In the COVID-19 pandemic, the Australian Government has made key decisions that directly impact the economy and the daily lives of every Australian. The purpose of these decisions has been to slow the rate of infection, otherwise known as to “flatten the curve”, and ensure the health system continues to operate efficiently and effectively, especially if presented with large numbers of infected patients. To date, this has resulted in Australia having one of the highest testing rates and lowest confirmed cases and deaths in the world, per capita. 

The George Institute believes the Australian Government’s long-term investment in health and medical research has helped Australia effectively respond to the COVID-19 pandemic. This includes ongoing support for the National Health and Medical Research Council (NHMRC) and establishing the $20 billion Medical Research Future Fund (MRFF). In the post pandemic recovery, further government support and investment in health and medical research will ensure Australia remains innovative and competitive.  

Like most businesses and not-for-profit organisations, The George Institute has been impacted by the COVID-19 pandemic. As a global medical research institute, we are continuing our work to improve the health of millions of people worldwide. There is much work ahead to better understand the long-term health implications from patients with COVID-19, particularly those who have co-morbidities and non-communicable diseases.

The George Institute welcomes the opportunity to make this submission to the Senate Select Committee on COVID-19. There are seven key recommendations related to the Australian Government's response to the COVID-19 pandemic and related matters, including the importance of investing in medical research and targeting non-communicable diseases.

Download full submission here.

The bushfires during the summer of 2019-20 were tragic for Australia, both for communities that were directly affected by fire through the loss of their homes and/or livelihoods; and for millions of Australians who were affected by the fires through exposure to smoke and witnessing the horrific scenes reported in the media. This has significantly impacted the health and wellbeing of Australians.  
 
Whilst bushfires raged, Australia experienced its hottest year on record in 2019 in addition to the ongoing drought impacting many parts of the country. The George Institute believes high temperatures, bushfires and drought is largely due to human-induced climate change.  
 
The long-term impacts of climate change on our health are not yet fully understood, particularly concerning prolonged exposure to smoke and pollutant particles. The Federal Government should be taking swift and comprehensive action to combat the impacts of climate change, according to recommendations by the World Health Organization, the United Nations Sustainable Development Goals 7, 11, 12, 13, 14 and 15 and The Paris Agreement. 

The George Institute for Global Health welcomes the opportunity to contribute a submission to the Australian Senate on "Lessons to be learned in relation to the Australian bushfire season 2019-20". 

Download full submission here.

Background & objectives:
The potential benefits of mobile health (mHealth) initiatives to manage the coronavirus disease-2019 (COVID-19) pandemic have been explored. The Government of India, State governments, and healthcare organizations have developed various mobile apps for the containment of COVID-19. This study was aimed to systematically review COVID-19 related mobile apps and highlight gaps to inform the development of future mHealth initiatives.

Methods:
Google Play and the Apple app stores were searched using the terms ‘COVID-19’, ‘coronavirus’, ‘pandemic’, and ‘epidemic’ in the first week of April 2020. A list of COVID-19-specific functions was compiled based on the review of the selected apps, the literature on epidemic surveillance, and national and international media reports. The World Health Organization guideline on Digital Health Interventions was used to classify the app functions under the categories of the general public, health workers, health system managers, and data services.

Results:
The search yielded 346 potential COVID-19 apps, of which 50 met the inclusion criteria. Dissemination of untargeted COVID-19-related information on preventative strategies and monitoring the movements of quarantined individuals was the function of 27 (54%) and 19 (32%) apps, respectively. Eight (16%) apps had a contact tracing and hotspot identification function.

Interpretation & conclusions:
Our study highlights the current emphasis on the development of self-testing, quarantine monitoring, and contact tracing apps. India’s response to COVID-19 can be strengthened by developing comprehensive mHealth solutions for frontline healthcare workers, rapid response teams and public health authorities. Among this unprecedented global health emergency, the Governments must ensure the necessary but least intrusive measures for disease surveillance

This project assessed the benefits of implementing the salt reduction programs throughout the whole of Australia, leading to the prevention of stroke and CHD events, reduction in healthcare need, informal care, and productivity costs. These benefits are compared with the cost of implementing the three different salt reduction programs.

The economic modeling explores the effect of varying levels of salt reduction through three types of salt reduction programs: (1) mandatory salt reduction legislation, which requires food manufacturers to comply with maximum salt targets across a wide range of processed foods, (2) voluntary participation of food manufacturers in limiting salt use in processed foods, and (3) a community health program for the prevention of cardiovascular diseases

Results showed that by reducing salt intake by 1 g/day across Australia, the number of potentially saved lives each year is estimated to be 1,364, with an estimated 2,626 strokes and 2,526 CHD events avoided.

The estimated social return on investment of implementing salt reduction programs across Australia is that for each dollar invested in a salt reduction program, $2.40 for a community program, $5.70 for a voluntary program, and $10 for a mandatory program are returned to society.

These findings demonstrate that whilst all programs produce a positive return on investment, the mandatory salt reduction program is likely to yield the best social return on investment from the prevention of cardiovascular events.

Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of mortality and morbidity in India. They have shown an increasing trend in their incidence in the past two decades. The State Health Resource Centre (SHRC), Chhattisgarh identified that there is a high burden of these two health conditions in the State, particularly in areas with high levels of industrial pollution. The Centre requested our RES team to review the existing evidence on prevention of asthma and COPD from a Low-and-Middle Income Countries (LMIC) perspective.

The rapid review thus conducted provided the SHRC with a summary of evidence-based policy considerations to enable decision makers in better managing and preventing asthma and COPD at the primary healthcare level in Chhattisgarh. The key policy considerations presented are:

Primary prevention for Asthma:

1. Parents should be advised to ensure that children are not exposed to environmental tobacco smoke during pregnancy or after birth.
2. Caesarean section increases the risk of childhood asthma. Vaginal delivery should be encouraged, unless medically indicated.
3. Exclusive breastfeeding, where possible is recommended for its overall health benefits.
4. Doctors should advise parents to avoid use of broad-spectrum antibiotics during the first year of a child’s life.
5. Lifestyle modification, including guided weight-loss programmes, exercise and diet should be offered in primary health care centres to obese and overweight children.
6. Dietary restrictions, unguided weight loss or changes during pregnancy should be discouraged for primary prevention of asthma in children.
7. Allergen avoidance as a general strategy for the primary prevention of asthma should be discouraged.

Primary prevention of chronic obstructive pulmonary disease (COPD)

1. Identification and reduction of exposure to risk factors (low birth weight, poor nutrition, acute respiratory infections of early childhood, indoor, outdoor and occupational air pollution) are recommended for primary prevention of COPD.
2. At-risk persons such as pregnant women should avoid exposure to occupational and environmental pollution, including passive tobacco smoke exposure.
3. Community awareness and multi-sectoral co-ordination are required to prevent indoor air pollution (usually from wood and coal for cooking), which is a key risk factor for COPD. Provisions of the Ujjwala Yojana should be used to provide and encourage LPG connections. Additional provisions beyond the free cylinders limit should be considered by the state.
4. Employers should relocate people who are at high-risk for COPD from areas with occupational dust or high air pollution. If this is not possible, employers need to adopt appropriate workplace dust-mitigation measures and/or provide government approved masks that provide adequate respiratory protection.
5. People should be advised on maintaining healthy lifestyle (including healthy diet and nutritional habits), and regular physical activity (for at least for 30 minutes a day).

The full policy brief and technical supplement document are available below:

Download policy brief (PDF 201 KB)

Download supplement document (PDF 323 KB)

Many of the present discussions and debates in Australia relating to sugar have focused on the implementation of a sugar tax or sugar-sweetened beverage levy—policy concepts that are often polarising and that have currently exhibited little traction. Additionally, even where implemented, a tax on certain sugary products would only be one small step, part of a solution to a much greater problem. 

A new report builds on the comprehensive overview by Vanessa Clarkson commissioned by The George Institute and published on February 2020, ‘Sugar in Australia: A Food Systems Approach: Competing Issues, Diverse Voices, and Rethinking Pathways to a Sustainable Transition’, to broaden the debate on sugar in Australia so that the entire system is considered, including sugar’s effects on people and the environment.

One in two Australians has one or more chronic diseases such as heart disease, stroke, or diabetes. Two in three adults are either overweight or obese, and one in four children are obese, with excess sugar consumption being a key contributor to obesity and diabetes.

In terms of the environment, sugar cane production is a significant consumer of Australia’s water supplies and the polluted run-off is damaging to natural ecosystems like the Great Barrier Reef.

The expert consensus report, Sweet Transition: Priorities for collaborating to transform the food system in Australia, is the outcome of a roundtable hosted by The George Institute for Global Health and calls for a whole of government, the whole of system approach to mitigate the broad impacts of sugar.

Chronic Obstructive Pulmonary Disease (COPD) contributes significantly to health systems burden in terms of primary care consultation, emergency visits and in-patient admissions. The public health systems are under strain due to COVID-19, across the world. Preventing acute exacerbations of COPD is crucial to ensure the health system is not burdened further.

This report summarises how hospital admission for acute exacerbations of COPD might be decreased through institutionalisation of self-management and written action plans for patients. The evidence summary informs governments about modalities for decreasing hospital burden through a patient -centric approach which can be delivered during COVID-19 and beyond

Key policy considerations are:

1. Patients with COPD should be oriented to use self-management strategies with a written action plan for worsening of symptoms. There is evidence that it improves health-related quality of life (high-quality evidence) and reduces hospital admissions due to respiratory problems (moderate-quality evidence).
2. Self‐management and action plans might be delivered by primary healthcare team during follow-up home visits for (as mandated by MoHFW, India guidance note on delivery of essential health services during COVID-19). Primary healthcare teams should be trained for this purpose.  
3. Self-management plans should be individualised with an assessment of COPD and developed based on discussions with patients. Self-management action plans may be delivered in writing (hard copy or digital), verbally or through audio-visual media. Action plans should include guidance and instructions on smoking cessation, self-recognition of COPD exacerbations, and structured education regarding COPD. For safety reasons, action plans should consider co-morbidities and ability to access care rapidly on further exacerbations. 

The document provides a summary of evidence from a single high-quality systematic review which uses reproducible, systematic and robust methods to summarise evidence from multiple research studies (in this case randomised controlled trials) to inform decision making. We summarise effect estimates but also the quality of evidence using the WHO recommended GRADE criteria. 

Download full report (PDF 328 KB)

This report is a part of the “Ensuring Health Systems Capacity for COVID-19 and Beyond: Evidence Series” .
The series aims to provide high quality and contextualised evidence from systematic reviews or rapid evidence synthesis to work on the opportunity the COVID-19 scenario offers i.e., to build a strong, resilient and equitable health system in India and other low and middle income countries.

COVID-19 is an unprecedented pandemic which has led to millions being affected and thousands dying every day across the world.  The Government of India has announced a 21-day lockdown to prevent COVID-19 transmission in India -essentially buying time for health systems to be better prepared. While tertiary care systems are also being prepared it is important to ensure preparedness of Primary Health Centres.

Towards this mammoth effort, the Indian medical and public health community is contributing in a big way. To ensure preparedness of Primary Health Centres in rural/community settings, 15 clinicians and public health experts from leading institutions, including The George Institute for Global Health, India formed the COVID-19 PHC Action Group. The COVID-19 PHC Action group,  a collaborative is led by Dr Prashanth NS, Institute of Public Health, Bangalore. Dr Soumyadeep Bhaumik from The George Institute for Global Health has contributed majorly to development of the policy resource.

The initial public version was released on 27th March 2020. The current and final version has been disseminated and shared with multiple state governments and other stakeholders.

COVID-19 is a respiratory illness caused by a newly discovered coronavirus was first reported in Wuhan, China in December 2019. Subsequently it has spread to 187 countries and territories with more than 294,110 cases and 12,944 deaths globally.

Countries across the world are introducing measures to prevent its spread, increasing capacity for quarantine and building capacity of hospitals (particularly intensive care units) to manage positive cases. With efforts to prevent community transmission of COVID-19 being a top priority, ensuring preparedness of frontline health workers (FLHWs) is essential.

The Government of India is embarking on a mammoth task to prevent COVID-19 spread among communities. The Rapid Evidence Synthesis team received a request to support the planning and development of resources for ensuring preparedness of FLHWs for COVID-19 . The rapid evidence synthesis was conducted in a period of three days.

The findings highlight what we can learn from recent pandemics such that we are prepared for potential scenarios and challenges due to COVID-19. Key issues which decision-makers need to consider, based on available evidence are:

1. FLHWs will be at an increased risk of COVID-19, even in the course of their normal activities. It is essential to provide personal protective equipment (gloves, surgical masks, hand sanitisers; N95 masks if involved in contact tracing) in adequate quantity. This should be accompanied by training on proper usage in the early phase itself.
2. Disruption in supply-chain, logistics and supportive supervision might be expected and this would impact routine service delivery. Advice should be given on which activities are to continue and which might be postponed. Guidelines and protocols for conducting additional activities and training is required.
3. Engaging FLHWs who continue to perform routine service delivery in additional contact identification and listing, is not without its risk including that of transmission of COVID-19. A role focussed on creating awareness and support for prevention and countering social stigma is recommended for FLHWs.
4. FLHWs might experience stigmatisation, isolation and been socially ostracised. Providing psychosocial support, non-performance-based incentives, additional transport allowance, child-care support should be planned. Awards and recognition are required for motivation.
5. Social distancing related measures might not be appropriate in many contexts like urban slums, large/joint families, those living in small houses and the homeless.

The rapid evidence synthesis goes beyond research evidence and integrates multiple types and levels of evidence from across the world. The inventories provided serve as a ready resource guide for any country considering the use of FLHWs to control COVID-19.

The full rapid evidence synthesis and supporting appendices are available below

Download full report (PDF 319 KB)

• Download Appendices for Frontline health workers in COVID-19 prevention and control: rapid evidence synthesis (PDF 381 KB)

• Download COVID-19 myths and facts poster (PDF 607 KB)

• Download Recommendations on the role of CHWs in the COVID-19 response poster (PDF 1.6 MB)

• Download Community health workers for pandemic response: rapid evidence synthesis (PDF 473 KB)

This report is a part of the “Ensuring Health Systems Capacity for COVID-19 and Beyond: Evidence Series”.
The series aims to provide high quality and contextualised evidence from systematic reviews or rapid evidence synthesis to work on the opportunity the COVID-19 scenario offers i.e., to build a strong, resilient and equitable health system in India and other low and middle income countries.

External Resources

Community health workers for pandemic response: a rapid evidence synthesis - an article published in BMJ Global Health