Journal articles on the topic 'Nosocomial infections – Western Australia – Prevention'

SummaryThrombosis is a common pathology underlying ischaemic heart disease, ischaemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD 2010) documented that ischaemic heart disease and stroke collectively caused one in four deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability. We performed a systematic review of the literature on the global disease burden due to VTE in low, middle and high income countries. Studies from Western Europe, North America, Australia, and Southern Latin America (Argentina) yielded consistent results with annual incidences ranging from 0.75 to 2.69 per 1,000 individuals in the population. The incidence increased to between 2 and 7 per 1,000 among those 70 years of age or more. Although the incidence is lower in individuals of Chinese and Korean ethnicity, their disease burden is not low because of population aging. VTE associated with hospitalisation was the leading cause of disability-adjusted-lifeyears (DALYs) lost in low and middle income countries, and second in high income countries, responsible for more DALYs lost than nosocomial pneumonia, catheter-related blood stream infections, and adverse drug events. VTE causes a major burden of disease across low, middle, and high income countries. More detailed data on the global burden of VTE should be obtained to inform policy and resource allocation in health systems, and to evaluate if improved utilisation of preventive measures will reduce the burden.Note: The copyright for the article is being held by the International Society on Thrombosis and Haemostasis under a CC-BY-NC-ND license.

In 1972 the Council of Europe, in which most of the Western European countries are represented, adopted a resolution aimed at the improvement of hospital hygiene and the promotion of the prevention of nosocomial infections. The member states were invited to take the required measures, but each country was free to implement the resolution according to its own needs and particularities. In Belgium, the first legal regulations were issued in 1974—every hospital was obliged to set up a committee for hospital hygiene.Although similar regulations were issued in most other member states. the actual infection control policies adopted can vary. This article highlights some of the particularities for Belgium.

ObjectivesAcute respiratory infections (ARIs) are a global cause of childhood morbidity. We compared temporal trends and socioeconomic disparities for ARI hospitalisations in young children across Western Australia, England and Scotland.DesignRetrospective population-based cohort studies using linked birth, death and hospitalisation data.Setting and participantsPopulation birth cohorts spanning 2000–2012 (Western Australia and Scotland) and 2003–2012 (England).Outcome measuresARI hospitalisations in infants (<12 months) and children (1–4 years) were identified through International Classification of Diseases, 10th edition diagnosis codes. We calculated admission rates per 1000 child-years by diagnosis and jurisdiction-specific socioeconomic deprivation and used negative binomial regression to assess temporal trends.ResultsThe overall infant ARI admission rate was 44.3/1000 child-years in Western Australia, 40.7/1000 in Scotland and 40.1/1000 in England. Equivalent rates in children aged 1–4 years were 9.0, 7.6 and 7.6. Bronchiolitis was the most common diagnosis. Compared with the least socioeconomically deprived, those most deprived had higher ARI hospitalisation risk (incidence rate ratio 3.9 (95% CI 3.5 to 4.2) for Western Australia; 1.9 (1.7 to 2.1) for England; 1.3 (1.1 to 1.4) for Scotland. ARI admissions in infants were stable in Western Australia but increased annually in England (5%) and Scotland (3%) after adjusting for non-ARI admissions, sex and deprivation.ConclusionsAdmissions for ARI were higher in Western Australia and displayed greater socioeconomic disparities than England and Scotland, where ARI rates are increasing. Prevention programmes focusing on disadvantaged populations in all three countries are likely to translate into real improvements in the burden of ARI in children.

HIV (Human Immunodeficiency Virus) and other sexually transmitted infections (STIs) in Western Australia are at their highest in 20 years. In response to this worrying escalation and the public need for accurate and balanced information about these diseases, the journalism department at Edith Cowan University, in partnership with the WA AIDS Council (WAAC), developed a pilot project that consisted of a series of media training and education programmes to enable WAAC staff to share information and stories with the media on HIV and STIs in a more confident and proactive way. The project offers a model framework for media and community engagement that can be applied to a broader range of health promotion and disease prevention issues.

The incidence of methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus(VRE) infections continues to rise in National Nosocomial Infections Surveillance system hospitals, and these pathogens are reportedly causing more than 100,000 infections and many deaths each year in US healthcare facilities. This has led some to insist that control measures are now urgently needed, but several recent articles have suggested that isolation of patients does not work, is not needed, or is unsafe, or that a single cluster-randomized trial could be used to decide such matters. At least 101 studies have reported controlling MRSA infection and 38 have reported controlling VRE infection by means of active detection by surveillance culture and use of isolation for all colonized patients in healthcare settings where the pathogens are epidemic or endemic, in academic and nonacademic hospitals, and in acute care, intensive care, and long-term care settings. MRSA colonization and infection have been controlled to exceedingly low levels in multiple nations and in the state of Western Australia for decades by use of active detection and isolation. Studies suggesting problems with using such data to control MRSA colonization and infection have their own problems, which are discussed. Randomized trials are epidemiologic tools that can sometimes provide erroneous results, and they have not been considered necessary for studying isolation before it is used to control other important infections, such as tuberculosis, smallpox, and severe acute respiratory syndrome. No single epidemiologic study should be considered definitive. One should always weigh all available evidence. Infection with antibiotic-resistant pathogens such as MRSA and VRE is controllable to a low level by active detection and isolation of colonized and infected patients. Effective measures should be used to minimize the morbidity and mortality attributable to these largely preventable infections.

Objective: To describe recent trends in the diagnosis of HIV infection in Australia. Methods: National HIV surveillance data from 1993 to 2006 were analysed with a focus on geographic differences by HIV exposure route and late presentation (HIV within 3 months of a first AIDS-defining illness or a CD4 count of less than 200 cells μL–1). Results: In 1993–99, the number of HIV diagnoses declined by 32%, and then increased by 39% from 1999 to 2006. From 2000 onwards, rates increased significantly in Victoria, Queensland, South Australia and Western Australia. The most frequently reported routes of HIV exposure were male to male sex (71%) and heterosexual contact (18%), and the population rate of diagnoses have increased in both categories. Among the cases reported as heterosexually acquired (n = 2199), 33% were in people born in a high-prevalence country and 19% in those with partners from a high-prevalence country. Late presentation was most frequent in heterosexually acquired infections in persons who had a partner from a high-prevalence country: 32% compared with 20% overall. Conclusions: Recent increases in annual numbers of HIV diagnoses in Australia underline the continuing need for HIV-prevention programs, particularly among men having male to male sex. Early diagnosis and access to care and treatment should also be emphasised, as a substantial proportion of people with HIV infection are unaware of their status until late in the course of disease.

Introduction. Among the most important causes of diarrhea in modern hospitals is Clostridium difficile (C. difficile). A wide spectrum of diseases caused by this bacterium is now known as C. difficile associated disease (CDAD). The development of CDAD is usually preceded by the administration of antimicrobial therapy and fecal-oral infections with C. difficile. Over the last years epidemiology of CDAD has significantly changed. Recently, a hypervirulent BI/NAP1/027 strain, the cause of severe epidemics in North America and Western Europe, has been identified. Objective. The aim of this study was to identify risk factors for CDAD in patients operated on at the Military Medical Academy (MMA). Methods. The study included all patients who underwent surgery at the MMA during 2010. Nested case-control study design was used. The subjects were divided into groups of operated patients with and without CDAD. The patients were under prospective follow-up, while their data were collected using a questionnaire during a routine epidemiological control. Results. During 2010 the incidence rate of CDAD was 3.3 per 10,000 hospital days. Univariate regression analysis showed that the length of administration of one or two antibiotics, as well as concurrent administration of two antibiotics, were far more frequently observed in the patients with than in the patients without CDAD. Independent risk factor for the development of CDAD was the length of the administration of one antibiotic. Conclusion Reduction in the incidence rate of CDAD can be achieved by using reliable measures of prevention and control; the rational use of antibiotics, early diagnosis and therapy of infected patients, contact isolation of infected persons, proper disinfection, and continued education of medical and non-medical personnel.

In this issue, Witte and colleagues report on the emergence, since 2002, of cases in Germany of infection with community-acquired methicillin-resistant Staphylococcus aureus (c-MRSA) producing the Panton-Valentine leukocidin. This report adds evidence to the rapid geographical dissemination of this emerging, hyper-virulent variant of an 'old pathogen' across Europe. First reported in the early 1990s among aboriginal populations in Western Australia, outbreaks of c-MRSA infections have more recently been described in population groups such as prison inmates, injecting drug users, sports teams and schoolchildren, in the United States and Europe. Current evidence from molecular studies points to the spread in each continent of a limited number of PVL-producing MRSA clones that are genetically distinct from epidemic nosocomial strains. This represents a public health threat, because these strains are associated with severe soft tissue and pulmonary infection and the outcome of MRSA infection is worse than with infection caused by beta-lactam susceptible S. aureus, especially if inappropriately treated with beta-lactams that are usually prescribed for these infections. We must, therefore, upgrade the diagnostic work-up for this kind of infection in the outpatient setting and adapt empirical therapy accordingly. Moreover, surveillance should be intensified to monitor the incidence of MRSA and detect and control outbreaks in the community. In this respect, the report by Witte et al underscores the important early warning role that reference laboratories can play by using high resolution molecular markers based on routine typing and susceptibility data.

Foodborne diseases (FBD) present high prevalence worldwide and more than 250 types have been reported. The main agents are Staphylococcus aureus, Escherichia coli, Salmonella and certain parasites. The habit of consuming foods sold in street markets in the city of São Paulo exposes consumers to the risk of acquiring FBD. 25 samples of vinaigrette salad were collected in the central, northern, southern, eastern and western regions of the city of São Paulo, Brazil. The samples were inoculated in selective, enriched culture media and biochemical analyses were performed. Bacterial and fungal growth occurred in all samples. The microorganisms detected were E. coli (64%), Enterobacter (60%), S. aureus (52%), Klebsiella (40%), Proteus sp. (32%), Shigella sp. (28%), Citrobacter sp. (16%), Edwardsiella sp. (12%), Alcaligenes sp. (8%), Serratia sp. (8%), Salmonella sp. (4%), Pseudomonas sp. (4%) and; 72% were positive for aflatoxins. Twelve species were identified, 50% of which can cause FBD. S. aureus and fecal coliforms can cause FBD, while Alcaligenes sp. can cause nosocomial infections and Edwardsiella sp. can cause hepatic abscess, meningitis and septicemia. Aflatoxins may cause mycotoxicoses and liver cancer. Therefore, inspections, and prevention and awareness measures should be reinforced to minimize the risks of contracting FBD from foods sold in street markets in the city of São Paulo.

AimTo characterise the epidemiology, clinical features and treatment of paediatric cellulitis.MethodsA retrospective study of children presenting to a paediatric tertiary hospital in Western Australia, Australia in 2018. All inpatient records from 1 January to 31 December 2018 and emergency department presentations from 1 July to 31 December 2018 were screened for inclusion.Results302 episodes of cellulitis were included comprising 206 (68.2%) admitted children and 96 (31.8%) non-admitted children. The median age was 5 years (IQR 2–9), 40 (13.2%) were Aboriginal and 180 (59.6%) boys. The extremities were the most commonly affected body site among admitted and non-admitted patients. There was a greater proportion of facial cellulitis in admitted patients (27.2%) compared with non-admitted patients (5.2%, p<0.01). Wound swab was the most frequent microbiological investigation (133/302, 44.0%), yielding positive cultures in the majority of those tested (109/133, 82.0%). The most frequent organisms identified were Staphylococcus aureus (94/109, 86.2%) (methicillin-susceptible S. aureus (60/94, 63.8%), methicillin-resistant S. aureus) and Streptococcus pyogenes (22/109, 20.2%) with 14 identifying both S. aureus and S. pyogenes. Intravenous flucloxacillin was the preferred antibiotic (154/199, 77.4%), with median intravenous duration 2 days (IQR 2–3), oral 6 days (IQR 5–7) and total 8 days (IQR 7–10).ConclusionsCellulitis is a common reason for presentation to a tertiary paediatric hospital. We confirm a high prevalence of extremity cellulitis and demonstrate that children with facial cellulitis often require admission. Cellulitis disproportionately affected Aboriginal children and children below 5 years. Prevention of cellulitis involves early recognition and treatment of skin infections such as impetigo and scabies.

IntroductionCaesarean delivery is steadily becoming one of the more common surgical procedures in Australia with over 100 000 caesarean sections performed each year. Over the last 10 years in Australia, the caesarean section rate has increased from 28% in 2003 to 33% in 2013. On the international stage, the Australian caesarean delivery rates are higher than the average for the Organisation for Economic Co-operation and Development, Australia ranked as 8 out of 33 and is second to the USA. Postoperative surgical site infections (SSIs) and wound complications are the most common and costly event following a caesarean section. Globally, complication rates following a caesarean delivery vary from 4.9% to 9.8%. Complications such as infection and wound breakdown affect the postpartum mother’s health and well-being, and contribute to healthcare costs for clinical management that often spans the acute, community and primary healthcare settings. Published level one studies using advanced wound dressings in the identified ‘at-risk’ population prior to surgery for prophylactic intervention are yet to be forthcoming.Methods and analysisA parallel group randomised control trial of 448 patients will be conducted across two metropolitan hospitals in Perth, Western Australia, which provide obstetric and midwifery services. We will recruit pregnant women in the last trimester, prior to their admission into the healthcare facility for delivery of their child. We will use a computer-generated block sequence to randomise the 448 participants to either the interventional (negative pressure wound therapy (NPWT) dressing, n=224) or comparator arm (non-NPWT dressing, n=224). The primary outcome measure is the occurrence of surgical wound dehiscence (SSWD) or SSI. The Centres for Disease Control reporting definition of either superficial or deep infection at 30 days will be used as the outcome measure definition. SWD will be classified as per the World Union of Wound Healing Societies grading system (grade I–IV). We will assess recruitment rate, and adherence to intervention and follow-up. We will assess the potential effectiveness of NPWT in the prevention of postpartum surgical wound complications at three time points during the study; postoperative days 5, 14 and 30, after which the participant will be closed out of the trial. We will use statistical methods to determine efficacy, and risk stratification will be conducted to determine the SWD risk profile of the participant. Follow-up at day 30 will assess superficial and deep infection, and wound dehiscence (grade I–IV) and the core outcome data set for wound complications. This study will collect health-related quality of life (European Quality of Life 5-Dimensions 5-Level Scale), mortality and late complications such as further surgery with a cost analysis conducted. The primary analysis will be by intention-to-treat. This clinical trial protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and the Consolidated Standards of Reporting Trials guidelines.Ethics and disseminationEthics approval was obtained through St John of God Health Care (HREC1409), Western Australia Department of Health King Edward Memorial Hospital (HREC3111). Study findings will be published in peer-reviewed journals and presented at international conferences. We used the SPIRIT checklist when writing our study protocol.Trial registration numberAustralian and New Zealand Clinical Trials Registry (ACTRN12618002006224p).

AbstractBackground:Short-term peripheral venous catheter–related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available.Methods:Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.Results:We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%).Conclusions:PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.

This paper describes a novel serendipitous discovery to successfully treat cancer with improved efficiency emerged while using Dr. M.S. Reddy’s Multiple Mixed Strain Probiotic Therapy (originally discovered to prevent or treat nosocomial infections) as an adjuvant therapy along with the immune checkpoint therapy and other conventional cancer therapies. This new discovery is named as “Dr. M.S. Reddy’s Multiple Mixed Strain Probiotic Adjuvant Cancer Therapy”. Cancer is rising as a global epidemic, currently killing over 9 million people every year. This figure is supposed to get up to 13 million by the year 2030. The cancer epidemic is more prevalent in the Western countries than Eastern countries. The cost of treating cancer was $290 billion in the year 2010 and it is supposed to get up to $458 billion/year by the year 2030. Recently checkpoint immune therapy is showing great promise as a treatment tool. Yet the global success in treating the cancer is only 20% or slightly higher, with all the advancements and discoveries. A new paradigm shift in cancer treatment has been discovered as serendipitous discovery to enhance the efficiency of the existing cancer therapies significantly. This serendipitous discovery came as a surprise while running community based clinical trials using the novel discovery of Dr. M.S. Reddy’s Multiple Mixed Strain Probiotic Therapy to prevent or cure the hospital acquired or nosocomial infections, which are affecting over six million people with severe mortality. Several physicians have observed that Dr. Reddy’s Probiotic therapy given for prevention or control of nosocomial infections significantly helped the recovery of cancer patients who were also receiving standard cancer therapies. This article outlines the mechanism by which Dr. M.S. Reddy’s Multiple Mixed Strain Probiotic Therapy assist to cure cancer at a much faster pace, with the least side effects, when used as adjuvant therapy along with the immune checkpoint therapy, and other standard cancer therapies. Details are presented how the PD-1 and CTLA-4 blockade therapy works to reduce cancer and also the possible scientific explanations why such an immune checkpoint therapy only works on limited cancer cases. The effect of Multiple Mixed Strain Probiotics on establishing the immune tolerance through reduction of local or systemic inflammation is also outlined. The possible biological and immunological mechanisms of how Multiple Mixed Strain Probiotic Therapy significantly enhances the immune checkpoint therapy (PD-1 and CTLA-4 blockade) has been presented with explicit details. The details are also presented showing how Multiple Mixed Strain Adjuvant Therapy can minimize or significantly reduce the unpleasant side effects of the current conventional and immune checkpoint cancer therapies. Practical clinical and experimental data presented to show the significance of Dr. M.S. Reddy’s Multiple Mixed Strain Probiotic Therapy, as an adjuvant therapy, along with the standard cancer therapies to improve the cancer treatment efficiencies by up to 60%. Evidence is presented to illustrate and point out that the current FDA regulations will allow the use of Dr. M.S. Reddy’s Multiple Mixed Strain Probiotic (Therapy) as nutritional supplement, since the probiotic strains used are categorized as food grade and GRAS (Generally Regarded as Safe), as per the 21 Code of Federal Regulations of the Food and Drug Administration. Details are presented with genus and species identification of individual probiotic strains used in the Multiple Mixed Strain Probiotic Therapy. Thus special and formal FDA approval is not required to use them as adjuvants to improve the efficiency of traditional cancer therapies. Finally the scientific reasoning is presented with evidence to illustrate the utmost urgency and necessity of using Dr. M.S. Reddy’s “Multiple Mixed Strain Probiotic Therapy” along with the immune checkpoint therapy and other traditional cancer therapies to protect the lives of millions of people dying with cancer annually.

In most countries of the world, infectious diseases of bees are an important problem for beekeeping, as they lead to a decrease and decrease in the number of bee colonies, a negative impact on the environment, a decrease in the yield of entomophilic crops and the overall productivity of the industry as a whole. According to data from statistical reporting and scientific publications, American and European flocks, ascospheros are registered in apiaries almost all over the world: in Western and Eastern Europe, North and Central America, Canada, Australia and New Zealand, Africa, in the CIS countries. The change in the epizootic situation in bee-keeping is associated with the widespread spread of the varioise invasion, which causes a steady increase in the incidence of bee infestation by infectious diseases, so the effect of this invasion on the intensity of the epizootic process requires constant monitoring research. Among the topical tasks of the veterinary support of the beekeeping industry in the improvement of the system of antiepizootic measures, the differential diagnosis of infectious diseases of the breeding pedigree in the mixed forms of their manifestation was very important. The difficulty in making the correct diagnosis in mixed forms of the course of infectious diseases leads to inadequate and untimely conduct of treatment and preventive measures, and as a consequence, to the weakening and death of bees. In this regard, the development of an epizootiological monitoring system aimed at recording and evaluating changes in the epizootic state of apiaries, the identification of sources and reservoirs of pathogens, the motive forces of the epizootic process and the forms of the disease, and the organization of a system of effective preventive, medical and veterinary-sanitary measures on the apiaries. In the period of economic transformations in the agrarian-industrial complex there was a lack of breeding of beekeeping farms and apiaries, a system of management of the industry and a form of ownership changed, all this created a qualitatively new environment of the bee colony and contributed to the evolution of the epizootic process in infectious diseases – the development of mixed infections. In connection with this, there was a need to improve the system of epidemiological surveillance in beekeepers and to introduce a more effective comprehensive system of measures for the prevention and control of infectious diseases of the breeding bee, in particular, American rot, varrosis and other contagious diseases of bees.

Introduction The highly contagious COVID-19 virus has presented particularly difficult public policy challenges. The relatively late emergence of an effective treatments and vaccines, the structural stresses on health care systems, the lockdowns and the economic dislocations, the evident structural inequalities in effected societies, as well as the difficulty of prevention have tested social and political cohesion. Moreover, the intrusive nature of many prophylactic measures have led to individual liberty and human rights concerns. As noted by the Victorian (Australia) Ombudsman Report on the COVID-19 lockdown in Melbourne, we may be tempted, during a crisis, to view human rights as expendable in the pursuit of saving human lives. This thinking can lead to dangerous territory. It is not unlawful to curtail fundamental rights and freedoms when there are compelling reasons for doing so; human rights are inherently and inseparably a consideration of human lives. (5) These difficulties have raised issues about the importance of social or community capital in fighting the pandemic. This article discusses the impacts of social and community capital and other factors on the governmental efforts to combat the spread of infectious disease through the maintenance of social distancing and household ‘bubbles’. It argues that the beneficial effects of social and community capital towards fighting the pandemic, such as mutual respect and empathy, which underpins such public health measures as social distancing, the use of personal protective equipment, and lockdowns in the USA, have been undermined as preventive measures because they have been transmogrified to become a salient aspect of the “culture wars” (Peters). In contrast, states that have relatively lower social capital such a China have been able to more effectively arrest transmission of the disease because the government was been able to generate and personify a nationalist response to the virus and thus generate a more robust social consensus regarding the efforts to combat the disease. Social Capital and Culture Wars The response to COVID-19 required individuals, families, communities, and other types of groups to refrain from extensive interaction – to stay in their bubble. In these situations, especially given the asymptomatic nature of many COVID-19 infections and the serious imposition lockdowns and social distancing and isolation, the temptation for individuals to breach public health rules in high. From the perspective of policymakers, the response to fighting COVID-19 is a collective action problem. In studying collective action problems, scholars have paid much attention on the role of social and community capital (Ostrom and Ahn 17-35). Ostrom and Ahn comment that social capital “provides a synthesizing approach to how cultural, social, and institutional aspects of communities of various sizes jointly affect their capacity of dealing with collective-action problems” (24). Social capital is regarded as an evolving social type of cultural trait (Fukuyama; Guiso et al.). Adger argues that social capital “captures the nature of social relations” and “provides an explanation for how individuals use their relationships to other actors in societies for their own and for the collective good” (387). The most frequently used definition of social capital is the one proffered by Putnam who regards it as “features of social organization, such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit” (Putnam, “Bowling Alone” 65). All these studies suggest that social and community capital has at least two elements: “objective associations” and subjective ties among individuals. Objective associations, or social networks, refer to both formal and informal associations that are formed and engaged in on a voluntary basis by individuals and social groups. Subjective ties or norms, on the other hand, primarily stand for trust and reciprocity (Paxton). High levels of social capital have generally been associated with democratic politics and civil societies whose institutional performance benefits from the coordinated actions and civic culture that has been facilitated by high levels of social capital (Putnam, Democracy 167-9). Alternatively, a “good and fair” state and impartial institutions are important factors in generating and preserving high levels of social capital (Offe 42-87). Yet social capital is not limited to democratic civil societies and research is mixed on whether rising social capital manifests itself in a more vigorous civil society that in turn leads to democratising impulses. Castillo argues that various trust levels for institutions that reinforce submission, hierarchy, and cultural conservatism can be high in authoritarian governments, indicating that high levels of social capital do not necessarily lead to democratic civic societies (Castillo et al.). Roßteutscher concludes after a survey of social capita indicators in authoritarian states that social capital has little effect of democratisation and may in fact reinforce authoritarian rule: in nondemocratic contexts, however, it appears to throw a spanner in the works of democratization. Trust increases the stability of nondemocratic leaderships by generating popular support, by suppressing regime threatening forms of protest activity, and by nourishing undemocratic ideals concerning governance (752). In China, there has been ongoing debate concerning the presence of civil society and the level of social capital found across Chinese society. If one defines civil society as an intermediate associational realm between the state and the family, populated by autonomous organisations which are separate from the state that are formed voluntarily by members of society to protect or extend their interests or values, it is arguable that the PRC had a significant civil society or social capital in the first few decades after its establishment (White). However, most scholars agree that nascent civil society as well as a more salient social and community capital has emerged in China’s reform era. This was evident after the 2008 Sichuan earthquake, where the government welcomed community organising and community-driven donation campaigns for a limited period of time, giving the NGO sector and bottom-up social activism a boost, as evidenced in various policy areas such as disaster relief and rural community development (F. Wu 126; Xu 9). Nevertheless, the CCP and the Chinese state have been effective in maintaining significant control over civil society and autonomous groups without attempting to completely eliminate their autonomy or existence. The dramatic economic and social changes that have occurred since the 1978 Opening have unsurprisingly engendered numerous conflicts across the society. In response, the CCP and State have adjusted political economic policies to meet the changing demands of workers, migrants, the unemployed, minorities, farmers, local artisans, entrepreneurs, and the growing middle class. Often the demands arising from these groups have resulted in policy changes, including compensation. In other circumstances, where these groups remain dissatisfied, the government will tolerate them (ignore them but allow them to continue in the advocacy), or, when the need arises, supress the disaffected groups (F. Wu 2). At the same time, social organisations and other groups in civil society have often “refrained from open and broad contestation against the regime”, thereby gaining the space and autonomy to achieve the objectives (F. Wu 2). Studies of Chinese social or community capital suggest that a form of modern social capital has gradually emerged as Chinese society has become increasingly modernised and liberalised (despite being non-democratic), and that this social capital has begun to play an important role in shaping social and economic lives at the local level. However, this more modern form of social capital, arising from developmental and social changes, competes with traditional social values and social capital, which stresses parochial and particularistic feelings among known individuals while modern social capital emphasises general trust and reciprocal feelings among both known and unknown individuals. The objective element of these traditional values are those government-sanctioned, formal mass organisations such as Communist Youth and the All-China Federation of Women's Associations, where members are obliged to obey the organisation leadership. The predominant subjective values are parochial and particularistic feelings among individuals who know one another, such as guanxi and zongzu (Chen and Lu, 426). The concept of social capital emphasises that the underlying cooperative values found in individuals and groups within a culture are an important factor in solving collective problems. In contrast, the notion of “culture war” focusses on those values and differences that divide social and cultural groups. Barry defines culture wars as increases in volatility, expansion of polarisation, and conflict between those who are passionate about religiously motivated politics, traditional morality, and anti-intellectualism, and…those who embrace progressive politics, cultural openness, and scientific and modernist orientations. (90) The contemporary culture wars across the world manifest opposition by various groups in society who hold divergent worldviews and ideological positions. Proponents of culture war understand various issues as part of a broader set of religious, political, and moral/normative positions invoked in opposition to “elite”, “liberal”, or “left” ideologies. Within this Manichean universe opposition to such issues as climate change, Black Lives Matter, same sex rights, prison reform, gun control, and immigration becomes framed in binary terms, and infused with a moral sensibility (Chapman 8-10). In many disputes, the culture war often devolves into an epistemological dispute about the efficacy of scientific knowledge and authority, or a dispute between “practical” and theoretical knowledge. In this environment, even facts can become partisan narratives. For these “cultural” disputes are often how electoral prospects (generally right-wing) are advanced; “not through policies or promises of a better life, but by fostering a sense of threat, a fantasy that something profoundly pure … is constantly at risk of extinction” (Malik). This “zero-sum” social and policy environment that makes it difficult to compromise and has serious consequences for social stability or government policy, especially in a liberal democratic society. Of course, from the perspective of cultural materialism such a reductionist approach to culture and political and social values is not unexpected. “Culture” is one of the many arenas in which dominant social groups seek to express and reproduce their interests and preferences. “Culture” from this sense is “material” and is ultimately connected to the distribution of power, wealth, and resources in society. As such, the various policy areas that are understood as part of the “culture wars” are another domain where various dominant and subordinate groups and interests engaged in conflict express their values and goals. Yet it is unexpected that despite the pervasiveness of information available to individuals the pool of information consumed by individuals who view the “culture wars” as a touchstone for political behaviour and a narrative to categorise events and facts is relatively closed. This lack of balance has been magnified by social media algorithms, conspiracy-laced talk radio, and a media ecosystem that frames and discusses issues in a manner that elides into an easily understood “culture war” narrative. From this perspective, the groups (generally right-wing or traditionalist) exist within an information bubble that reinforces political, social, and cultural predilections. American and Chinese Reponses to COVID-19 The COVID-19 pandemic first broke out in Wuhan in December 2019. Initially unprepared and unwilling to accept the seriousness of the infection, the Chinese government regrouped from early mistakes and essentially controlled transmission in about three months. This positive outcome has been messaged as an exposition of the superiority of the Chinese governmental system and society both domestically and internationally; a positive, even heroic performance that evidences the populist credentials of the Chinese political leadership and demonstrates national excellence. The recently published White Paper entitled “Fighting COVID-19: China in Action” also summarises China’s “strategic achievement” in the simple language of numbers: in a month, the rising spread was contained; in two months, the daily case increase fell to single digits; and in three months, a “decisive victory” was secured in Wuhan City and Hubei Province (Xinhua). This clear articulation of the positive results has rallied political support. Indeed, a recent survey shows that 89 percent of citizens are satisfied with the government’s information dissemination during the pandemic (C Wu). As part of the effort, the government extensively promoted the provision of “political goods”, such as law and order, national unity and pride, and shared values. For example, severe publishments were introduced for violence against medical professionals and police, producing and selling counterfeit medications, raising commodity prices, spreading ‘rumours’, and being uncooperative with quarantine measures (Xu). Additionally, as an extension the popular anti-corruption campaign, many local political leaders were disciplined or received criminal charges for inappropriate behaviour, abuse of power, and corruption during the pandemic (People.cn, 2 Feb. 2020). Chinese state media also described fighting the virus as a global “competition”. In this competition a nation’s “material power” as well as “mental strength”, that calls for the highest level of nation unity and patriotism, is put to the test. This discourse recalled the global competition in light of the national mythology related to the formation of Chinese nation, the historical “hardship”, and the “heroic Chinese people” (People.cn, 7 Apr. 2020). Moreover, as the threat of infection receded, it was emphasised that China “won this competition” and the Chinese people have demonstrated the “great spirit of China” to the world: a result built upon the “heroism of the whole Party, Army, and Chinese people from all ethnic groups” (People.cn, 7 Apr. 2020). In contrast to the Chinese approach of emphasising national public goods as a justification for fighting the virus, the U.S. Trump Administration used nationalism, deflection, and “culture war” discourse to undermine health responses — an unprecedented response in American public health policy. The seriousness of the disease as well as the statistical evidence of its course through the American population was disputed. The President and various supporters raged against the COVID-19 “hoax”, social distancing, and lockdowns, disparaged public health institutions and advice, and encouraged protesters to “liberate” locked-down states (Russonello). “Our federal overlords say ‘no singing’ and ‘no shouting’ on Thanksgiving”, Representative Paul Gosar, a Republican of Arizona, wrote as he retweeted a Centers for Disease Control list of Thanksgiving safety tips (Weiner). People were encouraged, by way of the White House and Republican leadership, to ignore health regulations and not to comply with social distancing measures and the wearing of masks (Tracy). This encouragement led to threats against proponents of face masks such as Dr Anthony Fauci, one of the nation’s foremost experts on infectious diseases, who required bodyguards because of the many threats on his life. Fauci’s critics — including President Trump — countered Fauci’s promotion of mask wearing by stating accusingly that he once said mask-wearing was not necessary for ordinary people (Kelly). Conspiracy theories as to the safety of vaccinations also grew across the course of the year. As the 2020 election approached, the Administration ramped up efforts to downplay the serious of the virus by identifying it with “the media” and illegitimate “partisan” efforts to undermine the Trump presidency. It also ramped up its criticism of China as the source of the infection. This political self-centeredness undermined state and federal efforts to slow transmission (Shear et al.). At the same time, Trump chided health officials for moving too slowly on vaccine approvals, repeated charges that high infection rates were due to increased testing, and argued that COVID-19 deaths were exaggerated by medical providers for political and financial reasons. These claims were amplified by various conservative media personalities such as Rush Limbaugh, and Sean Hannity and Laura Ingraham of Fox News. The result of this “COVID-19 Denialism” and the alternative narrative of COVID-19 policy told through the lens of culture war has resulted in the United States having the highest number of COVID-19 cases, and the highest number of COVID-19 deaths. At the same time, the underlying social consensus and social capital that have historically assisted in generating positive public health outcomes has been significantly eroded. According to the Pew Research Center, the share of U.S. adults who say public health officials such as those at the Centers for Disease Control and Prevention are doing an excellent or good job responding to the outbreak decreased from 79% in March to 63% in August, with an especially sharp decrease among Republicans (Pew Research Center 2020). Social Capital and COVID-19 From the perspective of social or community capital, it could be expected that the American response to the Pandemic would be more effective than the Chinese response. Historically, the United States has had high levels of social capital, a highly developed public health system, and strong governmental capacity. In contrast, China has a relatively high level of governmental and public health capacity, but the level of social capital has been lower and there is a significant presence of traditional values which emphasise parochial and particularistic values. Moreover, the antecedent institutions of social capital, such as weak and inefficient formal institutions (Batjargal et al.), environmental turbulence and resource scarcity along with the transactional nature of guanxi (gift-giving and information exchange and relationship dependence) militate against finding a more effective social and community response to the public health emergency. Yet China’s response has been significantly more successful than the Unites States’. Paradoxically, the American response under the Trump Administration and the Chinese response both relied on an externalisation of the both the threat and the justifications for their particular response. In the American case, President Trump, while downplaying the seriousness of the virus, consistently called it the “China virus” in an effort to deflect responsibly as well as a means to avert attention away from the public health impacts. As recently as 3 January 2021, Trump tweeted that the number of “China Virus” cases and deaths in the U.S. were “far exaggerated”, while critically citing the Centers for Disease Control and Prevention's methodology: “When in doubt, call it COVID-19. Fake News!” (Bacon). The Chinese Government, meanwhile, has pursued a more aggressive foreign policy across the South China Sea, on the frontier in the Indian sub-continent, and against states such as Australia who have criticised the initial Chinese response to COVID-19. To this international criticism, the government reiterated its sovereign rights and emphasised its “victimhood” in the face of “anti-China” foreign forces. Chinese state media also highlighted China as “victim” of the coronavirus, but also as a target of Western “political manoeuvres” when investigating the beginning stages of the pandemic. The major difference, however, is that public health policy in the United States was superimposed on other more fundamental political and cultural cleavages, and part of this externalisation process included the assignation of “otherness” and demonisation of internal political opponents or characterising political opponents as bent on destroying the United States. This assignation of “otherness” to various internal groups is a crucial element in the culture wars. While this may have been inevitable given the increasingly frayed nature of American society post-2008, such a characterisation has been activity pushed by local, state, and national leadership in the Republican Party and the Trump Administration (Vogel et al.). In such circumstances, minimising health risks and highlighting civil rights concerns due to public health measures, along with assigning blame to the democratic opposition and foreign states such as China, can have a major impact of public health responses. The result has been that social trust beyond the bubble of one’s immediate circle or those who share similar beliefs is seriously compromised — and the collective action problem presented by COVID-19 remains unsolved. Daniel Aldrich’s study of disasters in Japan, India, and US demonstrates that pre-existing high levels of social capital would lead to stronger resilience and better recovery (Aldrich). Social capital helps coordinate resources and facilitate the reconstruction collectively and therefore would lead to better recovery (Alesch et al.). Yet there has not been much research on how the pool of social capital first came about and how a disaster may affect the creation and store of social capital. Rebecca Solnit has examined five major disasters and describes that after these events, survivors would reach out and work together to confront the challenges they face, therefore increasing the social capital in the community (Solnit). However, there are studies that have concluded that major disasters can damage the social fabric in local communities (Peacock et al.). The COVID-19 epidemic does not have the intensity and suddenness of other disasters but has had significant knock-on effects in increasing or decreasing social capital, depending on the institutional and social responses to the pandemic. In China, it appears that the positive social capital effects have been partially subsumed into a more generalised patriotic or nationalist affirmation of the government’s policy response. Unlike civil society responses to earlier crises, such as the 2008 Sichuan earthquake, there is less evidence of widespread community organisation and response to combat the epidemic at its initial stages. This suggests better institutional responses to the crisis by the government, but also a high degree of porosity between civil society and a national “imagined community” represented by the national state. The result has been an increased legitimacy for the Chinese government. Alternatively, in the United States the transformation of COVID-19 public health policy into a culture war issue has seriously impeded efforts to combat the epidemic in the short term by undermining the social consensus and social capital necessary to fight such a pandemic. Trust in American institutions is historically low, and President Trump’s untrue contention that President Biden’s election was due to “fraud” has further undermined the legitimacy of the American government, as evidenced by the attacks directed at Congress in the U.S. capital on 6 January 2021. As such, the lingering effects the pandemic will have on social, economic, and political institutions will likely reinforce the deep cultural and political cleavages and weaken interpersonal networks in American society. Conclusion The COVID-19 pandemic has devastated global public health and impacted deeply on the world economy. Unsurprisingly, given the serious economic, social, and political consequences, different government responses have been highly politicised. Various quarantine and infection case tracking methods have caused concern over state power intruding into private spheres. The usage of face masks, social distancing rules, and intra-state travel restrictions have aroused passionate debate over public health restrictions, individual liberty, and human rights. Yet underlying public health responses grounded in higher levels of social capital enhance the effectiveness of public health measures. In China, a country that has generally been associated with lower social capital, it is likely that the relatively strong policy response to COVID-19 will both enhance feelings of nationalism and Chinese exceptionalism and help create and increase the store of social capital. In the United States, the attribution of COVID-19 public health policy as part of the culture wars will continue to impede efforts to control the pandemic while further damaging the store of American community social capital that has assisted public health efforts over the past decades. References Adger, W. Neil. “Social Capital, Collective Action, and Adaptation to Climate Change.” Economic Geography 79.4 (2003): 387-404. Bacon, John. “Coronavirus Updates: Donald Trump Says US 'China Virus' Data Exaggerated; Dr. Anthony Fauci Protests, Draws President's Wrath.” USA Today 3 Jan. 2021. 4 Jan. 2021 <https://www.usatoday.com/story/news/health/2021/01/03/COVID-19-update-larry-king-ill-4-million-december-vaccinations-us/4114363001/>. Berry, Kate A. “Beyond the American Culture Wars.” Regions & Cohesion / Regiones y Cohesión / Régions et Cohésion 7.2 (Summer 2017): 90-95. Castillo, Juan C., Daniel Miranda, and Pablo Torres. “Authoritarianism, Social Dominance and Trust in Public Institutions.” Annual Scientific Meeting of the International Society of Political Psychology, Istanbul, 9-12 July 2011. 2 Jan. 2021 <https://pdfs.semanticscholar.org/>. Chapman, Roger. “Introduction, Culture Wars: Rhetoric and Reality.” Culture Wars: An Encyclopedia of Issues, Viewpoints, and Voices. Eds. Roger Chapman and M.E. Sharpe. 2010. 8-10. Chen, Jie, and Chunlong Lu. “Social Capital in Urban China: Attitudinal and Behavioral Effects on Grassroots Self-Government.” Social Science Quarterly 88.2 (June 2007): 422-442. China's State Council Information Office. “Fighting COVID-19: China in Action.” Xinhuanet 7 June 2020. 2 Sep. 2020 <http://www.xinhuanet.com/english/2020-06/07/c_139120424.htm?bsh_bid=551709954>. Fukuyama, Francis. Trust: The Social Virtues and the Creation of Prosperity. Hamish Hamilton, 1995. Kelly, Mike. “Welcome to the COVID-19 Culture Wars. Why Are We Fighting about Masks?’ Yahoo News 4 Dec. 2020 <https://www.msn.com/en-us/news/us/welcome-to-the-COVID-19-culture-wars-why-are-we-fighting-about-masks-mike-kelly/ar-BB1bCOHN>. Luigi Guiso, Paola Sapienza, and Luigi Zingales, “Social Capital as Good Culture.” National Bureau of Economic Research Working Paper No. 13712. 2007. 18 ct. 2017 <http://www.nber.org/papers/w13712.pdf>. Malik, Nesrine. “The Right's Culture War Is No Longer a Sideshow to Our Politics – It Is Our Politics.” The Guardian 31 Aug. 2020. 6 Jan. 2021 <https://www.theguardian.com/commentisfree/2020/aug/31/the-rights-culture-war-politics-rightwing-fantasy-elections>. Offe, Carl. “How Can We Trust Our Fellow Citizens?” Democracy and Trust. Ed. M.E. Warren. Cambridge University Press, 1999. 42-87. Ostrom, Elinor, and T.K. Ahn. “The Meaning of Social Capital and Its Link to Collective Action.” Handbook of Social Capital: The Troika of Sociology, Political Science and Economics. Eds. Gert Tinggaard Svendsen and Gunnar Lind Haase Svendsen. Edward Elgar, 2009. 17–35. Paxton, Pamela. “Is Social Capital Declining in the United States? A Multiple Indicator Assessment.” American Journal of Sociology 105.1 (1999): 88-127. People.cn. “Hubeisheng Huanggangshi chufen dangyuan ganbu 337 ren.” [“337 Party Cadres Were Disciplined in Huanggang, Hubei Province.”] 2 Feb. 2020. 10 Sep. 2020 <http://fanfu.people.com.cn/n1/2020/0130/c64371-31565382.html>. ———. “Zai yiqing fangkong douzheng zhong zhangxian weida zhongguo jingshen.” [“Demonstrating the Great Spirit of China in Fighting the Pandemic.”] 7 Apr. 2020. 9 Sep. 2020 <http://opinion.people.com.cn/n1/2020/0407/c1003-31663076.html>. Peters, Jeremy W. “How Abortion, Guns and Church Closings Made Coronavirus a Culture War.” New York Times 20 Apr. 2020. 6 Jan. 2021 <http://www.nytimes.com/2020/04/20/us/politics/coronavirus-protests-democrats-republicans.html>. Pew Research Center. “Americans Give the U.S. Low Marks for Its Handling of COVID-19, and So Do People in Other Countries.” 21 Sep. 2020. 15 Jan. 2021 <https://www.pewresearch.org/fact-tank/2020/09/21/americans-give-the-u-s-low-marks-for-its-handling-of-covid-19-and-so-do-people-in-other-countries/>. Putnam, Robert D. “Bowling Alone: America’s Declining Social Capital.” Journal of Democracy 6.1 (1995): 65-78. ———. Making Democracy Work: Civic Traditions in Modern Italy. Princeton University Press, 1993. Roßteutscher, Sigrid. “Social Capital Worldwide: Potential for Democratization or Stabilizer of Authoritarian Rule?” American Behavioural Scientist 53.5 (2010): 737–757. Russonello, G. “What’s Driving the Right-Wing Protesters Fighting the Quarantine?” New York Times 17 Apr. 2020. 2 Jan. 2021 <http://www.nytimes.com/2020/04/17/us/politics/poll-watch-quarantine-protesters.html>. Shear, Michael D., Maggie Haberman, Noah Weiland, Sharon LaFraniere, and Mark Mazzetti. “Trump’s Focus as the Pandemic Raged: What Would It Mean for Him?” New York Times 31 Dec. 2020. 2 Jan. 2021 <https://www.nytimes.com/2020/12/31/us/politics/trump-coronavirus.html>. Tracy, Marc. “Anti-Lockdown Protesters Get in Reporters’ (Masked) Faces.” New York Times 13 May 2020. 5 Jan. 2021 <https://www.nytimes.com/2020/05/13/business/media/lockdown-protests-reporters.html>. Victoria Ombudsman. “Investigation into the Detention and Treatment of Public Housing Residents Arising from a COVID-19 ‘Hard Lockdown’ in July 2020.” Dec. 2020. 8 Jan. 2021 <https://assets.ombudsman.vic.gov.au/>. Vogel, Kenneth P., Jim Rutenberg, and Lisa Lerer. “The Quiet Hand of Conservative Groups in the Anti-Lockdown Protests.” New York Times 21 Apr. 2020. 2 Jan. 2021 <http://www.nytimes.com/2020/04/21/us/politics/coronavirus-protests-trump.html>. Weiner, Jennifer. “Fake ‘War on Christmas’ and the Real Battle against COVID-19.” New York Times 7 Dec. 2020. 6 Jan. 2021 <https://www.nytimes.com/2020/12/07/opinion/christmas-religion-COVID-19.html>. White, Gordon. “Civil Society, Democratization and Development: Clearing the Analytical Ground.” Civil Society in Democratization. Eds. Peter Burnell and Peter Calvert. Taylor & Francis, 2004. 375-390. Wu, Cary. “How Chinese Citizens View Their Government’s Coronavirus Response.” The Conversation 5 June 2020. 2 Sep. 2020 <https://theconversation.com/how-chinese-citizens-view-their-governments-coronavirus-response-139176>. Wu, Fengshi. “An Emerging Group Name ‘Gongyi’: Ideational Collectivity in China's Civil Society.” China Review 17.2 (2017): 123-150. ———. “Evolving State-Society Relations in China: Introduction.” China Review 17.2 (2017): 1-6. Xu, Bin. “Consensus Crisis and Civil Society: The Sichuan Earthquake Response and State-Society Relations.” The China Journal 71 (2014): 91-108. Xu, Juan. “Wei yiqing fangkong zhulao fazhi diba.” [“Build a Strong Legal ‘Dam’ for Disease Control.”] People.cn 24 Feb. 2020. 10 Sep. 2020 <http://opinion.people.com.cn/n1/2020/0224/c1003-31600409.html>.