Infectious diseases

Health system leaders should integrate alternative models of emergency care that proved useful during the pandemic into care pathways

Amith Shetty · Jean‐Frederic Levesque

To the Editor: In a recent Editorial,1 Grimwood and Chang cited a review of long COVID in children and adolescents,2 and wrote that symptoms are similar for those with and without evidence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. But this is an inaccurate description of the review's findings. Cases were more likely to experience persistent symptoms than controls in the majority of studies reviewed.2 The difference in prevalence might be even greater than reported owing to the well documented underdetection of coronavirus disease 2019 (COVID‐19) in children,3 resulting in misclassification of cases as controls. A growing body of evidence indicates children are more affected by COVID‐19 than initially thought. A recent US Centers for Disease Control and Prevention (CDC) analysis of 1.4 million children aged under 12 years and 1.7 million adolescents aged 12–17 years found increased rates of asthma, myocarditis and cardiomyopathy, cardiac dysrhythmias, diabetes, renal failure, venous thromboembolism, and coagulation disorders in children with laboratory‐confirmed COVID‐19 compared with children without COVID‐19. These increased risks (excluding asthma) were also experienced by adolescents with COVID‐19, who were additionally at increased risk of pulmonary embolism.4 Although uncommon or rare, such outcomes suggest children are not spared the cardiovascular and metabolic sequelae of COVID‐19. Recent research using low field magnetic resonance imaging (MRI) revealed persistent pulmonary dysfunction in non‐hospitalised children and adolescents (mean age, 11±3 years) who had recovered from COVID‐19 (n = 29) or had long COVID (n = 25). Despite all children having morphologically normal lungs (except for one recovered child), ventilation and perfusion (V/Q) matching was markedly lower in the recovered group (62±19%) and the long COVID group (60±20%) compared with nine healthy controls (81±6%; mean age, 10±3 years).5 Although the MRI study may be limited by selection bias (ie, children with greater symptomatology being more likely to participate), this and similar research indicate the health impact of paediatric COVID‐19 is greater than generally acknowledged. We do not know what the long term impact of SARS‐CoV‐2 infection might be, but the accumulating data are not encouraging. Reinfection is common and SARS‐CoV‐2 spreads readily in schools in the absence of mitigation measures, such as the use of masks, portable HEPA air cleaners, and improved ventilation. Notably, better ventilation has wider benefits, including improved academic performance. A poorly ventilated classroom can be equivalent to a student skipping breakfast.6 The COVID‐19 pandemic is not over. Ongoing commitment to a public health strategy informed by the precautionary principle is required. This will deliver wide‐ranging social, economic and health benefits.

Zoë Hyde

Universal screening would be cost-effective only if the test cost is low and people receive appropriate clinical management

Yinzong Xiao · Margaret E Hellard · Alexander J Thompson · Christopher Seaman · Jess Howell · Nick Scott

Having received three COVID-19 vaccine doses was associated with much lower likelihood of hospitalisation or death

Robert J Ellis · Cameron RM Moffatt · Luke T Aaron · Greta Beaverson · Khin Chaw · Corinne Curtis · Rhett Freeman‐Lamb · Deborah Judd · Khadija Khatry · Yee Sum Li · Terry Nash · Bonnie Macfarlane · Karen Slater · Yudish Soonarane · Mark Stickley · Satyamurthy Anuradha

Restrictions should be accompanied by advice about appropriate locations for seeking medical care, by condition severity and type

Amy L Sweeny · Gerben Keijzers · Andrea Marshall · Emma J Hall · Jamie Ranse · Ping Zhang · Gary Grant · Ya‐Ling Huang · Dinesh Palipana · Yang D Teng · Benjamin Gerhardy · Jaimi H Greenslade · Philip Jones · Julia L Crilly

A 38-year-old woman presented to the emergency department with a 2-week history of fever, headache and mild dry cough

Arvind Yerramilli · Michelle Sam · Aadith Ashok · Eugene Athan

What the future holds is unclear

Douglas Johnson · Megan Anne Rees

A 44-year-old man presented to the emergency department with left knee monoarthritis

Caitlin Paul · Joseph O'Brien · Sarah Huffam · Daryl Ridley

SARS-CoV-2 infection is associated with higher incidence of hospitalisation with several respiratory and non-respiratory conditions

Stacey L Rowe · Karin Leder · Kylie Dyson · Lalitha Sundaresan · Dennis Wollersheim · Brigid Lynch · Ifrah Abdullahi · Benjamin C Cowie · Nicola Stephens · Terence M Nolan · Sheena G Sullivan · Brett Sutton · Allen C Cheng

Australia has effectively instituted a vaccination mandate while maintaining critical workforce capacity in aged care

Sally Hall Dykgraaf · Jane Desborough · Anne Parkinson · Elizabeth A Sturgiss · Paul Kelly · Michael Kidd

Strategies to increase and sustain the COVID-19 vaccination rate among Australian children are needed

Katelyn Barnes · Sally Hall Dykgraaf · Lucas Toca · Michael Wright · Michael Kidd

A 71-year-old man with a history of 6 weeks of generalised decline presented for outpatient clinic assessment

Karen Bromley · Jessica Phillips · Ashley Irish

The unacceptably high prevalence among Indigenous people and people who need dialysis warrants a clinical trial of prophylactic antibiotics

Katherine Gibney · Andrew Steer

To the Editor: Molecular diagnostics with whole genome sequencing (WGS) of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has been well described as a method to monitor the evolving epidemiology of the coronavirus disease 2019 (COVID‐19) pandemic and coordinate public health responses.1,2 WGS allows for the accurate identification of COVID‐19 variants, which, when combined with accessible diagnostic testing with polymerase chain reaction (PCR) and rapid antigen tests, supports contact tracing and public health action.1,2 Since January 2022, by agreement with the Forensic and Scientific Services reference laboratory, it has been our practice at the Prince Charles Hospital — a tertiary cardiothoracic transplant centre in Brisbane — to sequence all SARS‐CoV‐2 samples of patients requiring hospital admission for COVID‐19. The rapid turnaround times, averaging 36 hours, supported decisions on variant‐specific therapeutics and optimised bed management. The first case of the Omicron BA.2 subvariant detected at our centre was from a sample collected on 4 March 2022 (Box). This was 17days before public announcements of the dominance of the BA.2 strain by the Queensland Chief Health Officer on 21 March 2022.3 With the anticipated increase in local BA.2 cases, we were able to tailor our hospital level response in real time.4 Initially, even though case numbers were low, from an infection prevention and control perspective, we cohorted BA.1 and BA.2 patients separately to mitigate the risk of nosocomial co‐infection. We maintained the workforce and resourcing surge capacity with a second COVID‐19 ward that opened within days of the initial BA.2 case being identified. Furthermore, genome sequencing for COVID‐19 therapeutics resistance mutations led to alterations in clinical management as BA.2 became the dominant local strain, given its lack of susceptibility to sotrovimab. At the hospital and health service level, access to rapid WGS for identification of emerging variants provides the basis for greater infection prevention and control practices, resource and workforce management, and epidemiological monitoring, and carries implications for clinical management and therapeutics. WGS allows for rapid detection and contact tracing of nosocomial outbreaks, supporting identification of chains of transmission within hospitals. This information augments infection prevention and control by identifying gaps in current practice as well as supporting safer health care environmental design that minimises nosocomial transmission. Furthermore, detection of novel variants at the hospital level can help to predict new waves that require allocation of additional staffing and resources. The Australian Government has recognised the evolving role of microbial genomics in public health surveillance but has not yet committed to further development to optimise personalised medicine, hospital care, and therapeutic decision making.5 We strongly advocate for the inclusion of funding for sustainable rapid WGS that provides real‐time results under the Medicare Benefits Schedule. This will expedite Australia's transition to living with COVID‐19 and will allow us to better prepare our health system to manage new and emerging pathogens into the future. Box – Number of patients admitted and sequenced with coronavirus disease 2019 (COVID‐19) at the Prince Charles Hospital from 1 January to 3 April 2022 by genotype* *Bubble size range, 1–9; total number of patients, 256.

Matthew B Eustace · Ambika Sud · Craig Thompson · Sanmarie Schlebusch · Robert L Horvath

When chlamydia is detected, retesting and thorough contact tracing and management can help to interrupt transmission and reduce the risk of reinfection and reproductive complications

Stephanie C Munari · Jane L Goller · Margaret E Hellard · Jane S Hocking

An intersectoral response to improving the social determinants of skin health is needed, particularly in remote communities

Johanna M Birrell · Rowena Boyd · Bart J Currie · Nicholas M Anstey · Asanga Abeyaratne · Sandawana William Majoni · Vicki L Krause

Future threats require an integrated approach to the health of humans, animals and the environment

Sandra G Steele · Jenny‐Ann LML Toribio · Siobhan M Mor

A 38-year-old woman with longstanding Crohn’s disease presented with 7 months of a nonhealing widespread rash

Fleur W Kong · David Wong · Kendall Sharpe · Louis Pool · James Muir

Assessing progress to trachoma elimination in Australia and elsewhere should therefore incorporate laboratory testing

Kathleen D Lynch · Wendy Morotti · Garry Brian · Lenore Ketchup · Kozue Kingston · Mitchell Starr · Robert S Ware · Beth Everill · Nazihah Asgar · Anne O'Keefe · Lisa J Whop · John M Kaldor · Stephen B Lambert

The Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth

for the National COVID‐19 Clinical Evidence Taskforce

The changes in the characteristics of the pandemic and in our health care responses have been anything but gradual

Theresa Jacques · Kush Deshpande

Eight drug treatments are currently recommended for people who do not require supplemental oxygen and six for those who do

Heath White · Steve J McDonald · Bridget Barber · Joshua Davis · Lucy Burr · Priya Nair · Sutapa Mukherjee · Britta Tendal · Julian Elliott · Steven McGloughlin · Tari Turner

By learning from Australia’s response to the pandemic and breaking down siloes, we can build a more integrated and resilient health system

Sarah L Larkins · Nicole L Allard · C Paul Burgess

Strep A POCT is a critical element in preventing acute rheumatic fever and will contribute to the elimination of rheumatic heart disease in Australia

Dylan D Barth · Gelsa Cinanni · Jonathan R Carapetis · Rosemary Wyber · Louise Causer · Caroline Watts · Belinda Hengel · Susan Matthews · Anna P Ralph · Janessa Pickering · Jeffrey W Cannon · Lorraine Anderson · Vicki Wade · Rebecca J Guy · Asha C Bowen