COVID-19 Update

Another COVID-19 (Coronavirus) update collated from evidence-based science, reports, official public health guidelines, and other reliable sources (medical professionals - both clinical and public health), dated 29/04/2020. This is all based on proven fact, not my opinions. 

*Disclaimer #1: I am a clinical General Practitioner (FRACGP), based in Tasmania, with a Masters of International Public Health. I am not a public health physician nor employed by the public health department. 

**Disclaimer #2: Data, guidelines and recommendations are changing daily based on the dynamic nature and developing understanding of this pandemic. 

• Curve-flattening in Aus: Physical distancing, as a public health policy, is working here in Australia – the ‘flattening of the curve’ is the good, intended outcome in mitigating the likely catastrophic consequences than many countries are experiencing. Those countries who have transitioned to stricter lockdowns have seen lowering case numbers and deaths.
  
• COVID-19 morbidity: Quite apart from the severe breathing and heart problems it causes, some data emerging (the Lancet) about patients coming out of ICU with kidney impairment, blood clots, brain damage, lung damage, psychiatric problems, and other morbidity. 
• Testing has now increased across Australia to include anyone with any respiratory symptoms so public health can get an idea about whether there’s any community transmission. Also those people who’ve improved, tested negative, and then re-tested positive again? Well that’s likely due to test failure and poor swab technique – you see the swab has to go right to the back of the nasal passage to collect the virus’ genetic material, and if it doesn’t collect it, it might show a false negative result. False Negative | Stability issues of RT‐PCR testing of SARS‐CoV‐2 for hospitalized patients clinically diagnosed with COVID‐19 | Positive RT-PCR Test Results in Patients Recovered From COVID-19
• ‘COVID safe’ app was launched by the government on Sunday night, and already approximately 3.2 million Australians have downloaded it. It works with Bluetooth sensing and storing the Bluetooth address (not device identity) of anyone’s phone that you’ve been in contact with for >15 mins for 21 days, then the data is deleted – you will be alerted that you’ve had a positive contact if any of those people get sick with SARS-CoV-2 – quicker than just manual contact tracing, and currently, the only way some restrictions can start lifting (if >40% of the population download it). You can delete the app (and data) at any time. There are already biosecurity laws in place concerning data usage and limitations – no Commonwealth or law enforcement agencies will have access, no US agencies will have access – and parliament will be reconvening in May to determine further privacy and security laws.
• Schools in or not? Teachers have done a phenomenal amount of work in a short amount of time to transition to online over the past few weeks – all will continue classes in one way or another; most are providing onsite supervision for children of essential workers and disadvantaged students, while others are encouraged to work from home. There was a small study suggesting that children are not super-spreaders, and in fact, if anyone’s spreading it at school, it’s likely to be the adult teachers. However the sample size was small (18 students and staff), and there are still some concerns about school campuses opening pre-emptively given so many unknowns, so not as convincing as federal government. COVID-19 in schools – the experience in NSW 
• Children spreaders? For great discussions about schools, children’s transmission capabilities, and contact tracing: Going Viral - Episode 35 | Going Viral - Episode 28 | Going Viral - Episode 27 
• Children’s illness: British GPs have received data overnight which suggests that children are developing a new condition called ‘multi-system inflammatory state’ (?atypical Kawasaki disease, with inflammation of blood vessels) after contracting SARS-CoV-2 – rare, but severe enough to warrant ICU. 
• Hydroxychloroquine now seems to be an ineffective treatment, after a recently-concluded US trial showed 28% of 368 COVID-19 patients treated with the drug at a veteran hospital died, vs 11% who weren’t treated with hydroxychloroquine. Trials in other countries were encountering too many serious side effects, so they were suspended before completion.
• 5G has nothing to do with the spread of this pandemic – caused by a virus. There is good evidence to show this, and many sources of this 5G-fearmongering have been identified – they have been proven to be misrepresenting information, deliberately falsifying data, or just simply making things up (including an American doctor who incorrectly claimed that Africa has less COVID-19 because of not having 5G yet). You see, 5G uses higher radio frequencies (in the 30-300 gigahertz range) than previous generations of mobile services (4G, 3G, etc). In the 30-300 gigahertz range (referred to as ‘non-ionising’ electromagnetic radiation), there is not enough energy to break chemical bonds or remove electrons when in contact with human tissue. Also viruses and radiation exist in different forms (biological vs electromagnetic), which do not interact, so the protein shell of the virus is incapable of hijacking 5G radio signals. The virus does, however, spread via small droplets from an infected person. 5G and other telecommunications do not affect the immune system | 5G mobile networks and health 
• Other myths: gargling salt water will not decrease your risk of contracting or developing COVID-19 ( ); the medications ibuprofen, ACE-inhibitors and Angiotensin II Receptor Blockers (ARBs) are not bad – if you’re taking the latter two medications for your cardiovascular health, this is important, so please continue to do so. Antihypertensive drugs and risk of COVID-19? – Authors' reply | Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers | Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19 | Is the ACE2 Overexpression a Risk Factor for COVID-19 Infection?
• Masks: The jury is still out on mask-wearing for the general public here in Australia. There are arguments both ways, and they are influenced by the country and rate of community transmission, and mask availability – especially for the more at-risk frontline healthcare workers (necessary during aerosol-generating procedures). 
• Vaccines and Antibody testing: vaccines are still a long way off (at least 12 months, according to Prof Ian Frazer), but Stanford University have been testing recovered patients to find that most of them had developed high numbers of antibodies to the virus. A small minority, however, only developed a small number of antibodies, meaning next time, it’s likely that their bodies will still recognise, but they might get a bit sicker than those who have more antibodies remaining (Viral Kinetics and Antibody Responses in Patients with COVID-19 | Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered patient cohort and their implications) WHO led a meeting where everyone (except US) agreed to cooperate on treatment, research and vaccine development. Watch this space. 
• Wuhan lab accident? Many scientists have ‘investigated the crime scene’ in China and examined the virus in all its intricate detail. Their unanimous conclusion? The genetic code of the virus suggests that it’s developed and mutated from a combination of horseshoe bats (96% genetic similarity) and pangolins (some sick ones were illegally shipped into China late last year, and were found to be carrying coronaviruses, one of which had the same spike protein as SARS-CoV-2). This virus also has 30,000 nucleotides (bits of genetic code) that all work in harmony – pretty much impossible for a human to design, and it does not have any ‘human fingerprints’ in its genetic code, meaning it wasn’t intentionally released from a Wuhan virology lab. References to evidence that backs up these statements: Statement in support of the scientists, public health professionals, and medical professionals of China combatting COVID-19 | The proximal origin of SARS-CoV-2 | A pneumonia outbreak associated with a new coronavirus of probable bat origin | Synthetic viruses—Anything new? | Probable Pangolin Origin of SARS-CoV-2 Associated with the COVID-19 Outbreak | Viral Metagenomics Revealed Sendai Virus and Coronavirus Infection of Malayan Pangolins (Manis javanica)
• Death rates: Many countries are uncovering thousands of ‘hidden fatalities’ (it seems like Paris has double the typical death rate compared to this time of year usually, and New York City has quadruple). 0.15% of all New York City residents have died (based on official fatality number of 13K and population data of 8.4M) – this is contrast against 0.1% deaths of those who’ve contracted influenza (not the whole population) in a bad year; ie. this is not just “another flu”. Many deaths happen in nursing homes and private residences, where most aren’t counted.
• Sweden? Attempt at ‘herd immunity’, despite 2,300 doctors and scientists dissenting, causing a very high fatality rate (population 10 million, with 18,000 confirmed cases and 2,100 deaths), without guaranteed ‘herd immunity’ (because of studies indicating immunity may not develop), and a huge blow to the economy anyway. Sweden disputes accusations of lack of coronavirus action | Cumulative number of coronavirus (COVID-19) cases in Sweden since February 2020 
• The UN is warning that the number of people facing dangerous food insecurity worldwide is likely to double. 
• Consequences. It is a sad but expected consequence that economies around the world have taken a huge hit, and now statistics emerging showing the increased rates of mental health illness and domestic violence. The UN projects global rates of domestic violence could rise by 20%: Impact of the COVID-19 Pandemic on Family Planning and Ending Gender-based Violence, Female Genital Mutilation and Child Marriage
• Lifting restrictions. Many countries now facing the dilemma of when to start lifting restrictions, opening things up and allowing more freedoms, without the disease resurgence that is happening in Singapore.
• Disinfectant? Do not ingest / inject disinfectant or bleach. The US poisons line has had many more calls about this than they usually do in the last couple of days. Do not do it.

COVID safe app

• Aust. Government Department of Health
• Tasmania
• Victoria
• NSW
• QLD
• NT
• WA
• SA 
• ACT