Psittacosis contagion in 1930: an old story in a new era of zoonotic disease.

The SARS-CoV-2 pandemic has highlighted the importance of zoonotic diseases. Psittacosis, a human disease resulting from infection spill-over from Chlamydia psittaci-infected birds, is a lesser-known example of a zoonosis. Psittacosis was responsible for numerous outbreaks in the 1930s, characterised by significant human mortality and disruption to the global trade in parrots. This paper describes the epidemiological and clinical details of one family group impacted by the purchase of an infected, imported parrot. Findings are discussed in the context of a growing awareness of the health risks of global disease outbreaks, as well as social and economic impacts. Health information recorded for cases of psittacosis associated with the 1930s cluster was reviewed using contemporary knowledge of disease symptoms and epidemiology. Case details and autopsy reports were examined. Public health investigation deduced that the cluster of infections was chronologically and physically connected to the purchase and subsequent death of an imported parrot. Disease symptoms were consistent with C. psittaci infection. Epidemiological data supported the diagnoses and causes of death, despite the presenting symptoms sharing significant overlap with other common respiratory diseases. There is growing awareness of the risks of epidemiological bridges in transmitting animal diseases to humans. Historical cases are a strong reminder of the fundamental role of scientific and public health responses in the face of such contagion.

The first Australian experience with ward-based continuous positive airway pressure for COVID-19 respiratory failure: a retrospective cohort study.

We present the first Australian cohort of patients with COVID-19 respiratory failure managed with escalating respiratory support including continuous positive airway pressure (CPAP) on a standard medical ward at a tertiary Sydney hospital during the 2021 COVID-19 Delta variant outbreak. We demonstrate an equivalent mortality to CPAP delivered in intensive care unit and outline our ward structure and management during the pandemic.

Medications for early treatment of COVID-19 in Australia.

Early treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can prevent hospitalisation and death in patients with coronavirus disease 2019 (COVID-19) who have one or more risk factors for serious COVID-19 progression. While early treatment presents a range of logistical challenges, clinicians are nevertheless aided by a growing number of approved medications for early treatment of COVID-19. Medications include drugs that inhibit SARS-CoV-2 viral replication, anti-SARS-CoV-2 monoclonal antibody formulations that provide passive immunisation, and immunomodulatory drugs that suppress the body's inflammatory response. Several drugs with different modes of action are approved in Australia for early treatment of COVID-19, including nirmatrelvir plus ritonavir, molnupiravir, and monoclonal antibody formulations. Although these drugs are recommended, clinicians are encouraged to remain up to date on current indications, contraindications and the clinical efficacy of these drugs against SARS-CoV-2 variants currently circulating in communities. Other treatments, including hydroxychloroquine, ivermectin and dietary supplements, have been popularised but are not recommended for early treatment of COVID-19. As new drugs and new data on use of existing approved drugs become available, clinicians face a growing challenge in determining the optimal treatments from the array of options. As it stands, early treatment of COVID-19 needs to be individualised depending on age, pregnancy status, existing medications, and renal and liver disease status. Future treatments in development might have roles in patients with lower risk profiles and in reducing transmission as we learn to live with SARS-CoV-2.

An Australian diagnostic microbiology surge response to the COVID-19 pandemic.

Diagnostic microbiology services form a critical component of the response to infectious disease outbreaks. Like previous respiratory virus pandemics, the COVID-19 pandemic has placed significant strains on the standing capacity of laboratories around the world. In this case study, we describe the surge response required by our laboratory to meet the fluctuating demand for SARS-CoV-2 in our regional pathology service in Western Sydney, Australia between March and May 2020. While the overall number of SARS-CoV-2 PCR positive cases was relatively low compared to other Australian local health districts, testing numbers were highly unpredictable and changed on a weekly basis as local outbreaks were detected. As with other laboratories, numerous other challenges were also faced during this period, including the requirement to introduce a new and unaccredited diagnostic PCR assay for SARS-CoV-2, local and global shortages of reagents for sampling and sample processing, and a significant institutional SARS-CoV-2 outbreak in our laboratory catchment area. A successful service delivery during this period could only be maintained by a dynamic whole-of-laboratory and organizational response including (1) operational changes to the hours of service and the expansion of diagnostic testing at our laboratory site and other sites within our organization (2) careful management of specialist staff and re-training and recruitment of additional staff (3) changes to laboratory workflows to improve SARS-CoV-2 PCR test turnaround time and to accommodate limits to precious laboratory reagents; (4) clear communication within our laboratory and the NSW Health Pathology organization; and (5) collaborative co-ordination and support by NSW Health Pathology.