Coronavirus (COVID-19) is raising valid concerns among our communities and one such concern is around the possibility of interrupted supply chains for medications for people living with HIV and PrEP users.
Following extensive consultation with pharmaceutical companies, the Therapeutic Goods Administration (TGA), and the Pharmaceutical Benefits Advisory Committee (PBAC) the key message is that COVID-19 poses no threat to the availability of HIV medications for Australian consumers.
To help you learn more about COVID-19 NAPWHA has co-produced with Australian Federation of AIDS Organisations (AFAO) and Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine an updated fact sheet released on 9 March 2020 (this is an updated version of the Factsheet published on 5 February 2020).
You’re probably inundated with news and messages about coronavirus at the moment. But how do you know if you’re consuming evidence-based information or just speculation and myth?
There’s still a lot we don’t know but here’s what the evidence tells us so far about the coronavirus, called SARS-CoV-2, and the disease it causes, COVID-19.
How does it spread?
COVID-19 is transmitted through droplets generated via coughing and sneezing.
This means it can spread during close contact between an infected and uninfected person, when it’s inhaled, or enters the body via the eyes, mouth or nose.
Infection can also occur when an uninfected person touches a contaminated surface.
What are the symptoms?
COVID-19 causes similar symptoms to the flu. Fever is the most common symptom, occurring in almost 88% of cases, while a dry cough is the next most common, affecting almost 68% of those with the virus.
Yes, you can still have coronavirus if you don’t have a fever. This occurs in about 12% of cases.
How long does it take to get sick?
The incubation is the period from when you’re infected to when you become sick. For COVID-19, the range is 1-14 days, with an average incubation period of 5-6 days.
How sick do people usually get?
Most people who get sick (80%) have a mild illness which rarely involves needing to go to hospital. They recover after about two weeks.
But just over 20% of people sick with COVID-19 will need to be hospitalised for severe difficulties with breathing.
Of the 20% who need to be hospitalised, 6% become critically ill with either respiratory failure (where you can’t get enough oxygen from your lungs into your blood), septic shock, and/or multiple organ failure. These people are likely to require admission to an intensive care unit.
It appears to take about one week to become severely ill after getting symptoms.
How often do people die of it?
The case fatality rate refers to the number of deaths among those who have tested positive for coronavirus. Globally, the case fatality rate today stands at 4%.
But this rate varies country to country and even within countries. These variations may partially be explained by whether hospitals has been overwhelmed or not.
The case fatality rate in Wuhan was 5.8% (although one model says it may be lower at 1.4%). In the rest of China, it was at 0.7%.
Similarly in Europe, Italy’s case fatality rate is (8.3%), greatly surpassing that of Germany (0.2%).
However the case fatality rate only includes people who are tested and confirmed as having the virus.
Some modelling estimates suggest that if you calculated the number of deaths from the total number of cases (those confirmed with tests and those that went undetected) the proportion of people who die from coronavirus might be more like 1%.
How infectious is it, and how does that compare with the flu?
COVID-19 and influenza are probably fairly similarly infections.
A single ill person with COVID-19 can infect more people than a single ill person with influenza. COVID-19 has a higher “reproduction number” of 2.0-2.5. This means one person will infect, on average, 2 to 2.5 people.
But this is balanced by influenza’s ability to infect more quickly. It takes, on average, 3 days to become sick with the flu, but you can still transmit it before symptoms emerge.
It takes 5-6 days to become sick with COVID-19. We still don’t know if you can be infectious before getting coronavirus symptoms, but it doesn’t seem to be a major driver of transmission.
So influenza can spread faster than COVID-19.
The case fatality rate of COVID-19 is higher than that of seasonal influenza (4% versus 0.1%), although as noted above, the true fatality of COVID-19 is still not clear.
It’s too early to know if someone infected with COVID-19 can get it again.
On the basis of what we understand about other coronaviruses, it is likely that infection will give you long-term immunity. But it’s unclear whether that will mean one year, two years or lifelong immunity.
Still have more questions? We might have you covered in this video.
Update: this article has been amended based on guidelines published on March 27 by the ARC Training Centre for Food Safety in the Fresh Produce Industry. They advise running produce under fresh water is sufficient, and the use of soap is not recommended. Hands should be washed with soap after touching produce.
Like the other 200 or so respiratory viruses we know of, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the new coronavirus, infects the cells of our airways.
It causes a range of signs and symptoms, or none at all. It can spread easily from person-to-person, and can be coughed into the air and onto surfaces.
Viruses only replicate inside a living cell – outside the cell, they’re on a path to either infect us, or their own destruction. How long a virus survives outside a cell varies.
Researchers found SARS-CoV-2 remains infectious in airborne droplets for at least three hours. This doesn’t mean infected humans produce enough virus in a cough to infect another person, but they might.
We think the virus also spreads by touch. Hard, shiny surfaces such as plastic, stainless steel, benchtops, and likely glass can support infectious virus, expelled in droplets, for up to 72 hours. But the virus rapidly degrades during this time. On fibrous and absorbent surfaces such as cardboard, paper, fabric and hessian, it becomes inactive more quickly.
How can we reduce risk from surfaces and objects?
Frequently touched surfaces are all around us. Benches, handrails, door handles – they are in our homes, on our way to work, school, play, shop, and every other destination. There’s a risk of contaminating these surfaces if we touch them with virus-laden fingers, and a risk we’ll contract the virus from such surfaces.
Think of your hands as the enemy. Wash them well, and much more often than usual. Between hand-washing, avoid constantly touching the mucous membranes that lead to your airways. Basically, try not to rub your eyes, pick your nose, or touch your lips and mouth.
Taking precautions through small actions
We’re already seeing engineering initiatives to help combat the virus’s spread. In Sydney, pedestrian crossings have been automated so people can avoid touching the buttons.
To slow the spread of SARS-CoV-2, assume everything outside your home is potentially contaminated, and act accordingly. So don’t touch your face, sanitise frequently while you are out, and wash your hands and clean your phone once home.
While it’s best to stay home, keep these tips in mind if you must leave the house.
Going shopping
Grocery shopping requires touching surfaces and items, including trolleys and baskets. Sometimes sanitiser or antibacterial wipes are available for hands and handles at the store entrance – but they’re often not, so bring your own (if you can get some). It probably doesn’t matter what type of bag you use, but have a plan for how to avoid bringing the virus into your home.
Making payments
Cards and cash could transfer the virus to your hands. That said, card payment is probably lower risk because you retain the card and don’t have to touch other people. But wherever possible, contact-free bank transfers would pose the least risk.
Handling and eating fresh and canned food
SARS-CoV-2 is inactivated at temperatures well below those required in the process of canning food, so canned food is free of it. For freshly packaged food, risk depends on whether the person doing the packing was sick or not. If you are concerned, stick with food that can be cooked and peeled. Produce should be washed thoroughly under running water without soap.
Avoid equipment that is likely used a lot, including play equipment and water fountains. It would be safer to kick a ball around or play on the grass, rather than use swings. Sandpits hold horrors other than SARS-CoV-2.
Takeaway and deliveries
When getting takeaway food, or for businesses offering it, avoid plastic containers and use more fibrous materials such as cardboard, paper and fabric for packaging. Researchers found no infectious SARS-CoV-2 on cardboard after 24 hours.
Also, avoid proximity to servers and delivery people, and opt for contactless delivery whenever you can.
Public transport, escalators, elevators and bathrooms
Frequently touched hard, shiny surfaces such as lift buttons and handle bars in trams are a big risk, more so than fabric seats, or taking the stairs. Even the most high-tech overseas surface cleaning efforts are intermittent, so you’ll need to take responsibility for yourself. Also, after using public bathrooms, wash your hands well.
Calm and calculated
It’s important to be calm, realistic and not focus on single events or actions once you step outside. You can’t account for everything.
Think more about the risk of the entire task rather than the many small risks encountered during the process. A silver lining in taking such precautions is that you’ll also reduce your risk of catching the flu this season.
It’s also important to keep your home clean. You can use diluted bleach, detergents or alcohol solutions on surfaces. Queensland Health has more information.
Ultimately, the best ways to avoid SARS-CoV-2 infection are primitive ones – sanitise your hands and stay away from others. Physical distancing remains the most effective measure to slow the progression of this pandemic.
The importance of consistent HIV health sector messaging
The current COVID-19 crisis has raised concerns about HIV treatment supply in Australia. Despite continued assurances that supply is not, nor is likely to be compromised, rumours to the contrary persist.
This speculation has the potential to raise anxiety levels and cause consumer panic. Maintaining message consistency across the HIV health workforce is vitally important at this time.
When patients or customers register concern about the supply of HIV medications, please reassure them with the following messages:
The pharmaceutical companies that supply antiretrovirals (ARVs) in Australia have given assurances that there is no shortage. There are enough HIV treatments in the country right now to meet the needs of people with HIV for many months.
Stock-outs or delays in re-stocking ARVs at a local pharmacy does not mean that national supply is limited.
In the unlikely event of an impending shortage of a particular ARV, the TGA would add it to this publicly available list and then take action to ensure ongoing access for people living with HIV taking that medication. NB: There are no ARVs currently on this TGA list.
It is important to keep taking HIV treatments as prescribed. People with HIV should not skip doses or share medication with friends who are worried about their own supply.
Prescriptions for ARVs are currently limited to two months’ supply at a time and this is standard for everyone. To minimise trips to the pharmacy, arrangements are in place so people living with HIV can have their medications posted to them. For more information about this issue please talk with your pharmacist.
NAPWHA has issued this communication with Australian Federation of AIDS Organisations (AFAO) and Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) on 3 April 2020.
As COVID-19 brings in unprecedented measures on how we interact and live our lives, the sense of disconnect has become a challenge for many of us. Even the language of social distancing and isolation can be triggering when contact, intimacy, and togetherness play such a big part in our lives.
As COVID-19 took hold, in places like China and Italy amazing videos started to surface. People began connecting through dance, joining in communal song from their balconies; Police officers in Spain showed their lighter side in a time of crisis and performed Baby Shark for children unable to play outside.
Reframing the concept to one of “physical distancing + social connection” is the first step. We are for the most part living in an accessible digital age and technology can be a tool to help us interact, maintain relationships and entertain ourselves.
In challenging times, a lot of creativity and compassion is born and that is especially true now. Social media has never felt more social. Businesses and performers have had to adjust and be nimble with how they engage with us. Applications like Zoom, once used for business meetings, are now used for dinner parties and drinks among friends. There are mechanisms to watch Netflix and play board games with your loved ones live on the Internet. Entertainers from all fields are bringing content online, from drag shows to dance parties to live music. And the vast majority of it is free. There is an understanding that even though this situation is difficult, we are all in the same boat doing the best we can to stay in touch and smile and persevere.
How we interact may have changed but there is evidence of a very real and unwavering sense of solidarity, resilience, and connection all around us… You just have to hit the reset button and join in.
This article was originally written for the MyLife+ App
