Coronavirus

Coronaviruses represent a large family of viruses that were first discovered in the 1930’s in animals and then subsequently, in humans in the 1960’s.  In animals, they cause a variety of diseases but in humans, the seven known coronaviruses cause various respiratory illnesses.  They get their name because the virus particle appears to have many protein spikes on its surface, giving the appearance of a crown (corona) as can be seen in the below image from the USA Centers for Disease Control and Prevention.

Four of these seven coronaviruses are associated with the common cold and mild upper respiratory tract disease.  However, the other strains may cause severe diseases.  You may have already heard of Severe Acute Respiratory Syndrome (SARS, now referred to as SARS-CoV), identified in 2002, and the Middle East Respiratory Syndrome (MERS), identified in 2012.  Both of these viruses were transmitted to humans via animals (SARS via civet cats and MERS via camels).

Now, a SARS and MERS related, but novel coronavirus strain has emerged as a significant health threat.  The first reported case of respiratory disease due to this virus originated in the Hubei province of China in November 2019.  This strain has now been designated SARS-CoV-2, to reflect the fact its structure is very similar to that of SARS-CoV virus, and the term COVID-19 is used to describe the disease.  As all previous human coronavirus strains are thought to have evolved from strains infecting animals, it is currently assumed that COVID-19 has emerged from an animal source, in particular, bats.  In support of an animal connection, many more cases of respiratory disease were reported in December 2019 in Hubei province, with the Huanan Seafood Market in Wuhan trading in exotic animal meats, at the epicentre.

The virus infection is thought to be spread by coming into contact with individuals demonstrating overt symptoms such as coughing and/or sneezing.  Exposure may occur by direct contact via touching etc or indirectly, by breathing in droplets released by aerosolization within a radius of about 2 metres around a symptomatic person.  It is possible individuals without such symptoms may be contagious, hence the self-isolation of people returning from overseas where the spread has been wider.  In addition to human contact, exposure to the virus may occur by contact with a surface, such as door handles and a variety of utensils, previously handled by an infected person.  However, it is not clear how long the coronavirus, once deposited, will remain viable on a surface as this will depend on a variety of factors such as temperature, humidity and its physical nature.  It has been estimated that survivability may range from a few hours or days.  The virus enters the body by recipients transferring it by touching their nose and/or mouth, and it has been estimated that an infected person may be capable of infecting between 2-3 non-infected individuals.

The symptoms associated with COVID-19 are varied and include:

• Fever
• Sore throat
• Cough
• Sneezing and/or
• Shortness of breath

Symptoms can occur anywhere between 2 to 14 days after exposure to the virus.  Most confirmed cases of COVID-19 have presented with a dry cough, fever and shortness of breath rather than with a sore throat and/or sneezing.  More than 80% of patients will recover from COVID-19 without problems but 1 in 6 may become seriously ill.  The symptoms associated with the disease are not produced by the virus itself but rather by the body’s attempt to limit or resolve infection in the short term (7-10 days) before antibodies can be produced.  Getting better shows that your immune system has done its job. 

COVID-19 has the potential to cause severe disease which may result in death, particularly in people over 65.  In severe cases, the virus causes pneumonia and a small proportion of these patients (17%) may develop severe acute respiratory distress (ARDS) resulting in the need for assisted breathing and possibly develop long-term health issues.  However, it is important to note that by just being in this age bracket does not necessarily mean that you will be susceptible to severe disease.  Data from China show that hospitalisation with pneumonia is associated with the presence of an underlying medical condition, in particular heart problems, diabetes or high blood pressure but also lung problems and cancer. 

As the number of people becoming infected increases, we are learning more about the risk factors involved but susceptibility includes increased age, other health problems as noted above, being on immunosuppressive medications and having underlying lung problems. Being in the age bracket 10-39 confers some protection, pregnant women do not seem to be particularly susceptible and it appears females are less susceptible than males.  People in specific occupations such as health care workers, nursing home personnel and people living in overcrowded conditions will be more susceptible to COVID-19. 

One of the most important risk factors for any of us at an individual level is social contact and travelling, with the latter both increasing the risk of being exposed and hastening the spread of the disease.  If you are older, have underlying health problems or are on medications that suppress your immune system you should take particular measures to protect yourself. 

People at higher risk of serious illness and those with a lung condition may take weeks to recover. If a person develops long-term health problems caused by COVID-19, symptoms most commonly continue for two to eight weeks after infection.

The infectious period varies from person to person. Most people with COVID-19 will have a mild illness and will recover in a few days.

Generally, people are considered infectious from 48 hours before symptoms start. In high-risk settings, they may be considered infectious from 72 hours before symptoms start.

People with mild illness are generally considered to be recovered after seven days if they have been asymptomatic or have not developed any new symptoms during this time.

Sometimes people can still return a positive COVID-19 test although they have recovered. This is because people with COVID-19 have infected cells in their body that release the virus into the environment through breathing, sneezing or coughing, or through their faeces and urine. This is called ‘viral shedding’.

What can I expect post–COVID-19?

Everyone will have a different experience in their recovery from COVID-19. Some people may recover in days, some in weeks. But for others, it could be months. Although each case is unique, people recovering from more severe symptoms are likely to face a longer recovery period.

Schedule regular appointments with your GP to discuss your symptoms and how best to manage them. Your GP will tell you about any medicines that might suit your needs.

Common symptoms you may experience during your recovery:

• fatigue
• cough
• breathlessness
• joint or muscle pain
• chest pain
• change in sense of taste or smell
• anxiety and/or low mood.

Less common symptoms:

• low-grade fever
• headache
• memory difficulties
• confusion
• muscle pain and weakness
• stomach and digestion difficulties
• rash
• depression.

Mask wearing is currently required in indoor settings in the Perth, Peel, South West, Wheatbelt and Great Southern regions.This also applies to anyone who has been in these regions and has since travelled to another region – visit  WA.gov.au (external site) for updates. 

Do I have to wear a face covering if I have a lung condition?

• Most people with a lung condition will be fine wearing a face mask.
• Some people will find wearing one uncomfortable, but face masks are not harmful to people wearing them.
• A few people with a lung condition will find that face masks increase their sensation of breathlessness to the extent they can’t tolerate wearing one. In this instance you might be exempt from having to wear one. Speak to your doctor for advice around this.

What are the different types of face mask?

Surgical masks are single use items and must be disposed after every use.

These are recommended for use if you:

• are caring for someone with COVID-19,
• have COVID-19 or are suspected of having COVID-9 or
• are over 60 or
• have underlying medical conditions such as cardiovascular disease, diabetes mellitus, chronic lung disease, cancer etc.
  
  

If you have, or are suspected to have, COVID-19, you must wear a surgical mask if you cannot avoid being in close contact with someone, e.g. if you are self-isolating and need to visit a GP or hospital.

Reusable fabric masks

Fabric masks should not be worn by healthcare workers at work or by people aged over 60 or with underlying medical conditions.

Fabric masks are used for source control. That is, they act as a barrier between your mouth and nose and the surrounding environment to protect those around you.

Fabric masks must be three layers. Each layer requires a different type of fabric.

These should be washed at least once a day, and when wet or visibly dirty. Wash with laundry detergent on the hottest setting (preferably at least 60 degrees C). Avoid using disinfectants to clean the mask because they may produce fumes that are harmful to inhale.

If you are unable to machine wash, wash in hot water with a laundry detergent then rinse thoroughly.

Make sure your fabric mask is dry before re-using.

Once dry, store your clean fabric masks in a disposable, sealable plastic bag to protect from contamination.

Over time, your fabric masks will need to be replaced. Replace your fabric mask if:

• it no longer fits snugly
• it starts to slide or fall off
• there are any holes
• you find you need to keep adjusting the fit
• the material has started to wear or fray.

What are the symptoms and when should I get a COVID-19 test?

Get tested if you have any of the following, no matter how mild:

• Fever (≥37.50C) OR recent history of fever (e.g. night sweats, chills), without a known source
  OR
• Acute respiratory symptoms (including cough, shortness of breath, sore throat, runny nose)
  OR
• Acute loss of smell or taste.

Types of COVID-19 tests

There are two types of test that can detect if you have the  virus:

1. polymerase chain reaction (PCR, or RT-PCR)
2. rapid antigen self-tests (RATs).

Find out more from the Therapeutic Goods Administration (TGA) about how COVID-19 testing works.

When to get tested

You should attend a walk-in or drive-through COVID-19 testing clinic if you: 

• have COVID-19 symptoms
• are a close contact of someone who has tested positive
• have been advised to do so by a health professional.

If you have COVID-19 symptoms you can have unlimited tests (rapid antigen or PCR) at a COVID-19 testing clinic. Isolate at home until you receive your result.

You do not need to get a COVID-19 test if you:

• do not have symptoms
• are seeking treatment in a public hospital
• are travelling to the ACT, NSW, SA or Vic. 

Where to get tested
Testing is available at COVID-19 clinics, regional public hospitals, health services and remote health clinics (where COVID-19 clinics are not available); and, private pathology centres

What does a COVID-19 PCR test involve?
A swab will be inserted into the back of your throat and then through your nose by a qualified practitioner. This is a fast procedure, lasting less than a minute. It may cause some mild discomfort but is not painful.

Your swab sample will be taken to a laboratory to be tested for COVID-19.

Accessing free rapid antigen tests
From 24 January, you can access free RATs if you hold an eligible Commonwealth concession card:

• Commonwealth Seniors Health Card
• Department of Veteran’s Affairs Gold, White or Orange Card
• Health Care Card
• Low Income Health Card
• Pensioner Concession Card.

You can access up to 10 RATs over a three-month period (max five over a one-month period) through community pharmacies.

RAPID ANTIGEN TESTING – CONCESSIONAL ACCESS PROGRAM

The new short-term rapid antigen test concessional access program provides people with valid, eligible Commonwealth concession cards access to up to 10 free rapid antigen tests.

You will need to attend a participating community pharmacy in person and present your Commonwealth concession card.

You will need to give consent to the pharmacy to record your concession card details. The pharmacy will check and confirm your details, including whether RATs have already been provided to you.

The pharmacy will give you a minimum of two RATs for each eligible individual. You can ask for up to the monthly limit of RATs per eligible individual at any one time, subject to availability.

RATs will be increasingly available from pharmacies in the coming weeks. Phone ahead of your visit to check that they are participating in the free RATs program and have any in stock.

Free RATs are only available to eligible Concession Card Holders through Participating Community Pharmacies.

Some supermarkets and other retail outlets may also carry them for private sale.

If you have COVID-19 symptoms do not attend a pharmacy to collect RATs. Go directly to a testing centre.

If you test positive

• If your rapid antigen or PCR test returns a positive result you must isolate at home. 
• If you took a PCR test your local health department will contact you. 
• If you took a rapid antigen test you must let health authorities know. 

If you test negative
If your rapid antigen or PCR test returns a negative result you do not need to isolate.

Isolation

When do I need to isolate?

You need to isolate if you:

• Have tested positive for COVID-19,
• Are a close contact, or
• Are directed to do so by WA Health.

Who is defined as a close contact?

• A household member or intimate partner of a person with COVID-19 who has had contact with them during their infectious period; or
• Someone who has had close personal interaction with a person with COVID-19 during their infectious period:
  • That have had at least 15 minutes face to face contact where a mask was not worn by the exposed person and the person with COVID-19; or
  • Greater than two hours within a small room with a case during their infectious period, where masks have been removed for this period by the exposed person and the person with COVID-19 (note: others wearing masks in this scenario would not be a contact); or
  • Someone who is directed by WA Health that they are a close contact.

How long do I need to isolate?

If you have tested positive to COVID-19, you will need to stay in isolation for a minimum of 7 days. At Day 7, if symptoms are still present, you should continue isolating until symptoms have cleared.  If you don’t have symptoms after Day 7, you can leave self-isolation, without testing requirements.

I’ve tested positive and need to let my household and some friends know they are close contacts. How far back should I go? How long would I be considered infectious for?

The infectious period is taken from 48 hours before onset of symptoms, or 48 hours before the positive test result, if you do not have symptoms until the end of your isolation period. For example, if you first tested positive on Wednesday afternoon, your infectious period started on Monday afternoon.

When can I leave isolation? Is it after 7 full days of isolation? Or on day 7?

Isolation for 7 days means 7 complete days from the date you took your test, regardless of the time of the test. For example, if you took your test at lunchtime on Monday 7 February, your isolation period finishes the following evening of Monday 14 February (12.01am Tuesday morning).

I have already commenced 14 days isolation as directed by WA Health, however the protocol has now changed to 7 days. Will I be able to isolate for 7 days instead of 14?

Yes. You are no longer required to isolate for 14 days, provided that you have a negative Day 6 PCR test or Day 7 RAT. You can count 7 days from your first day of isolation.

I am a close contact of someone who does not live with me, and I am isolating at home. Do other people in my household need to self-isolate?

No. Only close contacts of a positive case need to self-isolate.

If a household member tests positive to COVID-19, then the entire household would need to self-isolate (external link).

How should I isolate on my own if other people living in the house don’t need to?

Ideally, you should isolate in a room alone (external link), away from other occupants of the house. If you have more than one bathroom, reserve one bathroom for use by the person who is isolating. If this is not possible, ensure surfaces such as taps are cleaned following use.

If isolation within the home is not feasible, you can take the following precautions to reduce the risk of transmission:

• As a priority, place people who are experiencing excessive symptoms in single rooms.
• If there is more than one person with the same symptoms, they can be placed together in the same room.
• Importantly, ensure that people sharing a room are physically separated (more than 1.5 metres) from each other.

Some COVID-19 cases may be required to isolate in a hotel. Refer to the Department of Health guidelines for further advice (external link).

Is the isolation period different for vaccinated/unvaccinated people?

Requirements for isolation are the same for vaccinated and unvaccinated people.

My child is a close contact. Do I need to quarantine with my child?

No. Only close contacts of a positive case need to quarantine. However, parents or close contacts need to take extra precautions and limit interaction with the person who is a close contact where possible. It is important to monitor for symptoms. If you experience symptoms consistent with COVID-19, you should get tested immediately.

More information:

• COVID-19: My child is a close contact
• COVID-19: My child has tested positive  

What support is available to me if I need to isolate?

The WA COVID-19 Test Isolation Payment is a single $320 payment for workers living in WA who have been directed to quarantine while awaiting a COVID-19 test result, are unable to work from home and do not have access to paid leave or other income.

You may also be eligible for the Australian Government’s Pandemic Disaster Leave Payment (external link).

If I isolate with someone else, and they test positive on my last day of isolation, do I need to start my period of isolation again?

Yes, because you will be considered a close contact of a positive case. You must isolate for 7 days of a household member testing positive.

I’ve tested positive, is it recommended I isolate from the rest of my household, or can we isolate together?

Yes, if you have tested positive, and living within a household with people who have not tested positive, you should isolate away from others in your house, in a separate room and have access to a separate bathroom, if possible. If this is not possible, you need to take extra precautions.

I have just tested positive and need to isolate – who do I need to tell?

If you tested positive using a self-administered RAT kit, you need to report your result online, or call 13 COVID for assistance. You should isolate immediately for 7 days and notify your close contacts. They will need to get tested and isolate for 7 days.

I have just tested positive but can’t remember where I have been over the past few days, what should I do?

Isolate immediately for 7 days, and notify your close contacts. Information about what to do if you’ve tested positive is available on the COVID-19 testing and isolation protocols.

The best way to prevent the spread of COVID-19 is by practising good hand hygiene and sneeze/cough etiquette AND social distancing. This includes:

• Frequently washing your hands for at least 20-30 seconds with soap and water (sing Happy Birthday twice), or use an alcohol-based hand gel. Try doing this 10 times a day.
• Refraining from touching your nose and mouth.
• If coughing or sneezing, covering your nose and mouth with a paper tissue or flexed elbow – dispose of the tissue immediately after use and perform hand hygiene.
• Avoiding close contact with anyone if you, or they, have a cold or flu-like symptoms (maintain a distance of at least 1.5 metres).
• Avoid large public gatherings

You may have gleaned from the popular press that there may be a link between taking an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker for high blood pressure and increased harmful effect of COVID-19 infection.  The virus uses the angiotensin-converting enzyme on the cells lining the lung to gain entry to the body.  However, the Council on Hypertension of the European Society of Cardiology has just issued a statement to the effect that patients should continue the use of such drugs due to the lack of any scientific evidence to the contrary.

The infectious period varies from person to person. Most people with coronavirus will have a mild illness and will recover in a few days.

Generally, people are considered to be infectious from 48 hours before symptoms start. In high-risk settings, they may be considered infectious from 72 hours before symptoms start.

People with mild illness are generally considered to be recovered after seven days if they have been asymptomatic or have not developed any new symptoms during this time.

Symptoms in children and babies are milder than those in adults, and some infected kids may not show any signs of being unwell.

People at higher risk of serious illness may take weeks to recover. If a person develops long-term health problems caused by coronavirus, symptoms most commonly continue for two to eight weeks after infection.

While your risk of catching coronavirus again after recovering is lower, reinfection is still possible. The level of protection you have can also depend on factors like your age and immunosuppression.

Vaccination is the best way to protect yourself against reinfection. It’s also important to keep up measures like hand washing, wearing a mask and physical distancing.

The term ‘Long COVID’ is used to describe signs and symptoms that last for a few weeks or months after having a confirmed or suspected case of COVID-19.

Most people who test positive for coronavirus recover completely, but some people may develop long COVID.

Long COVID is where symptoms of coronavirus remain, or develop, long after the initial infection – usually after four weeks. Symptoms of long COVID can last for weeks or sometimes months, and include:

• extreme fatigue (tiredness)
• shortness of breath, heart palpitations, chest pain or tightness
• problems with memory and concentration
• changes to taste and smell
• joint and muscle pain.

It is not yet known how long symptoms of long COVID will last. In a large survey of people in the United Kingdom who had coronavirus, nearly 10% of people reported at least one symptom 12 weeks after their initial infection.

Think about friends, family, carers and anyone else who supports you. Make sure they are coping, provide support and make sure they know what to do about coronavirus. Share this information with them.