1. Six types of covid-19?
The New Scientist reports on a study in the UK where researchers grouped Covid_19 symptoms into six clusters:
1 Flu-like symptoms, no fever
Headache, loss of smell, cough, sore throat and aches and pains, but no fever. Around 1.5 per cent of this group will go on to require breathing support in hospital.
2 Flu-like symptoms with fever
Similar to group 1, plus a loss of appetite and fever.
Diarrhoea alongside loss of smell and appetite, headache, sore throat and chest pain. Typically, no cough.
This cluster is considered more severe than the previous three, as 8.6 per cent require breathing support. Fatigue accompanies headache, loss of smell, cough, chest pain and fever.
Another severe category. People experience confusion in addition to symptoms listed in cluster four. Around 10 per cent will require breathing support.
6 Abdominal and respiratory
Considered the most severe cluster, because almost half will require hospitalisation, and around a fifth will need breathing support. Symptoms include headache, fever, loss of smell and appetite, cough, sore throat and chest pain, along with shortness of breath, diarrhoea and abdominal pain, muscle pain, confusion and fatigue.
The last three represent severe cases.
Originally in Wuhan:
- health authorities listed cough, fever and difficulty breathing as key symptoms. People with severe infections developed pneumonia. The illness looked like many other respiratory infections.
Now we know that Covid-19 is not a respiratory disease as such. However, there are still problems in testing and diagnosis. In the UK the government currently advises that only those with fever, a persistent cough or a loss of taste or smell get tested. The study found this strategy would have missed 24 per cent of symptomatic children. If diarrhoea and vomiting were added then 97% of cases would be detected.
Young children tend to get different symptoms from older children, and for adults it’s different again.
- The amount of virus a person is exposed to might influence which symptoms they develop, too, as could the route of infection, for instance whether by nose, eyes or mouth.
As of now we don’t know.
2. Long COVID
Long COVID could form a seventh category. We’ve already mentioned it. Here in an ABC RN segment of Science Friction with the wonderful Natasha Mithchell is These doctors got COVID-19, now they’re suffering the serious, mysterious symptoms of ‘long COVID’:
Three accomplished doctors share their visceral personal experiences of ‘long COVID’.
Most likely infected with coronavirus early in the pandemic, months on they’re each grappling with bizarre and disabling symptoms.
… it seems Long COVID doesn’t discriminate. Healthy people. Young people. Those who apparently had a mild case of COVID-19.
Every system in our bodies can be affected.
Symptoms after a mild infection can be so bad that it is hard to walk, or gather concentration sufficiently to work at anything.
Some with the disease are finding it hard to get a COVID diagnosis, with Chronic Fatigue Syndrome in the mix, which can effect the benefits they receive, and their career prospects.
Ed Yong at The Atlantic writes Long-Haulers Are Redefining COVID-19:
Lauren Nichols has been sick with COVID-19 since March 10, shortly before Tom Hanks announced his diagnosis and the NBA temporarily canceled its season. She has lived through one month of hand tremors, three of fever, and four of night sweats. When we spoke on day 150, she was on her fifth month of gastrointestinal problems and severe morning nausea. She still has extreme fatigue, bulging veins, excessive bruising, an erratic heartbeat, short-term memory loss, gynecological problems, sensitivity to light and sounds, and brain fog. Even writing an email can be hard, she told me, “because the words I think I’m writing are not the words coming out.” She wakes up gasping for air twice a month. It still hurts to inhale.
There are tens of thousands of them. Most are women, their average age is 44, and most were formerly fit and healthy.
One of the many experts said the world is trying to compress 8 or 9 years of R&D normally required to produce a vaccine into 8 or 9 months.
Michael Bartos in Mission accomplished? looks at the global politics and positioning. On recent form, every country that can should manufacture the vaccine itself, which of course means a lot of kit to store and deliver the vaccine in addition to the vaccine itself.
The Morrison Government has struck a deal, see Australia to produce 84 million doses by mid-2021 in $1.7b deal:
- The Oxford University vaccine is slated to be available from early 2021 while the University of Queensland version is on track for midyear.
- About 84.8 million vaccine doses would be manufactured, primarily in Melbourne by CSL, which plans to produce 51 million doses of a UQ vaccine and 33.8 million doses of an Oxford vaccine under a heads of agreement signed with the Government.
The ink was hardly dry when we heard Oxford vaccine trial halted after patient’s ‘serious adverse reaction’.
It seems this was a minor hiccup, and one to be expected in such trials.
However, I heard other commentary that manufacturing may start around this time next year, and that it would take a years to produce the 80 million doses.
Of interest, two Queensland firms are developing vaccine manufacturing capacity. Also there is a third Australian candidate – Adelaide-based company Vaxine, which has laboratories at Flinders University, already has a vaccine in human trials and reckon they will be good to go by the end of 2020.
According to this article the vaccines from the US companies Moderna, Pfizer and German companies BioNTech and Curevac are based on mRNA (messenger RNA) technology which has the disadvantage of having to be stored at -80°C in freezer farms, then shipped in specialized, well-insulated boxes, filled with dry ice or frozen carbon dioxide. Repackaging will be done in rooms as low as -20°C, with workers requiring full PPE.
I believe the Oxford vaccine is not based on mRNA technology. Most vaccines require normal refrigeration of 2 to 8°C.
Four Chinese vaccines number among the dozen or so leading candidates, with promises being made about initial availability by the end of the year, on par with the rest.
On 9 October, China also announced that it had joined COVID-19 Vaccine Global Access (COVAX), the collaborative effort by Gavi, the Vaccine Alliance, together with the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO), which is aiming to provide two billion doses of vaccine to the most vulnerable people and to health-care workers, especially in poor countries. Some 80 wealthy ‘self-funding’ countries have committed to support the initiative, with the notable exception of the United States. It is not clear yet whether China will commit money or vaccines, and how much.
Countries which China has publicly pledged to make vaccines available to include the Philippines, Cambodia, Burma, Thailand, Vietnam and Laos, as well as African and Latin American countries, with specific deals with Brazil and Indonesia.
India is probably key to poorer country access – see India is key for global access to a COVID-19 vaccine – here’s why:
India has the potential to play a key role in overcoming vaccine nationalism because it is the major supplier of medicines to the global south. Médecins Sans Frontières once dubbed the country the “pharmacy of the world”. India also has, by far, the largest capacity to produce COVID-19 vaccines. Its role in manufacturing a vaccine could come in two different ways – mass-producing one developed elsewhere (likely) or developing a new vaccine as well as manufacturing it (less likely, though not impossible).
It has already started manufacturing the University of Oxford/AstraZeneca vaccine.
Just now Dr Norman Swan said that vaccine developers probably already know how effective their vaccine is going to be, but safety testing required tens of thousands of people in the trials, and months to wait for longer term effects.
4. Europe has lost the plot
Europe was completely unready for the COVID pandemic in spite of warnings over the years. As David Nabarro said:
- “We appeal to all world leaders: stop using lockdowns as your primary control method,” he said.
“The only time we believe a lockdown is justified is to buy you time to reorganise, regroup, rebalance your resources, protect your health workers who are exhausted.”
By and large Europe, rather than adopting Australia’s policy of aggressive suppression to the point of no community transmission, tried to live with an acceptable level of the virus. It seems clear now that too much travel and too much openness involving people to get together in groups was allowed, given the state of their health systems and abilities in testing and contact tracing. Now:
- Europeans are united, though, in asking themselves a single question: Is this the new normal? If a vaccine is a year or two away, are they supposed to live until then in this world of rolling restrictions, curtailed travel, distanced societies and depressed economies?
The answer is yes if your government has run out of ideas and money. But if your government has a find-test-trace-isolate system like those in Japan and South Korea, you can enjoy a more normal normality.
But that’s apparently a very big if.
That’s from an article Lessons from Europe as it faces second-wave setbacks by Hans van Leeuven in the AFR. He says that the Czech Republic was the poster child in defeating the virus. They had a big party on the Charles Bridge to celebrate the victory. Now their per capita infection rate is one of the worst in the world.
France now has over 50,000 new infections per day. Italy has over 21,000 per day, the UK roughly the same, and Spain thereabouts. Germany, which had suppressed the virus to around 250 per day by mid-June has now had a day of 13,400 with a sharp upward trend.
These figures are between two and seven times the first wave.
In Europe they seem all over the place with lockdowns, partial lockdowns, and difficulties in public compliance with whatever the authorities deem appropriate. In Britain the government rejected medical advice for a two-week circuit-breaker lockdown. Van Leeuven says:
- England’s contact tracing system is reaching less than 60 per cent of its targets. And only one in five people who is advised to isolate is doing so properly, for the full 14 days.
Philip Clarke on ABC Nightlife said his daughter, who is in England, tells him you can’t necessarily get a test if you have symptoms.
Van Leeuven says Germany is getting it right:
- Within Europe’s bleak canvas, there are brighter spots: places that show what a more sustainable pre-vaccine “new normal” could look like. The exemplar is Germany, which is experiencing a surge in cases now, but from a low base that’s the envy of Europe.
Chancellor Angela Merkel came out in early March – when everyone bar the Italians was still largely in denial – and said COVID-19 was the biggest crisis the country had faced since World War II. The German authorities took it seriously, mobilised, and swallowed the hard decisions.
“You have to balance between the harm of the virus and the social distancing, and we were on the side of being very cautious,” Health Minister Jens Spahn told the British think tank Policy Exchange.
They had a strong health system to begin with, beefed it up and put in a lot of work. They had expected the autumn and winter to be challenging – Chancellor Angela Merkel warned of 20,000 new cases per day. Der Spiegel published an interview with Helge Braun, the head of Merkel’s Chancellery, see “We Are Threatened By a Second Wave If We Don’t Act Very Quickly”.
The interview was published on 12 October. If you look at their worldometer site, the 7-day average took off about a week earlier than that, and is now doubling every 10 to 11 days. I think they have their second wave.
As the officer working most on national co-ordination, Braun won’t comment on how well particular states or doing. Nor does he have in mind any uniform target infection rate, but generally speaking infections need to be held to a point where they don’t take off rapidly. He does say, however, that particular attention needs to be applied to places like Berlin “where there is a diffuse infection pattern” and there has been exponential growth in the Berlin Mitte (central) in recent days. There he said that infection rates there needed to be held below 50 per 100,000 population per week. That’s 0.05% and converts to Melbourne as around 350 cases per day.
Seems high to me.
Germany feels it erred in closing schools and childcare first. Now they would close them last.
Travel and holidays is a problem. Generally Europe opened, (in August, 50 percent of Germany’s infections were from people who had traveled abroad) but now restrictions are being introduced. Hotels in most of Germany can’t accept bookings from Berliners.
Germany has put 500 million euros towards the conversion of air filter systems to eliminate virus circulation in air conditioning.
Overall, though, Van Leeuven says it could be a long time before the Czechs are partying on the Charles Bridge again.
There were several other articles of interest at Der Spiegel, including What the Pandemic Has in Store for the World, a useful roundup which mentions the success of Thailand and Vietnam, also unexpected countries like Sierra Leone and Rwanda. New Zealand gets a mention, but not Australia.
Their bottom line is that we are going to have to learn to live and die with COVID and expect more because it won’t be the last.
Vaccines and cures are being researched at a great pace, but indications are that the world has changed forever. There is no snap-back. One country that has regained a semblance of its former normality is China.
Georg Fahrion, a Berliner in Beijing, tells What Life Looks Like in an (Almost) COVID-Free Country. He was in Wuhan when the virus emerged, escaped to Beijing to suffer lockdown there, then in March returned to Berlin for a holiday, just in time for a lockdown there (a walk in the park by comparison).
Returning to China, he now lives in almost complete freedom, freedom as defined and experienced in China, where, if they want to celebrate, they go to a club. It’s a paradox.
China’s example is not available to us. Nor would we want it to be. Inconvenient as it is for China, Taiwan stands out as an entirely different example of the balance between freedom and coping with the virus within a democratic system.