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      Consequences of physical distancing emanating from the COVID-19 pandemic: An australian perspective

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          Abstract

          The sobering reality of the COVID-19 pandemic is that it has brought people together at home at a time when we want them apart in the community. This will bring both benefits and challenges. It will affect people differently based upon their age, health status, resilience, family support structures, and socio-economic background. This article will assess the impact in high income countries like Australia, where the initial wave of infection placed the elderly at the greatest risk of death whilst the protective measures of physical distancing, self-isolation, increased awareness of hygiene practices, and school closures with distance learning has had considerable impact on children and families acutely and may have ramifications for years to come.

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          Most cited references26

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          The effect of public health measures on the 1918 influenza pandemic in U.S. cities.

          During the 1918 influenza pandemic, the U.S., unlike Europe, put considerable effort into public health interventions. There was also more geographic variation in the autumn wave of the pandemic in the U.S. compared with Europe, with some cities seeing only a single large peak in mortality and others seeing double-peaked epidemics. Here we examine whether differences in the public health measures adopted by different cities can explain the variation in epidemic patterns and overall mortality observed. We show that city-specific per-capita excess mortality in 1918 was significantly correlated with 1917 per-capita mortality, indicating some intrinsic variation in overall mortality, perhaps related to sociodemographic factors. In the subset of 23 cities for which we had partial data on the timing of interventions, an even stronger correlation was found between excess mortality and how early in the epidemic interventions were introduced. We then fitted an epidemic model to weekly mortality in 16 cities with nearly complete intervention-timing data and estimated the impact of interventions. The model reproduced the observed epidemic patterns well. In line with theoretical arguments, we found the time-limited interventions used reduced total mortality only moderately (perhaps 10-30%), and that the impact was often very limited because of interventions being introduced too late and lifted too early. San Francisco, St. Louis, Milwaukee, and Kansas City had the most effective interventions, reducing transmission rates by up to 30-50%. Our analysis also suggests that individuals reactively reduced their contact rates in response to high levels of mortality during the pandemic.
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            Is Open Access

            COVID-19: ICU delirium management during SARS-CoV-2 pandemic

            The novel coronavirus, SARS-CoV-2-causing Coronavirus Disease 19 (COVID-19), emerged as a public health threat in December 2019 and was declared a pandemic by the World Health Organization in March 2020. Delirium, a dangerous untoward prognostic development, serves as a barometer of systemic injury in critical illness. The early reports of 25% encephalopathy from China are likely a gross underestimation, which we know occurs whenever delirium is not monitored with a valid tool. Indeed, patients with COVID-19 are at accelerated risk for delirium due to at least seven factors including (1) direct central nervous system (CNS) invasion, (2) induction of CNS inflammatory mediators, (3) secondary effect of other organ system failure, (4) effect of sedative strategies, (5) prolonged mechanical ventilation time, (6) immobilization, and (7) other needed but unfortunate environmental factors including social isolation and quarantine without family. Given early insights into the pathobiology of the virus, as well as the emerging interventions utilized to treat the critically ill patients, delirium prevention and management will prove exceedingly challenging, especially in the intensive care unit (ICU). The main focus during the COVID-19 pandemic lies within organizational issues, i.e., lack of ventilators, shortage of personal protection equipment, resource allocation, prioritization of limited mechanical ventilation options, and end-of-life care. However, the standard of care for ICU patients, including delirium management, must remain the highest quality possible with an eye towards long-term survival and minimization of issues related to post-intensive care syndrome (PICS). This article discusses how ICU professionals (e.g., physicians, nurses, physiotherapists, pharmacologists) can use our knowledge and resources to limit the burden of delirium on patients by reducing modifiable risk factors despite the imposed heavy workload and difficult clinical challenges posed by the pandemic.
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              The persistent legacy of the 1918 influenza virus.

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                Author and article information

                Contributors
                Journal
                Paediatr Respir Rev
                Paediatr Respir Rev
                Paediatric Respiratory Reviews
                Published by Elsevier Ltd.
                1526-0542
                1526-0550
                11 June 2020
                11 June 2020
                Affiliations
                [a ]Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney, New South Wales, 2145, Australia
                [b ]Discipline of Child and Adolescent Health, Sydney Medial School, Faculty of Health Sciences, University of Sydney, New South Wales, 2145, Australia
                [c ]Department of Psychological Medicine, The Children’s Hospital at Westmead, Sydney, New South Wales, 2145, Australia
                [d ]Department of Infectious Diseases, The Children’s Hospital at Westmead, Sydney, New South Wales, 2145, Australia
                Author notes
                [* ]Corresponding author at: Department of Respiratory Medicine, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia Dominic.fitzgerald@ 123456health.nsw.gov.au
                Article
                S1526-0542(20)30090-7
                10.1016/j.prrv.2020.06.005
                7289084
                32690355
                a6deb0b0-9b66-4dd7-a2f2-fd837d76bbba
                © 2020 Published by Elsevier Ltd.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 4 June 2020
                : 4 June 2020
                Categories
                Article

                covid 19,sars-cov-2,social distancing,isolation,infection,psychological trauma,education

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