Topics

We need strength and courage to live with COVID‐19, and still more to overcome chronic social and planetary neglect

Welcome to 2022! According to the Chinese zodiac, we are entering the Year of the Tiger, a symbol of strength — and danger. Despite nearly two years of the coronavirus disease 2019 (COVID‐19) pandemic, there is much to celebrate, including the huge uptake of vaccination by Australians that has saved many lives and made the return to a more open lifestyle possible. However, the pandemic has not yet passed, and health and medical professionals will need both strength and resilience during the coming year as we navigate the post‐pandemic recovery phase.1 But as I write this editorial (December 2021), it is clear that Europe and the United States will have tough COVID‐19 winters, and the implications of the new Omicron variant of the virus are unclear. We too need to prepare for the possibility of more difficult months ahead as winter approaches. So please get your booster dose of the vaccine when it is due (I have!), celebrate, rest up, re‐charge, and gear up for the year ahead!

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Editor‐in‐Chief, Medical Journal of Australia

Correspondence: ntalley@mja.com.au

Competing interests:

A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley

1. Duckett SJ, Sutton B. On entering Australia’s third year with COVID‐19. Med J Aust 2021; 215: 509–510. https://www.mja.com.au/journal/2021/215/11/entering‐australias‐third‐year‐covid‐19
2. Wiley; Council of Australian Universities Librarians. CAUL and Wiley sign transformative open access agreement that represents the largest in the ANZ region by article output [media release]. 4 Nov 2021. https://www.caul.edu.au/news/caul‐and‐wiley‐sign‐transformative‐open‐access‐agreement‐represents‐largest‐anz‐region‐article (viewed Nov 2021).
3. Caly L, Druce J, Roberts J, et al. Isolation and rapid sharing of the 2019 novel coronavirus (SARS‐CoV‐2) from the first patient diagnosed with COVID‐19 in Australia. Med J Aust 2020; 212: 459–462. https://www.mja.com.au/journal/2020/212/10/isolation‐and‐rapid‐sharing‐2019‐novel‐coronavirus‐sars‐cov‐2‐first‐patient
4. COVID‐19 Mental Disorders Collaborators. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID‐19 pandemic. Lancet 2021; 398: 1700–1712.
5. Batterham PJ, Calear AL, McCallum SM, et al. Trajectories of depression and anxiety symptoms during the COVID‐19 pandemic in a representative Australian adult cohort. Med J Aust 2021; 214: 462–468. https://www.mja.com.au/journal/2021/214/10/trajectories‐depression‐and‐anxiety‐symptoms‐during‐covid‐19‐pandemic
6. Burrell AJ, Pellegrini B, Salimi F, et al. Outcomes for patients with COVID‐19 admitted to Australian intensive care units during the first four months of the pandemic. Med J Aust 2021; 214: 23–30. https://www.mja.com.au/journal/2021/214/1/outcomes‐patients‐covid‐19‐admitted‐australian‐intensive‐care‐units‐during‐first; erratum: https://www.mja.com.au/journal/2021/214/10/erratum
7. Grout L, Katar A, Ait Ouakrim D, et al. Failures of quarantine systems for preventing COVID‐19 outbreaks in Australia and New Zealand. Med J Aust 2021; 215: 320–324. https://www.mja.com.au/journal/2021/215/7/failures‐quarantine‐systems‐preventing‐covid‐19‐outbreaks‐australia‐and‐new
8. Hill NT, Witt K, Rajaram G, et al. Suicide by young Australians, 2006–2015: a cross‐sectional analysis of national coronial data. Med J Aust 2021; 214: 133–139. https://www.mja.com.au/journal/2021/214/3/suicide‐young‐australians‐2006‐2015‐cross‐sectional‐analysis‐national‐coronial
9. Negin J, Bell J, Ivancic L, et al. Gun violence in Australia, 2002–2016: a cohort study. Med J Aust 2021; 215: 414–420. https://www.mja.com.au/journal/2021/215/9/gun‐violence‐australia‐2002‐2016‐cohort‐study
10. Freeman CR, Scott IA, Hemming K, et al. Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial. Med J Aust 2021; 214: 212–217. https://www.mja.com.au/journal/2021/214/5/reducing‐medical‐admissions‐and‐presentations‐hospital‐through‐optimising
11. Koczwara B, Meng R, Miller MD, et al. Late mortality in people with cancer: a population‐based Australian study. Med J Aust 2021; 214: 318–323. https://www.mja.com.au/journal/2021/214/7/late‐mortality‐people‐cancer‐population‐based‐australian‐study
12. te Marvelde L, Milne RL, Hornby CJ, et al. Differences in treatment choices for localised prostate cancer diagnosed in private and public health services. Med J Aust 2020; 213: 411–417. https://www.mja.com.au/journal/2020/213/9/differences‐treatment‐choices‐localised‐prostate‐cancer‐diagnosed‐private‐and
13. Yap ML, O’Connell DL, Goldsbury DE, et al. Patterns of care for men with prostate cancer: the 45 and Up Study. Med J Aust 2021; 214: 271–278. https://www.mja.com.au/journal/2021/214/6/patterns‐care‐men‐prostate‐cancer‐45‐and‐study
14. Woo HH, Teh A. Clinically significant localised prostate cancer: deciding what will provide the best clinical outcomes. Med J Aust 2021; 214: 264–265. https://www.mja.com.au/journal/2021/214/6/clinically‐significant‐localised‐prostate‐cancer‐deciding‐what‐will‐provide‐best
15. Hamarneh Z, Cock C, Young GP, et al. The influence of the surveillance time interval on the risk of advanced neoplasia after non‐advanced adenoma removal. Med J Aust 2021; 215: 465–470. https://www.mja.com.au/journal/2021/215/10/influence‐surveillance‐time‐interval‐risk‐advanced‐neoplasia‐after‐non‐advanced
16. Nadlacki B, Horton D, Hossain S, et al. Long term survival after acute myocardial infarction in Australia and New Zealand, 2009–2015: a population cohort study. Med J Aust 2021; 214: 519–525. https://www.mja.com.au/journal/2021/214/11/long‐term‐survival‐after‐acute‐myocardial‐infarction‐australia‐and‐new‐zealand
17. Atwoli L, Baqui AH, Benfield T, et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. N Engl J Med 2021; 385: 1134–1137.

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Perspectives

The health impacts of dowry abuse on South Asian communities in Australia

Manjula O'Connor and Amanda Lee

Med J Aust 2022; 216 (1): . || doi: 10.5694/mja2.51358
Published online: 17 January 2022

ARTICLE
AUTHORS
REFERENCES

Topics

Global health

Mental disorders

Social determinants of health

Dowry abuse is fundamentally driven by gender inequality and is a lesser known form of family violence in Australia

Dowry is a cultural tradition maintained by some migrant and refugee communities living in Australia. It has long been practised in India, but with rising materialism in the post‐colonial era, the size of gifts for marriage increased to multiple times that of the annual income of the bride’s family.1 Dowry is also linked to family prestige.2 Rampant dowry abuse associated with significant interpersonal, family and community harm in the newly independent India gave rise to the antidowry movement and laws prohibiting it in 1961.3 Decades later, countries with large South Asian diasporas, such as Canada, the United Kingdom and Australia, continue to experience cases of dowry‐related abuse, including the husband’s confiscation of dowry wealth followed by abandonment of brides.4

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1 University of Melbourne, Melbourne, VIC
2 University of New South Wales, Sydney, NSW
3 Harmony Alliance, Migration Council Australia, Canberra, ACT

Correspondence: manjulao@unimelb.edu.au

Acknowledgements:

The national Survey on Dowry Abuse was designed and conducted by the authors on behalf of Harmony Alliance (https://harmonyalliance.org.au) and the Australasian Centre for Human Rights and Health (www.achrh.org). The survey is published on both websites and forms part of the project National Platform for Prevention of Dowry Abuse — an action research project, which obtained ethics approval from the Human Research Ethics Committee from the Melbourne Clinic — and is funded by the Department of Social Services, Australian Government, through the Community‐led Projects to Prevent Violence Against Women and their Children program. We are grateful to the Indian and the broader South Asian communities for their generous support. We thank Harmony Alliance and the Australasian Centre for Human Rights and Health for supporting the project. We also thank the Department of Social Services for funding the project and Our Watch for providing guidance.

Competing interests:

No relevant disclosures.

1. Banerjee PR. Dowry in 21st‐century India: the sociocultural face of exploitation. Trauma Violence Abuse 2013; 15: 34–40.
2. Biao X. Gender, dowry and the migration system of Indian information technology professionals. Ind J Gend Stud 2005; 12: 357–380.
3. Kumari R. Brides are not for burning: dowry victims in India. New Delhi: Radiant, 1989.
4. Anitha S, Yalamarty H, Anupama R. Changing nature and emerging patterns of domestic violence in global contexts: dowry abuse and the transnational abandonment of wives in India. Womens Stud Int Forum 2018; 69: 67–75.
5. Department of Home Affairs. Country profile: India [website]. Canberra: Commonwealth of Australia, 2020. https://www.homeaffairs.gov.au/research‐and‐statistics/statistics/country‐profiles/profiles/india#:~:text=This%20makes%20the%20Indian%2Dborn,cent%20of%20Australia’s%20total%20population (viewed May 2021).
6. Singh S, Sidhu J. Coercive control of money, dowry and remittances among Indian migrant women in Australia. South Asian Diaspora 2020; 12: 35–50.
7. O’Connor M, Asthana MS. Refusal to comply with dowry demands leads to domestic violence and death in Victoria. Melbourne: Australasian Centre for Human Rights and Health, 2015. http://rcfv.archive.royalcommission.vic.gov.au/getattachment/43B1945E‐83EC‐490D‐B1F9‐73B44B79CC2E/Australasian‐Centre‐for%C2%A0Human‐Rights‐and‐Health.pdf (viewed May 2021).
8. Coroners Court of Victoria. Findings into death with inquest: Deepshikha Godara. Court Reference COR 2014 6332. Melbourne: Coroners Court of Victoria, 2016. https://www.coronerscourt.vic.gov.au/sites/default/files/2018‐12/deepshikhagodara_633214.pdf (viewed May 2021).
9. Smethhurst S. Till death do us part. The Australian 2018; 6 October. https://www.theaustralian.com.au/weekend‐australian‐magazine/dowry‐death‐and‐despair‐in‐australias‐indian‐community/news‐story/b49666d96ac623af5147d6d4edcce09e (viewed May 2021).
10. Ghafournia N, Easteal P. Are immigrant women visible in Australian domestic violence reports that potentially influence policy? Laws 2018; 7: 32.
11. O'Connor M, Ibrahim S. Suicidality and family violence in Australian immigrant women presenting to out‐patient mental health settings. Australas Psychiatry 2018; 26: 224–225.
12. Legal and Constitutional Affairs References Committee. Practice of dowry and the incidence of dowry abuse in Australia. Canberra: Commonwealth of Australia, 2019. https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/DowryAbuse/Report (viewed May 2021).
13. Harmony Alliance. Emerging insights from our national survey on dowry abuse. Canberra: Harmony Alliance, 2020. http://harmonyalliance.org.au/wp‐content/uploads/2020/11/HA‐Dowry‐Abuse‐Survey‐Insights.pdf (viewed May 2021).
14. Vives‐Cases C, La Parra D, Goicolea I, et al. Preventing and addressing intimate partner violence against migrant and ethnic minority women: the role of the health sector — policy brief. Copenhagen: World Health Organization; 2014. https://www.euro.who.int/__data/assets/pdf_file/0018/270180/21256‐WHO‐Intimate‐Partner‐Violence_low_V7.pdf (viewed May 2021).
15. O’Connor M, Colucci E. Exploring domestic violence and social distress in Australian‐Indian migrants through community theater. Transcult Psychiatry 2016; 53: 24–44.
16. Centre of Research Excellence Safer Families. The Readiness Program: primary care's readiness to address domestic and family violence. https://www.saferfamilies.org.au/readiness‐program (viewed Nov 2021).
17. O’Connor M. Dowry‐related domestic violence and complex posttraumatic stress disorder: a case report. Australas Psychiatry 2017; 25: 351–353.
18. Shidhaye R, Patel V. Association of socio‐economic, gender and health factors with common mental disorders in women: a population‐based study of 5703 married rural women in India. Int J Epidemiol 2010; 39: 1510–1521.

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Research letters

Second SARS‐CoV‐2 infections twelve months after initial infections in Australia, confirmed by genomic analysis

The Victorian SARS‐CoV‐2 Reinfection Study Group

Med J Aust 2022; 216 (4): . || doi: 10.5694/mja2.51352
Published online: 13 December 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Statistics, epidemiology and research design

Second infections with the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) are thought to affect fewer than 1% of people with resolved coronavirus disease 2019 (COVID‐19).1 Reinfections as soon as 26 days after the initial diagnosis have been reported, in some cases with increased disease severity.1,2 No confirmed cases of second SARS‐CoV‐2 infections have been reported in Australia, but public awareness of the possibility is needed to encourage continued testing and vaccination.

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The Victorian SARS‐CoV‐2 Reinfection Study Group

1 Victorian Department of Health, Melbourne, VIC
2 South East Public Health Unit, Melbourne, VIC
3 Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC

Correspondence: courtney.lane@unimelb.edu.au

Acknowledgements:

This investigation was funded by the Victorian Government, and by the National Health and Medical Research Council through the Medical Research Future Fund (MRF9200006). We acknowledge and thank Australian SARS‐CoV‐2 diagnostic and sequencing laboratories for their contributions to this research.

Competing interests:

No relevant disclosures.

1. Hansen CH, Michlmayr D, Gubbels SM, et al. Assessment of protection against reinfection with SARS‐CoV‐2 among 4 million PCR‐tested individuals in Denmark in 2020: a population‐level observational study. Lancet 2021; 397: 1204–1212.
2. Tillett RL, Sevinsky JR, Hartley PD, et al. Genomic evidence for reinfection with SARS‐CoV‐2: a case study. Lancet Infect Dis 2021; 21: 52–58.
3. Lane CR, Sherry NL, Porter AF, et al. Genomics‐informed responses in the elimination of COVID‐19 in Victoria, Australia: an observational, genomic epidemiological study. Lancet Public Health 2021; 6: e547–e556.
4. Andersson P, Sherry NL, Howden BP. Surveillance for SARS‐CoV‐2 variants of concern in the Australian context. Medical Journal of Australia 2021; 214: 500–502.e1. https://www.mja.com.au/journal/2021/214/11/surveillance‐sars‐cov‐2‐variants‐concern‐australian‐context
5. Hall VJ, Foulkes S, Saei A, et al; SIREN Study Group. COVID‐19 vaccine coverage in health‐care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study. Lancet 2021; 397: 1725‐1735.

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Christmas competition
Winner

A guide to the management of atrial fibrillation in Santa Claus

Mark T Mills and David R Warriner

Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51341
Published online: 13 December 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

General medicine

Summary

• In view of his advanced age and risk factors, Santa Claus is at high risk of developing atrial fibrillation. Despite this, no guidelines exist on the subject.
• Following a review of the literature, we present our position on the management of atrial fibrillation in Santa Claus, and propose the use of the SANTA CLAUS mnemonic to aid clinicians: Screen for atrial fibrillation; Anticoagulate; Normalise heart rate; Treat comorbidities; Anti‐arrhythmic drugs; Cardioversion; Lifestyle measures; Ablation treatment; Understand emotional and psychological impact; Save Santa Claus.

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1 University of Sheffield, Sheffield, United Kingdom
2 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
3 Doncaster and Bassetlaw, Teaching Hospitals NHS Foundation Trust, Doncaster, United Kingdom
4 Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom

Correspondence: marktmills1@gmail.com

Disclaimer

The guidance provided in this article is inspired by the National Institute for Health and Care Excellence (NICE),2 the European Society of Cardiology (ESC),3 and the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand (NHFA)4 guidelines. Our advice applies only to the management of atrial fibrillation (AF) in Santa Claus, and should not be used in other individuals with AF. Important areas of AF management not covered in our guidance include the prevention of AF, left atrial appendage occlusion for stroke prevention, and the surgical treatment of AF in Santa Claus.

Patient and public involvement

No patients or public were asked for input in the creation of this article, but we did send a copy to Santa Claus along with our Christmas list for 2021.

Competing interests:

No relevant disclosures.

1. Weng L, Preis SR, Hulme OL, et al. Genetic predisposition, clinical risk factor burden, and lifetime risk of atrial fibrillation. Circulation 2018; 137: 1027–1038.
2. National Institute for Health and Care Excellence. Atrial fibrillation: diagnosis and management. NICE guideline [NG196]. Published: 27 April 2021; last updated: 30 June 2021. https://www.nice.org.uk/guidance/ng196 (viewed Oct 2021).
3. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‐Thoracic Surgery (EACTS). Eur Heart J 2020 Aug 29; ehaa612.
4. Brieger D, Amerena J, Attia JR, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018. Med J Aust 2018; 209: 356–362. https://www.mja.com.au/journal/2018/209/8/national‐heart‐foundation‐australia‐and‐cardiac‐society‐australia‐and‐new
5. Engdahl J, Andersson L, Mirskaya M, et al. Stepwise screening of atrial fibrillation in a 75‐year‐old population: implications for stroke prevention. Circulation 2013; 127: 930–937.
6. Yes Santa is Real. How old is Santa Claus? https://yessantaisreal.com/how‐old‐is‐santa‐claus/ (viewed Oct 2021).
7. Friberg L, Rosenqvist M, Lip GYH. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J 2012; 33: 1500–1510.
8. Ovesen L, Lyduch S, Idorn ML. The effect of a diet rich in Brussels sprouts on warfarin pharmacokinetics. Eur J Clin Pharmacol 1988; 34: 521–523.
9. Paeng CH, Sprague M, Jackevicius CA. Interaction between warfarin and cranberry juice. Clin Ther 2007; 29: 6.
10. Grafton J. When Santa Got Stuck Up The Chimney [song]. 1953. https://www.discogs.com/artist/2059148‐Jimmy‐Grafton (viewed Oct 2021).
11. Connor T. I Saw Mommy Kissing Santa Claus [song]. 1952. https://en.wikipedia.org/wiki/I_Saw_Mommy_Kissing_Santa_Claus (viewed Oct 2021).
12. Straube S, Fan X. The occupational health of Santa Claus. J Occup Med Toxicol 2015; 10: 44.
13. Van Gelder IC, Groenveld HF, Crijns HJGM, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010; 362: 1363–1373.
14. Gumprecht J, Domek M, Lip GYH, et al. Invited review: hypertension and atrial fibrillation: epidemiology, pathophysiology, and implications for management. J Hum Hypertens 2019; 33: 824–836.
15. Huxley RR, Filion KB, Konety S, et al. Meta‐analysis of cohort and case–control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol 2011; 108: 56–62.
16. Sandle T. If Santa was human he’d have died aged 54. Digital Journal 2019; 20 Dec. http://www.digitaljournal.com/life/health/if‐santa‐was‐human‐he‐d‐have‐died‐aged‐54/article/563947 (viewed Jan 2021).
17. Shapira‐Daniels A, Mohanty S, Contreras‐Valdes FM, et al. Prevalence of undiagnosed sleep apnea in patients with atrial fibrillation and its impact on therapy. JACC Clin Electrophysiol 2020; 6: 1499–1506.
18. Pathak RK, Middeldorp ME, Meredith M, et al. Long‐term effect of goal‐directed weight management in an atrial fibrillation cohort. J Am Coll Cardiol 2015; 65: 2159–2169.
19. Smart NA, King N, Lambert JD, et al. Exercise‐based cardiac rehabilitation improves exercise capacity and health‐related quality of life in people with atrial fibrillation: a systematic review and meta‐analysis of randomised and non‐randomised trials. Open Heart 2018; 5: e000880.
20. University of Leicester. Calculations reveal Santa travels at 0.5% the speed of light. https://le.ac.uk/news/2018/december/21‐calculations‐reveal‐how‐quickly‐santa‐travels (viewed Oct 2021).

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Reflection

Living through a pandemic as an MJA editor and a general practitioner

Aajuli Shukla

Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51338
Published online: 13 December 2021

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Infectious diseases

The end of 2021 offers many opportunities to look back on the year that was and make predictions about what is to come. At the time of writing, modelling based on vaccination rates and plans for reopening the country are the trends du jour. Yet, in approaching the end of another year in which coronavirus disease 2019 (COVID‐19) has dominated medical, public health and media agendas, it is vital we take an opportunity to reflect on the impacts that the pandemic has had on Australia’s health system, including the way in which the crisis has spurred valuable innovation and reform. For me personally, experiencing this year as an MJA editor and a general practitioner working in Western Sydney, alongside being an expectant mother from a migrant background, has given me intersecting lenses through which to view the impact of the pandemic on medical publishing, clinical practice, and learning to “live with COVID”.

The Medical Journal of Australia , Sydney, NSW

Correspondence: ashukla@mja.com.au

Competing interests:

No relevant disclosures.

1. Fox GJ, Trauer JM, McBryde E. Modelling the impact of COVID ‐19 on intensive care services in New South Wales. Med J Aust 2020; 212: 468–469. https://www.mja.com.au/journal/2020/212/10/modelling‐impact‐covid‐19‐intensive‐care‐services‐new‐south‐wales
2. Mac OA, Muscat DM, Ayre J, et al. The readability of official public health information on COVID‐19. Med J Aust 2021; 215: 373–375. https://www.mja.com.au/journal/2021/215/8/readability‐official‐public‐health‐information‐covid‐19
3. Hyde Z, Berger D, Miller A. Australia must act to prevent airborne transmission of SARS‐CoV‐2. Med J Aust 2021; 215: 7–9. https://www.mja.com.au/journal/2021/215/1/australia‐must‐act‐prevent‐airborne‐transmission‐sars‐cov‐2
4. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. COVID‐19 vaccination in pregnant and breastfeeding women and those planning pregnancy. 18 Aug 2021. https://ranzcog.edu.au/statements‐guidelines/covid‐19‐statement/covid‐19‐vaccination‐information (viewed Oct 2021).
5. Adhikari E, SoRelle J, McIntire D, Spong C. Increasing severity of COVID‐19 in pregnancy with Delta (B.1.617.2) variant surge. Am J Obstet Gynecol 2021; https://doi.org/10.1016/j.ajog.2021.09.008 [online ahead of print].
6. Davey M. Pregnant Australian women demand to be considered priority group for Covid vaccinations. The Guardian (Australia) 2021; 9 July. https://www.theguardian.com/australia‐news/2021/jul/09/pregnant‐australian‐women‐demand‐to‐be‐considered‐priority‐group‐for‐covid‐vaccinations (viewed Oct 2021).
7. Mahimbo A, Abdi I, Heywood A. COVID‐19 vaccine uptake in CALD communities: support GPs better. InSight+ 2021; 13 Sept. https://insightplus.mja.com.au/2021/34/covid‐19‐vaccine‐uptake‐in‐cald‐communities‐support‐gps‐better/
8. Cunningham M, Ilanbey S. How coronavirus closed in on the City of Hume. The Age (Melbourne) 2021; 26 Sept. https://www.theage.com.au/national/victoria/how‐coronavirus‐closed‐in‐on‐the‐city‐of‐hume‐20210920‐p58t4h.html?fbclid=IwAR0H65r3bAS5HSRIQBEA6IVJPg0c7u7nDypkTbfgDvXxvFvvCB3xaCiJmog (viewed Oct 2021).
9. Australian Government Department of Health. COVID‐19 vaccines. https://www.health.gov.au/initiatives‐and‐programs/covid‐19‐vaccines (viewed Oct 2021).
10. Briggs C, Truu M. Why is the Indigenous COVID‐19 vaccination rate 20 per cent lower than the national average? ABC News 2021; 4 Sept. https://www.abc.net.au/news/2021‐09‐04/indigenous‐covid19‐vaccination‐rates‐behind‐national‐average/100432238 (viewed Oct 2021).
11. Cheng Y, Boerma C, Peck L, et al. Telehealth sexual and reproductive health care during the COVID‐19 pandemic. Med J Aust 2021; 215: 371–372. https://www.mja.com.au/journal/2021/215/8/telehealth‐sexual‐and‐reproductive‐health‐care‐during‐covid‐19‐pandemic
12. Hew A, Arunogiri S, Lubman DI. Challenges in delivering telemedicine to vulnerable populations: experiences of an addiction medical service during COVID‐19. Med J Aust 2021; 215: 237. https://www.mja.com.au/journal/2021/215/5/challenges‐delivering‐telemedicine‐vulnerable‐populations‐experiences‐addiction
13. Rasmussen B, Eleftheriou P, Liu L, et al. Where to next for telehealth in Australia’s health services? Insight+ 2020; 12 Oct. https://insightplus.mja.com.au/2020/40/where‐to‐next‐for‐telehealth‐in‐australias‐health‐services/
14. Woodley M. Longer phone consultations not part of telehealth extension. NewsGP 2021; 27 Apr. https://www1.racgp.org.au/newsgp/professional/longer‐phone‐consultations‐not‐part‐of‐telehealth (viewed Oct 2021).
15. Tsirtsakis A. GP launches petition against ‘unfair’ MBS changes to telehealth. NewsGP 2021; 8 June. https://www1.racgp.org.au/newsgp/professional/gp‐launches‐petition‐against‐unfair‐mbs‐changes‐to (viewed Oct 2021).

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Editorial

Goodbye, 2021: a year of triumphs and failures

Nicholas J Talley

Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51345
Published online: 13 December 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Environment and public health

Information science

Australians have been challenged in many ways over the past two years: some more than others

Welcome to the December issue of the MJA. It has not been a very jolly year, but I hope that reflecting on what has been and where we are (or should be) going is therapeutic. And I remain optimistic that, despite the challenges, the future is brighter.

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Editor‐in‐Chief

Correspondence: ntalley@mja.com.au

Acknowledgements:

I thank the tireless efforts of the editorial team throughout 2021, without which the quality and timely publication of our Journal would not be possible: deputy medical editors Alisha Dorrigan, Francis Geronimo, Robyn Godding, Tania Janusic, Wendy Morgan, Aajuli Shukla, and Elizabeth Zuccala; our scientific and structural editors, Paul Foley, Graeme Prince, and Laura Teruel; our consultant biostatistician, Elmer Villanueva; our news and online editor, Cate Swannell; our graphic designer, Leilani Widya; our head of publishing content, Ben Dawe; and our senior publishing coordinator, Kerrie Harding.

Competing interests:

A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley

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Guideline summary

Care of older people and people requiring palliative care with COVID‐19: guidance from the Australian National COVID‐19 Clinical Evidence Taskforce

Saskia Cheyne, Richard I Lindley, Natasha Smallwood, Britta Tendal, Michael Chapman, David Fraile Navarro, Phillip D Good, Peter Jenkin, Steve McDonald, Deidre Morgan, Melissa Murano, Tanya Millard, Vasi Naganathan, Velandai Srikanth, Penelope Tuffin, Joshua Vogel, Heath White, Samantha P Chakraborty, Elizabeth Whiting, Leeroy William, Patsy M Yates, Mandy Callary, Julian Elliott and Meera R Agar, for the National COVID‐19 Clinical Evidence Taskforce

Med J Aust 2022; 216 (4): . || doi: 10.5694/mja2.51353
Published online: 6 December 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Respiratory tract diseases

Health occupations

Palliative care

General medicine

Abstract

Introduction: Older people living with frailty and/or cognitive impairment who have coronavirus disease 2019 (COVID‐19) experience higher rates of critical illness. There are also people who become critically ill with COVID‐19 for whom a decision is made to take a palliative approach to their care. The need for clinical guidance in these two populations resulted in the formation of the Care of Older People and Palliative Care Panel of the National COVID‐19 Clinical Evidence Taskforce in June 2020. This specialist panel consists of nursing, medical, pharmacy and allied health experts in geriatrics and palliative care from across Australia.

Main recommendations: The panel was tasked with developing two clinical flow charts for the management of people with COVID‐19 who are i) older and living with frailty and/or cognitive impairment, and ii) receiving palliative care for COVID‐19 or other underlying illnesses. The flow charts focus on goals of care, communication, medication management, escalation of care, active disease‐directed care, and managing symptoms such as delirium, anxiety, agitation, breathlessness or cough. The Taskforce also developed living guideline recommendations for the care of adults with COVID‐19, including a commentary to discuss special considerations when caring for older people and those requiring palliative care.

Changes in management as result of the guideline: The practice points in the flow charts emphasise quality clinical care, with a focus on addressing the most important challenges when caring for older individuals and people with COVID‐19 requiring palliative care. The adult recommendations contain additional considerations for the care of older people and those requiring palliative care.

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1 NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW
2 Cochrane Australia, Monash University, Melbourne, VIC
3 Westmead Applied Research Centre, University of Sydney, Sydney, NSW
4 George Institute for Global Health, Sydney, NSW
5 Alfred Hospital, Melbourne, VIC
6 Monash University, Melbourne, VIC
7 Canberra Hospital, Canberra, ACT
8 Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
9 St Vincent’s Private Hospital, Brisbane, Brisbane, QLD
10 Resthaven, Adelaide, SA
11 Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA
12 Flinders University, Adelaide, SA
13 Centre for Education and Research on Ageing (CRGH), University of Sydney, Sydney, NSW
14 Royal Perth Hospital, Perth, WA
15 Fiona Stanley Hospital, Perth, WA
16 Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC
17 Prince Charles Hospital, Brisbane, QLD
18 Eastern Health, Melbourne, VIC
19 Centre for Cancer and Palliative Care Outcomes, Queensland University of Technology, Brisbane, QLD
20 Royal Adelaide Hospital, Adelaide, SA
21 IMPACCT Centre, University of Technology Sydney, Sydney, NSW

Correspondence: saskia.cheyne@monash.edu

Acknowledgements:

We acknowledge all members of the National COVID‐19 Clinical Evidence Taskforce, the member organisations, partners, governments and funders that support the initiative (online Supporting Information). These guidelines have received funding from the Australian Government Department of Health; the Victorian Government Department of Health and Human Services; the Ian Potter Foundation; the Walter Cottman Endowment Fund, managed by Equity Trustees; and the Lord Mayor’s Charitable Foundation.

Competing interests:

No relevant disclosures.

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Research

Increasing ICU capacity to accommodate higher demand during the COVID‐19 pandemic

Edward Litton, Sue Huckson, Shaila Chavan, Tamara Bucci, Anthony Holley, Evan Everest, Sean Kelly, Steven McGloughlin, Johnny Millar, Nhi Nguyen, Mark Nicholls, Paule Secombe and David Pilcher

Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51318
Published online: 15 November 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Emergency medicine

Environment and public health

Health services administration

Abstract

Objectives: To describe the short term ability of Australian intensive care units (ICUs) to increase capacity in response to heightened demand caused by the COVID‐19 pandemic.

Design: Survey of ICU directors or delegated senior clinicians (disseminated 30 August 2021), supplemented by Australian and New Zealand Intensive Care Society (ANZICS) registry data.

Setting: All 194 public and private Australian ICUs.

Main outcome measures: Numbers of currently available and potentially available ICU beds in case of a surge; available levels of ICU‐relevant equipment and staff.

Results: All 194 ICUs responded to the survey. The total number of currently open staffed ICU beds was 2183. This was 195 fewer (8.2%) than in 2020; the decline was greater for rural/regional (18%) and private ICUs (18%). The reported maximal ICU bed capacity (5623) included 813 additional physical ICU bed spaces and 2627 in surge areas outside ICUs. The number of available ventilators (7196) exceeded the maximum number of ICU beds. The reported number of available additional nursing staff would facilitate the immediate opening of 383 additional physical ICU beds (47%), but not the additional bed spaces outside ICUs.

Conclusions: The number of currently available staffed ICU beds is lower than in 2020. Equipment shortfalls have been remediated, with sufficient ventilators to equip every ICU bed. ICU capacity can be increased in response to demand, but is constrained by the availability of appropriately trained staff. Fewer than half the potentially additional physical ICU beds could be opened with currently available staff numbers while maintaining pre‐pandemic models of care.

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1 Fiona Stanley Hospital, Perth, WA
2 The University of Western Australia, Perth, WA
3 Centre for Outcome and Resource Evaluation (CORE), Australian and New Zealand Intensive Care Society (ANZICS), Melbourne, VIC
4 Royal Brisbane and Women's Hospital, Brisbane, QLD
5 Flinders Medical Centre, Adelaide, SA
6 Central Coast Local Health District, Charmhaven, NSW
7 The Alfred Hospital, Melbourne, VIC
8 Royal Children’s Hospital, Melbourne, VIC
9 NSW Agency for Clinical Innovation, Sydney, NSW
10 Nepean Hospital, Penrith, NSW
11 St Vincent's Hospital Sydney, Sydney, NSW
12 Alice Springs Hospital, Alice Springs, NT

Correspondence: ed.litton@health.wa.gov.au

Acknowledgements:

We thank all data collectors and clinicians, particularly the directors and nurse unit managers of all 194 Australian ICUs who contributed to this study.

Competing interests:

No relevant disclosures.

1. Litton E, Bucci T, Chavan S, et al. Surge capacity of intensive care units in case of acute increase in demand caused by COVID‐19 in Australia. Med J Aust 2020; 212: 463–467. https://www.mja.com.au/journal/2020/212/10/surge‐capacity‐intensive‐care‐units‐case‐acute‐increase‐demand‐caused‐covid‐19
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12. Pilcher D, Coatsworth NR, Rosenow M, McClure J. A national system for monitoring intensive care unit demand and capacity: the Critical Health Resources Information System (CHRIS). Med J Aust 2021; 214: 297–298.e1. https://www.mja.com.au/journal/2021/214/7/national‐system‐monitoring‐intensive‐care‐unit‐demand‐and‐capacity‐critical
13. Pilcher D, Duke G, Rosenow M, et al. Assessment of a novel marker of ICU strain, the ICU Activity Index, during the COVID‐19 pandemic in Victoria, Australia. Crit Care Resusc 2021; 23: 300–307.
14. Secombe P, Brown A, Bailey M, et al. Characteristics and outcomes of patients admitted to regional and rural intensive care units in Australia. Crit Care Resusc 2020; 22: 335–343.

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