July 6, 2022

COVID-19

True global death toll from COVID-19 almost 15 million: WHO

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The global death toll has been severely under-reported, the World Health Organization says.

WHO estimates that 14.9 million direct and indirect deaths occurred from SARS-CoV-2 in 2020 and 2021 – almost three times the 5.4 million reported by governments around the world.

The undercount is the result of a lack of COVID-19 testing and death certification, said William Msemburi, technical officer at WHO.

Seventy countries do not produce cause-of-death certificates and even before the pandemic, six in every 10 deaths went unreported, he said.

Of the excess deaths around the world, 68 per cent are concentrated in just 10 countries: Brazil, Egypt, India, Indonesia, Mexico, Peru, Russia, South Africa, Turkey, and the US.

Middle-income countries accounted for 81 per cent of the excess deaths, while high-income countries accounted for 15 per cent and low-income countries 4 per cent. Men made up a larger proportion of deaths from COVID-19 (57 per cent) than women (43 per cent).

The estimates of excess deaths were roughly in line with official tallies in the US, where WHO modelled 932,458 excess deaths, and in Brazil, where it modelled 681,267. But in India, WHO’s models estimated 4,740,894 excess deaths, nearly triple the figure in government reports.

The report has caused controversy in India, where the government has challenged WHO’s figures.

US exceeds one million COVID deaths

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The US passed one million deaths from COVID-19 on 4 May 2022, according to NBC News.

The Centres for Disease Control and Prevention (CDC) said that more than 80 per cent of US deaths had been among unvaccinated people. However, during the Omicron surge in January and February this year, some 42 per cent of deaths were among vaccinated people. Most were over 75s who had been vaccinated but had not received boosters.

On 3 May, the CDC reinstated its recommendation for people to wear masks on planes, trains and buses.

Although 70 per cent of the US population aged over five is fully vaccinated, vaccines for young children are still not available. Both Moderna and Pfizer-BioNTech have asked the FDA for approval of vaccines for children under five.

A CDC report found that 60 per cent of Americans have had COVID, including three out of four children. The highly contagious Omicron variant was responsible for most of the infections.

The study found that roughly 64 per cent of adults aged 18 to 49 years, about 50 per cent of those aged 50 to 64 years and about 33 per cent of older adults had been infected.

China sticks to “zero COVID”

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In a country of 1.4 billion people, “let it rip” is not an option.

China’s zero COVID policy is generating strong debate both at home and abroad, but a recent study outlines what a massive risk it would be to abandon it.

The peer-reviewed study, published in Nature magazine, said a decision by Chinese authorities to lift such measures could see “a tsunami” of more than 112 million symptomatic cases of COVID-19, 5 million hospitalisations, and 1.55 million deaths.

Researchers also noted that the health system would come under severe stress.

“We find that the level of immunity induced by the March 2022 vaccination campaign would be insufficient to prevent an Omicron wave that would result in exceeding critical care capacity with a projected intensive care unit peak demand of 15.6 times the existing capacity,” the research found.

The World Health Organization has warned China that its current policy might not be sustainable, considering “the behaviour of the virus”.

But it did recognise that China’s tough measures to curb the contagion had been very successful.

China counters that its approach is flexible and alert to changing circumstances.

The country has registered 15,000 deaths since the virus emerged in Wuhan in late 2019, compared with over 1 million deaths in the United States and the WHO’s estimate of more than 4.5 million deaths in India.

Shanghai has been the epicentre of the current outbreak and was put into a stringent lock-down in April. As of mid-May there was a significant drop-off in case numbers.

COVID relief funds misused for aggressive company buyouts: study

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A new US study found that at least US$5.3 billion stumped up by the US government for COVID pandemic relief went to 113 private equity-owned companies, which already had $908 billion in cash reserves available in 2020.

Many of these companies used their reserves to pursue aggressive new buyouts, and in many cases shed workers, according to the report by the Anti-Corruption Data Collective (ACDC).

The $5.3 billion in public funding was authorised by the Coronavirus Aid, Relief, and Economic Security (CARES) Act in response to the public health and economic crisis brought on by COVID.

The legislation imposed few conditions on recipients – such as requirements to support workers and maintain business operations – and failed to prohibit recipients from using public money to enrich investors.

“Public money not only went to companies that already had deep-pocketed backers, but also effectively allowed private equity owners to continue and even expand their predatory tactics during an economic and public health emergency,” the ACDC report said.

“With improved balance sheets shored up by government money, private equity firms were able to finance a buyout spree during the pandemic-driven economic downturn, as well as to extract dividends and fees from their portfolio companies.”

Over $4 billion, or 76 per cent of the total pandemic relief to the industry, went to just 10 private equity firms.

Public health employee information for COVID-19

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The NSW Nurses and Midwives’ Association is providing support and advice to any members seeking information regarding the novel coronavirus (COVID-19).

Join the NSWNMA to ensure you’re covered at work.

If members are concerned their employer is not following these guidelines, the NSWNMA can provide assistance to ensure appropriate measures are in place. Contact us.

Click here for the latest Workforce Advice for NSW Health staff

Click here for the latest WHS Advice for NSW Health staff

As the COVID-19 outbreak continues to grow, it’s important you know your rights and entitlements when it comes to special leave, sick leave and workers’ compensation. The following information applies to nurses and midwives working the NSW public health system.

Close contact changes

From 6pm Friday, 22 April, close contacts will no longer have to isolate provided you are asymptomatic and comply with guidelines on this page for seven days.

As per NSW Health advice, this removes the requirement for Health Care Workers (HCW) to seek an exemption to attend work if you’re a close contact, however there’s still a need for health services to undertake a risk assessment prior to your return to work.

Alongside the current risk assessment process, additional advice sent to NSW Health Chief Executives contains the following mitigation strategies which will be adopted:

Potential exposures in the workplace will continue to be assessed utilising the Health Care Worker COVID-19 Exposure Risk Assessment Matrix.

Sick leave will still apply if you’re unable to return to work because you’re symptomatic or have returned a positive test result. Remember, you can apply for additional sick leave if you’ve run out of sick leave for reasons related to COVID-19.

If you’re COVID-19 positive and there is a possibility the exposure occurred at work, then you should submit a workers’ compensation claim. You do not need to be able to prove you contracted COVID-19 at work. Once your claim is approved, any sick leave you’ve taken will be recredited to you.

Paid special leave will continue to apply if you are an asymptomatic close contact and have tested negative for COVID-19, but you’re unable to return to work due to the outcome of a risk assessment.

Having at least two doses of a COVID-19 vaccine remains as a condition of employment for all NSW Health staff under the existing Determination of the Health Secretary. Public Health Orders requiring aged care and disability workers to be appropriately vaccinated will remain in effect.

Check out our Public Health Sector Webinar- COVID-19 and Leave Entitlements Webinar below.

Paid Special Leave provisions for employees (pandemic leave)

With respect to COVID-19, paid special leave of up to 20 days in total may be granted to employees who are unable to work because they are:

  • Self-isolating in line with public health advice due to being a COVID-19 contact (if not symptomatic and not COVID-19 positive)
  • Caring for family members sick with COVID-19
  • Caring for family members due to closure of school/daycare
  • Unable to attend work due to transport disruptions or workplace closure
  • A vulnerable health worker who following completion of a risk assessment is unable to be redeployed to a lower COVID-19 risk environment and is unable to work from home or self-isolation.
  • COVID-19 Vaccination in the particular circumstances described below

Special leave is paid at the base rate (excluding allowances and penalty rates) and should be made available to you before other forms of leave.

After the 20 days total paid special leave has been used, your employer may grant additional NSW Health special leave on a case-by-case basis. If you’ve exhausted your 20 days special leave and you require further special leave, please apply through your employer in the first instance.

Paid Special Leave for casuals

Casual employees are generally not entitled to paid special leave. If a casual is required to self-isolate due to close contact COVID-19 exposure in the workplace, each situation should be considered by the Health agency on a case-by-case basis including such things as:

  • length of the casual engagement and
  • Whether the casual has regular and systemic shifts

Paid special leave may be appropriate for shifts which are already rostered during the self-isolation period.

Paid Special Leave for Vaccination for COVID-19

Health agencies will continue to make arrangements to support employees to access the COVID-19 vaccination whilst on duty, where it is possible to do this and with the need to ensure service delivery is maintained.

If an employee receives the vaccine and experiences an adverse reaction, they may access paid sick leave entitlements. Where sick leave is exhausted, Agency heads may grant special sick leave on a case by case basis.

Employees that receive a COVID-19 Booster vaccination on or after 7 December 2021 are eligible for a special leave payment of two hours per COVID-19 Booster vaccination if unable to be undertaken in work time.

Leave due to COVID-19 positive test

If an employee is sick due to COVID-19 or any other reason, current sick leave entitlements and conditions apply. This includes situations where an employee is:

  • Self-isolating on paid special leave and becomes sick for any reason; at that point the employee should transition onto sick leave.
  • Symptomatic (including a temperature with/ without other symptoms) and requires testing for COVID-19. Sick leave is applicable for the period from where the staff member becomes symptomatic; through to testing and until a negative COVID-19 test result is received by the staff member, regardless of whether the staff member becomes asymptomatic during the period.

Where sick leave is exhausted, your employer may grant additional sick leave on a case-by-case basis. If you’ve exhausted your sick leave due to COVID-19 and you require further sick leave, please apply through your employer in the first instance.

COVID-19 positive during annual leave or long service

If you are COVID-19 positive and sick for one week or longer during a period of annual leave or long service leave, then you are entitled to have the relevant period of leave recredited to you and to be placed on sick leave instead. You will need to provide a medical certificate as evidence of the period of illness. Please note that this entitlement does not apply if the period of leave occurs prior to resignation or other termination of employment.

Please read on in case workers compensation rights are applicable to you.

Workers Compensation

If you have contracted COVID-19 and transmission is likely to have occurred in the workplace, you are entitled to make a claim for workers compensation. There is currently a law in place that health workers are presumed to have contracted the virus at work or while working (something the NSW Government is trying to overturn), it should be workers compensation. Whilst you may be placed on sick leave initially, this should be recredited when your workers compensation claim is accepted.

For advice on what steps to take if you believe you are eligible for workers’ compensation, please read the Workers Compensation section found on this page.

Isolation exemption

On 31 December, the NSW Health Minister signed an exemption to the Public Health Order in an attempt to alleviate widespread staffing shortages across the healthcare system.

Under the change, asymptomatic workers in public and private hospitals who are close contacts of a positive COVID-19 case will be allowed to leave self-isolation and return to work, if they are identified as critical to the service.

This decision is not without risks.

The NSWNMA has urged the Ministry of Health to ensure all necessary steps are taken to protect staff from further exposures.

The rise of COVID-19 cases in the community and in health workers is clearly compromising staffing capacity across the hospital system. The Ministry of Health, guided by the Public Health Unit and the Clinical Excellence Commission, have made these decisions with brief consultation with the health unions.

The NSWNMA will continue advocating for the safety of nurses and midwives but we also recognise your safety and that of your patients is dependent on safe staffing levels, which are clearly unable to be supplied in the current circumstances.

Risk Matrix

NSW Health has updated risk escalation and guidance documents that provide advice for health care workers who have been exposed to COVID-19 in the community or while in the workplace. You can view the latest advice on the Clinical guidance and resources page.

If you have been exposed in the workplace, then your exposure will be assessed based on the PPE you were wearing at the time of the exposure, the nature of the contact and your vaccination status. Further information about how the assessment is made can be found on the NSW Health “Health Care Worker COVID-19 Risk Assessment Matrix” which you can find here.

If you have any questions or concerns about how the matrix works, please contact the Association.

Management of Heat Stress: Outdoor COVID-19 testing clinics

Working in heat can be hazardous. Your employer has an obligation to ensure your safety at work, this includes doing everything reasonably practicable to make sure that you are not exposed to harm from working in heat.

The NSWNMA made representations to NSW Health to ensure risks associated with working in hot conditions are managed appropriately, especially important for nurses working in outdoor COVID-19 testing clinics, where PPE requirements compound the risks of dehydration and heat stress.

NSW Health have since shared resources with Local Health Districts to make sure all appropriate steps are followed. Please refer to the following documents from the NSWNMA, SafeWork NSW and NSW Health:

If you have concerns the measures put in place to protect you from heat stress are inadequate or not being followed correctly, please contact the Association.

COVID-19 testing during paid work hours

The Ministry of Health has advised the NSWNMA that the up to two hours of paid special leave (at base rate of pay) to facilitate vaccinations (C2021-14 Employment Arrangements during COVID-19) will now be made available and extended to booster vaccinations for all government sector workers.

This special leave applies for a COVID-19 booster vaccination received on or after 7 December, 2021.

COVID-19 testing during paid work hours

Wherever possible, NSW Health agencies will facilitate the opportunity for affected NSW Health staff ​​​​​to undertake the required COVID-19 testing during normal working hours.

  • Where the COVID-19 test is available at the site where the staff member usually works, NSW Health agencies will facilitate the opportunity for employed staff to undertake the required testing during a rostered shift or normal working day wherever possible.
  • Where the COVID-19 test is only available at a site that is not the staff member’s usual work location, NSW Health agencies will facilitate wherever possible the release of staff for part of their rostered shift or working day to undertake the required COVID-19 testing at a site where it is available.
  • Where the NSW Health agency determines that neither option listed above is possible, employed staff who attend for the required testing outside of normal working hours will need to be paid for such attendance.

Personal Protective Equipment (PPE)

For detailed advice on PPE, visit this page.

Administration of COVID-19 vaccine

To access FAQs on administering COVID-19 vaccines, click here.

Vaccine preparation and procedure

A number of resources have been developed to support clinicians in the process of preparing vaccines, including labelling requirements. These have been developed separately for both of the vaccines:

Vaccination in work time

Ministry advice is that vaccination for health workers should occur in work time, although it is recognised that when scheduling the second dose it may not align with rosters issued for that day or if scheduled for three months time when the roster is unknown. The Ministry preference for the second dose to occur in work time (rostered shift) but in any event is to be treated as paid time if this is not possible.

Expanding the vaccination workforce

In advice issued 28 June 2021, the NSW Chief Health Officer expanded the classification of registered health professionals who can now assist in administering COVID-19 vaccinations at designated hubs, under appropriate supervision, and provided they have completed identified training. Such professionals will be engaged and remunerated at their relevant classification rate.

This decision makes it possible for certain health professional students to be engaged as ‘Vaccination Workers’ and hired as casuals under the Public Health System Nurses’ and Midwives’ (State) Award. Rates of pay for these staff will be determind by the Ministry.

The Statewide Protocol for the Supply or Administration of COVID-19 Vaccine sets out the framework and protocol for the supply and administration of vaccines that encompasses this additional workforce.

​As stated by the Ministry of Health, healthcare workers considered for prioritisation in Phase 1a of the vaccination program include:

  • Ambulance and patient transport staff
  • Emergency department staff
  • Critical care ward staff (ICUs and HDUs, ECMO and medical retrieval teams)
  • COVID clinic and COVID testing staff (public and private)
  • COVID ward staff
  • COVID immunisation clinic staff
  • COVID pathology lab staff (public and private)
  • Workers at the Special Health Accommodation facility

Vaccination position statements and supportive evidence

As professional leaders in this area, nurses and midwives can find the NMBA’s position statement on vaccination here.

Ahpra’s position statement on Registered health practitioners and students and COVID-19 vaccination is available to view here.

The National Boards and Ahpra have published a joint statement to help registered health practitioners and students understand what’s expected of them in giving, receiving and advising on and sharing information about COVID-19 vaccines. It can be viewed here.

The ANMF’s policy on vaccination is here.

ANMF Evidence on the COVID vaccine is here.

International Staff Travel for Recreational Purposes

Australian State and Territory borders are subject to varying degrees of quarantine or self-isolation requirements as a result of the COVID-19 pandemic. If you have been outside Australia in the previous 14 days and return to NSW, you must not go to any high-risk settings, such as aged care, disability care, healthcare, and correctional facilities until you receive a negative result from your day 7 test.

If you choose to travel overseas; regardless of the COVID-19 status of the destination, you will not be granted for example some form of paid special leave to cover your exclusion from the workplace upon return to New South Wales. Staff returning from private overseas travel will need to negotiate access to their own leave entitlements for the 7 day period.

Vulnerable Staff

The Australian Health Protection Principal Committee (AHPPC) considers that, based on the limited current evidence, the following people are, or are likely to be, at higher risk of serious illness if they are infected with the virus:

  • Aboriginal and Torres Strait Islander people 50 years and older with one or more chronic medical conditions
  • People 65 years and older with chronic medical conditions. Conditions included in the definition of ‘chronic medical conditions’ will be refined as more evidence emerges. The most current list can be accessed on the Department of Health website
  • People 70 years and older
  • People with compromised immune systems (see Department of Health website)

AHPPC recommends that where vulnerable workers undertake essential work, a risk assessment must be undertaken. Risk needs to be assessed and mitigated with consideration of the characteristics of the worker, the workplace and the work. This includes ensuring vulnerable people are redeployed to non-customer based roles where possible. Where risk cannot be appropriately mitigated, employers and employees should consider alternate arrangements to accommodate a workplace absence. In this case, those workers should be able to access the paid special leave (for COVID-19).

AHPPC recommends that special provisions apply to essential workers who are at higher risk of serious illness and, where the risk cannot be sufficiently mitigated, should not work in high risk setting. (AHPPC advice, 30 March 2020)

There is limited evidence regarding the risk in pregnant women. Currently there is no evidence of an increased risk of miscarriage, teratogenicity or vertical transmission of the COVID-19 virus. There is a possibility of an increased incidence of premature birth but there is insufficient evidence at this point in time. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends that, where possible, pregnant healthcare workers be allocated to patients, and duties that have reduced exposure to patients with confirmed or suspected COVID-19 infection.

Further information on PPE

Further information for private health nurses and midwives

The NSWNMA will continue to provide further updates for members as we receive them. Contact us here.

Wuhan market was epicentre of COVID according to two new studies

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Both pieces of research rule out a lab leak as the source of the virus.

The two reports trace the outbreak back to the Huanan Seafood Wholesale Market in Wuhan, which sold live animals.

The research included genetic analyses of coronavirus samples collected from the market and from people infected in December 2019 and January 2020, as well as geolocation analyses connecting these samples to a section of the market where live animals were sold.

Taken together, these different lines of evidence point towards the market as the source of the outbreak, Kristian Andersen, a virologist at the Scripps Research Institute in La Jolla, California, and an author on two of the reports told Nature magazine.

“This is extremely strong evidence,” he said.

Another virologist and research co-author, Michael Worobey, from the University of Arizona, told Nature that his thinking on the origins of COVID-19 had shifted.

In 2021, in a letter to Science magazine, he and other researchers pressed the scientific community to keep an open mind about whether the pandemic stemmed from a laboratory like the Wuhan Institute of Virology.

But since then, additional evidence has come to light that supports a zoonotic origin story similar to that of HIV, Zika virus, Ebola virus and multiple influenza viruses, he says.

“When you look at all of the evidence, it is clear that this started at the market,” he says.