Discussion
World Health Organization. Weekly Operational Update on COVID-19 – December 29, 2020 Geneva: World Health Organization; 2020 [Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update—29-december-2020.
]. There were 111 deaths per million, reflecting the high burden of residential care for the elderly, despite the relatively low incidence, as has been documented internationally [
- Yanez ND
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- judge Romand
- Treggiari MM.
,
- Garg S
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- et al.
].
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- et al.
]and the impacts on mortality. However, data limitations included quality, usability, changing definitions, and changing data collection practices. For example, the proportion of symptomatic cases at the time of testing should be interpreted in light of changes in testing criteria and the completeness of data collection at the height of phase 3, when interviews with cases have been completed. been shortened and symptom data has not been systematically collected, especially in some large epidemic settings, such as elderly care and health care.
The epidemiological features of the Victoria COVID-19 outbreaks described here highlight the challenges of effective prevention and control of SARS-CoV-2, none of which is unique to our environment. There were notable differences in the main epidemiological characteristics of the Victoria epidemic phases. There was a shift towards younger age groups: the highest cumulative incidence rates (adjusted for population size) of phase I were in the 20-29 age groups years and 50-74 year olds, while the highest cumulative incidence rates in phase III were those aged 80. + (associated with the care of the elderly) and 18-29 years (associated with the essential workforce). Phase I (and later IV) was also characterized by foreign acquired infection among cases of high socioeconomic position, while phase III was characterized by locally acquired infections among younger and socially disadvantaged communities. . During this phase, proportionally more cases came from non-English speaking backgrounds.
Consistent with the increase in cases among culturally and linguistically diverse communities, phase III has also been characterized by a large number of transmission events occurring in critical workplaces such as manufacturing, meat processing and care for the elderly. The increase in cases occurring in older Victorians and those residing in elderly care has thus changed the clinical characteristics of phase III to that of an epidemic with a burden of disease and mortality considerably higher than the phases previous epidemics. These complexities have necessitated several improvements in public health prevention and control activities, including: better community engagement and testing among culturally and linguistically diverse communities, income support for those who must self-isolate, housing at the hotel for essential workers unable to isolate themselves safely at home, improved testing and discharge of health workers and – for residents of elderly care facilities – a lower threshold for hospitalization to both minimize the risk of home transmission and manage the clinical deterioration of individual cases.
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,
]. The high incidence and burden of disease in disadvantaged communities has also been a hallmark of COVID-19 outbreaks in the United States [
- Islam N
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- et al.
]and United Kingdom [
Disparities in the risk and outcomes of COVID-19.
]. People from culturally and linguistically diverse communities are over-represented as workers in essential settings, such as elderly care and slaughterhouses, underscoring the need to ensure that pandemic control measures are adopted. without further aggravating the disadvantage [
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- Ronda-Pérez E
- Schenker MB.
]. Meaningful engagement with communities at high risk of exposure is essential to ensure future public health actions [
- Wild A
- Kunstler B
- Goodwin d
- Onyala S
- Zhang L
- Kufi M
- et al.
]. To this end, Victoria designed and implemented public health interventions that sought to authentically engage with diverse communities in order to maximize trust and cooperation and mitigate negative impacts. [].
Authors
Sheena G. Sullivan, COVID-19 Public Health Division, Department of Health, Victoria and WHO Collaborating Center for Influenza Reference and Research, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
Julia ML Brotherton, COVID-19 Public Health Division, Department of Health, Victoria and VCS Foundation, Victoria, Australia
Brigid M Lynch, COVID-19 Public Health Division, Department of Health, Victoria and Cancer Council Victoria, Australia
Allison Cheung, COVID-19 Public Health Division, Department of Health and Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Victoria, Australia
Michael Lydeamore, Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Victoria, Australia
Mark Stevenson, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Victoria, Australia
Simon Firestone, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Victoria, Australia
Jose Canevari, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Huu Nghia Joey Nguyen, Department of Education and Training, Victoria, Australia
Kylie S. Carville, COVID-19 Public Health Division, Victoria Department of Health and Infectious Disease Reference Laboratory, Victoria, Australia
Hazel J. Clothier, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Jessie Goldsmith, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Naveen Tenneti, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Carrie Barnes, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Nectaria Tzimourtas, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Rebecca F. Gang, COVID-19 Public Health Division, Department of Health, Victoria, Australia
James Armstrong, Health Protection Branch, Department of Health, Victoria, Australia
Lucinda Franklin, Health Protection Branch, Department of Health, Victoria, Australia
Daneeta Hennessy, Health Protection Branch, Department of Health, Victoria, Australia
Kara Martin, Health Protection Branch, Department of Health, Victoria, Australia
Mohana Baptista, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Michael Muleme, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Aaron Osborne, North East Public Health Unit, Victoria, Australia
Charles Alpren, Western Public Health Unit, Victoria, Australia
Frances H. Ampt, Western Public Health Unit, Victoria, Australia
Natasha Castree, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Andres Hernandez, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Annaliese van Diemen, North East Public Health Unit, Victoria, Australia
Allen C. Cheng, COVID-19 Public Health Division, Department of Health, Victoria and Alfred Health, Victoria, Australia
Simon Crouch, South East Public Health Unit, Victoria, Australia
Kira Leeb, COVID-19 Public Health Division, Department of Health, Australia
Kate Matson, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Finn Romanes, Western Public Health Unit, Victoria, Australia
Clare Looker, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Evelyn Wong, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Euan Wallace, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Brett Sutton, COVID-19 Public Health Division, Department of Health, Victoria, Australia
Stacey L Rowe, COVID-19 Public Health Division, Department of Health, Victoria, Australia
