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    Outcomes for patients with COVID‐19: known knowns, known unknowns, and unknown unknowns

    Mervyn Singer
    Med J Aust 2021; 214 (1): . || doi: 10.5694/mja2.50890
    Published online: 18 January 2021

    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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      A New Year, the top research articles, and a call to deliver a “net zero” Australian health care system by 2040

      Nicholas J Talley
      Med J Aust 2021; 214 (1): . || doi: 10.5694/mja2.50896
      Published online: 18 January 2021

      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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      • Medical Journal of Australia


      Correspondence: ntalley@mja.com.au
      Competing interests:

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

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        PPE for your mind: a peer support initiative for health care workers

        Tahnee L Bridson, Kym Jenkins, Kieran G Allen and Brett M McDermott
        Med J Aust 2021; 214 (1): . || doi: 10.5694/mja2.50886
        Published online: 18 January 2021

        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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        • 1 Hand‐n‐Hand Healthcare Workers Peer Support Network, Cairns, QLD
        • 2 Sunshine Coast Mental Health and Addiction Services, Sunshine Coast, QLD
        • 3 Council of Presidents of Medical Colleges, Canberra, ACT
        • 4 Monash Health, Melbourne, VIC
        • 5 College of Medicine and Dentistry, James Cook University, Townsville, QLD


        Correspondence: handnhandAU@gmail.com
        Acknowledgements: 

        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.

        Competing interests:

        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.

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          COVID‐19 and residential aged care: priorities for optimising preparation and management of outbreaks

          Georgia E Aitken, Alice L Holmes and Joseph E Ibrahim
          Med J Aust 2021; 214 (1): . || doi: 10.5694/mja2.50892
          Published online: 18 January 2021

          Recommendations to guide residential aged care facilities in preparing for and managing infectious disease outbreaks

          The coronavirus disease 2019 (COVID‐19) pandemic is devastating the residential aged care facility (RACF; eg, care homes, nursing homes, long term care) population. Globally, older people living in RACFs comprise almost half (47%) of all deaths from COVID‐19,1 which now exceeds 1.4 million deaths (at 27 November 2020).2

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          • 1 Victorian Institute of Forensic Medicine, Melbourne, VIC
          • 2 Queen Elizabeth Centre, Ballarat, VIC


          Correspondence: Joseph.Ibrahim@monash.edu
          Acknowledgements: 

          This work was supported by the Ballarat Health Service and the Department of Forensic Medicine, Monash University. None of the funders influenced the design, methods, subject recruitment, data collection, analysis or preparation of the article. We thank all the medical practitioners and nurses who participated in this study at short notice, and Safer Care Victoria for hosting and Ballarat Health Service for supporting Joseph Ibrahim’s sabbatical leave.

          Competing interests:

          No relevant disclosures.

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            Health and climate change MJA–Lancet Countdown report: Australia gets another failing grade in 2020 but shows signs of progress

            Nicholas J Talley, Fiona J Stanley, Tamara Lucas and Richard C Horton
            Med J Aust 2021; 214 (2): . || doi: 10.5694/mja2.50895
            Published online: 21 December 2020

            At the end of 2019 and into 2020, catastrophic fires in Australia consumed homes, lives, wildlife and land. Just as the fires subsided, Australia, like the rest of the world, faced another emergency — the COVID‐19 pandemic.1 It is instructive to reflect on lessons from the health disasters of the past year.

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            • 1 University of Newcastle, Newcastle, NSW
            • 2 Editor‐in-Chief, Medical Journal of Australia, Sydney, NSW
            • 3 Telethon Kids Institute, Perth, WA
            • 4 University of Western Australia, Perth, WA
            • 5 Executive Editor, The Lancet, London, UK
            • 6 Editor‐in-Chief, The Lancet, London, UK


            Competing interests:

            A complete list of Nick Talley’s disclosures is available at https://www.mja.com.au/journal/staff/editor-chief-professor-nick-talley.

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              The year of the ‘rona: an uncontrolled trial in verse

              Rob D Mitchell
              Med J Aust 2020; 213 (11): . || doi: 10.5694/mja2.50878
              Published online: 14 December 2020

              These days of 2020
              Have seen ravages aplenty
              An “unprecedented” year born in ash and smoke and flame.

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              • 1 Emergency and Trauma Centre, Alfred Hospital, Melbourne, VIC
              • 2 Monash University, Melbourne, VIC


              Correspondence: ro.mitchell@alfred.org.au
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                What the forks? A longitudinal quality improvement study tracking cutlery numbers in a public teaching and research hospital staff tearoom

                Mark Mattiussi, Amelia Livermore, Annabel Levido, Therese Starr, Melissa Lassig‐Smith, Janine Stuart, Cheryl Fourie and Joel Dulhunty
                Med J Aust 2020; 213 (11): . || doi: 10.5694/mja2.50862
                Published online: 14 December 2020

                Abstract

                Objectives: To evaluate the circulation lifespan of forks and teaspoons in an institutional tearoom.

                Design: Longitudinal quality improvement study, based on prospective tracking of marked teaspoons and forks.

                Setting: Staff tearoom in a public teaching and research hospital, Brisbane.

                Participants: Tearoom patrons blinded to the purposes of the study.

                Intervention: Stainless steel forks and teaspoons (18 each) were marked with red spots and introduced alongside existing cutlery (81 items) in the tearoom.

                Main outcome measures: Twice weekly count of marked forks and teaspoons for seven weeks; baseline and end of study count of all utensils on day 45.

                Results: The loss of marked teaspoons (six of 18) was greater than that of forks (one of 18) by the conclusion of the study period (P = 0.038). The overall rate of utensil loss was 2.2 per 100 days for teaspoons and spoons, and –2.2 per 100 days for forks and knives.

                Conclusions: Teaspoon disappearance is a more substantial problem than fork migration in a multidisciplinary staff tearoom, and may reflect different kleptomaniacal or individual appropriation tendencies. If giving cutlery this Christmas, give teaspoons, not forks. The symbolism of fork rebirth or resurrection is appropriate for both Christmas and Easter, and forks are also mighty useful implements for eating cake!

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                • 1 Royal Brisbane and Women's Hospital, Brisbane, QLD
                • 2 The University of Queensland, Brisbane, QLD
                • 3 Centre for Clinical Research, The University of Queensland, Brisbane, QLD


                Acknowledgements: 

                This study was undertaken with in kind support by the Royal Brisbane and Women’s Hospital Critical Care and Clinical Support Services Directorate; Cheryl Fourie contributed OPI Got the Blues for Red nail lacquer. We extend special thanks to Gordon McGurk, chair of the Royal Brisbane and Women’s Hospital Human Research Ethics Committee, whose insightful comments feature in our report.

                Competing interests:

                No relevant disclosures.

                • 1. Lim MS, Hellard ME, Aitken CK. The case of the disappearing teaspoons: longitudinal cohort study of the displacement of teaspoons in an Australian research institute. BMJ 2005; 331: 1498–1500.
                • 2. Metro North Hospital and Health Service (Brisbane). Vision and values. Updated July 2018. https://metro​north.health.qld.gov.au/about​-us/visio​n-and-values (viewed July 2020).
                • 3. Metro North Hospital and Health Service (Brisbane). Shaun Drummond: values in action at Metro North HHS [video]. 8 May 2018. https://vimeo.com/26852​3248 (viewed July 2020).
                • 4. Moore C. Australia’s “Shawshank redemption”: Some of the country’s most violent criminals use spoons and forks to remove bricks from their cell before plans to dig their way out are thwarted. Daily Mail Australia, 16 Sept 2019. https://www.daily​mail.co.uk/news/artic​le-74670​87/Austr​alias​-Shaws​hank-Redem​ption​-Priso​ners-caugh​t-diggi​ng-Port-Phill​ip-Prison.html (viewed July 2020).
                • 5. Hoyle C. Who stole all the forks? The science of missing office cutlery. Stuff (Wellington, New Zealand), 15 Apr 2017. https://www.stuff.co.nz/busin​ess/91303​980/who-stole​-all-the-forks​-the-scien​ce-of-missi​ng-offic​e-cutlery (viewed July 2020).
                • 6. Leedo E, Beck AM, Astrup A, Lassen AD. The effectiveness of healthy meals at work on reaction time, mood and dietary intake: a randomised cross‐over study in daytime and shift workers at an university hospital. Br J Nutr 2017; 118: 121–129.
                • 7. Morrison D. The happiness of the city and the happiness of the individual in Plato’s Republic. Ancient Philosophy 2001; 21: 1–24.
                • 8. Kelly PJ. Utilitarianism and distributive justice: the civil law and the foundations of Bentham’s economic thought. Utilitas 1989; 1: 62–81.
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                • 10. Nuño‐Maganda MA, Herrera‐Rivas H, Torres‐Huitzil C, et al. On‐device learning of indoor location for WiFi fingerprint approach. Sensors (Basel) 2018; 18: 2202.
                • 11. Hornyak R, Lewis M, Sankaranarayan B. Radio frequency identification‐enabled capabilities in a healthcare context: an exploratory study. Health Informatics J 2016; 22: 562–578.
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                  Scientists in pyjamas: characterising the working arrangements and productivity of Australian medical researchers during the COVID‐19 pandemic

                  David G Chapman and Cindy Thamrin
                  Med J Aust 2020; 213 (11): . || doi: 10.5694/mja2.50860
                  Published online: 14 December 2020

                  Abstract

                  Objective: To characterise the working arrangements of medical research scientists and support staff in Australia during the COVID‐19 pandemic, and to evaluate factors (in particular: wearing pyjamas) that influence the self‐assessed productivity and mental health of medical institute staff working from home.

                  Design: Prospective cohort survey study, 30 April – 18 May 2020.

                  Setting, participants: Staff (scientists and non‐scientists) and students at five medical research institutes in Sydney, New South Wales.

                  Main outcome measures: Self‐assessed overall and task‐specific productivity, and mental health.

                  Results: The proportions of non‐scientists and scientists who wore pyjamas during the day were similar (3% v 11%; P = 0.31). Wearing pyjamas was not associated with differences in self‐evaluated productivity, but was significantly associated with more frequent reporting of poorer mental health than non‐pyjama wearers while working from home (59% v 26%; P < 0.001). Having children in the home were significantly associated with changes in productivity. Larger proportions of people with toddlers reported reduced overall productivity (63% v 32%; P = 0.008), and reduced productivity in writing manuscripts (50% v 17%; P = 0.023) and data analysis (63% v 23%; P = 0.002). People with primary school children more frequently reported reduced productivity in writing manuscripts (42% v 16%; P = 0.026) and generating new ideas (43% v 19%; P = 0.030). On a positive note, the presence of children in the home was not associated with changes in mental health during the pandemic. In contrast to established researchers, early career researchers frequently reported reduced productivity while working at home.

                  Conclusions: Our findings are probably applicable to scientists in other countries. They may help improve work‐from‐home policies by removing the stigma associated with pyjama wearing during work and by providing support for working parents and early career researchers.

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                  • 1 Woolcock Institute of Medical Research, Sydney, NSW
                  • 2 University of Technology Sydney, Sydney, NSW
                  • 3 The University of Sydney, Sydney, NSW


                  Acknowledgements: 

                  We thank the survey respondents for their participation and time, and for the candid free text responses that provided much amusement to the researchers, no doubt alleviating the impact of the COVID‐19 pandemic on our own mental health (and hopefully theirs as well). We also thank the many electronic devices and children’s television shows that provided the necessary distraction for our children, allowing this research to be completed.

                  Competing interests:

                  No relevant disclosures.

                  • 1. National Health and Medical Research Council. COVID‐19: Guidance on clinical trials for institutions, HRECs, researchers and sponsors. Mar 2020. https://www.nhmrc.gov.au/sites/default/files/documents/attachments/ctprg-statement-clinical-trials-covid.pdf (viewed Oct 2020).
                  • 2. Servick K, Cho A, Guglielmi G, et al. Updated: labs go quiet as researchers brace for long‐term coronavirus disruptions. Science [online], 16 Mar 2020. https://www.sciencemag.org/news/2020/03/updated-labs-go-quiet-researchers-brace-long-term-coronavirus-disruptions (viewed Sept 2020).
                  • 3. van der Lippe TL, Lippényi Z. Co‐workers working from home and individual and team performance. New Technol Work Employ 2020; 35: 60–79.
                  • 4. Chan C, Oey NE, Tan EK. Mental health of scientists in the time of COVID‐19. Brain Behav Immun 2020; 88: 956.
                  • 5. Delmas H, Batail JM, Falissard B, et al. A randomised cross‐over study assessing the “blue pyjama syndrome” in major depressive episode. Sci Rep 2017; 7: 2629.
                  • 6. Oliver D. Fighting pyjama paralysis in hospital wards. BMJ 2017; 357: j2096.
                  • 7. Ferrers RA. Enhancing NBN’s value: comparing NBN with Australia's top 10 trading partners and OECD. Journal of Telecommunications and the Digital Economy 2020; 8(2): 1–17.
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                  • 9. Inouye DW, Underwood N, Inouye BD, Irwin RE. Support early‐career field researchers. Science 2020; 368: 724.
                  • 10. Levecque K, Anseel F, De Beuckelaer A, et al. Work organization and mental health problems in PhD students. Research Policy 2017; 46: 868–879.
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                  • 12. Paula JR. Lockdowns due to COVID‐19 threaten PhD students’ and early‐career researchers’ careers. Nat Ecol Evol 2020; 4: 999.
                  • 13. Blume C, Schmidt MH, Cajochen C. Effects of the COVID‐19 lockdown on human sleep and rest–activity rhythms. Curr Biol 2020; 30: R795–R797.
                  • 14. Adam H, Galinsky AD. Enclothed cognition. J Exp Soc Psychol 2012; 48: 918–925.
                  • 15. Moore A. “FIT TO SIT” in the emergency department. Nurs Stand 2017; 32: 22–23.
                  • 16. Fernandez C. 14 perfect work‐from-home outfits that feel like pajamas without looking like them. Business Insider Australia [online], 1 Apr 2020. https://www.businessinsider.com.au/work-from-home-loungewear-clothes-to-try-2020-3 (viewed July 2020).
                  • 17. Pinho‐Gomes AC, Peters S, Thompson K, et al. Where are the women? Gender inequalities in COVID‐19 research authorship. BMJ Global Health 2020; 5: e002922.
                  • 18. Myers KR, Tham WY, Yin Y, et al. Unequal effects of the COVID‐19 pandemic on scientists. Nat Hum Behav 2020; 4: 880–883.
                  • 19. Johnston E; Office of the Chief Scientist. The impact of the COVID‐19 pandemic on women in the STEM workforce. May 2020. https://www.science.org.au/covid19/women-stem-workforce (viewed Oct 2020).
                  • 20. Gewin V. The career cost of COVID‐19 to female researchers, and how science should respond. Nature 2020; 583: 867–869.
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                    Health and medicine in a pandemic year: moving from the “winter of despair” to the “spring of hope”

                    Nicholas J Talley
                    Med J Aust 2020; 213 (11): . || doi: 10.5694/mja2.50861
                    Published online: 14 December 2020

                    Despite a year of floods, fires and pestilence, we approach 2021 with optimism

                    It has been a strange and disturbing year. Here in Australia, we would usually now be looking forward to the long summer break, the barbeques and the parties, the leisure time at home. Many would be traveling overseas to visit friends and family. But these have not been normal times.

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                    Correspondence: ntalley@mja.com.au
                    Acknowledgements: 

                    I thank the tireless efforts of the Editorial team throughout 2020, without which the quality and timely publication of our Journal in print and online would not be possible: our departing Head of Publishing Content, Lilia Kanna; our former Senior Deputy Medical Editor, Christine Gee; Deputy Medical Editors Francis Geronimo, Robyn Godding, Tania Janusic, Selina Lo, Wendy Morgan, Aajuli Shukla, and Zoë Silverstone; 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; and our Senior Publishing Coordinator, Kerrie Harding.

                    Competing interests:

                    A complete list of disclosures is available at https://www.mja.com.au/journ​al/staff/editor-chief-professor-nick-talley

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                      Enough seagulls! Rural and remote communities need local researchers living, walking and talking with locals

                      Ruth Stewart
                      Med J Aust 2020; 213 (11): . || doi: 10.5694/mja2.50857
                      Published online: 7 December 2020

                      Researchers who live and work in community can respond to local clinical questions and provide feedback to community on their findings

                      Australians enjoy some of the best health outcomes in the world1 and those benefits are concentrated in our urban centres. Australians who live in rural and remote Australia have poorer health than their urban peers. The more remote your residence, the shorter your life span and the greater the burden of disease carried by your community.2


                      • Australian Government Department of Health, National Rural Health Commissioner, Canberra, ACT


                      Correspondence: NRHC@health.gov.au
                      Competing interests:

                      No relevant disclosures.

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