Doctors, nurse practitioners and pharmacists can develop a <a href="https://www.allergy.org.au/images/pc/ASCIA_Allergic_Rhinitis_Treatment_Plan_2024.pdf">hay fever care plan</a>. This may include using a nasal spray containing a topical corticosteroid to help reduce the swelling inside the nose, which causes stuffiness or blockage. Nasal sprays need to delivered <a href="https://allergyfacts.org.au/are-you-using-your-nasal-spray-correctly/">using correct technique</a> and used over several weeks to work properly. Often these sprays can also help lessen the itchy eyes of hay fever. Drying bed linen and pyjamas inside during spring can <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-minimisation">lessen symptoms</a>, as can putting a <a href="https://www.nps.org.au/consumers/managing-hay-fever">smear of Vaseline</a> in the nostrils when going outside. Pollen sticks to the Vaseline, and gently blowing your nose later removes it. People with asthma should also have an <a href="https://asthma.org.au/manage-asthma/asthma-action-plan/">asthma plan</a>, created by their doctor or nurse practitioner, explaining how to adjust their asthma reliever and preventer medications in hay fever seasons or on allergen exposure. People with asthma also need to be <a href="https://www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/factsheets/thunderstorm-asthma">alert for thunderstorms</a>, where pollens can burst into tinier particles, be inhaled deeper in the lungs and cause a severe asthma attack, and even death. <h2>What if it’s COVID, RSV or the flu?</h2> Australians aged 70 and over and others with underlying health conditions who test positive for COVID are <a href="https://www.healthdirect.gov.au/covid-19/medications#at-home">eligible for antivirals</a> to reduce their chance of severe illness. Most other people with COVID, RSV and influenza will recover at home with rest, fluids and paracetamol to relieve symptoms. However some groups are at greater risk of serious illness and may require additional treatment or hospitalisation. For <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/respiratory-syncytial-virus.aspx">RSV</a>, this includes premature infants, babies 12 months and younger, children under two who have other medical conditions, adults over 75, people with heart and lung conditions, or health conditions that lessens the immune system response. For influenza, people at <a href="https://www.health.nsw.gov.au/Infectious/Influenza/Pages/at-risk.aspx">higher risk</a> of severe illness are pregnant women, Aboriginal people, people under five or over 65 years, or people with long-term medical conditions, such as kidney, heart, lung or liver disease, diabetes and decreased immunity. If you’re concerned about severe symptoms of COVID, RSV or influenza, consult your doctor or call 000 in an emergency. If your symptoms are mild but persist, and you’re not sure what’s causing them, book an appointment with your doctor or nurse practitioner. Although hay fever season is here, we need to avoid spreading other serious infectious. For more information, you can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria); use the <a href="https://www.healthdirect.gov.au/symptom-checker">online Symptom Checker</a>; or visit <a href="http://healthdirect.gov.au/">healthdirect.gov.au</a> or the <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-minimisation">Australian Society of Clinical Immunology and Allergy</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/240453/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/deryn-thompson-1449312">Deryn Thompson</a>, Eczema and Allergy Nurse; Lecturer, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-have-a-stuffy-nose-how-can-i-tell-if-its-hay-fever-covid-or-something-else-240453">original article</a>. </div>

Body

Simon Dorante-Day calls for "four-way paternity test" to prove royal lineage

Simon Dorante-Day has called for a "four-way paternity test" to prove his royal lineage, while also casting doubt on if Prince William and Prince Harry are actually sons of the monarch. The Queensland man, who has been claiming to be the secret son of King Charles and Queen Camilla since 2005, has called for an official DNA test to prove his claims in a lengthy Facebook post. Dorante-Day's post highlights a photo comparison of himself, King Charles and William and Harry as evidence supporting his demand for answers from the royal family. “This comparison of William, Myself, Charles, and Harry demonstrates something very clearly, there is no consistency. The fact that the left side of my face identically matches Charles whilst neither William nor Harry’s does, raises the obvious question, just who are Charles’s real sons?” "This is why my wife, Dr. Elvianna, and I believe a 4-way Paternity test is the only way to resolve this issue once and for all. The truth of the game that has been played by the Monarchy, the Government, and the Establishment for 58 years needs to be exposed." "It's not just what happened to me as a child, and what I remember from growing up in England, but it’s also what’s happened since to myself, my wife, and my children in Australia that supports our argument. These covert and illegitimate activities that are targeted towards us constantly are an attempt to stop us on this journey, nothing more. They will not succeed. They will only strengthen our argument and provides us with evidence to demonstrate what has occurred, in a court room, to judges." "My question to all of you is how will you truly react when you hear the truth of what has occurred? Would you still want them on the throne?" Dorante-Day was born in Portsmouth in the UK in 1966, and was adopted at just eight months old. According to his claims, his adoptive mother, who worked for Queen Elizabeth II confessed on her death bed that he was the son of Charles and Camilla. Image credits: Facebook

Family & Pets

"No show": Wild reason couple denied refund on flights scheduled during Covid

A Melbourne couple, who had booked flights with Qantas during the state's fifth lockdown, were left furious after they were told they were ineligible for a refund because they were a "no show". Kieran McGregor told news.com.au that he and his partner had originally booked the flights to Darwin for July 18, 2021 through travel giant Expedia. When the number of Covid cases started rising, he moved the flights forward to fly out on the 16th of July, hoping that they would be able to get out before another lockdown, but the day before their flight, Victorian Premier Daniel Andrews announced the state's fifth lockdown. Three years later, McGregor was still stuck between trying to get the refund from Expedia, who said Qantas had the money, and Qantas, who said the travel agent had it. Last year, McGregor contacted Expedia on their X account to try to resolve the issue, but the company said: “We just got off the phone with the airline, and as per advised, the ticket shows suspended on their end due to a no show." “Your ticket is no (sic) eligible for a refund, and has no value as per the airline. We apologize for the inconvenience.” He was "incredulous" when he received the message. “How could I fly if the state of Victoria was in lockdown and I couldn’t move more than 5km from the house?” he told news.com.au. When he contacted Qantas, the airline claimed “the funds will still remain with the agency that you’ve booked with” and to contact them directly for a refund. McGregor told news.com.au the ordeal was “utterly disgraceful” and that he was unaware if the flight went ahead or not. The publication reportedly contacted Expedia and Qantas and on Tuesday morning they finally said that a refund would be issued, but McGregor said he was yet to be contacted. “For flight bookings at Expedia, we generally follow the policies of our travel partners, so any refund is determined by the airline,” an Expedia spokeswoman said. “We have looked into this case with Qantas, and we will be contacting the traveller to process the refund.” While a Qantas spokesman said: “We apologise for the extended delay in resolving this issue and are processing a full refund for their bookings.” It is unclear which company held McGregor's funds, which was reported to be around $2,500. Adam Glezer from Consumer Champion told news.com.au that McGregor came to him recently when he felt he had nowhere else to turn. He said that these situations were quite common. “What Kieran has gone through with Expedia and Qantas is extremely common where the third party says the airline has the money and the airline says the third party has the money. I call it the blame game and there’s only one loser out of it and that’s the customer," he said. “Transparency in these situations is of utmost importance and unfortunately it just doesn’t exist.” Images: news.com.au/ DLeng / Shutterstock.com

Travel Trouble

I feel sick. How do I know if I have the flu, COVID, RSV or something else?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> You wake with a sore throat and realise you are sick. Is this going to be a two-day or a two-week illness? Should you go to a doctor or just go to bed? Most respiratory illnesses have very similar symptoms at the start: sore throat, congested or runny nose, headache, fatigue and fever. This may progress to a dry cough. Best case scenario is that you have “<a href="https://lungfoundation.com.au/wp-content/uploads/2018/09/Factsheet-Common-Cold-Mar2016.pdf">a cold</a>” (which can be any one of hundreds of viruses, most commonly rhinovirus), which is short-lived and self-limiting. But some respiratory illnesses can be much more serious. Here is a brief guide to some important bugs to know about that are circulating this winter, and how to work out which one you have. <h2>Respiratory syncytial virus (RSV)</h2> For most people an RSV infection will feel like “a cold” – annoying, but only lasting a few days. However, for babies, older adults and people with immune issues, it can lead to <a href="https://www.rch.org.au/kidsinfo/fact_sheets/bronchiolitis/">bronchiolitis</a> or pneumonia, and even become life-threatening. RSV isn’t seasonal, which means you are just as likely to get it in summer as in winter. However, it is highly contagious so we noticed it <a href="https://pubmed.ncbi.nlm.nih.gov/32986804">disappearing almost completely</a> during COVID lockdowns. There is now a <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">rapid-antigen test (RAT) for RSV</a> which also checks for influenza and COVID, and is the best way of finding out if RSV is what is causing symptoms. Recently, a preventative immune therapy has become available for high risk babies (<a href="https://www.schn.health.nsw.gov.au/respiratory-syncytial-virus-rsv-monoclonal-antibody-factsheet">nirsevimab</a>) and there are also <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked">vaccines for higher risk adults</a>. Nirsevimab is also available to all babies for free in <a href="https://www.health.wa.gov.au/Articles/N_R/Respiratory-syncytial-virus-RSV-immunisation">Western Australia</a> and <a href="https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/paediatric-rsv-prevention-program">Queensland</a>. But there are no specific treatments. Adults who get it simply have to ride it out (using whatever you need to <a href="https://www.mayoclinic.org/diseases-conditions/common-cold/diagnosis-treatment/drc-20351611">manage symptoms</a>). Babies and higher risk patients need to present to an emergency department if they test positive for RSV and are also looking or feeling very unwell (this might mean rapid shallow breathing, fevers not coming down with paracetamol or ibuprofen, a baby not feeding, mottled-looking skin, or going blue around the mouth). If a patient has developed a bronchiolitis or pneumonia, they may need to be hospitalised. <h2>Influenza</h2> Once you have had the “true flu” (influenza), you will find it frustrating when people call their sniffly cold-like symptoms a “flu”. Influenza infections generally start with a sore throat and headache which quickly turns into high fevers, generalised aches and excessive fatigue. You feel like you have been hit by a truck and may struggle to get out of bed. This can last a week or more, even in people who are generally fit and healthy. Influenza is a major public health issue internationally, with 3–5 million cases of severe illness and <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">290,000 to 650,000 respiratory deaths annually</a>. People who are at <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu">greater risk of complications</a> from influenza include pregnant women, children under five, adults aged 65 and over, First Nations peoples, and people with chronic or immunosuppressive medical conditions. For this reason, annual vaccination is <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommended and funded</a> for vulnerable people. Vaccination is also readily available for <a href="https://www.health.gov.au/topics/immunisation/immunisation-contacts">all Australians who want it</a>, through pharmacies as well as medical clinics, usually at a cost of less than A$30. In <a href="https://www.vaccinate.initiatives.qld.gov.au/what-to-vaccinate-against/influenza#:%7E:text=The%20flu%20vaccine%20is%20free,.qld.gov.au">some states</a>, it’s free for all residents. Influenza is seasonal, with definite peaks in the winter months. This is why vaccines are offered from early autumn. If you think you may have influenza, there are now home-testing RATs: all current influenza RATs are in combination with COVID RATs, as the symptoms overlap. Treatment for most people is to manage symptoms and try to avoid spreading it around. Doctors can also <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">prescribe antivirals</a> to vulnerable patients; these work best if started within 48 hours of symptoms. <h2>COVID</h2> It has been less than five years since COVID-19, caused by SARS-CoV-2, started to spread around the world in pandemic proportions. Although COVID is no longer a <a href="https://www.health.gov.au/news/ahppc-statement-end-of-covid-19-emergency-response">public health emergency</a>, it still causes <a href="https://www.abs.gov.au/articles/deaths-due-covid-19-influenza-and-rsv-australia-2022-may-2024">more deaths than influenza and RSV combined</a>. Unlike RSV and influenza, only those <a href="https://www.health.gov.au/topics/covid-19/protect-yourself-and-others/high-risk-groups">aged over 70</a> are in a high-risk age group for COVID. Other <a href="https://www.cdc.gov/covid/risk-factors/?CDC_AAref_Val=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">factors besides age</a> may put you at higher risk of becoming very unwell when infected by this virus. This includes having other respiratory diseases (such as asthma or chronic obstructive pulmonary disease, also known as COPD), diabetes, cancer, kidney disease, obesity or heart disease. Unlike most respiratory viruses, SARS-CoV-2 tends to set off inflammation beyond the respiratory system. This can involve a range of other organs including the heart, kidneys and blood vessels. Although most people are back to their usual work or study after a week or two, a significant proportion go on to experience extended symptoms such as fatigue, breathlessness, brain fog and mood changes. When these last <a href="https://aci.health.nsw.gov.au/statewide-programs/critical-intelligence-unit/post-acute-sequelae">more than 12 weeks</a>, without any other explanation for symptoms, it’s called <a href="https://www.healthdirect.gov.au/covid-19/post-covid-symptoms-long-covid">long COVID</a>. COVID vaccines can prevent serious illness and have been <a href="https://pubmed.ncbi.nlm.nih.gov/38282394/">monitored</a> for several years now for their safety and effectiveness. Current vaccination recommendations are <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024?language=en">based on age and immune status</a>. It’s worth discussing them with your doctor if you are unsure whether you would benefit or not. <a href="https://www.health.gov.au/topics/covid-19/oral-treatments">Antivirals</a> can treat COVID in higher-risk people who contract it, whether vaccinated or not. Specific advice about what to do if you test positive on a RAT will vary according to your current state guidelines and workplace, however the <a href="https://www.health.gov.au/topics/covid-19/testing-positive">general principles</a> are always: avoid spreading the virus to others, and give yourself time to rest and recover. <hr /> <iframe id="ConNR" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/ConNR/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>What if it’s not one of those?</h2> So you’ve done your combined RSV/flu/COVID RAT and the result is negative. But you still have symptoms. What else could it be? More than 200 different viruses can cause cold and flu symptoms, including rhinovirus (mentioned above), adenovirus and sometimes even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2130424/">undefined pathogens</a>. If an illness progresses to a cough which will not go away, and/or you start coughing up sputum, this could be a bacterial infection, such as pertussis (whooping cough), streptococcus pneumoniae, haemophilus influenzae or moraxella catarrhalis. So it’s worth <a href="https://www.racgp.org.au/getattachment/0a637812-c8f0-45a2-af9c-fa215b64f8e4/attachment.aspx">getting assessed by a GP</a> who may do a chest Xray and/or <a href="https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/M/MCS-sputum">test your sputum</a>, particularly if they suspect pneumonia. You also may also start out with what is clearly a viral infection but then get a secondary bacterial infection later. So if you are getting more unwell over time, it’s worth getting tested, in case antibiotics will help. However, taking antibiotics for a purely viral illness will not only be useless, it can contribute to harmful <a href="https://www.nps.org.au/consumers/antibiotic-resistance-the-facts">antibiotic resistance</a> and give you unwanted side effects.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234266/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">original article</a>. </div>

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