Good morning. It's the first time I've said that, I usually say good afternoon
but good morning, it's Dr Nick Coatsworth with today's top three
and today's shout out is to our allied health professionals. Our
physiotherapists, our dietitians, our occupational therapists and social
workers, podiatrists, there's so many of you out there and you're doing such a
great job during COVID-19. And what I want to say is for patients out there
who have an allied health professional, don't be afraid to go to their places of
practise, because I know that they've been putting in in place processes that
are going to keep you safe during this COVID-19 epidemic and it's more
important now that you get your treatment for those chronic conditions
that you need. And you will be safe going going to those practices. So always call
ahead just to make sure that they're happy, they'll probably have processes
in place to make sure there's not too many people in the waiting room for
example. And of course if you're all unwell with any of those respiratory
symptoms that we speak about, make sure you contact your GP and get tested for COVID-19.
First question for Dr Nick, will COVID-19 ever be fully eradicated in Australia?
So this is a really important question at the moment,
particularly when you see on the news there's so many questions about borders
internally in Australia. So let's go through these concepts of eradication,
elimination and suppression, because they're all slightly different in health
terms. For those of you, and I'm not old enough to remember this, but obviously as
an infectious disease physician I've looked at it. But for those of you who
are old enough to remember smallpox. Smallpox was a condition, in fact the
condition in the 20th century, that we were able to eradicate with a vaccine. So
eradicate means it's just not here anymore in the world, probably sitting in
a couple of labs somewhere, but it's certainly not circulating in any
communities in the world. And we're trying to do the same with polio, been
sort of less successful with that. But both were eradicated because they had
very effective vaccines, and they were so effective that they actually stopped a
transmission within the world community. Elimination is a different concept,
elimination means that the virus is not within a defined geographic area. It's
still in the world, but it's been eliminated from a geographic area. Now
this might sound like a very attractive proposition for Australia. We are an
island, we can strongly regulate who's coming in and out, and that has been
successful closing the international borders. In terms of stopping spread into
Australia. But then you've got to kind of look at what is the impact on society of
those measures that you are going to take to actually eliminate it? And then
you've got to consider is this virus actually going to be hanging around for
so long that elimination whilst it might be an attractive idea, is a completely
impractical idea, because it'd mean we'd have to close our borders in perpetuity.
Suppression is the concept that we have advocated at the Australian Department
of Health and the Australian Health Protection Principle Committee. That is
that you have such an effective public health response with great disease
detectives who are able to jump on these cases and work out who the contacts have
been of the patients who are COVID-19 positive. We have an excellent testing
regime where you have tens of thousands of tests being done every week to try
and find COVID-19 and we have a very strong healthcare system. So it means
that we can live with cases. And for those of you who are living in states
where there are very few or zero cases at the moment, that is not a sufficient
reason to say we are going to eliminate this virus from our state. Because that
would mean that you can't visit anywhere else in Australia. I think it is unlikely
that we're going to get elimination in this continent. the continent of
Australia. Then with it- so then we need to move on to the, well if we- if we're
not going to get elimination, we're just going to suppress this virus, what about
the vaccine? Is that going to lead us to elimination? And again, it's really
difficult sitting in this seat because I have to say it depends. It depends
firstly if we get a safe and effective vaccine. And even if we do that's about
12 to 18 months away. Secondly it depends well
effective is that vaccine? Is this going to be like the TB vaccine which just
stops severe illness in young children? Is it going to be like the influenza
vaccine, which is good at decreasing the burden of influenza every year in the
community, but is I need between 30 to 60% effective. Or is it going to be like
the smallpox or the polio vaccine where you can actually hope for worldwide
eradication? I don't think it's going to be the latter, I think it's probably
going to be something like the influenza vaccine. So we need to prepare ourselves
that COVID-19 may become at what we call an endemic, that means it circulates
within the global community and might just become another coronavirus that
can make us unwell just like coronaviruses that- coronaviruses
can at the moment. So for all those reasons, I think we need to be very
careful when we talk about elimination versus suppression in Australia. Because
the consequences for our social and economic and mental health, all those
sort of things that are affected by locking down, our magnified if we go for
an elimination strategy. So that is why the national strategy has been
suppression. And I think our goal should be to have just restricted geographic
clusters that are jumped on very quickly, bit like in bushfire season when we
would put out a spot fire. And that's why we've recommended that sort of approach.
Taken a little while to answer that question but I think it was worth it.
Second question, can vitamin supplements improve the body's response to COVID-19?
Well this- this one's going to be a little bit quicker. It it is an
attractive option to be able to take vitamins and feel as though they might
be giving a bit of an extra boost to the immune system. The reality is that
anything you buy as a supplement from a vitamin perspective is many times,
thousands, tens of thousands of times in excess of what your body needs and most
of it, once you put it in, it just gets put straight out again. Either when you
go to the toilet- when you go to the toilet really. Or it gets it gets
metabolised. So you know there vitamins that you need for a functioning immune
system are obtained from a healthy balanced diet. And, so there's so many other
reasons to have a healthy balanced diet, low cholesterol amongst one of them, that
you know, if you really want to have good vitamins, enough vitamins, just have a
balanced diet with lots of fresh fruit and veggies and that'll be right. There
are some notable exceptions though, and you will see that a lot of our cereals
have folate supplementation and that we encourage folate use in early pregnancy.f
That has specifically been shown to help with something called neural tube
defects or spina bifida. So there are specific instances where vitamins can be
a good idea, but things like high dose vitamin C for respiratory infections, not
a particularly good use of your money I have to say.
Last question for today, how effective are alcohol-based hand sanitisers in killing viruses?
So I'm really glad this question has come up, because like every sort of treatment for
COVID-19 or possible mitigating risk factor, not all alcohol-based
hand sanitisers are equal. It depends on what's actually in them and how
effective that is, killing viruses depends on having a certain amount of
alcohol within within them. So it needs to be at least 60% to be
effective at killing COVID-19. Now there's a very good section in the World
Health Organisation website that actually gives them some recipes. And it
talks about containing 80% ethanol or 75% isopropyl alcohol.
So you can actually make this stuff and I did go somewhere, I won't say exactly
where, in Canberra that had made their own. It was potent and effective, it
didn't exactly burn my hands but it wasn't quite- the scent wasn't quite as
good as the commercially made products. So you can make your own but
there's no shortage at the moment around, there's plenty in Chemist Warehouse
and other chemists around the country where you can get your alcohol-based
hand sanitiser. But if you're worried about whether it's, you know, the real
deal, make sure you have a look at the label. Because there's the TGA, the
Therapeutic Goods Administration number on there. And it should have a AUST, Aust
for Australia, and then it should have an R number.
And so a number with the letter R in front of it, and that will tell you that it's
actually been tested by the TGA. If it has an L number, that's slightly
different, it hasn't has it had its ingredients tested, but it's still be
passed through the TGA processes. So just make sure you have a look, you can see it.
I think there's one on my hand sanitiser just on my desk, I checked it just then.
So if you want to know if it's the real deal, that's the way. Finally if you don't
have hand sanitiser, soap and water, very effective. And for the kids out there, if
you do the ABC rhyme, that happens to be 20 seconds and that's the amount of time
you need to really wash your hands to get rid of the virus. So that's so
important, hand hygiene, it's one of the three things in the COVID three that we
all have to do. Maintain good hand hygiene keep our distance where we can,
and download that app. I'll see you next week.