Background

On 31 December 2019, the World Health Organization (WHO) received reports of a cluster of viral pneumonia cases of unknown cause in Wuhan, Hubei, and an investigation was launched at the start of January 2020. The first symptomatic reported case of Covid-19 infection was hospitalised on 01.12.2019, after a visit to Huanan Seafood Wholesale market. Out of the early cases, two thirds were associated with visiting the market. The SARS-CoV-2 virus is a member of coronavirus family, closely related to bat corona viruses. As the virus spread, many countries, had no policies on testing those with mild symptoms. As the transmission of the virus increased exponentially with 7,818 cases and 19 countries being affected, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC) on 30.01.2020. The first confirmed COVID-19 death was in Wuhan on 9 January 2020.

Fortunately, most people who contract COVID-19 do recover. For those who do not, the time between the onset of symptoms and death usually ranges from 6 to 41 days, typically about 14 days.

Based on Johns Hopkins University statistics, the global death-to-case ratio is 3.6 percent (773,649 deaths for 21,593,607 cases) as of 17 August 2020.

Symptoms of COVID-19 infection

If you experience any of these symptoms it is vital that you get tested, and self-isolate for 14 days.

Pathophysiology, transmission diagnosis and treatment for COVID-19

Clinical and laboratory researchers are learning more about SARS-CoV-2 each day. However, currently the messaging is still the same: All of our community needs to continue with:

• Frequent handwashing/hand sanitising;
• Cough and sneeze etiquette; and
• Physical distancing, with prompt isolation of affected individuals;
• Mandatory face masks have recently introduced as an additional transmission safety measure in Metropolitan and Reginal Melbourne area;
• One hour of exercise is allowed per day
• Only one person from the household is allowed to go to shop for essential items
• Curfew is introduced for all metropolitan Melbourne between 8pm-5am
• Working from home is mandatory for those that are able to do so

Masks and COVID-19

In Melbourne, masks are mandatory in all environments as well as 1.5m physical distancing

• Many individuals with SARS-CoV-2 infection remained asymptomatic for a prolonged period, and viral load was similar to that in symptomatic patients;
• Isolation of infected persons should be performed regardless of symptoms

Current developments of COVID-19 vaccine candidates in clinical trials

There are several steps to Vaccine development, testing, approval and administration https://www.scirp.org/html/5-2101019_52733.htm#txtF6 .

Preclinical testing: Vaccine administered to laboratory animals and monitored for immune response.

Phase 1 safety trials: Vaccine administered to a small number or healthy adults to test safety and dosage of the vaccine. Furthermore, blood tests are taken to confirm stimulation of the immune system.

Phase 2 trial: Healthy individuals are recruited and divided into groups such as children and elderly to investigate the effect of the vaccine. Phase 2 trials are designed to further validate the safety and efficacy of the vaccine. FDA has announced that a SARS-CoV-2 vaccine would have to protect at least 50% vaccinated volunteers to be considered effective.

Phase 3 trials: The vaccine is given to thousands of volunteers. Infection rate is observed and compared to those receiving placebo.

Approval: Regulators in each country review the trial results and decide whether to approve vaccine for population wide administration, During a pandemic, a vaccine may receive emergency authorisation before receiving formal approval.

Top three vaccine contenders in currently progressing to Phase 3 clinical trials:

1. Moderna vaccine
   • Uses mRNA from SARS-CoV-2 to produce viral proteins
   • Was administered in two doses; 28 days apart in early phase trials
   • Phase 1 results showed a production of SARS-CoV-2 specific Neutralising antibodies (Nab) with no severe side effects in 45 participants
     • Results published July 14th 2020
   • Phase 3 trials commenced July 27th 2020
   • End of Phase 3 testing and expected early 2021

2. Pfizer/BioNTech/Fosun Phasma
   • Uses mRNA from SARS-CoV-2 to produce viral proteins
   • Was administered in two doses; 21 days apart in early phase trials
   • All 45 volunteers developed Nab and T cells against SARS-CoV-2
   • Was given in 3 different doses
   • Minor side effects such as sore arms and insomnia were reported
   • Early phase data was published in July 2020
   • Fast track status to commence Phase 3 testing was granted by FDA July 13th 2020
3. AstraZeneca/Oxford University
   • Viral vector vaccine; utilising attenuating virus
   • Early Phase results reported
   • 1077 volunteers were inoculated
   • All recipients developed good antibody responses and vaccine was well tolerated
   • Currently undergoing phase 2/3 trials

Limited approval of a CanSinoBIO vaccine by Chinese military (https://www.reuters.com/article/us-health-coronavirus-cansinobio-idUSKCN24L1NP )

• Viral vector vaccine; based upon ad5 adenovirus
• Phase 2 trials reported July 20th
• Strong immune response was reported
• Chinese military approved the vaccine on June 25th as a “specially needed drug” (https://www.msn.com/en-us/news/world/beijing-approves-cansino-biologics-s-experimental-covid-19-vaccine-for-use-in-chinese-military/ar-BB169DKi )
• Unclear about plans for administration
• No indication that this will be available outside of Chinese military

A total of 138,000 volunteers are already signed up to participate in clinical trials of 4 leading candidates.

Summary

• There are many ongoing clinical trials for treatment of SARS-CoV-2, however there is no treatment proven effective to date.
• Three vaccine trials have shown promise and progressed to Phase 3 testing; however, the end of study is estimated in 2021 and 2022 respectively

Stage 4 restrictions and mental and physical wellbeing – what can we do to stay healthy and active?

Melbourne is currently in stage 4 lockdown. That means residents will have to provide just four reasons to leave home – seeking medical care, providing care, buying groceries, and working or learning if it can’t be done remotely.

Exercise during lockdown

Exercise is currently limited to a maximum of one hour per day and no more than 5km from your home. Group size is limited to a maximum of two people; whether they live with you or not.

Gyms are closed and community sport has stopped.

So how do keep motivated to stay active during lockdown?

Several suggestions for staying active during stage 4 lockdown in Melbourne have been recommended by (Associate Professor Nathan Grills, Public Health Physician and NHMRC Fellow, University of Melbourne)

A/Prof Grills has noted that due to his physical inactivity from not walking in the office and between meetings at work, his daily count of 8,000 – 10,000 steps has decreased to about 4,000 steps.

Additionally, he found, like many Melbournians, that his work efficiency has also decreased.

Many people any are struggling with motivation and following a healthy diet during lockdown, due to strains on mental health and financial stressors.

And if many people are exercising less and eating more, there we may have a myriad of serious health problems in our community due to lockdown restrictions, such as an increased risk of non-communicable diseases (NCDs) like heart disease diabetes and cancer which are top 5 leading underlying causes of death in Australia. The main risk factors for NCDs are an increase of alcohol and tobacco use, heightened stress, anxiety and tension. We also tent to comfort-eat when stressed.

Below is a quote from A/Prof Grills:

“A woman I saw had limited mobility prior to the pandemic and relied on assistance to access the community and do her shopping. She was unable to exercise for two months as a result of the lockdown. With the decreased availability of assistance, she had sadly lost her ability to mobilise which led to a fall and a visit to Emergency.”

So what is the solution to staying healthy and active?

Everybody is different and will need to adjust their lives and find what suits them. It can be a daily run or a brisk walk between meetings. Additionally, many gyms are offering online sessions you can join between the meetings.

• Exercise exercising is a great way to help stimulate the body and by keeping active we help the body produce endorphins and serotonin which help us to feel good about ourselves this also supports us mentally as our aptitude towards doing things changes. Suggested doing thirty minutes to an hour of exercise would be ideal we can break this down for example if your work is sedentary you could look to accumulate a total number of repetitions during the course of the day I little short bursts.  A Daily challenge could be one hundred or two hundred repetitions of four exercises Eg. Squats, Lunges, push ups, sit ups.
• Fresh Air we need to take in fresh oxygen to have oxygenated blood circulate around our bodies to sustain our respiratory system therefore fresh air is important for a body to function try and take timeout from your day to stay in an outdoor environment like a garden or parks etc for twenty minutes to an hour or maybe have your lunch there too.
• Vitamin D Sunshine is important again for our bodily functions twenty minutes a day helps to kick in endorphins and serotonin and makes us feel good about ourselves Vitamin D also helps us against the Covid Virus as it helps to boost our immune system too if possible try and be out in the sun as much as possible twenty minutes is the minimum.
• Walking and or Bike Riding getting out doors and being active are so important and these exercises might be things we can do socially or with friends whilst exercising social distancing safety measures will help us mentally and physically too.
• Read a Book reading is a great way to escape and detach as well as giving us more stimulus for our brain our brain is a muscle so if it is stimulated it will serve us better.
• Jigsaw Puzzles Board Games are another way to stimulate our brains which support our mental health stimulate our brains and support our wellbeing too they can be challenges for us as individually as well sin our family groups and household settings these can along with books can be shared and swapped with other families and work colleagues.
• Home improvements and Decorating we may find within these lockdown sessions that we have more time on our hands so this maybe an ideal time to work on projects around the home and also decorating to create new spaces or revamp an old space to give it a new look.
• Gardening is another way to get outdoors within our own space it can be an ideal time to grow edibles which maybe determined by the seasons also supports us getting vitamin D and fresh air whilst working on projects

How lockdown is affecting our mental health?

• Elevated levels of anxiety, depression, distress and stress are found in both the general population and healthcare workers, with higher estimates than before the pandemic.
• Younger people and females are more likely to experience these outcomes of poor mental health across the board.
• Work-related stressors are associated with all examined mental health outcomes. This includes factors such as losing a job, working from home, being exposed to COVID-19 in the workplace, and having colleagues quarantined or treated for COVID-19.
• Issues related to physical distancing restrictions such as spending less time with or communicating with others, loneliness, high impact of restrictions and experience of quarantine are now being identified in the literature as being associated with poorer mental health.
• For frontline workers, stress is associated with less experience, having colleagues diagnosed with COVID-19 and higher risk of contact with COVID-19 during work duties
• For depression, several modifiable behaviours such as poor sleep, exercise or alcohol intake are associated with poorer outcomes. This is also the case to a lesser extent for anxiety, distress and stress.

The way we live and work is changing rapidly in the time of COVID-19 and what was strange six months ago is now the new normal. Stay active and eat well for your health.

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