Welcome to the August 26 edition of SafetyNet - from Melbourne: week four of a six-week Stage 4 lock-down.
The number of new COVID-19 cases in Victoria announced today was 149, which is the third day in a row that the numbers have been under 150. Very sadly though, there were 24 further deaths - the highest number we've had.
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Victorian Report on Healthcare workers
The Victorian government has released a new report through the Department of Health and Human Services, which has led the government to take immediate steps, such as fast-tracking healthcare workers comp claims, running PPE fit-testing, deploying "PPE spotters" in hospital settings to ensure workers properly don and remove protective gear when they enter and leave COVID-19 environments, and more.
Further, the Health and Human Services Building Authority is undertaking a "COVID Aerosol Hot Spot Analysis Study" which aims to identify possible "hot spots" in clinical settings created by exhaled aerosols coming to rest on surfaces. The study models aerosol behaviour and then tracks particles as they are carried in the heating, ventilating, and air conditioning (HVAC) airstreams, until they impact and stick to a surface, and will be used to inform a new series of guidance notes.
Read more: Protecting our healthcare workers [pdf]
World's first confirmed case of coronavirus reinfection
A 33-year-old man in Hong Kong may be the first confirmed case of reinfection, according to researchers in Hong Kong.
The man was diagnosed with COVID-19 on March 26, hospitalized, then recovered. He then tested positive again on August 15. The viral sequence disparity indicates that this case is not one of prolonged infection. Kwok-Yung Yuen, MD, of the University of Hong Kong, and colleagues in a manuscript which has apparently been accepted for publication in Clinical Infectious Diseases (but not yet published) said “the whole genome sequencing of viral isolates from the two episodes indicated they were from different clades”.
This is almost unassailable evidence that the man was infected a second time, and another indication, although far from definitive, that immunity to SARS-CoV-2 may not last very long.
The man experienced fever and a heavy cough during the March episode and tested positive for SARS-CoV-2. He was discharged on April 14 after two negative tests, taken a day apart. But in August, he returned to Hong Kong from Spain via the United Kingdom, and tested positive for SARS-CoV-2 upon reentry screening at the Hong Kong airport. He was hospitalized, but remained asymptomatic.
Reinfection has been suspected in a few previous cases of COVID-19, but never documented. Many experts believed what appeared to be reinfection was simply prolonged infection. But these researchers were absolutely clear: "We report the first case of reinfection of COVID-19," they wrote. "Epidemiological, clinical, serological and genomic analyses confirmed that the patient had reinfection instead of persistent viral shedding from first infection."
The discovery is important because it adds to growing concerns that antibodies in some patients may only last as little as four months. Experts are hoping that although the reinfection has been confirmed, it turns out to be a rare or uncommon occurrence. Matthew Spinelli, MD, of University of California San Francisco, said this was an important study, but unsurprising since people are often reinfected with seasonal coronaviruses responsible for common colds.
Read more: Medpage Today; Sydney Morning Herald
USA: Race inequalities in Covid-19 linked to worse jobs
Higher rates of COVID-19 in Hispanic and other non-white workers are explained by these groups being over-represented in high risk jobs, a US study has found. In the period from 6 March to 5 June 2020, workplace outbreaks occurred in 15 Utah industry sectors, with 58 per cent in just three sectors - manufacturing, wholesale trade, and construction. Despite representing 24 per cent of Utah workers in all affected sectors, Hispanic and non-white workers accounted for 73 per cent of workplace outbreak-associated COVID-19 cases. Overall, 12 per cent of total cases in the state were associated with outbreaks in workplace settings (1,389 of 11,448 cases), a figure that does not include cases in educational and health care settings.
A 17 August report in the US government’s Morbidity and Mortality Weekly Report (MMWR) noted: “Systemic social inequities have resulted in the overrepresentation of Hispanic and non-white workers in frontline occupations where exposure to SARS-CoV-2, the virus that causes COVID-19, might be higher; extra vigilance in these sectors is needed to ensure prevention and mitigation strategies are applied equitably and effectively to workers of racial and ethnic groups disproportionately affected by COVID-19. Health departments can adapt workplace guidance to each industry sector affected by COVID-19 to account for different production processes and working conditions.”
The report added: “These disparities might be driven, in part, by longstanding health and social inequities, resulting in the overrepresentation of Hispanic and non-white workers in frontline occupations (ie. essential and direct-service) where risk for SARS-CoV-2 exposure might be higher than that associated with remote or nondirect–service work. In addition, Hispanic and non-white workers have less flexible work schedules and fewer telework options compared with white and non-Hispanic workers. Lack of job flexibility (ie. ability to vary when to start and end work), lack of telework options, and unpaid or punitive sick leave policies might prevent workers from staying home and seeking care when ill, resulting in more workplace exposures, delayed treatment, and more severe Covid-19 outcomes.”
Read more: Bui DP, et al. Racial and Ethnic Disparities Among COVID-19 Cases in Workplace Outbreaks by Industry Sector — Utah, March 6–June 5, 2020. MMWR Morb Mortal Wkly Rep. ePub: 17 August 2020. [also in pdf format].