This week, the world recorded one million lives lost from COVID-19. It is timely to reflect on the recent past, as well as looking to what may lie ahead.
Over at The Conversation, experts shared some of their burning unanswered questions about the coronavirus, including:
- How can we explain the extreme geographical variation in COVID-19 mortality rates?
- How can COVID-safe behaviour become embedded in people’s lives?
- What is the full spectrum of health consequences of COVID-19 infection?
When public health researcher Alison Barrett took stock of the past six months of compiling Croakey’s COVID-19 wrap, she concluded that one of the most prominent themes is the importance of “clear, consistent and accessible communication when delivering pandemic-response messages”.
Alison Barrett writes:
This week marks six months since I started writing the COVID-19 Wrap for Croakey News, an opportunity that came about fortuitously after seeing a tweet from managing editor, Melissa Sweet, asking for contributions to their COVID-19 coverage.
Especially in the early stages of the pandemic, writing the wrap provided me with a routine task and a weekly deadline while I was working from home, something that I found very beneficial during a time when everything else felt quite chaotic and uncertain. It also helped me to stay informed and focused on the facts, filtering through the mass of COVID-19 misinformation.
As a result of writing the COVID-19 Wrap for Croakey, I’ve had the great opportunity to attend a series of webinars and learn about how people experiencing homelessness were supported during the pandemic; collaborate with a fellow HDR candidate at UniSA, Elisio Pereira-Neto, on a piece about the COVID-19 situation in Brazil; and learn valuable critical reading and writing skills.
I have been following the progress of support for rough sleepers and was really pleased to read last week that 72 people experiencing homelessness in Adelaide were housed in July, as part of the Adelaide Zero Project and their quick response to the pandemic in March.
With the vast amount of COVID-19 related research and updates being published daily, it is definitely a challenge to keep up-to-date. If any Croakey readers see anything you think other readers would be interested in, please ping me on Twitter: @alisonsbarrett.
Variation
In the six months since the first COVID-19 Wrap was published, the worldwide numbers of both coronavirus cases and deaths have increased more than hundredfold, from 300,000 cases to 33.3 million; and 9,000 deaths to 1 million deaths.
Some countries have managed better than others.
As early as March, the United States (US) and United Kingdom (UK) were being touted as having “provided among the world’s worst responses to the pandemic”, and while some gains were made in flattening the epidemic curve during shutdowns in April and May, that progress has since been reversed.
Both countries are experiencing large numbers of COVID-19 cases each day and a current upward trend, as shown in the graph below.
Daily new confirmed COVID-19 cases as of 29 Sep 2020. Source: ourworldindata.org under creative commons license.
Some, but not all, of the reasons for the situation in the US and UK include delays in testing and contact tracing, having inadequate supplies of personal protective equipment (PPE) for healthcare workers, disregard for the seriousness of the pandemic, and reopening earlier than recommended (see COVID-19 Wrap, 1 Apr and 14 Jul).
On the other hand, countries that have reached elimination and managed to maintain a very low number of cases, such as Vietnam, Taiwan and New Zealand, have done so by acting quickly in implementing extensive testing regimes and closing their borders to international arrivals.
Public health and government communication has been highlighted in these countries as being transparent, effective and consistent throughout the pandemic (see COVID-19 Wrap, 24 Jun and 12 Aug).
It is a challenge to truly measure and compare individual countries’ responses as they have all had their own experience of the pandemic and implemented measures based on their own local political and social contexts. However, a lot can be learned from these examples.
Key paper: Successful Elimination of Covid-19 Transmission in New Zealand.
Baker, MG, et al., The New England Journal of Medicine, 7 August 2020
Key resources for coronavirus data: ourworldindata.org and John Hopkins Coronavirus Tracker
Other key themes
While we wait for pharmaceutical interventions and vaccines to be trialled and developed, the best ways to minimise SARS-CoV-2 infections and manage the pandemic are non-pharmaceutical interventions (NPIs), such as physical distancing, stay-at-home policies and wearing of masks.
Throughout the past six months, a wide range of evidence has been published to support this. Some of the evidence includes:
- NPIs implemented in Wuhan, China, in particular travel restrictions and stay-at-home policies, resulted in the number of confirmed cases of COVID-19 dropping from 162.6 cases per million people to 17.2 cases per million in two months.
- Approximately 18,686 cases of COVID-19 were prevented as a result of the stage three restrictions (public gatherings limited to two people, closure of pubs, bars, places of worship and entertainment venues) in Melbourne in July.
- A systematic review found the risk of infection without wearing a mask was 17.4 percent compared to 3.1 percent when wearing a mask or respirator.
- A mathematical modelling study found that if 60 percent of the population wore a mask that is at least 60 percent efficient at blocking the virus, the rate of transmission would drop below 1.0.
Key paper: Victoria’s response to a resurgence of COVID-19 has averted 9,000-37,000 cases in July 2020
Saul, A, et al., Medical Journal of Australia, Preprint, 4 August 2020
Clear, consistent communication is vital
One of the most prominent themes I’ve come across in monitoring the literature and social media for news and updates on the pandemic is how vital it is for clear, consistent and accessible communication when delivering pandemic-response messages.
And, while we have responded better than other countries, Australia’s public health messages have been criticised for being inconsistent, and implemented too slowly, resulting in confusion and uncertainty about restrictions.
An exception to this is the leading example from the Aboriginal Community Controlled Health Organisations, who were quick to respond to the pandemic and communicated culturally appropriate health promotion messages about COVID-19 for their communities.
As the pandemic continues and situations change in each country, it is imperative that communication and messages are delivered clearly, consistently and tailored appropriately to the audience.
Communication strategy guide: New behaviour change guidance to help reduce spread of COVID-19
British Psychological Society, 17 April 2020
Research, medications and vaccines
As mentioned earlier, it is a challenge to keep up with the research and updates on COVID-19.
A quick and basic search in Medline Database on 24th September, came up with 56,788 results about the novel coronavirus. With the speed and amount of research being published, concerns have been raised about the quality of the research and the impact it has on other important and necessary research.
Some of the studies that I’ve summarised for the COVID-19 Wrap include:
- Analysing wastewater to detect community spread of COVID-19;
- Changes in the incidence of stillbirth and preterm delivery during the pandemic;
- Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020;
- Re-infection with SARS-CoV-2;
- Cardiovascular disease, drug therapy and mortality in COVID-19; published in May and retracted in June after concerns were raised about the raw data, which came from the same source as another retracted paper about the effects of hydroxychloroquine on COVID-19 patients. In good news to come from the two retractions, The Lancet journal have recently announced changes to their review process; and
- Updates on vaccine trials.
On 23 September, the Australian Government announced they have joined the World Health Organization’s COVAX initiative, which means that Australia will have access to more vaccines if they pass clinical trials.
While this is promising for Australians, concerns have been raised from early on in the pandemic that many people across the globe might miss out on a vaccine if richer countries stockpile doses for their own populations’ use (which has happened in previous epidemics).
Long-term impacts
While much of the focus during the pandemic has been on the immediate impacts of COVID-19 cases and deaths, some discussions have occurred about the long-term effects of the virus.
Patients recovering from the virus have reported symptoms including fever, headaches, brain fog, breathlessness, chest pain and fatigue, persisting up to two months or more.
In a recent COVID-19 Wrap (9 Sep), I wrote a piece about “long-haulers” and that many are reporting symptoms similar to those of myalgic encephalomyelitis/chronic fatigue syndrome.
While researchers continue to collect data on the long-term impacts, it is important to remember that without a vaccine, we may be dealing with the novel coronavirus for years and it is important that COVID-19 patients are supported and cared for appropriately as they recover.
This is true for, not only those suffering long-term physical impacts, but those experiencing long-term social and mental health impacts.
As found in a systematic review in February in The Lancet, periods of time in quarantine can result in a range of negative psychological outcomes including insomnia, depression, anxiety, post-traumatic stress and emotional exhaustion.
Key paper: The psychological impact of quarantine and how to reduce it
The Lancet, 26 February
Some, but definitely not exhaustive, key sources of information about COVID-19: Burnet Institute, John Hopkins University of Medicine: Coronavirus Resource Centre, The Lancet, BMJ, Nature, Science Mag, World Economic Forum, and Twitter
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions of the COVID wrap.
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