- Key takeaways – what’s new?
- Covid-19 – what to look out for?
- What is Covid-19?
- How bad is it?
- How does it spread?
- What should I do to minimise my risk of getting infected?
- What is the best way to self-isolate?
- How do I stay healthy to improve my immunity?
- Should I be worried about Covid-19?
- How do I know if I am high risk?
- When should I get tested for Covid-19?
- What do I do if I get infected?
- Where do I get more information?
Key takeaways – what’s new?
- Covid-19 has overtaken the Spanish flu i n 1918 in terms of rate of excess deaths – it is serious stuff
- 44% of transmission occurs when there are no symptoms – social distancing and risk mitigation is key
- Covid-19 is airborne, and can last on surfaces for up to 3 days – masks prevent transmission by 75% (surgical) up to 95% (P2, N95)
- People with chronic health conditions, such as obesity, diabetes or heart disease, fare the worse – 94% of hospital admissions have a chronic illness
- Staying healthy is critical – for example Vitamin D can reduce respiratory illnesses by 40% and adequate sleep can reduce the common cold by 4 times
- If you get infected, there may be long term health issues such as breathlessness, hair loss, fatigue, anxiety, clotting disorder and cognitive impairment
- Greatest infection rates during second wave are now in the younger age groups – important to avoid hot spots, test, isolate & contact trace anyone exposed
- Antibody blood tests, as opposed to virus nose swabs, show that the rate of infection is much higher than reported – 13% of people in London have had it
- Immunity once you get Covid, may be only limited to months, and younger people are getting infected – stay home & safe until we get a vaccine
- Mental health deterioration is affecting 78% of Australians during this pandemic – talk to your GP or psychologist for support
- Please note our clinics will screen for respiratory infections, fever and Covid exposure risks before in person appointments are offered; temperature checks are required upon attending our clinics and we ask that all visitors wear a mask, adhere to social distancing rules and respect our space restrictions within our clinics.
What is Covid-19?
- Coronavirus is a group of viruses that range from the common cold to recent severe outbreaks such as SARS (Severe Acute Respiratory Syndrome, 8098 cases in 2003, 17 countries, 774 deaths, 10% death rate) and MERS (Middle East Respiratory Syndrome, 2,000 cases during 2012-2017, 21 countries, 600 deaths, 30% death rate)
- These viruses typically cause respiratory and flu-like symptoms. In a study from China’s initial outbreak, 80% of cases had fever, 69% had coughing, 38% had fatigue, 34% had mucous or phlegm, 30% had loss of smell, 19% had shortness of breath, 15% had body aches, 14% had headache, 14% had sore throat and 5% had gastro-intestinal symptoms. Recent studies have also reported rash and conjunctivitis. In many cases however, it can be asymptomatic, in up to two-thirds of cases
- Covid-19 originated in China during late 2019 and has been classified as a pandemic, indicating prevalence and a risk of spread globally (as of this month, over 30 million cases and 1 million deaths globally)
- Other notable pandemics include Swine flu in 2009 (200,000 fatalities), Spanish flu in 1918 (40-50 million fatalities), Smallpox in 1520 (56 million fatalities) and the Bubonic plague in 1347 (200 million fatalities).
How bad is Covid-19?
- There are 3 ways to assess severity of an outbreak. The first is the Ro or R naught (reproductive number), which is how infectious a virus is, the second is death rate (case fatality), which is how deadly a virus is across a population, and the third is how stealthy it can spread undetected
- Covid-19’s R0 is 2.2 (more infectious than Salmonella or Syphillus, but less than measles or chicken pox), and its death rate is currently 3.4% (less fatal than SARS, MERS and Ebola, but more than influenza). These data points may be conservative if many cases were initially unreported in China or if countries run out of test kits
- A key challenge is 44% of transmissions occur before the onset of symptoms (you’re infectious 2.5 days before symptoms, and most infectious 14 hours before symptoms) and 60% to 78% of total cases may be asymptomatic
- Once infected with Covid-19, 14% of cases become severe (shortness of breath, pneumonia) and 7% of cases become critical (respiratory failure, septic shock, multi-organ failure). Importantly, the risk of severe complications and death is higher in the elderly and those with chronic health conditions (e.g. 10% death rate in people with cardiovascular disease).
- Fatalities are thought to occur as a result of heart and lung failure, clotting in blood vessels, depressed immune function and septic shock, coupled with kidney impairment. Unfortunately there appears to be evidence of long term effects from Covid-19, even after recovery – including brain inflammation or stroke.
- Children appear to develop less severe symptoms but can be vectors for transmission (CT scans of asymptomatic kids with Covid-19 infection show lung inflammation). Importantly, some studies in the UK, Italy and New York have shown a minority of children manifest in an autoimmune complication called Kawasaki Disease, which is severe inflammation of blood vessels leading to a severe prognosis.
How does Covid-19 spread?
- The virus can spread by symptomatic and asymptomatic patients through respiratory droplets when sneezing or coughing, or on contaminated surfaces. It has now been shown to be airborne, with micro-droplet spread up to 10 metres. Covid-19 lasts up to 3 days on hard surfaces (e.g. counter tops or utensils), up to 24 hours on porous surfaces (e.g. paper or cardboard). There is also evidence it may be transmissible via food and stool contamination
- Incubation (time between exposure and symptoms) is typically 5 days, but can be up to 3-4 weeks. If symptoms arise, mild cases recover within a few days whilst severe or critical cases may last weeks before recovery or deterioration
- Anyone with respiratory infections needs to wear a mask and adhere to strict lock-down rules; the best way to prevent spread is to consider and treat everyone as if they have Covid-19 (universal precautions)
- As virus, it has 30,000 base pairs in its genome (humans have 3 billion in comparison) – 11 pairs have mutated since the initial Wuhan outbreak and most mutations in the pandemic can be traced back to China; the mutation rate is 8 times slower than normal influenza (a good thing, which allows the potential for a medium term vaccine, rather than an annual vaccination like the flu).
What should I do to minimise my risk of getting infected?
- Wash hands thoroughly – use an antiseptic soap or cleanser for 30 seconds, covering wrists, palms, fingers and webbing between fingers, tips of fingers and back of the hand; use alcohol disinfectant or sanitiser often, especially if contact common surfaces e.g. door handles, mobile devices, shared keyboards, stair rails, light switches etc.
- Minimise unnecessary crowd contact – epidemics spread in concentrated areas with high pedestrian traffic or close living quarters. Avoid anyone with cold or flu symptoms; avoid overseas travel and cruises at all costs
- Practise social distancing – Stay 2 metres away from others in public. Avoid physical touch including shaking hands, hugging and kissing. Avoid all unnecessary social gatherings in enclosed areas, including restaurants, cafes and events. Aim not to interact physically with elderly or immune compromised people
- Cover nose and mouth when sneezing or coughing, and wear an appropriate surgical mask if you have one (shave facial hair where possible when wearing masks). Don’t touch your face during the day
- Be diligent with food and general hygiene – cook all your meat thoroughly, avoid contact with wild animals, sanitise rooms and bedding as often as you can.
What is the best way to self-isolate?
- Be positive. Know that all pandemics end and that we are starting to see reducing cases in China and Italy, so there is a finite point for lock down and the promise of vaccinations and treatments being developed. Remember 80% of cases are mild, similar to a flu-like illness
- Appreciate basic things in life. Spend time with family, call friends you’ve not been in touch with recently. Enjoy your garden and a walk around the block. Spend quality time that you don’t normally get with the busyness of our normal lives
- De-stress by taking time out and practising self-care. Switch off from the news cycle if you are anxious, and focus on your breathing, relaxing hobbies you enjoy and try meditation, online yoga, pilates or tai chi. Talk about your feelings with loved ones and seek help if you continue to feel panicky. Osana GPs and psychologists are only a phone call away
- Build routine, stay active. Recreate a normal school or work day with activities, learning, breaks and opportunities for social interaction. Having a routine creates structure and this will help us get through day to day
- Take the opportunity to learn and build. Take a course, learn a language, work on your garden, do some home improvement, get creative with painting, write music, start an online business, learn to touch type – so much we can do to keep busy
- Find laughter and positivity – tell jokes, look at holiday photos, have a virtual dinner party with friends, play dress ups with young kids. Use humour to lighten the load and counteract the doom and gloom
- Look for ways to help others – gratitude and philanthropy are therapeutic in themselves, so consider “Adopt a healthcare worker” groups on Facebook, donate old iPads to underprivileged kids so they don’t miss out, call up seniors in aged care homes for a chat
- Spend time outdoors, even if nearby your home. Important to get natural light, fresh air and Vitamin D. Build this into your daily self-care routine.
How do I stay healthy to improve my immunity?
- Improve your Diet and Exercise
- Managing Stress and getting enough Rest
- Managing Medications and getting Vaccinations
- Addressing Symptoms and high risk Illnesses.
Should I be worried about Covid-19?
- It is imperative we maintain caution as we ease lockdowns, especially for anyone with hypertension, diabetes, heart disease, lung disease, kidney disease, obesity and for seniors generally. There are over 7,000 confirmed cases in Australia, mainly through community human-to-human spread in small clusters
- Osana recommends that everyone is aware of the preventative measures, and understand what to look out for and where to get help if they are at risk or develop symptoms. Most importantly, if you have a chronic health condition, make sure you talk urgently to your GP via telehealth (phone call or video) to ensure it is absolutely well managed and stable. 94% of New York hospitalisations to date were in patients who have a chronic health condition
- Everyone must get a flu vaccination to avoid the double whammy of influenza and Covid-19. And if you are over 65 years of age, please get a pneumonia vaccination as well (every 5 years).
How do I know if I am high risk?
- High risk is now defined as anyone with respiratory symptoms, in close contact with positive cases, and living in close quarters with other people.
- If infected, modelling has predicted 80% of severe cases have clinical hallmarks being elevated alanine aminotransferase (ALT) (a liver enzyme), the presence of myalgias (body aches), and an elevated hemoglobin (red blood cells)
- Most critical is preserving respiratory (breathing) and cardiac (heart) function, because that is how Covid-19 causes severe disease and fatalities. There are specific medications to avoid (such as ibuprofen) as well as potential vitamins that may reduce the likelihood of respiratory infections (such as Vitamin C and Vitamin D). It is critical to control blood pressure and sugar levels, and make sure medications for breathing and your heart are optimal (e.g. using puffers or inhalers correctly, taking the correct dose of medication for you)
- At a population level, there is evidence men may be more susceptible to infection than women (similar infection rates, but men exhibit higher death rates). Conversely, infection rates are lower (than population averages) in children and pregnant women
- Once infected, experts are predicting the individual gains immunity (antibodies to the virus) for 5 to 10 years, although there has been cases of re-infected in the current outbreaks, so this remains to be validated (30% of infected cases fail to develop adequate antibodies afterwards and those that do may lose immunity after some months). Over 1,300 clinical trials are underway to develop a vaccine, treatment (such as a steroid called dexamethasone, or statins used to treat high cholesterol, or anti-virals such as remdesivir) or test passive immunity (such as blood transfusions from those that have recovered from Covid-19).
Should I get tested for Covid-19?
- Get a respiratory swab at a designated testing site if you have any respiratory symptoms at all. Download the Covid-19 App and call your Health Assistant or the National hotline if any concerns (1800 020 080)
- North Shore testing sites:
- Ryde GP Respiratory Clinic (8am – 5pm, 7 days, 11-17 Khartoum Road, Macquarie Park)
- Royal North Shore Hospital (8am – 10pm, 7 days, Reserve Road, St Leonards)
- Roseville Respiratory Clinic (10am – 2pm, 5 days, 132 Pacific Hwy)
- Hornsby Hospital
- Eastern suburb testing sites:
- St Vincent’s Hospital, East Sydney Community and Arts Centre, (9am – 4pm, 7 days, 390 Victoria Street , Darlinghurst NSW)
- Bondi Junction GP Respiratory Clinic (9am – 9pm Monday to Friday, 47 Spring St, Bondi Junction, 9194 2788)
- Kirketon Road Centre Mobile Clinic (12.30pm -9pm Monday to Friday, Martin Place, Woolloomooloo, Northcott Housing estate – Surry Hills)
- Northern Beaches testing sites:
- Dee Why Respiratory Clinic (G/5 Mooramba Road)
- Northern Beaches Hospital (9.30am – 6pm, 7 days, 105 Frenchs Forest Road, Frenchs Forest)
- Mona Vale Hospital
What do I do if I get infected?
- Stop smoking if you do and maximise your lung function. Do this by taking 10 deep breaths in, holding each breath for five seconds. On the tenth breath, breathe in and make a large cough (into your elbow). Repeat this twice and lie prone (on your tummy) to help with drainage and maximise lung volume. Do this breathing exercise a few times throughout the day.
- Ensure adequate rest by sleeping, keeping warm and hydrated, and managing your symptoms (such as a humidifier or hot shower to ease a sore throat, cough or congestion). Use inhalers if they are on your asthma or COPD action plan, and take paracetamol if you have a fever or body aches.
- Protect your heart by actively managing high blood pressure, avoid excessive straining or exertion, and minimising alcohol intake. Monitor your heart rate per minute, your blood pressure if you have a machine at home, and your oxygen saturation (some smart phones can do this) – write it down and talk to your GP about your measurements.
- Call your GP immediately if you get short of breath, feel dizzy, are increasingly cold, or get chest pain.
How do I get more information?
- For updates on Covid-19 recommendations, join our Facebook groups in your local area here>
- For Government and Health Department updates, go to their official websites here> and here>
- For evidence-based answers to questions such as should I wear a mask, can we treat Covid-19 with Malaria tablets, do I stop my blood pressure medications, refer to the University of Oxford evidence repository (or ask your GP).