Victoria may have eliminated COVID-19, but eradication is a distant dream - The Conversation AU

Victoria may have eliminated COVID-19, but eradication is a distant dream - The Conversation AU
Over 1 Million Children Tested Positive For Coronavirus In The United States - NPR
From polio to COVID: Central Ohio woman joins vaccine trial to help end another outbreak - The Columbus Dispatch

Posted: 26 Nov 2020 01:11 PM PST

Today Victoria satisfied a common definition of elimination for COVID-19, recording its 28th consecutive day of zero new cases. While there is no international definition of elimination, two average incubation periods without community transmission is widely accepted as local elimination, especially in a geographically isolated country like Australia.

It's a remarkable achievement following a severe second wave which peaked at daily new case rates of around 700 in early August. But elimination is not eradication, and we can expect the virus to return at some point, as has happened in several countries that previously boasted minimal or no community transmission.

So how did Victoria get here, and what can it do to keep numbers as low as possible?

Elimination is not eradication

There's no universal definition of elimination. As applied to other infectious diseases such as polio and measles, it means a prolonged period of zero local transmission in a country or region. For measles, the World Health Organisation (WHO) is very exacting and demands no community transmission for 36 months.

With more than 500,000 new daily COVID cases being reported globally, preventing new local transmission in Victoria will depend on the state building a virus-proof defence.

Several countries have shown the virus can return after a long period of minimal local transmission. The most pertinent example is New Zealand, which experienced 102 consecutive days of zero community transmission before a cluster cropped up in Auckland on August 11. Israel, South Korea, Vietnam and Hong Kong have also experienced reemergence of the virus following significant periods of minimal community transmission. And this month, we witnessed a cluster in suburban Adelaide that originated in a quarantine hotel, after South Australia had experienced many months of no community transmission.

Indeed elimination doesn't mean the virus is completely gone. For example, Australia eliminated local transmission of polio in 1972. But it wasn't until 30 years later, in 2002, that the WHO declared Australia polio-free.

Almost 20 years after that declaration, we still can't say we've eradicated polio because eradication refers to the global removal of a human pathogen; only smallpox has achieved that status. One strain of the polio virus continues to circulate in Afghanistan and Pakistan. In 2007, a 22-year-old student from Pakistan was diagnosed with polio at Box Hill Hospital in Melbourne's East.

Shoppers at Bourke Street Mall, Melbourne — Victorians are now enjoying relative freedom as coronavirus restrictions eased significantly. Erik Anderson/AAP

So, how did we get to zero?

Since the grim height of Victoria's second wave in July and August, several coordinated interventions have eventually borne fruit. One of the most important was the strengthening of the test-trace-isolate-support system. While details are emerging during the parliamentary inquiry into Victoria's hotel quarantine system, some of the features of this strengthening are known:

decentralisation through regional hubs and metropolitan public health units
increased engagement and involvement of communities, through programs aimed at public housing estates and local initiatives led by GPs and community health centres
adoption of "upstream" contact tracing, identifying contacts of index cases before they developed symptoms as well as after developing symptoms. In both groups, contacts of contacts were identified. This led to the rapid control of clusters such as those in Kilmore and Shepparton.

Other important initiatives included the joint federal-state Victorian Aged Care Response Centre, which eventually managed the explosive outbreaks in residential aged care facilities, and more effective infection prevention and control in health-care settings.

And there were the containment measures that kept people from intermingling. Stage 3 restrictions were reimposed on July 8, limiting the reasons people could leave home. A study published in early August found these restrictions averted between 9,000 and 37,000 cases. From July 23, masks were mandatory at all times outside the home. On August 2, stage 4 restrictions and a night curfew effectively shut down Melbourne. From then on, the number of new cases steadily declined.

Perhaps the greatest achievement of Victoria's response was to maintain a strong health focus amid a chorus of criticism, much of it from Canberra or the Sydney-based media, pushing the "economy first" mantra. In fact, data show countries that managed to protect the health of their citizens have generally protected their economy more effectively.

How can we stay where we are?

The first requirement is an effective quarantine system for returned travellers. With cases surging globally, the proportion of travellers who are infected will increase significantly from the 0.7% reported between March and August. This will require arrangements that employ well-trained and adequately paid workers who are regularly monitored by infection control and occupational health and safety experts. The advance contact tracing, which will identify the close contacts of staff before they might test positive for the virus, announced by Premier Daniel Andrews would be a useful adjunct as long as confidentiality is assured.

Crucially, experienced teams of contact tracers must be on standby. They need to maintain the rigorous standards developed over the past few months and engage in simulation exercises that test their capacities. They must retain a focus on community trust and avoid the vilification of individuals that marred the South Australian response.

What's more, the state must sustain proven containment measures such as physical distancing, hand hygiene, masks indoors, and getting tested if you have symptoms.

Australia is an almost COVID-free oasis, surrounded by a tsunami of virus. Maintaining this status for the next six months or so, while at the same time opening up, will be a huge challenge. Recent responses in Victoria, NSW and SA suggest we are up to it.

And as the story of the sharp-eyed doctor in Adelaide showed us — when she tested a patient in the emergency room who'd initially felt "weak" but had very few COVID symptoms, alerting authorities to the previously silent spread of the virus — to maintain elimination we're also going to need a little luck.

Over 1 Million Children Tested Positive For Coronavirus In The United States - NPR

Posted: 16 Nov 2020 12:00 AM PST

A child wears a protective mask while playing in April in Prospect Park in the Brooklyn borough of New York City. Stephanie Keith/Getty Images hide caption

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Stephanie Keith/Getty Images

A child wears a protective mask while playing in April in Prospect Park in the Brooklyn borough of New York City.

Stephanie Keith/Getty Images

Children now make up at least 1 in 11 of all reported U.S. coronavirus cases.

That's according to data from the American Academy of Pediatrics and the Children's Hospital Association. On Monday, the AAP said more than 1 million children have tested positive for the coronavirus in the United States.

"As a pediatrician who has practiced medicine for over three decades, I find this number staggering and tragic. We haven't seen a virus flash through our communities in this way since before we had vaccines for measles and polio," AAP President Sally Goza said in a statement.

The data are compiled from state reports and show 1,039,464 children have tested positive for the coronavirus as of Nov. 12. In the one-week period ending that day, there were nearly 112,000 new cases in children, the largest one-week increase.

The virus has had a disproportionate impact on Black and Hispanic children, the AAP said. They have suffered a higher number of infections and are more likely to be affected by economic harms and lack of access to education and other critical services.

The number of children with the coronavirus is thought to be widely underestimated. Because most have no or few symptoms, and it is rare for them to experience severe symptoms, many children are never tested, the AAP noted.

Babies under 1 year old and children with certain underlying conditions may be more likely to have severe illness from the virus, according to the Centers for Disease Control and Prevention. Some children can experience a rare complication associated with COVID-19 that can cause organ inflammation.

Children's mental health is also being affected by the pandemic. According to a recent CDC report, children ages 5 to 11 made emergency room visits related to mental health about 24% more than last year. Visits from children ages 12 to 17 increased about 31%.

As winter approaches and people stay indoors more, the AAP's Goza emphasized the need to get a coronavirus vaccine approved. She also highlighted other immediate control measures.

"We urgently need a new, nationwide strategy to control the pandemic, and that should include implementing proven public health measures like mask-wearing and physical distancing," Goza said. "This pandemic is taking a heavy toll on children, families and communities as well as on physicians and other front-line medical teams."

Reese Oxner is an intern on NPR's News Desk.

From polio to COVID: Central Ohio woman joins vaccine trial to help end another outbreak - The Columbus Dispatch

Posted: 21 Nov 2020 02:31 AM PST

Max Filby | The Columbus Dispatch

Patricia Iams remembers how big a deal it was when, at 8 years old, she lined up in school in 1955 to get the polio vaccine. Decades later, that memory is one of the many things that pushed her to join a local coronavirus vaccine trial.

Iams, now 73, of Upper Arlington was the first person to participate in a vaccine trial at the Ohio State University Wexner Medical Center. Iams was injected with either the vaccine or a placebo on Nov. 10 and will return for a second shot in December.

"I remember from childhood that polio was so scary and our parents were even more scared," Iams said. "If this makes a difference, then I want to be part of it."

Although a polio vaccine was discovered in 1955, Iams recalled similar circumstances surrounding the lead-up to one. She remembers her parents not allowing her to swim at the community pool, for fear that she'd catch the disease.

Like COVID-19, which has killed more than 250,000 Americans including nearly 6,000 Ohioans, polio is considered one of the most dreaded diseases of all time. Polio typically paralyzed up to 20,000 Americans per year in the early 1950s and killed between 2% and 5% of children who contracted it and up to 30% of adults with it, according to the Immunization Action Coalition, based in Saint Paul, Minnesota.

While a polio vaccine took 20 years to develop, results for the COVID-19 vaccine Ohio State is testing could be published in record time by the end of the year, according to AstraZeneca, the company producing it.

The drug maker has produced the potential vaccine, called AZD1222, in partnership with the University of Oxford in the United Kingdom. It is also part of the United States' Operation Warp Speed, which has pumped billions of dollars into COVID research to expedite the creation of a vaccine.

The university is seeking 500 volunteers to participate while AstraZeneca is looking to enroll about 30,000 people total at 80 locations across the country, according to Ohio State.

Half of the participants for AstraZeneca's clinical trials will receive the potential vaccine and the other half will receive a placebo. They will then have blood samples drawn and follow up with medical experts over two years, according to Ohio State.

"I think it's important because the entire world is in need of a vaccine. There isn't going to be any one company to do it," said Dr. Susan Koletar, director of infectious diseases at Ohio State who is overseeing the trial. "We're going to need a lot of options."

Though it could be another two months before AstraZeneca's full trial results are available, the data is already in on potential vaccines from Moderna and Pfizer.

Both companies have said their vaccines are 95% effective. Pfizer applied Friday for emergency authorization from the Food and Drug Administration and will begin distributing the shots immediately after approval.

While the vaccines from Moderna and Pfizer use different technology than the AstraZeneca version Ohio State is testing, their success bodes well for it, said Dr. Kelly Moore, associate director of education for the national Immunization Action Coalition and a professor of health policy at Vanderbilt University in Nashville, Tennessee.

Each of the three vaccine candidates targets a spike protein found on the virus that causes COVID-19. The spiky or crown-like surface of the virus gives the disease its name and allows it to attach to human cells once it enters a person's body.

Since the vaccines from Moderna and Pfizer have proven successful, it's likely AstraZeneca's will too, Moore said.

"Everybody's bet was pretty much on the spike protein on the surface of the virus. What Pfizer and Moderna's vaccines show us is that was the right target," Moore said. "That's good news for the whole field of vaccines being studied because hitting the right target is half the battle."

It's likely that more than one or two successful vaccines will be needed to end the pandemic, Moore said.

Over time, Moore said, some could prove to work better in certain age and demographic groups. That's where vaccines from AstraZeneca, Johnson & Johnson and other companies could be helpful.

Early data from the AstraZeneca trial shows the vaccine appears effective in older adults, a group of people in whom vaccines aren't always as strong. In a Thursday announcement, AstraZeneca also said that in 100% of participants it found high levels of neutralizing antibodies, an immune system protein that can defend one's body against COVID-19 and might prevent symptoms altogether.

If protection from vaccines ends up lasting long enough, it's thought they could bring COVID-19 to heel as they have other diseases, such as polio.

It took 24 years to eradicate polio in the United States. With a few exceptions, the U.S. has largely been polio-free since 1979, according to the Centers for Disease Control and Prevention.

Iams hopes it won't take quite so long for forthcoming vaccines to make COVID-19 disappear. After spending her career as a nurse, Iams said she thinks a vaccine is critical to ending the pandemic.

"People just don't see (polio) anymore, but I know how bad that had been. &mldr; It made a big difference to have a vaccine," Iams said. "I don't think we'll really be able to deal with this COVID until we have a vaccine."

mfilby@dispatch.com

@MaxFilby

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