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Infectious diseases

Infectious diseases Letters 1 November 2021 Free

Evidence and advocacy in Melbourne maternity care during the COVID‐19 pandemic

To the Editor: The average woman giving birth in Australia has ten to 12 antenatal visits and a 2–4 days inpatient stay, representing 8 months of intense engagement with health services. In 2020, women in Melbourne endured a prolonged lockdown period due to the coronavirus disease 2019 (COVID‐19) pandemic.1 During this time, the maternity sector had to move quickly to address three urgent priorities. Firstly, all 12 public maternity hospitals in Melbourne joined forces to create the Collaborative Maternity and Newborn Dashboard for the COVID‐19 pandemic (CoMaND) to meet the need for timely perinatal data collection.2 By harnessing hospital maternity data collection systems under a research protocol, they could centrally monitor perinatal outcomes to assess indirect impacts of the sector’s pandemic response (Box). The second of the priorities was to institute a system to record outcomes for women who were infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) during pregnancy. To this end, the Coronavirus Health Outcomes in Pregnancy and Newborns (CHOPAN) registry was established. It has collected information from 100 women with confirmed SARS‐CoV‐2 infection during pregnancy and has since expanded nationally (https://www.psanz.com.au/covid-19/). The third priority was to address the exclusion of pregnant women from COVID‐19 treatment trials, which occurred despite the fact that many of the investigational drugs had established pregnancy safety profiles.4 The Australasian COVID‐19 Trial (ASCOT) is an international multicentre randomised adaptive platform clinical trial of COVID‐19 therapies (https://www.ascot‐trial.edu.au). After representations from the maternity sector, a pregnancy ASCOT working group tasked with facilitating the safe inclusion of pregnant women was appointed, which established a welcome precedent for inclusion of pregnant women in future clinical research.5 The CoMaND and CHOPAN collaborations are exemplars of clinician‐led initiatives for data‐informed emergency responses in maternity care. It is anticipated that these resources will be of ongoing value into the COVID‐19 vaccination era. Successful advocacy for the inclusion of pregnant women in clinical trials may be another positive legacy of the COVID‐19 pandemic. Their safe inclusion in clinical trials takes us a step closer to an equitable health service, ensuring we generate a robust evidence base to direct clinical care for pregnant women and their children. Box – An example of outcome reporting from the fifth CoMaND report2 Denominator: number of singleton babies at ≥ 20 weeks’ gestation. Numerator: number of babies who meet the denominator criteria with birth weight ≥ 90th percentile adjusted for fetal sex and gestational age. Pre‐pandemic median: 8.75%. Significant shifts (≥ 6 weeks above the pre‐pandemic median) indicated with red arrows. Percentile source: Dobbins et al.3

Lisa Hui · Clare Whitehead · Susan P Walker

Infectious diseases Research 20 September 2021 Open Access

Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS‐CoV‐2 in primary care and children

Saliva may be suitable as a stand-alone test specimen for people aged 10 years or more

Jane Oliver · Shidan Tosif · Lai‐yang Lee · Anna‐Maria Costa · Chelsea Bartel · Katherine Last · Vanessa Clifford · Andrew Daley · Nicole Allard · Catherine Orr · Ashley Nind · Karyn Alexander · Niamh Meagher · Michelle Sait · Susan A Ballard · Eloise Williams · Katherine Bond · Deborah A Williamson · Nigel W Crawford · Katherine B Gibney

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Infectious diseases Letters 20 September 2021 Free

A hospital‐wide response to multiple outbreaks of COVID‐19 in health care workers: lessons learned from the field

To the Editor: We congratulate Buising and colleagues1 on their article published in the MJA and agree that the approach needs to be multidimensional and iterative. To expand upon the multidimensional theme of their article, we would like to emphasise the need for the approach to be multidisciplinary and to include the whole of the health service workforce. The article highlighted the ubiquitous nature of coronavirus disease 2019 (COVID‐19) transmission in health care settings, with 18.3% (or almost one in five) of health care workers infected, and that these workers are traditionally regarded as non‐clinical staff (food services, environmental services, administrative and security staff). The non‐clinician workforce has been overlooked in other research investigating COVID‐19 transmission risk factors.2 At Monash Health, we used multidisciplinary shift briefings to ensure all health service team members were included in the information and safety messages.3 Human factor‐designed briefing cards, based on the airline industry pre‐flight safety cards, were used to ensure consistent messaging (Box and online Supporting Information). The early involvement of a design team, from the Design Health Collab at Monash University, ensured clear and unambiguous messaging to health care workers. The images were designed to represent diversity in gender, race and role to ensure all health care workers would see themselves reflected in the briefing card and that the safety messages were relevant and directed towards them. Providing information that is timely and accessible as well as readable and visually clear is important.4 Commentaries have emphasised the need for clear and concise communication to ensure the safety and wellbeing of health care workers during the COVID‐19 pandemic.5 However, we believe that involving all workers, not just clinicians, in the safety messages and interventions is paramount to the health and safety of non‐clinical health care workers and to the ongoing operation of health care services. COVID‐19 does not recognise the individual worker role in the health care service and the pandemic has offered us a unique and powerful opportunity to bring together the whole health care workforce and break down traditional barriers. We believe that a multidisciplinary approach is just as vital as a multidimensional one. Box – Card used to ensure consistent messaging during shift briefings Permission to reproduce this image was obtained from the American Journal of Infection Control.

Diana Egerton-Warburton · Lisa Kuhn · Daphne Flynn

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Health occupations Letters 6 September 2021 Free

Challenges in delivering telemedicine to vulnerable populations: experiences of an addiction medical service during COVID‐19

To the Editor: Despite the rapid uptake of telemedicine during the coronavirus disease 2019 (COVID‐19) pandemic,1 it is important to identify the barriers that hinder the delivery of alternate modes of care among specific populations. We share our reflections on the challenges of implementing telemedicine in a tertiary addiction medical clinic in Melbourne, providing treatment for about 105 patients each month. At the start of the COVID‐19 pandemic in February 2020, videoconferencing appointments were encouraged, supported by technical assistance from a clinician. During the Stage 4 lockdown period (August to September 2020 inclusive), appointments were switched to videoconferencing, with face‐to‐face only offered where clinically necessary (eg, for long‐acting injectable opioid agonist treatment). For patients unable to access videoconferencing, telephone appointments were offered. The uptake of videoconferencing was low, comprising 21% (n = 47) of appointments conducted during lockdown versus 57% (n = 128) via telephone (Box). After the lockdown (November 2020 to February 2021), there was a gradual return to face‐to‐face appointments. Seven per cent (n = 28) of appointments were done via videoconferencing while 40% (n = 155) remained via telephone. Difficulties in connecting to the videoconferencing platform, poor audiovisual quality and time spent troubleshooting contributed to the low uptake of videoconferencing. While telemedicine has been a convenient mode of health care delivery during the COVID‐19 pandemic,3 not all patients benefit from it. People accessing specialist addiction treatment are often from sociodemographic groups that are digitally excluded, such as the unemployed and people with low income or with disabilities.4 We found several barriers to telemedicine in our patient cohort. Many patients did not own a computer, had poor digital literacy, could not afford internet access or did not have privacy for consultations. Telephone appointments raise clinical gaps, with physical signs, mental state and visual cues unable to be assessed. Digital inequality further marginalises an already vulnerable population. Access, affordability and digital ability issues need to be managed for telemedicine to be a viable option.4 Examples of how this might be achieved include the establishment of hubs with telemedicine facilities, technical support and private spaces, located at local community health centres for practicality and accessibility, along with providers offering more affordable internet plans for health care card holders. Box – Modality of clinic appointments by month during the coronavirus disease 2019 (COVID‐19)‐related restrictions in Melbourne, Victoria (total monthly COVID‐19 Victorian cases also shown2)

Anthony Hew · Shalini Arunogiri · Dan I Lubman

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Infectious diseases Medical education 16 August 2021 Free

Cerebral gnathostomiasis

A previously well, 42-year-old man presented with a 4-day history of sudden onset, bilateral, occipital headache, 4 weeks after returning from a holiday in Thailand

Simon Smith · Ian Wilson · Lea Starck · Enzo Binotto · Jennifer Ho · Joshua Hanson

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Child health Research 16 August 2021 Free

The characteristics of SARS‐CoV‐2‐positive children who presented to Australian hospitals during 2020: a PREDICT network study

Ambulatory monitoring or hospital in the home may reduce presentations and admissions to hospital of children with COVID-19

Laila F Ibrahim · Doris Tham · Vimuthi Chong · Mark Corden · Simon Craig · Paul Buntine · Shefali Jani · Michael Zhang · Shane George · Amit Kochar · Sharon O’Brien · Karen Robins‐Browne · Shidan Tosif · Andrew Daley · Sarah McNab · Nigel W Crawford · Catherine Wilson · Franz E Babl

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