Tegan Taylor: Hello, this is Coronacast, a podcast all about the coronavirus. I'm health reporter Tegan Taylor.
Norman Swan: And I'm physician and journalist Dr Norman Swan, it's Monday, 6 July.
Tegan Taylor: So Norman, when the Victorian cases started rising a couple of weeks ago, I'm a bit of an optimist, I think I thought that maybe it was just a blip, but it's really not. We've had sizeable increase in case numbers each day over the weekend, and now we are looking at people in social housing buildings being put into a hard lockdown.
Norman Swan: Yes, I don't want to go too much into numbers because when people listen to Coronacast, things could well have changed. But it's still double digits, we got into triple digits over a couple of days. It's a serious situation, it's spreading to other suburbs, which is not a great surprise. We haven't instituted masks, which would only make a small difference but it could be significant, and now we've got this lockdown in public housing in Melbourne.
Tegan Taylor: So these people in public housing, they are obviously already disadvantaged. Some of them are worried about care for their sick or frail residents. It is going to make life even harder for them or disadvantage them further?
Norman Swan: It's a huge impost on them. But let's go back and focus a little bit to the broader story here because this is a potential nightmare. Think Queens in New York, think the migrant worker area in Singapore where you've got relatively disadvantaged people living in crowded circumstances where it's very hard to socially distance. And if coronavirus starts to spread through those people, it's going to be very hard to control. So this is a cause of major concern.
And what happened in Singapore was that they had several hundred cases a day in the migrant worker area, very few cases each day outside the migrant worker area in Singapore, but nonetheless the whole of Singapore went down into very, very strict lockdown, including inspectors knocking on people's doors to find out if there was anybody in your home who shouldn't be there. It was incredibly strict, with strict mask usage outside. So that's obviously the prospect, is that even though it's relatively isolated to contain it, the temptation is to go citywide and create a lockdown so that you can just get things under control.
Tegan Taylor: On that, we've got these buildings in lockdown and that's probably some of the harshest lockdowns we've seen in Australia so far, maybe with the exception of hotel quarantine. Is it going to be enough to stamp it out or is it just a matter of time until it's a citywide lockdown?
Norman Swan: Again, at the time of us recording this Coronacast I haven't been able to verify…I have asked for verification from the Department in Victoria, is whether or not people who are positive or found to be positive in the blocks are going to be isolated at home, because it's very hard to isolate yourself at home, particularly in disadvantaged circumstances.
What they did in other places, not New York but what they did in other places was take people out of the home and quarantine them, if you like, in a COVID-19 positive area, which is much easier because you can circulate freely in that area, you don't actually have to be confined to your room because everybody is COVID-19 positive, and then the staff can wear PPE to protect themselves. But if you actually leave people in their home, the potential is that it does spread and it's very, very hard to control once it's out there.
Tegan Taylor: So part of this conversation about Victoria is the broadscale testing that they are doing, and we made some comments about this last week that we need to just clarify a little bit. So we talked about the reasons why people were refusing tests. One of the responses that we got was that people felt like they couldn't afford the time off work between being tested and having their results come back. But apparently Victoria's Department of Health and Human Services has said that people getting tested in hotspots who are asymptomatic are not required to self-isolate between being tested and their results coming back.
Norman Swan: Yes, which should be very encouraging to people in terms of agreeing to have their test done.
Tegan Taylor: Exactly, and it's different to when you are getting tested elsewhere in Australia where you probably do have symptoms and you are required to self-isolate. I was required to self-isolate between my test and getting my results back.
Norman Swan: Hopefully they are reducing the barriers to people saying no, but a lot of people have said no so far. One of the things that has come through I think in communication to us is 'are people going to collect my genetic material and keep my genetic material', in other words not the virus but my own genes. And my belief about that is no, that would be a disaster if that was the case. But they will keep the genetic material of the virus. So if you are positive for the virus, that will be kept so that they can trace where the virus comes from and also forward-looking in terms of where that family of viruses might have gone to. So they will keep the virus in stock but not your genes.
Tegan Taylor: We've actually got some more questions from the audience. Anne is asking…she is based in Melbourne but not in a hotspot or lockdown area, got plans to catch up with some friends for dinner. They made the plans when Victoria was looking good and the numbers were low, now she is concerned. Should they revert back to only going out when they need to go out?
Norman Swan: So you've got to differentiate here between what is advised by the Victorian government versus what you think you should be doing yourself or what is prudent. As far as I'm aware the Victorian government has said that you just need to follow current restrictions in terms of numbers at home, numbers of people in restaurants and bars and so on if you are not in a lockdown area.
The problem is the virus is probably quite spread out through Melbourne, it's just that in the lockdown areas it's in a high enough prevalence to need to be locked down and not in a high enough prevalence elsewhere. So my view would be that you need to be prudent. This is early March before the government announced its restrictions. People were already starting to behave in the right way, and I think that everybody in Melbourne should be thinking about socially distancing themselves, being very careful, not going into large enclosed areas with lots of people where social distancing is very difficult.
This would be a lot easier if such venues were to insist on masks. Pretty hard in a bar when you've got a drink. Masks would make that a little bit easier. If you are wanting to protect yourself you could wear an N95 mask. But by and large people should start in Melbourne to be behaving like they did in early March; socially distancing, being super careful, and not going into crowded or overly packed situations indoors.
Tegan Taylor: And a question from Justin who is one of the few people getting on a plane in Australia at the moment. He is flying interstate from Sydney for a job interview on Tuesday and he is asking what precautions should he take in the flight?
Norman Swan: So Justin, I think the first thing that you need to do, and I'm assuming that you're flying to Melbourne for your job interview since there is not many other places that you can fly to from Sydney. The first thing you've got to do before you get on the flight is assess for yourself of the risks that the New South Wales government will close the borders to Victoria or to somebody coming from anywhere in Melbourne. It could seriously hamper you there.
I would be asking the people whether you could do your job interview on Zoom, to be prudent. That would be the most prudent thing to do. If you do decide to fly, given that most airlines are not insisting that everybody wears masks and you want to protect yourself, go to the expense of buying an N95 mask, make sure it's well sealed, how you make sure about that is puff some perfume nearby or something that's smelly, and if you can smell it, it's not well enough sealed. But an N95 mask will help to protect yourself and then just take hand sanitiser with you. And good luck with the job.
Tegan Taylor: So let's talk about some research now and it's about time we had a bit of an update on some of the treatments that are being investigated for COVID-19. The World Health Organisation has discontinued a few from its big Solidarity Trial.
Norman Swan: There's a huge trial going on in the United Kingdom called the Recovery Trial where they are randomising patients with severe COVID-19 disease or potentially severe COVID-19 disease, to various treatments. We reported on their hydroxychloroquine study a few weeks ago on Coronacast which showed that hydroxychloroquine did not have any benefit at all. So they discontinued their hydroxychloroquine trial.
They also showed…I lose touch with time now…probably a couple of weeks ago now, that dexamethasone, a strong steroid, used in a fairly modest dose does prevent people either dying or going onto ventilation, so that was a good news trial, and that has changed practice around the world. So dexamethasone is being used around the world, and may be one of the reasons why the American death rates has actually declined is because they've changed practice in intensive care from this British trial.
And then most recently, which is last week, they found that lopinavir and ritonavir, two antiviral HIV treatments, they were trying that for COVID-19 to see if it would have an effect, there was some indication from China that maybe it did, and that had no effect on the virus at all unfortunately. So the British have discontinued that trial and I think the WHO have removed both hydroxychloroquine and lopinavir/ritonavir from their treatment arms in their large global trial.
It's bad news that we haven't got treatments. It would be lovely if one of those treatments did work but they are not, but what it means is that we are sifting away the treatments that don't work and focusing on things that could have potential.
Tegan Taylor: Well, that's all we've got time for on Coronacast today. Tell a friend about us if you like us, and please don't forget to leave us a review on Apple Podcasts if you can.
Norman Swan: And to leave a question or comment go to abc.net.au/coronavirus, go to 'Ask Us Your Questions' and fill in the form and mention Coronacast. And we'll see you tomorrow.
Tegan Taylor: See you then.
https://news.google.com/__i/rss/rd/articles/CBMiW2h0dHBzOi8vd3d3LmFiYy5uZXQuYXUvcmFkaW8vcHJvZ3JhbXMvY29yb25hY2FzdC9pcy1tZWxib3VybmUtYmVjb21pbmctYS1uaWdodG1hcmUvMTI0MjQwNjLSAQA?oc=5
2020-07-06 01:41:02Z
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