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Tegan Taylor: Hi, this is Coronacast, a daily podcast all about the coronavirus. I’m health reporter Tegan Taylor.
Norman Swan: And I’m Dr. Norman Swan, a physician and journalist, it’s Thursday 19th November. Big day.
Tegan Taylor: Yes, a great day, especially for the people in South Australia, where yesterday we heard that not only South Australians entered an incredibly tough, but also short, lockout, we are also listening to Chief Public Health Officer Nicola Spurrier there talking about how this strain that is circulating in Adelaide is different, it has a shorter incubation period, people with it don’t seem to have as many symptoms. What do we know about this strain in Adelaide and does it really look different or does it appear to act differently?
Norman Swan: This was said during the Crossroads Motel outbreak in New South Wales when the virus spread from Victoria, it was said there was a shorter incubation period, more likely to spread symptomatically, and explaining why. there was a very significant super shedding event at that hotel in New South Wales. We haven’t heard of it since. This was certainly at the beginning. They are saying the same things here.
I’ve talked to a couple of people who know how this virus behaves and are wondering if really what’s going on is that you actually have super spread events, and they are so significant, super spread events, that you start wondering if incubation is short or not. It might be true.
It is not yet clear what the virus is, what the subset of the COVID-19 virus is. There was a variety called N439K that was harvested in South Australia. It is not entirely clear whether this is the form circulating now. This is one that is growing in the UK and Europe and really quite common there. It’s on the peak, it’s where it gets stuck in the so-called ACE-2 receptor, which is how you get the locking and key mechanism that enters the cell.
And people looked at various strains and wondered whether or not there were any significant characteristics. So what they’re talking about here, to use technical terms, is a short replication cycle. In other words, it replicates very quickly but infects people and is more likely to cause asymptomatic disease earlier. This is the kind of image I suspect the South Australian Chief Health Officer was communicating.
If that will confirm when you look at it, and when you compare the data from Europe, it clearly comes from the UK. Certainly this N439K came from the UK. There have been suggestions in the UK that they are receiving some short-term incubation viruses with asymptomatic spread. You certainly have a lower death rate but hospitals are filling up. So I think this is a story that has yet to be realized, but it clearly scared the authorities.
It is not possible to separate the blockage from the belief that it is a short replication cycle, more infectious virus, which could spread asymptomatically. If that’s what they believe, you have to try to extinguish this virus, you have to get it out of South Australia and the only way to get this virus out and extinguish it, because you don’t have any antiviral treatments, is by blocking and preventing people from mixing and stopping them. abruptly and quickly and stop the spread of the virus. This is the way to extinguish the virus.
Tegan Taylor: It occurs to me that you had James Hadfield in March, if you remember that far, on the Norman Health Report, and pointed out that the golden rule of phylogenetics, then basically virus family trees is that if it looks like the virus is behaving differently, 99% of the time it is actually due to epidemiology or the way humans, the hosts of the virus, interact with each other. So couldn’t it be possible that it’s just the way we behave rather than the virus itself?
Norman Swan: Yes exactly, this is the point I was making a few minutes ago which is that it could be that they just had some really pretty dramatic super diffusion events, they are worried about the pizzeria, 4,000 people, for the sake of love, they are in. isolation, even though it is now the entire population that is in isolation.
So it could very well be that the behavior rather than the sudden appearance of a new strain that has these characteristics, particularly when the strain that hit from Victoria to New South Wales, said the same thing, and fell silent because in The end I’m not so sure the virus they had in New South Wales was so terribly different than the one in Victoria. And I don’t think people in Victoria claimed it had particularly unusual characteristics.
Tegan Taylor: So let’s talk about this block. It’s an incredibly difficult block, much harder than what they had in Victoria but, on the flip side, only for six days. Even with a short incubation period, if that’s really what this virus has, is six days actually enough?
Norman Swan: You’ll only find out when the six days pass and they take the tests. Test rates have gone up impressively, we were a little bit equivocal about that in yesterday’s Coronacast, they really got up a lot, so South Australians are really stepping up and doing great things by coming forward for testing. It’s a good thing, but you will only know it as time goes on.
So this virus has been around for a few days. We were saying, looking at what they were talking about in terms of the sources of the outbreak, we were starting to say, well, maybe 9 started. It keeps coming sooner and earlier when this virus may have erupted and started to spread. So at the very least it has been spreading for a week, probably longer, which is a long time, especially if it is true that this virus has a greater tendency to super-spread. And the fact that they found 4,000 contacts means there have been widespread circles.
Coming to your point, Tegan, the people in South Australia have been inadvertently acting to let the virus take off, and it’s not their fault, it’s just that.
So this blockade is exactly what should have happened to Victoria (easy to say in retrospect), when they tried to demarcate those 36 incredibly difficult suburbs. But modeling from the University of Sydney by Professor Prokopenko, which we talked about several months ago, showed that for every day you wait to get into a serious block, you have a week on the other side to actually recover. the virus.
So, entering now that they’ve only had a few days of release, they have the ability to check and control it incredibly quickly. And I hope for all the people in South Australia that is exactly what happens, but it depends on how far it has already spread. They must be extremely worried about doing this.
Tegan Taylor: So one of your favorite sayings about this pandemic, Norman, is that you have to go hard and you have to go soon, and South Australia definitely did. Is this a model for what could happen with future outbreaks in Australia? This SA-style block is something the rest of Australia should be … maybe you don’t expect but is prepared?
Norman Swan: Yes is the answer. It’s easier in Adelaide, it’s more geographically defined, with a smaller population than a larger, amorphous city like Sydney or Melbourne. But still this is the way to go, go fast, go early and minimize the impact.
And basically WHO is wrong about this, where they are saying that blocking is not a tool here. A blocker is an extremely important tool and South Australia has put together their contact tracking feature, but the virus they’re worried about is getting out of control and you don’t want the contact tracking system to be overwhelmed. So they did absolutely the right thing, and I think WHO needs to look closely at its policy here because, frankly, they are wrong.
Tegan Taylor: So, Norman, we’ve heard that there are about 4,000 people in solitary confinement in South Australia, as you just said before. If we’re dealing with a variant of the virus that has a really short incubation period, why haven’t we seen more cases popping up in the past few days if its spread potential is so great?
Norman Swan: Well, here’s the theory. Whether this is true or not is another question. If it has a short replication cycle, in other words it can infect you very quickly and start replicating, but it is asymptomatic and all they do are symptomatic tests, asymptomatic cases are missing. They will know. In fact two days ago I heard the Medical Director, Professor Spurrier, say that only people with symptoms should come forward. But if it actually spreads asymptomatically to a much greater extent than other forms of the virus, then they don’t know how far it has spread.
Then, as they move on to asymptomatic tests, they will begin to learn more. However, the problem with asymptomatic tests is that you are more likely to get a false positive and you are also more likely to get a false negative. So the tests potentially become less accurate in an asymptomatic population.
Tegan Taylor: We have so many questions from South Australia and elsewhere about this today, but one that I thought was really relevant to people who are going to be in a really tough lockdown next week is from Carolyn, actually writes from New Jersey to the United States, and she is saying; do you have any tips on how to be mentally resilient in times like these?
Norman Swan: Well, not having lived it, aside from when everyone did it in March, is really hard. I think the main thing about psychological resilience is social support and social contact, not being socially isolated. Social support and contact with other people is important for mental well-being, even when you’re not stuck.
It is difficult for South Australians because it suddenly crashed, but you have to find the techniques, be it Zoom, Skype, phone calls, regular contact with other people so that the borders of your home are not the four walls, you have the world in front of you. And it doesn’t have to be someone around the corner, it could be someone on the other side of the world, maybe in New Jersey, that you need to be able to connect with, that’s for the best.
And then don’t be afraid to ask for help. I think the South Australian authorities will provide support to people who need it, without fear of asking for help, and using the support lines available in South Australia and neighbors who actually care for each other. If you know that there is someone isolated next to you, they are really reaching you. This will make you feel better and make them feel better. So contact between people is the best thing you can describe. You can stock up on books, you can figure out what you’ll be watching on Netflix, but ultimately it’s person-to-person.
Tegan Taylor: And Norman, just a quick clarification sent by Anne-Marie. We talked yesterday about the three cases currently active in Melbourne, and I think we have given a somewhat confused answer. Deputy Head of Health Allen Cheng actually made this clear at a recent press conference.
Norman Swan: Yeah, he said at least two of these people aren’t well enough and they might be in the hospital, so they’re not just viral shedders, they might be in the hospital. And in fact I checked with someone else in the system in Victoria and it looks like two are still pretty sick.
Tegan Taylor: Well that’s all we have time for Coronacast today.
Norman Swan: And if you have a question, go to our website which is abc.net.au/coronacast, click “Ask a Question” and mention Coronacast during the process. And from Tegan and I to all South Australians, we’re thinking of you.
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