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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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How can we improve public health communication for the next pandemic? Tackling distrust and misinformation is key

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/shauna-hurley-203140">Shauna Hurley</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/rebecca-ryan-1522824">Rebecca Ryan</a>, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a> There’s a common thread linking our <a href="https://www.visualcapitalist.com/history-of-pandemics-deadliest/">experience of pandemics</a> over the past 700 years. From the black death in the 14th century to COVID in the 21st, public health authorities have put emergency measures such as isolation and quarantine in place to stop infectious diseases spreading. As we know from COVID, these measures upend lives in an effort to save them. In both the <a href="https://www.thinkglobalhealth.org/article/pandemic-protests-when-unrest-and-instability-go-viral">recent</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559034/">distant past</a> they’ve also given rise to collective unrest, confusion and resistance. So after all this time, what do we know about the role public health communication plays in helping people understand and adhere to protective measures in a crisis? And more importantly, in an age of misinformation and distrust, how can we improve public health messaging for any future pandemics? Last year, we published a <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015144/full">Cochrane review</a> exploring the global evidence on public health communication during COVID and other infectious disease outbreaks including SARS, MERS, influenza and Ebola. Here’s a snapshot of what we found. <h2>The importance of public trust</h2> A key theme emerging in analysis of the COVID pandemic globally is public trust – or lack thereof – in governments, public institutions and science. Mounting evidence suggests <a href="https://www.washingtonpost.com/world/2022/02/01/trust-lancet-covid-study/">levels of trust in government</a> were <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00172-6/fulltext">directly proportional</a> to fewer COVID infections and higher vaccination rates across the world. It was a crucial factor in people’s willingness to follow public health directives, and is now a key focus for future pandemic preparedness. Here in Australia, public trust in governments and health authorities steadily eroded over time. Initial information from governments and health authorities about the unfolding COVID crisis, personal risk and mandated protective measures was generally clear and consistent across the country. The establishment of the <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1920/Quick_Guides/AustralianCovid-19ResponseManagement#_Toc38973752">National Cabinet</a> in 2020 signalled a commitment from state, territory and federal governments to consensus-based policy and public health messaging. During this early phase of relative unity, <a href="https://theconversation.com/inflation-covid-inequality-new-report-shows-australias-social-cohesion-is-at-crossroads-195198">Australians reported</a> higher levels of belonging and trust in government. But as the pandemic wore on, public trust and confidence fell on the back of conflicting state-federal pandemic strategies, blame games and the <a href="https://theconversation.com/we-lost-the-plot-on-covid-messaging-now-governments-will-have-to-be-bold-to-get-us-back-on-track-186732">confusing fragmentation</a> of public health messaging. The divergence between <a href="https://www.theaustralian.com.au/nation/tale-of-two-cities-gripped-by-covid-fear-outbreak/news-story/cf1b922610aeb0b0ee9b0b53486bf640">lockdown policies and public health messaging</a> adopted by <a href="https://www.theage.com.au/national/victoria/a-tale-of-two-cities-that-doesn-t-seem-fair-20211012-p58z79.html">Victoria and New South Wales</a> is one example, but there are plenty of others. When state, territory and federal governments have conflicting policies on protective measures, people are easily confused, lose trust and become harder to engage with or persuade. Many tune out from partisan politics. Adherence to mandated public health measures falls. Our research found clarity and consistency of information were key features of effective public health communication throughout the COVID pandemic. We also found public health communication is most effective when authorities work in partnership with different target audiences. In Victoria, the case brought against the state government for the <a href="https://www.abc.net.au/news/2023-07-24/melbourne-public-housing-tower-covid-lockdown-compensation/102640898">snap public housing tower lockdowns</a> is a cautionary tale underscoring how essential considered, tailored and two-way communication is with diverse communities. <h2>Countering misinformation</h2> Misinformation is <a href="https://reutersinstitute.politics.ox.ac.uk/hydroxychloroquine-australia-cautionary-tale-journalists-and-scientists">not a new problem</a>, but has been supercharged by the advent of <a href="https://theconversation.com/health-misinformation-is-rampant-on-social-media-heres-what-it-does-why-it-spreads-and-what-people-can-do-about-it-217059">social media</a>. The much-touted “miracle” drug <a href="https://www.vox.com/future-perfect/22663127/ivermectin-covid-treatments-vaccines-evidence">ivermectin</a> typifies the extraordinary traction unproven treatments gained locally and globally. Ivermectin is an anti-parasitic drug, lacking evidence for viruses like COVID. Australia’s drug regulator was forced to <a href="https://www.theguardian.com/australia-news/2021/sep/10/australian-drug-regulator-bans-ivermectin-as-covid-treatment-after-sharp-rise-in-prescriptions">ban ivermectin presciptions</a> for anything other than its intended use after a <a href="https://www.theguardian.com/world/2021/aug/30/australian-imports-of-ivermectin-increase-10-fold-prompting-warning-from-tga">sharp increase</a> in people seeking the drug sparked national shortages. Hospitals also reported patients <a href="https://www.theguardian.com/australia-news/2021/sep/02/sydney-covid-patient-in-westmead-hospital-after-overdosing-on-ivermectin-and-other-online-cures">overdosing on ivermectin</a> and cocktails of COVID “cures” promoted online. The <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01585-9/fulltext">Lancet Commission</a> on lessons from the COVID pandemic has called for a coordinated international response to countering misinformation. As part of this, it has called for more accessible, accurate information and investment in scientific literacy to protect against misinformation, including that shared across social media platforms. The World Health Organization is developing resources and recommendations for health authorities to address this “<a href="https://www.who.int/health-topics/infodemic#tab=tab_1">infodemic</a>”. National efforts to directly tackle misinformation are vital, in combination with concerted efforts to raise health literacy. The Australian Medical Association has <a href="https://www.ama.com.au/media/action-needed-tackle-health-misinformation-internet-social-media">called on the federal government</a> to invest in long-term online advertising to counter health misinformation and boost health literacy. People of all ages need to be equipped to think critically about who and where their health information comes from. With the rise of AI, this is an increasingly urgent priority. <h2>Looking ahead</h2> Australian health ministers recently <a href="https://www.cdc.gov.au/newsroom/news-and-articles/australian-health-ministers-reaffirm-commitment-australian-cdc">reaffirmed their commitment</a> to the new Australian Centre for Disease Control (CDC). From a science communications perspective, the Australian CDC could provide an independent voice of evidence and consensus-based information. This is exactly what’s needed during a pandemic. But full details about the CDC’s funding and remit have been the subject of <a href="https://www.croakey.org/federal-budget-must-deliver-on-climate-health-and-the-centre-for-disease-control-sector-leaders-warn/">some conjecture</a>. Many of our <a href="https://www.cochraneaustralia.org/articles/covidandcommunications">key findings</a> on effective public health communication during COVID are not new or surprising. They reinforce what we know works from previous disease outbreaks across different places and points in time: tailored, timely, clear, consistent and accurate information. The rapid rise, reach and influence of misinformation and distrust in public authorities bring a new level of complexity to this picture. Countering both must become a central focus of all public health crisis communication, now and in the future. 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/226718/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/shauna-hurley-203140">Shauna Hurley</a>, PhD candidate, School of Public Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/rebecca-ryan-1522824">Rebecca Ryan</a>, Senior Research Fellow, Health Practice and Management; Head, Centre for Health Communication and Participation, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe 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/how-can-we-improve-public-health-communication-for-the-next-pandemic-tackling-distrust-and-misinformation-is-key-226718">original article</a>. </div>

Technology

Why are we seeing more pandemics? Our impact on the planet has a lot to do with it

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/olga-anikeeva-1522907">Olga Anikeeva</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>; <a href="https://theconversation.com/profiles/jessica-stanhope-1129888">Jessica Stanhope</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>; <a href="https://theconversation.com/profiles/peng-bi-1522908">Peng Bi</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>, and <a href="https://theconversation.com/profiles/philip-weinstein-882901">Philip Weinstein</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> Pandemics – the global spread of infectious diseases – seem to be making a comeback. In the Middle Ages we had the Black Death (plague), and after the first world war we had the Spanish flu. Tens of millions of people <a href="https://assets.cureus.com/uploads/review_article/pdf/69273/20211019-25919-an4y6h.pdf">died from these diseases</a>. Then science began to <a href="https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2011.00053/full">get the upper hand</a>, with vaccination eradicating smallpox, and polio nearly so. Antibiotics became available to treat bacterial infections, and more recently antivirals as well. But in recent years and decades pandemics <a href="https://assets.cureus.com/uploads/review_article/pdf/69273/20211019-25919-an4y6h.pdf">seem to be returning</a>. In the 1980s we had HIV/AIDS, then several flu pandemics, SARS, and now COVID (no, COVID isn’t over). So why is this happening, and is there anything we can do to avert future pandemics? <h2>Unbalanced ecosystems</h2> Healthy, stable ecosystems provide services that keep us healthy, such as supplying food and clean water, producing oxygen, and making green spaces available for our <a href="https://www.millenniumassessment.org/documents/document.356.aspx.pdf">recreation and wellbeing</a>. Another key service ecosystems provide is disease regulation. When nature is in balance – with predators controlling herbivore populations, and herbivores controlling plant growth – it’s more difficult for pathogens to emerge in a way that causes pandemics. But when human activities <a href="https://books.google.com.au/books?hl=en&lr=&id=rWozz12K1aUC&oi=fnd&pg=PP15&dq=planetary+overload&ots=c9mWuESUXN&sig=-1iP3uSOWazvC2OFLk4vginWbQQ&redir_esc=y#v=onepage&q=planetary%20overload&f=false">disrupt and unbalance ecosystems</a> – such as by way of climate change and biodiversity loss – <a href="https://academic.oup.com/bioscience/article/58/8/756/381265">things go wrong</a>. For example, climate change affects the number and distribution of plants and animals. Mosquitoes that carry diseases can move from the tropics into what used to be temperate climates as the planet warms, and may infect more people in the months that are normally disease free. We’ve studied the relationship between weather and dengue fever transmission in China, and <a href="https://pubmed.ncbi.nlm.nih.gov/27883970/">our findings</a> support the same conclusion reached by <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008118">many other studies</a>: climate change is likely to put more people at risk of dengue. Biodiversity loss can have similar effects by disrupting food chains. When ranchers cleared forests in <a href="https://www.mdpi.com/1999-4915/6/5/1911">South America</a> for their cattle to graze in the first half of the 20th century, tiny forest-dwelling, blood-feeding vampire bats suddenly had a smörgåsbord of large sedentary animals to feed on. While vampire bats had previously been kept in check by the limited availability of food and the presence of predators in the balanced <a href="https://cir.nii.ac.jp/crid/1130000797648461952">forest ecosystem</a>, numbers of this species exploded in South America. These bats carry the rabies virus, which causes <a href="https://www.who.int/news-room/fact-sheets/detail/rabies">lethal brain infections</a> in people who are bitten. Although the number of deaths from bat-borne rabies has now fallen dramatically due to vaccination programs in South America, rabies caused by bites from other animals still <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168224/">poses a global threat</a>. As urban and agricultural development impinges on natural ecosystems, there are increasing opportunities for humans and domestic animals to become infected with pathogens that would normally only be seen in wildlife – particularly when people hunt and eat animals from the wild. The HIV virus, for example, <a href="https://www.tandfonline.com/doi/abs/10.1076/jmep.27.2.163.2992">first entered human populations</a> from apes that were slaughtered for food in Africa, and then spread globally through travel and trade. Meanwhile, bats are thought to be <a href="https://www.sciencedirect.com/science/article/pii/S0006291X20319434">the original reservoir</a> for the virus that caused the COVID pandemic, which has killed more than <a href="https://www.worldometers.info/coronavirus/">7 million people</a> to date. Ultimately, until we effectively address the unsustainable impact we are having on our planet, pandemics will continue to occur. <h2>Targeting the ultimate causes</h2> Factors such as climate change, biodiversity loss and other global challenges are the ultimate (high level) cause of pandemics. Meanwhile, increased contact between humans, domestic animals and wildlife is the proximate (immediate) cause. In the case of HIV, while direct contact with the infected blood of apes was the proximate cause, the apes were only being slaughtered because large numbers of very poor people were hungry – an ultimate cause. The distinction between <a href="https://link.springer.com/article/10.1007/BF02207379">ultimate causes and proximate causes</a> is important, because we often deal only with proximate causes. For example, people may smoke because of stress or social pressure (ultimate causes of getting lung cancer), but it’s the toxins in the smoke that cause cancer (proximate cause). Generally, health services are only concerned with stopping people from smoking – and with treating the illness that results – not with removing the drivers that lead them to smoke in the first place. Similarly, we address pandemics with lockdowns, mask wearing, social distancing and vaccinations – all measures which seek to stop the spread of the virus. But we pay less attention to addressing the ultimate causes of pandemics – until perhaps very recently. <h2>A planetary health approach</h2> There’s a growing awareness of the importance of adopting a “planetary health” approach to improve human health. This <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60901-1/fulltext?nr_email_referer=1">concept</a> is based on the understanding that human health and human civilisation depend on flourishing natural systems, and the wise stewardship of those natural systems. With this approach, ultimate drivers like climate change and biodiversity loss would be prioritised in preventing future pandemics, at the same time as working with experts from many different disciplines to deal with the proximate causes, thereby reducing the risk overall. The planetary health approach has the benefit of improving both the health of the environment and human health concurrently. We are heartened by the increased uptake of teaching planetary health concepts across the environmental sciences, humanities and health sciences in many universities. As climate change, biodiversity loss, population displacements, travel and trade continue to increase the risk of disease outbreaks, it’s vital that the planetary stewards of the future have a better understanding of how to tackle the ultimate causes that drive pandemics. This article is the first in a series on 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/226827/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/olga-anikeeva-1522907">Olga Anikeeva</a>, Research Fellow, School of Public Health, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>; <a href="https://theconversation.com/profiles/jessica-stanhope-1129888">Jessica Stanhope</a>, Lecturer, School of Allied Health Science and Practice, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>; <a href="https://theconversation.com/profiles/peng-bi-1522908">Peng Bi</a>, Professor, School of Public Health, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>, and <a href="https://theconversation.com/profiles/philip-weinstein-882901">Philip Weinstein</a>, Professorial Research Fellow, School of Public Health, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</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/why-are-we-seeing-more-pandemics-our-impact-on-the-planet-has-a-lot-to-do-with-it-226827">original article</a>. </div>

Body

It’s 4 years since the first COVID case in Australia. Here’s how our pandemic experiences have changed over time

<a href="https://theconversation.com/profiles/deborah-lupton-9359">Deborah Lupton</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> It might be hard to believe, but four years have now passed since the <a href="https://www.health.gov.au/topics/covid-19/about">first COVID case</a> was confirmed in Australia on January 25 2020. Five days later, the <a href="https://www.who.int/publications/m/item/covid-19-public-health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum">World Health Organization</a> (WHO) declared a “public health emergency of international concern”, as the novel coronavirus (later named SARS-CoV-2) began to spread worldwide. On March 11 the WHO would declare COVID a pandemic, while around the same time Australian federal and state governments hastily <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/pubs/rp/rp2021/Chronologies/COVID-19StateTerritoryGovernmentAnnouncements">introduced measures</a> to “stop the spread” of the virus. These included shutting Australia’s international borders, closing non-essential businesses, schools and universities, and limiting people’s movements outside their homes. I began my project, <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2023.1092322/full">Australians’ Experiences of COVID-19</a>, in May 2020. This research has continued each year to date, allowing me to track how Australians’ attitudes around COVID have changed over the course of the pandemic. <h2>Evolving pandemic experiences</h2> We recruited participants from across Australia, including people living in regional cities and towns. Participants range in age from early adulthood to people in their 80s. The first three stages of the project each involved 40 interviews with separate groups of participants (so 120 people in total). These interviews were done in May to July 2020 (stage 1), September to October 2021 (stage 2), and September 2022 (stage 3). Stage 4 was an online survey with 1,000 respondents, conducted in September 2023. Limitations of this project include the small sample sizes for the first three stages (as is common with qualitative interview-based research). This means the findings from those phases are not generalisable, but they do provide rich insights into the experiences of the interviewees. The quantitative stage 4 survey, however, is representative of the Australian population. The findings show that as the conditions of the pandemic and government management have changed across these years, so have Australians’ experiences. In the <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10743-7">early months of the pandemic</a>, some people reported becoming confused, distressed and overwhelmed by the plethora of information sources and the fast-changing news environment. On the other hand, seeking out information provided reassurance and comfort in response to their anxiety and uncertainty about this new disease. Australians <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781003280644-28/covid-19-crisis-communication-deborah-lupton">continued to rely heavily</a> on news reports and government announcements in the first two years of the pandemic. Regular briefings from premiers and <a href="https://theconversation.com/chief-health-officers-are-in-the-spotlight-like-never-before-heres-what-goes-on-behind-the-scenes-166828?utm_source=twitter&utm_medium=bylinetwitterbutton">chief health officers in particular</a> were highly important for how they learned what was happening, as were updates in the media on case numbers, hospitalisations, deaths and progress towards vaccination targets. <h2>Trust has eroded</h2> Australians appear to have lost a lot of trust in COVID information sources such as news media reports, health agencies and government leaders. Early strong support of federal, state and territory governments’ pandemic management in <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10743-7">2020</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/14649365.2023.2240290">2021</a> has given way to much lower support more recently. My <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4626720">2023 survey</a> (this is published as a report, not peer-reviewed) found doctors were considered the most trustworthy sources of COVID information, but even they were trusted by only 60% of respondents. After doctors, participants trusted other experts in the field (53%), Australian government health agencies (52%), global health agencies (49%), scientists (45%) and community health organisations (35%). Australian government leaders were towards the lower end of the spectrum (31%). In <a href="https://academic.oup.com/heapro/article/38/1/daac192/7026242?login=false">2021</a>, Australians responded positively to the vaccine targets and “<a href="https://www.premier.vic.gov.au/victorias-roadmap-delivering-national-plan">road maps</a>” set by governments. These clear guidelines, and especially the promise that the initial doses would remove the need for lockdowns and border closures, were strong incentives to get vaccinated in 2021. Unfortunately, the prospect that vaccines would control COVID was shown to be largely unfounded. While COVID vaccines were and continue to be very effective at protecting against severe disease and death, they’re less effective at <a href="https://coronavirus.jhu.edu/vaccines/vaccines-faq">stopping people becoming infected</a>. Once very high numbers of eligible Australians became vaccinated against the delta variant, <a href="https://pubmed.ncbi.nlm.nih.gov/37068078/">omicron reached Australia</a>, resulting in Australia’s first big wave of infection. This led to disillusionment about vaccines’ value for many participants. In the <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4626720">2023 survey</a>, respondents reported a high uptake of the first three COVID shots. But when asked whether they planned to get another vaccine in the next 12 months, almost two-thirds said they did not, or they were unsure. <h2>Enter complacency</h2> Complacency now seems to have set in for many Australians. This can be linked to the progressive withdrawal of strong public health measures such as quarantine, mandatory isolation when infected, and testing and tracing regimens. Meanwhile, the media, government leaders and health agencies have played less of an active public role in conveying COVID information. This has led to uncertainty about the extent to which COVID is still a risk and lack of incentive to take protective actions such as mask wearing. In <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4626720">2023</a>, after mandates had ended, only 9% of respondents said they always wore a mask in indoor public places. Only a narrow majority of respondents even supported compulsory masking for workers in health-care facilities. The <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4626720">2023 survey</a> confirmed many Australians no longer feel at risk from COVID. Some 17% of respondents said COVID was definitely still posing a risk to Australians, while a further 42% saw COVID as somewhat of a risk. This left 28% who did not view COVID as much of a continuing risk, and 13% who thought it was not a risk at all. <h2>COVID is still a risk</h2> Whether or not people feel at continuing risk from COVID, the pandemic is still significantly affecting Australians. The <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4626720">2023 survey</a> found more than two-thirds of respondents (68%) reported having had at least one COVID infection to their knowledge, including 13% who had experienced three or more. Of those who’d had COVID, 40% said they experienced ongoing symptoms, or long COVID. If the pandemic loses visibility in public forums, people have no way of knowing the risk of infection continues, and are therefore unlikely to take steps to protect themselves and others. Updated case, hospitalisation, death and vaccination numbers should be communicated regularly, as <a href="https://theconversation.com/covid-is-surging-in-australia-and-only-1-in-5-older-adults-are-up-to-date-with-their-boosters-220839">used to be the case</a>. To combat confusion, complacency and misinformation, all health advice should be based on the latest robust science. Australians are operating in a vacuum of information from trusted sources. They need much better and more frequent public health campaigns and risk communication from their leaders.<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/220336/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/deborah-lupton-9359">Deborah Lupton</a>, SHARP Professor, Vitalities Lab, Centre for Social Research in Health and Social Policy Centre, and the ARC Centre of Excellence for Automated Decision-Making and Society, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images 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/its-4-years-since-the-first-covid-case-in-australia-heres-how-our-pandemic-experiences-have-changed-over-time-220336">original article</a>.

Caring

Qantas found guilty of firing health worker during pandemic

Qantas has been found guilty of firing a health and safety officer during the early days of the pandemic, a NSW district court judge has found. The airline dismissed Theo Seremetidis in early 2020 after he expressed concerns about safety protocol for flights arriving from China in the first months of the Covid-19 pandemic. According to SafeWork NSW, Qantas breached part 6 of the Work Health and Safety Act and discriminated against Mr Seremetidis when he was stood down. On Thursday, the court heard elements of the matter brought by SafeWork NSW were established beyond reasonable doubt and Qantas Ground Services is “guilty of the offence charged”. They specifically related to standing down Mr Seremetidis “to his detriment” and the main reason for his dismissal was a prohibited reason, because he had exercised a power as a health and safety representative by directing workers to cease unsafe work. The prosecution was brought about after Mr Seremetidis launched a complaint about his former workplace with the Transport Workers Union (TWU), who took the complaint to SafeWork NSW. Judge David Russell said he accepted SafeWork NSW’s submissions that Qantas Ground Services “actively sidelined” Mr Seremetidis and ignored his concerns. <div>“Firstly … by cutting him off from other staff who were seeking his help,” he said. “And secondly, by standing him down and requiring him to leave the airport forthwith. “I formed the view that he attempted to carry out his duties as a health and safety representative conscientiously and carefully,” he said. TWU President and NSW/Qld Secretary Richard Olsen welcomed the verdict on SafeWork NSW’s primary charge. “This is a fantastic result. Theo is a workplace hero and today he has been vindicated. When the TWU urged SafeWork NSW to prosecute this case, Theo courageously took on one of Australia’s biggest corporate bullies and won,” he said. Image credits: TWU </div>

Legal

People with long COVID continue to experience medical gaslighting more than 3 years into the pandemic

<a href="https://theconversation.com/profiles/simran-purewal-1405366">Simran Purewal</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kaylee-byers-766226">Kaylee Byers</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kayli-jamieson-1431392">Kayli Jamieson</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>, and <a href="https://theconversation.com/profiles/neda-zolfaghari-1431577">Neda Zolfaghari</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a> It’s increasingly clear that the <a href="https://www.worldometers.info/coronavirus/country/canada/">SARS-CoV-2 virus is not going away</a> any time soon. And for some patients, their symptoms haven’t gone away either. In January 2023, our team of researchers at the <a href="https://pipps.ca/">Pacific Institute on Pathogens, Pandemics and Society</a> published a <a href="https://pipps.cdn.prismic.io/pipps/bd160219-3281-4c5d-b8be-57c301e7f99b_Long+Covid+Brief+Feb+2023.pdf">research brief</a> about how people seek out information about long COVID. The brief was based on a scoping review, a type of study that assesses and summarizes available research. Our interdisciplinary team aims to understand the experiences of people with long COVID in order to identify opportunities to support health care and access to information. <h2>Lingering long COVID</h2> Long COVID (also called <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms/post-covid-19-condition.html">Post COVID-19 condition</a>) is an illness that occurs after infection with COVID-19, lasting weeks to months, and even years. First coined by a <a href="https://doi.org/10.1016%2Fj.socscimed.2020.113426">patient on Twitter</a>, the term also represents a collective movement of people experiencing the long-term effects of COVID-19 and advocating for care. <a href="https://science.gc.ca/site/science/sites/default/files/attachments/2023/Post-Covid-Condition_Report-2022.pdf">Around 15 per cent</a> of adults who have had COVID still have symptoms after three months or more. Long COVID affects systems <a href="https://doi.org/10.1016/j.socscimed.2021.114619">throughout the body</a>. However, symptom fluctuations and limited diagnostic tools make it challenging for health-care providers to diagnose, especially with <a href="https://doi.org/10.1038/s41579-022-00846-2">over 200 symptoms</a> that may present in patients. Perhaps because long COVID presents itself in many different ways, the illness has <a href="https://doi.org/10.1016/j.socscimed.2021.114619">been contested</a> across the medical field. To identify opportunities to reduce barriers to long COVID care, our team has explored how patients and their caregivers access <a href="https://pipps.cdn.prismic.io/pipps/bd160219-3281-4c5d-b8be-57c301e7f99b_Long+Covid+Brief+Feb+2023.pdf">information about long COVID</a>. We have found that one of the most significant barriers faced by patients is <a href="https://doi.org/10.1177/20552076211059649">medical gaslighting</a> by the people they have turned to for help. <h2>Lack of validation leads to stigma</h2> <a href="https://doi.org/10.1136/bmj.o1974">Medical gaslighting</a> occurs when health-care practitioners dismiss or falsely blame patients for their symptoms. While new information about long COVID has become more readily available, some patients continue to face gaslighting and feel that their symptoms are <a href="https://doi.org/10.1016%2Fj.ssmqr.2022.100177">treated less seriously</a> by some health-care professionals. This dismissal can <a href="https://doi.org/10.1111/hex.13602">erode trust</a> in the health-care system and can also lead to <a href="https://doi.org/10.1111/hex.13518">stigma and shame</a>. Preliminary findings from our ongoing study with long COVID patients indicate that, when medical practitioners do not validate a patient’s condition, this extends into community networks of family and friends who may also dismiss their symptoms, contributing to further stigmatization at home. Medical gaslighting can present additional barriers to treatment, such as not being referred to specialists or long COVID clinics. This can, in turn, compound other symptoms such as fatigue, and <a href="https://doi.org/10.1192/bjo.2022.38">exacerbate the psychological symptoms of long COVID</a>, such as depression and anxiety. Medical gaslighting isn’t new. It has been documented by patients with other chronic conditions, such as <a href="https://doi.org/10.5772/intechopen.107936">myalgic encephalomyelitis or chronic fatigue syndrome</a>. And while this is common for patients with <a href="https://doi.org/10.1001/amajethics.2021.512">non-visible illnesses</a>, medical gaslighting is more commonly experienced by <a href="https://doi.org/10.1111/1467-9566.13367">women and racialized people</a>. Long COVID patients also note gender biases, as women with prolonged symptoms feel they are not believed. This is particularly worrisome, as studies have found that <a href="https://doi.org/10.1001/jama.2020.17709">women are disproportionately more likely to experience long COVID</a>. <h2>Where do we go from here?</h2> While long COVID information is constantly shifting, it’s clear that patients face many barriers, the first of which is having their illness minimized or disregarded by others. To ensure that patients have access to compassionate care, we suggest: 1. Educating physicians on long COVID Because definitions of long COVID, and its presentation, vary widely, primary care physicians need support to recognize and acknowledge the condition. General practitioners (GPs) must also provide patients with information to help manage their symptoms. This requires actively listening to patients, documenting symptoms and <a href="https://doi.org/10.1136/bmj.m3489">paying close attention to symptoms that need further attention</a>. Training physicians on the full range of symptoms and referring patients to available supports would reduce stigma and assist physicians by reducing their need to gather information themselves. 2. Raise awareness about long COVID To increase awareness of long COVID and reduce stigma, public health and community-based organizations must work collaboratively. This may include a public awareness and information campaign about long COVID symptoms, and making support available. Doing so has the potential to foster community support for patients and improve the mental health of patients and their caregivers. 3. Ensure information is accessible In many health systems, GPs are <a href="https://doi.org/10.1186/s12913-019-4419-0">gatekeepers to specialists</a> and are considered trusted information sources. However, without established diagnostic guidelines, patients are left to <a href="https://doi.org/10.2196/37984">self-advocate</a> and prove their condition exists. Because of negative encounters with health-care professionals, patients turn to social media platforms, including long COVID <a href="https://doi.org/10.7861%2Fclinmed.2020-0962">online communities</a> on Facebook. While these platforms allow patients to validate experiences and discuss management strategies, patients should not rely only on social media given the <a href="https://doi.org/10.3389/fpubh.2022.937100">potential for misinformation</a>. As a result, it is crucial to ensure information about long COVID is multi-lingual and available in a wide range of formats such as videos, online media and physical printouts. The <a href="https://science.gc.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/post-covid-19-condition-canada-what-we-know-what-we-dont-know-and-framework-action">recent recommendations of the Chief Science Advisor of Canada</a> to establish diagnostic criteria, care pathways and a research framework for long COVID are a positive development, but we know patients need support now. Improving long COVID education and awareness won’t resolve all of the issues faced by patients, but they’re foundational to compassionate and evidence-based care.<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/203744/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/simran-purewal-1405366">Simran Purewal</a>, Research Associate, Health Sciences, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kaylee-byers-766226">Kaylee Byers</a>, Regional Deputy Director, BC Node of the Canadian Wildlife Health Cooperative; Senior Scientist, Pacific Institute on Pathogens, Pandemics and Society, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kayli-jamieson-1431392">Kayli Jamieson</a>, Master's Student in Communication, Research Assistant for Pacific Institute on Pathogens, Pandemics and Society, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>, and <a href="https://theconversation.com/profiles/neda-zolfaghari-1431577">Neda Zolfaghari</a>, Project Coordinator, Pacific Institute on Pathogens, Pandemics and Society, and the Pandemics & Borders Project, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a> Image credits: Getty Images 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/people-with-long-covid-continue-to-experience-medical-gaslighting-more-than-3-years-into-the-pandemic-203744">original article</a>.

Caring

Three years into the pandemic, it’s clear COVID won’t fix itself. Here’s what we need to focus on next

On March 11 2020 the World Health Organization classified COVID as a <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">pandemic</a>. Three years on, it remains just that. As much as we don’t want it to be, and as much as it is off the front pages, COVID is still very much with us. But how bad has it really been? And, more importantly, what have we learned that could help us accelerate a real and sustained exit? <h2>COVID has hit us hard</h2> There was a <a href="https://theconversation.com/too-late-already-bolted-how-a-faster-who-response-could-have-slowed-covid-19s-spread-160860">slow initial</a> global response to what we now call SARS-CoV-2, the virus that causes COVID. This allowed the virus to get a foothold, contributing to unexpectedly rapid <a href="https://theconversation.com/why-are-there-so-many-new-omicron-sub-variants-like-ba-4-and-ba-5-will-i-be-reinfected-is-the-virus-mutating-faster-182274">viral evolution</a>. Three years into the pandemic, with the removal of almost all mitigation measures in most countries, it’s clear the virus has hit the world very hard. <a href="https://www.worldometers.info/coronavirus/">So far</a>, almost 681 million infections and more than 6.8 million deaths have been reported. This is perhaps best visualised by its impact on life expectancy. There were <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/padr.12477">sharp declines</a> seen across the world in 2020 and 2021, reversing 70 years of largely uninterrupted progress. The excess mortality driving this drop in life expectancy has continued. This includes in Australia, <a href="https://www.actuaries.digital/2023/03/06/almost-20000-excess-deaths-for-2022-in-australia/">where over 20,000 more lives</a> than the historical average are estimated to have been lost in 2022. <h2>Not just COVID deaths</h2> The indirect impacts on the health systems in rich and poor countries alike continue to be substantial. Disruptions to health services have led to <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00079-6/fulltext">increases</a> in stillbirths, maternal mortality and postnatal depression. Routine <a href="https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades">child immunisation coverage</a> has decreased. Crucial malaria, tuberculosis and HIV programs have been <a href="https://www.theglobalfund.org/en/news/2021/2021-09-08-global-fund-results-report-reveals-covid-19-devastating-impact-on-hiv-tb-and-malaria-programs/#:%7E:text=GENEVA%20%E2%80%93%20The%20COVID%2D19%20pandemic,history%20of%20the%20Global%20Fund">disrupted</a>. A paper out this week highlights the <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1107560/full">severe impact</a> of the pandemic on mental health globally. <h2>Then there’s long COVID</h2> Meanwhile, more evidence of long COVID has emerged around the world. At least <a href="https://www.nature.com/articles/s41579-022-00846-2">65 million people</a> were estimated to be experiencing this debilitating syndrome by the end of 2022. The Australian Institute of Health and Welfare <a href="https://www.aihw.gov.au/reports/covid-19/long-covid-in-australia-a-review-of-the-literature/summary">estimates</a> 5-10% of people who are infected with SARS-CoV-2 will develop long COVID, with symptoms persisting more than three months. That’s between 550,000 and 1.1 million Australians, based on the more than 11 million cases reported <a href="https://www.worldometers.info/coronavirus/country/australia/">so far</a>. <h2>COVID highlighted inequalities</h2> The pandemic has also had a huge economic impact, both directly and indirectly. The United States alone spent <a href="https://impact.economist.com/perspectives/economic-development/understanding-economic-consequences-covid-19-pandemic">US$4 trillion</a> on its response. Economists have estimated the pandemic will contribute an average 0.75% reduction in GDP in countries with high infection rates and high productivity in 2025. Studies in the <a href="https://www.local.gov.uk/health-inequalities-deprivation-and-poverty-and-covid-19">United Kingdom</a>, <a href="https://www.theguardian.com/world/2022/apr/04/us-covid-devastating-toll-poor-low-income-communities">US</a> and <a href="https://www.theguardian.com/australia-news/2022/feb/25/disease-of-disadvantage-melbournes-lower-socioeconomic-areas-suffer-most-covid-deaths-amid-omicron">Australia</a> show COVID has had a disproportionate impact – including higher death rates – in disadvantaged communities and ethnic minorities. The causes range from high exposure in low-paid jobs to inadequate access to health care. And <a href="https://www.brookings.edu/blog/future-development/2021/05/27/covid-19-is-a-developing-country-pandemic/">poorer countries</a> have fared terribly on all fronts from COVID, including inequitable access to vaccines. <h2>There’s no end in sight</h2> We cannot assume there will be a natural exit to the pandemic, where the virus reaches some benign endemicity, a harmless presence in the background. In fact, there is little indication anything like that is imminent. In Australia, since the beginning of January, <a href="https://www.worldometers.info/coronavirus/country/australia/">more than 235,000 COVID cases</a> have been reported, almost as many as in 2020 and 2021 combined. Since the start of January, there have been 2,351 COVID-related deaths, more than twice as many as in the whole of 2020 and around the same as in the whole of 2021. <h2>What needs to happen next?</h2> The future response can be practically distilled into three overlapping actions. 1. Politicians need to be frank Our political leaders need to communicate frankly with the public that the pandemic is not over. They need to stress we still have an exceptional problem on our hands with acute disease as well as worrying concerns about long COVID. It’s crucial politicians acknowledge sufferers and those who have died. They need to do this while delivering the good news that addressing COVID does not require lockdowns or mandates. If our politicians did this, the public would be more likely to have their booster vaccines, get tested and treated, and adopt measures such as improving indoor ventilation and wearing high-quality masks. The health system also needs to be greatly strengthened to deal with long COVID. 2. Avoiding infections is still important Suppressing the virus is still important. We still can and should reduce the burden of newly acquired COVID and, therefore, long COVID. We have the tools to do this. We need full recognition that COVID is transmitted largely through the air. As this just-published article in the journal <a href="https://www.nature.com/articles/d41586-023-00642-9">Nature</a> discusses, there are things we can do right now to ensure we all breathe air that is safer, not just from SARS-CoV-2 but from other respiratory viruses. 3. Adopt new knowledge and technology We should be focusing on the science and be ready to adopt new knowledge and products rapidly. Just a few days ago we had trials of a <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4375620&utm_source=substack&utm_medium=email">promising new approach</a> to treat long COVID with the diabetes drug metformin. There is also intriguing research that has identified <a href="https://www.nature.com/articles/s41579-022-00846-2">persistent infection</a> as a potential underlying cause of organ damage and disease after COVID and in long COVID. This suggests anti-viral drugs such as Paxlovid may have an important role to play in reducing the impact of chronic disease. Many types of new COVID vaccines are being trialled, such as <a href="https://www.nature.com/articles/d41586-022-02824-3">versions administered by nasal sprays</a>, which may be game changers. <h2>The virus won’t fix itself</h2> As we enter the fourth year of the pandemic, we must not leave it up to the virus to fix itself. The biggest lesson of the past three years is there’s little chance that is going to work, at least without an intolerably high cost. Rather, we can end the pandemic by choice. We know <a href="https://theconversation.com/from-covid-control-to-chaos-what-now-for-australia-two-pathways-lie-before-us-174325">what to do</a>. But we are simply not doing it. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/three-years-into-the-pandemic-its-clear-covid-wont-fix-itself-heres-what-we-need-to-focus-on-next-201181" target="_blank" rel="noopener">The Conversation</a>.

Caring

The wellbeing ‘pandemic’ – how the global drive for wellness might be making us sick

Are we in the midst of a wellbeing pandemic? The question may seem curious, even contradictory. But look around, the concept is everywhere and spreading: in the media, in government institutions and transnational organisations, in schools, in workplaces and in the marketplace. To be clear, it’s not just wellbeing’s infectiousness in public discourse that makes it pandemic-like. It’s also the genuine malaise that can be caused by the term’s misuse and exploitation. Do you sense, for example, that your wellbeing is increasingly being scrutinised by peers, managers and insurance companies? Are you noticing an increasing number of advertisements offering products and services that promise enhanced wellbeing through consumption? If so, you’re not alone. But we also need to ask whether this obsession with wellbeing is having the opposite to the desired effect. To understand why, it’s important to look at the origins, politics and complexities of wellbeing, including its strategic deployment in the process of what we call “<a href="https://otagouni-my.sharepoint.com/personal/jacst99p_registry_otago_ac_nz/Documents/Documents/SJ-Wellness/SJ-Conversation-Wellbeing/Jackson-Sam-Dawson-Porter-Frontiers-Sociology-Wellbeing-2022.pdf">wellbeing washing</a>”. <h2>The halo effect</h2> While concerns about wellbeing can be traced to antiquity, the term has emerged as a central feature of contemporary social life. One explanation is that it is often conflated with concepts as diverse as happiness, quality of life, life satisfaction, human flourishing, mindfulness and “wellness”. Wellbeing is flexible, in the sense that it can be easily inserted into a diverse range of contexts. But it’s also surrounded by a kind of halo, automatically bestowed with a positive meaning, similar to concepts such as motherhood, democracy, freedom and liberty. To contest the value and importance of such things is to risk being labelled a troublemaker, a non-believer, unpatriotic or worse. These days, there are two main concepts of wellbeing. The first – subjective wellbeing – emphasises a <a href="https://www.frontiersin.org/articles/10.3389/fsoc.2022.950557/full#B21">holistic measure</a> of an individual’s mental, physical and spiritual health. This perspective is perhaps best reflected in the World Health Organization’s <a href="https://www.corc.uk.net/outcome-experience-measures/the-world-health-organisation-five-well-being-index-who-5/">WHO-5 Index</a>, designed in 1998 to measure people’s subjective wellbeing according to five states: cheerfulness, calmness, vigour, restfulness and fulfilment. Translated into more than 30 languages, the overall influence of the WHO-5 Index should not be underestimated; both governments and corporations have embraced it and implemented policy based on it. But the validity of the index, and others like it, has been questioned. They’re prone to oversimplification and a tendency to marginalise alternative perspectives, including Indigenous approaches to physical and mental health. <h2>Individual responsibility</h2> The second perspective – objective wellbeing – was a response to rising social inequality. It focuses on offering an <a href="https://www.frontiersin.org/articles/10.3389/fsoc.2022.950557/full#B60">alternative to GDP</a> as a measure of overall national prosperity. One example of this is New Zealand’s <a href="https://www.treasury.govt.nz/information-and-services/nz-economy/higher-living-standards/our-living-standards-framework">Living Standards Framework</a>, which is guided by four operating principles: distribution, resilience, productivity and sustainability. These new and purportedly more progressive measures of national economic and social outcomes signal societal change, optimism and hope. The trouble with such initiatives, however, is that they remain rooted within a particular neoliberal paradigm in which individual behaviour is the linchpin for change, rather than the wider political and economic structures around us. Arguably, this translates into more monitoring and “disciplining” of personal actions and activities. Intentionally or not, many organisations interpret and use wellbeing principles and policies to reinforce existing structures and hierarchies. Consider how the wellbeing agenda is playing out in your organisation or workplace, for example. Chances are you have seen the growth of new departments, work units or committees, policies and programs, wellness workshops – all supposedly linked to health and wellbeing. You may even have noticed the creation of new roles: wellbeing coaches, teams or “champions”. If not, then “lurk with intent” and be on the lookout for the emergence of yoga and meditation offerings, nature walks and a range of other “funtivities” to support your wellbeing. <h2>Wellbeing washing</h2> The danger is that such initiatives now constitute another semi-obligatory work task, to the extent that non-participation could lead to stigmatisation. This only adds to stress and, indeed, unwellness. Deployed poorly or cynically, such schemes represent aspects of “wellbeing washing”. It’s a strategic attempt to use language, imagery, policies and practices as part of an organisation’s “culture” to connote something positive and virtuous. In reality, it could also be designed to enhance productivity and reduce costs, minimise and manage reputational risk, and promote <a href="https://otagouni-my.sharepoint.com/personal/jacst99p_registry_otago_ac_nz/Documents/Documents/SJ-Wellness/SJ-Conversation-Wellbeing/Jackson-Sam-Dawson-Porter-Frontiers-Sociology-Wellbeing-2022.pdf">conformity, control and surveillance</a>. Ultimately, we argue that wellbeing now constitutes a “field of power”; not a neutral territory, but a place where parties advance their own interests, often at the expense of others. As such, it’s essential that scholars, policymakers and citizens explore, as one author <a href="https://www.google.com.au/books/edition/Measuring_Wellbeing/lWBXjk1nocIC?hl=en&gbpv=1&dq=%E2%80%9Cwhat+and+whose+values+are+represented,+which+accounts+dominate,+what+is+their+impact+and+on+whom%E2%80%9D&pg=PA4&printsec=frontcover">put it</a>, “what and whose values are represented, which accounts dominate, what is their impact and on whom”. Because if wellbeing is becoming a pandemic, we may well need the “vaccine” of critical reflection. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/the-wellbeing-pandemic-how-the-global-drive-for-wellness-might-be-making-us-sick-198662" target="_blank" rel="noopener">The Conversation</a>.

Caring

How the pandemic affected our approach to reading and interpretation of books

During the pandemic, reading took on new meaning. People turned to books for comfort. Some read to confront difficult issues, especially following the murder of George Floyd in 2020. Others used reading as a way to care for their children in locked-down houses. <a href="https://www.theguardian.com/books/2020/mar/25/book-sales-surge-self-isolating-readers-bucket-list-novels" target="_blank" rel="noopener">Sales figures and lending data</a> showed a huge spike in people buying and borrowing books. We wanted to follow the stories of real readers and <a href="https://global.oup.com/academic/product/reading-novels-during-the-covid-19-pandemic-9780192857682?q=reading%20novels%20during%20the%20pandemic&lang=en&cc=dk" target="_blank" rel="noopener">our new book</a> uses a rare combination of literary analysis and qualitative interviewing to capture these dynamics of reception. While many commentators at the beginning of the pandemic <a href="https://www.refinery29.com/en-us/2020/03/9581961/long-books-to-read-in-quarantine" target="_blank" rel="noopener">endorsed reading</a> as a straightforward way to relax, our readers showed that the practice morphed and took on new forms and meanings. Based on hundreds of survey responses and hours of reader interviews from Denmark and the UK, the study makes the interpretation of literature something dynamic and ongoing. And it suggests that readers themselves are agents of meaning, even in the case of novels that seem the most stable in our culture. Reading during the pandemic showed how books and their meanings change. Novels that we think of as settled in their significance acquire new meaning as they are read under unfolding conditions, exposed to the vagaries of history. In our research we show how Albert Camus’s The Plague became an unlikely hit in 2020, how the affordances of Sally Rooney’s romantic fiction seemed suddenly to apply to the lovers unable to meet, and how long novels that had intimidated pre-pandemic readers became lifelines in their heft. <h2>Tricky reading</h2> For many people, reading became more difficult during this time. Far from giving everyone uninterrupted time to attend to long novels by authors like Tolstoy, lockdown exacerbated the separations and challenges of everyday life. Take Jane Eyre, a novel that many readers picked up during lockdown because it was on their shelves. Suddenly, this classic seemed to be a novel about a woman locked in small rooms and living through a cholera epidemic. Many also took it up under conditions that overlapped directly with the book’s scenes of homeschooling. One respondent called Phoebe, for instance, deliberately avoided rereading Jane Eyre for these reasons. Charlotte Brontë’s classic novel of loneliness and love was, in 2020, “too creepy”. The story of Jane being locked up made her feel unsafe while she lived alone through lockdown in the confines of her own room. Another interviewee, Alexandra, was troubled by the idea of reading Hilary Mantel’s bestseller The Mirror and the Light, explaining: <blockquote> I knew that I would be saying goodbye to Sir Thomas Cromwell […] I looked at it and I thought, what if I die before I get to the end of this? It will be the most unsatisfactory experience. </blockquote> Rather than sizing up the third part of Mantel’s intimate portrayal of the life of Thomas Cromwell as offering the ideal opportunity for narrative immersion, Alexandra viewed the very thickness of the book as problematic. Her intense fear of death in the pandemic and expectation of Cromwell’s literary demise converge on the length of narrative, which stretches into a future that had become harder to face. <h2>Slipperiness of time</h2> For the reader caught up in a global pandemic, a novel like The Plague, Albert Camus’s famous story of a town suffering a deadly virus, reads differently than it usually would for, say, the school student of French literature. One interviewed reader, for instance, discussed the novel’s temporal slipperiness. Normally, of course, the very lack of measurable time would suggest the novel as an allegory – untied to a particular time, a warning of dark political forces turning up and spreading at any moment. But in 2020, when time <a href="https://theconversation.com/a-philosophical-idea-that-can-help-us-understand-why-time-is-moving-slowly-during-the-pandemic-151250" target="_blank" rel="noopener">felt like it was moving oddly</a> The Plague’s confused sense of time felt realistic, as if it were mimicking our lived experience of a pandemic. <figure></figure> Yet, it would be a mistake to assume all readers suddenly ditched allegory for realism or real-life correspondence. As Kirsten, a Danish woman in her 30s, explained: <blockquote> I ended up buying The Plague because I was more interested in the metaphorical portrait of the occupation (of France by the Nazis) than in what epidemics do to a society. </blockquote> By following real readers, our study provides a snapshot of a phenomenal moment in modern history and shows the movement of readers between new purchases and books long kept in their collections. By exploring these varied experiences, we investigated the larger question of how the consumption of novels depends on and shapes people’s experience of non-work time, providing a specific lens through which to examine the experience of reading more generally. Perhaps most importantly, it demonstrates the dynamic process of reading and the ways in which books change depending on where and when they are read and by whom. This article originally appeared on <a href="https://theconversation.com/how-the-pandemic-affected-our-approach-to-reading-and-interpretation-of-books-195238" target="_blank" rel="noopener">The Conversation</a>. Image: Shutterstock

Books

Can ‘voluntourism’ outgrow the white saviour stereotype and make a positive change post-pandemic?

As the tourism industry emerges from pandemic shutdowns and border closures, so too is “voluntourism”, the sometimes controversial combination of overseas volunteer work and more traditional tourist experiences. Although hard to measure, pre-pandemic estimates suggest voluntourism was worth <a href="https://sites.lsa.umich.edu/mje/2022/01/22/the-paradox-of-voluntourism-how-international-volunteering-impacts-host-communities/">US$2 billion annually</a>, with up to <a href="https://www.cbi.eu/market-information/tourism/save-tourism/market-potential">ten million volunteers</a> globally. While COVID shut the practice down for the duration, it remains a <a href="https://roadbook.com/opinion/negative-effects-of-voluntourism/">multi-billion-dollar industry</a>, now poised to <a href="https://www.sbs.strath.ac.uk/blogs/SBS/post.aspx?id=1420">return and rebuild</a>. But volunteer tourism has met with considerable criticism. Voluntourists have been accused of putting <a href="https://www.stuff.co.nz/travel/news/109983663/nz-school-students-pay-thousands-to-visit-orphanages-and-volunteer-overseas">vulnerable people at risk</a> (<a href="https://drivingchange.org/do-no-harm-the-dark-side-of-voluntourism/">including children</a>), <a href="https://tourismteacher.com/commodification-volunteer-tourism/">commodifying volunteer work</a>, perpetuating <a href="https://darbymatt.medium.com/voluntourism-is-neo-colonialism-56b6a25f6924">neo-colonialism</a> and <a href="https://www.euronews.com/travel/2022/02/21/how-white-saviour-voluntourism-gets-you-famous-on-tiktok">reinforcing</a> a “white saviour” complex. Voluntourism is also <a href="https://www.thenewhumanitarian.org/2021/06/14/travel-opens-again-aid-voluntourism-needs-get-real">largely unregulated</a>, raising important <a href="https://journalofethics.ama-assn.org/article/voluntourism/2019-09">ethical questions</a> about who it really aims to serve – travellers or hosts. These issues are now being felt in the Pacific, where voluntourism is a relatively new but growing industry. As <a href="https://e-tangata.co.nz/reflections/the-problem-with-white-saviours/">Simone Kaho wrote</a> of her experience in Tonga: <blockquote> In many cases, voluntourism asks the local community to stand back, and allow themselves to be helped. It turns helping into a business model. </blockquote> <a href="https://blog.geographydirections.com/2019/09/03/global-encounters-voluntourism-in-fiji/">My research</a> in Fiji has also highlighted the problems associated with the commercialisation and commodification of volunteering. These are real and important issues that need close examination as tourism in general picks up. <blockquote class="twitter-tweet"> End voluntourism and the white saviour industrial complex <a href="https://t.co/gMHkZfTlsf">https://t.co/gMHkZfTlsf</a> via <a href="https://twitter.com/mailandguardian?ref_src=twsrc%5Etfw">@mailandguardian</a> — NGO Watch Africa (@NGOWatchAfrica) <a href="https://twitter.com/NGOWatchAfrica/status/1582376611449491457?ref_src=twsrc%5Etfw">October 18, 2022</a></blockquote> Behind the ‘bula smile’ The Fiji case study – conducted with an international, for-profit, specialist voluntourism agency – tells a complex story about the benefits and downsides of voluntourism. Volunteers are hosted by local families and included in household life, attending church or religious functions, learning to cook Fijian food, and spending time with children and other family members. Through this, they gain an understanding of life behind the famous “bula” smile. As one staff member said: <blockquote> The host may get angry with you if you leave the light on, you may feel like you are back living with mum and dad because they may give you a lunch box, things like that. But it’s important that they see the person who is paid to smile at the Hilton, what they are like at home with their kids, how they make ends meet, how they eat. </blockquote> Hosts often put considerable energy into sharing their way of life and teaching volunteers Fijian culture. Most hosts and staff took pride in helping travellers find their way around and teaching them Fijian ways. In turn, this helped Fijian staff build knowledge and pride in their own culture. <blockquote> Also the good thing is that we keep up with our culture. Because if you are talking about it every day and you show them and try to talk about it, then the history remains […] Now when we go to the village we do the sevusevu [kava ceremony] and all those things, and we go with the elders. It was our mothers that did that, but now we are doing it, the next generation. When we have volunteers in a Fijian village we will go to any lengths to give them what they want, to try and serve them […] But of course then the volunteers change to become more Fijian! </blockquote> <blockquote class="twitter-tweet"> Are you itching to start travelling, but want to do it with care? Listen to this week's <a href="https://twitter.com/hashtag/WisdomWalks?src=hash&ref_src=twsrc%5Etfw">#WisdomWalks</a> to discover how you can avoid traps like voluntourism and greenwashing when travelling. 🎧 27 mins.<a href="https://t.co/f366FJcyQG">https://t.co/f366FJcyQG</a> — Curio (@curioio) <a href="https://twitter.com/curioio/status/1587821837932797953?ref_src=twsrc%5Etfw">November 2, 2022</a></blockquote> A chance to improve voluntourism The growth of voluntourism in Fiji follows half a century of <a href="https://medium.com/tourism-geographic/paradise-the-noble-savage-and-the-white-savior-in-fiji-7ac7e302e5ec">mass tourism</a>, in which contact between Fijians and tourists has been largely limited and manufactured. Hosts embrace the opportunity to interact with tourists more directly and to build connections across the globe. However, the commercial nature of the encounter has the potential to significantly undermine these connections. The large fees paid by voluntourists mean they – like any tourist – are consumers. Volunteers have certain expectations, ranging from the mundane (internet access, good food and logistical support) to the more profound (a sense of accomplishment, a feeling they’ve made a difference). They will complain if these expectations aren’t met. The pandemic also raised questions about the sustainability of voluntourism. The organisation I studied cut its global workforce significantly. In Fiji it had provided jobs for about a dozen Fijian staff, as well as home-stay income for many households. While there is evidence that <a href="https://theconversation.com/traditional-skills-help-people-on-the-tourism-deprived-pacific-islands-survive-the-pandemic-148987">reliance on customary knowledge, systems and practices</a> helped tourism workers to survive and even thrive during the pandemic, the future for many is uncertain. COVID-19 has been something of a wake-up call that we need to move beyond voluntourism as a pseudo-development practice or as a commodified, profit-making experience. This is an opportunity for the industry to take on board the criticisms, examine past practice and reassess the role and impact of volunteering. Rather than rush back to business as usual, this is the perfect moment to look at reconfiguring the industry in line with the principles of sustainability and <a href="https://medium.com/activate-the-future/understanding-the-opportunity-of-regenerative-tourism-894136cafd3b">regenerative tourism</a>. In the process, perhaps voluntourism’s strengths – building cross-cultural relationships, learning and solidarity – can contribute more to meaningful social and environmental change.<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/195719/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Writen by Sharon McLennan. Republished with permission from <a href="https://theconversation.com/can-voluntourism-outgrow-the-white-saviour-stereotype-and-make-a-positive-change-post-pandemic-195719" target="_blank" rel="noopener">The Conversation</a>. Image: Getty Images

International Travel

Floods, pandemics, wars and market forces: what’s driving up the price of milk

At the end of 2021, the cost of a litre of home-brand milk in an Australian supermarket <a href="https://www.abc.net.au/news/rural/2021-11-25/dairy-farmers-welcome-woolworths-milk-price-lift/100650118" target="_blank" rel="noopener">was about $1.30</a>. It’s now about $1.60. What will it cost at the end of 2022? That depends on the continued effect of flooding on prime dairy-production regions in New South Wales, Victoria and Tasmania, as well as on global economic conditions. The Australian Bureau of Agricultural and Resource Economics and Science has projected <a href="https://www.agriculture.gov.au/abares/research-topics/agricultural-outlook/dairy" target="_blank" rel="noopener">a 28% increase</a> in the farm-gate milk price in 2022-23 – to 72.5 cents per litre, a record high. With less milk being produced, it could be even more. <hr /> Australia’s dairy regions <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/490779/original/file-20221020-19-64n8np.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/490779/original/file-20221020-19-64n8np.png?ixlib=rb-1.1.0&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/490779/original/file-20221020-19-64n8np.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490779/original/file-20221020-19-64n8np.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490779/original/file-20221020-19-64n8np.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490779/original/file-20221020-19-64n8np.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=583&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490779/original/file-20221020-19-64n8np.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=583&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490779/original/file-20221020-19-64n8np.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=583&fit=crop&dpr=3 2262w" alt="" /></a><figcaption><a class="source" href="https://www.agriculture.gov.au/abares/research-topics/surveys/dairy#financial-performance" target="_blank" rel="noopener">ABARES</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/" target="_blank" rel="noopener">CC BY-NC-ND</a></figcaption></figure> <hr /> It’s a case of higher demand and lower supply. Production has been declining since 2014. In the first half of 2022, ABARES says milk production was about 7% lower than the same period in 2021: <blockquote> This was driven by extreme weather events: a drier than average start of the year in southern Victoria and northwest Tasmania, flooding in regions of Queensland and northern New South Wales. Also, with export prices for Australian dairy products increasing substantially at the start of 2022, less milk was available to the domestic market. </blockquote> Obviously, things aren’t all rosy. Some dairy farmers face the devastation of natural disasters. All face the same post-COVID challenges as other primary producers. Russia’s war on Ukraine has help drive up <a href="https://www.austrade.gov.au/news/insights/insight-farm-food-costs-rise-due-to-higher-energy-prices" target="_blank" rel="noopener">costs of inputs</a>, from fertilisers to <a href="https://www.agriculture.gov.au/abares/data/weekly-commodity-price-update/australian-agricultural-prices" target="_blank" rel="noopener">feed</a>. Labour is <a href="https://www.reuters.com/business/australia-needs-workers-million-are-stuck-door-2022-08-31" target="_blank" rel="noopener">hard to find</a>. But for all that, the record high farm-gate price is good news for an industry where the number of farmers has declined by a quarter in the past decade (from <a href="https://www.aph.gov.au/DocumentStore.ashx?id=b16a172f-6300-4ee0-918a-b235cf9da725">about 7,500</a> in 2011 to <a href="https://www.dairy.com.au/our-industry-and-people/our-regions">about 5,700</a> now). Deregulation stirs the pot Until 2000, farm-gate milk prices were regulated. State and territory governments set minimum farm-gate prices that maintained farmer income. This was abandoned in July 2000. With deregulation, farmers, processors and supermarkets were set free to negotiate prices. In economic theory, free trade works fine when you have a large number of buyers and sellers, all with the same amount of information about what is happening in the market. But in the milk industry, thousands of producers sell to a handful of milk processors, who then sell to even fewer retailers. The major supermarkets control almost <a href="https://milkvalue.com.au/australian-dairy-market/sales-trends/" target="_blank" rel="noopener">60% of total milk sales</a>. This is not always such a problem. It is not often you hear fresh producers screaming at supermarkets, in what is a very similar arrangement. But with the dairy industry, as noted in a <a href="https://www.agriculture.gov.au/sites/default/files/documents/review-report-dairy-industry-code.docx" target="_blank" rel="noopener">2021 report</a> from the Department of Agriculture, Waters and the Environment, there is a “perceived market failure”. Why? It has to do with how supermarkets have used their power. Waging the milk price war To give time for the market to find an equilibrium, the Howard government introduced a “Dairy Adjustment Levy” of 11 cents per litre to support farmers through deregulation. This levy remained in place until 2008, when it was abolished by the Rudd government. Then, in 2011, the “milk war” broke out. Coles had the idea of luring shoppers from Woolworths by selling milk <a href="https://www.smh.com.au/business/milk-wars-leave-sour-taste-in-farmers-mouths-20120120-1q9st.html" target="_blank" rel="noopener">at $1 a litre</a>. Woolworths responded. Aldi joined the move. And the war kept prices artificially low for almost a decade. Supermarkets put the squeeze on processors, who had little option but to accept what was offered for crucial supermarket contracts. Processors then put the squeeze on farmers. <hr /> <iframe id="5TukM" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/5TukM/1/" width="100%" height="400px" frameborder="0"></iframe> <hr /> Many decided the effort was not worth it, and quit farming. Milk production peaked in 2014 then declined. Supermarkets finally abandoned $1/litre milk in 2019, under considerable public and <a href="https://www.abc.net.au/news/2019-02-23/milk-wars-whats-at-the-heart-of-dairys-battles/10838390" target="_blank" rel="noopener">political pressure</a> to acknowledge that, after eight years with no increase, some rebalancing was needed. During this time, overseas demand for dairy products has also been increasing, especially in Asia. Now <a href="https://www.dairyaustralia.com.au/westvic-dairy/industry-statistics/industry-reports/australian-dairy-industry-in-focus#.YzA0_nZByM9" target="_blank" rel="noopener">about 32%</a> of Australian dairy production is exported – not as fresh milk, but as cheese, butter and other dairy products. (It takes about 10 litres of milk to make <a href="https://www.dairysafe.vic.gov.au/consumers/dairy-foods/cheese" target="_blank" rel="noopener">1 kilogram of cheese</a>, and 20 litres to make <a href="https://www.dairysafe.vic.gov.au/consumers/dairy-foods/butter" target="_blank" rel="noopener">1kg of butter</a>.) On top of that, lately US and European dairy farmers have had a hard time <a href="https://www.agriculture.gov.au/abares/research-topics/agricultural-outlook/dairy#milk-production-to-increase-but-export-volumes-to-fall" target="_blank" rel="noopener">with drought</a>, increasing international prices. The United Nations’ Food and Agriculture Organization’s Dairy Price Index increased by more <a href="https://www.fao.org/3/cc1189en/cc1189en.pdf" target="_blank" rel="noopener">than 17%</a> from 2020 to 2021, and is expected to rise another 15% by the end of this year. <hr /> Australian milk production and farm-gate price <figure class="align-center "><img src="https://images.theconversation.com/files/486429/original/file-20220926-15788-17niif.png?ixlib=rb-1.1.0&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/486429/original/file-20220926-15788-17niif.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=350&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486429/original/file-20220926-15788-17niif.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=350&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486429/original/file-20220926-15788-17niif.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=350&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486429/original/file-20220926-15788-17niif.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=440&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486429/original/file-20220926-15788-17niif.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=440&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486429/original/file-20220926-15788-17niif.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=440&fit=crop&dpr=3 2262w" alt="" /><figcaption><a class="source" href="https://www.agriculture.gov.au/sites/default/files/images/ac-sept-2022-dairy-fig-1-2.png">ABARES; Dairy Australia</a></figcaption></figure> <hr /> The projected 28% rise in farm-gate milk prices in 2022-23 will bring the value of the Australian dairy production to a record <a href="https://www.agriculture.gov.au/abares/research-topics/agricultural-outlook/dairy" target="_blank" rel="noopener">$6.2 billion</a>. Which is good news for the long term sustainability of dairy farming in Australia. You might not appreciate it, but to keep dairy farmers in business, a fair price must be payed for your fresh milk. <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/191064/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" />Writen by Flavio Macau. Republished with permission from <a href="https://theconversation.com/floods-pandemics-wars-and-market-forces-whats-driving-up-the-price-of-milk-191064" target="_blank" rel="noopener">The Conversation</a>. Image: Getty Images

Money & Banking

Elizabeth Strout’s Lucy By the Sea: a claustrophobic portrait of a terrible pandemic year

In her latest novel, Lucy by the Sea, Elizabeth Strout captures the bewilderment of us all at the onset of the pandemic. Her character Lucy Barton admits not only did she not see it coming, but even when she did notice the virus’s existence, she did not really believe it would ever reach New York. It is March, 2020, and Lucy, a writer, had been scheduled to travel to Italy and Germany, a book tour which she had, with fortuitous prescience, cancelled back in December. Lucy is a woman who is given to sudden flashes of insight – much like her mother, who was known for having “visions” – which is why, looking back at those early days of the pandemic, not having sensed its threat surprises her. Even when her ex-husband William’s oldest friend is put on a ventilator and subsequently dies, it is still difficult for her to accept that this is happening to people she knows. With hindsight, Lucy remarks: “It’s odd how the mind does not take in anything until it can.” William has been quicker to spot the looming danger. He pleads with their two daughters Becka and Chrissy to leave New York city with their husbands, before hastily scooping up Lucy from her apartment and carrying her away to the town of Crosby on the coast of Maine. At this point in the book, devotees of Strout’s Pulitzer Prize-winning novel Olive Kitteridge, will experience a shiver of recognition and anticipation, for the fictional coastal town of Crosby is “Olive territory”. With this one deft move, Strout draws together the separate threads of much of the fiction she has written since Olive Kitteridge was published in 2008. Before establishing herself as a successful writer in New York, Lucy Barton’s territory was the small Midwest town of Amgash, Illinois. The deprivation of her Amgash childhood has haunted Lucy through Strout’s earlier novels, My Name is Lucy Barton, and Oh William! (the latter now <a href="https://www.abc.net.au/news/2022-10-01/booker-prize-shortlist-best-books-2022/101482730" target="_blank" rel="noopener">shortlisted for the 2022 Booker Prize</a>) and in two of the short stories in Anything is Possible. Now it continues to tug at her in the house beside the sea in Maine. In My Name is Lucy Barton, Lucy is told by a writer she admires: <blockquote> You will have only one story … You’ll write your one story many ways don’t ever worry about story. You will have only one. </blockquote> The story Lucy has to tell, over and over, and in many different ways, is the story of her childhood, its poverty and isolation, and her complex relationship with a mother who was unable to tell her own child that she loved her. Even as an adult, Lucy does not know her mother’s story. In Lucy by the Sea she has invented for herself a “nice mother” she can talk to in private as distinct from the real mother with whom the silences that fell between them were necessarily more poignant than words. <h2>Emotional lockdown</h2> Locked down in a house on a cliff with a view of the waves, Lucy and William endeavour to fill their days. Lucy struggles to read, and as for writing, she believes she will never write another word. This sense of being frozen and unable to concentrate was all too common at that uncertain and anxiety-inducing point in the pandemic, especially among writers. But for Lucy there is the realisation that this is a state she recognises, having spent her childhood in a kind of emotional lockdown. In Maine, unable to retreat into the activities that usually soothe her, Lucy is also grieving for her husband David, a cellist with the New York Philharmonic, who has died only a year earlier. William, too, is unexpectedly single since his wife, Estelle, walked out and took their daughter Bridget, along with a good bit of their furniture. With no escape from the monotony of their self-isolation, Lucy, who in ordinary circumstances is endearingly quick to declare her love – especially for people – finds herself continually finding things to hate: she hates being in other people’s houses, hates the smell; she hates being cold, but hates sitting inside a house with a coat on; she hates the jigsaw puzzle of Van Gogh William insists they try; she hates snow, and she hates William after dinner when she suspects he is not really listening to her. With extraordinary patience, William tells Lucy to stop hating everything. To make matters worse, far from being welcome in Maine, some locals are so antagonistic towards the couple that a message urging them to go back to New York is anonymously attached to their car. Then, on a visit to a grocery store, a woman shouts at Lucy: “You goddamn New Yorkers! Get the hell out of our state!” When Lucy reproaches William for not being nice to her after the woman yelled, William, becoming uncharacteristically emotional, answers that hers is the life he has wanted to save. <blockquote> ‘My own life I care very little about these days. But Lucy, if you should die from this, it would –’ He shook his head with weariness. ‘I only wanted to save your life, and what if some woman yelled at you.’ </blockquote> When their daughters experience difficulties – one still in New York, the other in Connecticut – Lucy and William must support them as best they can from Maine. Many readers will recognise the torment of handling family crises at arm’s length, and of not being able to hug loved ones even when distance is finally overcome. <h2>Not Olive</h2> Elizabeth Strout has captured perfectly the fear, frustration, and boredom experienced by so many of us during the first year of Covid. Even her fragmentary writing style adds authenticity to a time when few of us could concentrate, when we flicked from news broadcast to news broadcast, to tallies of the latest case numbers, and deaths, while feeling that the very air we breathed carried risk. Among Strout fans Lucy Barton is a much-loved character, but it is Olive Kitteridge who has most often made headlines, with the <a href="https://www.imdb.com/title/tt3012698/" target="_blank" rel="noopener">television mini-series</a> based on the book, starring Frances McDormand, winning multiple awards. The polarising nature of Olive’s character stirs a strong response in readers, whereas the more reticent Lucy speaks quietly, like someone whispering in the reader’s ear. Strout’s extraordinary achievement as a writer has been to illuminate so many flawed, ordinary, yet far from unremarkable lives, through a series of interconnected stories and novels. Though each book is complete, they work satisfyingly together as a cohesive whole, so that reading them we come to know not just a handful of characters but entire communities in a few small towns on the coast of Maine, and in New York and Illinois. Olive Kitteridge and its sequel are elegantly wrought, with their third-person (and at times omniscient) point of view allowing for more nuanced storytelling. Lucy Barton’s intimate, first-person voice in the reader’s ear, with its tendency to speak in run-on sentences that often end with ‘"… is what I mean"’ or “‘… is what I’m saying"’, can become tiresome. In the end, one feels as if one has spent a year in lockdown inside the head of a small, loving, anxious, slightly neurotic person named Lucy Barton. Lucy By the Sea is a pitch-perfect portrait of a terrible year, and oh, how sweet it is to get out and about, to breathe fresh air, and to see the world from other, less claustrophobic angles, both for Lucy Barton and the reader. This article originally appeared in <a href="https://theconversation.com/elizabeth-strouts-lucy-by-the-sea-a-claustrophobic-portrait-of-a-terrible-pandemic-year-191073" target="_blank" rel="noopener">The Conversation</a>. Images: Yahoo/Penguin

Books

Did our personalities change during the pandemic?

While we might think our personality won’t change that easily, it turns out that might not be the case after a new study reported measurable changes following the COVID-19 pandemic. The study, published in the journal <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0274542#sec010" target="_blank" rel="noopener">PLOS One</a>, found that the personalities of people they surveyed before and after the pandemic changed - and that several particular traits were affected. A total of 7,109 people, ranging from 18 to 109 years old, took part in the Understanding America Study, which saw them take surveys before the pandemic, in 2020, and between 2021-2022. They found that extraversion, openness, agreeableness and conscientiousness declined when they compared results from 2021-2022 and pre-pandemic, with younger adults seeming particularly affected. Interestingly, the researchers reported that levels of neuroticism declined significantly in 2020, and that older adults showed the largest change in this trait. “There was limited personality change early in the pandemic but striking changes starting in 2021,” they write. “Of most note, the personality of young adults changed the most, with marked increases in neuroticism and declines in agreeableness and conscientiousness. That is, younger adults became moodier and more prone to stress, less cooperative and trusting, and less restrained and responsible.” They concluded that, if these changes are enduring, stressful events that affect a wider population could slightly change the trajectory of our personalities over time. But, they stress that other significant nationwide events were also occurring during this period, such as the highly publicised death of George Floyd and resulting protests, and the January 6th Capitol riots. With most of the changes to our personalities occurring while we are adolescents and young adults, it’s not surprising that the impact of the pandemic was seen most strongly in younger people. Even though previous research has indicated that our personalities stabilise around the age of 30, the researchers found similar disruptions to personality among middle-aged participants that were absent in the oldest participants. They argue that this could be due to greater malleability of personality during middle age or because of different stressors and strains that this age group experienced in comparison to older adults. Why this matters We like to think our personality is who we are, and certain traits are even associated with our health and trajectory of our life. Previous studies have found that people who are more conscientious have a lower risk of dementia, develop fewer chronic illnesses, and tend to achieve more in education, while a higher level of neuroticism is a risk factor for mental health conditions such as anxiety and depression. “It is especially worrying that the largest changes in these two traits were among younger adults, as the implications of these changes may ripple throughout their adult lives,” the authors write. Image: Getty Images

Mind

How the pandemic has impacted retirees

Two years of lockdowns, mask-wearing and rapidly expanding our medical knowledge during the COVID-19 pandemic has affected the world in a variety of ways - and retirees are no exception. New research has found that Australia’s over 50s have shifted their priorities since the pandemic, with 44 percent of seniors wanting to live closer to their families and nearly 70 percent feeling their appreciation of the little things in life has changed. According to the <a href="https://www.seniors.com.au/news-insights/australian-seniors-series-quality-of-life-report" target="_blank" rel="noopener">Australian Seniors Quality of Life Report</a>, which surveyed over 5,000 Australians over 50, one in three Aussies have changed their priorities in retirement because of Covid, and approximately half find that good physical and mental health is their highest priority during retirement. Though Covid has had the biggest impact on retirees' travel plans - according to 55 percent of respondents - spending time with family (42 percent), and socialising and being in the community (36 percent) have been listed as a close second and third. Seniors’ expectations for their quality of life during retirement have also changed following the pandemic. A majority (62 percent) expect they might not be able to travel in the ways they want to, while just over 50 percent expect they may have to deal with greater health risks - with people over 60 more at risk of becoming seriously ill with Covid, it’s unsurprising that this is a big issue for retirees. Even with all of the changes the pandemic has brought to our lives, nearly all seniors agree that living independently is the most important part of retirement and it ranks in the top five of key goals Aussies have. It comes as the preference for living at home and receiving residential care outstrips aged care, with the <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services" target="_blank" rel="noopener">Productivity Commission’s Report on Government Services</a> finding that the number of home-care packages reached 236,554 in the last financial year, while the number of aged care packages stayed stable. “If you asked 100 people where you would rather be, 100 percent say ‘I want to stay home’,” Darren Nelson, an adjustable bed expert at Solace Sleep, told OverSixty. “We are seeing a huge increase in people reaching out, desperate to avoid having to go into an aged care facility.” As a result of this spike in demand, Solace Sleep – a company providing in-home care supplies – has seen the sale of mechanical beds go from less than 10 beds a year to over 300. Not only that, but living at home means that it’s easier to stay connected to friends and family - another key retirement goal. All in all, the COVID-19 pandemic has seen many of us question our priorities in life, and shift our focus to spending time with the people that matter most - and it might be that it’s an antidote to the isolation we’ve faced over the past few years and the key ingredient for a fulfilling life. Image: Getty Images

Retirement Life

The pandemic’s gardening boom shows how gardens can cultivate public health

As lockdowns went into effect in the spring of 2020 to slow the spread of the coronavirus, reports emerged of a <a href="https://www.sfchronicle.com/culture/article/A-comeback-for-victory-gardens-amid-Bay-Area-15177272.php">global gardening boom</a>, with plants, flowers, vegetables and herbs sprouting in backyards and on balconies around the world. The data backs up the narrative: An analysis of Google Trends and infection statistics found that during the first few months of the COVID-19 pandemic, country-by-country interest in gardening, from Italy to India, <a href="https://www.bostonglobe.com/2021/11/26/opinion/covid-inspired-gardening-was-worldwide-phenomenon/">tended to peak just as infections peaked</a>. Why did so many people find themselves being pulled toward the earth in a time of crisis? And what sort of effect did gardening have on them? <a href="https://doi.org/10.1016/j.ufug.2022.127483">In a new study</a> conducted with a team of environmental and public health scholars, we highlight the extent to which gardening became a coping mechanism during the early days of the pandemic. Even as restrictions related to COVID-19 have eased, we see some real lessons for the way gardening can continue to play a role in people’s lives. <h2>Dirt, sweat, tranquility</h2> To conduct our study, we used an online questionnaire to survey more than 3,700 respondents who primarily lived in the U.S., Germany and Australia. The group included experienced gardeners and those who were new to the pursuit. More than half of those we surveyed said they felt isolated, anxious and depressed during the early days of the pandemic. Yet more than 75% also found immense value in gardening during that same period. Whether done <a href="https://doi.org/10.3733/ucanr.6720">in cities or out in the country</a>, gardening was almost universally described as a way to either relax, socialize, connect with nature or stay active. More than half of the respondents reported a significant increase in the amount of time they were able to spend gardening. Other respondents found some value in growing their own food, but few felt financially compelled to do so. Instead, most respondents saw gardening as a way to connect with their community and get some exercise. People with more personal difficulties due to COVID-19, like the inability to work or struggling with child care, were more likely to spend more time gardening in their spare time than they had in the past. <h2>The garden as a refuge</h2> In our analysis of written responses to the survey, most gardeners seemed to either experience a heightened sense of joy and reassurance or feel more attuned to the natural world. This seemed to have positive therapeutic and psychological benefits, regardless of age or location. To many people, <a href="https://doi.org/10.1016/j.wss.2021.100055">gardening became a sort of safe space – a haven from daily worries</a>. One German gardener started seeing their garden as a sanctuary where even “birds felt louder.” “Gardening has been my salvation,” a respondent from the U.S. noted. “I’m very grateful I can surround myself with beauty as a buffer to the depressing news COVID brings each day.” Another German gardener wrote that their garden became their “little safe universe in a very uncertain and somewhat dangerous time. … We have learned to appreciate the so far very high value of ‘own land, own refuge’ even more.” <h2>A green prescription</h2> As life returns to normal, work ramps up and obligations mount, I wonder how many pandemic gardens are already being neglected. Will a hobby born out of unique circumstances recede into the background? I hope not. Gardening shouldn’t be something that’s only taken up in times of crises. If anything, the pandemic showed how gardens serve a public health need – that they’re not only places of beauty or sources of food, but also conduits for healing. In fact, several countries like New Zealand, Canada and some in Europe now allow “<a href="https://www.weforum.org/agenda/2022/02/green-prescriptions-health-wellbeing/">green prescriptions</a>” to be issued as alternatives to medication. These are directives from doctors to spend a certain amount of time outdoors each day or month – an acknowledgment of the very real health benefits, from lowered stress to better sleep and improved memory, that venturing into nature can offer. I also think of the people who never had a chance to garden in the first place during the pandemic. Not everyone has a backyard or can afford gardening tools. Improving access to home gardens, urban green spaces and <a href="https://theconversation.com/not-all-community-gardens-are-environmental-equals-10485">community gardens</a>could be an important way to boost well-being and health. Making seeding, planting, pruning and harvesting part of your daily routine seems to open up more opportunities, too. “I never previously had the time to commit to a garden,” one first-time gardener told us, “but [I’ve] found such satisfaction and happiness in watching things grow. It has been a catalyst for making other positive changes in my life.” Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/the-pandemics-gardening-boom-shows-how-gardens-can-cultivate-public-health-181426" target="_blank" rel="noopener">The Conversation</a>.

Home & Garden

Gordon Ramsy praises pandemic for closing “bad” restaurants

Celebrity chef Gordon Ramsay has been caught stirring the pot again. This time, saying that a silver lining of the Covid-19 pandemic has been the forced closure of many bad restaurants taking up space in prime locations. “The crap’s gone,” Ramsay told UK magazine Radio Times in a recent interview. “Just sh**holes in a prime position and taking advantage because they’re in a great location, and they’ve got the footfall [have closed]. “But now we’ve wiped the slate clean, which is good.” In the interview, the Hell’s Kitchen host, known for being fiery in the kitchen, admitted the last two years of the pandemic have been “devastating” for the hospitality sector in Britain. He said the industry “was on its arse, but it’s getting better”. “It’s been devastating the last two years. Landlords don’t say, ‘Take a holiday for two years.’ But I think what has been evident for all of us is the crap’s gone.” Last year, the restaurateur himself estimated his eateries in England lost more than $100 million in the first year of the pandemic due to loss of business during lengthy UK lockdowns. “I get criticised for being wealthy, but the responsibility on my shoulders – the livelihoods at stake – is huge,” Ramsay told The Sun at the time. “I do feel under pressure to give my younger members of staff, especially, some hope, and the sense that we can get out of this. There have been so many tears, people at their wits’ end.” At the start of the pandemic in April 2020, more than 1.5 million hospitality workers in the UK were furloughed. It accounted for a quarter of all furloughed staff across Britain. Last year in the week leading up to Christmas, as the Omicron variant ripped through the UK, pubs, bars and restaurants each lost on average $18,000 in what should have been the busiest trading week of the year. In the recent interview with Radio Times, the 55-year-old said throughout the pandemic, restaurants have had to “raise their game” to stay alive. He said that it has meant a positive outcome of the last two years is that customers are getting better quality from eateries. “Customers have got so much smarter in the last two years,” he said. “They know a lot more about food than they ever have done and have been making their own sourdough, so it’s taught everyone [in the restaurant industry] to raise their game. “It’s wiped the arrogance from the industry.” Ramsay takes over Jamie Oliver’s ‘failure’. Gordon recently took advantage of a business closing himself, when he took over a location formerly owned by fellow celebrity chef Jamie Oliver in Liverpool, England. “It’s sad that Jamie didn’t make it here – the site is amazing”. “It was never my intention to take over Jamie’s Italian. Jamie and I are mates everyone thinks we’re not, but we are. Two summers ago we sat in the garden with our kids and had an amazing evening talking, drinking, laughing, crying and just having a proper heart-to-heart. “It had nothing to do with it being his old site. Whether it was Marco Pierre White or Jamie Oliver, it didn’t matter who had the house beforehand. The location was absolutely spot on. “Where Jamie failed, there’s a big learning curve for all of us. One man’s failure is the next man’s success.” The site is the new home to Ramsay’s 35th restaurant – the Liverpool Bread Street Kitchen & Bar. Image: Getty

Food & Wine

Global emissions almost back to pre-pandemic levels after unprecedented drop in 2020, new analysis shows

Global carbon dioxide emissions have bounced back after COVID-19 restrictions and are likely to reach close to pre-pandemic levels this year, <a href="https://essd.copernicus.org/preprints/essd-2021-386/">our analysis</a> released today has found. The troubling finding comes as world leaders meet at the COP26 climate talks in Glasgow in a last-ditch bid to keep dangerous global warming at bay. The analysis was undertaken by the <a href="https://www.globalcarbonproject.org/carbonbudget">Global Carbon Project</a>, a consortium of scientists from around the world who produce, collect and analyse global greenhouse gas information. The fast recovery in CO₂ emissions, following last year’s <a href="https://theconversation.com/global-emissions-are-down-by-an-unprecedented-7-but-dont-start-celebrating-just-yet-151757">sharp drop</a>, should come as no surprise. The world’s strong economic rebound has created a surge in demand for energy, and the global energy system is still heavily dependent on fossil fuels. Most concerning is the long-term upward trends of CO₂ emissions from oil and gas, and this year’s growth in coal emissions, which together are far from trending towards net-zero by 2050. <img src="https://images.theconversation.com/files/429724/original/file-20211102-28770-1s1j889.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="people seated around U-shaped table" /> The troubling findings come as world leaders meet at the COP26 climate summit in Glasgow. Evan Vucci/AP <h2>The global emissions picture</h2> Global CO₂ emissions from fossil fuels dropped by 5.4% in 2020, compared to the previous year. But they are set to increase by about 4.9% above 2020 levels this year, reaching 36.4 billion tonnes. This brings them almost back to 2019 levels. We can expect another 2.9 billion tonnes of CO₂ emissions this year from the net effect of everything we do to the land, including deforestation, degradation and re-vegetation. This brings us to a total of 39.4 billion tonnes of CO₂ to be emitted by the end of this year. The fast growth in emissions matches the corresponding large increase in energy demand as the global economy opens up, with the help of <a href="https://www.f4b-initiative.net/post/majority-of-17-2-trillion-covid-stimulus-packages-doing-more-harm-than-good-to-environment">US$17.2 trillion</a> in economic stimulus packages around the world. CO₂ emissions from all fossil fuel types (coal, oil and natural gas) grew this year, with emissions from coal and natural gas set to grow more in 2021 than they fell in 2020. Emissions from global coal use were declining before the pandemic hit in early 2020 but they surged back this year. Emissions from global gas use have returned to the rising trend seen before the pandemic. CO₂ emissions from global oil use remain well below pre-pandemic levels but are expected to increase in coming years as road transport and aviation recover from COVID-related restrictions. <a href="https://images.theconversation.com/files/429469/original/file-20211031-17-1pa5f0i.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/429469/original/file-20211031-17-1pa5f0i.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="" /></a> Global fossil CO₂ emissions. Source: Global Carbon Project, https://www.globalcarbonproject.org/carbonbudget <h2>Nations leading the emissions charge</h2> Emissions from China have recovered faster than other countries. It’s among the few countries where emissions grew in 2020 (by 1.4%) followed by a projected growth of 4% this year. Taking these two years together, CO₂ emissions from China in 2021 are projected to be 5.5% above 2019 levels, reaching 11.1 billion tonnes. China accounted for 31% of global emissions in 2020. Coal emissions in China are estimated to grow by 2.4% this year. If realised, it would match what was thought to be China’s peak coal emissions in 2013. India’s CO₂ emissions are projected to grow even faster than China’s this year at 12.6%, after a 7.3% fall last year. Emissions this year are set to be 4.4% above 2019 levels – reaching 2.7 billion tonnes. India accounted for 7% of global emissions in 2020. Emissions from both the US and European Union are projected to rise 7.6% this year. It would lead to emissions that are, respectively, 3.7% and 4.2% below 2019 levels. US and EU, respectively, accounted for 14% and 7% of global emissions in 2020. Emissions in the rest of the world (including all international transport, particularly aviation) are projected to rise 2.9% this year, but remain 4.2% below 2019 levels. Together, these countries represent 59% of global emissions. <a href="https://images.theconversation.com/files/429471/original/file-20211031-75805-1jh07jf.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/429471/original/file-20211031-75805-1jh07jf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="" /></a> Regional fossil CO₂ emissions 2019-2021. Source: Global Carbon Project, https://www.globalcarbonproject.org/carbonbudget <h2>The remaining carbon budget</h2> The relatively large changes in annual emissions over the past two years have had no discernible effect in the speed at which CO₂ accumulates in the atmosphere. CO₂ concentrations, and associated global warming, are driven by the accumulation of greenhouse gases – particularly CO₂ – since the beginning of the industrial era. This accumulation has accelerated in recent decades. To stop further global warming, global CO₂ emissions must stop or reach net-zero – the latter meaning that any remaining CO₂ emissions would have to be compensated for by removing an equivalent amount from the atmosphere. Carbon budgets are a useful way of measuring how much CO₂ can be emitted for a given level of global warming. In our latest analysis, we updated the carbon budget outlined by the Intergovernmental Panel on Climate Change (<a href="https://templatelab.com/climate-change-report-2021/">IPCC</a>) in August this year. From the beginning of 2022, the world can emit an additional 420 billion tonnes of CO₂ to limit global warming to 1.5℃, or 11 years of emissions at this year’s rate. To limit global warming to 2℃, the world can emit an additional 1,270 billion tonnes of CO₂ – or 32 years of emissions at the current rate. <a href="https://images.theconversation.com/files/429886/original/file-20211103-19-fl69o8.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/429886/original/file-20211103-19-fl69o8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="" /></a> The remaining carbon budgets to limit warming to 1.5℃ and 2℃. Updated from IPCC 2021. Source: Global Carbon Project, https://www.globalcarbonproject.org/carbonbudget These budgets are the compass to net-zero emissions. Consistent with the pledge by <a href="https://eciu.net/netzerotracker">many countries</a> to reach net-zero emissions by 2050, CO₂ emissions need to decline by 1.4 billion tonnes each year, on average. This is an amount comparable to the drop during 2020, of 1.9 billion tonnes. This fact highlights the extraordinary challenge ahead and the need to increase short- and long-term commitments to drive down global emissions.<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; text-shadow: none !important;" src="https://counter.theconversation.com/content/170866/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/pep-canadell-16541">Pep Canadell</a>, Chief research scientist, Climate Science Centre, CSIRO Oceans and Atmosphere; and Executive Director, Global Carbon Project, <a href="https://theconversation.com/institutions/csiro-1035">CSIRO</a>; <a href="https://theconversation.com/profiles/corinne-le-quere-315624">Corinne Le Quéré</a>, Royal Society Research Professor of Climate Change Science, <a href="https://theconversation.com/institutions/university-of-east-anglia-1268">University of East Anglia</a>; <a href="https://theconversation.com/profiles/glen-peters-114835">Glen Peters</a>, Research Director, <a href="https://theconversation.com/institutions/center-for-international-climate-and-environment-research-oslo-707">Center for International Climate and Environment Research - Oslo</a>; <a href="https://theconversation.com/profiles/pierre-friedlingstein-903247">Pierre Friedlingstein</a>, Chair, Mathematical Modelling of Climate, <a href="https://theconversation.com/institutions/university-of-exeter-1190">University of Exeter</a>; <a href="https://theconversation.com/profiles/robbie-andrew-422668">Robbie Andrew</a>, Senior Researcher, <a href="https://theconversation.com/institutions/center-for-international-climate-and-environment-research-oslo-707">Center for International Climate and Environment Research - Oslo</a>, and <a href="https://theconversation.com/profiles/rob-jackson-213135">Rob Jackson</a>, Professor, Department of Earth System Science, and Chair of the Global Carbon Project, <a href="https://theconversation.com/institutions/stanford-university-890">Stanford 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/global-emissions-almost-back-to-pre-pandemic-levels-after-unprecedented-drop-in-2020-new-analysis-shows-170866">original article</a>. Image: Shutterstock

Travel Trouble

“Please come back”: Bali’s plea over pandemic fallout

Before the world was struck with Covid-19, Bali was a thriving holiday hotspot for millions of global travellers each year. The sandy beaches and bustling nightlife saw more than 1.3 million Australians descend on Bali in 2019 alone, injecting billions into the local economy. However, two years later, the pandemic has had a devastating effect on the Indonesian island, with local businesses struggling to survive. The busy streets of Seminyak, which were once filled with boutiques and shops, are now dead and devoid of people. Shop windows are boarded up, while other businesses have been abandoned all together. An employee at a local jewellery shop, whose store was the only one open in the street, told news.com.au, that the past two years had “not been good”. “We barely see anybody, it’s so quiet. Nothing is open. Most of the people I know haven’t been able to work. We are one of the only places that managed to stay open,” she said. A local tour guide said she had spent the last years of the pandemic doing whatever she could to survive, by making snacks and selling them to local shops. “Please, please come back to Bali,” she said. “We are ready for Aussies.” The guide also asked travellers to be patient and understanding of the Balinese people when they return for holidays. “Before the pandemic, the shops would charge maybe four or five times the price but now they’re not. They know they need to build that trust and relationship back with the Aussies so you can barter a little bit but please don’t do it too much,” she said. On March 15th, the first flight from Australia to Bali was packed full of eager travellers, with the people of Bali welcoming tourists back to their home to reinvigorate their economy. Image credits: Getty Images

International Travel

"We’ve got a pandemic baby and a flood baby": Mum’s twin miracles

A woman trapped by flood waters was rescued by a heroic neighbour in his kayak just in time for her to give birth. Krystle Henry was stranded in her home in Taringa, Brisbane, after flood waters surged up the driveway - preventing her from leaving to go to the hospital. But her quick-thinking neighbour Rob came to the rescue, kayaking Ms Henry to dry land on Sunday afternoon. She and her partner Matt Bridges welcomed their newborn son, Angus, into the world at Mater Mothers’ Hospital Brisbane on Tuesday morning. Mr Bridges said he would be forever grateful to his neighbour for helping their son arrive safely. “We didn’t know Bob, but he was more than happy to help us out and I’m so thankful Angus arrived safely,” he <a href="https://7news.com.au/lifestyle/parenting/mum-gives-birth-to-baby-boy-after-she-was-rescued-in-a-kayak-from-flood-waters-in-brisbane-c-5911798" target="_blank" rel="noopener">said</a>. <img src="https://oversixtydev.blob.core.windows.net/media/2022/03/krystle.jpg" alt="" width="1280" height="720" /> Krystle Henry and Matt Bridges with their newborn son, Angus. Image: Krystle Henry “I’m so glad I got to the delivery room in time. Angus is the couple’s second child, after Ms Henry gave birth to their daughter Olive in 2020. “We’ve got a pandemic baby… and now we have a flood baby,” Mr Bridges said. Mater obstetrician Dr Paul Conaghen said he had never delivered a baby in such a chaotic situation, and praised the couple for their calm attitude. “Considering the situation, Krystle and Matt remained very calm,” he said. “I couldn’t imagine being 39 weeks pregnant stuck in flood waters.” But Angus isn’t the only flood baby to be born in such circumstances, after another couple were rescued by kayak, this time by the SES. <img src="https://oversixtydev.blob.core.windows.net/media/2022/03/felicity-jacques.jpg" alt="" width="1280" height="720" /> Felicity and Alex were rescued by SES volunteers before going on to welcome their newborn son into the world. Image: Felicity Jacques Sherwood couple Felicity and Alex Jacques called the SES for help when their cars flooded in the underground carpark of Alex’s parents home, where they were staying. The couple stayed in a hotel near the hospital overnight, before Ms Jacques went into labour early on Monday morning. Their baby son, Andrew Jacques, was also born on Tuesday, weighing 3.35 kg. “I hate to think what would have happened if we weren’t close to the hospital,” Ms Jacques said. “I’m so relieved our little one is here. He is definitely a little miracle.” Paula Foley, the chief operating officer at Mater Mothers’ Hospital, said the past week had seen many mums and families going to extraordinary lengths to get to the hospital to give birth. “It’s been an incredibly stressful time for many of our new mums and dads,” she said. “But we’ve had 188 babies born at Mater Mothers’ South Brisbane in the past week, despite the flooding.” Image: Krystle Henry

News

Two years on from the first COVID case, New Zealand’s successful pandemic response still faces major challenges

Two years ago today, the first confirmed case of COVID-19 was reported in Aotearoa New Zealand. Few of us could have imagined the huge impact this pandemic would still be having two years later. As New Zealand enters its third year of the pandemic, we are facing widespread community transmission as an epidemic wave of the Omicron variant sweeps across the country. A majority of New Zealanders <a href="https://cpb-ap-se2.wpmucdn.com/blogs.auckland.ac.nz/dist/c/828/files/2021/07/omicron-preliminary.pdf" target="_blank" rel="noopener">may become infected</a> in coming months, but many with few or no symptoms. Australian experience suggests we might see a peak of around <a href="https://blogs.otago.ac.nz/pubhealthexpert/covid-19-hospitalisation-peaks-in-australian-states-since-omicron-emerged-potential-relevance-to-aotearoa-nz/" target="_blank" rel="noopener">1,100 people with COVID-19 in hospitals</a> during March and April. We have previously written about the challenges apparent after <a href="https://theconversation.com/6-months-after-new-zealands-first-covid-19-case-its-time-for-a-more-strategic-approach-144936" target="_blank" rel="noopener">six months</a> and <a href="https://theconversation.com/a-year-on-from-the-arrival-of-covid-19-in-nz-5-lessons-for-2021-and-beyond-155367" target="_blank" rel="noopener">one year</a> of the pandemic. Today, we examine what we’ve learned — the major challenges that have persisted or emerged and how New Zealand can manage them to achieve the best possible outcomes. Shifting strategies New Zealand has demonstrated the benefits of a science-informed response with a <a href="https://www.bmj.com/content/371/bmj.m4907" target="_blank" rel="noopener">strong strategic focus</a>. During the first year of the pandemic when there were no vaccines available, the <a href="https://journal.nzma.org.nz/journal-articles/new-zealands-elimination-strategy-for-the-covid-19-pandemic-and-what-is-required-to-make-it-work" target="_blank" rel="noopener">elimination strategy</a> protected people and the economy. Following the emergence of the Delta variant, <a href="https://journal.nzma.org.nz/journal-articles/the-next-phase-in-aotearoa-new-zealands-covid-19-response-tight-suppression-may-be-optimal-for-health-equity-and-wellbeing-in-the-months-ahead" target="_blank" rel="noopener">tight suppression</a> was also highly effective. Now, with the growing surge driven by the Omicron variant, New Zealand has been forced to shift to a <a href="https://blogs.otago.ac.nz/pubhealthexpert/preparing-for-omicron-a-proactive-government-response-is-urgently-needed-to-minimise-harms/" target="_blank" rel="noopener">mitigation strategy</a>. New Zealand’s strategic approach has supported the country in achieving some of the world’s <a href="https://blogs.otago.ac.nz/pubhealthexpert/mortality-declines-in-aotearoa-nz-during-the-first-two-years-of-the-covid-19-pandemic/" target="_blank" rel="noopener">lowest COVID-19 mortality rates and increased life expectancy</a>. New Zealand has also had a relatively small amount of time in lockdown and comparatively <a href="https://www.oecd.org/economy/new-zealand-economic-snapshot/" target="_blank" rel="noopener">good economic performance</a>. To achieve these successes, New Zealand has had to deliver major public health interventions very rapidly and their limitations have become apparent over time. Border quarantine is <a href="https://www.mja.com.au/journal/2021/215/7/failures-quarantine-systems-preventing-covid-19-outbreaks-australia-and-new" target="_blank" rel="noopener">difficult to maintain</a> if not done well and creates <a href="https://www.nzherald.co.nz/nz/its-a-case-of-wait-and-see-grounded-kiwis-wrap-up-two-day-bid-for-judicial-review/X43JEMEEEL47I7JBPHTZIBJPFI/" target="_blank" rel="noopener">severe consequences for some</a>. The vaccine rollout has been <a href="https://www.bmj.com/content/376/bmj.o180" target="_blank" rel="noopener">highly inequitable</a>. Mandates for vaccine and mask use have been divisive and <a href="https://www.theguardian.com/world/2022/feb/09/lets-remember-why-we-are-here-new-zealand-anti-vax-protest-splinters-into-jibes-and-jabs" target="_blank" rel="noopener">sometimes vigorously opposed</a> by a vocal minority. Challenges and opportunities ahead The experience of the last two years highlights five major opportunities to enhance New Zealand’s pandemic response and achieve lasting benefits for our ability to manage other major public health threats. 1. Taking a precautionary approach in the face of uncertainty Possibly the biggest challenge has been the changing nature of the pandemic threat itself. The virus <a href="https://www.nature.com/articles/s41586-021-03792-w" target="_blank" rel="noopener">continues to evolve</a> and new variants of concern with increased infectiousness have emerged. We do not know whether future variants will be <a href="https://www.theguardian.com/world/2022/jan/11/will-covid-19-become-less-dangerous-as-it-evolves" target="_blank" rel="noopener">more or less virulent</a>. Omicron shows a <a href="https://www.nature.com/articles/d41586-022-00438-3" target="_blank" rel="noopener">high capacity for reinfection</a> which will need to be managed if this variant remains dominant. Optimistically, we may see the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00100-3/fulltext?s=09" target="_blank" rel="noopener">end of the pandemic</a> though not the end of COVID-19. The full population impact of <a href="https://www.nature.com/articles/d41586-020-02598-6" target="_blank" rel="noopener">post-acute illness</a> (long COVID) is not yet known and evidence about <a href="https://www.nature.com/articles/d41586-022-00177-5" target="_blank" rel="noopener">prevention</a> and management is still at an early stage. 2. Enhancing equity and better protecting the most vulnerable The move to mitigation (from elimination and suppression) shifts protection away from the collective, population-level focus to individual measures like vaccination, mask use and self-isolation. Despite a strongly stated commitment to equity, Māori and Pasifika have <a href="https://thespinoff.co.nz/business/23-02-2022/the-spinoff-covid-tracker-the-live-graphs-that-tell-the-story-of-delta-in-aotearoa" target="_blank" rel="noopener">lower vaccine and booster coverage rates</a>. They are also <a href="https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-data-and-statistics" target="_blank" rel="noopener">over-represented among COVID-19 cases and hospitalisations</a>. Mitigation aims to flatten the epidemic curve to protect the healthcare system from being overwhelmed. During such periods, there is potential for the most vulnerable (people who are Māori, Pasifika, low-income, living with other illnesses and disabilities) to miss out on care. There are multiple ways of improving equity in the response. These include greater support for Māori and Pasifika <a href="https://www.waitangitribunal.govt.nz/assets/Documents/Publications/Covid-Priority-W.pdf" target="_blank" rel="noopener">health providers</a>, further efforts to <a href="https://www.newsroom.co.nz/ideasroom/eliminating-maori-inequities-in-covid-19-outcomes" target="_blank" rel="noopener">raise vaccine coverage for Māori</a> in particular, policies to <a href="https://www.stuff.co.nz/business/125804726/sick-leave-increase-what-you-need-to-know" target="_blank" rel="noopener">support sick workers staying at home</a> and a <a href="https://blogs.otago.ac.nz/pubhealthexpert/making-the-most-of-masks/" target="_blank" rel="noopener">national mask strategy</a> that makes effective masks freely available. We also need a stronger focus on protecting children’s health and well-being, including a pivot to a whānau-centred approach and efforts to reduce transmission in <a href="https://blogs.otago.ac.nz/pubhealthexpert/tag/ventilation-schools/" target="_blank" rel="noopener">schools</a> and <a href="https://blogs.otago.ac.nz/pubhealthexpert/strengthening-omicron-mitigation-strategies-in-early-childhood-education-settings/" target="_blank" rel="noopener">early childhood education</a>. 3. Improving communication, policy responsiveness and trust Pandemics are different from other public health emergencies because the behaviour of individuals directly affects the level of risk for the wider population. Inevitably, after two years, the response has become more contested and social cohesion has weakened. Some of this shift appears fuelled by the global pandemic of <a href="https://www.theguardian.com/world/2022/feb/26/so-many-rabbit-holes-even-in-trusting-new-zealand-protests-show-fringe-beliefs-can-flourish" target="_blank" rel="noopener">disinformation</a>. The New Zealand government can enhance public trust by showing that the response is risk-based, for example by phasing out travel restrictions and border isolation requirements now that Omicron infection is widespread. Some mandates are needed for critical public health interventions but require continuing review to ensure they are proportionate. Trust and <a href="https://informedfutures.org/social-cohesion/" target="_blank" rel="noopener">social cohesion</a> will also be improved by maximising transparency around the pandemic response, with clear statements about the rationale and level of risk, supported with evidence and local surveillance data presented in meaningful ways. We also need <a href="https://www.newsroom.co.nz/cracking-the-misinformation-code" target="_blank" rel="noopener">specific strategies</a> to reduce misinformation and disinformation on social media. <figure class="align-center "><img src="https://images.theconversation.com/files/448759/original/file-20220227-95880-851xvy.jpg?ixlib=rb-1.1.0&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/448759/original/file-20220227-95880-851xvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448759/original/file-20220227-95880-851xvy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448759/original/file-20220227-95880-851xvy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448759/original/file-20220227-95880-851xvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448759/original/file-20220227-95880-851xvy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448759/original/file-20220227-95880-851xvy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Tent and sign from an anti-mandate protest." /><figcaption>Anti-mandates protests have been partly fuelled by misinformation. Adam Bradley/SOPA Images/LightRocket via Getty Images</figcaption></figure> 4. Improving evidence-informed leadership and adaptability While New Zealand’s science-informed strategic response has been generally successful, it has at times been reactive rather than proactive in rapidly adapting to changes in the pandemic. We need better mechanisms, such as the multi-party <a href="https://www.parliament.nz/en/visit-and-learn/history-and-buildings/special-topics/epidemic-response-committee-covid-19-2020/" target="_blank" rel="noopener">epidemic response committee</a> of parliamentarians, and advisory processes that ensure high-level science input into the all-of-government response. This could include the formation of a COVID-19 science council/rōpu. Other measures include a <a href="https://www.mbie.govt.nz/science-and-technology/science-and-innovation/research-and-data/nzris/covid-19-research-database/" target="_blank" rel="noopener">well-resourced research strategy</a> to provide high-quality scientific evidence and an <a href="https://blogs.otago.ac.nz/pubhealthexpert/five-key-reasons-why-nz-should-have-an-official-inquiry-into-the-response-to-the-covid-19-pandemic/" target="_blank" rel="noopener">official inquiry</a> to assess the pandemic response and drive wider system improvements. 5. Investing in public health infrastructure The current <a href="https://dpmc.govt.nz/our-business-units/transition-unit/response-health-and-disability-system-review/information" target="_blank" rel="noopener">health sector reforms</a> are an opportunity to establish essential infrastructure, including a Public Health Agency and Māori Health Authority. Investment in the national immunisation register may help with reversing the recent <a href="https://www.immune.org.nz/sites/default/files/publications/Coverage%20Report%20-%20July%202021.pdf" target="_blank" rel="noopener">decline in childhood immunisations</a>. The pandemic also demonstrates that <a href="https://www.newsroom.co.nz/rethinking-rebreathing-how-to-end-the-pandemic" target="_blank" rel="noopener">clean indoor air</a> is as essential to health as clean drinking water. We should learn from other countries that have also delivered effective responses. <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(20)30044-4/fulltext" target="_blank" rel="noopener">Taiwan is an example</a> we have previously documented. In summary, New Zealand is well placed to navigate the pandemic and the Omicron wave successfully. As we enter our third pandemic year, we can improve the effectiveness of our response by maintaining a precautionary approach in the face of uncertainty. We also need to improve equity, communication and trust, and evidence-informed leadership, as well as investing in public health infrastructure. These improvements will provide legacy benefits that <a href="https://ojs.victoria.ac.nz/pq/article/view/6550/5715" target="_blank" rel="noopener">prepare us well for other public health challenges</a> we face.<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; text-shadow: none !important;" src="https://counter.theconversation.com/content/177134/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-baker-169808" target="_blank" rel="noopener">Michael Baker</a>, Professor of Public Health, <a href="https://theconversation.com/institutions/university-of-otago-1304" target="_blank" rel="noopener">University of Otago</a>; <a href="https://theconversation.com/profiles/amanda-kvalsvig-1143399" target="_blank" rel="noopener">Amanda Kvalsvig</a>, Senior Research Fellow, Department of Public Health, <a href="https://theconversation.com/institutions/university-of-otago-1304" target="_blank" rel="noopener">University of Otago</a>; <a href="https://theconversation.com/profiles/matire-harwood-1323164" target="_blank" rel="noopener">Matire Harwood</a>, Associate Professor Department of General Practice and Primary Care, <a href="https://theconversation.com/institutions/university-of-auckland-1305" target="_blank" rel="noopener">University of Auckland</a>, and <a href="https://theconversation.com/profiles/nick-wilson-133898" target="_blank" rel="noopener">Nick Wilson</a>, Professor of Public Health, <a href="https://theconversation.com/institutions/university-of-otago-1304" target="_blank" rel="noopener">University of Otago</a> This article is republished from <a href="https://theconversation.com" target="_blank" rel="noopener">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/two-years-on-from-the-first-covid-case-new-zealands-successful-pandemic-response-still-faces-major-challenges-177134" target="_blank" rel="noopener">original article</a>. Image: Getty Images

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