Shedding light on virus-shedders

This week’s expert:
Prof Hubertus Jersmann, Senior Respiratory Physician, SA Health; Senior Consultant, Adelaide Hospital; Professor, Discipline of Medicine, University of Adelaide.

Drawn from an interview with Prof Jersmann by Dr Harry Nespolon on the Healthed podcast Going Viral.

• Of the people admitted to Adelaide Hospital with COVID-19, the commonest early symptoms were lethargy, fever and cough. Sore throat was rarely described as an initial symptom.

• Only about 85% of people with COVID-19 actually shed the virus, the reason for this is unclear.

• The ‘virus-shedders’ usually have mild symptoms early and then will test negative for the virus eight days later.

• The other COVID-19 patients, who often don’t shed the virus early, get unwell slowly, becoming worse in the second week of infection with pulmonary infiltrates noted on CT scanning and decreased oxygen saturation.

• Less than 3% of all people with COVID-19 have been admitted to ICU.

• Why some patients deteriorate to the point that they need ICU admission remains unknown but to date, pre-existing cardiovascular disease and old age remain the biggest predictors of who will require more intensive care.

• Experience suggests COVID-19 is more than just a respiratory virus, it appears to cause inflammation of the vascular bed. In the UK, hospitals have seen the highest number of Kawasaki-like presentations in an atypical population which they are attributing to a vasculitis caused by COVID-19.

• It is believed that it is the effect of COVID-19 on the vascular system that is prolonging the recovery time in some patients. It is also the reason why some severely affected patients deteriorate very quickly, developing cardiac and renal involvement which can be fatal.

• Hydroxychloroquine is not being used routinely as treatment for COVID-19 in Australian hospitals. If it is used, it is part of a trial, as, to date there is no evidence it is effective and there is a possibility it can cause harm. Currently there are insufficient cases of COVID-19 currently being treated in Australian hospitals to allow us to play a major international role in researching possible treatments – fortunately.

• Current social and personal practices that have been instigated to prevent the spread of COVID-19 appear to also be successful in preventing the spread of seasonal influenza. To date there has not been a single case of influenza admitted to Adelaide Hospital this season. It could be that COVID-19 prevention methods may prevent an outbreak of influenza completely this year and we hopefully won’t see a repeat of the 663 influenza deaths that occurred last year.

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