The two possible vaccines the Australian government has signed an in principal agreement to purchase and manufacture in Australia are the: Oxford viral vector vaccine, and the Queensland Uni molecular clamp vaccine.

The below article is a very good 4 minute read about the two most likely vaccines Australia may get (if they suppress COVID-19) why one needs a booster, and how they engender immunity.

Read more in Medical Republic

The “Oxford vaccine” is perhaps one of the most well known candidate for a successful COVID-19 vaccine. Although there may not be success, and if there is “success” it may still be many years until widespread application, there are two groups in Australia making great progress.

The University of Queensland has developed a “molecular clamp” model. Trials thus far in hamsters have shown a strong immune response. In South Australia the Finders University is working with a firm called Vaxine to produce a vaccination called Covax-19, which is looking to get to human trials soon.

For more information read RACGP

More evidence has emerged showing the benefits of extra virgin olive oil.

Researchers from La Trobe University have shown that 3 tablespoons a day reduce blood pressure by 2.5%. It’s not a huge amount, but it’s a safe nutritional additive that contributes to improved cardiovascular outcomes.

More information is in Nutrients 2020

That is a big “IF”. There are many issues with finding a vaccine for coronavirus. In very short some include:

• There has never been a vaccine for a coronavirus (one of the main causes of the common cold),
• It usually takes many years to develop a vaccine,
• For a vaccine to be effective, a large portion of people need to “seroconvert”, that is develop immunity to the vaccine. Recent studies have show that only 60% of people who have acquired COVID-19 through the community develop protective antibodies, and
• The vaccine needs to produce long term immunity. Some studies have shown that in those who develop antibodies to COVID-19 after infection, that immunity wanes by 23-fold within only a few months. This may require multiple booster vaccinations at 2-3 month intervals.

With the above concerns aside, there are other issues too, like:

• There are about 8 billion people on earth. At best, if all world vaccination production is switched to producing a viable vaccine, the world vaccination manufacturing capacity is estimated at 6.4 billion p.a. If, those vaccines require 2 or 3 doses, then that is a few years of vaccine production at maximum capacity to vaccinate the whole world.
• Then there is the challenge with vaccine distribution. Vaccines need to be kept strictly between 2 and 8 degrees C. It is estimated that 50% of world vaccines fail the “cold chain” and so if there is 50% wastage, then world production would need to further double. How do we get the vaccine between 2-8deg C to remote areas of Asia, Africa and South America, just to mention some remote locations?
• Will vaccine distribution be equitable worldwide? If wealthy countries buy up the supplies of the vaccine, and poorer countries which are in hot spots cannot get supply and not for a long time, then the virus may continue to rage on around the world for longer too.

Getting a good vaccine, with minimal side effects, that produces long-lasting, high levels of seroconversion to the whole world will be herculean effort.

Read more in Medical Republic

A study performed in MedUni Vienna showed that just over half of patients develop protective antibodies after they are infected with COVID-19. And, it appears that these antibodies potentially make it easier to virus to infect cells.

This combined with previous studies showing that immunity wanes significantly after 3 months raise significant concerns about the effectiveness of any COVID-19 vaccine and long term human immunity to it.

Read more in MDLinx

There have been 36 deaths from influenza in Australia this year – only 1 since the start of April! Over the same April to July period last year, 550 people died.

This suggests hundreds of lives may have been saved by measures taken to halt the COVID-19 pandemic – including social distancing and a very high uptake of the influenza vaccine.

Read more in Medical Republic

1. wash your glasses with soap and water,  then dry them with a microfibre cloth. Soap reduces surface tension, preventing fog from sticking to the lenses.
2. apply a thin layer of shaving cream to the inside of your glasses, then gently wipe it off.
3. use a commercial de-misting spray.
4. Improving the fit around the curve of the nose and cheeks is the best approach – mould the nose bridge at the top of your surgical mask to your face to reduce the gap that allows warm moist air up to the glasses.
5. Apply some tape (eg: Micropore that’s designed for skin) to the top edge of the mask to close the gap.
6. slightly moistening a tissue, folding it and placing it under the top edge of the mask.

A review of suicide research in the Medical Journal of Australia indicates that Australian suicides could increase by between 276 to 1500 per year.

Read more in the Medical Journal of Australia

Surgical masks are really superior to cloth masks, whether the cloth masks are double layer or not.

See link to a short video demonstration

There is mounting evidence that the body doesn’t mount a very strong immune memory to COVID-19 and that memory falls markedly over 3 months after initial infection.

Read more here on RACGP.org 

Read full article on: RACGP

Dr Lachlan Soper

Read full article on: The Conversation

Dr Lachlan Soper

Dr Lachlan Soper

Dr Lachlan Soper

If you open this link https://www.covid19data.com.au/ and then scroll down to the 3rd graph, hover over the yellow line you’ll see that since Australia hit roughly 600 active cases we’ve gone down by approximately 10 cases a day. With 530 “active cases”, on the assumption that health authorities have tracked down and are following every single COVID-19 case in the nation, and the count dropping by 10 cases a day, there is the possibility that Australia could be COVID-19 free from August. Possibly. Then it would be a matter of extremely strict quarantine, and checking all those people who work with anyone who comes into the country (airline staff, customs, quarantine hotels). We would still be physically isolated from the rest of the world, but there could be some semblance of “life as normal”. Noting that industries that rely on international travel like tourism and education will remain severely affected.

Dr Lachlan Soper

For those with asthma in the family it is worth noting that clinical guidelines will be updated in coming months. They will emphasise the importance of using puffers with corticosteroids used in combination with relievers, as opposed to only using relievers.

It will be recommended that short-acting-beta-agonists (SABAs), or better known as blue puffers like Ventolin, cease to be used as quick relief in the treatment of mild asthma. Instead, all adults and adolescents be initiated on the combination therapy of budesonide-formoterol (brand name Symbicort – a red puffer).

Recent studies, and backed by the Global Initiative for Asthma (GINA) have shown that using this combination therapy both if used daily or as needed to relieve symptoms reduces the risk of severe exacerbations by between 1/2 and 2/3 compared with SABA-only (blue puffer) treatment. This because the SABAs only open up the airways, they do not deal with the underlying pathology – the inflammation.

Read full article on: medicalrepublic.com.au

Dr Lachlan Soper

Australian Chief Medical Officer Professor Murphy said evidence is growing that the majority of COVID-19 transmission occurs indoors and also said “There’s an absolute risk about gathering size”.

Each state in Australia will implement these stages at different times and slightly differently, but here are the broad brush-strokes:

Stage 1: Allowing five visitors in private homes and 10 visitors in businesses and public places. Restaurants, cafes, retail, libraries, community centres, playgrounds and exercise boot camps will be allowed to open and resume. Travel within states for non-essential reasons will also be allowed.

Stage 2: will allow gatherings of up to 20 people, as well as the opening of gyms, beauty shops, cinemas, galleries, amusement parks, caravan parks and camping grounds.

Stage 3: will let people gather in groups of up to 100, and see the opening of nightclubs, food courts and saunas. There may be the possibility of travel to New Zealand.

These changes will be reviewed every three weeks by national cabinet to assess the impacts and when to move to stages 2 and 3.

Dr Lachlan Soper

WHO Director-General Dr Tedros Adhanom Ghebreyesus has reminded the world of six essential criteria that WHO argues need to be met before lifting restrictions:
1. countries must have strong surveillance, declining cases, and controlled transmission;
2. the health system must have the capacity to detect, isolate, test and treat every COVID-19 case and contacts;
3. outbreak risks must be minimised in special settings such as health facilities and aged care;
4. essential venues such as schools must have preventive measures in place.
5. the risks of importing the virus must be managed;
6. communities must be fully educated, engaged and empowered to adjust to “the new norm”.
“The risk of returning to lockdown remains very real if countries do not manage the transition extremely carefully and in a phased approach,”

Dr Lachlan Soper

Researchers from the University of Queensland and CSIRO have successfully been able to identify genetic traces of COVID-19 in raw sewage.

‘The hope is eventually we will be able to not just detect the geographic regions where COVID-19 is present, but the approximate number of people infected, without testing every individual in a location’ – CSIRO Chief Executive Dr Larry Marshall

Read full article on: mja.com.au

Dr Lachlan Soper

Major metropolitan hospitals are reporting a 25-40% drop in road trauma, assaults and sports injuries. Even more pleasing, with pubs closed alcohol-linked violence and injury have plummeted!

Infectious disease presentations have also fallen sharply, with dropping rates of influenza, rotaviruses, and other infections meaning fewer hospital attendances.

A question arises regarding the reduction in presentations for strokes, heart attacks, and chronic obstructive pulmonary disease exacerbations. Has there been a real reduction in the incidence of these things because people were at home (and there were not inflammatory or infective triggers for these)? Or is it a problem, where people didn’t attend hospital when they should have?

The latter theory may be backed up by surveys showing that general practices are overall down 30% in revenue (despite telehealth). Also by data showing that 30% and 40% of private and community pathology testing was currently not being done due to people not visiting their medical practitioner and not having their pathology samples collected.

Will there be a surge of serious medical issues once the lockdown eases, as patients who may have put off treatment return to the healthcare system? Time will tell.

Read more in: mja.com.au

Dr Lachlan Soper

CareFlight has noticed a “dramatic” upswing in people falling from roofs. As people are restricted to home, they lose their jobs or they cannot get help, more of them are attempting unsafe home renovation work. Work safely!

“As more people are undertaking home projects that put them at risk, CareFlight urges individuals to take appropriate precautions when performing maintenance around the house.”

Dr Lachlan Soper

How do we balance the prolonged damage to the economy, society and medicine (in other medical issues not being treated) by choosing to ease restrictions vs the potential consequences of further spikes in COVID-19 cases and deaths?

Do we keep the strict “lockdown” until all active cases diminish to zero, and then wait a further 14 days until there have been no new cases – eliminating the virus?

Or do we ease things a little, knowing that COVID-19 will not be controlled and more people will die from it?

The Group of Eight, an affiliation of leading Australian research universities, this week published a report inviting the Australian Government to choose between two contrasting but related strategies: ‘elimination’ of COVID-19, and a ‘controlled adaptation strategy’.

Under the elimination scenario, Australia would continue its nationwide please stay-home order for two further weeks after daily cases reach zero. That means lockdown would last until likely June, given the current trajectory of cases. BUT after that, many social distancing measures could be lifted quite quickly, due to minimal risk of societal spread of disease.

However, in the ‘controlled adaptation’ strategy, the Government would still use extensive “test-and-trace” protocols (to test broadly and trace comprehensively anyone who has come into contact with someone with COVID-19) to keep the number of new cases as low as possible. The positive with this strategy is that lockdown restrictions would be lifted sooner, not fully, but gradually, with continued social distancing measures – in parks, work, schools and shopping areas. These measures lasting for perhaps years.

The advantage of elimination is that people can go back to close proximity sooner (eg: gyms and sitting down in cafes).

The advantage of controlled adaptation is that it may allow less strict travel restrictions later this year or next year. Something which is important for the parts of our economy which rely on people flying in from overseas – in particular the education industry.

Read full article on: theconversation.com

Dr Lachlan Soper

All cause mortality will pick up deaths caused:

• directly by the virus (eg: respiratory failure),
• because another disease worsened by the impact of the virus (eg: COVID-19 predisposed to a heart attack), and
• due to non-presentation or treatment of a disease due to the COVID-19 lockdowns and changes to outpatient and inpatient medical systems

Official statistics are significantly underestimating the true death toll across the world. To calculate excess deaths, the Financial Times compared deaths from all causes in the weeks of a location’s outbreak in March and April 2020 to the average for the same period between 2015 and 2019. The total of 122,000 amounts to a 50 per cent rise in overall mortality relative to the historical average for the locations studied.

The ABC reports that for the UK alone the number of ‘excess deaths’ – deaths above a usual year – have more than doubled in recent weeks, with 22,351 in the week ending 17 April. A normal year would have 10,000 deaths.

https://www.abc.net.au/news/2020-04-30/coronavirus-deaths-likely-higher-due-to-excess-deaths/12200850

While some of these deaths may be due to other causes than COVID-19, the fact the death rate is so much higher than a normal year indicates the pandemic is playing a major role.

The surge in all-cause mortality suggests either an underreporting of COVID-19 deaths, or increases in other causes of mortality because people are avoiding healthcare.

Read more on: Financial Times.

Dr Lachlan Soper

According to today’s data from John Hopkins University https://coronavirus.jhu.edu/map.html , the United Kingdom has a Case Fatality Rate (CFR) of 15.5%, this means that for every 6 & 1/2 people diagnosed with COVID-19 in the UK, one will die. However, the CFR for Australia is 1.33%. Both of these countries share a similar heritage, wealth and good medical systems. So why the huge difference?

University of Queensland virologist Ian Mackay said that testing is likely to be the key:  ‘My crude presumption has been that in jurisdictions where rates of death are above 1%, there has been too little testing to capture the denominator,’

The Oxford University Centre for Evidence Based Medicine (CEBM) postulates the following reasons that the CFR varies so greatly country by country:

• The number of cases detected by testing will vary considerably by country
• Selection bias can mean those with severe disease are preferentially tested
• There may be delays between symptoms onset and deaths, which can lead to underestimation of the CFR
• There may be factors that account for increased death rates such as coinfection with another disease, more inadequate healthcare and patient demographics
• There may be increased rates of smoking in some countries or comorbidities (such as cardiovascular disease) amongst the fatalities
• Countries with populations that are older get worse hit by COVID-19 (eg: Italy with the 2nd oldest population in the world)
• Differences in how deaths are attributed to coronavirus – dying with the disease (association) is not the same as dying from the disease (causation)

Another point to note is that COVID-19 may not be as fatal as the “Case Fatality Rate” implies. CFR rates are subject to selection bias as more severe cases are tested – generally those in the hospital settings or those with more severe symptoms. The number of currently infected asymptomatic people is uncertain: estimates put it at least a half are asymptomatic; the proportion not coming forward for testing is also highly doubtful (i.e. you are symptomatic, but you do not present for testing). Therefore we can assume the IFR (infection fatality rate) is significantly lower than the CFR.

Read full article on: cebm.net

Dr Lachlan Soper

Dr Kathryn Snow and Professor James McCaw, infectious diseases epidemiologists at the University of Melbourne advise that it is too early to lift social restrictions at large risk of a large secondary wave of infections.

“Any epidemic is a random, unpredictable process like a bushfire….At the moment we have spot fires, but they have a habit of surprising you.”

“There’s no surveillance system in the world that picks up every single case. We will still need other risk mitigation in place, and for this virus that means social distancing until we have a vaccine.”

Read full article on: medicalrepublic.com.au

Dr Lachlan Soper

During the 1918 Spanish flu pandemic, “social distancing” was also employed. Like is happening in our time businesses were suffering from the lack of revenue, and so there was pressure to ‘re-open’ society.

The below article looks at Denver, a city which loosened social distancing rules too early. They ‘opened up’ before cases were effectively eliminated or there was sufficient heard immunity and had a second wave of infections that killed even more.

“Premature declarations of victory guarantee defeat. Buckling to protests increased the number of dead.”

It shows that towns, cities, states, countries that socially distanced for longer and consistently did better in terms of the number of infections and deaths.

Read full article on: cnn.com

Dr Lachlan Soper

Dr Lachlan Soper

Dr Lachlan Soper

Read full article on: covid19data.com.au

Dr Lachlan Soper

Prof Ian Fraser (who developed the cervical cancer vaccine) and others such as Dr Guy Campbell have proposed that IF a vaccine for COVID-19 is developed it is likely 12-18 months away. Therefore we need to think about “controlled contagion” whereby younger (less vulnerable) people are gradually allowed back into society.

The reason for this is the questions that have been rightly asked by many about the negative effects of the social isolation policies (or lockdown as colloquially phrased), including:

• Deterioration in mental health – increasing anxiety, depression, domestic violence and suicide.
• Missed cancers in people not presenting to their usual doctor or hospitals as they usually would.
• Deterioration of chronic diseases such as diabetes and cardiovascular disease
• Delayed surgery
• Not to mention the broad and likely long-lasting economic and employment effects of the social isolation policies to combat the COVID-19 pandemic.

The idea with “Controlled Contagion” is to slowly develop a community “heard immunity” in a sustainable way. This could be done by bit by bit allowing those at lowest risk of severe disease and death from COVID-19 back into society. Noting that statistics from Imperial College London, UK, show only 0.06% of those younger than 40 who are diagnosed with COVID-19 require intensive care. The risk of mortality in those under 40 years is less than 0.03%, and so is less than the current consequences of influenza.

However, 23% of those infected with COVID-19 who are over 60 year old will require hospital admission, of which 47% will require ICU. As a result, those over 60 will account for 90% of ICU demand, even though they make up only about 20% of the population.

Nobel Prize winner Professor Peter Doherty is strongly convinced re-infection is unlikely, and “even if it was … your prior infection would give you very rapid immunity and you would recover very quickly.”

By allowing all healthy individuals under the age of 60 to return to work under the present restrictions of social distancing, the virus would be allowed to spread in a sustainable and more controlled manner.

We could start with those under 40, and then under 50, and then under 60, while maintaining self-isolation for those over 60-years of age.

This is a proposal worth reasoned consideration – to minimise the medical, economic and societal consequences of the COVID-19 pandemic (in their totality over the next number of years as all of the consequences play out).

Dr Lachlan Soper

According to the latest weekly FluTracking report, rates of flu-like symptoms in the community have dropped from a peak of 1.6% in early March to a historic low of 0.3% in mid-April.

This is significantly lower than the 1.8% incidence of flu-like symptoms reported at the same time last year.

Influenza vaccination has also skyrocketed thus far this year. Since 1 March over 2.1 million flu vaccines have been administered and recorded in the Australian Immunisation Register compared to 634,000 at the same time in 2019, and 235,000 in 2018.

For more information see info.flutracking.net

Dr Lachlan Soper

Keep exercising, but stay outside slipstreams.

As the paper has not been peer reviewed yet, a link to a journal is not yet available, but he has released his data considering the need for good data in short time with the current pandemic.

Dr Lachlan Soper

Read full article on: healthed.com.au

Dr Lachlan Soper

The attachment below is the infographic flow chart that primary health care workers use for telehealth. Although it’s intended for doctors, it gives a good idea what they are looking for. The little circles down the right hand side indicate the frequency of symptoms.

The most common symptoms of COVID-19 in order are:

Cough, temperature, fatigue, sputum with the cough, shortness of breath, muscle aches, sore throat, headache, chills.

Read full article on: health.gov.au

Dr Lachlan Soper

COVID-19 is spread by our shoes. Consider taking off shoes & putting them in a bag after you leave potentially infectious areas.

Also COVID-19 has been detected in air about 4 metres away from patients, as well as on computer mouses, bins and sickbed handrails.

Is 1.5m enough for social distancing?

Read full article on: cdc.gov

Dr Lachlan Soper

https://coronavirus.jhu.edu/map.html

Dr Lachlan Soper

“The least-bad endgame is to eliminate the virus from Australia, continue to control our borders until there is a vaccine or a cure, and restore domestic economic and social activity to “normal”, albeit keeping a close watch for new cases” Grattan Institute.

I think this makes the best sense as a strategy. Australia is lucky to be an island, and a long way away from other countries. We can keep our borders locked down. And, if possible, complete elimination enables people to go back to work, school, local holidays etc… (albeit somewhat disengaged from world trade).

Read full article on: theconversation.com

Dr Lachlan Soper

A paper from the Grattan Institute, looking at the reduction in new cases of COVID-19 in Australia, using modelling from the Universities of Sydney and Melbourne give hope that Australia could possibly get to 0 cases of coronavirus around June.

As they say “Getting from ‘nearly 0 cases’ to 0 cases is the toughest part of the elimination strategy.”

Read full article on: blog.grattan.edu.au

Dr Lachlan Soper

The attached link is an educational piece from Wolters Kluwer who do medical education. It’s a good, simple yet reasonably comprehensive piece on COVID-19. It’s particularly good for those who have not been following the disease closely – like children, teenagers or to give to patients as a starting point for discussions. It discusses things like:

What is coronavirus?

What it affects.

How does it spread?

How long it takes to get sick after exposure.

What are it’s symptoms?

How to get help – call first.

How to prevent it: Good use of hand sanitiser and handwashing technique; social distancing; cleaning surfaces; masks

Read full article on: wolterskluwer.com

Dr Lachlan Soper

This ‘health-economics’ blog by Scottish GP Dr Malcolm Kendrick is worth considering in any rational discussion on the whole-of-society impacts of COVID-19. The fact that money to treat patients is finite is a harsh reality worth consideration.

Every person comes at such a discussion with a different bias and perspective, in what is a very emotive topic. Lives will be lost, in large numbers, whatever choices or paths are taken.

Read full article on: drmalcolmkendrick.org

Dr Lachlan Soper

Read full article on: racgp.org

Dr Lachlan Soper

By “living guidelines”, it means that they are updated as new information comes in, rather than multiple versions over time. This will have up-to-the-minute recommendations.

There are 4 key tabs:

• Living Guidelines
• Decision Flowcharts
• Evidence Under Review
• What Further Guidance is Needed.

While these guidelines are intended to assist overwhelmed medicos, they are also a good source of information to the discerning reader in the public.

As time goes on the guidelines will endeavour to answer questions that people ask of their GP when consulting them.

Read full article on: covid19evidence.net.au

Dr Lachlan Soper

For those interested in vaccine development this is a technical (but I think quite well explained) article on a complex medical science. It gives an understanding of what scientists need to do, the different methodologies and what is in the ‘pipeline’.

Read full article on: The Conversation

Dr Lachlan Soper

Click on the below link and then plug in your postcode to see how your local area is affected.

Read full article on: nsw.gov.au

Dr Lachlan Soper

Dr Lachlan Soper

This link to the Oxford University COVID-19 Evidence Service has many links within it to good evidence-based data on all kinds of aspects of COVID-19. eg:

what is coronavirus,

diagnosis,

treatments,

comparison of masks,

evidence for social distancing,

how to manage older populations etc…

Read full article on: cebm.net

Dr Lachlan Soper

Read full article on: health.nsw.gov.au

Dr Lachlan Soper

The Commonwealth Scientific and Industrial Research Organisation (CSIRO) has started pre-clinical trials for two COVID-19 vaccine candidates, which is expected to take 3 months.

Read full article on: csiro.au

Dr Lachlan Soper