COVID-19 information - Dr Alice Lam, GP & Medical Writer

COVID INFORMATION

A case of TMI (too much information) can cause us to feel overwhelmed. Here’s a hand-picked selection of important things to know about COVID right now.

Let’s run through what you need to know about boosters, antiviral treatment, testing and more.

ATAGI 2023 booster update

2 April 2023

Australian Technical Advisory Group on Immunisation (ATAGI) now recommends the following to prevent severe COVID-19 illness, regardless of number of previous doses received. The vaccine should be given 6 months after known COVID-19 infection (or last COVID vaccine), although there is no known risk if someone receives a vaccine after having had the illness without knowing it. This advice takes into account effectiveness of current vaccines (including new bivalent type) and the evolving Omicron strains.

WHICH VACCINE IS BEST?

Bivalent mRNA booster vaccines (e.g. Pfizer Original/Omicron BA.4/5, as well as Pfizer Original/Omicron BA.1 or Moderna Original/Omicron BA.1) are preferable over the other available COVID-19 vaccines although they should also provide some benefit.

You can receive the COVID-19 vaccine at the same time as an influenza and other vaccines.

Out of the new Omicron subvariants in Australia, none appear to be dominant, and none are thought to be more severe than the older variants, Although the COVID-19 vaccines may be less effective and less long-lasting than the previous variants, the vaccines are expected to provide good protection along with hybrid immunity – combined immunity from past infection and past vaccination.

WHO SHOULD HAVE A BOOSTER THIS YEAR?

ATAGI’s advice is summarised in the table below. Risk factors (ongoing medical conditions that increase risk of severe COVID-19, or disability with significant or complex health needs)
(marked * in table) are listed here.

More information is available at https://www.health.gov.au/news/atagi-2023-booster-advice

Reference

ATAGI 2023 booster advice [Internet]. Australian Government | Department of Health and Aged Care. 2023 [cited 2023 Feb 9]. Available from: https://www.health.gov.au/news/atagi-2023-booster-advice

Do boosters work?

There is good evidence that having a primary course (for most people that consists of two doses) reduces your risk of infection, and having a booster dose has an even stronger effect (Figure 1).

On 21 January 2022, a Press Briefing by White House COVID-⁠19 Response Team and Public Health Officials announced that boosters were proven to provide increased effectiveness against Delta and Omicron variants in:

Preventing COVID-19–associated emergency department and urgent care visits, and
Preventing COVID-19–associated hospitalisations

COVID-19 boosters in more depth

Updated 13 July 2022

Get your COVID-19 booster or winter dose PLUS flu shot if you haven’t already. You can check out this link for current recommendations on who should receive additional fourth (or fifth) COVID doses, or see the summary (Figure 2).

You are eligible for a booster dose if you completed your primary dose course of COVID-19 vaccination at least 3 months ago, and:

Figure 2. Australian eligibility criteria for additional booster doses.

Adapted from Australian Government Department of Health and Aged Care. COVID-19 booster vaccine advice [Internet]. Australian Government Department of Health. 2022 [cited 2022 Jul 13]. Available from: https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-your-vaccination/booster-doses

The rise of Omicron - what do we know?

Updated 25 December 2021

On 24th November 2021, the latest COVID-19 variant was reported to the World Health Organization (WHO), following a steep rise in infections.

Omicron was reported to have been found in 76 countries as of 12 December 2021 [1] and 89 countries in all six WHO regions by 19 December 2021 [2]. Most Omicron cases in November 2021 were travel-related but now community clusters are being seen [2].

The WHO has now advised that Omicron is spreading faster than Delta, with Omicron cases doubling every 1.5 to 3 days in places with community transmission – even in places where there are high levels of population immunity [3]. Omicron appears to be spreading faster than Delta in countries such as South Africa and the UK [3]. In fact, Omicron is now the dominant strain in several countries, and in Australia, community transmission of the Omicron variant is occurring in every jurisdictions apart from Western Australia [4].

Interestingly, a snapshot of total number of COVID-19 cases on 14 December 2021 reported that in the past two months, Delta made up 99.2% of cases, followed by Omicron at less than 1 in 1,000 cases [2].

Awaiting peer-review, a recent report by Imperial College London suggests that there is just over a five-fold higher risk of being re-infected with the Omicron variant compared to the Delta variant – implying that past Omicron infection only gives 19% protection. This can be compared against the 85% protection for the six months following Delta infection. Data suggest that booster doses are needed to improve vaccine effectiveness against symptomatic Omicron infection (see Figure 1 below) [5].

As preliminary evidence also suggests that vaccines may be less effective against Omicron transmission [3,5], booster doses are now being recommended. A little more on booster shots coming up. ATAGI advise shortening the interval between the primary course and the booster dose from five months to four months for all adults aged 18 and over; in time this is expected to reduce to three months. This shortened booster interval also applies to pregnant women, and to immunocompromised people who have had a three-dose primary course [4].

More data are still needed to confirm whether Omicron will cause more severe disease compared to other variants. Although generalisations cannot be made, in Scotland and South Africa it has been reported that there is a reduced risk of hospitalisations of around 67-80% respectively than for people with the Delta strain [4]. However, current COVID-19 treatments are expected to still be effective for Omicron [2].

And finally, Omicron appears to be detectable using our current polymerase chain reaction (PCR – where genetic material is detected) and rapid diagnostic tests (or lateral flow tests, LFTs, where viral proteins are detected) [2]. You can read more about LFT versus PCR testing here.

Researchers continue to collaborate globally to assess the performance of our current vaccines, tests and treatments [1].

References

1. World Health Organization. Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern [Internet]. 2021 [cited 2021 Dec 19]. Available from: https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern

2. World Health Organization. Weekly epidemiological update on COVID-19 – 14 December 2021 [Internet]. 2021 [cited 2021 Dec 19]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20211214_weekly_epi_update_70.pdf?sfvrsn=ad19bf83_3&download=true

3. World Health Organization. Enhancing Readiness for Omicron (B.1.1.529): Technical Brief and Priority Actions for Member States | Overview [Internet]. 2021 [cited 2021 Dec 19]. Available from: https://www.who.int/publications/m/item/enhancing-readiness-for-omicron-(b.1.1.529)-technical-brief-and-priority-actions-for-member-states

4. ATAGI. ATAGI Statement on the Omicron variant and the timing of COVID-19 booster vaccination | Australian Government Department of Health [Internet]. 2021 [cited 2021 Dec 25]. Available from: https://www.health.gov.au/news/atagi-statement-on-the-omicron-variant-and-the-timing-of-covid-19-booster-vaccination

5. Head E, van Elsland S. Omicron largely evades immunity from past infection or two vaccine doses [Internet]. Imperial News. 2021 [cited 2021 Dec 19]. Available from: https://www.imperial.ac.uk/news/232698/omicron-largely-evades-immunity-from-past/

In this section, we’ll start with the ins and outs of testing, what to do if you test positive, and a look at the main antiviral medications and who is eligible.

Rapid antigen tests (RATs)

Updated 8 March 2022

From 1 November 2021, the Therapeutic Goods Administration (TGA) approved use of rapid antigen self-tests (RATs or RA tests), which are sold in participating pharmacies and retail outlets.

Useful for home or workplace testing, RATs detect the virus via either nasal swab or saliva, giving a likelihood of having COVID-19. This is important to understand, as these tests are less accurate than standard (PCR) tests (i.e. have more false-positives and false-negatives than PCR tests), but they are quicker, generally giving a result in 15-20 minutes. RATs can also be used by children aged 12-17 years with parental/guardian guidance, and by a parent/guardian if under 12.

Here is a good summary of when and which tests are useful in different situations.

If you have a positive test, you have COVID and must isolate immediately. See below for “If you test positive for COVID”.

If you have a negative test, especially if you are well, it is likely you do not have COVID. But if you have any symptoms, you can repeat the RAT in 1-2 days (repeated tests will give better accuracy of result) whilst isolating, or you could get a PCR test.

You can read more about RATs by clicking on the links in the below references.

References

1. Therapeutic Goods Administration. Home Use Tests for COVID-19 [Internet]. 2021. Available from: https://www.tga.gov.au/sites/default/files/consumer-fact-sheet-rapid-antigen-self-tests.pdf

2. Victoria State Government Department of Health. Rapid antigen self-tests [Internet]. 2021. Available from: https://content.vic.gov.au/sites/default/files/2021-11/rapid_antigen_testing_simplified_factsheet.pd

If you test positive for COVID

Updated 8 January 2022

First, don’t panic. Most people have mild symptoms and make a full recovery. If you have possible risk factors for more severe disease, such as pregnancy, obesity, chronic/complex medical conditions (such as heart or lung), diabetes, immunocompromise or severe mental illness, then it is especially important you contact your GP or State/Territory number below.

Second, be aware that the official advice around testing, isolating and notification of contacts is constantly evolving. The best sources of latest information will be one one of the following:

Your GP
The 24/7 National Coronavirus Helpline: 1800 020 080

and your State/Territory website:

ACT — What to do if you have COVID-19
NSW — What to do if you have COVID-19
Northern Territory — COVID-19 testing
Queensland — What to do if you have COVID-19
South Australia — What to do if you have COVID-19
Tasmania — Care if you have COVID-19
Victoria — Managing COVID-19 at home
Western Australia — After your COVID-19 test

Third, practical resources to help you manage COVID at home (such as how to monitor symptoms and an action plan) include the healthdirect website and the Royal Australian College of General Practitioners’ online booklet.

Medications including antivirals

Updated 24 October 2022

Post-exposure hydroxychloroquine – there is no strong evidence for their safety and efficacy in prevention of COVID-19. This medications can also cause many serious side effects, including heart rhythm disturbances, especially if prescribed with azithromycin [1].

Ivermectin [2,3] is not approved for use in COVID-19 treatment in Australia or other developed countries. This is because of several reasons. It is often recommended at doses much higher than those safe for use in its usual indications, such as scabies. These doses could cause serious side effects, including diarrhoea and dizziness. Also, the studies used to check ivermectin’s efficacy were not done with sound scientific method so evidence is lacking that ivermectin might be beneficial. As yet there is no evidence that ivermectin can prevent COVID-19 infection.

Vaccines – Check your country’s Department of Health website. For instance, in Australia, the Government has a webpage to keep Australians informed about the COVID-19 vaccines and the latest news.

Antiviral treatment

An evolving landscape, treatment of an infected person ranges from home management to hospitalisation.

For people with milder disease (no pneumonia and normal oxygen levels) can generally be managed at home with a doctor assessing regularly, especially in patients who are at higher risk of getting worse. Rising age is the greatest risk factor for severe illness and dying from COVID-19, but also those with chronic conditions such as heart, lung, diabetes and cancer also need to be considered on a case-by-case basis as to optimal treatment.

On 4th November 2021, the UK became the first country to approve and purchase Lagevrio (molnupiravir). The antiviral works by essentially confusing the virus’ ability to replicate by throwing in multiple errors, so eventually the virus cannot survive [3]. Merck (the manufacturer of Lagevrio) claims that the drug halves the number of hospitalisations in people with mild to moderate COVID-19, and Pfizer have announced that their antiviral, Paxlovid (contains two medicines called nirmatrelvir and ritonavir), cuts hospitalisations by almost 90% [4].

Taken for five days as a twice-daily pill, Lagevrio’s side effects have been reported as mild to moderate, including diarrhoea, nausea, dizziness and headache. It is not recommended for women who are:

Pregnant
Who are at risk of pregnancy
Breastfeeding (breastfeeding can restart four days after the last dose) [5]

Paxlovid is taken as three tablets, twice-daily for five days. Side effects may include a change in taste, muscle aches, and diarrhoea. It can also affect the liver and kidneys, as well as interacting with many medications. Your doctor recommend the best medication for you.

Could there be a risk of the COVID-19 virus developing resistance to Lagevrio or Paxlovid? We already know that resistance is seen in some people with hepatitis B and C. At this early stage of new innovations, only time will tell.

References

1. Boulware, D., 2020. A Randomized Trial of Hydroxychloroquine as Post-exposure Prophylaxis for Covid-19. The New England Journal of Medicine, [Online]. 10.1056, Online ahead of print.. Available at: https://pubmed.ncbi.nlm.nih.gov/32492293/ [Accessed 17 June 2020].

2. Popp M, Reis S, Schießer S, Hausinger RI, Stegemann M, Metzendorf MI, et al. Ivermectin for preventing and treating COVID-19. Cochrane Database Syst Rev [Internet]. 2022 Jun 21 [cited 2022 Oct 25];CD015017(6). Available from: https://www.cochrane.org/CD015017/INFECTN_ivermectin-preventing-and-treating-covid-19

3. COVID-19 Treatment Guidelines Panel. COVID-19 Treatment Guidelines | Ivermectin [Internet]. National Institutes of Health. 2022 [cited 2022 Oct 25]. Available from: https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ivermectin/

4. Ledford, H. (2021). COVID antiviral pills: what scientists still want to know. Nature, [online] (ISSN 1476-4687). Available at: https://www.nature.com/articles/d41586-021-03074-5 [Accessed 27 Nov. 2021].

5. European Medicines Agency (2021). EMA issues advice on use of Lagevrio (molnupiravir) for the treatment COVID-19 – European Medicines Agency. [online] European Medicines Agency. Available at: https://www.ema.europa.eu/en/news/ema-issues-advice-use-lagevrio-molnupiravir-treatment-covid-19 [Accessed 27 Nov. 2021].

More Australians able to access COVID antiviral treatment

Updated 2 April 2023

More Australians than ever with mild to moderate COVID-19 can receive antiviral medication as the Australian Government. The antivirals are aimed at those who have tested positive for COVID-19 and are at higher risk of severe disease. The antivirals have been found to reduce the risk of hospitalisation (including ICU), and death rates.

Medication should be ideally taken within five days of symptom onset.

Figure 3 below summarises the recently updated eligibility criteria, including which risk factors contribute, and some cautionary notes.

Figure 3. Updated eligibility for oral COVID-19 treatments

Adapted from:

[1] Australian Government Department of Health and Aged Care. (2022, July 11). Updated eligibility for oral COVID-19 treatments. Australian Government Department of Health and Aged Care. https://www.health.gov.au/health-alerts/covid-19/treatments/eligibility COVID-19 information

[2] Paxlovid® (nirmatrelvir and ritonavir) | Pharmaceutical Benefits Scheme Factsheet – Updated April 2023 [Internet]. Pharmaceutical Benefits Scheme. 2023 [cited 2023 Apr 2]. Available from: https://www.pbs.gov.au/publication/factsheets/covid-19-treatments/Factsheet-paxlovid-nirmatrelvir-and-ritonavir-April-2023.pdf

COVID-19 FAQs

Updated 26 December 2021

Is there an in-depth resource on COVID-19 vaccines I can go to next?

There are quite a few websites which are based on scientific findings and widely accepted knowledge.

From questions about safety and efficacy, to vaccination in children, to the risk of blood clots, and even decision-making guides for women planning pregnancy, this site is easy to navigate:

National Centre for Immunisation Research and Surveillance (NCIRS)

In addition, people in Australia may find this site produced by the Department of Health quick and practical to use:

And for a general, global overview of COVID-19, check out the World Health Organization’s website for news, research and situation updates, The WHO even have a YouTube channel called “Science in 5” where they cover COVID-19 questions in a video and podcast series

What is coronavirus?

Coronaviruses are a large group of viruses that cause the common cold, and more seriously illnesses such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).

The novel coronavirus (COVID-19) is a new strain in humans, which researchers believe may have been passed to humans by exposure to bats or pangolins, following genomic sequencing.

On 20 January 2020, Chinese authorities confirmed the novel coronavirus was spreading person-to-person. The first case in Australia was confirmed on 23 January 2020,

Should I get tested?

Testing is recommended in people who display the following symptoms:

Fever OR chills in the absence of an alternative diagnosis that explains the clinical presentation

Acute respiratory infection that is characterised by runny nose, cough, sore throat, shortness of breath or loss of sense of smell/taste

Consider testing if you have headache, muscle aches, stuffy nose, nausea, vomiting or diarrhoea and:

You have returned from overseas in the past 14 days
You have been in close contact with someone diagnosed with COVID-19
You are a health care or aged care worker

If you’re not sure, use the healthdirect Symptom Checker or ask your doctor.

In addition, check with official guidance on testing when travelling.

Where can I get tested?

Here are the main ways you can find out.

You can phone the 24/7 National Coronavirus Helpline on 1800 020 080.

If you use the healthdirect Symptom Checker, you will be shown your closest COVID-19 clinics (not including GPs).

Or, you can also check the following links for your State or Territory:

ACT — covid19.act.gov.au
Qld — covid19.qld.gov.au
NT — coronavirus.nt.gov.au
NSW — nsw.gov.au/covid-19
SA — covid-19.sa.gov.au
Tas — coronavirus.tas.gov.au
Vic — dhhs.vic.gov.au/coronavirus
WA — healthywa.wa.gov.au

How can I keep up to date on changes with masks, travel and so on?

Find out what you can and can’t do in your state or territory here. Includes current advice on domestic travel.

For up-to-date travel advice, click here for the Smartraveller website.

I think my mental health has become worse with the pandemic. what help is out there?

It is widely recognised that public health emergencies can affect so many people, including affecting their mental health.

Firstly, please don’t feel that you have to manage this alone. I’d like to invite you to check out the Mental Health during COVID page I’ve written especially for people struggling during the pandemic. Reach out to someone you trust – partner, friend, family or colleague. Ring a mental health helpline. Book in with your GP. If you haven’t seen your psychologist for a while, give them a call.

There are many avenues of support. Don’t walk alone.