#coronavirus covid-19 australia health medicine publichealth

[nickylovesrefugees]

Coronavirus myths and facts

I am writing this as a doctor with an interest in infectious diseases who is currently studying a masters of international public health. Myths and facts about COVID-19. Please share if you think this is worthwhile. References in link at the end.

MYTHS

Myth: “COVID-19 is just like getting the flu”

COVID-19 is not just like the flu! The symptoms are often similar, that’s true. But there are key differences:

Influenza

Mortality: 0.1%

Vaccine availability: Vaccine updated yearly

Scientific understanding: Excellent

R0: 1.2

COVID-19

Mortality: ~3%

Vaccine availability: Does not exist

Scientific understanding: Limited, highly unpredictable

R0:2-4

Note: R0 is the number of people that the average infected person then goes on to infect

So essentially - coronavirus is much more contagious, is many times more deadly, there’s no vaccine and it’s highly unpredictable.

Myth: “Coronavirus is killed by warm weather”

I saw this floating around in a chain email purportedly from “Stanford University”, which claimed that a temperature of 26 degrees would kill the virus. There is no evidence to suggest this. If this were the case, the virus would die inside our bodies (~36 degrees) and nobody would get sick… It is important to note also that the WHO points out that cold weather similarly does not kill the virus.

Myth: “Drinking warm water kills viruses”

Nope. Water doesn’t have any toxic effects, and warming it slightly doesn’t change that. Even if it did, the virus is in your airways, not your stomach.

Myth: “If you have a runny nose, you cannot have COVID-19”

Another ridiculous claim. In general, in medicine, never/always statements are rarely correct, especially when looking at symptoms. There are always variations in symptoms between different people in the real world.

Myth: “Hand sanitiser is better than soap and water”

False. It’s the other way around. Soap breaks down the fatty bilayer which forms the “envelope” or wall of the viral particle. It does this in a similar way to ethanol-based handwashes, but most commercial hand sanitisers have a lower ethanol content and are not as effective. To be effective against coronavirus, your hand sanitiser should have at least a 60% ethanol content.

Myth: “I’m young and healthy, if I get coronavirus I’ll be fine”

Many young people who get COVID-19 will suffer a flu-like illness and not need hospitalisation but there’s also strong evidence that young healthy people can also get very sick with COVID-19. For example, more than 50% of patients admitted to ICU in France were under 60.

Myth: “If you can hold your breath for ten seconds without coughing, you cannot have COVID-19”

If it were that easy to diagnose coronavirus, the hospital and GP system would be under a whole lot less pressure. Once again, these simple, “too good to be true” claims are exactly that.

Myth: “Antibiotics can treat COVID-19”

Antibiotics have no activity against viruses - they are used exclusively for bacteria. Occasionally, very unwell people with COVID-19 may develop superimposed bacterial infections in hospital, and is this setting antibiotics will be used. But this is to treat the bacterial pneumonia, not the COVID-19 infection. Currently, there are no WHO-recommended medications to treat COVID-19, although reports are coming out of some countries that some antivirals usually used in treatment of hepatitis or HIV may be beneficial.

FACTS

Fact: Ibuprofen should be avoided in patients with COVID-19.

Ibuprofen, sold under brand names such as nurofen or advil, is an NSAID (non-steroidal anti-inflammatory drug). It’s used for a variety of inflammatory conditions, and is also sometimes used for fever that is not responding to paracetamol. However, a paper was published on March 11 in the Lancet linking increased ACE2 levels (an enzyme that coronaviruses use to bind to target cells) with COVID-19 infection. This is relevant because ibuprofen can increase levels of ACE2, at least in rats. More research is needed in this area, but for now the WHO has recommended avoiding ibuprofenin COVID-19, and instead using paracetamol. This also implies that theremay be an argument for withholding ACE-Inhibitors (a common blood pressure medication) but the European Society of Cardiology recommends that they are continued.

Fact: Healthcare workers on the front line are doing their absolute best in a very difficult time.

Many of my best friends are working on the front lines as junior doctors, GPs, emergency or medical registrars, nurses, pharmacists and other allied health professions. They are doing their best, but the situation is constantly evolving, and guidelines continue to do change. As such, they may not test you for COVID-19 when you are expecting a test, or otherwise treat you in some way that differs from your expectations. Rest assured that they are working very hard to keep up to date, and to behave in a manner that prioritises not only your health, but also public health and the best possible allocation of resources. Please be patient and honest with, and kind to, them in these challenging times. Speaking as one of them, we really do care about you.

Fact: Panic buying deprives vulnerable people of vital necessities, and is completely unnecessary.

I’ve touched on this earlier, but please do not hoard groceries. Many elderly or people with disabilities do not have the luxury or option of visiting multiple stores, so if they go to a supermarket that has had its shelves cleared out, they have no backup option and may be forced to go without. If everyone were to return to how they shopped a month ago, everyone would have enough food!! The supermarkets never run out of pasta or toilet paper normally, and they will stop running out if people just shop normally. The supermarkets are not going to close, there is no need to hoard food.

Fact: We still have a lot of control over what happens over the next few weeks.

Here, we must learn from the examples of other countries. If we continue to treat COVID-19 with the same cavalier attitude, continuing to attend large events, public places like gyms, churches etc, we will follow in the footsteps of Italy, which now has over 30,000 cases and over 2,500 dead. The death toll there is now climbing by hundreds per day. On the other hand, a combination of widespread closures and shutdown measures, combined with individuals taking responsibility to do their absolute best, will see us closer to countries like Singapore or South Korea, which have dramatically curbed their cases.

Fact: Social distancing will save lives.

Social distancing will dramatically reduce coronavirus spread. This works both because undiagnosed cases of COVID-19 have less opportunity to spread, and because uninfected people have less opportunity to encounter coronavirus as you go about your life. So please take it seriously, even if you are feeling perfectly well. Stay home unless it is absolutely essential that you leave the house. Wash your hands often, with soap and water. Avoid touching your face.

In summary, we need to make informed, evidence-based decisions to combat this pandemic. It poses grave public health risks if not taken seriously, but we can do a lot to mitigate these risks. This needs to be led by Government, but in the absence of decisive leadership there, we must take the lead ourselves. But our response needs to be one that continues to look after the needs of our most vulnerable members of the community.

[nickylovesrefugees]

How to limit the spread of coronavirus, prevent our health system being overwhelmed and save lives

For those who read my first post, good news - I have been cleared of COVID-19. For those that haven’t, I’m writing this as a medical doctor with an interest in infectious diseases and international public health. I was meant to be flying to NZ today for a hiking holiday, but I’ve had to cancel that due to NZ’s strict new COVID-19 border security measures. As such, once again I find myself with unexpected free time, and I thought the most productive thing I could do with this is write again about coronavirus.

Over the last few days, it has become apparent that Australia is likely to be hit hard, and soon, by COVID-19. However, we can still control whether or not this outbreak overwhelms our health systems or not. You may have heard mention of a concept called “flattening the curve” which is absolutely essential to save lives. The underlying principle is that our health system only has a limited volume of COVID-19 cases that we can deal with safely, and we must do everything to not exceed this capacity. This is important for two reasons. If we exceed this capacity, we will have more COVID-19 cases than we can safely treat, leading to inadequate treatment not only of people with COVID-19, but the myriad other conditions - heart attacks, strokes, gastrointestinal bleeds - that our hospitals are still going to be dealing with on a daily basis.

How do we flatten the curve? One of the most important variables in the spread of coronavirus is the number of people that each infected person then goes on to infect - this number is known as R0. A study by the Lancet used computer modelling to compare simulated outbreaks for a range of R0s, and showed a tremendous difference in the likelihood of outbreak control between R0s of 1.5 and 3.5. This makes logical sense - the less others that each infected person spreads COVID-19 to, the less cases are going to be overwhelming our health system.

So finally, how do we reduce R0? Social distancing is key. For all the introverts out there, you’re ready for this. As it is likely that at least in some cases, people appear to be infecting others BEFORE their own symptoms develop, we must be very proactive in preventing transmission. We cannot wait for the development of symptoms before isolating, as this may be too late. As such, by far the safest thing we can do is drastically reducing our contact with other people.

Avoid leaving the house for anything that isn’t essential, especially anything with large crowds or confined spaces - think concerts, sporting events, community gatherings

Work from home if you can

Avoid physically attending school or university if possible

When you do have to leave the house, keep a safe distance from other people - imagine the concept of “personal space” to have now expanded to 1.5 m

Avoid any physical contact - handshakes, hugging, kissing etc

Wash your hands regularly with soap or hand sanitiser

Avoid touching your face

For those of you who are young and healthy, and aren’t worried about getting COVID-19 - I ask you to consider your parents and grandparents. If you were to contract COVID-19, you may not know it as you may still feel well. But you could very easily pass it on to your parents or grandparents, who would be far more likely to become very ill or die - do you want to live with this on your conscience? Furthermore, there are people in the community with compromised immune systems who will be at very high risk. We need to act proactively, collectively and responsibly to contain the spread of coronavirus. We can flatten the curve, but only by working together.