Q&A session with Professor Rinaldo Bellomo, Director of Intensive Care Research and Staff  Specialist in Intensive Care at the Austin Hospital.

This morning the Rotary Club of Ivanhoe held a Corona Virus Q&A session with Professor Rinaldo Bellomo,
Director of Intensive Care Research and Staff  Specialist in Intensive Care at the Austin Hospital.

Please find attached a summary of the session for the personal benefit of Club members Rotarians and friends.

Rotary Club of Ivanhoe

Wed 10 June 2020

Professor Rinaldo Bellomo
Director of Intensive Care Research at Austin Hospital

Q. What are the most common symptoms of Covid-19?
A. Loss of sense of smell is an important indicator and 20 – 30% of patients experience diarrhoea. Muscle aches and pains and general malaise are also symptoms.

Q. If you have flu symptoms what are the chances you actually have Covid-19?
A. Prevalence of the virus in the general population has decreased to the extent that if you have symptoms it is most probably something other than Covid-19. As a result of the community health measures put into place for Corona Virus, the common flu has decreased dramatically by 50-70% compared with last year. If you have respiratory symptoms it is best to isolate for a week or two and get tested. You need to book in by telephone and results are usually available in about 1 ½ hours.
We will need to do this until we get to the NZ level of almost eradication.

Q. Why is Australia doing so well compared with USA and UK?
A. The public health system has failed in the USA and UK and governments have behaved irresponsibly. In the UK it is claimed there have been 40,000 more deaths than there would have been if best practices had been adopted.
Taiwan has had experience with SARS so its community is tuned into infectious disease control. They had been closely monitoring Chinese media and by 31 Dec 2019 had already detected something unusual going on in Hubai Province. This knowledge was then shared with international health authorities.
The Australian response has been fantastic.

Q. Are ICUs in Australia back to normal?
A. We continue to be very vigilant given uncertainty about anyone coming into the hospital with respiratory distress. Patients must be treated as if they have COVID 19 to prevent transmission to medical staff, who would then require isolation and would not be able to work. The hospital enacts protocols for ‘suspected COVID 19’ until there are two negative swabs. Special hazmat suits are used during patient intubation. Expect it will take a month or two until the system goes back to normal.
Australia has the lowest ICU mortality rate in the world – 20 per cent. This is because our system is not overloaded so individual patient care can be optimised.

Q. Why do only some people become sick?
A. We don’t know. The protean ACE2 plays an important role in allowing the virus to enter cells. ACE2 is more strongly expressed in males, and also increases with age. Serology studies are showing that asymptomatic patient numbers are probably very high. Serology testing has only become reliable in the last month or so. It is likely that waves of infection last about 10-12 weeks as natural immunity develops, and then subsides.

Q. Is the method of transmission different from common cold or flu?
A. COVID virus remains viable in aerosols in a Petrie dish for about 2 hours.
The best advice is to wash hands before going into a café or train etc, avoid touching your face, and wash hands or sanitise again when you leave.

Q. Are there effective treatments for Covid-19 infection?
A. Not really. Remdesivir has only a very mild effect. It decreases the duration of symptoms in people with mild disease but does not reduce the risk of death in seriously ill patients.

Q. Do you become immune after being infected?
A. No one knows. Neutralising antibodies have been shown to last for about one month. It could be longer but there is not enough data yet.

Q. for how long do infected people remain infectious?
A. People shed the virus for up to one month even if well. Next month there will be broad serology testing across the population to determine how many people have been exposed, the number of asymptomatic people in the community and how much virus is circulating. You have to assume there are asymptomatic people carrying the virus.

Q. How reliable is nasal swab testing?
A. Nasal swabs do have limitations – if negative it means one is very unlikely to be carrying the virus but limited sensitivity of the test can give false negatives.

Q. What is the expected outcome?
A. If we get 30 days with no new cases, then we are probably virus free. The problem will be people coming into the country bringing new infection from overseas.

Q. When are we likely to get a vaccine?
A. The Chinese are moving to phase 2 vaccine studies. They have proven they can generate antibodies. We may get a vaccine by the end of the year. Testing will be in India and Brazil. But it will be next year before the vaccine is generally available. The best advice is to not get the virus.

Q. When will overseas travel be allowed?
A. Do not expect open skies until next year.

Q. What will the future be like?
A. ‘Track and suppress’ is the way of the future. The key is to quickly find isolate and test contacts of infected people.

Q. It has been reported that there are several strains of the virus in circulation. What impact will this have?
A. Genetic typing of the virus has identified several strains, but nothing overly significant. Normally one would expect some genetic abnormalities given so many virus particles are generated.

Q. Will the Black Lives Matter protests affect the timeframe for coming out of lockdown?
A. We won’t know the outcome for 2 weeks so need to wait. It is difficult to know when to stop lockdown measures. Governments tend to err on the side of caution. Don’t want to have to lock down again.

Q. What do you think of Sweden’s approach?
A. Sweden has been irresponsible. Despite a lack of lock-down, Sweden’s economy has suffered like everyone else’s. They could have saved many more people.

Q. Why has the per-capital death rate been so much higher in some countries?
A. The difficulty is in the classification of deaths. Belgium classifies deaths as anyone who dies during the epidemic, even if by stroke. Mortality figures are plus/minus 30 per cent.

Q. Is Australia’s timing of schools re-opening appropriate?
A. Younger children susceptibility is less. Return to school timing is a reasonable balance between risks and benefits.

Q. What level of confidence can we put on Covid-19 statistics?
A. All statistics should be treated as false outside of western countries. Countries like India can’t keep up with their data. Chinese data, however, is now quite accurate because the world is watching so closely.