With novel coronavirus (Covid-19) spreading with astonishing speed, the World Health Organization (WHO) has warned that many health systems are not prepared to control infections if the disease hits. To mitigate the risk of outbreaks, WHO warned that countries need to have proactive surveillance, rapid diagnosis and immediate quarantine, plus an education campaign so the public knows proper hygiene and what to do if they become sick.
Australia reported its first Covid-19-related death on Sunday – 78-year-old James Kwan from Perth, a passenger on the Diamond Princess cruise ship. To date 30 cases have been reported in Australia and of those, 15 have recovered. There have been two cases of community transmission in NSW. One case involved a woman catching it from her brother who had recently returned from Iran. However, in a second case, a healthcare worker is believed to have contracted it without having travelled to an infection zone or been in direct contact with one of the few known infected people. Some health experts and researchers have said community spread is inevitable in Australia, and questions are being asked about how many people might need treatment in hospital and how many might become critically ill – and whether resources will cope.
However, such predictions can be irresponsible or misleading because the fatality rate is so dynamic. When asked about Iran, which recently reported an 11% mortality rate, Dr Michael Ryan from WHO said: “We need to be very careful in the first wave of infections and any newly affected country because we may only be detecting severe cases and the deaths will be over-represented in that.”
The risk and death rate differs between countries because of a range of factors such as how quickly the source of transmission is identified, the available health system resources, the health of the population and the way testing is conducted.
Australia’s deputy chief medical officer, Prof Paul Kelly, told the ABC: “We’ve had the very best modellers in Australia trying to predict what might happen, and it ranges from [Covid-19] not coming to Australia, all the way to everyone getting it, and we’re looking to prepare for all of those possibilities.”
Prof Mary-Louise McLaws, an infection control expert who has advised WHO, said: “The correct thing to do with a new virus is to wait until the end before giving solid death rate figures.
“Trying to maintain a running death rate commentary is difficult because you never know the amount of people who are undiagnosed or who is diagnosed but yet to die.”
What should Australians do to prepare?
Australian health authorities have urged people not to waste face masks. They are only useful for people with the virus and for healthcare workers treating those infected. According to WHO, airborne spread has not been reported for Covid-19 and it is not believed to be a major driver of transmission based on available evidence.
It seems to spread most readily by human-to-human transmission. Preventing its spread is similar to many other respiratory infections: by avoiding close contact with ill people and through frequent hand washing.
An associate professor in disaster and emergency response at Edith Cowan University, Erin Smith, said it was concerning to see widespread shortages of face masks. “It’s a fear-driven response,” she said. “Those surgical-based face masks don’t do a huge amount to prevent community transmission, so if that’s what people are hoping there are other ways to prevent spread that are more effective, like washing your hands with soap and water.
“If you can’t get soap and water, that’s when hand sanitiser is useful,” she said. “But hand sanitisers do not replace washing hands with soap and water and a good old scrub, which is more effective.” Learning not to touch your face – which people do up to 3,000 times per day – could also prevent disease spread.
“I see so many people in the Australian community wearing a face mask at the moment and I just want to ask them whether they’ve had their flu vaccine, because they are more likely to get influenza at the moment,” she said.
Finally, Smith said, it would not hurt for people with children, especially, to have a couple of weeks’ worth of medication and food on hand in case someone in the family became sick and everyone needed to stay home from work and school. But she said this was no different to preparing for other infectious diseases, such as influenza. Stockpiling beyond that is unnecessary, Australia’s chief medical officer Prof Brendan Murphy said.
McLaws agreed. “I’m not a doomsdayer,” she said. “Telling people to stock up on months’ worth of food and to expect the worst is not helpful, and I’m actually very impressed with our health department and government commitment to this potential pandemic.”
What are the government and health departments doing?
Australia has a national medical stockpile, a reserve of drugs and protective equipment for use in a public health emergency. Hospitals also have procedures for responding to infectious diseases, including pandemics.
On Thursday the prime minister, Scott Morrison, said Australia was acting as though a pandemic had already been declared in order to be well prepared. The health minister, Greg Hunt, said state and territory health departments were particularly focused on making sure there would be enough medical personnel if there was a surge of hospital patients. Hospitals are used to this type of planning already from previous outbreaks, such as influenza spikes.
Every week, the Australian Health Protection Principal Committee will update its travel advice. Its latest statement, issued on Friday, said travel restrictions and self-quarantine procedures for people coming from mainland China had been successful. There have been no cases detected in the more than 30,000 Australians returning from mainland China since 1 February. The committee said as the disease spreads, “extending travel bans to restrict travel from multiple countries is not likely to be feasible or effective in the medium term”.
“However, it may be appropriate to consider self-isolation or practise social distancing upon return from higher risk regions.”
If Covid-19 hits Australia, who is most at risk?
Coronavirus is a very mild illness for the majority of people infected, Smith said. “The majority of those people with serious infections or who have died are elderly and with comorbidities such as asthma, diabetes, cancer or cardiac or renal disease. This is largely a pneumonia-type of illness so people with respiratory illnesses need to be aware.”
A report from the WHO-China joint mission on coronavirus said the disease was relatively rare and mild in children, with 2.4% of the total reported cases in people age under 19. These figures will change as more data is gathered. Mortality increases with age, with the highest mortality among people over 80 years of age. Men seem to have a higher fatality rate than women in China, where it’s important to note there are high smoking rates among men. Pregnant women seem to be no more at risk than the average person.
Smith said it was prudent to be aware, “but we don’t want people to be alarmed”. “Once that happens you have panic-buying and antisocial behaviour,” she said. “We have excellent healthcare in Australia and we have been planning for this for years – every public health system has a pandemic plan. The managers would have drilled for it.”
McLaws said Australia’s health system would likely be stretched, “but it will manage”.
“The quarantine has given us time to prepare well,” she said. “If coronavirus does hit and people become unwell, they should stay at home, put a mask on and ring in to their doctor to be triaged on the phone. For vulnerable people with a comorbidity, they should get themselves to a fever clinic or hospital and again, they should be triaged on the phone first.”
If it spreads throughout Australia it will be important to heed government advice if community events are cancelled, such as sporting and cultural events, and to stay home if unwell. Currently, however, the prime minister said “there is no need for us to be moving towards not having mass gatherings of people”.
“You can still go to the football, you can still go to the cricket, you can still go and play with your friends down the street, you can go off to the concert, and you can go out for a Chinese meal,” he said.
Is comparing Covid-19 to other illnesses, such as Sars and influenza, useful?
It can be useful to learn from previous disease outbreaks when preparing emergency response plans, and consistent community messaging around hygiene and prevention of infectious diseases is also helpful.
However, looking at infection and death rates from influenza and Sars is not useful, WHO has said.
“Covid-19 is not Sars and it is not influenza,” the WHO-China joint mission on coronavirus report said. “It is a new virus with its own characteristics. Building scenarios and strategies only on the basis of well-known pathogens risks failing to exploit all possible measures to slow transmission of the Covid-19 virus, reduce disease and save lives.”
As WHO states, if you are not in an area where Covid-19 is spreading, or have not travelled from an area where Covid-19 is spreading, or have not been in contact with an infected patient, your risk of infection is low. The federal government and WHO websites are the best sources for up-to-date information. There is also a coronavirus information line: 1800 020 080.