It seems a long time ago that we learned a new kind of coronavirus, a dangerous kind, had jumped from animals into humans, thousands of kilometres away in China. But it is only three months. And, still, we’re on a steep learning curve about this virus and the illness it causes, COVID-19. So far, more than 4700 people have been infected in Australia and 21 have died.
As the pandemic shuts down more of daily life, questions from you, our readers, are flooding in. Our explainer team, as well as our health, science and data reporters, will answer as many of them as we can in the coming weeks. And when new information comes to light, we’ll bring you updates too. Here’s what we know so far.
Can I leave my home?
To stem the spread of the virus, we are told to live our lives further apart – literally – by avoiding gatherings, staying home and keeping 1.5 metres clear of each other. And this will likely be the norm for at least six months. To this end, the federal government has closed many public places such as pubs and gyms to stop people gathering. Prime Minister Scott Morrison says there are now really only four acceptable reasons to go out:
- Shopping for what you need (such as food or supplies to help keep you at home)
- Getting medical care or going somewhere for compassionate reasons such as caring for someone
- Exercising outside (but you must stick with just those in your household or a maximum of one other person)
- Attending work or school if you cannot attend either remotely
Can I visit my partner, friend or relative if I don’t live with them?
It depends on the circumstances – and what state you live in. Under the new two-person limit on non-essential gatherings (so those other than, say, for work, school or healthcare), you can still meet another person outside to exercise so long as it’s just the two of you and you stay 1.5 metres apart. You could even grab a takeaway coffee afterwards but keep moving. The aim is to avoid people clustering together.
Child custody arrangements seem largely unaffected and the Prime Minister has said a family split across homes can still visit one another. But enforcement on the ground is up to the states. And they’re all interpreting the rules differently – with some such as NSW and Victoria calling on emergency powers to roll out on-the-spot fines and even jail time for breaches.
But the question of romantic partners who don’t cohabit initially caused consternation when NSW and Victoria appeared to come down with different rulings.
After some confusion in NSW, which has the nation’s largest cluster of cases, Police Commissioner Mick Fuller said you can still visit your partner as it falls under the category of “care”. “Mental health, we get it … we need to look after each other – but don’t take the whole family with you”.
In Victoria, all social visits are banned. You can visit someone’s house to care for them or in an emergency – say, if you are fleeing danger. On the morning of April 1, a Victorian health department spokeswoman said, “You shouldn’t be physically intimate with people you’re not living with, even if they are your partner.” (You should also only drive in cars with people you live with.) But the rules on romantic partners were set to be relaxed later in the day, when Chief Health Officer Brett Sutton said couples who lived apart were exempted.
Meanwhile, jurisdictions such as Tasmania and the ACT let you have one visitor over to your home as long as you are following social distancing measures – no hugging or kissing, and allowing space for one person per four square metres.
In Queensland, Health Minister Steven Miles said the national guidelines “effectively mean that anyone who doesn’t live alone can’t have visitors, and that’s going to be very challenging”. But if you both live alone, visits were OK. WA’s rules were similar. “What we are trying to do here is stop the transmission of the virus from one person to another,” said Australia’s Deputy Chief Medical Officer, Paul Kelly. While one way of doing that was to “keep 1.5 metres away from each other”, the other was to “limit the number of interactions you have in a day”. “In terms of what that means for specific groups of people, in particular jurisdictions, it is really for them to make that decision from a government point of view,” Professor Kelly said. – with Lydia Lynch, Dana McCauley
What if I’m moving house?
Physical distancing from others is still essential but you can leave your old place to move into the new one (and removalists and professional cleaners are still allowed but it’s best to avoid introducing unnecessary people into your home).
How should I handle takeaway coffee?
Wash your hands after holding your cup. “It’s all about interrupting the chance of self-inoculation,” says Associate Professor Ian Mackay, an expert on coronaviruses, at the University of Queensland. The virus has been found to last for shorter periods on card and paper than some other surfaces but it can persist, according to lab studies. “Whether there is ever likely to be enough virus on that surface to infect another person remains an unanswered question,” says Professor Mackay.
“The overarching rule here is simple: wash your hands before you touch your face if you have come into contact with something that is likely to have been contaminated with virus.”
Can I still have parties?
Aren’t you the optimist? The new rules spell the end of the backyard barbecue or the extended family dinner – at least for now. House parties might even become an offence in some states.
But experts say these tough temporary measures reflect just how easily the virus can spread. Victorian Premier Daniel Andrews has warned of a dinner party where one person was infected with COVID-19 – at the start of the night. “By the end of the dinner party, almost everybody [there] had the coronavirus – this spreads rapidly,” he said.
Why do we have to live like this?
The virus needs us to move; it jumps person to person after close contact so the idea is to slow its infection rate by temporarily changing our behaviour through physical distancing (staying home where possible, avoiding gatherings and keeping 1.5 metres clear of others). As the world waits for a vaccine, this will save lives by helping stop a surge of cases overwhelming emergency departments all at once.
Along with measures such as lockdowns and tracing and isolating cases, social distancing has worked against outbreaks in the past, including the Spanish Flu of 1918. The recent surge in Australian cases has started to slow a little in recent days as new rules come into force. But if people do not follow them, Chief Medical Officer Brendan Murphy warns that Australia could lose its window to contain the outbreak – and cases could rapidly explode.
What about high-risk groups?
The federal government is urging those aged 70 or over (as well as those with a chronic condition over the age of 60 or Indigenous people over 50) to stay home “where practicable”, avoiding contact with others as much as they can, including family such as grandchildren. If you fall into these categories, this measure is designed to protect you, not keep you a prisoner at home. You can still go outside or shop if absolutely necessary but it is best to opt for delivery or seek help from family, friends or even the local council to get supplies. Visits to aged-care homes have also been restricted to protect vulnerable elderly residents.
Deputy Chief Medical Officer Paul Kelly says Australians weighing up whether to bring elderly relatives home to care for them now face a difficult “trade-off”. On the one hand, Professor Kelly says “the most frail, elderly people requiring, for example, a lot of home care … may be best to shelter with relatives”. But if other family members are going “out into the world … and interacting with others”, they risk bringing the virus into the home. The answer isn’t always clear-cut and will come down to personal circumstances.
What’s the death rate?
Calculating the mortality rate of a pandemic that is still spreading is an imprecise science – people may be diagnosed or succumb to the illness further down the line. Based on the first 55,000-odd cases recorded in China, the WHO estimates the fatality rate so far as 3.4 per cent. But, given so many milder cases will go under the radar, most experts, including the WHO, agree the true number is likely closer to 1 per cent.
That makes it deadlier than the flu but less dangerous than the other two rare coronaviruses to emerge in humans: SARS-CoV, which also caused global panic when it exploded onto the scene in late 2002, and MERS-CoV, which causes a condition more deadly again known as MERS (Middle East Respiratory Syndrome). On the raw figures so far, about 775,000 people have been infected worldwide and at least 37,000 have died.
More than 160,000 have already officially recovered but this number is also hard to track as countries keep track of patients to different degrees and sometimes symptoms disappear before the infection leaves the body. The case of the Diamond Princess outbreak has so far offered one of the most stable data sets from which to make calculations- analysis of deaths and infections there put the overall fatality rate at just below 1 per cent.
Am I going to die?
Data out of China found most people (about 80 per cent) recovered from the new virus on their own, even if they developed pneumonia. But about one in five needed more serious medical intervention (such as ventilation to help them breathe) and, of those, 6 per cent were pushed into critical care – as multiple organs began to fail along with the lungs, or septic shock (whole-body infection) set in.
Anyone can catch the virus – but people most at risk of complications are older or have other conditions such as diabetes or heart disease, making their bodies may be less able to cope with the extra strain. Smokers are also more likely to develop a nasty infection, as the virus breeds via cell receptors in the lungs known to increase with cigarette smoke.
Experts say the higher the dose of virus you are hit with, the faster you will show symptoms and the more dangerous it can be for your immune system to fight off. For example, catching the virus from a doorknob is likely to give you a smaller dose than caring for an infected person without protective clothing such as a mask. For more on how the new virus affects the body and what it feels like to get it, you can read this explainer here.
But I’m young and not at high risk. Why can’t I socialise?
While the elderly and those with underlying conditions are more likely to die from COVID-19, young people can too. Figures from China, Europe and the US show concerningly high hospitalisation rates among the under 60s and in Australia there are people under 50 already in need of intensive care. And note this: there have now been more coronavirus cases in both NSW and Victoria among 25- to 29 year-olds than any other age group. In any case, even if you’re young and get a milder case you can still spread the virus to someone who might not be so lucky.
Where are the cases?
The first NSW COVID-19 cases were reported in Burwood, Parramatta, Randwick and Ku-Ring-Gai in late January. Clusters of cases began appearing in Ryde, Parramatta, Hornsby and central Sydney in mid-March. The virus began to spread outside Sydney on March 5, with early cases in Goulburn, the Mid-Coast and Orange. It has since spread up and down the state’s east coast and in regional areas inland. By the end of March, the biggest clusters – in Waverley, the Northern Beaches and Sydney – had more than 100 cases each. More than 100 cases were linked to three cruise ships, including the Ruby Princess, which docked at Circular Quay in late March. On April 1, a pop-up testing clinic opened in Bondi, in the local government area of Waverley, which has the highest number of confirmed cases and the highest number of those with an unknown source of infection.
In Victoria, about four in five confirmed cases of coronavirus have been recorded in the Greater Melbourne area, but COVID-19 has spread to almost every corner of the state. At the start of April, at least one resident had been diagnosed in 68 of the state’s 79 municipalities. So far, the areas with the highest numbers of cases have been among the most affluent parts of Melbourne. A woman infected with COVID-19 on a ski holiday in the US attended a 21st birthday party in wealthy inner-east Malvern, and at least six guests contracted the virus. On April 1, the Stonnington local government area, which encompasses Malvern, had the highest number of confirmed cases with 77. In recent days there have been cases among retail workers, such as a Coles and K-Mart outlet in Melbourne’s east. Hospitals have also been the site of smaller clusters and, as it stands at the moment, about 10 per cent of Victoria’s confirmed coronavirus diagnoses have been in healthcare workers.
How is the virus spread?
Viruses need hosts to survive – they can’t make it on their own. This one is shed by water droplets from the nose and mouth, usually expelled by coughing. They can travel for about a metre but are not thought to survive as long in the air as other infectious viruses such as measles. The virus spreads through close contact with infectious people. We don’t know if a person produces enough infectious particles in a single cough to infect someone, but they might. The virus can also be transmitted when you touch a surface with the virus on it and transfer it to your body, say, by touching your face.
How long does the virus live on surfaces?
So far, the best evidence we have on how long the virus lasts on surfaces comes from a letter to the editor by a team of American scientists published in The New England Journal of Medicine, one of the world’s top medical journals. The data is still early stage and needs to be interpreted with caution. They placed samples of SARS-CoV-2 on plastic, stainless steel, cardboard and copper and tracked what happened to the virus. The virus was the most stable on plastic and stainless steel and could be detected up to 72 hours later. On absorbent surfaces such as cardboard, fabric or paper it degrades much faster. However, the amount of the virus fell quickly over time. On plastic, for example, it halved in about seven hours. That indicates these surfaces do not remain infectious forever.
The overarching rule here is simple: wash your hands before you touch your face if you have come into contact with something that is likely to have been contaminated with virus.
Professor Ian Mackay, coronavirus expert
It is possible, although unlikely, exchanging cash could transmit the virus. Using a card is “probably lower risk”, write Professor Ian Mackay and Dr Katherine Arden on The Conversation, because you keep the card and don’t have to touch other people. In fact, using “tap and pay” is a social distancing practice recommended by the federal government. – Liam Mannix
What about takeaway food?
Nobel prizewinner and medical researcher Peter Doherty says that while food delivery is unlikely to be a major source of infection, it’s something to keep in mind when you’re “taking hold of the pizza box”.
“Before you take the food out, wash your hands and then put the pizza box somewhere out of the way,” Professor Doherty suggests in a webinar for the Australian Academy of Science. “It can certainly survive longer on plastics and steel … in the SARS epidemic, of course, we saw people wiping down elevator buttons. […] Just open everything, wash your hands before you take the food out of the plastic and maybe transfer it to another plastic bag before you put it in the fridge.”
Should I disinfect my fruit and vegetables?
No. The Centre for Food Safety’s guidelines say there is no evidence the virus that causes COVID-19 can be passed on via food. The US Centres for Disease Control and Prevention agrees. Food should be washed with water before you eat it. Soap or dishwashing liquid should not be used, as they can stay on food and cause sickness. There is no need to wash food you are going to cook, as the heat will kill the virus, says Arden. You also don’t need to scrub food that you are going to later peel, such as oranges.
Touching produce and then touching your face is more relevant. “Think of your hands as the enemy,” write Professor Ian Mackay and virologist Katherine Arden. If the virus comes into contact with your hands, and then you touch your nose, mouth or eyes, it can gain entry to your body. You must wash your hands with soap and water thoroughly before eating. – Liam Mannix
What temperature should I do my laundry?
We don’t need to be worried about the temperature of a wash because we use strong detergents in our washing powders, even when they are cold wash formulations, says virologist Katherine Ardern and coronavirus expert Associate Professor Ian Mackay, both at the University of Queensland. They cite a recent study, which, although not having yet been through a peer review process so not conclusive, provides an early picture of how the virus reacts in certain conditions. In a laboratory, a 30-minute incubation of the virus at 56C or a five-minute incubation at 70C rendered SARS-CoV-2 inactive. In its recommendations for households where someone is ill, or suspected of being ill with COVID-19, the US Centers for Disease Control and Prevention recommends laundering items “using the warmest appropriate water setting for the items”, and drying the items completely.
Will my dishwasher kill the virus?
A similar answer applies as with washing machines. Professor Mackay notes that if you are caring for an ill person, you need to be extra vigilant in cleaning their crockery and cutlery to ensure that you limit the risk of family spread. The US Centers for Disease Control and Prevention says this if someone has COVID-19 in your household: “The ill person should eat/be fed in their room if possible. Non-disposable food service items used should be handled with gloves and washed with hot water or in a dishwasher. Clean hands after handling used food service items.”
What disinfectant should I use on surfaces?
The NSW Health Department advises using common household disinfectant sprays for surfaces. SARS-CoV-2 is what is known as an “enveloped virus”, which means it is made of a little ball of fat and protein. That makes it relatively easily to kill with standard disinfectants.
In Australia, disinfectants are regulated by the Therapeutic Goods Administration, so if you pick the right one – look for a specific disinfectant, not a cleaner – you can be confident it works. Not all disinfectants are regulated by the same standards. Look for a specific label on the disinfectant that means it kills viruses, such as virucidal or antiviral activity. Importantly, this is different to antibacterial – antibacterial ingredients kill bacteria, not viruses.
Make sure you follow the instructions on the label, which may include cleaning a surface before disinfecting it. Cleaning and disinfecting are different things. As the CDC notes, cleaning does not kill germs in itself but, by removing them, it lowers their numbers and the risk of spreading infection. The Australian Department of Health advises you target frequently touched surfaces: door handles, bed rails, table tops and light switches.
As with all things COVID-19, there is still much we don’t know. The advice above is based on guidelines from the US Centers for Disease Control and Prevention, guidance from the Australian Department of Health, from the Australian Research Council Training Centre for Food Safety, and expert commentary from Associate Professor Ian Mackay (an expert on coronaviruses) and Katherine Ardern (a virologist), both at the University of Queensland. – Liam Mannix
Can the virus be transmitted by people without symptoms?
One of the big mysteries of the virus is how infectious asymptomatic people really are. Some experts say people shed the most virus when they are unwell, especially while coughing, and the WHO calculates a danger window of infectivity about 48 hours before symptoms first appear. But other studies have tracked infections in parts of China and Singapore to “stealth” transmitters with mild or no symptoms. This also played out in the case of the cruise ship turned floating quarantine site the Diamond Princess in early February. A study found that 18 per cent of those infected on board never showed symptoms. Because this virus can spread before symptoms appear, it is especially hard to contain.
What’s the difference between JobSeeker and JobKeeper?
JobSeeker is a payment of $550 a fortnight (now increased to $1100 a fortnight as part of a coronavirus stimulus boost) for those who have lost their employment. JobSeeker replaced the NewStart allowance in March. However, the new JobKeeper scheme is a $1500 payment (before tax) per staff member provided to employers by the government over the next six months to help businesses hold onto workers so that after the pandemic is over they can more easily start over. Employers can only receive the subsidy if they have turnover of less than $1 billion and this figure has fallen by 30 per cent or more, or they have a turnover higher than $1 billion and this has fallen by 50 per cent or more. Employers receiving the subsidy must report to the Australian Tax Office every month. See here for details. – Jennifer Duke
How does COVID-19 compare to the flu?
“Let’s stop saying it’s a bad flu,” pleaded doctor Daniele Macchini, from the northern Italian city of Bergamo, where the virus had gained a deadly foothold. Patients inundating intensive care wards had “far from the complications of a flu”, the doctor wrote on Facebook in March.
While flu has many of the same symptoms and results in tens of thousands of deaths worldwide every year, COVID-19 is more than 10 times deadlier. In Australia, government figures for the most recent flu season ending October 2019 show 812 people died of influenza out of 298,120 reported cases – a fatality rate of about 0.27%.
Emerging coronaviruses such as this strain and SARS can also do more damage to the body, particularly the lungs. And the new virus is more infectious than the flu, or SARS or MERS, with one COVID-19 patient likely to infect between two and three others.
Can you get COVID-19 and the flu at the same time?
Yes, it’s possible. As it breeds in the lungs, the virus can impair your body’s ability to filter out germs falling down from the upper airways and so leave some people susceptible to another bug – whether the common cold, influenza or a case of bacterial pneumonia. So this year there is a particular urgency behind calls for people to have their flu shots, as hospitals brace for a surge of COVID-19 and flu cases hitting all at once. On April 1, Deputy chief medical officer Paul Kelly urged Australians, especially those aged over 65, to get their flu vaccines as soon as possible. “As of now there are millions of vaccines out there ready,” Professor Kelly said.
How long will the pandemic last?
That’s the big question. This virus’s closest relative, SARS, while deadly, spread more slowly and to far fewer countries and so early containment efforts worked to wipe it out, largely within a year. For COVID-19, many experts are instead drawing parallels with the 1918 Spanish Flu pandemic, which killed millions around the world because it spread so far. The good news is medicine has taken a quantum leap forward since then. Still, modelling by the Imperial College London suggests countries will need to use control measures such as social distancing, aggressive case detection, even shutdowns right through until a vaccine becomes available – between 12 and 18 months.
How fast is it spreading?
The virus has now reached most of the world – more than 170 countries, and the World Health Organisation warns it is “accelerating”. It took the virus 67 days to infect the first 100,000 people, just 11 to reach 200,000 and four to top 300,000. By mid-March in Australia, the number of cases was doubling every three to four days. In recent days, since stricter social distancing rules came into force and more people start to stay home, that growth has slowed a little but authorities say now is “not the time to take the foot off the brake”. Outside China, major clusters of the virus have broken out in Italy, where hospitals have been pushed to the brink as well as the US, Spain, Germany, Iran, France and South Korea.
What are other countries doing to ‘flatten the curve’?
Some nations, including many in Europe, have turned to the “China model” of forced home quarantines and transport shutdowns to stop the virus. But experts note that China, as well as countries such as Singapore, Taiwan and South Korea, have also started to “flatten their curve” of infection growth through exhaustive testing, contact tracing of known cases and community take-up of “social distancing” measures such as working from home or taking schools online.
China’s success so far means it is already starting to relax many of its lockdowns, even as it braces for a potential second wave. In Italy and now other countries such as Spain, France and the UK, people are only allowed to leave their homes to run essential errands such as grabbing groceries (and they must queue 1.5 metres apart). Anyone caught breaking Singapore’s rules can land themselves in prison after the city-state made it an offence for a person to intentionally stand close to another.
Is it a cold or COVID-19?
The main symptoms of the new coronavirus are:
- Shortness of breath
A patient might also complain of chills, headaches or a sore throat. Nausea or diarrhea have also been reported, though not in the numbers seen during SARS, and a blocked nose is less common again.
What’s shutting down?
The federal government has ruled people shouldn’t gather together except for “essential” activities such as school, public transport and work – but working from home is strongly encouraged and schools will move to mostly online lessons after Easter, except for students who have to attend in person.
Shopping centres will stay open but food courts will be for takeaway only. People are urged to just buy what they need and not collect together or take time browsing. Those indoor gatherings still running should allow space for one person per four square metres.
While the government is yet to move towards a full-scale shutdown of all but non-essential services, the following have already closed or suspended:
- Indoor venues such as pubs, clubs, casinos, cinemas, and places of worship
- Auction houses
- Real-estate auctions and open-house inspections
- Personal services such as beauty therapists, waxing and tanning salons, nail bars, spas, massage and tattoo parlours (excluding related health services such as physiotherapy)
- Amusement parks, playgrounds, skateparks and arcades, indoor and outdoor play centres
- Gyms, health clubs, fitness or yoga centres, and public swimming pools
- Galleries, museums, national institutions, historic sites, libraries and community centres and facilities such as halls or RSLs
- Strip clubs and brothels
- Outdoor boot camps – but personal training (with just two people) can continue
- Retail outlets at international airports
The good news is the other thing shutting down is evictions – with a moratorium on evictions from commercial and residential rental properties as a “result of financial distress” for the next six months.
Services so far considered “essential” under a wider shutdown include pharmacies, fuel stations, health care, food shops and public transport and airports. Hairdressers and barbers are not on that list but can remain open for now – though they must strictly manage social distancing and the four-square-metre rule. The federal government says hotels, hostels, campsites, caravan parks and boarding houses will be a decision for each state and territory.
All non-urgent elective surgeries are postponed until further notice.
“If you can stay home, you must stay home,” Victorian Premier Daniel Andrews has said. “No dinner party, no shopping trip is worth a life.” Children on school holidays should not have friends over nor hang around shopping centres together, he says, and it’s not a case of moving beers at the pub to the living room. “We cannot have people queuing for intensive care beds,” Mr Andrews said. “That will mean they will die. We’ve got to buy time.”
What about weddings and funerals?
Weddings are limited to five people – the couple, the celebrant and the witnesses – and funerals must be capped at 10 people, in what the government has called “very difficult” but necessary measures.
I have asthma. Am I more at risk?
At least one in 10 Australians have asthma but the condition doesn’t mean you’re more likely to catch COVID-19. The problem is that because your lungs are already inflamed, it can leave you open to a more severe case or trigger an asthma attack. “It’s a double-whammy, really,” says National Asthma Council Australia chief Siobhan Brophy.
Respiratory physician Peter Wark says there’s not enough data yet to know exactly how COVID-19 affects asthmatics but, from previous experience with other respiratory illnesses, they’ll likely be at higher risk of complications – as was observed during the SARS outbreak and still occurs with common illnesses such as cold and flu. The WHO and other health authorities are urging extra precautions for asthmatics. Brophy says now is the time to be on your “best behaviour”: following your asthma plan and doctor’s advice to the letter and refilling prescriptions so your lungs are in their best shape possible should an infection come. While people without the condition have been hoarding ventolin, she notes there’s little point as the medication is designed to treat an asthma attack and not COVID-19.
There has been some concern about continuing asthma medication such as steroid tablets or injections, which could suppress the body’s overall immune system, Brophy says, but steroid inhalers are still fine – they only travel to the lungs and remain vital for asthmatics. “Talk to your doctor before you stop taking anything but if you’re still using an old nebuliser to take your medication, use a puffer and a spacer instead. A nebuliser will spray out particles [and possibly germs] from your lungs.” Tell your doctor about your asthma and your medication if you develop symptoms.
Don’t coronaviruses only cause colds?
Coronaviruses are a family of viruses causing respiratory illness mostly found in animals. Only seven have been identified in humans, including the four that commonly give us coughs and colds. But when a new strain jumps across from wildlife, such as SARS and now this new strain, it can be dangerous as there is no natural immunity to fight it off.
Why are there so many names for the virus?
Because it’s new, at first the virus was known simply as the “novel” coronavirus. Then the WHO named it SARS-CoV-2, given it shares so much of its DNA – about 75 per cent – with the SARS-CoV strain behind the SARS outbreak. The illness caused by this current strain is now called COVID-19.
Where did the virus come from?
The illness was first identified in a wet market reported to sell wild animals in the Chinese city of Wuhan. Unfounded theories that the virus is man-made quickly began to circulate online but scientists studying its genome already agree it came from animals – as more than 70 per cent of all new diseases emerging in humans do. Wild animals packed together and then butchered in live markets throughout Asia can be incubators for viruses to evolve and jump species barriers – SARS was traced back to a colony of bats but was believed to have passed into humans again in a wet market via the Himalayan palm civet, an ancient species of mammal eaten as a delicacy in China. And MERS also has bat origins but mostly spreads from infected camels, often in slaughterhouses. Bats are essential to many ecosystems we rely on but, through a lucky quirk in their immune system, they also carry a whole host of diseases that do not harm them. Early work suggests this new virus is 96 per cent similar to a SARS-like strain already discovered in bats a few years back, but experts think it likely first jumped into another animal, possibly the highly endangered and heavily trafficked pangolin, where it gained potency before passing into humans.
How does self-isolation work?
The question of who should practice this social distancing (everyone) versus who should seal themselves off completely has sparked some confusion. To stem the spread of COVID-19, millions of people infected or exposed around the world are also being urged to go into voluntary exile at home or in isolation wards. While some people have chosen to start home isolation themselves, thousands of others in Australia been already been issued formal notices to comply as states call in police to help enforce them.
We dive into the rules in this explainer here but in brief: if you have been in close contact with a confirmed case of COVID-19 or have returned from overseas, then you must self-isolate for a full fortnight (the estimated period of virus incubation before symptoms appear). If you are self-isolating at home, your household can still go out but you should try to keep to yourself, wearing a mask around others, ordering in food rather than going out, disinfecting common areas and keeping a close eye on how you are feeling (symptoms to watch out for are a high fever and shortness of breath). If you are infected yourself or awaiting tests, then everyone should stay home.
You can still wander into your garden or balcony but, while some officials have said you can walk the dog or stretch your legs, Deputy Chief Medical Officer Paul Kelly says you must stay home if you’ve been told to self-isolate: “Sorry.”
Despite these rules, Chief Medical Officer Brendan Murphy said, on March 27, that Australia was still seeing large numbers of returned travellers with the virus and, in many cases, passing it on to their families. “More than two-thirds are returned travellers, and a significant proportion of the other cases have been transmitted from returned travellers,” he said. From March 29, all overseas arrivals are being escorted from airports into hotels and other accommodation for the 14-day window, at the government’s expense. The army has been called in alongside police to enforce these quarantines after a number of people were caught out of their homes breaking self-isolation orders.
Can someone test negative but be a carrier?
Yes. Some people will be infected without symptoms or very mild symptoms. To test for the virus right now, clinicians need to either take a direct sample, from a throat or nose swab or in lung phlegm, and examine the genetic code of the virus. Those tests are considered very accurate but in some cases if they miss the virus – say, because it is further down in the lungs and someone doesn’t cough up any phlegm (or sputum) – they can return a false negative. That’s why tests are often repeated, especially for patients recovering and returning to the community. Blood tests, which look for the body’s immune response to the infection, can also be used but are not yet widely available outside China.
Why aren’t we testing more?
Countries that have succeeded in “flattening their curve” and dramatically slowing outbreaks have carried out exhaustive testing and contact tracing. In many cases, people without symptoms are tested, and health officials actively hunt for others, checking temperatures on entry to buildings. Australia’s testing rates are proportionately high compared to many other countries (more than 178,000 have been done so far) but the criteria for being tested is still very strict due to a global shortage of testing kits, the government says.
In recent days, the government has moved to both ramp up the operation to 10,000 tests a day and expand that criteria, meaning frontline staff with symptoms can now qualify too. Sample testing of people with symptoms who have not been overseas or exposed to a known case will also start in areas identified as at risk of community transmission, such as Sydney. Deputy Chief Medical Officer Paul Kelly says faster tests that can be done at home are also due to arrive in Australia but still needed to go through quality, safety and efficacy checks by the Therapeutic Goods Administration.
On March 29, Chief Medical Officer Brendan Murphy said Australia had one of the lowest positive rates for testing in the world, meaning authorities felt “reasonably confident that we are detecting a significant majority of cases in Australia and that means we can get on top of cases” through contact tracing. That’s in contrast to countries such as Iran, Italy and even the US, where Professor Murphy says it’s likely that “when they detected significant outbreaks they probably had much, much larger outbreaks in community that were undetected”.
Still, at times Australian authorities have also faced criticism for letting contacts of cases slip through the net, most notably allowing 2700 passengers to disembark in Sydney from the Ruby Princess cruise ship, about 200 of whom later tested positive. But the states have also threatened hefty fines and even jail time for those at risk of spreading the virus who break home quarantine orders.
How long does it take to recover?
Symptoms tend to clear up in just a week or two in mild cases or three to six for more serious, according to WHO data, but early evidence suggests the virus can stick around in the body even longer. Australian researchers have now mapped the body’s immune response, identifying the antibodies it recruits to defeat the new virus, in some people starting the fight within just three days of the initial infection. Experts say it’s too early to say if this illness will result in permanent damage, such as the lung tissue scarring seen in more severe SARS and MERS patients.
Are you immune after catching COVID-19?
Scientists aren’t sure yet. Recovering from a virus leaves us armed with antibodies in our system to fight it off, and usually confers at least a period of immunity (though not always a life-long shield). Many experts say reports of people appearing to catch this new virus twice are probably best explained by false negative tests clearing them of the infection too early (when the virus had actually remained in their system). Common coronaviruses such as the ones that give you a cold tend to go away for at least a year or so before we become susceptible again. Studies of MERS-CoV has found antibodies still present in survivors more than 18 months after recovery, and some survivors of SARS retained antibodies for many years thereafter.
Can I still travel?
Only if you really have to. Our borders have closed and overseas travel is now banned under biosecurity powers, except in exceptional circumstances. Citizens still travelling abroad are urged to come home as countries impose similar shutdowns of their own.
Starting with Tasmania, most states have also started to close their domestic borders – police patrols will now ask people crossing over to go into quarantine for the recommended 14-day window.
What treatment is given in intensive care?
Difficulty breathing is the main reason that people with COVID-19 present to a hospital, says the head of the Alfred Hospital’s intensive care unit, Associate Professor Steve Mcgloughin. The virus, which attacks the lungs, can progress quite quickly, worsening beyond shortness of breath. Once admitted to a ward and receiving oxygen via a mask, a person’s condition may improve – but other people will need increasing amounts of support to keep their lungs sending oxygen throughout their body.
“That’s where intensive care would step in,” says Dr Mcgloughin. “If it’s bad enough that you need to be put on a breathing machine then you would definitely be in intensive care. If there was a sense that a patient was deteriorating towards needing a ventilator or a life-support machine, we’d also put them in intensive care. What intensive care is able to offer is the medical specialists and more monitoring … It’s very intense – not surprisingly, given the name.”
Without a drug that is definitively proven to halt or even slow COVID-19 at this stage, the aim is to support patients until they recover. “We wait for the virus to clear up and then the lungs will often repair themselves if we can wait and just support them while they do that. So you might have a period of, say, a week on a life-support machine where the virus starts to clear itself and the lungs start to improve and then we take the breathing machine away.”
But, as experience has shown worldwide, the outcome is not always positive. “Keeping people in a sort of induced sleep, the energy demands of their body go right down,” says Dr Mcgloughin. “They’re not using as much oxygen as they would normally. The problem with that is it works quite well and it’s a really effective therapy but, obviously, being in that state puts the body in quite a vulnerable position.”
There are two problems that can arise, he says. One is that the infection itself can affect the other organs. And there is “just the stress of being so sick”. “We’re supposed to be up and walking around but when you’re in intensive care your body is a little bit vulnerable to either getting another infection from bacteria, or the virus itself affecting your other organs. That’s why there is a difference, unfortunately, that people who are a little bit older or those a bit more vulnerable beforehand don’t do as well as people that are younger.”
Dr Mcgloughin, who chaired the group that wrote the COVID-19 guidelines for The Australian and New Zealand Intensive Care Society, says Australian hospitals are benefiting from the advice of colleagues overseas, including in Italy and Singapore, both about treatments and how to protect themselves. “Within weeks of what happened in Italy, they had already published very detailed summaries of what happened. I’m amazed the guys were able to do that.”
So what would he say to younger people, including those aged 20-29 who have been diagnosed with COVID-19 in NSW and Victoria more than any other age group?
“Stay home. Do what the government’s asking us to do. Let’s do that for a week or a few months. You’re doing it potentially to protect yourself – it’s not impossible that young people get sick – but you’re really doing it to protect the older people in our community. To me, it’s a real social responsibility. It’s sort of a good test of Australians’ ability to look after each other, really. You know, we all like to think we do that – but this is probably the chance to prove it.”
How are ventilators used to treat COVID-19?
Anyone who’s had a general anaesthetic will have relied on a ventilator, whether they know it or not. It happens between the bit where you start to feel drowsy – ”you stop breathing and then I put in a breathing tube and put you on to a breathing machine,” says Dr Suzi Nou, president of the Australian Society of Anaesthetists – and the bit where you wake up in the recovery room. That breathing machine is a ventilator, pushing oxygen into your body. “For healthy patients undergoing routine surgery, [when] I stop giving them anaesthetic, they start breathing for themselves,” says Dr Nou.
Treating patients with COVID-19, whose lungs are compromised by the disease, is another story. “They’re too unwell to do the job of breathing for themselves. We’d induce the state of sleepiness, put a breathing tube in and put them on the ventilator.” While a patient having routine surgery will rely on a ventilator for minutes or hours – and it’s not uncommon for a patient in intensive care to rely on one for four or five days – a patient with COVID-19 might need one for as long as 10 days.
This is why ventilators have become such a precious commodity worldwide since the pandemic took hold, prompting a doctor in the hard-hit Italian region of Lombardy to say they had become as precious as gold. There are plans for the number of ventilators (and intensive care beds to go with them) in Australia to be doubled to 4000 while more have been freed up by the suspension of non-urgent elective surgery and still more are now being manufactured in Australia. As of march 31, there were 20 patients with COVID-19 on ventilators in Australian hospitals.
But behind every ventilator is a team of experts too, such as Dr Nou and highly trained nurses. In Australia, every patient on a ventilator has a dedicated nurse. It’s these professionals who need to be supported to keep coming to work in the coming weeks and months, says the head of the Alfred Hospital’s intensive care unit, Associate Professor Steve Mcgloughin. “Everyone is very focused on the machines,” he says, “but the most valuable resource we have in healthcare is the people.”
How does the virus affect pregnant women – and babies?
At this early stage, we are still not absolutely sure how the virus affects women and babies. Different governments have offered different advice.
For now, let’s stick to what Australia’s peak body, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZOG), has to say. Note these guidelines are changing regularly and you should check back on their website for the most up-to-date advice. According to guidelines, at this stage it does not appear that pregnant women are at greater risk from COVID-19 than the rest of the population. Most will get mild symptoms, similar to a cold or flu. There are no reported deaths in pregnant women.
However, generally pregnant women who get any respiratory disease, such as the flu, are at an increased risk of serious complications. This fact, combined with scientists not knowing enough about the virus, means pregnant women should remain vigilant of their own health. There is no evidence of an increased risk of miscarriage or birth abnormalities, nor is there evidence the virus can pass from woman to unborn child. Newborn babies do not appear to be at increased risk of infection. There is no evidence the virus can be carried in breast milk. “The safest place to birth your baby is in a hospital, where you have access to highly trained staff and emergency facilities,” the guidelines state. If the mother is infected at the time of birth, she should not be separated from her newborn, but should wear a mask and take precautions. The health advice is the same for pregnant women as it is for everyone else: work from home, avoid public places, and nail your hand hygiene.
Are pregnant women allowed to have a support person in the labour ward with them?
The RANZCOG guidelines suggest visitors in hospital are limited only to the immediate partner. But this is just a suggestion – different hospitals will have different rules.
Is public transport stopping?
No. Public transport is still running as it is considered one of the essential activities exempt from the government’s ban on gatherings but cleaning has been ramped up. While calls are growing from some experts to shut down public transport already, many people rely on it. Still, as social distancing rules come into force, travellers are deserting normally packed routes in droves. When on public transport, health officials say you should allow room for others as much as possible, rather than crowding in. It’s also important to keep an eye on what you’ve been touching. If you then touch your face, a virus surviving on, say, a metal handrail could jump across – so carry a disinfectant or even wear one (stylish) glove for holding on and touching things.
Can you catch it from pets?
It appears that, as with SARS, it’s possible for our pets to catch the virus from us in very rare cases (although they do not fall sick or become infectious). But despite hysteria about a pomeranian in Hong Kong returning a “weak positive” test for COVID-19, the WHO stresses there’s no evidence the virus can jump the other way, from pets to people, and no one should abandon their animals. The risk instead would come in if a pet itself became a contaminated “surface” (from all those sloppy kisses). You should exercise the usual cautions around animals, washing your hands after touching them.
How far away is a vaccine?
The most hopeful estimates fall within the range of 12 to 18 months. A report for the British government put it at “potentially 18 months or more”. Why? Because making a vaccine is really, really hard. To make a vaccine, you first need to design a way of giving a human immunity against a virus. Then you need to make sure the vaccine is not toxic. Then you need to test it in animals. Then you need to test it in humans – and the tests need to be large so we can make sure it works and is safe. And then you need to make the billions of doses needed. And there is every chance a vaccine that looks promising in the lab, or in animal tests, won’t work in humans. Experts are hoping to roll out a safe vaccine within 18 months. But even that would be unprecedented. No vaccine has ever been developed that quickly. – Liam Mannix, science reporter
What treatment is being developed?
The Peter Doherty Institute in Australia is working on both a vaccine and a potential therapeutic treatment for the virus, and director Sharon Lewin says the latter might offer a faster fix. A drug that could block the virus from replicating in the body (or calm down the body’s intense immune response to it) could keep patients with severe infections alive and, in the case of an antiviral, reduce transmission. Several existing drugs are now being trialled against the new virus worldwide, including those used to treat HIV, malaria, and arthritis. The results look promising but it’s not time to rush out to the pharmacy just yet.
Should I wear a face mask?
Face masks can protect against the water droplets that spread the virus and are now commonly worn out in parts of the world such as Hong Kong and Singapore. But because this virus spreads through close contact, rather than from simply passing someone on the street, many experts in Australia say wearing masks if you’re not interacting with an infected person is largely pointless. More concerningly, people hoarding masks is leading to critical shortages for those who really need them – healthcare workers on the frontline. Chief Medical Officer Brendan Murphy has urged people not to “waste” masks unless they themselves have symptoms or are caring for someone who is infected. Masks should be changed regularly but Professor Doherty recommends sterilising used masks rather than throwing them away, given the shortage. Still calls are growing in many Western countries, including the US, for a wider take-up of face masks to slow community transmission.
How does this outbreak compare to others such as SARS?
It took this new coronavirus 48 days to infect the first thousand people. By contrast, SARS took 130 days and the less infectious MERS more than two years to infect a thousand people after it emerged in 2012. When SARS finished its spread after nine months in 2003, only 8098 cases had been confirmed across 26 countries but close to 10 per cent of those were fatal. (Most clusters happened in hospitals or households.) MERS has been circulating for eight years across 27 countries so far, and kills about a third of those who fall ill – out of about 2500 confirmed cases. Ebola is even more deadly, killing more than 40 per cent of those diagnosed over a number of outbreaks since the 1970s but it has been reported in just a handful of countries.
In the pandemic records, the infamous 1918 Spanish flu killed about 2.5 per cent of its victims over two years – but because it infected so many people (close to 27 per cent of the world’s population) at a time of much cruder medical care, about 50 million died. Today, doctors are much better able to stave off secondary bacterial infections, which proved particularly deadly during that outbreak. And, unlike the Spanish flu, young people are not dying at the same rates – with very few children coming down with severe cases ( a phenomenon also observed during SARS).
The last pandemic was swine flu in 2009, the second coming of a H1N1 influenza that infected between 11 and 21 per cent of the world’s population. Governments mounted costly responses until it was ruled to be over in October 2010. But the virus killed about 285,000 people (fewer than seasonal flu normally does) with a relatively low fatality rate of .02 per cent, and the WHO copped criticism for labelling it a pandemic at all.
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What happens if I lose income?
Billions of dollars are being poured into the Australian economy to offset the damage being done to businesses and employment by the coronavirus pandemic. For details of who gets what from stimulus packages, look here.
Centrelink payments have been lifted and expanded. And, in a bid to stop companies cutting jobs, employees of eligible businesses can claim a new $1500 fortnightly ‘Jobkeeper’ payment, even some who have already been let go so long as they were with the company on March 1. Businesses and not-for-profits that have experienced more than a 30 per cent downturn in revenue are eligible and payments will be delivered in May but backdated to March.
The federal government estimates about half of the workforce – or six million people – will get this payment over the next six months.
If you’ve lost your job because of the crisis, this explainer outlines what support is available.
Our team will answer more questions and update information in this story regularly.
If you suspect you or a family member has coronavirus you should call (not visit) your GP or ring the national Coronavirus Health Information Hotline on 1800 020 080.