COVID-19 Medical Director update

3 April 2020

I am asking specialists from around the country to write short pieces on the latest evidence regarding COVID-19, titled ‘Opinion from an Expert’ advice. I have highlighted the key points below alongside links to the full summary article.

Two examples of the kinds of think pieces I’m seeking are below. One was written by Stephen Ritchie, an Infectious Disease Specialist in Auckland, and the other by Professor Jeremy Krebs, a Diabetologist in Wellington.

The key things that stand out for me in these articles is that nasal symptoms are reported as relatively rare with coronavirus; that initial reports on asymptomatic transmission were wrong; and that coronavirus is primarily spread by droplets. 

Additionally, the articles note that patients with diabetes have a higher morbidity rate; that more young people with Type1 diabetes are being hospitalised with ketoacidosis, and that it is unknown if there is a difference in risk between those with Type 1 and Type 2 diabetes. Professor Krebs also emphasises the need to vaccinate for flu and to continue angiotensin converting enzyme inhibitors ACE’s and ARB’s. 

A snapshot of the experts’ key points:

Steven Ritchie, Infectious Disease Expert

  • SARS-CoV-2 virus is an illness primarily characterised by a fever and cough.
  • In Wuhan, most people diagnosed with coronavirus were admitted to hospital, regardless of the severity of their illness. Very little is known about the clinical features of people who had very mild symptoms (more than 80 percent of total coronavirus cases).
  • Clinical information about Chinese coronavirus cases is likely to have included more cases at the severe end of the disease spectrum.
  • The mean time from symptom onset following exposure was 7.1 days.
  • Notably, nasal congestion was an uncommon symptom.
  • Coronavirus is transmitted via contact and droplets produced by symptomatic patients. Airborne transmission was not suspected in analysis of 75,465 coronavirus cases from China reported to the World Health Organisation1.
  • Early in the coronavirus epidemic in China, it was reported that asymptomatic people were able to transmit disease , but this report was incorrect.
Read Stephen's full article.

Professor Jeremy Krebs, Diabetes Expert

  • There is currently not enough data to conclude whether individuals with diabetes are more likely to contract coronavirus than the general population.  
  • In China, people with diabetes had much higher rates of serious complications and death than people without diabetes if they contracted coronavirus.
  • In general, the more health conditions someone has the higher their chance of getting serious complications from coronavirus.  
  • The Chinese Centre for Disease Control and Prevention reported increased mortality in people with diabetes (7.3 percent versus 2.3 percent overall) in a series of 72, 314 cases. (1)
  • A recent report from24 March from Louisiana in the States showed 41 percent of those who died from coronavirus had diabetes as a co-morbidity, the highest rates reported so far.  
  • It is still unknown whether there is a difference in risk between patients with Type 1 or Type 2 diabetes.
  • An important message for patients is that if they effectively manage their diabetes, the risk of getting severely sick from COVID-19 is about the same as the general population. Prevention against getting coronavirus is very important for people with diabetes.
  • It has been reported that more people with Type 1 diabetes are being hospitalised with ketoacidosis during the pandemic than actually having coronavirus. 
  • People with Type 1 diabetes should frequently measure their glucose levels and check for ketones if they are unwell.Continue to vaccinate for flu, and continue ACE and ARB’s.

Next week, I will be posting the latest advice on asthma, chronic obstructive pulmonary disease and prednisone.

Dr Bryan Betty
Medical Director

References 

  1. Report of the WHO-China Joint Mission on Coronavirus Disease 2019; https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf.