Implications of COVID-19 for an ageing population An evolving public health policy in response to the COVID-19 pandemic must address the needs of older people C oronavirus disease 2019 (COVID-19) encompasses a broad clinical spectrum caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Accumulating evidence indicates a strong age-related gradient for risk of severe disease, hospitalisation and death. A model-based analysis found that hospitalisation estimates for COVID-19 increased with age: 1.04% for people aged 20-29 years, increasing to 18.40% for those aged 80 years and older. 1 Applying these infection fatality rates (assuming a uniform attack rate by age group) to the Australian population, 2 we project that if 0.5 million Australians were infected with SARS-CoV-2, 66% of deaths would occur in those aged 70 years and older. Eighty-eight percent of deaths would occur in Australians aged 60 years and older (Box 1). The individual contributions related to frailty and physiological changes associated with ageing or multimorbidity remain uncertain. Given Australia's ageing population (21.4% are aged 60 years and older), 2 an evolving public health policy in response to the COVID-19 pandemic must address the needs of this vulnerable population. Key points regarding COVID-19 infection in older people are summarised in Box 2. Specific populations Health care workers account for an estimated 20% of positive cases in Italy, 3 14% in the United Kingdom, 4 and 11% in the United States. 5 In Australia in 2018, the average age of practising general practitioners and specialists was 51.1 and 49.9 years, respectively. 6 This creates complex challenges to strained health infrastructure and resources to ensure allocation of vulnerable staff to non-COVID-19-related roles while maintaining valuable clinical experience. Evidence for risk stratification for health care workers is currently lacking; specific occupational risk of SARS-CoV-2 infection and individual risk of morbidity and mortality (eg, age, medical comorbidities) must be assessed on a case-by-case basis.

A 22-year-old woman presented with methanol toxicity manifesting as headache, reduced conscious state and visual change after consuming home-made grappa. She progressed to a coma with fixed mydriasis and severe acidaemia (pH 6.55). She was treated with empirical antidote administration (intravenous ethanol) and enhanced elimination through haemodialysis. She survived despite her delayed presentation but developed significant neurological sequelae, including visual impairment. We provide an overview of key elements of diagnosis and recent updates in treatment recommendations.

Background and objective In 2014, a 6‐week‐long fire at the Hazelwood coal mine exposed residents in the adjacent town of Morwell to high concentrations of fine particulate matter with an aerodynamic diameter < 2.5 μm (PM2.5). The long‐term health consequences are being evaluated as part of the Hazelwood Health Study. Methods Approximately 3.5–4 years after the mine fire, adults from Morwell (n = 346) and the comparison town Sale (n = 173) participated in the longitudinal Respiratory Stream of the Study. Individual PM2.5 exposure was retrospectively modelled. Lung mechanics were assessed using the forced oscillation technique (FOT), utilizing pressure waves to measure respiratory system resistance (Rrs) and reactance (Xrs). Multivariate linear regression was used to evaluate associations between PM2.5 and transformed Rrs at 5 Hz, area under the reactance curve (AX5) and Xrs at 5 Hz controlling for key confounders. Results There were clear dose–response relationships between increasing mine fire PM2.5 and worsening lung mechanics, including a reduction in post‐bronchodilator (BD) Xrs5 and an increase in AX5. A 10 μg/m3 increase in mine fire‐related PM2.5 was associated with a 0.015 (95% CI: 0.004, 0.027) reduction in exponential (Xrs5) post‐BD, which was comparable to 4.7 years of ageing. Similarly, the effect of exposure was associated with a 0.072 (0.005, 0.138) increase in natural log (lnAX5) post‐BD, equivalent to 3.9 years of ageing. Conclusion This is the first study using FOT in adults evaluating long‐term respiratory outcomes after medium‐term ambient PM2.5 exposure to coal mine fire smoke. These results should inform public health policies and planning for future events.