June 5, 2020

General

What does it mean to be immunocompromised? And why does this increase your risk of coronavirus?

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Immunocompromised is a broad term reflecting the fact someone’s immune system isn’t as strong and balanced as it should be.

Because immunocompromised people’s immune systems are defective or ineffective, they’re unable to stop invasion and colonisation by foreign intruders, including the SARS-CoV-2 virus, which causes COVID-19.

An under-performing immune response leaves people susceptible to infection, but the severe symptoms in some people are actually caused by a huge immune response sweeping over the whole body.

The reasons for this are varied, and can be complex and intertwined.

What causes compromised immune systems?

Primary immunodeficiencies arise when someone is born with a condition that directly affects their immune system. These illnesses are rare and usually diagnosed early in life. They include common variable immunodeficiency, severe combined immunodeficiency and X-linked agammaglobulinaemia.

Secondary immunodeficiencies are more common and arise as a consequence of outside factors. Exposure to environmental toxins including some pesticides, heavy metals, petrochemicals and air pollutants such as cigarette smoke can reduce the effectiveness of the immune system, particularly at the surface of the lung.

Poor nutrition and drug and alcohol abuse can also impair immunity, as can medications, age and even pregnancy.

Illness and injury

Some illnesses and injuries can cause someone to be immunodeficient. These are also classified as secondary immunodeficiencies. This includes acquired immunodeficiency syndrome (AIDS) as a consequence of human immunodeficiency virus (HIV) infection, severe burns, and not having a functional spleen. This organ is crucial for blood filtration and coordinating the immune response.

Cancers of the bone marrow and white blood cells, such as leukemia and lymphoma, can also cause immunodeficiency.

Bone marrow and white blood cells usually fight infections. The treatment for these cancers is commonly to wipe out all white blood cells using chemotherapy. This incapacitates the immune system even more.

Early information about COVID-19 in a small number of cancer patients in China suggests they have a higher risk of contracting coronavirus and developing severe disease.

Medications

Like chemotherapy, other medications can bring about an immunocompromised state. These drugs are called immunosuppressants.

People who receive organ transplants are one group who need to take immunosuppressants. This dampens their immune system so it cannot react against and reject the donor’s transplant.

People with autoimmune diseases, which cause the immune system to attack the body’s own cells and tissues, also use these medications. Between 2% and 7% of the population have an autoimmune disease, such as multiple sclerosis, type I diabetes, lupus, rheumatoid arthritis and Sjögren’s syndrome, to name a few.

It’s too soon to know the impact of immunosuppressants on COVID-19, but anecdotal evidence is coming through from affected regions.

In Northern Italy, for example, two kidney transplant recipients were treated for COVID-19. Hospital doctors quickly switched their usual broad immunosuppressive medications to drugs that more specifically suppress the parts of the immune system that appear to go haywire in this infection. One patient recovered, the other did not.

Steroids are the most commonly used immunosuppressants – 1-2% of the population in developed countries take them, and the rate is far higher in developing countries where access to more sophisticated medicines is limited.

Clinical trials are currently underway to assess whether steroids might actually protect people against the severe immune response linked to severe illness in COVID-19.

But until the results are clear, steroid use is not recommended to treat COVID-19.

Age

Age is a key element to consider when thinking about our immune system and its ability to work optimally.

A newborn will have no mature immune system to protect his or her body against invaders. In this context, breastmilk will be a precious source of antibodies to help fight viruses.

On the other side, older people are also considered immunocompromised, as they have an ageing, weakened immune system, not fit enough to start and win a fight. As a consequence, elderly people are more susceptible to contracting symptomatic coronavirus infection.

COVID-19 can become severe when older people have underlying health issues that weaken the organs which are strained by the coronavirus infection, such as the heart and lungs.

Pregnancy

Pregnancy weakens women’s immune systems.

Through our evolution, we have developed a necessary state of immunosuppression during pregnancy. This is because within the pregnant mother’s body is an organism with parts that look foreign to the mother, encoded by the DNA from the other biological parent.

Natural suppression of the immune system during pregnancy stops the mother’s immune system from mounting a response against the baby.

The early information we have on the severity of COVID-19 in pregnancy is encouraging, although it’s still too early to know the full story.

So what does the research say so far?

There are a few early reports emerging from heavily hit areas on how COVID-19 differs in prevalence and severity among immunocompromised people.

The world has been primed to worry about these people contracting COVID-19 because they’re more susceptible to severe illness when infected with the range of viruses that usually cause respiratory illness, including common colds.

However, because the severe illness in COVID-19 is actually a result of excessive immune responses, immunocompromised people don’t seem to be presenting with more severe disease than the general population.

It’s worth exploring each case, though, and reviewing our understanding as the evidence emerges.

So far in a key hospital in Bergamo, in the red zone of the Italian COVID-19 outbreak, none of the immunocompromised patients who tested positive for coronavirus developed a severe disease.

Meanwhile, a 47-year-old woman from Wuhan who was taking steroids to suppress her autoimmune disease lupus, contracted the coronavirus and didn’t fall ill. But her compromised immune system couldn’t efficiently clear the virus and she spread it to her father and sister before testing positive.

While this gives hope that immunocompromised people may not be in such dire straits as we had predicted, they may fly under the radar, picking up the virus and spreading it while remaining asymptomatic.

Immunocompromised individuals may also be at risk of losing out to coronavirus through indirect competition for treatment and the medications that allow them to lead relatively normal lives.The Conversation

Sarah Jones, Research Fellow, Centre for Inflammatory Disease Monash Health, Monash University and Fabien B. Vincent, Research Fellow; Rheumatology Research Group, Centre for Inflammatory Diseases, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What do you love about nursing? 4 nurses share their stories

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This International Nurses Day, we asked four nurses from very diverse backgrounds what it is they loved about being a nurse.

Deanna – Private Hospital nurse

I must love being a nurse as I have been in the profession for 30 years (minus babies and travel). My reasons for staying have changed over the years. I initially chose nursing as I wanted to travel and work overseas. I achieved this with basing myself in London working in many specialties, travelling extensively and making some lifelong nursing friends (where else can you find fellow souls with the same rude and dark humour?). When I returned to Australia I discovered it was possible to balance family life with continuing to work in nursing. My reasons for staying now is that I love working in a caring profession, and I love being able to pass on skills and sound practices to young nurses joining the field.

Sue – Aged Care nurse

I love working as an Aged Care nurse. The beautiful people I look after could be my mum or dad. They have seen things we will never see in our lifetime. Now in their declining years, they are a privilege to look after. Even though aged care nursing is extremely hard, with everything that is happening today, it’s very satisfying just to go to work and spend time, listen to their lives, just to be there to assist them with their needs, talk to them and help any way I can. I also feel very privileged to be able to spend their last hours with them, particularly when family aren’t able to be there.

Everybody should be treated with respect and dignity and if I can just do this in my work life I am happy. That is why I chose to work in aged care. It is also why I am heavily involved in campaigning for our elderly in care. I will speak up and let everybody know what is happening in aged care. 

Silvana – Emergency Nurse

I always wanted to be a nurse. When I was 16 years old, I did work experience at Shellharbour Public Hospital – now 30 years later I’m still here. I have also worked in a variety of areas, including in vascular, orthopaedic, surgical, day surgery, medical and aged care wards, as well as at a Nursing home. But what I really love working is in the Emergency Department as I feel like I can help all my patients with our extra clinical skills. 

Alison – Intensive Care nurse and Clinical Nurse Educator

I started in nursing in Cambridge, England and came to Australia when hospital based training transferred to university. Australia was experiencing shortages of nurses, and especially in ICU, which was my specialty. Nursing has continued to be a pleasure and a privilege over the years, particularly in my roles in ICU and as a Clinical Nurse Educator. Being able to help somebody, whether patient, relative or nervous young nurse sounds mawkish and trite. But it’s what has kept me in this profession for all these years.

 

Coronavirus: there are no miracle foods or diets that can prevent or cure COVID-19

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Since the global outbreak of the novel coronavirus (SARS-CoV-2), there have been widespread claims on social media that certain foods and supplements can prevent or cure COVID-19. Even though the World Health Organization (WHO) has tried to dispel such myths surrounding “miracle” foods and coronavirus, misinformation continues to circulate.

Though we all want to protect ourselves against COVID-19, there is currently no evidence that eating certain foods or following certain diets will protect you against coronavirus. Here are some of the most common myths debunked:

Myth 1: garlic

There is some evidence showing that garlic has antibacterial effects, with existing studies indicating the active compounds of garlic (including allicin, allyl alcohol and diallyl disulfide) are protective against some types of bacteria like salmonella and staphylococcus aureus. However, research investigating garlic’s antiviral properties is limited.

Though garlic is considered to be a healthy food, there’s no evidence showing that eating it can prevent or cure COVID-19.

Myth 2: lemons

One viral Facebook video claimed that drinking warm water with lemon slices could combat novel coronavirus. However, there’s no scientific evidence that lemon can cure the disease.

Lemon is a good source of vitamin C, which is important for helping immune cells work properly. However, many other citrus fruits and vegetables contain vitamin C.

Myth 3: vitamin C

As previously stated, Vitamin C is known to play a role in supporting the normal functioning of the immune system. Yet, it’s not the only nutrient that maintains the the immune system. Most of the misinformation on vitamin C and coronavirus comes from studies that have investigated the links between vitamin C and the common cold. Despite claims online that vitamin C can prevent and treat the common cold, the evidence in support of this is not only limited, but conflicting too. There are also significant differences between the common cold and coronavirus.

There’s currently no strong evidence that supplementing with vitamin C will prevent or cure COVID-19.

Most adults will also meet their vitamin C requirements from a diet that includes a variety of fruits and vegetables.Myth 4: alkaline foods

Misinformation spread on social media suggests the virus can be cured by eating foods with a pH (level of acidity) that is higher than the virus’s pH. A pH below 7.0 is considered acidic, a 7.0 pH is neutral, and above pH 7.0 is alkaline. Some of the “alkaline foods” said to “cure” coronavirus were lemons, limes, oranges, turmeric tea and avocados.

However, many of these online sources give incorrect pH values to these foods. For example, the pH of a lemon was said to be 9.9, when it’s actually very acidic, with a pH of 2. There are claims that acidic foods can become alkaline after being metabolised by the body.

Overall, there’s no evidence indicating that foods can even affect the pH levels of blood, cells or tissues – let alone cure viral infections. The body regulates acidity levels, regardless of the types of food being consumed.

Myth 5: keto diet

The ketogenic (keto) diet, which is a high-fat and low-carbohydrate diet, has been said to be protective against COVID-19.

This comes from the idea that it can “boost” the immune system. Though one study showed that keto might prevent or treat the flu, this study used mice models. This makes it difficult to know if keto would have a similar effect on humans at preventing or treating the flu.

There is also currently no existing scientific evidence demonstrating that a ketogenic diet can prevent coronavirus.

Current advice

The British Dietetic Association (BDA) has stated no specific food or supplements can prevent a person from catching COVID-19. Alongside WHO advice, the BDA encourages people to consume a healthy, balanced diet to support the immune system.

A healthy and varied diet containing the five main food groups can help provide most people with the nutrients they need. Most of the nutrients we already get from our regular diet (including copper, folate, iron, zinc, selenium, and vitamins A, B6, B12, C, and D) are all involved in maintaining normal immune function.

People are also encouraged to take protective measures against COVID-19, including washing hands frequently, maintaining social distancing, and following lockdown orders.

However, the BDA does advise adults living in the UK to take a daily supplement of 10 micrograms of vitamin D and eat vitamin D rich foods, like oily fish, egg yolks, and fortified breakfast cereals to ensure adequate vitamin D levels. This is because our main source of vitamin D is sunlight – and because of lockdown measures, many of us aren’t getting enough sunlight exposure.

When it comes to online misinformation, it can sometimes be difficult to spot what is and isn’t true. But in general, a claim is likely to be “fake” if it:

  • Recommends eating a specific food, drink, or supplement (especially in high doses) to cure and prevent coronavirus
  • Encourages restricting main food groups from your diet
  • Singles out a certain food over others to protect or treat the virus
  • Includes buzzwords – such as “cleanse”, “cure”, “treat”, “boost”, “detox” or “superfoods” – when recommending a single food item or supplement
  • It’s not provided by a reliable and trusted health authority or organisation, like the NHS or WHO.

Social media is a powerful and great tool. However, it can also be a catalyst for spreading misinformation. The bottom line is that there are no miracle foods or supplements guaranteed to protect people from novel coronavirus. In addition, there are no EU approved nutrition and health claims that a single food or supplement can fight viral infections, like COVID-19.The Conversation

Taibat Ibitoye, Registered Dietitian and Doctoral Researcher, University of Reading

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Even in a pandemic, continue with routine health care and don’t ignore a medical emergency

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As we continue to navigate the coronavirus pandemic, many hospitals and health services are actually less busy than usual.

Fewer patients are presenting to emergency departments and primary care services in Australia and around the world.

They might be choosing to stay away for fear of catching coronavirus, or because they don’t want to put pressure on the health system at this time, or both.

But particularly if you’re someone with a chronic health condition, it’s essential you continue to seek medical care routinely, and especially in an emergency.

Delaying or avoiding necessary medical care could lead to preventable deaths.

Anxiety and fear

Delaying or avoiding medical care despite health problems is not a new concept. People often downplay the severity of their symptoms, believe they will resolve on their own or perceive they can manage themselves at home.

This reasoning is now compounded by fear of becoming infected with COVID-19 as well as overburdening the health-care system.

Some people living with chronic conditions such as heart failure, lung or kidney disease may be more concerned about contracting COVID-19. This is justified. People with chronic conditions tend to get sicker than the overall population if they catch coronavirus, and are more likely to die.

Concerns about overburdening the health-care system, which people already perceive to be stretched, has been a common reason for delayed care-seeking, even before the current pandemic.

But constant reports of overflowing hospitals and scarce resources during the coronavirus crisis may serve to validate this concern for people who are considering whether or not to seek medical care.

While it’s too early to have definitive statistics, Australian estimates suggest attendance at hospitals and general practices could be down by as much as 50%.

Why it’s important to continue to seek care

People with chronic health conditions may need to seek medical care for a range of reasons. This could be routine care for a chronic disease such as chronic obstructive pulmonary disease (COPD), asthma, diabetes, cancer, bowel or heart disease.

They may need to seek unscheduled care if their condition flares up. For example, for a person with chronic heart failure, it would be important for them to seek timely health care if they were experiencing symptoms such as breathlessness, fatigue, or peripheral oedema (the accumulation of fluid causing swelling, usually in the lower limbs).

Importantly, if people delay seeking care for chronic illnesses, we may see an increase in preventable deaths.

For example, for people with heart disease, untreated symptoms could lead to long-term heart damage, need for intensive care, and death.

It’s also possible if a large number of people avoid seeking treatment now, hospitals will find themselves overwhelmed when the pandemic is over.

You can go out for medical care

While the global public health messaging urges people to stay home to save lives, it’s important to understand one of the key exemptions is medical treatment. And this doesn’t apply only to people with COVID-19 symptoms.

Regular GP or specialist appointments

People with chronic conditions may already be receiving advice from their health professionals about how regular appointments will be conducted.

To minimise risks to staff and patients, many health services are offering telehealth appointments (via phone or video conference). It’s best to contact your GP or specialist by phone prior to your appointment to see whether this service is available and appropriate.

There will be times when a telephone or video-conference is not suitable, such as when your doctor needs to perform a physical examination, administer therapies including medications, or you need tests such as blood tests or x-rays.

If you do need to attend a clinic or hospital in person, you should be assured they’re taking additional precautions to prevent the spread of infection during this time.

If symptoms flare up or in an emergency

If your symptoms get worse, you should still contact your GP or specialist if this is your normal course. This is important even if you don’t think your symptoms are urgent.

And it remains critical that in life-threatening circumstances – like if you believe you’re having a heart attack or stroke – you seek medical attention immediately by calling triple zero (000).

These are medical emergencies and our hospitals are well-equipped to respond, even during COVID-19.

Some practical tips

The Heart Foundation offer the following advice for people living with chronic conditions during COVID-19:

  • keep looking after your health and stay connected with your doctor
  • get your annual flu vaccination
  • practise physical distancing and good hand hygiene
  • stay active and eat a healthy diet.

And most importantly: don’t ignore a medical emergency.

Serra Ivynian, Research Fellow, Faculty of Health, University of Technology Sydney, University of Technology Sydney; Caleb Ferguson, Senior Research Fellow, Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District &, Western Sydney University, and Michelle DiGiacomo, Associate Professor, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Early flu shot critical for people with asthma

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The COVID-19 outbreak makes the influenza vaccination more important than ever for the 2.7 million Australians with asthma.

The National Asthma Council Australia is urging health professionals to speak with their asthma patients about getting vaccinated and ensure they are managing their asthma optimally.

National Asthma Council CEO Siobhan Brophy says seasonal viral respiratory infections are among the most common triggers for flare-ups, including potentially serious acute asthma, in adults and children.

“Receiving a vaccination in April, ahead of the peak influenza period, will help protect your patients’ health,” Ms Brophy says.
“It’s especially important for more vulnerable groups, such as those over 65 years, who may be more severely impacted by the flu.”

Ms Brophy says while we are still learning about how COVID-19 affects people with asthma, previous experience suggests that people with asthma are likely to be at more risk if they contract the disease.

“It’s crucial for patients with asthma to maintain good asthma control and follow the advice from health authorities, so they are ready as the virus spreads,” Ms Brophy says.

The National Asthma Council Australia has developed information in the Australian Asthma Handbook on managing asthma during the COVID-19 pandemic.

Key recommendations include:

• Make sure patients have an up-to-date written asthma action plan and access to all the medications specified in their plan.

• Avoid lung function testing during the COVID-19 containment phase, unless essential to guide management and if comprehensive infection control can be maintained.

• Advise patients with asthma to continue taking their inhaled corticosteroids, as stopping their preventer increases the risk of severe asthma flare-ups. Use systemic corticosteroids only when indicated.

• Do not use nebulisers to administer inhaled medicines, unless unavoidable. The use of nebulisers carries a high risk of transmitting viral infections.

Worried about your child getting coronavirus? Here’s what you need to know

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The new coronavirus SARS-CoV-2, which causes the disease COVID-19, has infected nearly 90,000 people and caused more than 3,000 deaths so far.

Parents are understandably concerned. But it’s important to keep in mind that comparatively few children have tested positive for the virus, and deaths in children are very rare.

Here’s what we know so far about how children are affected.

Remind me, what is COVID-19?

COVID-19 is caused by a new strain of a family of viruses discovered in the 1960s. Coronaviruses get their name from a distinctive corona or “crown” of sugary proteins surrounding the virus when seen under a powerful microscope.

Coronaviruses circulate in humans, usually causing a mild illness with cough and a runny nose. Coronaviruses are also frequently found in animals with speculation COVID-19 emerged from animals, most likely bats.

Three novel coronaviruses have emerged this century.

In 2002-03, SARS-CoV (Severe Acute Respiratory Syndrome Coronavirus) emerged in China spreading to North America, South America and Europe. More than 8,000 cases were identified and around 10% of those infected died.

MERS-CoV (Middle East Respiratory Syndrome Coronavirus), emerged from camels in Saudi Arabia in 2012. A large outbreak followed in South Korea in 2015. Nearly 2,500 cases have been reported and 34% of those infected died.

SARS-CoV and MERS-CoV infection in children is less commonly reported than would be expected. For example, 3.4% of cases of MERS coronavirus in Saudi Arabia were in children, where around 15% of the population is under 19 years of age.

A similar pattern was seen in SARS, where the rate of reported infection in children under 14 years of age was much lower than in older age groups.

COVID-19 was first detected in Wuhan, China in December 2019 and has already caused more deaths than SARS-CoV and MERS-CoV combined.

So what about children?

The number of reported COVID-19 cases in children remains low: of more than 44,000 confirmed cases from China, only 416 (less than 1%) were aged nine years or younger. No deaths were reported in this age group.

In Australia, only one child has so far had confirmed COVID-19 infection.

It remains unclear whether the low numbers of child infections recorded is due to:

  • low numbers of children being exposed to the virus
  • low numbers of children being infected, or
  • low numbers of infected children developing symptoms severe enough to present for care.

If large numbers of children are not getting sick, why does it matter?

If children are infected yet have milder symptoms, they may still play a critical role in COVID-19 transmission. Children are mobile, shed large volume of virus, congregate in groups and are at lower risk of severe disease so often maintain their daily activities.

Preventing school-age children getting infected with influenza has been shown to be an effective community prevention strategy. In the absence of a COVID-19 vaccine, school closures may need to be considered when looking at ways to decrease community spread, if children are found to be key transmitters of infection.

What symptoms do children get?

Chinese doctors report infected children often have a cough, nasal congestion, runny nose, diarrhoea and a headache. Less than half of the children have a fever. Many have no symptoms.

The majority of children and adolescents with COVID-19 in China had mild infections and recovered within one to two weeks.

Even infants, who are traditionally more susceptible to severe respiratory infections, had relatively mild infections.

How can you tell if it’s COVID-19?

Most children with COVID-19 present with respiratory symptoms and/or a cough, which is indistinguishable from other common viruses including influenza and rhinovirus.

But so far, all children with confirmed COVID-19 have had family members or close contacts with confirmed infection.

In the early part of an Australian epidemic, confirming COVID-19 infections will be important to guide our public health response. However if COVID-19 cases continue to climb, this testing approach may change to only test patients who are hospitalised as the only benefit of confirming COVID-19 infection will be to inform treatment and infection control practices in hospitalised patients.

At this stage, it’s unclear if antiviral therapies are useful in the treatment of COVID-19. Many older drugs, such as lopinavir used to treat HIV, have been used to treat some severe cases but need to be formally evaluated. Clinical trials have been registered and some results from Chinese researchers are expected soon.

However, as children have such mild symptoms, it would be hard to justify exposing them to potential side effects of antiviral medication, such as nausea, vomiting and allergic reactions, for little benefit.

How do I prevent my family from being infected?

COVID-19 is spread by droplets generated when an infected person coughs or sneezes. Infection can be transmitted if a person touches objects or surfaces that an infected person has coughed and sneezed on and then touches their mouth, nose or face.

The best way to avoid COVID-19 infection (and infection with any other respiratory virus) is by washing your hands with soap and water, using a tissue or the crook of your elbow to cover your mouth when you cough or sneeze and by avoiding close contact with others who are unwell.

Masks in the community are only helpful in preventing people who have COVID-19 disease from spreading it to others. There is little evidence supporting the widespread use of surgical masks in healthy people to prevent transmission in public – and it’s almost impossible to get small kids to consistently wear these.

A vaccine for COVID-19 is still some way off. But it’s worthwhile getting your child vaccinated against influenza. This is not only to protect your child against influenza, but also to reduce the chance your child might be considered to have COVID-19, and to minimise other illnesses in the community that would use health resources.

Christopher Blyth, Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, University of Western Australia; Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash University, and Asha Bowen, Head, Skin Health, Telethon Kids Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.