Erasmus :Which groups are especially at risk?
Dr Xxxxx : People at most risk of serious infection from COVID-19 include:
* Older people
* People with weakened immune systems
* People with diagnosed chronic medical conditions (such as high blood pressure, heart and lung conditions, kidney disease and diabetes)
* Aboriginal and Torres Strait Islander people, who have higher rates of chronic illness
At risk People are strongly advised — for their own protection — not to leave the home unless absolutely necessary. Wherever possible, you should ask family, friends, neighbours or community members to shop for groceries or collect medicines for you.
Immunocompromised state (weakened immune system) from blood, bone marrow, or organ transplant; HIV; use of corticosteroids; or use of other immune weakening medicines
Many conditions and treatments can cause a person to be immunocompromised or have a weakened immune system. These include: having a solid organ transplant, blood, or bone marrow transplant; immune deficiencies; HIV with a low CD4 cell count or not on HIV treatment; prolonged use of corticosteroids; or use of other immune weakening medicines..
Being a current or former cigarette smoker may increase your risk of severe illness from COVID-19.
Erasmus : Who Else is at risk?
Dr Xxxxx : In Australia, the people most at risk of getting the virus are:
* Travellers who have recently been overseas or cruise ship passengers
* Those who have been in close contact with someone who has been diagnosed with COVID -19 (including in the 48 hours before their symptoms appeared)
* People in aged care facilities
* People in detention facilities
* People in group residential settings
* Aboriginal and Torres Strait Islander people who live in remote communities are at a higher risk of serious infection from COVID-19 because it can be harder to access healthcare and there are higher rates of other health conditions in the community.
According to the U.S. Centers for Disease Control and Prevention (CDC), eight out of 10 deaths in the U.S. from the new coronavirus have been in people 65 and older. An estimated 6% to 29% of people 85 and older who get COVID-19 will require intensive care.
The risk of having symptoms increased with age—roughly 4% a year in adults 30 to 60 years.
The overall risk of dying after having symptoms of the coronavirus was 1.4% (0.9% to 2.1%).
Mean time from illness onset to death was 20 days (17 to 24; standard deviation [SD], 10 days [7 to 14]).
People younger than 30 also were 84% less likely to have a symptomatic infection (0.16 as likely; 0.15 to 0.17) than those 30 to 59 years,
While those older than 59 years were 2.0 (1.95 to 2.08) times more likely to have a symptomatic infection.
Children, however, were more likely to have a symptomatic infection than were those 20 to 29.
Erasmus : What Specific Medical Conditions
May Put You at Risk of Severe CoVid Infection?
Dr Xxxxx : People of any age with the following conditions are at increased risk of severe illness from COVID-19:
* Chronic kidney disease
* COPD (chronic obstructive pulmonary disease)
* Immunocompromised state (weakened immune system) from solid organ transplant
* Obesity (body mass index [BMI] of 30 or higher)
* Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
* Sickle cell disease
* Type 2 diabetes mellitus
Children who are medically complex, who have neurologic, genetic, metabolic conditions, or who have congenital heart disease are at higher risk for severe illness from COVID-19 than other children.
Travellers : at at risk of Corona. People contact and high people proximity underlies risk. Having greater air exchanges in a plane and freshh air venting down onto people creating a clean air cup over each person is a basic and well overlooked strategy.
Based on what we know at this time, people with the following conditions might be at an increased risk for severe illness from COVID-19:
* Asthma (moderate-to-severe)
* Cerebrovascular disease (affects blood vessels and blood supply to the brain)
* Cystic fibrosis
* Hypertension or high blood pressure
* Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
* Neurologic conditions, such as dementia
* Liver disease
* Pulmonary fibrosis (having damaged or scarred lung tissues)
* Thalassemia (a type of blood disorder)
* Type 1 diabetes mellitus
Erasmus :What About Children’s Risk of CoVid?
Dr Xxxxx : Emerging epidemiologic reports on COVID-19 in children in China show that, while they are less likely than adults to be infected and have severe illness, they are still vulnerable to the pandemic coronavirus.
The illness is less severe illness in kids, but no ages are spared.
Young children were more at risk of serious illness than older children were.
The proportion of severe and critical cases was 10.6 % for children younger than 1 year, 7.3% f
Or those 1 to 5, 4.2%
For those 6 to 10, 4.1%
For those 11 to 15,
And 3.0% for those 16 to 18.
Personal Protective Equipment.
Erasmus : Any other comments about Children with Special Risks for CoVid:
Children with Certain Underlying Conditions
Dr Xxxxx : While children have been less affected by COVID-19 compared to adults, children with certain conditions may be at increased risk for severe illness. Children who are medically complex, who have serious genetic, neurologic, metabolic disorders, and with congenital (since birth) heart disease may be at increased risk for severe illness from COVID-19.
Similar to adults, children with obesity, diabetes, asthma and chronic lung disease, or immunosuppression may be at increased risk for severe illness from COVID-19.
Erasmus : What About Risks for Men vs. Women?
The X chromosone has more immune genes, so perhaps this is the basis of greater risk of disease in men than in women.
Dr Xxxxx : According to Garima Sharma of Johns Hopkins University School of Medicine in Baltimore, who with colleagues recently published a paper on sex differences in Covid-19 mortality, women are protected by virtue of having a “backup” X chromosome. “X chromosomes contain a high density of immune-related genes, so women generally mount stronger immune responses,” she says.
It is also becoming clear that protecting the vulnerable has made a big difference to outcomes so far. Italy and Germany, for example, have similar proportions of over-65-year-olds – just over 20% of the population in both cases – and yet the two have reported strikingly different fatality rates. The case fatality rate (CFR) – the proportion of the sick who go on to die – is less informative but easier to measure than the IFR, because sick people are more visible than merely infected ones, and as at 26 May the CFR in Italy was about 14%, compared to 5% in Germany.
Italy is more densely populated than Germany, and Italian homes tend to be smaller than German ones. Many Italians in their 20s and 30s live at home with their extended families, which meant that transmission to the elderly was high and, when critical care units were overwhelmed, so were deaths. This is rarer in Germany, where many elderly care homes also enacted a strict isolation regime. In Germany, says Heymann, “they did a better job in keeping the elderly protected”. Some estimates suggest that only 20% of German Covid-19 cases were over 60, as compared to more than 90% in Italy.
The elderly are at risk.
The UK, which has recorded the second highest death rate from Covid-19 after Spain, has not looked after its elderly so well – deciding at one point to discharge patients from hospitals back to care homes without testing them for the disease. It has been suggested by some reseearchers that the UK’s high death rate reflects a deeper problem – years of erosion of community support services that provided pastoral care. “There is just not enough investment in the NHS and in that GP or other frontline individual who advises the vulnerable person,” she says.
It appears that lockdown was an overreaction and that frontline care and protection of the vulnerable – which should have been a priority from the beginning – should be prioritised now. She also thinks that the worst is behind us, and that while subsequent waves can’t be ruled out, they will probably be less bad than what we have experienced so far. The disease will settle into an endemic equilibrium, in her view, perhaps returning each winter like a seasonal flu.
One thing seems clear: there are many reasons why one population is more protected than another. Theoretical epidemiologist Sunetra Gupta of the University of Oxford thinks that a key one is immunity that was built up prior to this pandemic. “It’s been my hunch for a very long time that there is a lot of cross-protection from severe disease and death conferred by other circulating, related bugs,” she says. Though that cross-protection may not protect a person from infection in the first place, it could ensure they only experience relatively mild symptoms.
In this world of air travel, any disease can spread around the globe in 24 hours.
Erasmus : What do Health Authorities Tell you to do?
Dr Xxxxx : In general, the more people you interact with, the more closely you interact with them, and the longer that interaction, the higher the risk of COVID-19 spread. So, think about:
* How many people will you interact with?
* Can you keep 6 feet of space between you and others?
* Will you be outdoors or indoors?
* What’s the length of time that you will be interacting with people?
Encourage social distancing during your visit
* Visit with your friends and family outdoors, when possible. If this is not feasible, make sure the room or space is well-ventilated (for example, open windows or doors) and large enough to accommodate social distancing.
* Arrange tables and chairs to allow for social distancing. People from the same household can be in groups together and don’t need to be 6 feet apart from each other.
* Consider activities where social distancing can be maintained, like sidewalk chalk art or yard games.
* Try to avoid close contact with your visitors. For example, don’t shake hands, elbow bump, or hug. Instead wave and verbally greet them.
* If possible, avoid others who are not wearing cloth face coverings or ask others around you to wear cloth face coverings.
* Consider keeping a list of people you visited or who visited you and when the visit occurred. This will help with contract tracing if someone becomes sick.
Remember the issue is to reduce INFECTIVE EXPOSURE, not stopping infection.
Wear cloth face coverings
* Cloth face coverings should be worn over the nose and mouth. Cloth face coverings are especially important when it is difficult to stay at least 6 feet apart from others or when people are indoors to help protect each other.
* Cloth face coverings may slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others
o Wearing a cloth face covering helps protects others in case you’re infected, while others wear one to protect you should they be infected.
* Who should NOT use cloth face coverings: Children under age 2 or anyone who has trouble breathing, is unconscious, or is incapacitated or otherwise unable to remove the mask without assistance.
Erasmus : How effective would this be?
Dr Xxxxx : Cloth masks may filter off something, but what. Most infectious particles are likely 1-10 microns in size. These would go through most cloth masks. Maybe some of the “super-size” particles would be filtered off, but cloth masks are unlikely to filter off the small particles.
A P95 mask catches 95% of particles over 1 micron in size, but is of course prone to side leakage around the mask , where the edge of the mask seals against the face.
If this was respiratory Ebola, I would be wearing a full sealing germ warfare mask. Nothing less would do. Even then the filters of most masks set a limit of 1 micron for particles caught. Smaller air filter pores make the mask too hard to breathe through. So even wearing all the super effective gear, in the case of Ebola you could still get exposed to infection via sub-micron sized particles. Now these are largely breathed in AND then out, so your risk is much less than for larger particles. But it is not zero. In the case of an illness like Ebola with a LOW infective dose and high mortality, even out particle masks would not GUARANTEE safety.
Erasmus : How about hand washing and cleaning?
Dr Xxxxx : This is not likely to make much difference to CoVid infection rates, but is very likely to be a good thing to teach the population as a general disease control measure. So I heartily approve of pushing this strategy, but not for CoVid reasons. Same for environmental spraying and cleaning: probably close to useless for CoVid.
But in the case of Ebola, Cleaning and spraying and sterilizing are critical to stop the spread of such an agent.
Wash hands often
* Everyone should wash their hands for at least 20 seconds at the beginning and end of the visit and whenever you think your hands may have become contaminated.
* If soap and water are not readily available, such as with outdoor visits or activities, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
* Remind guests to wash or sanitize their hands before serving or eating food.
* Use single-use hand towels or paper towels for drying hands so visitors do not share towels. Have a no-touch trash can available for guests to use.
Limit contact with commonly touched surfaces or shared items
* Encourage your visitors to bring their own food and drinks.
* Clean and disinfect commonly touched surfaces and any shared items between uses.
* If you choose to use any shared items that are reusable (e.g., seating covers, tablecloths, linen napkins), wash, clean, and sanitize them after the event.
If you are thinking about participating in an event or gathering:
If you are at increased risk for severe illness, consider avoiding high-risk gatherings. The risk of COVID-19 spreading at events and gatherings increases as follows:
Lowest risk: Virtual-only activities, events, and gatherings.
More risk: Smaller outdoor and in-person gatherings in which individuals from different households remain spaced at least 6 feet apart, wear cloth face coverings, do not share objects, and come from the same local area (e.g., community, town, city, or county).
Higher risk: Medium-sized in-person gatherings that are adapted to allow individuals to remain spaced at least 6 feet apart and with attendees coming from outside the local area.
Highest risk: Large in-person gatherings where it is difficult for individuals to remain spaced at least 6 feet apart and attendees travel from outside the local area.