Coronavirus COVID-19 General Information - Updated 15-3-2020
Author Dr Cedric Chu
Please note that we have 2 pages on Coronavirus. This page is for general information and is aimed at people who want to learn more about it to understand their risk and pre-prepare. It also includes links.
What is this page about?
There has been an overwhelming amount of opinion and information that makes it very hard for the average person and also us GPs to get a proper working plan in action. Additionally, the situation at this stage is changing almost on a daily basis so policies and actions plans made one day may not be feasible the next day.
There is also a concern of whose opinion and information can be trusted. Many news sites are aimed at being alarmist because alarmist headlines sell. On the other side our government seems to be very out of step with other Governments around the world. It is no secret that most doctors are not supporting the casual measures from our government and instead we are looking to advice from doctors in Italy and China who are all supporting social distancing and locking down public gatherings and schools.
This page exists to give our patients the real situation directly from our GPs in relationship to our practice and our local area. We will try and distil the important information that will help our patients understand the situation better.
This page will also act as a FAQs where we try and provide links for more information.
Please check back on this page regularly as it will be updated as the situation evolves.
Please also take comfort in that our doctors are reading and filtering through the available information, and speaking to each other regularly about action plans. We have found that advice from other countries' health departments is sometimes better than ours and we will incorporate what we think is the superior advice into our practice advice.
We will always try and interpret the information at hand rather than blindly following guidelines that aren’t always correct. We aim to be flexible and adaptable to the situation as it unfolds rather than having formal protocols and we will aim to keep this webpage as our communication channel.
What is coronavirus?
Coronaviruses are a group of viruses that are often seen in common colds, but this version COVID-19, also known as SARS-CoV-2, that has come out of China is a new strain that has the potential to cause SARS which stands for Severe Acute Respiratory Syndrome. SARS is a severe form of chest infection that can cause death. SARS can come from a variety of viruses and has been present in human epidemics in the past but fortunately it had been contained. Coronavirus COVID-19 seems to be more virulent in its spread compared to previous epidemics which is why we are in a a worldwide pandemic.
What is a pandemic?
A pandemic is called by governments when the spread of a disease spreads beyond local borders and is serious enough to cause severe illness usually due to a lack of immunity in the population. It has politico-social-economic applications as it helps governments decide on action plans dependent on which phase of a pandemic that we are in.
Containment has failed and in the near future we will definitely see COVID-19 in our community.
The biggest concern is that irrespective of the medical severity of the COVID-19 virus, the economic implications will be seen. Illness and needing to isolate people can lead to supply chain problems for essential items.
What are we expecting?
Although no-one can predict the future, most medics believe that it is inevitable that the COVID-19 strain of coronavirus will spread into the community and just mesh into our normal range of respiratory viruses. No doubt there will be some deaths similar to what we see with influenza but as the virus becomes mainstream, it is likely that humans will develop a natural immunity that will lessen the frequency and severity of the virus.
Modelling reported in the media believes that we will see slowly increasing numbers of infection peaking in our winter months of July and August consistent with when we see more respiratory infections.
Which countries are we concerned about?
At this stage with the rapid progression of the virus it would be safe to say that if you have had any overseas travel and have the symptoms listed above, then we would want you to have a high suspicion for COVID-19.
The official list is at this link and is likely to grow. https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert
How does Coronavirus present and behave?
Our current belief is that a large percentage of people who get the disease will have a mild to moderate fever illness with aches and pains and also some upper respiratory symptoms such as sore throat, runny nose and cough. There are even people who are thought to have had it and not known.
Unfortunately, in a percentage of people the virus will spread into the lungs causing a pneumonia which will present with cough and breathing problems. A smaller percentage will develop and even die from SARS due to their immune system attacking the virus and in turn damaging the lung cells so which will affect breathing. Some people can die from a secondary bacterial infection that can cause more damage.
Traditionally this is most common in people with weakened immune systems due to other medical problems, and also in the elderly. Alarmingly we have also seen reports out of China where middle aged people have also developed pneumonia and died and this includes medical staff.
It appears that the first week of symptoms can be mild and if it is to worsen, it will be in the second week.
At this stage the current death rate seems to be 2-3% based mostly on those who have had the disease in China. We are not sure whether this is due to a difference in medical care in China. The majority of deaths is still in elderly people with the death rate being less in younger and healthier people. In comparison the influenza virus causes about 0.1% death rate, so COVID-19 seems to be higher than the flu.
A small fortunate mercy is that it appears that SARS and deaths from SARS and MERS in the past seem to be less common in children under 12 years of age who are well. Most children get a milder illness than adults.
How does it spread?
We believe that Coronavirus is spread through droplet transmission such as from sneezing and coughing, and also from direct contact with people. We also believe that touching your face with contaminated hands is a major contributor to getting infected.
For this reason, wearing a mask, limiting your contact with people who are ill, as well as hand washing with antibacterial soap are all very helpful in limiting your exposure. Definitely do not touch your face. Sick people should wear a mask to prevent spreading the disease and they should be isolated.
It can also live on surfaces so it is advised to clean surfaces with a disinfectant if they become contaminated. We do not know for sure how long the virus can live outside the human body but there is evidence that it lasts in the vicinity of hours.
What is social distancing?
Our government has been slower than the rest of the world to push for social distancing and locking down public events and schools. This is out of step with many other countries and Singapore, Hong Kong and Wuhan have proven that isolating the public works to contain the spread of the virus. Our doctors along with many doctors across many social forums all stand in unity with medical staff from Italy and China who are advocating for social distancing to limit the spread of the virus.
Why is it important to limit the spread of the virus when it is likely to spread regardless?
This is a good question and there are many social media stories showing predicted graphs on how the spread will affect the health system.
Even at 1% of Australians getting the illness severely, our ICU and ventilator capacities will be overloaded which means that if you have a car accident then there will be nowhere for you to go if you need ICU. Preventing spread is about not overloading our medical system in a short amount of time as people will die.
How is it investigated?
Nasal and throat swabs are all used to investigate coronavirus. Sputum tests are also used. Blood tests are taken but currently these are held as there is no way to test blood at this moment. A chest x-ray will help us diagnose if the infection is in the lungs.
We have now been told that there is a shortage of testing equipment and for this reason you cannot get tested just if you are curious. You will need to fulfil the criteria of illness and also the criteria of exposure to COVID-19 or recent travel. We have heard that the private pathology agencies have run out of testing kits and so it is our belief that if you are sick enough for testing you need to be presenting to a hospital.
We will not be conducting testing within our practice.
The QML pathology agency in our Reading Shopping Centre cannot do the testing.
The hospitals are all setting up fever units that are specialised in testing and treating coronavirus.
How is it treated?
People with mild coronavirus generally need no medication except for pain and fever control such as paracetamol. There is a recent concern about using anti-inflammatories like aspirin and ibuprofen as it may worsen prognosis. This is not confirmed but for now it will be best to avoid these medications.
For more severe illnesses, from what we have seen from China and previous SARS outbreaks, patients are treated with antiviral medications especially medications used for HIV which can limit the replication of the virus. They can also be treated with a broad spectrum antibiotic to prevent secondary bacterial infections. They may sometimes need steroids to decrease the inflammation in their lungs. And they may also need interferon a medication aimed at modifying your immune system. Other medications are aimed at helping people breath.
Unfortunately, most of these medications can only be used in hospital settings which limits what GPs can do in the community.
What can a GP do?
It is important for our practice to set the record straight so that our patients have the correct expectations about what we can and cannot do.
We cannot isolate, test or treat you at our practice.
Despite the government saying to consult your GP, in truth GPs cannot do a lot to treat COVID-19 in the community. As you can see above, the treatment of severe disease requires hospital management and the milder forms are untreatable.
Our best role is to give advice and this can often be on the phone which will limit the spread to other people. We expect our role will be to determine if an ill patient has Coronavirus or another illness which we may be able to treat. Although it is early days, we would expect that we could make a reasonable determination over the phone as to the next logical course of action based upon the risk of COVID-19.
In most cases we will send you to the hospital where they have more dedicated resources and experience to test you and exam you in one place.
Another limitation that we have as GPs is that we have limited protective equipment due to a worldwide shortage of masks and gowns. Contrary to what the health department is saying, we have not been issued with a large amount of masks.
We also have limited space within our medical centre so we do not have an isolation room to isolate patients who are infected.
What should I do if I am concerned about being infected?
To prevent spread to others, it is safer for all involved to have you call us and we are likely to be able to get a feel for the severity of your illness over the phone. At this stage we would send you to hospital for testing.
If you feel that you have been exposed to the coronavirus then you will need to immediately isolate yourself for 14 days.
Your illness it likely to follow 3 main scenarios.
If you are asymptomatic then no treatment is needed.
2. MINOR ILLNESS
If you have minor fever and runny nose and cough without any shortness of breath, then there is no real need to come to the doctor as we will not have anything to offer you. Paracetamol will be the best medication to help with fever and aches. In this situation you should be tested and it is still better to see the hospital as they have dedicated units to manage testing. You should not come to our practice without phoning first as we can help you with advice over the phone. Your main concern will be to monitor for signs of a severe illness.
3. SEVERE ILLNESS
If you develop a bad cough, or you have difficulty breathing, or you have a fever that you cannot control, then you are best to be in a hospital as it is likely you have a pneumonia. Unfortunately presenting to the GP will not be helpful as we are likely to refer you to the hospital.
In all situations of presenting for help to any clinic or hospital,
you should ring ahead first.
What can I do right now?
The short answer is to educate yourself on this page as to how our practice will operate in the event of a pandemic.
You need to start social isolation.
Get the influenza vaccination when it comes out in April as having the risk of influenza is an extra burden to be concerned about.
Start thinking about how your household will function if one person gets sick. How will they wash, clean and toilet without infecting others in the house? Who will look after the kids if the adults are sick? See our other page for isolation advice.
Ensure that you speak to our doctors about having enough important medications to see you through in case of a supply chain or availability problem. This is particularly important for respiratory medications.
Start putting aside extra amounts of non-perishable foods that contain protein, fibre and carbohydrates. As well as sanitary products and toilet paper. It would be wise to also have cleaning agents for surfaces.
Ensure enough baby food for infants that are on a limited diet.
For all adults but especially the elderly this is a good time to review legal matters such as wills, power of attorney and advance health directives.
For more detailed information on what to expect and how to pre-prepare please read this article which is a very well written piece from an Australian virologist gives the best practical no nonsense advice that I have read.
FAQs - This WHO site is the best site to follow for the answers to common questions.
This WHO link discusses protective measures such as hand washing and how to properly use masks
Good short video on how to not contaminate yourself when removing protective equipment
Four step removal of Personal Protective Equipment
WHO info on how to isolate
Australian Government Department of Health information and advice
Centres for Disease Control USA
This link is to a live map showing the current confirmed cases around the world.