The unique COVID-19 experience in Western Australia: lessons learnt

60-day mortality and the role of SARS-CoV-2 in hospital admissions of immunocompromised patients during later Omicron period: a population-based study in Sweden

BACKGROUND

Real-world data on hospitalised SARS-CoV-2-positive patients are important for post-pandemic preventive measures.

OBJECTIVES

This study aims to explore 60-day mortality of immunocompromised patients hospitalised in later Omicron period, accounting for the relevance of COVID-19 for hospital care.

METHODS

A retrospective population-based cohort study in Östergötland County, Sweden, included all adult patients with a positive SARS-CoV-2 PCR test within 3 weeks of hospital admission. Clinical data including functional level (combined assessment of frailty and performance status), and COVID-19's impact on hospital care were collected from medical records. An adjusted binary logistic regression model was applied for the main outcome of 60-day COVID-19-related mortality, with immunosuppression as the main exposure.

RESULTS

1128 hospitalised SARS-CoV-2-positive patients were included in the analysis whereof 12.9% were immunocompromised. Hospital admission due to COVID-19 was significantly more common among immunocompromised than non-immunocompromised (71.9% vs 49.5%), and 60-day COVID-19 mortality was 10.5% and 8.0% (p = 0.41), respectively. The median age of patients hospitalised due to COVID-19 was 78 years, with most having low/very low functional levels and ≥3 comorbidities. Adjusted for possible confounders, immunosuppression showed a significantly increased risk of 60-day COVID-19-related mortality (OR 2.41, 95% CI 1.06-5.47, p = 0.04).

CONCLUSION

A majority of COVID-19-related hospitalisations during later Omicron period in a high immunity population, involved people over 70 years with low/very low functional levels and multiple comorbidities. Immunocompromised patients had a 2.5 times higher risk of 60-day COVID-19-related mortality. These findings underscore the need for targeted preventive measures in vulnerable elderly and immunocompromised populations to mitigate COVID-19-related hospitalisations and deaths.

A longitudinal study of healthcare workers' mental health during Western Australia's unique policy response to COVID-19

BACKGROUND

Western Australia's response to the COVID-19 pandemic was swift and effective in implementing public health protections and preventing the spread of the virus for the first 2 years. However, healthcare staff continued to be at increased risk of mental health concerns.

AIMS

To investigate the longitudinal patterns of post-traumatic stress symptoms (PTSS), depression and anxiety among healthcare workers in Western Australia, and the risk and protective factors associated with changes in status during the first wave.

METHOD

Participants comprised 183 healthcare staff working at tertiary hospitals and major clinics across Perth, for whom longitudinal data were available. Questionnaire data were collected before Western Australia's first major COVID-19 community wave in early 2022 and following the first wave in late 2022. Online surveys comprised validated measures assessing psychological symptoms, risk and protective factors, and original measures of workplace factors.

RESULTS

Overall rates of PTSS, depression and anxiety remained stable across the two assessment points. However, latent growth models revealed that those with lower PTSS, depression or anxiety symptoms at baseline reported a larger increase in symptoms over time, and those with higher symptoms at baseline had a smaller decline over time, indicating a 'catch-up' effect. Workplace stressors, sleep difficulties and trauma exposure were key risk factors for changes in psychological symptoms from baseline, and workplace and social supports played protective roles.

CONCLUSIONS

Improvements in systemic workplace factors are needed to support healthcare workers' mental health during periods of acute stress, even in settings with high levels of emergency preparedness.

Recognising the heterogeneity of Indigenous Peoples during the COVID-19 pandemic: a scoping review across Canada, Australia, New Zealand and the USA

Objectives

The COVID-19 pandemic has had a disproportionate impact on the health of Indigenous Peoples in Canada, Australia, New Zealand and the USA, as reflected in the growing literature. However, Indigenous Peoples are often homogenised, with key differences often overlooked, failing to capture the complexity of issues and may lead to suboptimal public health policy-making. The objective of this review was to assess the extent to which the heterogeneity of the Indigenous Peoples in Canada, Australia, New Zealand and the USA has been reflected in COVID-19 research.

Design

This study took the form of a scoping review.

Data sources

Medline, Embase, CINAHL and Web of Science were searched for studies investigating COVID-19 pandemic outcomes among Indigenous Peoples in Canada, Australia, New Zealand and the USA. The search dates included January 2019 to January 2024.

Eligibility criteria

All citations yielded by this search were subjected to title and abstract screening, full-text review and data extraction. We included original, peer-reviewed research investigating COVID-19-related outcomes among Indigenous Peoples in Canada, Australia, New Zealand or the USA.

Data extraction and synthesis

Data extraction was conducted as an iterative process, reaching consensus between two of the study authors. All included studies were analysed through a combination of quantitative descriptive summary and qualitative thematic analysis.

Results

Of the 9795 citations found by the initial search, 428 citations were deemed eligible for inclusion. Of these citations: 72.9% compared Indigenous participants to non-Indigenous participants; 10.0% aggregated Indigenous and non-white participants; and 17.1% provided findings for Indigenous participants exclusively.

Conclusions

By overlooking the heterogeneity that exists among Indigenous Peoples in Canada, Australia, New Zealand and the USA, researchers and policy-makers run the risk of masking inequities and the unique needs of groups of Indigenous Peoples. This may lead to inefficient policy recommendations and unintentionally perpetuate health disparities during public health crises.

The Western Australian experience of COVID-19 after the borders reopened: evaluation of public health modelling predictions

BACKGROUND

Western Australia (WA) serves as a unique global case study on the impact of coronavirus disease 2019 (COVID-19) on an isolated, prepared and highly vaccinated population. This study builds upon the study performed by House et al. through an extended data set.

AIM

To examine the impact of COVID-19 at the only quaternary hospital in WA following the border opening from 3 March to 17 July 2022.

PARTICIPANTS

A total of 257 adults were admitted with COVID-19 under either respiratory or the intensive care unit (ICU).

OUTCOMES

Admission numbers, disease severity, ICU admission, prevalence of COVID-19 deterioration risk factors, length of stay and mortality.

RESULTS

A total of 257 patients were admitted with COVID-19, under respiratory (81.7%) and ICU (18.3%). COVID-19 was the primary reason for admission for 67.7%. Ten patients died during the study, with seven deaths attributed to COVID pneumonitis. COVID-19 severity was 37.4% mild, 37.0% moderate, 18.3% severe and 7.4% critical. Risk factors for requiring ICU included incomplete immunisation status (P = 0.011), chronic kidney disease (P = 0.008) and Aboriginal and Torres Strait Islander (ATSI) ethnicity. The WA Department of Health predicted that the number of hospitalisations and ICU cases were significantly higher than the actual number of cases.

CONCLUSION

The number of hospitalisations and ICU COVID-19 cases were significantly less than predicted, likely due to high population vaccination rates prior to border opening. The main risk factors for COVID-19 severity were incomplete immunisation and ATSI ethnicity.