Coronavirus - Institute for Respiratory Health

Coronavirus

Any news about the coronavirus can be worrying, especially if you know someone who is in a high-risk category. Here you’ll find up-to date-information on the coronavirus and what you can do to help mitigate the risk of infection. It is important to indicate that your risk of contracting the disease in Perth is currently low.

What is Coronavirus, SARS, MERS and COVID-19?

Coronaviruses represent a large family of viruses that were first discovered in the 1930’s in animals and then subsequently, in humans in the 1960’s.  In animals, they cause a variety of diseases but in humans, the seven known coronaviruses cause various respiratory illnesses.  They get their name because the virus particle appears to have many protein spikes on its surface, giving the appearance of a crown (corona) as can be seen in the below image from the USA Centers for Disease Control and Prevention.

Four of these seven coronaviruses are associated with the common cold and mild upper respiratory tract disease.  However, the other strains may cause severe diseases.  You may have already heard of Severe Acute Respiratory Syndrome (SARS, now referred to as SARS-CoV), identified in 2002, and the Middle East Respiratory Syndrome (MERS), identified in 2012.  Both of these viruses were transmitted to humans via animals (SARS via civet cats and MERS via camels).

Now, a SARS and MERS related, but novel coronavirus strain has emerged as a significant health threat.  The first reported case of respiratory disease due to this virus originated in the Hubei province of China in November 2019.  This strain has now been designated SARS-CoV-2, to reflect the fact its structure is very similar to that of SARS-CoV virus, and the term COVID-19 is used to describe the disease.  As all previous human coronavirus strains are thought to have evolved from strains infecting animals, it is currently assumed that COVID-19 has emerged from an animal source, in particular, bats.  In support of an animal connection, many more cases of respiratory disease were reported in December 2019 in Hubei province, with the Huanan Seafood Market in Wuhan trading in exotic animal meats, at the epicentre.

How has COVID emerged?

More virulent variants of an existing mild disease emerging or of a disease jumping from animals to humans causing pandemics (world-wide spread) and epidemics (localised outbreak) is not a new phenomenon.  It has occurred on several occasions in modern times (e.g., swine flu, Ebola), and COVID-19 is not likely to be the last such occasion. 

The variants arise because some part of the DNA or RNA of the original organism has mutated resulting in a subtle change to structure that increases infectivity.  In the case of the SARS-CoV-2, a change has occurred in the protein spike of a once animal-specific coronavirus which now enables it to gain entry to the cells lining human lungs.  The change also makes the new virus invisible to our immune system, so we cannot immediately fight it. 

Why is COVID-19 a problem?

It is a problem because of several factors.  Firstly it is highly infectious.  This property was not immediately recognised and this delay, in China and elsewhere, has contributed to the spread of the disease worldwide, with Europe now being regarded as the epicentre for transmission.  COVID-19 causes mild disease in the majority of infected individuals but severe disease occurs with increasing age.  As COVID-19 is a newly emergent disease, humans have not been exposed to it before and, consequently, have not developed any degree of what is called ‘herd immunity’ from prior exposure or vaccination which can slow or stop the spread.  Indeed, a vaccine has yet to be developed and it is likely to take at least a year for development, testing and distribution.  To have any impact on the spread of the disease, it has been estimated more than 60 percent of a community would need to have been vaccinated against the disease prior to its emergence.

In comparison to SARS and MERS, COVID-19 is infecting significantly more people worldwide.  For example, more than 8,000 people contracted SARS in the early part of this century, which resulted in 744 deaths (with no known cases from 2004 on) and about 2,500 people contracted MERS, of which 858 patients died.  In contrast, global cases are now over 3 million, resulting in over 200,000 deaths. Fortunately, Australia does not have a widespread community outbreak, current we have 6,725 confirmed cases with 546 confirmed in Western Australia.

How does COVID-19 spread through a community?

The virus infection is thought to be spread by coming into contact with individuals demonstrating overt symptoms such as coughing and/or sneezing.  Exposure may occur by direct contact via touching etc or indirectly, by breathing in droplets released by aerosolization within a radius of about 2 metres around a symptomatic person.  It is possible individuals without such symptoms may be contagious, hence the self-isolation of people returning from overseas where the spread has been wider.  In addition to human contact, exposure to the virus may occur by contact with a surface, such as door handles and a variety of utensils, previously handled by an infected person.  However, it is not clear how long the coronavirus, once deposited, will remain viable on a surface as this will depend on a variety of factors such as temperature, humidity and its physical nature.  It has been estimated that survivability may range from a few hours or days.  The virus enters the body by recipients transferring it by touching their nose and/or mouth, and it has been estimated that an infected person may be capable of infecting between 2-3 non-infected individuals.

What are the symptoms of COVID-19?

The symptoms associated with COVID-19 are varied and include:

  • Fever
  • Sore throat
  • Cough
  • Sneezing and/or
  • Shortness of breath

Symptoms can occur anywhere between 2 to 14 days after exposure to the virus.  Most confirmed cases of COVID-19 have presented with a dry cough, fever and shortness of breath rather than with a sore throat and/or sneezing.  More than 80% of patients will recover from COVID-19 without problems but 1 in 6 may become seriously ill.  The symptoms associated with the disease are not produced by the virus itself but rather by the body’s attempt to limit or resolve infection in the short term (7-10 days) before antibodies can be produced.  Getting better shows that your immune system has done its job. 

COVID-19 has the potential to cause severe disease which may result in death, particularly in people over 65.  In severe cases, the virus causes pneumonia and a small proportion of these patients (17%) may develop severe acute respiratory distress (ARDS) resulting in the need for assisted breathing and possibly develop long-term health issues.  However, it is important to note that by just being in this age bracket does not necessarily mean that you will be susceptible to severe disease.  Data from China show that hospitalisation with pneumonia is associated with the presence of an underlying medical condition, in particular heart problems, diabetes or high blood pressure but also lung problems and cancer. 

Am I at risk?

As the number of people becoming infected increases, we are learning more about the risk factors involved but susceptibility includes increased age, other health problems as noted above, being on immunosuppressive medications and having underlying lung problems. Being in the age bracket 10-39 confers some protection, pregnant women do not seem to be particularly susceptible and it appears females are less susceptible than males.  People in specific occupations such as health care workers, nursing home personnel and people living in overcrowded conditions will be more susceptible to COVID-19. 

One of the most important risk factors for any of us at an individual level is social contact and travelling, with the latter both increasing the risk of being exposed and hastening the spread of the disease.  If you are older, have underlying health problems or are on medications that suppress your immune system you should take particular measures to protect yourself. 

What should I do to remain healthy?

The best way to prevent the spread of COVID-19 is by practising good hand hygiene and sneeze/cough etiquette AND social distancing. This includes:

  • Frequently washing your hands for at least 20-30 seconds with soap and water (sing Happy Birthday twice), or use an alcohol-based hand gel. Try doing this 10 times a day.
  • Refraining from touching your nose and mouth.
  • If coughing or sneezing, covering your nose and mouth with a paper tissue or flexed elbow – dispose of the tissue immediately after use and perform hand hygiene.
  • Avoiding close contact with anyone if you, or they, have a cold or flu-like symptoms (maintain a distance of at least 1.5 metres).
  • Avoid large public gatherings

You may have gleaned from the popular press that there may be a link between taking an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker for high blood pressure and increased harmful effect of COVID-19 infection.  The virus uses the angiotensin-converting enzyme on the cells lining the lung to gain entry to the body.  However, the Council on Hypertension of the European Society of Cardiology has just issued a statement to the effect that patients should continue the use of such drugs due to the lack of any scientific evidence to the contrary.

What should I do if I have symptoms?

Please call your GP or the Coronavirus Health Information Line on 1800 020 080 and advise them of your symptoms and travel history.  

Please do not attend a clinic or your GP without contacting them first – unless you are very unwell and need to go to the Emergency Department of a major hospital.

Several COVID Clinics has opened at the major hospitals. They have issued the following advice:

Who should attend a COVID clinic?

People will only be tested if they have a fever and/or respiratory symptoms such as shortness of breath, cough or sore throat AND documented evidence of:

  • Overseas travel in the last 14 days (provide boarding pass or flight booking or airline bag tag with name and date of travel) OR 
  • Close contact of a confirmed COVID-19 case (provide name of case)

Patients who are tested should remain isolated at home until they receive their test results and further medical advice.

Who should avoid attending a COVID clinic?

Do not attend unless you have symptoms AND meet the above criteria, including documented evidence.

People presenting at COVID clinics may be infectious. People who don’t have symptoms and evidence will be turned away and asked to self-monitor for symptoms.

When and where are clinics?

  • Metro clinics are open 8.00 am to 8.00 pm daily
  • Royal Perth Hospital– Ground Floor, Ainslie House, 48 Murray Street, Perth
  • Sir Charles Gairdner Hospital– C Block, Hospital Avenue, Nedlands
  • Fiona Stanley Hospital– Bedbrook Row, north-eastern end of hospital, Murdoch
  • Bunbury Health Campus – 30m left of the main entrance, open 10.00 am to 4.00 pm daily
  • Patients in other regional areas with documented evidence should go to a public hospital, health service or remote health clinic.

If you are attending a GP or require urgent medical assistance at an emergency department in your local hospital, ring ahead and tell them that you have been overseas and are unwell.  This will prevent other people at the health service potentially being exposed. If you are experiencing a life-threatening emergency dial 000.

Be involved

Think about friends, family, carers and anyone else who supports you. Make sure they are coping, provide support and make sure they know what to do about coronavirus. Share this information with them.

Keep up to date from reliable sources

You can learn more about the novel coronavirus, including information about symptoms, travel and other advice and what you can do if you have concerns, by visiting www.healthywa.wa.gov.au/coronavirus. This website is regularly updated and includes links to other information and resources.

Remember to use the Coronavirus Health Information Line via telephone 1800 020 080 to seek additional advice.

The above information has been sourced via the Department of Health’s Healthy WA website. Image courtsey of CDC.