The Code COVID19 International Update – 30 September 2021

close up photo of the coronavirus

Dr Priscilla Robinson

This is a weekly snapshot of the COVID-19 pandemic, assessing efforts by nations around the world to test, track and fight the virus. It’s compiled by Dr Priscilla Robinson, an Adjunct Associate Professor of Public Health at LaTrobe University, and an editor for the Australian and New Zealand Journal of Public Health.

Things are slowly changing – cases slowly dropping, and vaccination rates rising. Just a reminder that, worldwide, every day there are still about half a million cases and 10,000 fatalities notified to Johns Hopkins / WHO.  Europe is the only region which as had about the same numbers as last week.

View the latest spreadsheet here

Australia has just clocked up 100,000 cases and over 1,250 deaths, a relatively low fatality rate compared with other countries. The relatively high fatality rate in Tasmania and Victoria is really a reflection of the older and infirm people who carried the COVID-19 burden early on. In most respects this still sadly reflects the ongoing problem which this year is about COVID rather than influenza and other communicable diseases which, although rare, Legionellosis for example, older people normally carry a higher death rate.

In Africa, Tanzania has started reporting their cases (I have left it in red for anyone who is interested), having reported nothing for over a year. This accounts for much of this week’s African cases. New Caledonia had a huge rise this week, nearly trebling case numbers and fatalities (this might be a reporting adjustment, but I cannot find out why it has happened). Thailand has had a 33% or so increase this week, and to some extent Brunei Darussalam has had a blip too, just not quite as dramatic.

COVID tests:

I have attached a summary of research into rapid COVID tests. In the USA, the FDA has approved – finally – the use of blocks of home test kits that are as easy to use as pregnancy tests. The problem is that the sensitivity (and probably specificity), i.e. false positives and false negatives, is not as good as the laboratory-based PCR tests which can detect lower levels of virus presence. But the argument is that more frequent use, even is the test is less accurate, is better over time than no testing, especially if people can do it themselves. There are of course some problems with this as an argument, but it also seems to me to have some merits, especially if people do not have to go to a test centre to get a test.

Interesting comment on this from Tony Wheeler in London, where Rapid Antigen Test (RAT) home kits are available and free.  It seems that in Australia they might become available later in the year. Who knows that that means or how they will collect the resultant clinical waste (will anybody even try to do so, or have they even thought about it?) Still, the idea has some merit, especially if they are not more complicated than a home pregnancy test. I remember, more than 40 years ago telling my GP I was pregnant, and he (yes, it was a male GO) said I couldn’t say that because he had not confirmed it.  I ask you. However, it does not work like that for COVID tests, so let’s see how this all rolls out. Although the tests involved are not the same rapid antigen tests (RATs), this article summarising a paper from the reliable Mayo Clinic about testing and travel is worth reading.

I have attached a paper, Science Advances – Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening, which explains the thinking behind it. (Don’t worry, the abstract is quite readable, even if the whole paper is complicated!). So: Modelling suggests that whilst PCR tests can identify low levels of virus, and that is when people are less (or even possibly non-) infectious – important when contact tracing – for asymptomatic people who have not have known contact with a case, and who have to provide evidence of being -ve (e.g. for travel or work), or who just need reassurance, home test kits could provide a reliable and inexpensive and accessible option. If you live somewhere where they are available that is. If the test returns a false negative, viral loads are low so the person is probably not (yet) infectious.

In the news this week:

The following article (note that it is not yet peer-reviewed, so considered speculative for now) with a complicated title has some disconcerting news – what these researchers (24 of them – rather a lot!) have found is that bats in various caves in northern Laos have been found to be carrying several coronaviruses that are very similar to SARS-19, with speculation that pangolins might be involved as an intermediate animal transmitter.

Temmam S et al. Coronaviruses with a SARS-CoV-2-like receptor-binding domain allowing ACE2-mediated entry into human cells isolated from bats of Indochinese peninsula.

If you are interested in reading about ivermectin here is a good clinical letter  – summarising the current lack of evidence that it works, and pointing to sound analyses of existing papers making that point in more detail. Note: it works really well for killing parasites such as roundworms, especially in animals. Only rarely prescribed for use for humans.

Lastly, a much-loved colleague of mine reminded me about the courses available on the WHO website. They are all free, and have a neat little certificate for you on completion. Of relevance to COVID-19 etc, there are courses on emergency response, antigen testing, vaccines, the use of personal protective equipment, infodemic management, infection prevention and control, and in several languages. Brilliant resource, and apologies for not remembering about it much earlier (and thanks SR for the reminder).

That’s it for this week,



About Dr Priscilla Robinson and The Code COVID19 International Update

Dr Robinson is a public health epidemiologist with particular interests in international health and communicable diseases, and public health competencies. She has worked in health departments in England and Australia, has managed public health teaching programmes, and taught and researched many aspects of public health epidemiology and policy in many countries. She is an adjunct Associate Professor at LaTrobe University, and to stop herself being bored is an editor of PHAA’s journal ANZJPH, and holds board positions (almost all unpaid) on various NGOs, journals, and at her local hospital. Otherwise, 10 acres of untamed bushland on a hill in South Gippsland, VIC, makes weight-bearing gym exercise and strength training a bit redundant.

The CODE Update is a regular Intouch feature to keep readers informed of COVID-19 developments around the world.

The CODE Update originally began at the start of the SARS CoV-2 pandemic as Priscilla’s way of explaining to her friends and family around the world what was happening, and counter their experiences of information overload and misinformation. The update provides links to practical materials and papers written for people who are not versed in the language of outbreaks and epidemic curves. Published weekly, it includes a short commentary to provide context to the numbers included in the spreadsheets.

Note: While every attempt is made to transcribe all data faithfully, every now and again mistakes are made and not noticed until the next Update. Also, on occasion, numbers are revised after posting at the source databases.

We hope you will find these updates to be a helpful tool, and the links to current information useful.

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