COVID-19

 

Please note that as I only have capacity to commit one day per week to this platform, these update will be intermittent and will be published on a Friday afternoon each week. They are intended to provide you with a non-biased, relatively brief and straightforward summary of the global COVID-19 situation weekly. If you want day to day updates, I suggest you refer to the World Health Organisation's Daily Situation Reports, which can be found HERE! 

Cumulative Incidence, Testing Criteria, Vulnerable Populations - 26th March 2020

(Covid-19 Data Australia, 2020)

We've been talking about cumulative incidence in the context of "flattening the curve" for a week or so now, and I think it's really important to acknowledge that for the next two to three weeks this rate will continue to rise - likely at rate of doubling every three days. It is not unwarranted to forecast that within this time we will see the national cumulative incidence reach over 10,000 confirmed cases.

 

There's a few reasons for this, mainly given we've only just officially begun social distancing nationally, and the incubation period for the virus is up to 14 days. In this time, more people will start to show symptoms and subsequently return positive results if/when tested.

In addition, this morning we awoke to news advising changes to the testing criteria, which has now expanded to include all health workers, aged/residential care workers, geographically localised areas where there is elevated risk of community transmission as defined by the local public health unit, in the context of clinical symptoms of fever or acute respiratory infection.

Those with clinically observed symptoms in high risk circumstances where there is no evidence of confirmed community transmission, such as aged and residential care facilities, rural and remote Aboriginal and Torres Strait Islander communities, detention centres and correctional facilities, boarding schools, and military bases that have live-in accommodation, will be eligible for testing.

Expanding the testing criteria is essential in providing us with a greater picture of how COVID-19 is impacting the Australian population, with particular emphasis on vulnerable population groups.

It's important to note that there are likely cases present in the population that are not confirmed, as the patients do not meet the previous testing criteria.

It's also important to note, that of the 2,677 confirmed cases in Australia today, majority will recover. Nonetheless, it's incredibly important that we continue to practice good social distancing behaviours to limit the burden on our health system and our communities.

Increasingly, we're hearing first hand accounts of otherwise young and healthy people ending up incredibly sick or in intensive care units. None of us are immune, and none of us are invincible.

What I've struggled with in the reporting of vulnerable populations is the neglect towards the essential notion that we're all valuable members of our communities regardless of our age, our health status, or how much money we have. We all need to continue to work together to ensure that we're not devaluing the worth of other peoples lives on the basis of their COVID-19 related risk.

At the end of the day, we are all people and we're all worthy of protection and help.

Stay home for them. Stay home for each other. Stay home for yourself.

Social Distancing - 25th March 2020

(Covid-19 Data Australia, 2020)

Well, the government won't lock us down (I hope this will come later this week), and the trajectory doesn't look good at the moment. The only way to mitigate it is to hang out in your own home, just for a little while.

You're all doing great, and we're all getting pretty frustrated with the lack of transparency and confusing rules. So, I've put myself into a position of leadership and am asking you now to...

Please:
1. Stay home unless it is for work
2. Stay home unless it is for essential grocery items
3. Stay home unless it is for non-social exercise
4. Stay home unless it is for essential medical appointments or essential pharmacy needs. Cancel all non-urgent medical appointments (if you're concerned, contact your GP practice and organise a tele-consult).

Do Not:
1. Do not invite people to your home. Do not visit friends or family at home.
2. Do not get a haircut. Haircuts are not essential.
3. Do not go to a shopping centre for purposes other than collecting essential groceries or medicines.
4. Do group exercise - sorry ScoMo, but Boot Camp is a big NO!

This means:
1. You stay home with your family or house mates, unless you are going to:
- work
- getting essential grocery items or medicines
- an essential medical appointment
- going for a run or a bike ride in an open, outdoor space. Again, for the people in the back, NO BOOT CAMP.

2. You hang out with your family or house mates only

No guests, no visits, no dinner parties because you're bored. Skype wines only.

Update - 17th March 2020

I have just listened to the Prime Minister Scott Morrison and Chief Medical Officer Dr Brendan Murphy address the situation after the national cabinet met last night.

We have 454 diagnosed cases in Australia. 94 of these are in Victoria. 210 are in NSW.

The associated fatality rate is still very low, with five deaths attributed nationally.

Dr Brendan Murphy emphasized that while there will be cases not diagnosed due to the diagnostic testing criteria in place and the high rate of asymptomatic cases identified in the initial Wuhan outbreak, the current rate for local transmission is low. We should be reassured by this.

Both Scott Morrison and Dr Brendan Murphy stressed the importance of social isolation, with the cabinet making the notable decision to ban non-essential indoor gatherings over over 100 people. As I am sure you are all aware by now, social isolation is key in ensuring this outbreak does not peak at a rate that is unmanageable by our health system.

Please ensure you are practicing this out of the workplace.

Schools remain open.

All international travel out of Australia has been banned.

The national cabinet will meet again on Friday to reassess as the situation evolves.

 

Update - 12th March 2020

The World Health Organisation have declared the COVID-19 outbreak a pandemic. This has been declared as the number of affected countries has increased with reported confirmed cases in 114 countries globally, with global rates of disease increasing daily. This mainly reflects the fact that the threat associated with COVID-19 is now at high global risk, rather than at high localised risk in affected regions (WHOd, 2020).

The World Health Organisation expect, as is indicated by the viral trend and how contagious COVID-19 is, that the number of cases, deaths and affected countries with continue to rise (WHOd, 2020). Remember here, when I reviewed publications back in February, I highlighted that virology indicated that COVID-19 is more contagious, but less severe than SARS.

The Numbers Internationally

Number of global confirmed cases as at 11th March 2020: 118, 326 (WHOe, 2020). 

 - Majority of these cases have been in patients who have recovered, as identified in calculating the fatality rate. 

Number of global associated fatalities as at 11th March 2020: 4, 292 (WHOe, 2020)

Fatality rate as calculated with reported cases: 3.6%

 

In China, the outbreak is stabilising and diagnosis and fatality rates have substantially declined. As published in the 11th March 2020 WHO Situation Report, 31 new confirmed diagnoses and 22 associated deaths were reported for the 24 hours period prior (WHOe, 2020). This, in contrast to the peak of viral transmission where up to 3,000 new cases were confirmed daily, is a reassuring fact indicating viral control. 

The Numbers in Australia

Australian Population in 2020: 26.4 million

Number of confirmed cases in Australia as at 11th March 2020: 112 (WHOe, 2020)

Number of associated fatalities in Australia as at 11th March 2020: 3 (WHOe, 2020)

Some Things to Note

It is important to consider here that there will be cases that have not been confirmed.

This is indicated by the large proportion of patients diagnosed with mild symptoms, or who are asymptomatic, who will not have sought diagnosis despite recent travel or potential exposure. In addition to this, there is criteria in place for who can be tested in Australia at present. These include:

-       Having recently travelled overseas, namely to mainland China, the Republic of Korea, Italy or Iran, or having been in close proximity to a person with a confirmed case of COVID-19.

These restrictions have been put in place to alleviate stress on the public health system as the situation in Australia continues to evolve. This works to ensure medical services are available to those who need them, whether that be related to COVID-19 or another medical condition, and to limit unnecessary exposure to the health workforce.

This means, we don’t have the whole picture, and there very well may be more people in the population who are infected with the virus, however it does provide us with an adequate amount of information to know that there are cases of COVID-19 within the Australian population and we need to protect those who have been identified as vulnerable, no matter how small the outbreak.

For those who are over 70 or have a pre-existing health condition (cancer, heart disease, etc.), the risk of poor outcomes associated with COVID-19 is high. As we visited back in February, the fatality rate for those diagnosed over 80 years was 49%, and through present day and historical epidemiology we know that people who experience co-morbid illnesses are more likely to be susceptible to communicable disease.  

With this in mind, if your event has been cancelled please consider that this is a method of viral transmission management. This is not fear mongering. It is simply action intended to ensure the viral spread does not reach epidemic levels that will pose a threat to the wellbeing of vulnerable Australians, whose lives hold equal value to everyone else. Whilst this may be an inconvenience or an annoyance to you, please consider it within the best interest of your community. It is these measures that help all members of the population to act in a way that protects the people who will be most impacted by a larger outbreak.

Are you going to get it?

Well, maybe, and that is important to acknowledge as well. Epidemiology investigating the reproductive rate of COVID-19 indicate that the virus maintains sustained transmission, which is evident when we look back at the way diagnosis rates increased in Wuhan from early January to late February. This does not necessarily mean we will see an outbreak as significant as that present in Wuhan, China, however it does highlight the need to contain the clusters of outbreak present in the population to limit the capacity for potential epidemic. 

 

If you are diagnosed with COVID-19, it’s important to follow the instructions of the Australian and state governments which are updated daily, for the exact reason mentioned before: restricting transmission of COVID-19 protects people.

How is the virus spread?

  1. close contact with an infectious person.

  2. contact with droplets from an infected person’s cough or sneeze

  3. or touching objects or surfaces (like doorknobs or tables) that have cough or sneeze droplets from an infected person, and then touching your mouth or face

Prevention:

  1. Wash your hands properly and regularly

  2. Avoid touching your face, particularly eyes, nose and mouth

  3. Cough, sneeze or yawn into the crook of your elbow

  4. Avoid physical contact with others

  5. If you are unwell, stay home.

 

What should you do if you suspect you have the virus?

Call ahead to your doctor and advise of the situation – they may accept you as a patient, and it’s important they are aware as to why you are coming so they can keep their practice a safe, secure place for non-suspect patients seeking medical care.

Wear a surgical mask to prevent viral spread in transit.

If your regular doctor will not see you, you can contact the Coronavirus Health Information Line on 1800 020 080 – I believe there may be lengthy hold times, but you should be self-isolating anyway if you are concerned, so you’ll have time to pass. They will be able to point you in the direction of assistance.

28th February 2020 - An Update

This week has really seen things amp up globally, with the World Health Organisation reporting on 26th February 2020 that for the first time since the first known presentation of COVID-19 on 8th December 2019, there have been more new cases reported from countries outside of China than from within China (WHOb, 2020). This can be attributed to the substantial increase in daily reported cases out of the Republic of Korea, Italy and Iran.   

 

In China

We've seen the outbreak in China potentially begin to stabilise with the number of daily reported cases declining. Prior to 20th February 2020, the number of daily reported new cases was within the range of 1,500 to 3,000 diagnoses within China, where in the week since this has declined to between 500 and 1,200 new reported diagnoses daily (WHOa, 2020).

The most up to date data across the Chinese Provinces is presented in Table 3, taken from the World Health Organisation Situation Report of 27th February 2020. Here we can see that the Hubei Province is still significantly experiencing the highest rates of disease and death associated with COVID-19. 

TABLE 3 - INCIDENCE IN CHINA BY PROVINCE

Situation Report 27 February 2020

(WHOa, 2020)

Internationally

The rates of COVID-19 internationally have increased, but are still small in comparison to those present within the Hubei Province of China. As reported on 27th February 2020, there are 3,664 confirmed cases of COVID-19, and 57 associated deaths, out of China. A major concern associated here is the increase in diagnoses presenting in patients who have no relation to the Hubei Province, as indicated in Table 4's column 'Total cases with site of transmission under investigation'.  

TABLE 4 - INCIDENCE OUT OF CHINA BY REGION/COUNTRY

Situation Report 27 February 2020

(WHOa, 2020)

The Republic of Korea (South Korea)

The worst outbreak of COVID-19 out of China is currently occurring in The Republic of Korea, with 1,766 confirmed cases and 13 associated deaths reported at 27th February 2020 (WHOa, 2020).  The majority of these cases are present within the region of Daegu, home to the the Shincheonji Church allegedly at the centre of the national outbreak (Birtles, 2020)

 

The  Shincheonji Church, whose members had recently travelled to Wuhan, is a Christian sect considered somewhat controversial within South Korea. Whilst we're not actually here to talk about sects, despite how interesting my curiosity may find them, I think this is important to note as this factor has contributed to social unrest within Christian communities in South Korea (WHOa, 2020; Birtles, 2020).

 

Disease outbreaks have historically had social or political unrest associated with them, and while it's understandable given people are afraid, the outcomes can be really dangerous. The unrest is often founded within discrimination, and it can enhance stigma associated with the virus causing people to hide their illness to avoid discrimination, preventing people from seeking health care assistance as soon as possible, and discouraging population members from adopting healthy preventative behaviours (WHOb, 2020).

In contrast to global prevention strategies, South Korean borders were not closed to incoming flights direct from China, and authorities have not enforced quarantine closures in the affected region. There are concerns of viral spread into North Korea, who most likely do not have the capacity to manage an outbreak of this severity. 

This situation is evolving, but at the moment, it's not looking particularly proactive in terms of implementing and managing disease prevention and control strategies. 

Italy

The outbreak in Italy has hit the headlines and this is with good reason - as at 27th February 2020 there were 400 laboratory confirmed COVID-19 cases nationally. Obviously in contrast to the situation in China this is a small cohort of confirmed cases, however this is substantially higher than other affected countries within Europe as presented in Table 4 (WHOa, 2020).

The outbreak was first reported on 21st February 2020, and is present in a clusters throughout the northern region of the country affiliated through local transmission of the virus. 

The World Health Organisation advised in an online statement on 24th February 2020, that it should be highlighted that based on the current data, 4 out of every 5 people diagnosed are asymptomatic (showing no symptoms), or experience mild symptoms. Despite this, understandably, Italian health authorities, in line with global containment strategies, are implementing measures to prevent viral transmission, including the closure of schools and public spaces, the cancellation of sports events and other mass gatherings in the affected areas (WHOc, 2020). 

This situation is evolving and we will know more about the efficiency of control and prevention strategies over the coming weeks. Remembering that the virus hosts a lengthy incubation period those within the affected region who are not yet diagnosed, may be diagnosed in potentially 14+ days. This is particularly relevant given the rate of asymptomatic diagnosed cases. 

Iran

Iran has been identified as an incubator for COVID-19 in the Middle East, counting 141 diagnosed cases, and 22 associated deaths, as at 27th February 2020 within the nations borders. This is the highest death toll associated with COVID-19 out of China (WHOa, 2020). 

I've honestly struggled to find reputable information on the situation in Iran, but through doing some reading online I've found that this outbreak has apparently been associated with cases reported in neighbouring countries, namely Kuwait, Bahrain, United Arab Emirates, Oman, and Iraq. Similarly to the response in the Republic of Korea, regional quarantine closures have not been enforced, however the President of Iran, Mr Hassan Rouhani, advised Iranians to avoid non-essential travel to the affected areas of Qom, Tehran and Gilan (BBC News, 2020). 

Hopefully more information will become available on the situation in Iran over the coming week. 

Fatality Rate

In my last post, we referred back to the publication from the Chinese Centre for Disease Control and Prevention when discussing the fatality rate. There we had much more of a demographical breakdown in the data, so the quick maths I've done is much more broadly applied. 

 

Global fatality rate as at 27th February 2020 = 3.4 %

(total number of deaths/total number of confirmed cases x 100)  

Total number of deaths:  2,804    

Confirmed diagnoses:     82,294

Fatality rate in China as at 27th February 2020 = 3.5%

(total number of deaths/total number of confirmed cases x 100) 

Total number of deaths: 2,747

Confirmed diagnoses:    78,630

Fatality rate out of China as at 27th February 2020 = 1.6%

(total number of deaths/total number of confirmed cases x 100) 

Total number of deaths: 57

Confirmed diagnoses:    3,664

Looking back to the CCDCP discussed in my initial post above, the fatality rate measured from the data set up spanning  31st December 2019 through 11th February 2020 in China, was 2.3%. Despite the increase, the rate of 3.5% is still very low. 

These fatality rate calculations tell us that the vast majority of people who contract COVID-19 will fully recover. 

What now?

Well, COVID-19 has obviously broken the boundaries of China and is presenting in larger numbers around the globe. It's important at this point to ensure what you're reading is reputable and the advice you're following is evidence based - The World Health Organisation are your best bet.  

 

With school holidays approaching please follow the travel advice of both the Australian Government and the World Health Organisation. Whilst the vast majority of health adults who are diagnosed with the virus will fully recover, the quarantine periods may impact your journey home and your ability to return to work/school. 

If you are travelling ensure you are following the prevention recommendations, including practicing good hygiene with regular hand washing, covering your nose and mouth when you cough or sneeze, and wearing a mask where required. The World Health Organisation provide instruction on how to effectively wear a barrier mask here.

If you're in an area where the Coronavirus is not a threat, your beard won't pose an increased risk of you contracting the virus despite what Channel 7 might say. Even then, if you're in an area with a higher risk of virus exposure, a beard isn't going to change anything other than the fact that your significant other might complain that your face is scratchy to kiss (yes, I'm holding on to some feelings)

References

Birtles, B. (2020). South Korean cases of coronavirus COVID-19 pass 1,500, with war games called off and troops confined to bases. Retrieved 18 February 2020, from: https://www.abc.net.au/news/2020-02-27/south-koreas-relaxed-approach-sparksfears-spread-to-north-korea/12005704

BBC News. (2020). Coronavirus: Iran has no plans to quarantine cities, Rouhani says. Retrieved 28 February 2020, from: https://www.bbc.com/news/world-middle-east-51651454

COVID-19 Data Australia. (2020). COVID-19 Data Australia. Retrieved 25th March 2020, from: https://www.covid19data.com.au/

WHOa. (2020). Novel Coronavirus(2019-nCoV) - Situation Report as 27 February 2020. Retrieved 28 February 2020, from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200227-sitrep-38-covid-19.pdf?sfvrsn=47fdaf7_4

WHOb. (2020). Novel Coronavirus(2019-nCoV) - Situation Report 26 February 2020. Retrieved 28 February 2020, from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200224-sitrep-35-covid-19.pdf?sfvrsn=1ac4218d_2

WHOc. (2020). Joint WHO and ECDC mission in Italy to support COVID-19 control and prevention efforts. Retrieved 28 February 2020, from: http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/2/joint-who-and-ecdc-mission-in-italy-to-support-covid-19-control-and-prevention-efforts

WHOd. (2020). WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. Retrieved 12 March2020, from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020

 

WHOe. (2020). Coronavirus Disease 2019 (COVID-19) Situation Report 51. Retrieved 12 March 2020, from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_4

Stephanie Says acknowledges the traditional custodians of the land on which we live - the Wurundjeri people of the Kulin nation. We acknowledge their Elders past, present and emerging. Always was, always will be Aboriginal land. 

Note: Stephanie Sayss is not run by medical professionals. This platform is an educational tool only, and not intended to be used for medical advice. Always seek the assistance of a doctor - this platform is intended to be used a tool to assist you in doing so.

All references are cited on the page they are relevant to. 

©2019 by Stephanie Sayss.