While we grapple with the challenges that the COVID-19 pandemic is placing on our healthcare systems, our economies, and our way of life, we must not forget the critical importance of injury prevention. We are all very much aware of the burden of injury-related emergency department presentations and hospital admissions during non-pandemic times. For example, injuries typically account for 25% of ED presentations in Australia (1) and New Zealand (2). With the potential for prehospital and hospital systems to be overwhelmed by COVID-19, the role of injury prevention has arguably never been more important.
Social distancing practices have the potential to reduce exposure to injury-related risk in some circumstances. For example, lower motor vehicle volumes may decrease collisions with people walking and cycling, reductions in the number of industries operating may reduce the amount of exposure to work-related hazards, and reductions in the number of people attending public pools, beaches and waterways may reduce drowning numbers, similarly, reductions in organised sport could lead to decreased sport-related injuries. In the first full week of the lockdown, injury claims with the Accident Compensation Commission (ACC) in New Zealand dropped to less than a third of their level in the same week last year. (3)
Data from ACC also showed that home injuries were the leading setting by number of injuries with falls, strains for lifting and carrying and bites and scratches from animals and insects being the leading injuries at home. Injuries outside the home have fallen in New Zealand by 70% apart from farms where accidents were down 58% on the year earlier. Agriculture, forestry and fishing industries are the workplaces with the highest rate of injury reflecting activities that continue during lockdown. However, all workplace injuries have declined. (3)
It is clear that these social distancing practices also have the potential to increase injury risk. This pandemic can be stressful and impact our mental health and wellbeing. It is likely that we will see rising rates of mental health conditions, both in the short and long term, and associated increases in self-harm and suicide. And while we have seen significant public health benefits resulting from adherence to social distancing measures, sadly for many, particularly women and children, home is not always a safe place to be. Globally, we have seen an increase in calls to family violence helplines and family violence cases.
Furthermore, with many children spending more time at home, exposures to risks in the home have increased. Our trauma colleagues have reported seeing large increases in burns and scalds in children. Additionally, more time at home has anecdotally increased the number of DIY-related injuries, particularly related to ladder falls. These are just a few examples.
Pandemic planning and response to COVID-19 must also consider implications on exacerbating existing inequities, including for populations at most risk of injuries. Within Australia and New Zealand, Aboriginal and Torres Strait Islander and Maori peoples respectively, experience a disproportionate burden of risk to the disease. Any response must consider First Nations communities and the intersection of cultural and social determinants with public health imperatives, as well as the need for culturally safe and trauma-informed practice as essential to ensure equitable provision of care. The COVID-19 response requires engaging and working with First Nations communities to develop culturally appropriate and safe risk reduction strategies in collaboration with governments, health services, community organisations and other relevant stakeholders.
The current situation also provides us with unique opportunities. In many parts of the world, cities are reallocating road space from cars to people on foot and on bicycles in order to enable people to keep physically active whilst adhering to social distancing measures. New York City, Mexico City, and Bogota are examples of cities that have rolled out ‘emergency’ cycleways.(4) And recently, New Zealand has announced that it too will fund expanded footpaths and temporary cycleways.(5) In line with these measures, the AIPN was pleased to contribute to and support a proposal led by colleagues in road safety including Prof Ivers, for a temporary reduction in New South Wales’ default urban speed limit to 30 km/h.
The New Zealand government has taken affirmative action to reduce injuries by introducing a ‘Health Act Notice’ which prohibits people from leaving home to hunt, tramp, swim, take part in other water-based activities, such as surfing and boating, or do anything that may put them in danger or require help from rescue services during the Level 4 Lockdown.(6)
It is during these times that the health, safety and wellbeing of our communities becomes more important than ever. To ensure that we contribute to reducing the demand on our health system, and to enable our communities to flourish, injury prevention is paramount. This extends to risk assessment and mitigation in the home to prevent child unintentional injuries, falls in older adults and DIY injuries; targeted conditioning exercises to reduce sport-related injuries in preparation for when people do return to their organised sporting activities; provision of tailored ‘at-home’ programs to support people experiencing mental ill-health, and providing information and access to support for families and individuals experiencing extreme stress and increased intentional injury risk. Throughout this time, we mustn’t lose sight of prioritising injury prevention among people with an inequitable injury burden.
To all of those people working on the front line of the COVID-19 pandemic, we thank you and your families for your efforts and the sacrifices you make. To our community, thank you for contributing to reducing injury, and we hope you and your loved ones remain healthy.
Ben Beck (AIPN President) & the AIPN Executive Committee.
1. Australian Institute of Health and Welfare. Emergency department care 2017–18 [Internet]. Canberra: Australian Institute of Health and Welfare, 2019 [cited 2020 Apr. 17]. Available from: https://www.aihw.gov.au/reports/hospitals/emergency-dept-care-2017-18
2. Personal communication, Dr Peter Jones, Director Emergency Medicine Research, Auckland City Hospital, New Zealand
3. Accident Compensation Commission. ACC Claims During Lockdown [press release]. Wellington: New Zealand, [cited 15 April 2020].
4. Reid, Carlton. Generously Fund Cycleways, Experts Say As Covid-19’s Spread Boosts Bicycle Use. 22 March 2020 [Internet]. Available from: https://www.forbes.com/sites/carltonreid/2020/03/22/generously-fund-cycleways-say-experts-as-covid-19s-spread-boosts-bicycle-use/#316da2006b12
5. Watkins,Tracy. How coronavirus will change the face of the cbd. Stuff Online [Internet]. 2020 Apr 12; Available from: https://www.stuff.co.nz/national/120970386/how-coronavirus-will-change-the-face-of-the-cbd
6. Ministry of Health New Zealand. Section 70(1)f) Health Act Order [Internet]. 2020 Mar. Available from: https://covid19.govt.nz/assets/resources/legislation-and-key-documents/COVID-19-Section-701f-Notice-to-all-persons-in-New-Zealand-3-April-2020.PDF