Getting antivirals for COVID too often depends on where you live and how wealthy you are
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Medical experts recommend antivirals for people aged 70 and older who get COVID, and for other groups at risk of severe illness and hospitalisation from COVID.
But many older Australians have missed out on antivirals after getting sick with COVID. It is yet another way the health system is failing the most vulnerable.
Who missed out?
We analysed COVID antiviral uptake between March 2022 and September 2023. We found some groups were more likely to miss out on antivirals including Indigenous people, people from disadvantaged areas, and people from culturally and linguistically diverse backgrounds.
Some of the differences will be due to different rates of infection. But across this 18-month period, many older Australians were infected at least once, and rates of infection were higher in some disadvantaged communities.
How stark are the differences?
Compared to the national average, Indigenous Australians were nearly 25% less likely to get antivirals, older people living in disadvantaged areas were 20% less likely to get them, and people with a culturally or linguistically diverse background were 13% less likely to get a script.
People in remote areas were 37% less likely to get antivirals than people living in major cities. People in outer regional areas were 25% less likely.
Even within the same city, the differences are stark. In Sydney, people older than 70 in the affluent eastern suburbs (including Vaucluse, Point Piper and Bondi) were nearly twice as likely to have had an antiviral as those in Fairfield, in Sydney’s south-west.
Older people in leafy inner-eastern Melbourne (including Canterbury, Hawthorn and Kew) were 1.8 times more likely to have had an antiviral as those in Brimbank (which includes Sunshine) in the city’s west.
Why are people missing out?
COVID antivirals should be taken when symptoms first appear. While awareness of COVID antivirals is generally strong, people often don’t realise they would benefit from the medication. They wait until symptoms get worse and it is too late.
Frequent GP visits make a big difference. Our analysis found people 70 and older who see a GP more frequently were much more likely to be dispensed a COVID antiviral.
Regular visits give an opportunity for preventive care and patient education. For example, GPs can provide high-risk patients with “COVID treatment plans” as a reminder to get tested and seek treatment as soon as they are unwell.
Difficulty seeing a GP could help explain low antiviral use in rural areas. Compared to people in major cities, people in small rural towns have about 35% fewer GPs, see their GP about half as often, and are 30% more likely to report waiting too long for an appointment.
Just like for vaccination, a GP’s focus on antivirals probably matters, as does providing care that is accessible to people from different cultural backgrounds.
Care should go those who need it
Since the period we looked at, evidence has emerged that raises doubts about how effective antivirals are, particularly for people at lower risk of severe illness. That means getting vaccinated is more important than getting antivirals.
But all Australians who are eligible for antivirals should have the same chance of getting them.
These drugs have cost more than A$1.7 billion, with the vast majority of that money coming from the federal government. While dispensing rates have fallen, more than 30,000 packs of COVID antivirals were dispensed in August, costing about $35 million.
Such a huge investment shouldn’t be leaving so many people behind. Getting treatment shouldn’t depend on your income, cultural background or where you live. Instead, care should go to those who need it the most.
People born overseas have been 40% more likely to die from COVID than those born here. Indigenous Australians have been 60% more likely to die from COVID than non-Indigenous people. And the most disadvantaged people have been 2.8 times more likely to die from COVID than those in the wealthiest areas.
All those at-risk groups have been more likely to miss out on antivirals.
It’s not just a problem with antivirals. The same groups are also disproportionately missing out on COVID vaccination, compounding their risk of severe illness. The pattern is repeated for other important preventive health care, such as cancer screening.
A 3-step plan to meet patients’ needs
The federal government should do three things to close these gaps in preventive care.
First, the government should make Primary Health Networks (PHNs) responsible for reducing them. PHNs, the regional bodies responsible for improving primary care, should share data with GPs and step in to boost uptake in communities that are missing out.
Second, the government should extend its MyMedicare reforms. MyMedicare gives general practices flexible funding to care for patients who live in residential aged care or who visit hospital frequently. That approach should be expanded to all patients, with more funding for poorer and sicker patients. That will give GP clinics time to advise patients about preventive health, including COVID vaccines and antivirals, before they get sick.
Third, team-based pharmacist prescribing should be introduced. Then pharmacists could quickly dispense antivirals for patients if they have a prior agreement with the patient’s GP. It’s an approach that would also work for medications for chronic diseases, such as cardiovascular disease.
COVID antivirals, unlike vaccines, have been keeping up with new variants without the need for updates. If a new and more harmful variant emerges, or when a new pandemic hits, governments should have these systems in place to make sure everyone who needs treatment can get it fast.
In the meantime, fairer access to care will help close the big and persistent gaps in health between different groups of Australians.
Peter Breadon, Program Director, Health and Aged Care, Grattan Institute
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Blue Zones Kitchen – by Dan Buettner
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We’ve previously reviewed Buettner’s other book, The Blue Zones: 9 Lessons For Living Longer From The People Who’ve Lived The Longest, and with this one, it’s now time to focus on the dietary aspect.
As the title and subtitle promises, we get 100 recipes, inspired by Blue Zone cuisines. The recipes themselves have been tweaked a little for maximum healthiness, eliminating some ingredients that do crop up in the Blue Zones but are exceptions to their higher average healthiness rather than the rule.
The recipes are arranged by geographic zone rather than by meal type, so it might take a full read-through before knowing where to find everything, but it makes it a very enjoyable “coffee-table book” to browse, as well as being practical in the kitchen. The ingredients are mostly easy to find globally, and most can be acquired at a large supermarket and/or health food store. In the case of substitutions, most are obvious, e.g. if you don’t have wild fennel where you are, use cultivated, for example.
In the category of criticism, it appears that Buettner is very unfamiliar with spices, and so has skipped them almost entirely. We at 10almonds could never skip them, and heartily recommend adding your own spices, for their health benefits and flavors. It may take a little experimentation to know what will work with what recipes, but if you’re accustomed to cooking with spices normally, it’s unlikely that you’ll err by going with your heart here.
Bottom line: we’d give this book a once-over for spice additions, but aside from that, it’s a fine book of cuisine-by-location cooking.
Click here to check out The Blue Zones Kitchen, and get cooking into your own three digits!
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Food for Life – by Dr. Tim Spector
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This book is, as the author puts it, “an eater’s guide to food and nutrition”. Rather than telling us what to eat or not eat, he provides an overview of what the latest science has to say about various foods, and leaves us to make our own informed decisions.
He also stands firmly by the “personalized nutrition” idea that he introduced in his previous book which we reviewed the other day, and gives advice on what tests we might like to perform.
The writing style is accessible, without shying away from reference to hard science. Dr. Spector provides lots of information about key chemicals, genes, gut bacteria, and more—as well as simply providing a very enjoyable read along the way.
Bottom line: if you’d like a much better idea of what food is (and isn’t) doing what, this book is an invaluable resource.
Click here to check out Food for Life, and make the best decisions for you!
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Blind Spots – by Dr. Marty Makary
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From the time the US recommended not giving peanuts to infants for the first three years of life “in order to avoid peanut allergies” (whereupon non-exposure to peanuts early in life led to, instead, an increase in peanut allergies and anaphylactic incidents), to the time the US recommended not taking HRT on the strength of the claim that “HRT causes breast cancer” (whereupon the reduced popularity of HRT led to, instead, an increase in breast cancer incidence and mortality), to many other such incidents of very bad public advice being given on the strength of a single badly-misrepresented study (for each respective thing), Dr. Makary puts the spotlight on what went wrong.
This is important, because this is not just a book of outrage, exclaiming “how could this happen?!”, but rather instead, is a book of inquisition, asking “how did this happen?”, in such a way that we the reader can spot similar patterns going forwards.
Oftentimes, this is a simple matter of having a basic understanding of statistics, and checking sources to see if the dataset really supports what the headlines are claiming—and indeed, whether sometimes it suggests rather the opposite.
The style is a little on the sensationalist side, but it’s well-supported with sound arguments, good science, and clear mathematics.
Bottom line: if you’d like to improve your scientific literacy, this book is an excellent illustrative guide.
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The Other Significant Others – by Rhaina Cohen
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As we get older, it’s a function of statistics that increasingly many of us are divorced or widowed. While some will—after whatever time seems right to them—get back into dating, what about those of us who decide that we won’t?
Rhaina Cohen explores the importance of friendship, mutual support, and (Platonic!) closeness and yes, even kinds of intimacy (for that too can be Platonic!) as we go on.
Even from a purely evolutionary approach, we are fundamentally social creatures, and while as individuals we may exist on a spectrum from reclusive to extroverted, we all thrive better when we at least have access to community and friends.
The style of the book is easy-reading and exploratory, and is very compelling as a call-to-arms for those who may wish to give/receive support to/from those with whom we are not necessarily sleeping.
Because at the end of the day, why should sex and/or romance be a required feature for legal protections? Aren’t we adults who can make our own decisions about whom we trust to care for us?
Bottom line: if you’re happily partnered and expect to pre-decease your partner, this book might not be directly important for you (it might for your partner, though). Everyone else? This book may be important at some point. That point might even be now already; only you know.
Click here to check out The Other Significant Others, and make your own choices in life!
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Ginger Does A Lot More Than You Think
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Ginger’s benefits go deep!
You are doubtlessly already familiar with what ginger is, so let’s skip right into the science.
The most relevant active compound in the ginger root is called gingerol, and people enjoy it not just for its taste, but also a stack of health reasons, such as:
- For weight loss
- Against nausea
- Against inflammation
- For cardiovascular health
- Against neurodegeneration
Quite a collection! So, what does the science say?
For weight loss
This one’s quite straightforward. It not only helps overall weight loss, but also specifically improves waist-hip ratio, which is a much more important indicator of health than BMI.
Against nausea
Ginger has proven its effectiveness in many high quality clinical trials, against general nausea, post-surgery nausea, chemotherapy-induced nausea, and pregnancy-related nausea.
Source: Ginger on Human Health: A Comprehensive Systematic Review of 109 Randomized Controlled Trials
However! While it very clearly has been shown to be beneficial in the majority of cases, there are some small studies that suggest it may not be safe to take close to the time of giving birth, or in people with a history of pregnancy loss, or unusual vaginal bleeding, or clotting disorders.
See specifically: Ginger for nausea and vomiting of pregnancy
As a side note on the topic of “trouble down there”, ginger has also been found to be as effective as Novafen (a combination drug of acetaminophen (Tylenol), caffeine, and ibuprofen), in the task of relieving menstrual pain:
See: Effect of Ginger and Novafen on menstrual pain: A cross-over trial
Against inflammation
Ginger has well-established anti-inflammatory (and, incidentally, which affects many of the same systems, antioxidant) effects. Let’s take a look at that first:
Read: Effect of Ginger on Inflammatory Diseases
Attentive readers will note that this means that ginger is not merely some nebulous anti-inflammatory agent. Rather, it also specifically helps alleviate delineable inflammatory diseases, ranging from colitis to Crohn’s, arthritis to lupus.
We’ll be honest (we always are!), the benefits in this case are not necessarily life-changing, but they are a statistically significant improvement, and if you are living with one of those conditions, chances are you’ll be glad of even things described in scientific literature as “modestly efficacious”.
What does “modestly efficacious” look like? Here are the numbers from a review of 593 patients’ results in clinical trials (against placebo):
❝Following ginger intake, a statistically significant pain reduction SMD = −0.30 ([95% CI: [(−0.50, −0.09)], P = 0.005]) with a low degree of inconsistency among trials (I2 = 27%), and a statistically significant reduction in disability SMD = −0.22 ([95% CI: ([−0.39, −0.04)]; P = 0.01; I2 = 0%]) were seen, both in favor of ginger.❞
To de-mathify that:
- Ginger reduced pain by 30%
- Ginger reduced disability by 22%
Read the source: Efficacy and safety of ginger in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials
Because (in part) of the same signalling pathways, it also has benefits against cancer (and you’ll remember, it also reduces the symptoms of chemotherapy).
See for example: Ginger’s Role in Prevention and Treatment of Gastrointestinal Cancer
For cardiovascular health
In this case, its benefits are mostly twofold:
- It significantly reduces triglycerides and LDL cholesterol, while increasing HDL cholesterol
- It significantly reduces fasting blood sugar levels and HbA1c levels (both risk factors for CVD)
Against neurodegeneration
This is in large part because it reduces inflammation, which we discussed earlier.
But, not everything passes the blood-brain barrier, so it’s worth noting when something (like gingerol) does also have an effect on brain health as well as the rest of the body.
You do not want inflammation in your brain; that is Bad™ and strongly associated with Alzheimer’s and Parkinson’s.
As well as reducing neuroinflammation, ginger has other relevant mechanisms too:
❝Its bioactive compounds may improve neurological symptoms and pathological conditions by modulating cell death or cell survival signaling molecules.
The cognitive enhancing effects of ginger might be partly explained via alteration of both the monoamine and the cholinergic systems in various brain areas.
Moreover, ginger decreases the production of inflammatory related factors❞
Check it out in full, as this is quite interesting:
Role of Ginger in the Prevention of Neurodegenerative Diseases
How much to take?
In most studies, doses of 1–3 grams/day were used.
Where to get it?
Your local supermarket, as a first port-of-call. Especially given the dose you want, it may be nicer for you to have a touch of sliced ginger root in your cooking, rather than taking 2–6 capsules per day to get the same dose.
Obviously, this depends on your culinary preferences, and ginger certainly doesn’t go with everything!
If you do want it as a supplement, here is an example product on Amazon, for your convenience.
Enjoy!
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Kiwi Fruit vs Pineapple – Which is Healthier?
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Our Verdict
When comparing kiwi fruit to pineapple, we picked the kiwi.
Why?
In terms of macros, they’re mostly quite comparable, being fruits made of mostly water, and a similar carb count (slightly different proportions of sugar types, but nothing that throws out the end result, and the GI is low for both). Technically kiwi has twice the protein, but they are fruits and “twice the protein” means “0.5g difference per 100g”. Aside from that, and more meaningfully, kiwi also has twice the fiber.
When it comes to vitamins, kiwi has more of vitamins A, B9, C, E, K, and choline, while pineapple has more of vitamins B1, B2, B3, B5, and B6. This would be a marginal (6:5) win for kiwi, but kiwi’s margins of difference are greater per vitamin, including 72x more vitamin E (with a cupful giving 29% of the RDA, vs a cupful of pineapple giving 0.4% of the RDA) and 57x more vitamin K (with a cupful giving a day’s RDA, vs a cupful of pineapple giving a little under 2% of the RDA). So, this is a fair win for kiwi.
In the category of minerals, things are clear: kiwi has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while pineapple has more manganese. An overwhelming win for kiwi.
Looking at their respective anti-inflammatory powers, pineapple has its special bromelain enzymes, which is a point in its favour, but when it comes to actual polyphenols, the two fruits are quite balanced, with kiwi’s flavonoids vs pineapple’s lignans.
Adding up the sections, it’s a clear win for kiwi—but pineapple is a very respectable fruit too (especially because of its bromelain content), so do enjoy both!
Want to learn more?
You might like to read:
Bromelain vs Inflammation & Much More
Take care!
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