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COVID-19
Rhabdomyolysis After COVID-19
We report a case of a kidney transplant recipient who presented with generalised muscle pain, weakness and brown urine discoloration in the setting of acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Investigations demonstrated rhabdomyolysis with elevated creatine kinase levels and severe acute kidney injury (AKI). A muscle biopsy was consistent with an immune-mediated necrotising myositis. The patient received intravenous fluids, remdesivir and haemodialysis, with subsequent resolution of muscle injury and recovery of kidney function. This case indicates the potential for severe myositis to develop in patients with SARS-CoV-2 infection with the potential for rhabdomyolysis and AKI to occur.
Navya Kataria, Abel Devadass, Lana Sundac, Laura De Souza, Nabeel Sheikh, Samantha Ng, Scott Campbell, Yishen Wang, Ross S. Francis
Still Treating Yesterday's Risk? Reconsidering Antiviral Use for Mild-to-Moderate COVID-19 Cases in a Broadly Immune Population
Antivirals for mild-to-moderate coronavirus disease 2019 (COVID-19) were adopted for use based on trials in unvaccinated adults during the pre-Omicron period. In today's broadly immune populations, where the risk of hospitalisation and death has decreased substantially, there is a lack of high-quality contemporary evidence to support routine antiviral use for mild-to-moderate disease. Comparing the Australian and New Zealand experiences in the evolving COVID-19 landscape highlights differences in policy and prescribing practice. Treatment guidelines should be informed by systematic evaluation of emerging data, given uncertainty regarding antiviral effectiveness in a context of widespread immunity and milder disease, which have altered the balance of risks and benefits.
Hadar Mudrik-Zohar, Tim Cutfield, Susan Morpeth, Thomas Hills, Eamon Duffy, Laura J. Edwards, Allen C. Cheng, Steven Y. C. Tong
Lesson From Practice: Not Gone, Should Not Be Forgotten: Recognising PIMS-TS Cases in a Post-Pandemic World
We describe the clinical presentation, laboratory findings and complications of severe paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS), also known as multisystem inflammatory syndrome in children in a 16-year-old female diagnosed in June 2025. This case highlights the importance of prompt diagnosis of PIMS-TS in the post-coronavirus disease 2019 pandemic era to ensure timely and appropriate management.
Rana Sawires, Anneke Engwerda, Mehyar Khair Baik, Philip N. Britton, David P. Burgner
Effectiveness of COVID‐19 vaccine boosters for reducing COVID‐19 mortality among people aged 65 years or older, Australia, August 2023 – February 2024: a retrospective observational cohort study
Regular vaccine boosting saves lives, particularly of older Australians, who are at greatest risk of death from COVID-19
Bette Liu · Anish Scaria · Sandrine Stepien · Kristine Macartney
The long tail of COVID‐19
Earlier this year, Australia for the first time hosted the Regional Meeting of the World Health Summit. Among the key themes on the packed three‐day agenda were the geopolitical environment for global health, improving health in an increasingly divided world, the impacts of misinformation and technology on the health of populations, health equity, and pandemic preparedness. Speaking at the meeting, Helen Clark distilled the major challenges facing global health today as the “three Cs” — conflict, climate, and COVID‐19. Indeed, over four years on from the World Health Organization declaring COVID‐19 a global pandemic, although the world has moved on from the acute phase of the response, it is clear that the so‐called long tail of COVID‐19 continues to affect health directly and through its effects on our social and political systems. Three articles in this issue of the MJA remind us that Australia is not immune from these ongoing impacts. The act of care, on individual and communal levels, has the power to foster a sense of shared humanity. Many health and medical practitioners, experts and advocates thus envisage the health system as an important driver of social cohesion. But during the COVID‐19 pandemic, health arguably became something that divided us instead of something that brought us together. Jessica Kaufman and colleagues (https://doi.org/10.5694/mja2.52304) explore how this dynamic has played out in terms of parental misconceptions about routine childhood vaccinations. Surveys of a nationally representative sample of Australian parents of children done in 2017 and 2023 showed that after the onset of the pandemic, there were increases in the proportion of respondents who believed children receive too many vaccines (17% v 25%), that vaccine ingredients cause harm (15% v 19%), and that vaccines cause autism (9% v 14%). Such misconceptions might help explain the documented increases in vaccine hesitancy and decreases in childhood vaccination coverage that occurred during the pandemic, and point to the need for health institutions to re‐establish trust with the communities that they serve. A major way that COVID‐19 transformed Australia's health system was by prompting the widespread adoption of telehealth services. In a perspective article, Sagda Osman and colleagues (https://doi.org/10.5694/mja2.52294) argue that whereas the many benefits of telehealth have been widely explored — including improved health care access, reduced costs, increased clinician learning opportunities, and gains in productivity, satisfaction and convenience — less recognised are the unintended negative consequences of this transformation, especially in rural and remote areas of Australia. In particular, the authors highlight how “dependency on telehealth can mask the need to invest long term to improve rural health, such as direct investment in infrastructure and the rural health workforce. By relying on metropolitan centres to provide care to rural Australians, telehealth essentially redirects rural resources to these centres, reducing future rural health care funding”. If telehealth is to help reduce geographic‐based health inequities, they contend, “studies relying on complexity science and systems thinking” are needed. Finally, despite a markedly decreased sense of political urgency about COVID‐19 in recent years, the disease continues to cause substantial morbidity and mortality among Australians. Using data from the Australian Cardiovascular COVID‐19 Registry (AUS‐COVID), Hari Sritharan and colleagues (https://doi.org/10.5694/mja2.52307) investigated the cardiovascular outcomes among 1714 people admitted to hospital with COVID‐19. Among the participants, 11% died, 17% required intensive care, pre‐existing cardiomyopathy or heart failure was exacerbated in 19%, and around 1–3% developed new atrial fibrillation or flutter, had pulmonary embolisms, or experienced new heart failure or cardiomyopathy. Having received at least one dose of a COVID‐19 vaccine was associated with lower risk of in‐hospital mortality (adjusted odds ratio [aOR], 0.38; 95% CI, 0.18–0.79) and intubation (aOR, 0.30; 95% CI, 0.15–0.61). Notably, of the study participants with known vaccination status, around 40% had not received a COVID‐19 vaccine dose. Given the well documented protective effects of vaccination against severe disease, hospitalisation and death from COVID‐19, the study findings point to the ongoing need to support uptake of COVID‐19 vaccination in the Australian community.
Elizabeth Zuccala
Medications for early treatment of COVID‐19 in Australia
An increase in options available would appear to be our best chance at living alongside SARS-CoV-2
Adam Polkinghorne · James M Branley
COVID‐19: estimated number of deaths if Australia had experienced a similar outbreak to England and Wales
To the Editor: Australia has had a remarkably successful response to coronavirus disease 2019 (COVID‐19), even considering the second wave experienced in Victoria. The Australian rate of COVID‐19‐related deaths of 35 per million population is 15–20 times lower than that observed in countries across Europe and the Americas.1 However, as the second wave in Melbourne has shown, it is important not to become complacent. Using all‐cause mortality data in England and Wales over the peak of the COVID‐19 outbreak in March and April 2020, we directly estimated the number of excess deaths that might have occurred if the outbreak in Australia had been of a similar extent to that in England and Wales. We estimated the relative risk of all‐cause mortality in England and Wales from the COVID‐19 outbreak by dividing the total deaths from all causes for weeks 11–21 in 2020 (9 March – 24 May) by the mean number of deaths for the weeks 11–21 averaged over 5 years (2014–2018) (limited to years when comparable Australian data were available). We calculated age and sex stratified relative risks as there are well documented differences in COVID‐19 fatality by age and sex.2 To estimate the baseline risk of all‐cause mortality in the Australian population, we estimated the mean number of deaths by age and sex for weeks 11–21 over the period 2014–2018. Finally, to estimate the total deaths that might have occurred if Australia had experienced a similar outbreak to England and Wales, we multiplied the baseline expected number of deaths by the age‐specific relative risks for men and women (Box). This resulted in an estimated additional 16 313 deaths in Australia: 9295 men and 7018 women. In contrast, by 26 May 2020 there had been 102 COVID‐19‐attributed deaths in Australia and 1365 excess total deaths from weeks 11 to 21 according to provisional mortality statistics.3 This enormous difference underlies the importance of Australia’s response using a combination of extensive testing and contact tracing, mandatory quarantine of people returning from overseas, and shutdowns to control community transmission. While acknowledging that these measures carry with them substantial social and economic harms, we wish to highlight the scale of the loss of life avoided. Further details of our methods and results are available in InSight+.4 Box – Estimating the relative risk (RR) for death in England and Wales during weeks 11–21 in 20201 and applying it to the Australian2 population (Stanaway et al) Age group (years) RR for death in England and Wales* Mean total deaths† in Australia, 2014–2018 Total expected deaths in similar outbreak‡ Estimated absolute increase in number of deaths§ Males 0–14 0.86 167.2 144.3 −22.9 15–44 1.06 864.0 916.7 52.7 45–64 1.46 2629.4 3844.7 1215.3 65–74 1.47 3111.6 4573.3 1461.7 75–84 1.62 4589.4 7461.7 2872.3 ≥ 85 1.73 5118.2 8834.2 3716.0 Total 1.57 16 429.8 25 774.8 9295.0 Females 0–14 0.92 127.2 116.8 −10.3 15–44 1.10 440.2 482.4 42.2 45–64 1.36 1670.0 2265.8 595.8 65–74 1.35 1960.6 2640.8 680.2 75–84 1.48 3714.8 5493.0 1778.2 ≥ 85 1.52 7591.6 11 523.9 3932.3 Total 1.46 15 504.4 22 522.7 7018.3 * Calculated as deaths in 2020 (weeks 11–21)/average deaths in the same period 2014–2018. † Weeks 11–21. ‡ Average deaths in Australia × RR. § If outbreak in Australia had been similar to the United Kingdom. Calculated as expected deaths minus average deaths. Data source: Office of National Statistics website. Deaths registered weekly in England and Wales, provisional. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales (viewed July 2020). The number of deaths for weeks 11–21 in the period 2014–2018 by age and sex were provided on request from the Australian Bureau of Statistics.
Fiona Stanaway · Les M Irwig · Armando Teixeira‐Pinto · Katy JL Bell
