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We need more robust strategies with targeted, customised approaches, and funding for evidence‐based interventions
Suicide is the leading cause of death of young people in Australia,1 despite extensive research into risk factors for self‐harm. In this issue of the MJA, Hill and colleagues2 report their analysis of National Coronial Information System (NCIS) data for the 3365 young people (10–24 years old) who died by suicide in Australia during 2006–2015. Most were boys or young men (74%); many had diagnosed or possible mental health problems (57%), but fewer than one in three had been in contact with mental health services. A large proportion (38%) were not employed or in education or training at the time of their deaths; 14% were Indigenous Australians, 8% resided in remote locations, and 38% lived in the socio‐economically most disadvantaged regions of Australia.2 Although Hill and her co‐authors could not assess causal relationships between these factors and suicide, their statistics suggest potential targets for focused prevention.
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No relevant disclosures.
While apparently non‐inferior to originator biologics, other factors need to be considered before switching
Biologic drugs are large monoclonal antibodies or genetically engineered proteins produced by live organisms. With highly specific targets, they have revolutionised the treatment of inflammatory, endocrine, and malignant conditions. However, these drugs are expensive, partly because of the complex and costly manufacturing processes required, partly because long periods of therapy are often needed.
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Gregory Moore has received payment for advisory boards from AbbVie, BMS, Chiesi, Emerge, Gilead, Hospira, Janssen, Orphan, MSD, Pfizer, Shire, Takeda; speaker’s fees from AbbVie, Ferring, Janssen, Orphan, Pfizer, Roche, Shire, and Takeda; and research and educational support from AbbVie, Janssen, Pfizer, Shire, and Takeda.
Posts provide valuable feedback during public consultation for health guidelines
Guidelines provide important information on key health behaviours that can influence the population, with public consultation forming an important part of guideline development.1 Public consultation provides transparency, while improving the quality, legitimacy and acceptability of guidelines to the public.1 Although the public are encouraged to provide formal feedback, they may also discuss and provide valuable feedback on popular social networking sites such as Twitter and Reddit. Social networking sites are universal, with 5.8 million Australians using Twitter and 110 000 using Reddit each month.2 Given that a number of these posts are publicly available, they can be used to answer research questions and track health behaviours,3,4,5 and may be an informative source of feedback on health guidelines during public consultation.6
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Objectives: To assess the risks associated with relaxing coronavirus disease 2019 (COVID‐19)‐related physical distancing restrictions and lockdown policies during a period of low viral transmission.
Design: Network‐based viral transmission risks in households, schools, workplaces, and a variety of community spaces and activities were simulated in an agent‐based model, Covasim.
Setting: The model was calibrated for a baseline scenario reflecting the epidemiological and policy environment in Victoria during March–May 2020, a period of low community viral transmission.
Intervention: Policy changes for easing COVID‐19‐related restrictions from May 2020 were simulated in the context of interventions that included testing, contact tracing (including with a smartphone app), and quarantine.
Main outcome measure: Increase in detected COVID‐19 cases following relaxation of restrictions.
Results: Policy changes that facilitate contact of individuals with large numbers of unknown people (eg, opening bars, increased public transport use) were associated with the greatest risk of COVID‐19 case numbers increasing; changes leading to smaller, structured gatherings with known contacts (eg, small social gatherings, opening schools) were associated with lower risks. In our model, the rise in case numbers following some policy changes was notable only two months after their implementation.
Conclusions: Removing several COVID‐19‐related restrictions within a short period of time should be undertaken with care, as the consequences may not be apparent for more than two months. Our findings support continuation of work from home policies (to reduce public transport use) and strategies that mitigate the risk associated with re‐opening of social venues.
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We thank Allan J Saul, Angela Davis, Joseph Doyle, Sherrie Kelly and Suman Majumdar (Burnet Institute) for their contributions to parameter estimates, and additional members of the Institute for Disease Modelling team who contributed to the base Covasim model.
No relevant disclosures.
Current Good Clinical Practice guidelines are bureaucratic and should align with less burdensome examples of international trial policy
Clinical trials must be conducted in ways that protect participants and produce reliable results. Both are central tenets of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Good Clinical Practice (GCP) guideline.1 The ICH GCP guideline was developed to harmonise the conduct of trials across world regions and, since the mid‐1990s, its core principles have provided the bedrock for trial conduct. However, the devil is in the detail and, in the case of the ICH GCP guideline, that detail (and the interpretation of each word) has far‐reaching consequences.
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Inappropriate behaviour harms health workers and patients, and evidence‐based solutions are needed
Health care is the largest employment sector in Australia, more than 1.7 million workers (14% of all employees).1 Incivility, bullying, aggression, and negative workplace cultures seem endemic and have repeatedly been associated with poor workforce and clinical outcomes, but high quality evaluation of interventions for eliminating these behaviours are rare.2,3,4
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Adequate capacity — beds, equipment, consumables, and, crucially, trained personnel — is needed to cope with a surge of critically ill patients
In this issue of the MJA, Burrell and his co‐authors report on the management and outcomes of patients with coronavirus disease 2019 (COVID‐19) admitted to Australian intensive care units (ICUs) during February–June 2020.1 The ICU mortality rate was impressively low (22% for patients requiring mechanical ventilation, 5% for those who did not). Given the excellent quality of care, it is worth exploring other reasons for this low mortality.
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I was involved with UCL, the UCL Hospitals NHS Foundation Trust, and Mercedes F1 in the development of a CPAP device (UCL Ventura) for use in patients with COVID‐19 on a not‐for profit, humanitarian basis.
As we all look forward to 2021 after a horror year, the MJA will continue to work to cement its status as a highly influential top‐tier journal
Welcome to the MJA in 2021. Many will be pleased 2020 is finally over and will be looking forward to a better year.1,2 There are hopeful signs. The public health response to the coronavirus disease 2019 (COVID‐19) pandemic across Australia has been exemplary to date,3,4 and while challenges remain, multiple vaccines have been successful in phase 3 trials and vaccination is anticipated to commence in Australia soon.5 The United States presidential election is over after a very prolonged dispute, and for many this is a relief. I leave it up to the historians to debate how a US administration could fail so spectacularly in the public health response to a pandemic, but wonder if the necessary lessons will be learned globally before the next major infectious diseases outbreak, the risk of which continues to increase with a warming planet.6 The dire impact of climate change on health, including mortality, appears to be being taken more seriously in the United Kingdom, Europe and, at last, the US, although Australia disappointingly remains a laggard for now.6,7
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A complete list of my conflict of interest disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley.
Peer support initiatives can help health professionals experiencing mental health and wellbeing challenges during the COVID‐19 pandemic and beyond
The coronavirus disease 2019 (COVID‐19) pandemic has placed the health care workforce under an unprecedented level of stress. No area of the health workforce is immune to COVID‐19‐related changes to usual work practices. The impact of this acute stress has occurred in the context of a health care profession that was already struggling with major work‐related challenges including anxiety, depression, secondary trauma, compassion fatigue and burnout. Importantly, these issues may have been exacerbated by the COVID‐19 pandemic due to the direct consequences of health care workers being infected, and the indirect consequences of the economic impact on their families and friends, the rigours of lockdown and the adverse effects on health and wellbeing felt across all aspects of society.
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We thank the many health care professionals who have enthusiastically supported the Hand‐n‐Hand initiative from its humble beginnings, those who have volunteered to support their colleagues during these challenging times and those who have helped to promote the importance of peer support in the health care sector.
We are all founding members of the Hand‐n‐Hand peer support initiative. Kym Jenkins and Brett McDermott are also members of the #MindingCOVID writing group, which has provided resources for Hand‐n‐Hand.
Abstract
Objectives: To estimate SARS‐CoV‐2‐specific antibody seroprevalence after the first epidemic wave of coronavirus disease 2019 (COVID‐19) in Sydney.
Setting, participants: People of any age who had provided blood for testing at selected diagnostic pathology services (general pathology); pregnant women aged 20–39 years who had received routine antenatal screening; and Australian Red Cross Lifeblood plasmapheresis donors aged 20–69 years.
Design: Cross‐sectional study; testing of de‐identified residual blood specimens collected during 20 April – 2 June 2020.
Main outcome measure: Estimated proportions of people seropositive for anti‐SARS‐CoV‐2‐specific IgG, adjusted for test sensitivity and specificity.
Results: Thirty‐eight of 5339 specimens were IgG‐positive (general pathology, 19 of 3231; antenatal screening, 7 of 560; plasmapheresis donors, 12 of 1548); there were no clear patterns by age group, sex, or location of residence. Adjusted estimated seroprevalence among people who had had general pathology blood tests (all ages) was 0.15% (95% credible interval [CrI], 0.04–0.41%), and 0.29% (95% CrI, 0.04–0.75%) for plasmapheresis donors (20–69 years). Among 20–39‐year‐old people, the age group common to all three collection groups, adjusted estimated seroprevalence was 0.24% (95% CrI, 0.04–0.80%) for the general pathology group, 0.79% (95% CrI, 0.04–1.88%) for the antenatal screening group, and 0.69% (95% CrI, 0.04–1.59%) for plasmapheresis donors.
Conclusions: Estimated SARS‐CoV‐2 seroprevalence was below 1%, indicating that community transmission was low during the first COVID‐19 epidemic wave in Sydney. These findings suggest that early control of the spread of COVID‐19 was successful, but efforts to reduce further transmission remain important.