Victorians, and anyone else at risk, should now be wearing face masks. Here’s how to make one


C Raina MacIntyre, UNSW; Kerryn Phelps, Western Sydney University; Lisa Maher, UNSW, and Shovon Bhattacharjee, UNSW

After early success in suppressing COVID-19, we are facing a resurgence in Victoria, which is threatening disease control for the whole country.

Outbreaks in northwestern Melbourne, including in public housing tower blocks in inner Melbourne, and now in the twin border towns of Albury-Wodonga, signal a risk of losing our hard-won gains. These gains have already come at a heavy price to the economy and mental health, which is all the more reason to throw everything we can at this resurgence – including widespread use of face masks, as we have seen in other countries such as the United States and United Kingdom.

With 191 new cases announced on July 7, Victorian Premier Daniel Andrews has announced a return to stage 3 restrictions for six weeks from July 9 for metro Melbourne and Mitchell Shire. This means residents will be confined to their homes except for essential trips such as work, medical care, exercise or shopping for essentials. The evidence suggests both sick and healthy people wearing masks will help curb the spread of COVID-19 during this precarious time.




Read more:
Coronavirus spike: why getting people to follow restrictions is harder the second time around


Australia is one of the few countries that has suppressed COVID-19 after a peak in disease incidence in late March. The current resurgence, unlike the peak in March which was largely travel-related, has arisen mostly from community transmission, which is a more serious concern.

Health authorities have a range of measures at their disposal, including expanded testing to find all new cases, diligent contact tracing, travel bans, border closures and quarantine of returning travellers. As members of the public, there are five main things we can do to stop the spread: get tested if we have symptoms, download the COVIDSafe App, practise physical distancing, wash our hands often, and wear a face mask.

Why masks help

The most extreme form of physical distancing is a lockdown, already enforced in Melbourne. Keeping at least 1.5 metres away from others also dramatically reduces the risk of COVID-19, even in crowded households. Victorians should think about wearing a mask, especially in indoor spaces like shops or public transport or in outdoor crowds. There may be epidemics developing in other states, so people at risk in those states should think about masks too.

There’s no doubt masks help stop the spread. A recent study commissioned by the World Health Organisation showed that face masks reduce the risk of infection with viruses such as SARS-CoV-2, the coronavirus that causes COVID-19, by 67% if a disposable surgical mask is used, and up to 95% if specialist N95 masks are worn, although these are not widely available to the public.

This study prompted the WHO to change its position to recommending community mask use. It had long advised masks should be worn only by sick people to stop them infecting others, although this was perhaps motivated in part by concerns over supplies.

Many countries, perhaps most notably the United States, initially adopted this advice but then began to encourage community-wide mask use when the epidemic began to get out of hand.

Why not in Australia?

Australia has not yet adopted community masking as a tool in the fight against COVID-19. The WHO issued a long list of dangers of mask wearing, including that masks give “a false sense of security, leading to potentially lower adherence to other critical preventive measures such as physical distancing and hand hygiene”.

There is no scientific evidence to support this – in fact, the evidence suggests the opposite. In an illustrative exercise, Italian researcher Massimo Marchiori found people stayed more than twice as far away from him when he wore a mask.

Not all masks are the same, however. For community use, the options are surgical masks and cloth masks. Surgical masks are single-use only and should not be re-used. If they are unavailable or too expensive, you can make an effective cloth version yourself if you follow a few key principles.




Read more:
Should I wear a mask on public transport?


Cloth masks can vary widely depending on the material and design – a single or even double-layered mask or bandanna is likely not protective at all.

A cloth mask should have at least three or four layers, including a water-resistant outer layer, a fine weave and high thread count, and should be washed and worn fresh each day. It should fit snugly around your face, or air will flow through the gaps on the sides. A nylon stocking over the top can help.

Research shows a 12-layered cloth mask can be as good as a surgical mask, although you may not have the time or inclination to make a homemade version with 12 layers.

How to make an effective cloth mask.
Shovon Bhattacharjee, Author provided

Modelling shows that even a modestly effective mask that delivers just a 20% reduction in viral transmission can successfully flatten the COVID-19 curve. Masks have a double benefit, stopping infected people spreading the virus and protecting uninfected people from catching it.

Given the possibility this coronavirus can also be spread by people without symptoms or even people who have already left the room, handwashing and physical distancing may not be enough. We need every tool at our disposal, and that includes masks.




Read more:
Is the airborne route a major source of coronavirus transmission?


Masks can be worn in public or indoors. Surgical masks worn at home can prevent the spread of the coronavirus to family members, which may be worth considering if you live with a health worker or someone else at high risk.

As Melbourne and Australia struggle to regain control of COVID-19, positive promotion of face masks, and simple how-to guides for making, as well as wearing and removing them could be a powerful addition to our armoury. A clear, consistent public health directive in relation to masks is needed now to help avoid longer lockdowns and more draconian measures, and enable safer community activities.The Conversation

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW; Kerryn Phelps, Adjunct Professor, NICM Health Research Institute, Western Sydney University; Lisa Maher, Professor, Faculty of Medicine, UNSW, and Shovon Bhattacharjee, PhD Candidate, The Kirby Institute, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus and sex hormones — baldness may be a risk factor and anti-androgens a treatment


Shutterstock

Jenny Graves, La Trobe University

Two small studies published recently suggested most men hospitalised with COVID-19 are bald, generating headlines around the world.

While this may sound strange, science does offer a plausible explanation.

Male pattern baldness is associated with high levels of male sex hormones called androgens. And androgens seem to play an important role in the entry of SARS-CoV-2, the coronavirus that causes COVID-19, into cells.

So it’s possible high levels of androgens might increase the risk of severe infection and death from COVID-19.

This hypothesis is important to identify people at risk and raises the possibility of new treatment strategies for COVID-19.

Sign up to The Conversation

Men suffer more than women from COVID-19

It’s been obvious from early in the pandemic. Men are at greater risk of severe infection and death from COVID-19 than women.

There are several possible factors at play here. For one, men are more likely to suffer from chronic conditions known to pose a higher risk of serious illness from COVID-19. These include heart disease and diabetes.

Another is that men’s immune systems are not as good as women’s at warding off the severe effects of viral infections.

These factors are indirectly influenced by sex hormones. Now it seems sex hormones might also have a direct effect on SARS-CoV-2’s ability to enter our cells and establish infection.

Baldness and COVID-19

In one study of 122 male COVID-19 patients admitted to hospitals in Madrid, 79% were bald — about double the population frequency.

Another small study in Spain observed a similar overrepresentaton of baldness among men hospitalised with COVID-19.




Read more:
Starting to thin out? Hair loss doesn’t have to lead to baldness


Male pattern baldness is strongly associated with a higher level of dihydrotestosterone (DHT), a more active derivative of testosterone, and one of the androgen family of male sex hormones.

Confirming this correlation between baldness and susceptibility to COVID-19 with larger samples, controlling for age and other conditions, would be significant. It would suggest a higher DHT level could be a risk factor for severe COVID-19.

How does this link make biological sense?

SARS-CoV-2 enters human lung cells when a protein on the virus’ surface (the spike protein) latches onto protein receptors (ACE2 receptors) embedded in the cells’ surfaces.

How does this work? Recently scientists discovered that an enzyme called TMPRSS2 cleaves the SARS-CoV-2’s spike protein, enabling it to bind to the ACE2 receptor. This allows the virus to enter the cell.

The gene that encodes TMPRSS2 is activated when male hormones, particularly DHT, bind to the androgen receptor (a protein on the surface of cells, including hair cells and lung cells).

So the more male hormone, the more androgen receptor binding, the more TMPRSS2 is present, and the easier it is for virus to get in.

SARS-CoV-2 gets into our cells by latching onto ACE2 receptors.
Shutterstock

A preliminary, non-peer-reviewed study which correlated the androgen levels of hundreds of people in the UK with COVID-19 severity supports this theory. Higher androgen level was associated with susceptibility to and severity of COVID-19 in men (but not women, who have much lower androgen levels in their blood).

The same researchers showed that inhibiting androgen receptors reduced the ability of SARS-CoV-2’s spike protein to bind to ACE2 receptors on stem cells in culture.

Androgen disruptions are linked to different diseases

Over- or underproduction of androgens in the body causes a variety of conditions in both men and women.

For instance, men with benign prostate enlargement overproduce androgen, as do women with polycystic ovary syndrome.

Many such conditions are treated with androgen deprivation therapy (ADT), which inhibits the production or effect of androgens. For instance, prostate cancer, in which cancer cell growth is fuelled by androgens, is routinely treated with ADT.

Conversely, some people have low androgen production, or mutations that affect the binding and action of androgens — such as women with androgen insensitivity syndrome caused by mutations of the androgen receptor.

It will be important to find out whether, as the androgen hypothesis predicts, patients with over- or under-production of male hormones are at greater — or lesser — risk of COVID-19.




Read more:
How can I treat myself if I’ve got – or think I’ve got – coronavirus?


A potential treatment option?

If the androgen link holds up, this would encourage exploration of anti-androgens as a way to prevent and treat COVID-19.

Many anti-androgens are already approved for the treatment of other conditions. Some, like baldness treatments, have been used safely for years or decades. Some, like cancer treatments, can be tolerated for months.

A study which looked at men hospitalised with COVID-19 in Italy showed the rate of infection was four times lower in prostate cancer patients on ADT than in untreated cancer patients.

Perhaps a single dose given to someone who tests positive to SARS-CoV-2, or has just been exposed, would suffice to lower the chance of the virus taking hold.

But we need research to confirm this. Several androgen-suppressing drugs are now undergoing clinical trials to determine whether they reduce complications among men with COVID-19.

It will be important to verify that anti-androgen treatment works in the lungs as well as the prostate, and is effective in cancer-free patients. We’d also need to find out what dose is effective, and when it should be administered.

Anti-androgen treatments have several side effects in men, including breast enlargement and sexual dysfunction, so medical oversight is a must.

Men who are bald have higher levels of the hormone dihydrotestosterone.
Shutterstock

A promising new direction in COVID-19 research

The androgen link could go a long way to explaining why men are more susceptible to COVID-19 than women. It also may explain why children younger than ten seem very resistant to COVID-19 because, until puberty, boys as well as girls make little androgen.

The more we know about who is at heightened risk from COVID-19, the better we can target information.

The androgen link also opens up an avenue for the discovery of drugs which might mitigate some of the impact of COVID-19 as it continues to sweep the globe.




Read more:
COVID-19’s deadliness for men is revealing why researchers should have been studying immune system sex differences years ago


The Conversation


Jenny Graves, Distinguished Professor of Genetics and Vice Chancellor’s Fellow, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A disease that breeds disease: why is type 2 diabetes linked to increased risk of cancer and dementia?



Shutterstock

Rachel Climie, Baker Heart and Diabetes Institute and Jonathan Shaw, Baker Heart and Diabetes Institute

In Australia, more than 1.1 million people currently have type 2 diabetes.

A host of potential complications associated with the disease mean a 45-year-old diagnosed with type 2 diabetes will live on average six years less than someone without type 2 diabetes.

This week we published a report bringing together the latest evidence on the health consequences of type 2 diabetes.

Aside from demonstrating the complications we know well – like the link between diabetes and heart disease risk – our report highlights some newer evidence that suggests type 2 diabetes is associated with an increased risk of cancer and dementia.




Read more:
How Australians Die: cause #5 – diabetes


Common complications of type 2 diabetes

Type 2 diabetes, which typically develops after the age of 40, is usually due to a combination of the pancreas failing to produce enough of the hormone insulin, and the cells in the body failing to adequately respond to insulin.

Since insulin is the key regulator of blood glucose (sugar), this causes a rise in the blood sugar levels.

Risk factors for developing type 2 diabetes include being overweight, being physically inactive, having a poor diet, high blood pressure and family history of type 2 diabetes.

Being overweight is a risk factor for type 2 diabetes – but not all people with type 2 diabetes are overweight.
Shutterstock

People with type 2 diabetes are about twice as likely to develop heart disease than people without type 2 diabetes.

While heart attacks, due to blockages in the coronary arteries, are perhaps the better recognised form of heart disease, heart failure, where the heart muscle is unable to pump enough blood around the body, is becoming more common, especially in people with type 2 diabetes.

This is due to a number of factors, including better treatment and prevention of heart attacks, which has allowed more people to survive long enough to develop heart failure.

People with type 2 diabetes are up to eight times more likely to develop heart failure compared to those without diabetes.




Read more:
Got pre-diabetes? Here’s five things to eat or avoid to prevent type 2 diabetes


Meanwhile, diabetes is the most common cause of kidney failure and vision loss in working age adults, and accounts for more than 50% of foot and leg amputations.

But beyond these common and familiar complications of diabetes, there’s mounting evidence to suggest type 2 diabetes increases the risk of other diseases.

Emerging complications of type 2 diabetes

People with type 2 diabetes are approximately two times more likely to develop pancreatic, endometrial and liver cancer, have a 30% higher chance of getting bowel cancer and a 20% increased risk of breast cancer.

Increased cancer risk is of particular concern for the growing number of people under 40 living with type 2 diabetes. In Australia, this group saw a significant increase in deaths from cancer between 2000 and 2011.

Dementia, too, is a recently recognised complication of type 2 diabetes. A meta-analysis involving data from two million people showed people with type 2 diabetes have a 60% greater risk of developing dementia compared to those without diabetes.




Read more:
Type 2 diabetes increasingly affects the young and slim; here’s what we should do about it


Why the increased risk?

It’s important to acknowledge the studies we looked at are observational and can’t tell us diabetes necessarily caused these conditions. But they do suggest having diabetes is associated with an increased risk.

The two leading theories for why cancer risk is increased in people with type 2 diabetes relate to glucose and insulin.

Many types of cancer cells use glucose as a key fuel, so the more glucose in the blood, potentially, the more rapidly cancer will grow.

Alternatively, insulin can promote the growth of cells. And since in the early stages of type 2 diabetes insulin levels are elevated, this might also promote the development of cancer.

It’s especially important people with diabetes take up cancer screening programs.
Shutterstock

There are several possible explanations for the link between diabetes and dementia. First, strokes are more common in people with type 2 diabetes, and both major and repeated mini-strokes can lead to dementia.

Second, diabetes affects the structure and function of the smallest blood vessels throughout the body (the capillaries), including in the brain. This may impair the delivery of nutrients to a person’s brain cells.

Third, high glucose levels and other metabolic disturbances associated with diabetes may, over time, directly affect the way certain types of brain cells function.

Room for improvement

Despite well-established recommendations for the management of type 2 diabetes, such as guidelines for medication use, healthy diet and regular physical activity, there remains a significant gap between the evidence and what happens in practice.

A study from the US showed only one in four patients with type 2 diabetes met all the recommended targets for healthy levels of glucose, cholesterol and blood pressure.

Australian data has shown having diabetes is associated with 14% increased likelihood of discontinuing cholesterol medication after one year.

In our report, we showed increasing the use of a range of effective medications would prevent many hundreds of people with diabetes developing heart disease, strokes and kidney failure each year.




Read more:
Unscrambling the egg: how research works out what really leads to an increased disease risk


With the burden of diabetes complications in our community casting such a large shadow in terms of death rates, disability and impact on the health system, we need greater education and support for people with living diabetes, as well as health professionals treating the condition.

For people with type 2 diabetes, close monitoring for other diseases such as cancer through screening programs is particularly important.

And alongside managing their blood sugar levels, it’s essential Australians with type 2 diabetes are supported to keep risk factors for complications, such as blood pressure and cholesterol, at healthy levels.

A healthy diet and regular physical activity is a good place to start.The Conversation

Rachel Climie, Exercise Physiologist and Research Fellow, Baker Heart and Diabetes Institute and Jonathan Shaw, Deputy Director, Baker Heart and Diabetes Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Donald Trump is taking hydroxychloroquine to ward off COVID-19. Is that wise?


Teresa G. Carvalho, La Trobe University

The White House’s confirmation that US President Donald Trump has been taking hydroxychloroquine every day for the past two weeks, with his doctor’s blessing, has reignited the controversy over the drug. It has long been used against malaria but has not been approved for COVID-19.

Trump said he has “heard a lot of good stories” about hydroxychloroquine, and incorrectly claimed there is no evidence of harmful side-effects from taking it. His previous claims in March that the drug could be a “game changer” in the pandemic prompted many people, including Australian businessman and politician Clive Palmer, to suggest stockpiling and distribution of the drug to the public.

But the dangers of acting on false or incomplete health information were underlined by the death of an Arizona man in March after inappropriate consumption of the related drug chloroquine. It’s important to know the real science behind the touted health benefits.

How do these medicines work?

Hydroxychloroquine is an analogue of chloroquine, meaning both compounds have similar chemical structures and a similar mode of action against malaria. Both medications are administered orally and have common side-effects such as nausea, diarrhoea and muscle weakness. However, hydroxychloroquine is less toxic, probably because it is easier for the body to metabolise.

Chloroquine and hydroxychloroquine are listed by the World Health Organisation as an essential medicine. Both drugs have been used to treat malaria for more than 70 years, and hydroxychloroquine has also proved effective against auto-immune diseases such as systemic lupus erythematosus and rheumatoid arthritis. The US Food and Drug Administration has approved both chloroquine and hydroxychloroquine for treating malaria, but not for COVID-19.




Read more:
In the rush to innovate for COVID-19 drugs, sound science is still essential


We don’t know exactly how these drugs work to combat the malaria parasite. But we know chloroquine disrupts the parasite’s digestive enzymes by altering the pH inside the parasite cell, presumably effectively starving it to death.

Malaria parasites and coronaviruses are very different organisms. So how can the same drugs work against both? In lab studies, chloroquine hinders replication of the SARS coronavirus, apparently by changing the pH inside particular parts of human cells where the virus replicates.

This offers a glimmer of hope that these pH changes inside cells could hold the key to thwarting such different types of pathogens.

Is it OK to repurpose drugs like this?

Existing drugs can be extremely valuable in an emergency like a pandemic, because we already know the maximum dose and any potential toxic side-effects. This gives us a useful basis on which to consider using them for a new purpose. Chloroquine is also cheap to manufacture, and has already been widely used in humans.

But we shouldn’t be complacent. There are significant gaps in our understanding of the biology of SARS-CoV-2, which causes COVID-19, because it is a brand new virus. There is a 20% genetic difference between SARS-CoV-2 and the previous SARS coronavirus, meaning we should not assume a drug shown to act against SARS will automatically work for SARS-CoV-2.

Widely used, but with common side effects.
Gary L. Hider/Shutterstock

Even in its primary use against malaria, long-term chloroquine exposure can lead to increased risks such as vision impairment and cardiac arrest. Hydroxychloroquine offers a safer treatment plan with reduced tablet dosages and lessened side-effects. But considering their potentially lethal cardiovascular side-effects, these drugs are especially detrimental to those who are overweight or have pre-existing heart conditions. Despite the urgent need to confront COVID-19, we need to tread carefully when using existing medicines in new ways.

Any medication that has not been thoroughly tested for the disease in question can have seriously toxic side-effects. What’s more, different diseases may require different doses of the same drug. So we would need to ensure any dose that can protect against SARS-CoV-2 would actually be safe to take.

The evidence so far

Although many clinical trials are under way, there is still not enough evidence chloroquine and hydroxychloroquine will be useful against COVID-19. The few trials completed and published so far, despite claiming positive outcomes, have been either small and poorly controlled or lacking in detail.

A recent hydroxychloroquine trial in China showed no significant benefits for COVID-19 patients’ recovery rate. A French hydroxychloroquine trial was similarly discouraging, with eight patients prematurely discontinuing the treatment after heart complications.

The fascination with chloroquine and hydroxychloroquine has also adversely affected other drug trials. Clinical trials of other possible COVID-19 treatments, including HIV drugs and antidepressants, have seen reduced enrolments. Needless to say, in a pandemic we should not be putting all our eggs in one basket.

Then there is the issue of chloroquine hoarding, which not only encourages dangerous self-medication, but also puts malaria patients at greater risk. With malaria transmission season looming in some countries, the anticipated shortage of chloroquine and hydroxychloroquine will severely impact current malaria control efforts.




Read more:
Coronavirus: scientists promoting chloroquine and remdesivir are acting like sports rivals


Overall, despite their tantalising promise as antiviral drugs, there isn’t enough evidence chloroquine and hydroxychloroquine are safe and suitable to use against COVID-19. The current preliminary data need to be backed up by multiple properly designed clinical trials that monitor patients for prolonged periods.

During a pandemic there is immense pressure to find drugs that will work. But despite Trump’s desperation for a miracle cure, the risks of undue haste are severe.


This article was coauthored by Liana Theodoridis, an Honours student in Microbiology at La Trobe University.The Conversation

Teresa G. Carvalho, Senior Lecturer in Microbiology, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Aged care visitor guidelines balance residents’ rights and coronavirus risk – but may be hard to implement



Shutterstock

Yun-Hee Jeon, University of Sydney

One in four Australians who have died from COVID-19 is from an aged care facility.

These deaths show how fatal and fast the spread of the infection can be, and the extreme challenge of containing the virus once a positive case appears in aged care homes.

But there is also community pressure to ease social distancing rules for aged care residents and, for facilities that banned visits, to start allowing family members and friends to see their loved ones again.




Read more:
Banning visitors to aged care during coronavirus raises several ethical questions – with no simple answers


To address these concerns, on Friday the aged care sector and consumer advocacy organisations released a draft visitor access code. The code aims to meet the needs of residents to see their families and friends while minimising any risk of spreading COVID-19.

But putting the code into practice will require more staff time to implement them. And while additional funding is on its way, existing workforce shortages may mean a delay to boosting the front-line workforce.

Rights and responsibilities of residents and visitors

According to the code, visitors should be provided with regular updates and information about what’s happening in the facility.

They should also have the option to talk to their loved one via video conference or telephone calls to supplement in-person visits.

But they can’t visit while they have cold or flu symptoms. They must also have had their flu vaccination, wash their hands, remain in the resident’s room or designated area, and to call ahead before visiting. They may also have their temperature taken on arrival.

The code says residents should have access to video conferencing or phone calls.
Georg Arthur Pflueger /Unsplash

Each facility will create its own guidelines about where residents can have guests visit – whether it’s in a dedicated room, the resident’s room, a visiting window or something else.

Most visits should be brief. But residents in their final weeks of life and those with an established pattern of care from a family member or friend, for example to help them eat, should be allowed longer and/or more frequent visits.

The code states residents can continue to use public spaces in the facility, including outdoor spaces. But if there is an outbreak, they will need to be confined to their rooms.

Rights and responsibilities of providers

Facilities have the right to refuse entry to someone for a justifiable reason, and to move to lockdown if there is an outbreak.

They have a responsibility to ensure all staff have their flu shots, to facilitate video conferencing or phone calls with family and friends, and enable in-person visits.

These changes require more staff

All of these changes require additional staff to facilitate better communication, video conferencing and increased visits during the pandemic.

Use of new technologies requires a significant amount of staff time. Many residents would need help holding the phone or dialling the number, or using Zoom or Facetime and maintaining a video conversation online. For some residents, such technologies may be a whole new world of experience.




Read more:
Our ailing aged care system shows you can’t skimp on nursing care


Taking bookings for visit times and screening visitors for temperature, flu vaccination status and hand sanitising takes considerable staff time. As does escorting visitors to the room and back out of the facility while ensuring they’re keeping physical distance throughout.

Staff increases will take time to implement

Residential aged care has long experienced workforce problems, including high staff turnover, failure to attract staff with sufficient qualification and training, and leadership issues, to name a few.

A timely and effective response to the COVID-19 outbreak is likely to be hampered by the sector’s existing challenges.

Implementing the guidelines will take up more staff time.
Shutterstock

The Australian government, as the primary funder and regulator of the aged care system, has promised to inject more than A$850 million into the aged care sector in response to the COVID-19 pandemic to:

  • address workforce issues, through staff up-skilling, boosting numbers and helping to retain staff
  • support new services such as telehealth and the use of technologies to help residents and their families and friends communicate
  • continue to improve quality and safety.

However, it’s likely to take some time to see the real effect of this funding on the ground and across the whole sector.




Read more:
Why are older people more at risk of coronavirus?


The draft code is a positive step in addressing some confusion around social distancing measures in aged care homes. Many providers have already been implementing the principles in the code, and beyond. But some haven’t.

Hopefully the code will be more broadly and consistently practised by all aged care providers.

Public consultations about the code are underway and close 3pm Thursday May 7. If you are a family member or friend of someone living in aged care, or you’re an aged care provider or staff member, you can raise concerns or views about the code here. The code is due to be finalised on May 11.The Conversation

Yun-Hee Jeon, Susan and Isaac Wakil Professor of Healthy Ageing, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

People with coronavirus are at risk of blood clots and strokes. Here’s what we know so far



Shutterstock

Karlheinz Peter, Baker Heart and Diabetes Institute; Hannah Stevens, Baker Heart and Diabetes Institute, and James McFadyen, Baker Heart and Diabetes Institute

As well as causing severe respiratory problems, there is mounting evidence COVID-19 causes abnormalities in blood clotting. Patients with severe COVID-19 infection appear to be at greater risk of developing blood clots in the veins and arteries.

Blood clots can occur deep in the veins of the leg (deep vein thrombosis) and can move to the lungs, causing a pulmonary embolism, which restricts blood flow and oxygen, and can be fatal.




Read more:
Explainer: what is deep vein thrombosis?


Blood clots in arteries can cause heart attacks when they block blood supply to the heart, or strokes when they block oxygen supply to the brain.

So what is going on in the bodies of people with coronavirus? And what are clinicians doing to treat or prevent this complication?

What do these clots do?

Recent data from the Netherlands and France suggest that of the patients with coronavirus who are admitted to intensive care units (ICU), 30-70% develop blood clots in the deep veins of the legs, or in the lungs.

Around one in four coronavirus patients admitted to ICU will develop a pulmonary embolism.

These rates are much higher than we would usually see in patients requiring admission to ICU for reasons other than COVID-19.

Greater risk of stroke

Patients who present to hospital with COVID-19 are also more likely to have a stroke when compared with the general population.

Typically, the chance of having a stroke is associated with increasing age, as well as other risk factors such as high blood pressure, elevated cholesterol levels, or smoking.

Usually it’s older people who have strokes.
Shutterstock

However, higher rates of strokes in patients with COVID-19 is somewhat unusual because it also seems to be happening in people under 50 years of age, with no other risk factors for stroke.

Low levels of oxygen

COVID-19 also appears to be associated with blood clots in the tiny blood vessels that are important for the transfer of oxygen in organs. Autopsy reports have shown elements of SARS-CoV-2, the virus causing COVID-19, in cells lining these small blood vessels in the lungs, kidney, and gut.

This may result in tiny blood clots in these small blood vessels that disturb normal blood flow and the ability of the blood to deliver oxygen to these organs.




Read more:
ICU ventilators: what they are, how they work and why it’s hard to make more


Importantly, these small blood clots could reduce normal lung function. If these small blood clots reach the lungs it may prevent oxygen getting into the blood as efficiently as normal. This may explain why patients with severe COVID-19 can have very low oxygen levels.

Treating and diagnosing clots is difficult

When patients are admitted to hospital, for coronavirus or any other condition that leaves them bed-bound, it is common practice to administer low-dose blood thinners to prevent the development of blood clots.

However, given that patients with COVID-19 seem to be at a higher risk of developing blood clots, it’s currently being debated whether higher doses of blood thinners are required to prevent these clotting complications.

Trials are underway to attempt to answer this important question.

Higher doses of blood thinners might one day play a role in treating COVID-19.
Shutterstock

Diagnosing these blood clots in patients with COVID-19 can also be particularly challenging.

Firstly, the symptoms of a worsening lung infection associated with the virus can be indistinguishable from the symptoms of a pulmonary embolism.

Another challenge in COVID-19 is that the virus can impact laboratory tests which may also be used to diagnose venous blood clots.

A good example of this is a test called D-dimer, which is a measure of clotting in the body. Normally, this test would be higher in almost everyone with new venous blood clots. However, people with severe COVID-19 infection can also have an elevated D-dimer simply due to the severe infection.

In some patients, this means that the test is no longer helpful to diagnose blood clots.

Why does COVID-19 cause blood clotting?

One theory is that the increased rate of blood clots in COVID-19 is simply a reflection of being particularly unwell and immobile.

However, the current data suggest the risk of blood clots is significantly greater in patients with COVID-19 than what is usually see in patients admitted to hospital and ICUs.

We still don’t know why clotting occurs.
Shutterstock

Another potential explanation is that the virus is directly impacting on the cells lining our blood vessels. When the body fights an infection, the immune system becomes activated to try and kill the invader, and research shows an activated immune system can cause blood clots.

In severe COVID-19, the immune system appears to go into overdrive. This could lead to the unchecked activation of cells that typically stop blood clotting.




Read more:
Coronavirus ‘cytokine storm’: this over-active immune response could be behind some fatal cases of COVID-19


Another possibility is that the virus triggers blood clotting to provide it with a survival advantage.

The SARS virus, another member of the coronavirus family, can be further “activated” by a blood clotting protein, enabling the virus to more efficiently invade cells.

However, whether this is the case with COVID-19 remains to be investigated.

Intriguingly, preliminary research suggests that a commonly used blood thinner, heparin, may have antiviral effects by binding to SARS-CoV-2 and inhibiting a key protein the virus uses to latch onto cells.

What we know for sure is that blood-clotting complications are rapidly emerging as a significant threat from COVID-19. In this area, we still have much to learn about the virus, how it affects blood clotting, and the best options for prevention and treatment of these blood clots.The Conversation

Karlheinz Peter, Lab Head, Atherothrombosis and Vascular Biology and Deputy Director, Baker Heart and Diabetes Institute; Interventional Cardiologist, Alfred Hospital; Professor of Medicine and Immunology, Monash University, Baker Heart and Diabetes Institute; Hannah Stevens, Haematologist and PhD student, Baker Heart and Diabetes Institute, and James McFadyen, Research Fellow, Baker Heart and Diabetes Institute, Haematologist, Alfred Hospital, Baker Heart and Diabetes Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Evidence obesity is a risk factor for serious illness with coronavirus is mounting – even if you’re young



World Obesity

Andrea Pattinson, University of Sydney and Amanda Salis, University of Western Australia

Recent studies have found alongside older age and chronic health conditions, obesity is a risk factor for becoming seriously ill with COVID-19, the disease caused by the coronavirus SARS-CoV-2.

It’s true a number of the health conditions which we know increase the risk of severe illness from COVID-19 are also associated with obesity. These include type 2 diabetes, high blood pressure, heart disease and respiratory disease.

But new research suggests obesity independently is a strong predictor of severe illness, particularly in those aged under 60 years.

This is concerning given two-thirds (67%) of the Australian adult population have a body mass index (BMI) in the overweight or obese range.




Read more:
Explainer: how does excess weight cause disease?


BMI is a person’s weight in kilograms divided by the square of their height in metres (kg/m²). While it’s an imperfect measure for an individual person, BMI is very useful in comparing health and weight across a population and between groups.

For adults, overweight is a BMI of 25 or above, but less than 30kg/m². For a woman of average height (162 cm), this would be equivalent to a weight of 66kg or above, and for a man of average height (176 cm), a weight of 78kg or above.

Obesity is defined as a BMI of 30kg/m² or above. This equates to a weight of 79kg and above for a woman and 93kg and above for a man, both of average height.

The evidence

One study from China looking at data from 112 patients reported overweight and obesity were almost five times more prevalent in patients with COVID-19 who died (88%) compared to those who survived (19%).

Preliminary data from another Chinese study involving 383 patients, although not yet peer reviewed, suggests overweight or obesity more than doubled the risk of developing severe pneumonia as a result of COVID-19, particularly in men.

We’re still working out why exactly obesity might increase the risk of coronavirus complications.
Shutterstock

Researchers in France found almost half of 124 patients admitted to an intensive care unit (ICU) with COVID-19 had a BMI in the obese range. This was nearly double the rate of a comparison group of ICU patients with severe acute respiratory disease unrelated to COVID-19.

Further, the need for mechanical ventilation increased with increasing BMI.

A UK surveillance study of patients admitted to intensive care with COVID-19 reported almost three-quarters (75%) of the 6,720 patients had a BMI in the overweight or obese range, which is greater than the population prevalence of overweight and obesity in adults in the UK (around 67%).




Read more:
Why are older people more at risk of coronavirus?


Although some of these studies factored in chronic conditions when reporting their results, it’s difficult to separate all of the conditions associated with obesity that may contribute to some degree to the poorer outcomes.

So it’s likely that some – but not all – of the increased risk of severe COVID-19 associated with obesity could be due to people having other chronic conditions.

Young people

It seems obesity may have more of an impact on the severity of COVID-19 in young people, according to two studies from New York.

One study of 3,615 people who tested positive for COVID-19 found those aged under 60 years with a BMI of between 30 and 34 were almost twice as likely to be admitted to ICU compared to patients with a BMI of less than 30. This likelihood increased to 3.6 times in those patients with a BMI of 35 or greater.

In patients over 60 years, the researchers didn’t find a significant link between obesity and severe illness (as indicated by admission to ICU).

Another study, which recorded weight for 178 patients, found obesity was the most common underlying condition for patients aged under 64 years admitted to hospital for COVID-19.

Why the greater risk?

Taken together, the above data suggest there is an association between obesity and more severe COVID-19 illness, particularly in those with a BMI of 35 or greater.

The US Centers for Disease Control and Prevention (CDC) now lists “severe obesity” as a risk factor for serious COVID-19 illness.

We don’t know exactly what role obesity plays in the severity of COVID-19 symptoms. But the mechanisms are likely to be multifaceted, particularly since obesity itself is the result of a complex interaction between genetic, hormonal, behavioural, social and environmental factors.

We know obesity can have a significant impact on lung function. Excess weight around the abdomen can compress the chest, making it more difficult for the diaphragm to move and the lungs to expand and take in air. This can contribute to lower levels of oxygen in the blood, which may exacerbate the symptoms of COVID-19.

We also know obesity results in a chronic state of inflammation which can impair the body’s immune response. This could potentially make it more difficult for the body to fight coronavirus.




Read more:
Does anyone know what your wishes are if you’re sick and dying from coronavirus?


The challenges in caring for patients with severe obesity may also affect their outcomes from COVID-19.

For example, it’s more difficult to intubate or perform imaging such as X-rays and CT scans in patients with obesity.

Further, positioning ventilated patients on their stomachs can increase the amount of oxygen entering the lungs. But this is often not possible for patients with severe obesity.

Should I be worried?

The short answer is no. If your body weight is above the healthy range, these results should not be cause for panic or impetus to engage in crash diets to reduce COVID-19 risk.

While the data does suggest obesity is a risk factor for more severe illness, it’s early days in the life of COVID-19 and we need more research before we can definitively say what’s going on.

The most significant thing you can do to lower your risk is to follow the government’s guidelines.

It’s not a time to panic about your weight, but it could be a good time to concentrate on healthier choices.
Shutterstock

These restrictions can be challenging and might lead to reduced physical activity and eating for comfort or to ease boredom, potentially resulting in weight gain.

If you find yourself with extra time during the pandemic, you may find it helpful to view it as an opportunity to make healthy choices and cultivate new habits to reduce your risk of illness in general and to enhance health and well-being going forward.




Read more:
How to stay fit and active at home during the coronavirus self-isolation


The Conversation


Andrea Pattinson, PhD Candidate, University of Sydney and Amanda Salis, NHMRC Senior Research Fellow in the School of Human Sciences, University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Drought, fire and flood: how outer urban areas can manage the emergency while reducing future risks



paintings/Shutterstock

Elisa Palazzo, UNSW; Annette Bardsley, University of Adelaide, and David Sanderson, UNSW

First the drought, then bushfires and then flash floods: a chain of extreme events hit Australia hard in recent months. The coronavirus pandemic has only temporarily shifted our attention towards a new emergency, adding yet another risk.

We knew from the Intergovernmental Panel on Climate Change (IPCC) that the risk of extreme events was rising. What we perhaps didn’t realise was the high probability of different extreme events hitting one after the other in the same regions. Especially in the fringes of Australian cities, residents are facing new levels of environmental risk, especially from bushfires and floods.




Read more:
Some say we’ve seen bushfires worse than this before. But they’re ignoring a few key facts


But this cycle of devastation is not inevitable if we understand the connections between events and do something about them.

Measures to slow climate change are in the hands of policymakers. But, at the adaptation level, we can still do many things to reduce the impacts of extreme events on our cities.

We can start by increasing our capacity to see these phenomena as one problem to be tackled locally, rather than distinct problems to be addressed centrally. Solutions should be holistic, community-centred and focused on people’s practices and shared responsibilities.

Respond to emergency

We can draw lessons from humanitarian responses to large disasters, including both national and international cases. A recent review of disaster responses in urban areas found several factors are critical for more successful recovery.

One is to prioritise the needs of people themselves. This requires genuine, collaborative engagement. People who have been through a bushfire or flood are not “helpless victims”. They are survivors who need to be supported and listened to, not dictated to, in terms of what they may or may not need.

Another lesson is to link recovery efforts, rather than have individual agencies provide services separately. For instance, an organisation focusing on housing recovery needs to work closely with organisations that are providing water or sanitation. A coordinated approach is more efficient, less wearying on those needing help, and better reflects the interconnected reality of everyday life.

In the aid world this is known as an “area-based” approach. It prioritises efforts that are driven by people demand rather than by the supply available.

A third lesson is give people money, not goods. Money allows people to decide what they really need, rather than rely on the assumptions of others.

As the bushfires have shown, donations of secondhand goods and clothes often turn into piles of unwanted goods. Disposal then becomes a problem in its own right.




Read more:
How to donate to Australian bushfire relief: give money, watch for scams and think long term


Combining local knowledge and engagement

Planning approaches in outer urban areas should be realigned with our current understanding of bushfire and flood risk. This situation is challenging planners to engage with residents in new ways to ensure local needs are met, especially in relation to disaster resilience.

In areas of high bushfire risk, planning needs to connect equally with the full range of locals. Landscape and biodiversity experts, including Indigenous land managers, and emergency managers should work in association with planning processes that welcome input from residents. This approach is highly likely to reduce risks.

Planners have a vital job to create platforms that enable the interplay of ideas, local values and traditional knowledge. Authentic engagement can increase residents’ awareness of environmental hazards. It can also pave the way for specific actions by authorities to reduce risks, such as those undertaken by Country Fire Service community engagement units in South Australia.




Read more:
Rebuilding from the ashes of disaster: this is what Australia can learn from India


Managing water to build bushfire resilience

Regenerating ecosystems by responding to flood risk can be crucial to increase urban and peri-urban resilience while reducing future drought and bushfire impacts.

Research on flood management suggests rainwater must be always seen as a resource, even in the case of extreme events. Sustainable water management through harvesting, retention and reuse can have long-term positive effects in regenerating micro-climates. It is at the base of any action aimed at comprehensively increasing resilience.




Read more:
Design for flooding: how cities can make room for water


In this sense, approaches based on decentralised systems are more effective at countering the risks of drought, fire and flood locally. They consist of small-scale nature-based solutions able to absorb and retain water to reduce flooding. Distributed off-grid systems support water harvesting in rainy seasons and prevent fires during drought by maintaining soil moisture.

Decentralisation also creates opportunities for innovation in the management of urban ecosystems, with responsibility shared among many. Mobile technologies can help communities play an active role in minimising flood impacts at the small scale. Information platforms can also help raise awareness of the links between risks and actions and lead to practical solutions that are within everybody’s reach.

Tailor responses to people and ecosystems

Disrupted ecosystems can make the local impacts of drought, fire and flood worse, but can also play a role in global failures, such as the recent pandemic. It is urgent to define and implement mechanisms to reverse this trend.

Lessons from disaster responses point towards the need to tailor solutions to community needs and local environmental conditions. A few key strategies are emerging:

  • foster networks and coordinated approaches that operate across silos

  • support local and traditional landscape knowledge

  • use information platforms to help people work together to manage risks

  • manage water locally with the support of populations to prevent drought and bushfire.

Recent environmental crises are showing us the way to finally change direction. Safe cities and landscapes can be achieved only by regenerating urban ecosystems while responding to increasing environmental risks through integrated, people-centred actions.The Conversation

Elisa Palazzo, Urbanist and landscape planner – Senior Lecturer, Faculty of Built Environment, UNSW; Annette Bardsley, Researcher, Department of Geography, Environment and Population, University of Adelaide, and David Sanderson, Professor and Inaugural Judith Neilson Chair in Architecture, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Is the government’s coronavirus app a risk to privacy?



Shutterstock

Rick Sarre, University of South Australia

Few people can fault the government’s zeal in staring down the coronavirus and steering a path for Australia to emerge on the other side ready to do business again.

Unlike the crowds amassing in some US cities to declare their scorn for “stay at home” rules, Australians, generally speaking, have been supportive of federal and state government strategies to tackle the pandemic.

Prime Minister Scott Morrison has added a potential new weapon to his armoury – a COVID-19 tracing app. Government Services Minister Stuart Robert has been spruiking the plan to introduce the app, which is based on technology in use in Singapore.




Read more:
The coronavirus contact tracing app won’t log your location, but it will reveal who you hang out with


But the idea of a government potentially monitoring our daily travels and interactions has drawn suspicion or even scorn. Nationals MP Barnaby Joyce says he won’t be downloading the app.

Robert has since gone on the offensive, explaining the process and playing down any concerns.

So if your app has been within 15 minutes’ duration of someone within 1.5 metres proximity, there’ll be a ping or swapping of phone numbers, and that’ll stay on your phone. And then of course if you test positive … you’ll give consent and those numbers will be provided securely to health professionals, and they’ll be able to call people you’ve been in contact with … Those numbers will be on your phone, nowhere else, encrypted. You can’t access them, no one else can.

Downloading the app is to be voluntary. But its effectiveness would be enhanced, Robert says, if a significant proportion of the population embraced the idea.

On ABC Radio National Breakfast this week he backed away from a previously mentioned minimum 40% community commitment. Instead, Robert said: “Any digital take-up … is of great value.”

He has strong support from other quarters. Epidemiologist Marion Kainer said the adoption of such an app would allow contact tracing to occur much more quickly.

Having the rapid contact tracing is essential in controlling this, so having an app may allow us to open up society to a much greater extent than if we didn’t have an app.

This all sounds well and good. But there are potential problems. Our starting point is that governments must ensure no policy sacrifices our democratic liberties in the pursuit of a goal that could be attained by other, less intrusive, schemes.

The immediate concern comes down to the age-old (and important) debate about how much freedom we are prepared to give up in fighting an existential threat, be it a virus, terrorism, or crime more generally.

Law academic Katharine Kemp last week highlighted her concerns about the dangers of adopting a poorly thought-through strategy before safeguards are in place.

The app, she said:

will require a clear and accurate privacy policy; strict limits on the data collected and the purposes for which it can be used; strict limits on data sharing; and clear rules about when the data will be deleted.

Other commentators have warned more broadly against “mission creep”: that is, with the tool in place, what’s to stop a government insisting upon an expanded surveillance tool down the track?

True, downloading the app is voluntary, but the government has threatened that the price of not volunteering is a longer time-frame for the current restrictions. That threat fails any “pub” test of voluntariness.




Read more:
Latest coronavirus modelling suggests Australia on track, detecting most cases – but we must keep going


On the other hand, there is a privacy trade-off that most people are willing to make if the benefits are manifestly clear. For example, our in-car mapping devices are clever enough (based on the speed of other road users with similar devices) to warn us of traffic problems ahead.

Remember, too, that Australians have had a 20-year love affair with smart technologies. We’re a generation away from the naysayers who argued successfully against the Hawke government’s failed Australia Card in the mid-1980s.

By the same token, the Coalition does not have a strong record of inspiring confidence in large-scale data collection and retrieval. One need only recall the lack of enthusiasm healthcare provider organisations showed for the My Health Record system. In 2019, the National Audit Office found the system had failed to manage its cybersecurity risks adequately.

So where do we go from here? The government sought to allay public concerns about the metadata retention scheme, a program introduced in 2015 to amass private telecommunications data, by giving a role to the Commonwealth Ombudsman to assess police agencies’ compliance with their legislated powers. In the case of the COVID-19 tracing app, the government has, appropriately, enlisted the support of the Office of the Australian Information Commissioner. Robert has said:

Right now a privacy impact assessment is being conducted, the Privacy Commissioner is involved, and all of that will be made public.

While that is an admirable sentiment, one would hope the government would put specific legislation in place to set out all of the conditions of use, and that the commissioner would not be asked for her view unless and until that legislation is in order. The Law Council of Australia has today joined this chorus.

Once the commissioner gives the “all clear”, I will be happy to download the app. Let’s hope it then works as intended.The Conversation

Rick Sarre, Adjunct Professor of Law and Criminal Justice, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Smoking increases your coronavirus risk. There’s never been a better time to quit




Billie Bonevski, University of Newcastle; Caitlin Bialek, University of Newcastle, and Eliza Skelton, University of Newcastle

If you’re a smoker, there’s really never been a better time to quit. Coronavirus affects your lungs, causing flu-like symptoms such as fever, cough, shortness of breath, sore throat and fatigue. In the most serious cases, sufferers struggle to breathe at all and can die of respiratory failure.

The World Health Organisation recommends people quit smoking as it makes them more vulnerable to COVID-19 infection.

Here’s what we know about smoking and COVID-19 risk – and how you can boost your chances of quitting while under lockdown.




Read more:
It’s safest to avoid e-cigarettes altogether – unless vaping is helping you quit smoking


Smoking and COVID-19 risk

Early data from China suggests smoking history is one factor that the risk of poor outcomes in COVID-19 patients.

According to the Australian Institute of Health and Welfare, smoking is a leading risk factor for chronic disease and death.

Smokers are more susceptible to developing heart disease, which so far seems to be the highest risk factor for the COVID-19 death rate. The Centre for Evidence-Based Medicine at the University of Oxford reports that smoking seemed to be a factor associated with poor survival in Italy, where 24% of people smoke.

We know that immunosuppressed people are at higher risk if they get COVID-19 and cigarette smoke is an immunosuppressant.

And the hand-to-mouth action of smoking makes smokers vulnerable to COVID-19 as they are touching their mouth and face more often.

We don’t yet know if recent ex-smokers are at higher risk of COVID-19 than people who have never smoked. Given the lungs heal rapidly after quitting smoking, being an ex-smoker is likely to decrease your chances of complications due to COVID-19.

Reduce your COVID-19 risks today by quitting

The benefits of quitting smoking are almost immediate. Within 24 hours of quitting, the body starts to recover and repair. Lung function improves and respiratory symptoms become less severe.

You might not notice the changes immediately, but they will become obvious within months of quitting. And the improvements are sustained with long-term abstinence.

Tiny hairs in your lungs and airways (called cilia) get better at clearing mucus and debris. You’ll start to notice you’re breathing more easily.

Symptoms of chronic bronchitis, such as chronic cough, mucus production and wheeze, decrease rapidly. Among people with asthma, lung function improves within a few months of quitting and treatments are more effective.

Respiratory infections such as bronchitis and pneumonia also decrease with quitting.




Read more:
Smoking at record low in Australia, but the grim harvest of preventable heart disease continues


People should seek behavioural counselling support to work through motivations to quit, strategies for dealing with triggers, and distraction techniques.

And you can get behavioural support from your doctor or a psychologist via telephone Quitlines in your state or territory or online.

Several studies suggest that some people quit smoking without assistance. If you feel you need extra help, talk to your doctor about nicotine gum, patches, inhalators, lozenges or prescription medications. If you can’t get in to see a GP, you can try a telehealth consultation or consider over-the-counter products.

Calculate how much money you’ll save by quitting.
Shutterstock

Quitting while in lockdown

Physical distancing and lockdown measures may make it more challenging to get the support you need to quit smoking – but not impossible.

If financial stress is undermining your attempts to stop smoking, calculate how much money you can save by quitting (and whatever you do, don’t share cigarettes with someone else). Financial support is available if COVID-19 has affected your income.

Social support, even during lockdown, is crucial. Why not organise a group of friends also wanting to quit and support each other via Houseparty, Zoom or Skype?

Pandemic or no pandemic, smoking poses an enormous risk to your health – and hurts your finances, too.

Any effort you put in now to reduce your smoking or stub it out altogether will reduce your risk if you do get COVID-19, help you live longer and enjoy a higher quality of life. We wish you the very best of luck with it.The Conversation

Billie Bonevski, Women in Science Chair, University of Newcastle; Caitlin Bialek, Research Assistant, University of Newcastle, and Eliza Skelton, Research Academic, Faculty of Health and Medicine, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.