Melbourne Medical School Collected Works - Research Publications

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    Ethical Issues in AI-enabled Disease Surveillance: Perspectives from Global Health
    Borda, A ; Molnar, A ; Neesham, C ; Kostkova, P ( 2022-02-18)
    Infectious diseases, as COVID-19 is proving, pose a global health threat in an interconnected world. In the last 20 years, resistant infectious diseases such as SARS, MERS, H1N1, Ebola, Zika and now COVID-19 have been impacting global health defences, and aggressively flourishing within the rise of global travel, urbanization, climate change and ecological degradation. In parallel, this extraordinary episode in global human health highlights the potential for artificial intelligence (AI)-enabled disease surveillance to collect and analyse vast amounts of unstructured and real-time data to inform epidemiological and public health emergency responses. The uses of AI in these dynamic environments are increasingly complex, challenging the potential for human autonomous decisions. In this context, our study of qualitative perspectives will consider a responsible AI framework to explore its potential application to disease surveillance in a global health context. Thus far, there is a gap in the literature in considering these multiple and interconnected levels of disease surveillance and emergency health management through the lens of a responsible AI framework.
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    Assessing the risk of spread of COVID-19 to the Asia Pacific region
    Shearer, F ; Walker, J ; Tellioglu, N ; McCaw, J ; McVernon, J ; Black, A ; Geard, N ( 2020-04-11)
    During the early stages of an emerging disease outbreak, governments are required to make critical decisions on how to respond appropriately, despite limited data being available to inform these decisions. Analytical risk assessment is a valuable approach to guide decision-making on travel restrictions and border measures during the early phase of an outbreak, when transmission is primarily contained within a source country. Here we introduce a modular framework for estimating the importation risk of an emerging disease when the direct travel route is restricted and the risk stems from indirect importation via intermediary countries. This was the situation for Australia in February 2020. The framework was specifically developed to assess the importation risk of COVID-19 into Australia during the early stages of the outbreak from late January to mid-February 2020. The dominant importation risk to Australia at the time of analysis was directly from China, as the only country reporting uncontained transmission. However, with travel restrictions from mainland China to Australia imposed from February 1, our framework was designed to consider the importation risk from China into Australia via potential intermediary countries in the Asia Pacific region. The framework was successfully used to contribute to the evidence base for decisions on border measures and case definitions in the Australian context during the early phase of COVID-19 emergence and is adaptable to other contexts for future outbreak response.
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    Modelling the impact of COVID-19 in Australia to inform transmission reducing measures and health system preparedness
    Moss, R ; Wood, J ; Brown, D ; Shearer, F ; Black, AJ ; Cheng, AC ; McCaw, JM ; McVernon, J ( 2020-04-11)

    ABSTRACT

    Background

    The ability of global health systems to cope with increasing numbers of COVID-19 cases is of major concern. In readiness for this challenge, Australia has drawn on clinical pathway models developed over many years in preparation for influenza pandemics. These models have been used to estimate health care requirements for COVID-19 patients, in the context of broader public health measures.

    Methods

    An age and risk stratified transmission model of COVID-19 infection was used to simulate an unmitigated epidemic with parameter ranges reflecting uncertainty in current estimates of transmissibility and severity. Overlaid public health measures included case isolation and quarantine of contacts, and broadly applied social distancing. Clinical presentations and patient flows through the Australian health care system were simulated, including expansion of available intensive care capacity and alternative clinical assessment pathways.

    Findings

    An unmitigated COVID-19 epidemic would dramatically exceed the capacity of the Australian health system, over a prolonged period. Case isolation and contact quarantine alone will be insufficient to constrain case presentations within a feasible level of expansion of health sector capacity. Overlaid social restrictions will need to be applied at some level over the course of the epidemic to ensure that systems do not become overwhelmed, and that essential health sector functions, including care of COVID-19 patients, can be maintained. Attention to the full pathway of clinical care is needed to ensure access to critical care.

    Interpretation

    Reducing COVID-19 morbidity and mortality will rely on a combination of measures to strengthen and extend public health and clinical capacity, along with reduction of overall infection transmission in the community. Ongoing attention to maintaining and strengthening the capacity of health care systems and workers to manage cases is needed.

    Funding

    Australian Government Department of Health Office of Health Protection, Australian Government National Health and Medical Research Council
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    Breadth of concomitant immune responses underpinning viral clearance and patient recovery in a non-severe case of COVID-19
    Thevarajan, I ; Nguyen, THO ; Koutsakos, M ; Druce, J ; Caly, L ; van de Sandt, C ; Jia, X ; Nicholson, S ; Catton, M ; Cowie, B ; Tong, SYC ; Lewin, S ; Kedzierska, K ( 2020-02-23)
    We report the kinetics of the immune response in relation to clinical and virological features of a patient with mild-to-moderate coronavirus disease-19 (COVID-19) requiring hospitalisation. Increased antibody-secreting cells, follicular T-helper cells, activated CD4 + and CD8 + T-cells and IgM/IgG SARS-CoV-2-binding antibodies were detected in blood, prior to symptomatic recovery. These immunological changes persisted for at least 7 days following full resolution of symptoms, indicating substantial anti-viral immunity in this non-severe COVID-19.