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Despite relatively few COVID-19 cases within New South Wales, the uncertainty surrounding the pandemic has prevented a return to business as usual for the delivery of surgical services. This study aims to describe the evolving impact of COVID-19 on surgical activity and patient outcomes at a major public tertiary referral hospital. A retrospective cohort study involving adult surgical patients treated at a large public tertiary referral hospital in Sydney, Australia. Surgical activity, surgical outcomes and patient demographics were compared across two time periods, including the ‘first wave’ (February-May 2020 vs. February-May 2019) and the ‘perseverance phase’ (June-September 2020 vs. June-September 2019). Variables across both groups were compared using an independent t test or chi-squared test. A -32% reduction in surgical separations was observed in the ‘first wave’,...

This paper compares the direct benefits to the State of Western Australia from employing a “suppression” policy response to the COVID-19 pandemic rather than a “herd immunity” approach. An S-I-R (susceptible-infectious-resolved) model is used to estimate the likely benefits of a suppression COVID-19 response compared to a herd immunity alternative. Direct impacts of the virus are calculated on the basis of sick leave, hospitalizations, and fatalities, while indirect impacts related to response actions are excluded. Preliminary modeling indicates that approximately 1700 vulnerable person deaths are likely to have been prevented over 1 year from adopting a suppression response rather than a herd immunity response, and approximately 4500 hospitalizations. These benefits are valued at around AUD4.7 billion. If a do nothing policy had been adopted, the number of people in need of...

We compare the health and economic costs of early and delayed mandated suppression and the unmitigated spread of ‘first-wave’ COVID-19 infections in Australia in 2020. Using a fit-for-purpose SIQRM-compartment model for susceptible, infected, quarantined, recovered and mortalities on active cases, that we fitted from recorded data, a value of a statistical life year (VSLY) and an age-adjusted value of statistical life (A-VSL), we find that the economic costs of unmitigated suppression are multiples more than for early mandated suppression. We also find that using an equivalent VSLY welfare loss from fatalities to estimated GDP losses, drawn from survey data and our own estimates of the impact of suppression measures on the economy, means that for early suppression not to be the preferred strategy requires that Australia would have to incur more than 12,500-30,000 deaths, depending...

Significance of the Study. The Known. Face masks were mandated in Victoria from 23 July 2020 onward, along with a 6-week stage three lockdown which commenced on 9 July 2020. Masks reduce the risk of infection with beta-coronaviruses. The New. Without masks, a 6-week lockdown and the current control measures would likely have resulted in a resurgence in Victoria by September 2020. Masks of modest to good quality with high enough usage (at least 50% of people) can substantially improve epidemic control. Early universal mask use results in a smaller epidemic than late mask use adoption.The ImplicationsThe Victorian government’s decision to mandate mask use is supported by our research. All efforts should be made to ensure the community have the information and means to obtain or make good quality cloth masks, along with instructions on correct mask use. High levels of mask use are...

We examine the short-term labour market effects of COVID-19 and the associated national lockdown in Australia by estimating person-fixed-effects models using the Longitudinal Labour Force Survey. COVID-19 decreased labour force participation (LFP) by 2.1%, increased unemployment by 1.1% and reduced weekly working hours by 1.1. The national lockdown decreased LFP by 3.3%, increased unemployment by 1.7%, and decreased weekly working hours by 2.5. The probability of working on Fridays decreased by 10% while working fewer hours due to being on leave, work shifts, not having enough work and losing jobs all increased due to the lockdown. The pandemic and the lockdown increased underemployment and job search efforts significantly. In terms of heterogeneity of these effects, our analysis shows that those with up to high-school education experienced larger reductions in their LFP and working...

Importance Determining the best policy on social restrictions and lockdowns for the COVID-19 pandemic is challenging. Objective To determine the optimal policy response ranging from aggressive and moderate elimination, tight suppression (aiming for 1 to 5 cases per million per day) and loose suppression (5 to 25 cases per million per day). Design Two simulation models in series: an agent-based model to estimate daily SARS-CoV-2 infection rates and time in four stages of social restrictions; a proportional multistate lifetable model to estimate long-run health impacts (health adjusted life years (HALYs) arising from SARS-CoV-2) and costs (health systems, and health system plus GDP). The net monetary benefit (NMB) of each policy option at varying willingness to pay (WTP) per HALY was calculated: NMB = HALYs × WTP – cost. The optimal policy response was that with the highest NMB. ...

COVID-19 has resulted in broad impacts on the economy and aspects of daily life including our collective mental health and well-being. The Australian health care system already faces limitations in its ability to treat people with mental health diagnoses. Australia has responded to the COVID-19 outbreak by, among other initiatives, providing reimbursement for telehealth services. However, it is unclear if these measures will be enough to manage the psychological distress, depression, anxiety and post-traumatic distress shown to accompany infectious disease outbreaks and economic shocks. Decision making has focused on the physical health ramifications of COVID-19, the avoidance of over-burdening the health care system and saving lives. We propose an alternative framework for decision making that combines life years saved with impacts on quality of life. A framework that simultaneously...

Objective(s): Australia requires high quality evidence to optimise likely health and economy outcomes to effectively manage the current resurgence of COVID-19. We hypothesise that the most stringent social distancing (SD) measures (100% of level in Australia in April 2020) deliver better public health and economy outcomes. Design: Fit-for-purpose (individual-based and compartment) models were used to simulate the effects of different SD and detection strategies on Australian COVID-19 infections and the economy from March to July 2020. Public reported COVID-19 data were used to estimate model parameters. Main outcome measures: Public health and economy outcomes for multiple social distancing levels were evaluated, assessing hard versus soft lockdowns, and for early versus later relaxation of social distancing. Outcomes included costs and the timing and magnitude of observed COVID-19...

Many countries have suspended kidney transplantation programmes during the COVID-19 pandemic because of concerns for patient safety and the shortage of healthcare resources. This study aimed to describe patient, family member and potential donor perspectives on the suspension and resumption of kidney transplant programmes due to COVID-19. We conducted seven online focus groups involving 31 adult kidney transplant candidates (n = 22), caregivers (n = 4) and potential donors (n = 5). Transcripts were analysed thematically. We identified five themes: cascading disappointments and devastation (with subthemes of shattering hope, succumbing to defeat, regret and guilt); helplessness and vulnerability (fear of declining health, confronted by the threat of and change in dialysis, disconnected from health care, susceptibility to infective complications); stress from uncertainty (confusion...