Professor Allen Cheng, Professor of Infectious Diseases Epidemiology in the School of Public Health and Preventive Medicine at Monash University has answered the following questions.
On immunity / immunology
Can we please have some commentary on herd immunity + the coronavirus? It’s a big issue in the UK. “It (herd Immunity) is a risky strategy, but may very well be the ultimate outcome. It’s hard to get enough situational awareness to know when things might need to be tightened up, we don’t know the duration of immunity after infection, the intensity of transmission in children isn’t clear, and it would be hard to prevent mixing between less susceptible and more susceptible groups. Public health interventions are a very blunt tool — it’s hard to work out how effective they are, and can’t easily be turned on or off.”
On Biosecurity / Epidemiology / Social distancing Is the 1.5 metres for social distancing accurate? Is there any scientific basis for it?
“The 1.5m level clearly isn’t a sharp demarcation (you’re not safe at 1.51m and at risk at 1.49m!), and some more recent studies have suggested that most droplets do fall mostly within 1m, so the 1.5 recommendation allows for some uncertainty. Here’s a paper that looks at droplet spread with coughing.”
Professor Bruce Thompson Dean of Health at Swinburne University has answered the following questions.
Does surviving Covid-19 give you immune protection? “Yes it does. We are still not entirely clear whether it is full protection however it is much better than no protection.”
Does one need to experience at least lower respiratory symptoms like bronchitis to mount a protective antibody response needed for immunity? If the virus stays in the nose, would it only illicit a mucosal response and no humoral response? “No that is not the case. Some people with the virus have not discernible symptoms at all, and the body still forms an immune response.”
Could this be a factor influencing why kids are under-represented among more severe Covid-19 cases? (Are their snotty noses protecting them?) “No that is not the case. The reason why children and younger people overall have not been as effected is that they are usual[ly] health[y] and well with an immune system that is working as it should. People with comorbidities such as asthma, emphysema, bronchitis, diabetes, heart disease are at higher risk irrespective of age. As we get older, as with everything else, our immune system gets tired as well.”
Can we please have some commentary on herd immunity + the coronavirus? It’s a big issue in the UK. “The Herd Immunity concept works on the principle that if I am vaccinated or already had the virus I am protected from it, but more importantly I cannot give it some else. Furthermore if you have say have 100 people, 1 has the virus and the other 99 people have either been vaccinated or indeed had the virus, there is no where the virus can go — ie it can’t be transmitted so it eventually dies out. So it comes down to statistics. If 1 person has the virus and the other 99 are not vaccinated or have it, the virus will spread easily. The more people that are vaccinated the better, as it makes it harder for the virus to spread. So the UK saying let the virus spread and all will be fine, as it will eventually build up a herd immunity. That would be fine if there was no risk to having the virus. However we know that the mortality is ~1–3% which in a population of the size of the UK could mean hundreds of thousands of deaths and millions hospitalised. This is not correct approach to take.”
On Biosecurity / Epidemiology / Social distancing
Should healthy people wear a mask? It’s also a big concern from the Chinese communities in Australia, who are angry at the advice from Australia health authorities saying ‘‘If you are well, you do not need to wear a surgical mask. There is little evidence that widespread use of surgical masks in healthy people prevents transmission in public.” “The advice from the Australian Department of Health and Chief Medical Officer is correct. As panic buying of masks is stopping supply to the hospitals which really do need them.”
But a study in The Lancet finds wearing masks is effective in a hospital setting during SARS. “Yes in a hospital setting where you know that the person has the virus.”
Should we be reconsidering the role of masks given that an “absence of evidence of effectiveness should not be equated to evidence of ineffectiveness”? “We know they are effective on an individual basis if the person in front you has the virus and yes I take the point that no evidence is indeed evidence however from my previous point we don’t have the supply chain for everyone to have them and the hospitals need them.”
What is ‘flattening the curve’ and why is it important? “The flattening of the curve is in relation to the number of people who have the virus. Basically we are trying to stop the increase, or rise, in the number of new cases so if you imagine the curve of number of cases versus time, if there are no new cases the curve flattens out. The reason why it is so important is that we are demonstrating that the control measures are working and the virus is not being spread and hopefully eventually dies out.”
What is the best ways for individuals to do this / what are the best ways for communities to do this? “The best thing to do is the simple things like hand washing and hand sanitising. Social distancing. If you are sick then isolate — staying at home is perfectly fine. Keep a distance from each other. It is very similar to having a horrible cold. If you have a horrible cold you don’t want to give it to anyone and if you know someone with a horrible cold you normally don’t want to catch it, so you distance yourself. Don’t shake hands or kiss each other, etc.”
What is the current situation like for the healthcare system and will it hold up? “At this stage all is OK, however if the virus spreads as it has done in other countries like China and Italy it will put huge pressure on the health care system. This the very thing that we are trying to avoid by placing the country into isolation. It is also bigger than COVID-19 as taking up hospital beds with COVID-19 is displacing people with the usual things people go to hospital for. Plus we are about to enter influenza season which 300,000 people had in Australia and which killed ~800 people.”
Why hasn’t Australia moved to general school closures? Do epidemiologists agree that children continuing to go to school minimises the risk to vulnerable groups such as the elderly? “This is an interesting argument. Understandably we need to protect the most vulnerable which are the elderly and people with comorbities. So increasing their exposure is not a great idea. So if the government does close schools, which on one level makes sense, then children need to be looked after by a low risk group.”
Is Australia heading for the same situation as Italy? What’s the modelling? “Hopefully not! And is the very reason the government is correctly following the advice of the CMO and putting into place the current measures. The sooner we do this, the quicker we can stop the spread of the virus. We know from countries such as Singapore etc that have putting in isolation measures they have effectively stopped the increase in cases. Countries that didn’t do this such as Italy etc have struggled to contain the virus.”
Solutions as well as grim predictions: What works to contain the spread? Any data/research on that would be very valuable. “The basic stuff. Hand washing, hand washing and hand washing! Social isolation.”
On vaccine development
Why does it take a long time to build a vaccine? “A vaccine is like a medicine. First it needs to be developed. For any medicine to be sold it needs to go through the standard process of clinical trials including phase 1–3 trials. We need to insure that the medicine is safe, will not do harm, and know how effective it is.”
How would a coronavirus vaccine work? “Same is an influenza vaccine.”
How would a coronavirus vaccine be deployed? “Same as the influenza vaccine.”
Are there examples of other coronavirus vaccines we can look to/studies showing SARS/MERS safety/efficacy? “Yes they do help point us in the right direction.”
Professor Mike Kyrios is Vice President & Executive Dean, College of Education, Psychology & Social Work; and Director, Órama Institute of Mental Health, Wellbeing & Neuroscience at Flinders University
On limiting panic
“As Australia experiences the implications of the coronavirus crisis, the issue is not just a health or economic concern, but also a mental health and wellbeing crisis.
Beyond medical and public health interventions that the government is developing to combat COVID-19, it is necessary to start developing wellbeing, mental health and resilience supports for individuals and communities — including a simple 6-step strategy called STREAM that individuals can put into effect [refer below].
If wellbeing and resilience interventions are rolled out early, we prevent people turning up unnecessarily to medical services, and becoming too anxious, developing mental health problems or exacerbating any existing problems such as OCD, anxiety or trauma conditions.
South Australia is at the forefront of pre-emptive and preventative wellbeing interventions that can mitigate the development of mental health dysfunction and improve community outcomes. Therefore, existing resources can easily be upscaled and adapted for the current situation, to help people if they’re stuck at home or are beginning to feel stressed.
Flinders University’s Órama Institute of Mental Health, Wellbeing and Euroscience and SAHMI’s Wellbeing and Resilience Centre have been working to develop more effective wellbeing interventions and can easily provide upscaleable adaptations to counter the challenges of the COVID-19 crisis.
STREAM is the acronym for 6 simple strategies we can all follow if we are quarantined or working from home.
- S is for Social networking. Social distancing or quarantining may be necessary for our general health, but it doesn’t mean we should cease all social networking. Remain in touch with people through social media or a simple phone call. Share your experiences to facilitate support, or use the best of Australian humour to lighten the situation. Dinners or dessert and coffee over Skype are always a hoot!
- T is for Time Out. Remember to separate from each other when you’re stuck in the home for long periods. It can be particularly useful to timetable periods of Time Out to minimise the ongoing stress of being in a limited space with others for long periods.
- R is for Relaxation, mindfulness or yoga strategies. Managing anxiety can be helped through using a variety of relaxation strategies. Breathing and muscular relation exercises, mindfulness training, dancing, yoga and playing musical instruments are a few available strategies that are effective.
- E is for Exercise and Entertainment. Burn off some energy if you have a yard or a space where you can get some exercise. Find opportunities in the home to undertake some exercise. Alternatively, entertain yourself by catching up on some reading, streaming services, digital or board games, hobbies, or playing music.
- A is for Alternative thinking. Uncertainty and novelty will lead to heightened tension and stress. Question yourself if you’re becoming angry (such as supermarket or car rage). Are your fears likely to eventuate? What does science tell us about the most likely outcomes? Is your response reasonable? Are there better ways to manage your underlying motivations? Think things through to find resolution, or talk to someone else, such as a friend or a counsellor.
- M is for being Mindful of others. Remember, this is just a short-term situation that we can all get through if we work together. Resolving crisis is not new to Australians. We’ve done it before, working together and maintaining courteous and caring interpersonal relationships. Neighbours help each other and no one gets left behind after fires, floods and other times of need. Make sure it happens now. Check on your neighbours, making sure you maintain good hygiene practices. The elderly and those with previous medical conditions are particularly vulnerable and may need support. Never forget that simple acts of kindness make us feel good about ourselves, the world and the future.
Much of what we experience is based on more than objective experiences. It’s also our perception of what happens, our attitudes or beliefs, and how we regulate our emotions.
It’s no different in the current COVID-19 crisis. Many people appear to be controlling their fears and their need for certainty or control through panic buying — but the resulting pandemonium will not see us in good stead in the long run. Panic buying not only leads to many people in need missing out, but also builds further panic.
Numerous irrational behaviours that we currently see will not quell fears or increase our sense of control over perceived uncertainties. Compulsive hoarding of toilet paper, in response to COVID-19, not only doesn’t make sense but is indicative of the mental health challenges we will see at the population level if we don’t take additional actions.”
ARTICLE SOURCE: The Australian Science Media Centre works to enhance the media’s coverage of science, for the benefit of all Australians. Article publicly released 16 March 2020. IMAGE: Brian McGowan, Unsplash.