Coronavirus (COVID-19) – Video – Top 3 questions from 15 September 2020

Good morning everybody, it's Dr Nick Coatsworth with today's top three. And a couple of shout outs today.

The first one is to everybody who viewed my episode last week with Dr Ben Gauntlett on disability and COVID-19.

Today I'm going to write to all the heads of the peak medical and nursing bodies and commend Ben Gauntlett and the Ben Gauntlett report on disability people with disability in COVID-19. It's such a fantastic guideline on how we can help people with disability navigate their health system both during COVID-19 and beyond.

And the second shout out today is anyone who hasn't been to their GP and got a medical test or cancer screening done. Now I know you're out there. I know you're watching and I need you to go and get in touch with your GP. And I need you to get your cancer screening done. Whether that's a breast cancer screening, whether that's a pap smear or whether that's bowel cancer screening.

You know we have amongst the best cancer screening programs in the world funded by the Government - federal and state, to make sure that you're safe and things are detected as early as possible. Cancer won't wait and what I want to reassure you is that we have learned so much so far during the COVID-19 outbreak.

All our health care facilities are working hard to keep them clean and safe for you to go and get your normal health care. Because whilst COVID-19 has had a tragic impact on many families, what we don't want is for it to have an even more tragic impact with people who have not got tests done.

It is time to put aside some of that fear and get out there and get your usual medical care done and remember that's not just your physical health, it's not just cancer screening, it's also your mental health as well.

And if you're feeling anxious or your mood is low, remember that the Australian Government has now funded an extra 10 Medicare funded psychological, clinical psychological visits in addition to the ten that you're already entitled to.

Question one – we are fast approaching the holiday season. What should people be considering during this time?

Well what a long hard winter it's been. Particularly for our friends and family down in Victoria, who have really done it tough for us over the past six weeks. And fortunately the light at the end of the tunnel is getting bigger for them, with today Dan Andrews announcing some easing of restrictions in rural and regional Victoria.

So that's my third shout out for today – everybody in rural and regional Victoria.

But the holiday season has to be a little different this year. And we're all going to be busting out of our skin to get to the holiday destinations, absolutely we are, both in these school holidays coming up and also in the summer holidays. This is going to create a certain environment and that we have to do our bit to control that.

And it is a fertile environment for COVID-19 to move around. Move around into rural areas and regional areas of Australia which as we know from reality, don't have as good a health services in terms of they don't have tertiary hospitals of course and people who get sick, they need to be evacuated. So you don't want to be the one bringing COVID-19 to a rural area.

And also you've got to remember that a lot of Australians, I know I'll probably be one of these, choose to retire to rural and regional areas. So there's a lot of elderly Australians and we know they're vulnerable to COVID-19. So what do we do?

Well it's a matter of not forgetting those behaviours. You're going to see kids in the playgrounds, adults in the playgrounds, you're going to see cues at the ice cream store. You know all the businesses are going to have COVID Safe plans of course but they can't do it on their own. Government can't do it on their own, can't do it without you. And what do we need you to do?

Well, physical distance is still going to be important, washing hands is going to be critically important, you shouldn't be walking around anywhere without a bottle of hand sanitiser. And if your kids are anything like mine, they don't like using that stuff but you know they have to and set an example by doing it yourself. So physical distance, hand hygiene.

If you're unwell and you get unwell on your holidays – make sure you know where you can get a COVID test. That's critically important.

In New South Wales, now I've noticed that you have to actually scan in on a QR code to any restaurant, with the Services New South Wales app. What a fantastic initiative that is. And if you're into your apps, highly recommend that you download before the holidays, COVIDSafe. COVIDSafe is still live, it's still working and it's still finding contacts. Particularly in New South Wales at the moment. And if you have a look, I'm not sure if it's going to show up very well, but you can actually see the total number of cases in the latest updated edition.

So particularly for my, our audience down in Victoria. As your restrictions lift, you'll be you'll be wearing masks and if you believe that masks make a difference, as I do. Then you believe that COVIDSafe makes a difference as well. So have it active on your phone. Same to any Australians but particularly those on the eastern seaboard in New South Wales and Queensland.

Question two – does every coronavirus cluster start with just one person?

Well what a great question and the answer is yes. It does. The cluster isn't there until one person brings COVID-19 in.

And the difficulty with this virus is that we don't know which person's going to be the one that makes that transmission event, we call it, to others and sometimes that transmission event might be one person, sometimes it might be 10 or more if you have a so-called super spreader event.

We know that on average if we do nothing in terms of our restrictions or our hand hygiene masks or our public health measures, that the average number of people that will get infected individual sits between about 2.5 and 3. That was from the early data from Wuhan and probably hasn't changed too much.

But the question is, what can you do to make sure that you're not the one person that transmits this virus. And overwhelmingly the most effective way of controlling this virus is, if you've got symptoms, you need to get tested. And so once again know where you can get tested, don't wait for a day to see if your cold goes away because it might have been COVID.

And you might need to know about it to tell the contact tracers who to isolate and that'll break, certainly break the chains of transmission. Remembering of course that if you've got a respiratory tract infection in Melbourne at the moment it's probably going to be COVID or at least there's a very, very good chance that it will be. And in the rest of Australia, you really need to make sure that you still get tested. Because that's the way we'll find the clusters when they're early.

Obviously not when they're one person because you tend not to find the cluster when it's only one person, it's a bit impossible, but when it's only two or four. What you don't want is to find the cluster where there's already been not just one generation of transmission but those people that have caught the virus have then gone on to generate another layer of transmission and that's when it starts to to get out of control.

Keeping in mind the way that COVID-19 is transmitted, it's predominantly about contact and droplet. So direct contact with a person, 15 minutes face to face at a distance of 1.5 metres, that is still our contact definition. And contact with droplets, so droplets on surfaces when a person sneezes and touching those objects or surfaces and then your hands go near your mouth and you can you can get COVID-19.

Aerosols are an interesting matter and there's an increasing realisation that probably all respiratory viruses but particularly COVID-19 have an element of aerosolization. What is aerosolization? Well it's those droplets that COVID-19 expire is expired with. Instead of dropping to the surface they actually stay within in the air suspended in the air and people can breathe them in.

Now this is particularly an issue in health care worker settings. This is particularly an issue when you have prolonged contact and you're caring for someone who is very unwell. It is much less likely to be the main form of transmission for the general public

But one of the ways you can stop droplet and assist with aerosol transmission of course is if you're wearing a mask. If you're in that pre-symptomatic phase and you don't actually know whether you've got COVID, wearing a mask will help block some of those aerosols. It's compulsory in Victoria of course and is highly recommended in Sydney and also in southeast Queensland. So keep in mind that that's the other thing you can do.

Mask wearing is a critically important intervention in COVID-19. Just like hand washing, just like social distancing, getting yourself tested and downloading the COVIDSafe app.

Question three – were you telling people to get tested if they have symptoms but should people be getting a COVID-19 test even if they're sure it's only allergies?

Well this is a difficult question. In spring I mean, it's almost part of being Australian getting hay fever in in spring isn't it? And that those symptoms are sinusitis. Those symptoms of a scratchy nose runny nose, even waking up in the morning with a sore throat because of your hay fever. All those could easily be COVID-19.

So what I recommend in this situation is if you're starting to get hay fever and you haven't had a COVID test for a while or at all, get yourself a COVID test to make sure it's not COVID and then start treating your hay fever.

Because one thing that we're sure about of course COVID-19 symptoms don't tend to go away with hay fever treatments, some of them do, the congestion can be helped a little bit. But the idea is that you would start you get a negative test, start treating your hay fever aggressively and then your hay fever symptoms disappear. And then if you get symptoms again, well it may well be another respiratory virus.

So that's the order. Is it hay fever? Not sure? Get yourself tested. Treat the hay fever. And I think as long as you've got that negative test then you and your family can be reassured. But don't forget to treat your hay fever. Otherwise you'll spend most of spring getting yourself a COVID test, which won't be pleasant for you and would put a bit of a burden on the testing resources.

So I hope that helps with that hay fever. I know it's that is not easy in spring. And I think the last thing that I forgot to mention was don't assume that because we're going to spring and summer that COVID-19 is going to behave any differently in the spring or summer months. I know that the flu does as a general rule. Although we did have two years ago an increase in flu numbers in January. Can you believe? It that's I think in 2018–19 summer.

But the northern hemispheres had their first wave during summer. So clearly we have no evidence at all to suggest that our COVID-19 numbers are going to go down just because it's summer. So don't behave any differently and this is the COVID normal. You are COVIDSafe and thanks for doing that.

And next time Allison McMillan is going to do a solo top 3 on Thursday for community nurses day. So please tune in to that and give our community nurses your support.