What’s your risk of catching COVID?

Several tools have been developed to help predict the chance of infection and illness depending on what you’re doing and where you are.

Since January 2020, millions have struggled with questions about what is and isn't safe to do during the pandemic.

These COVID risk calculators below can assist users while Scientists and clinicians are still learning about the epidemiology and pathology of the coronavirus SARS-CoV-2.

COVID risk calculators

Tool	Data it collects from the user	What it returns
19 and Me	Location, health status, safety precautions being taken and exposure to non-household members.	Numerical score reflecting risk of contracting COVID-19, or of developing severe disease.
MyCOVIDRisk	Location, the nature of the activity being done, the number of people involved and mask usage.	Relative risk of exposure and infection, on a scale from very low to very high.
COVID-19 Event Risk Assessment Planning Tool	Location and size of gathering.	The likelihood of coming into contact with someone who has COVID-19.
COVID-19 Mortality Risk Calculator	Information on demographic, pre-existing conditions and lifestyle.	Risk of dying from COVID-19 relative to the general population.

The full article published in Nature.com can be read here. 

Evidence check: new COVID-19 variants

Over the past few weeks there has been widespread reporting on the emergence of new variants of SARS-CoV-2, the virus that causes COVID-19.

It is known that viruses can mutate and new variants frequently occur, however two relatively recent SARS-CoV-2 variants (one first seen in the UK and one in South Africa), have been shown to be more infectious than previous strains. 

Current advice states that approved vaccines should provide protection against the variants. Public health measures including physical distancing, face masks, and limitations on large gatherings will also remain effective. However, control of a more transmissible variant may require enhanced adoption of these measures.

Read the rapid evidence check from the Agency for Clinical Innovation - COVID-19 Critical Intelligence Unit.

Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive but aim to provide a balanced assessment of what is already know about a specific problem or issue. This brief has not been peer reviewed. Information current as at 21 January 2021.

Understanding the heart - views of Aboriginal women

 An original article published recently in Heart, Lung and Circulation:

Good Heart: Telling Stories of Cardiovascular Protective and Risk Factors for Aboriginal Women, by Katherine F. McBride et. al

Heart, Lung and Circulation (2021) 30, 69–77 

https://doi.org/10.1016/j.hlc.2020.09.931

Gives health workers insight and understanding of how the women they treat view the world, as well as the knowledge and beliefs they hold as essential to maintaining heart health. An essential read for those working in Cardiovascular Care.

The adapted grounded theory study seeks to explore Australia Aboriginal women's views of cardiovascular protective and risk factors. A total of twenty-eight women from Central and South Australia participated. The women identified the heart as being central to their wellbeing, both spiritually and physically. Attributes identifies  that keep a woman's heart strong, as well as those that make it sick as well as socio-ecological factors that impact on a woman's ability to care for her heart. Identifying as Aboriginal women, the connection to family and community. having a healthy life and body and being engaged in their own health care are identified as being essential to maintaining a healthy heart.

Figure 2 Visual depiction of Aboriginal women’s stories of a strong, healthy heart.

Source: Heart, Lung and Circulation (2021) 30, 69–77 

The authors conclude that there are gaps in the way cardiovascular risk assessment is provided and managed, gaps in the cultural safety of primary health care services, and gaps in the communication of the sex-specific warning signs of a heart attack, all of which must be addressed.

"This research is unique in terms of exploring Australian Aboriginal women’s conceptualisation of heart health. Aboriginal women have identified what is important for a healthy heart; this is not matched in the delivery or quality of services to meet cultural, spiritual and psychological health needs. There is an urgent need for the health system’s responses to improve the knowledge and provision of cardiovascular risk assessment and management for women; address the emotional and cultural safety of primary health care services and; effectively communicate the warning signs of myocardial infarction to and with Aboriginal women. Further to this, addressing social, economic and political drivers are fundamental for enabling Aboriginal women to care for their heart."

Hospital Libraries and the Librarian-mediated literature search service

Did you know that the Librarians in the Mid North Coast Local Health District offer a literature search service? As NSW Health employees the library is there to support you in your work and study and this is one of the many services provided.

Why might you request a search? There are many reasons, but most often searches are requested for: research or publication, teaching or training, informing a policy or standard practice, personal study, direct patient care, quality improvement projects, and personal knowledge improvement.

How can you request a literature search? You can request a search by: directly e-mailing your librarian or library generic e-mail box, using the online form through the library’s website, filling in a hard copy form at the library, via telephone or in person. Verbal communication is often the best way to be able to correctly interpret the topic and direction of the literature you are seeking, however this is not always an option. The Librarian will e-mail or call you to clarify any points after your initial contact if required so be sure to add that contact information to your inquiry. It helps the librarian to know the purpose of the search request, whether you have any known articles on the subject, preferred age groups being studied where relevant, and the time period to be searched. 

Do you expect to find a lot of results or just a few? This can determine how specific you need to be. If the main topic has a large number of results. For example, heart failure, you need to be very specific about the patient group, age, sex, or specific circumstance.

How does this service help you? Librarian-mediated literature searching is one of the key services that health sciences librarians provide. The literature shows that health service staff can save time, gain access to evidence that can influence clinical decision making, and positively impact on patient outcomes by utilising their health Librarian.

I have my search results and want some of the articles but can't get full-text. The Library offers a document delivery service to obtain articles from your own searching or from literature searches provided by the Library. Contact the library via e-mail as linked above or request using the online form.

The Library staff at Hastings Macleay Clinical Network (based at PMBH) and Coffs Clarence Clinical Network (based at CHHC) are available to help. Check out the website to discover what we can do for you.

Can we really change our life in 28 days?

There are ways to develop good habits — and make them stick — that are backed by scientific evidence.

And it all begins in the brain.

Most of our daily life is made up of habitual actions and we run on autopilot without really noticing, such as the daily drive work when we pull up and sometimes can't remember much of the drive. 

The actions we repeat that can go on to form a habit are known as goal-directed actions.

Read this article by ABC Science reporter Belinda Smith about the science of making, breaking and replacing habits. 

Photo by Drew Beamer on Unsplash

Child protection in a COVID-19 environment - an AIHW report

Child protection services seek to protect children from abuse and neglect in family settings. One in every thirty-three children in Australia—or 174,700 children—received child protection services in 2019–20, a similar rate to 2018–19.

Child abuse or neglect suspicions are often reported by schools, child care centres, and other people or services children come into contact with. The COVID-19 pandemic has affected daily life through restrictions on people’s movements and interactions, while also affecting how businesses and services can operate— this potentially limits opportunities for child abuse and neglect to be detected and reported.

                                                                                            Source: AIHW

The pandemic has also affected the way families live and work, with many people experiencing financial hardship and other stresses. All families experience challenges when caring for their children, but the COVID-19 pandemic may have made some more vulnerable. While this does not necessarily mean a child will be harmed, these factors may impact on the likelihood of abuse and neglect occurring. The concerns raised are based on experiences from previous crises including disease outbreaks, natural disasters and financial downturns.

This Australian Institute of Health and Welfare report presents child protection data from March to September 2020 (including the ‘first wave’ of COVID-19 restrictions for Australia, and some of the ‘second wave’ of restrictions for Victoria) with comparisons to the same period in 2019. Information is also presented on a number of risk factors for child abuse and neglect, including financial and housing stress, parental mental health and substance use, and domestic violence. This report complements the regular annual national reporting on child protection, for example, Child protection Australia 2019–20 (AIHW forthcoming 2021).

What help is being offered and sought? 

Parental access to support reduces the risk of child abuse and neglect. The social and financial impact of COVID-19 restrictions may not only increase parental need for support but also make accessing support more difficult.

Recommended reading for health and other workers involved in Child Protection Services.

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) (AstraZeneca) against SARS-CoV-2.

 A recent article published in The Lancet, Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK by Merryn Voysel et al on behalf of the Oxford COVID Vaccine Trial Group.  VOLUME 397, ISSUE 10269, P99-111, JANUARY 09, 2021 DOI:https://doi.org/10.1016/S0140-6736(20)32661-1 provides the preliminary safety and efficacy analysis from ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa.

The finding show that the vaccine has efficacy ranging from 62.1% to 90% depending on dosage and or pooling of results but no safety concerns.

Contact the Library to request a copy of this article.

                                                                                                                Source: Sciencemag.org

The World Health Organisation have indicated a minimum efficacy of 50% in it's target product profile. Some infectious diseases experts have voiced concerns as to whether the Oxford AstraZeneca vaccine will be effective enough to deliver the desired herd immunity in Australia given that the Australian government has purchased 54 million doses of that vaccine as opposed to 10 million of Pfizer's more effective vaccine. It has been suggested that the government look at boosting supplies of the Pfizer and Moderna vaccines that have higher efficacy rates. 

However, a logistics problem for the vaccine efficacy frontrunners could be a pivotal factor with Australia being in the height of it's summer and average temperatures of between 21-35 degrees Celsius. The Pfizer vaccine needs to be kept extremely cold at minus 70 degrees Celsius and the Moderna vaccine at minus 20 degrees Celsius. The AstraZeneca vaccine can be stored and transported at a normal refrigerator temperature of 2 to 8 degrees Celsius. This could give this vaccine the edge as it can be stored and administered in existing healthcare settings.

Who gets what vaccine has been determined by the government -  workers dealing with international arrivals and quarantine, frontline health workers, aged care and disability workers and those living in aged care or with a disability would be first receiving the Pfizer vaccine.

The Therapeutic Goods Administration (TGA) should have enough information to make a decision on whether to approve the AstraZeneca Vaccine for use in Australia by February. The Prime Minister has confirmed that the vaccine would be voluntary.

Congratulations to MNCLHD Staff on the following Publications!

Congratulations to the highlighted Mid North Coast Local Health District staff on the publication of their articles.

Aherne, N. J., A. Dhawan, J. G. Scott and H. Enderling (2020). "Mathematical oncology and its application in non-melanoma skin cancer - A primer for radiation oncology professionals." Oral Oncol 103: 104473.

 Alqahtani, J. S., C. M. Njoku, B. Bereznicki, B. C. Wimmer, G. M. Peterson, L. Kinsman, Y. S. Aldabayan, A. M. Alrajeh, A. M. Aldhahir, S. Mandal and J. R. Hurst (2020). "Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis." Eur Respir Rev 29(156).

 Banjade, D., J. Allan, K. Thuraisingam, A. Mishra, B. Newham, S. J. E. Tan, A. Renshaw, R. Hammond, G. Stevens and G. Warr (2020). "Implementation of advanced radiotherapy technology to improve clinical outcomes in rural NSW." Aust J Rural Health 28(3): 311-316.

 Borghaei, H., C. J. Langer, L. Paz-Ares, D. Rodríguez-Abreu, B. Halmos, M. C. Garassino, B. Houghton, T. Kurata, Y. Cheng, J. Lin, M. C. Pietanza, B. Piperdi and S. M. Gadgeel (2020). "Pembrolizumab plus chemotherapy versus chemotherapy alone in patients with advanced non-small cell lung cancer without tumor PD-L1 expression: A pooled analysis of 3 randomized controlled trials." Cancer 126(22): 4867-4877.

 Cardoso, M., A. Choudhury, D. Christie, T. Eade, F. Foroudi, A. Hayden, T. Holt, A. Kneebone, G. Sasso, T. P. Shakespeare and M. Sidhom (2020). "FROGG patterns of practice survey and consensus recommendations on radiation therapy for MIBC." J Med Imaging Radiat Oncol 64(6): 882-893.

 Chojnowski, J. M., J. R. Sykes and D. I. Thwaites (2020). "Practical beam steering of X-ray beams on Elekta accelerators: The effect of focal spot alignment on beam (symmetry and position) and radiation isocentre (size and position)." Phys Eng Sci Med.

 Chojnowski, J. M., G. B. Warr, J. R. Sykes and D. I. Thwaites (2020). "Assessment of error in the MV radiation isocenter position calculated with the Elekta XVI software." J Appl Clin Med Phys 21(5): 93-97.

 Desai, J., H. Gan, C. Barrow, M. Jameson, V. Atkinson, A. Haydon, M. Millward, S. Begbie, M. Brown, B. Markman, W. Patterson, A. Hill, L. Horvath, A. Nagrial, G. Richardson, C. Jackson, M. Friedlander, P. Parente, B. Tran, L. Wang, Y. Chen, Z. Tang, W. Huang, J. Wu, D. Zeng, L. Luo and B. Solomon (2020). "Phase I, Open-Label, Dose-Escalation/Dose-Expansion Study of Lifirafenib (BGB-283), an RAF Family Kinase Inhibitor, in Patients With Solid Tumors." J Clin Oncol 38(19): 2140-2150.

 Gortman, A. M., N. J. Aherne, J. Amalaseelan, A. Last, J. Westhuyzen, L. Chamberlain and T. P. Shakespeare (2020). "Long-term outcomes of patients with conserved breast cancer treated with adjuvant hypofractionated prone breast intensity-modulated radiation therapy." J Med Imaging Radiat Oncol 64(6): 845-851.

 Grimison, P., A. Mersiades, A. Kirby, N. Lintzeris, R. Morton, P. Haber, I. Olver, A. Walsh, I. McGregor, Y. Cheung, A. Tognela, C. Hahn, K. Briscoe, M. Aghmesheh, P. Fox, E. Abdi, S. Clarke, S. Della-Fiorentina, J. Shannon, C. Gedye, S. Begbie, J. Simes and M. Stockler (2020). "Oral THC:CBD cannabis extract for refractory chemotherapy-induced nausea and vomiting: a randomised, placebo-controlled, phase II crossover trial." Ann Oncol 31(11): 1553-1560.

 Hoffmann, M., K. Waller, A. Last and J. Westhuyzen (2020). "A critical literature review on the use of bellyboard devices to control small bowel dose for pelvic radiotherapy." Rep Pract Oncol Radiother 25(4): 598-605.

 Hurley, J., M. Hutchinson, D. Kozlowski, M. Gadd and S. van Vorst (2020). "Emotional intelligence as a mechanism to build resilience and non-technical skills in undergraduate nurses undertaking clinical placement." Int J Ment Health Nurs 29(1): 47-55.

 Isobel, S., A. Wilson, K. Gill and D. Howe (2020). "'What would a trauma-informed mental health service look like?' Perspectives of people who access services." Int J Ment Health Nurs. Epub date 2020/11/22.

 Isobel, S., A. Wilson, K. Gill, K. Schelling and D. Howe (2020). "What is needed for Trauma Informed Mental Health Services in Australia? Perspectives of clinicians and managers." Int J Ment Health Nurs. Epub date 2020/11/11.

 Johnston, J. J., J. M. Longman, D. P. Ewald, M. I. Rolfe, S. Diez Alvarez, A. H. B. Gilliland, S. C. Chung, S. K. Das, J. M. King and M. E. Passey (2020). "Validity of a tool designed to assess the preventability of potentially preventable hospitalizations for chronic conditions." Fam Pract 37(3): 390-394.

 Lock, M., O. Burmeister, F. McMillan and G. Whiteford (2020). "Absence of rigorous evidence undermines cultural safety reforms." Australian Journal of Rural Health 28(1): 4-5.

 Lower, T., L. Kinsman, M. M. Dinh, D. Lyle, R. Cheney, J. Allan, A. Munro, B. Taylor, J. H. Wiggers, A. Bailey, L. Weller, A. Jacob and A. S. Stephens (2020). "Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018." Aust J Rural Health 28(5): 490-499.

 Lwin, N., J. Burgess, C. Johnston, N. Johnson and S. Chung (2020). "Hospital-in-the-Home experience of first 23 COVID-19 patients at a regional NSW hospital." Intern Med J 50(10): 1271-1273.

 Njoku, C. M., J. S. Alqahtani, B. C. Wimmer, G. M. Peterson, L. Kinsman, J. R. Hurst and B. J. Bereznicki (2020). "Risk factors and associated outcomes of hospital readmission in COPD: A systematic review." Respir Med 173: 105988.

 Rawther, T., B. J. Rebolledo, K. K. Das and N. Joshi (2020). "Circumaortic left renal vein: a rare but important anatomical variation to consider prior to a radical nephrectomy." ANZ J Surg 90(9): 1781-1782.

 Salindera, S. and M. Brennan (2020). "Development of the 'People-Processes-Paradigm' critical analysis tool for mortality and morbidity reviews: improving understanding of systems factors." ANZ J Surg 90(6): 984-990.

 Shakespeare, T. P., J. Westhuyzen, T. Lim Yew Fai and N. J. Aherne (2020). "Choosing between conventional and hypofractionated prostate cancer radiation therapy: Results from a study of shared decision-making." Rep Pract Oncol Radiother 25(2): 193-199.

 Southey, M., A. Kathirgamalingam, B. Crawford, R. Kaul, J. McNamara, F. John-Leader, J. Heslop and S. W. Pit (2020). "Patterns of ecstasy use amongst live music event attendees and their opinions on pill testing: a cross sectional study." Subst Abuse Treat Prev Policy 15(1): 55.

 Sutherland, R., E. Campbell, M. McLaughlin, N. Nathan, L. Wolfenden, D. R. Lubans, P. J. Morgan, K. Gillham, C. Oldmeadow, A. Searles, P. Reeves, M. Williams, N. Kajons, A. Bailey, J. Boyer, C. Lecathelinais, L. Davies, T. McKenzie, J. Hollis and J. Wiggers (2020). "Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 12-month implementation outcomes from a cluster randomized controlled trial." International Journal of Behavioral Nutrition & Physical Activity 17(1): 100.

 Travers, A., A. Jalali, S. Begbie, C. Semira, S. Kosmider, S. Ananda, R. Wong, M. Lee, J. Shapiro, M. Burge, D. Yip, J. Torres, B. Ma, L. Nott, A. Dean, J. Tie, A. Khattak, S. Lim, H. L. Wong and P. Gibbs (2020). "Real-World Treatment and Outcomes of Metastatic Colorectal Cancer Patients with a Poor or Very Poor Performance Status." Clin Colorectal Cancer. DOI. 10.1016/j.clcc.2020.08.002.

 Unwin, M., E. Crisp, J. Stankovich, D. McCann and L. Kinsman (2020). "Socioeconomic disadvantage as a driver of non-urgent emergency department presentations: A retrospective data analysis." PLoS One 15(4): e0231429.

Venchiarutti, R. L., J. R. Clark, C. E. Palme, T. P. Shakespeare, J. Hill, A. R. M. Tahir, P. Dwyer and J. M. Young (2020). "Influence of remoteness of residence on timeliness of diagnosis and treatment of oral cavity and oropharynx cancer: A retrospective cohort study." J Med Imaging Radiat Oncol 64(2): 261-270.

 Wilson, A., J. Hurley, M. Hutchinson and R. Lakeman (2020). "'Can mental health nurses working in acute mental health units really be trauma-informed? An integrative review of the literature." J Psychiatr Ment Health Nurs. doi: 10.1111/jpm.12717.

 Wilson, C. L., E. J. Tavender, N. T. Phillips, S. J. Hearps, K. Foster, S. L. O'Brien, M. L. Borland, G. O. Watkins, L. McLeod, M. Putland, S. Priestley, C. Brabyn, D. W. Ballard, S. Craig, S. R. Dalziel, E. Oakley and F. E. Babl (2020). "Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand." Emerg Med J 37(11): 686-689.

 Yoong, S. L., K. Bolsewicz, A. Grady, R. Wyse, R. Sutherland, R. K. Hodder, M. Kingsland, N. Nathan, S. McCrabb, A. Bauman, J. Wiggers, J. Moullin, B. Albers, M. E. Fernandez, A. Hall, J. Sims-Gould, N. Taylor, C. Rissel, A. Milat, A. Bailey, S. Batchelor, J. Attia and L. Wolfenden (2020). "Adaptation of public health initiatives: expert views on current guidance and opportunities to advance their application and benefit." Health Educ Res 35(4): 243-257.

MNCLHD Staff Publications Database - HMCN Health Services Library

Original articles on efficacy and safety of COVID 19 Vaccines

The New England Journal of Medicine has published articles recently on the important issue of safety and efficacy of vaccines being rolled out for COVID 19.

Efficacy and safety of the mRNA-1273 SARS-CoV-2 Vaccine by Lindsey R. Baden et al., for the COVE Study Group. December 30, 2020 DOI: 10.1056/NEJMoa2035389

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine by Fernando P. Polack et al., for the C4591001 Clinical Trial Group. December 31, 2020 DOI: 10.1056/NEJMoa2034577 N Engl J Med 2020; 383:2603-2615. 

These vaccines showed a 94.1% and 95% efficacy in preventing COVID 19.

Both articles have a "Quick Take" video linked into it - great visuals to share. 

                                                                                                                Source: www.nejm.org

Read the full articles or the research summaries available. NSW Health employees can download these using CIAP or request the articles from the Library using forms or direct e-mail.