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Aged care must prepare for coronavirus: Experts


Doug Hendrie


2/03/2020 4:27:02 PM

With older people most at risk, Australia’s aged care facilities urgently need better infection control ahead of any outbreak.

Graph showing mortality rate between age groups.
Mortality rate data from China CDC Weekly; original graph prepared by Associate Professor Ian Mackay. Used with permission.

There is something strange about the coronavirus now leaping from country to country.
 
Based on the best available data, coronavirus is most dangerous to older people, while leaving young people all but untouched.
 
People aged over 80 who contract the virus have a 14.8% chance of dying from COVID-19, the associated disease, according to a large epidemiological study of 72,000 cases in China.
 
But in that study, no children under the age of nine died – and only one young person between 10 and 19 died. Rates of infection for young people were also very low.
 
That makes this coronavirus quite different to the flu, which is particularly dangerous to the very young, very old and pregnant women.
 
While that may come as a relief for parents, experts have told newsGP that coronavirus will pose a major challenge to Australia’s ageing population – particularly those in aged care facilities.  
 
Around one in six Australians (16%) is now aged over 65, and coronavirus gets steadily more dangerous once you’re over 60.
 
The risk has led Federal Health Minister Greg Hunt to call on aged care and medical workers returning from virus-afflicted Italy or South Korea to not to return to work for 14 days.
 
The idea of coronavirus loose in Australian residential aged care facilities is enough to make GP and lecturer Dr Ken McCroary wince.
 
‘I’m just imagining some of the [aged care facilities] I go to. If it took hold, there’s no way you could quarantine it,’ he told newsGP.
 
‘The risk to the aged population may well be significant, particularly with a non-vaccinated population and a highly contagious respiratory droplet virus.’
 
Infection control is often lacking, and personal protective equipment minimal or non-existent, Dr McCroary said.
 
‘Where we’ve had contagions like gastro or influenza, I’ve seen it spread so quickly – and with lethal consequences in that population,’ he said.
 
Dr McCroary said it is now time to put education and prevention strategies in place ahead of any outbreak.
 
‘The whole point is to do it now rather than once we’ve had a number of facilities infected. Older people are at higher risk of the flu anyway, and it looks like we may well see increased coronavirus at the same time as the influenza peak. That would be pretty scary,’ he said.
 
Dr McCroary believes staff screening, as well as a lockdown on visitors, could be necessary.
 
‘Staff may well have to be quarantined away from the home as well. Staff as well as visitors can be carriers of the virus,’ he said. 
 
The calls come after the US outbreak widened, with concerns centring on a nursing home in Washington state where five residents and a staff member have tested positive – with one resident dying.
 
The news has triggered widespread alarm among residents and their families, while the The New York Times has reported the facility has long had issues with infection control.
 
The virus may pose even larger issues in ageing nations like Japan, where almost 30% of the population is aged over 65.
 
University of Queensland virologist Ian Mackay told newsGP that aged care facilities will need to increase their vigilance by banning or restricting visitors if the virus is circulating in the community.
 
‘The cat is out of the bag – and has been for quite a while,’ he said. ‘This will be the fifth coronavirus that circulates widely amongst us.
 
‘GPs are going to have to manage a whole lot of community concern, especially from older people. There will be a lot more community angst than usual.’
 
Australia’s Chief Medical Officer Professor Brendan Murphy has warned that some carriers of the virus may have symptoms so mild they are unaware they are infected.
 
‘All of the evidence suggests people are most infectious when they are symptomatic. That is still the most important piece of advice, to isolate when you are symptomatic,’ he said in a press conference.
 
The infection has been mild in the vast majority of people receiving medical attention for the virus, but Associate Professor Mackay cautioned that fears around the transmissibility of the virus could be overstated.
 
‘It doesn’t spread as much as people think it does, it does take time and some exposure,’ he said.
 
‘It’s not like measles. Yes, we’ve seen large numbers and spread, but we’re talking lots of exposures and not everyone is getting infected.’
 
The RACGP has more information on coronavirus available on its website.
 
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