Clinical characteristics and outcomes of COVID-19 in a low-prevalence, well resourced setting, Sydney, Australia.

BACKGROUND: The Northern Sydney Local Health District was one of the first health regions to be affected by COVID-19 in Australia. AIMS: To describe the clinical characteristics, risk factors and outcomes in our low-prevalence Australian population. METHODS: This is a retrospective analysis of 517 laboratory-confirmed COVID-19 cases between January and June 2020. Patient information was collected as part of routine care within the COVID-19 Virtual Hospital system. Outcomes examined were death, recovery at 30 days and intensive care unit (ICU) admission. RESULTS: The case fatality rate was 1.8%. Multivariate analysis showed factors independently associated with death, composite outcome of death/ICU admission or incomplete recovery at 30 days were age >80 years and presence of two or more comorbidities. Most cases acquired COVID-19 through international (50.9%) or cruise ship travel (9.1%). Healthcare workers comprised 12.8% of the cohort and represented a disproportionately high percentage of the 'unknown' source group (27.6%). The median incubation period was 5 days (interquartile range 3-8); one patient had an incubation period of 15 days. Hospitalisation was required in 11.8%, ICU admission in 2.1% and ventilation in 1.4%. A Radiographic Assessment of Lung Oedema score on chest X-ray of >10 was independently associated with death. CONCLUSIONS: In this low prevalence, well resourced Australian setting, we report an overall low mortality. Factors associated with adverse patient outcomes on multivariate analysis were age greater than 80 and the presence of two or more comorbidities. These data can assist in early risk stratification of COVID-19 patients, and in surge capacity planning for hospitals.

Blue economy: industrialisation and coastal fishing livelihoods in Ghana.

The growing focus on the blue economy is accelerating industrial fishing in many parts of the world. This intensification is affecting the livelihoods of small-scale fishers, processors, and traders by depleting local fishery resources, damaging fishing gears, putting fishers' lives at risk, and compromising market systems and value chain positions. In this article, we outline the experiences, perspectives, and narratives of the small-scale fishing actors in Ghana. Drawing on qualitative interview data, we examine the relationship between small-scale and industrial fisheries in Ghana using political ecology and sustainable livelihood approaches. We demonstrate how industrialised, capital-intensive fishing has disrupted the economic and social organisation of local fishing communities, affecting incomes, causing conflicts, social exclusion and disconnection, and compromising the social identity of women. These cumulative impacts and disruptions in Ghana's coastal communities have threatened the viability of small-scale fisheries, yet coastal fishing actors have few capabilities to adapt. We conclude by supporting recommendations to reduce the number and capacity of industrial vessels, strictly enforce spatial regulations, and ensure "blue justice" against marginalisation.

'It's not just about fish': Assessing the social impacts of marine protected areas on the wellbeing of coastal communities in New South Wales.

Managing Marine Protected Areas (MPAs) is about managing human behaviours, but decision-making processes have traditionally focussed on ecological aspects, treating social aspects as secondary. It is now becoming more evident that an equal focus on the ecological and social aspects is required. Without the collection of information about social aspect such as impacts and sharing this as well as ecological information with communities, MPAs are at higher risk of opposition and social acceptability problems. This paper explores the development of a wellbeing framework to understand the social aspects, including the impacts of MPAs on the wellbeing of local communities. This research investigates two case study MPAs: Cape Byron and Port Stephens-Great Lakes Marine Parks in New South Wales, Australia. The MPAs are multiple-use and were implemented in 2006 and 2007, respectively. The research began with a review of the literature, followed by fieldwork, including semi-structured qualitative interviews with community members. Through thematic coding of the interview transcripts in light of the literature on assessing the social impacts of MPAs, a community wellbeing framework of domains and associated attributes was developed to investigate social impacts. Our analysis shows; first, local perspectives are crucial to understanding social impacts. Second, understanding social impacts gives insight into the nature of trade-offs that occur in decision-making regarding MPAs. Third, the intangible social impacts experienced by local communities are just as significant as the tangible ones for understanding how MPAs operate. Fourth, governance impacts have been the most influential factor affecting the social acceptability of the case study parks. We argue that failure to address negative social impacts can undermine the legitimacy of MPAs. We propose that the framework will support policymakers to work towards more effective, equitable and socially sustainable MPAs by employing much-needed monitoring of human dimensions of conservation interventions at the community level to shape adaptive management.