New coronavirus cases in Victoria have been falling nicely this week, but if you look a little closer there are still some concerning numbers. A large number of healthcare workers are still being infected. And cases from aged care still appear to be making up…

New coronavirus cases in Victoria have been falling nicely this week, but if you look a little closer there are still some concerning numbers. A large number of healthcare workers are still being infected. And cases from aged care still appear to be making up…

Tegan Taylor: Hello, this is Coronacast, a podcast all about the coronavirus. I’m health reporter Tegan Taylor.Norman Swan: And I’m physician and journalist Dr Norman Swan. It’s Friday, 21 August.Tegan Taylor: Norman, we are still looking to Victoria to see which way the numbers are going there, and it does seem to be that the daily new cases are trending downwards, which is good. But another thing that seems to be trending downwards or at least it was over the previous few days, is the number of tests that are being taken. And so I guess the question is; is there a true drop in new case numbers there or is it just that fewer people are getting tested?Norman Swan: Well, there are a couple of worrying things. One is the numbers haven’t gone down that much, so I suppose the seven-day average is tending down, but there is a feeling of plateauing about it, that the numbers are still in the low 200s to mid 200s, and yes, over the last two or three daysI mean, yesterday the numbers went back up again I think to 20,000-odd, or just over 20,000, which is starting to look like a respectable number again, but they were dropping down quite precipitously, I think almost half that at one point.Tegan Taylor: Of tests you mean?Norman Swan: Of tests, yes. So if you are not testing, you’re not finding, and therefore the case numbers are pretty artificial in that case. You’ve really got to be up at very high numbers to be very sure about your case numbers. So that’s the first thing.The second thing is it’s very hardit looks transparent what they are telling us in Victoria, but it’s not that transparent. Very hard to tell what’s happening. At least 50% are still under investigation every day, and when you just go into the numbers and extract numbersand I’m very grateful to Will Ockenden our producer who spends hours every day just delving into these numbers, and occasionally I’d pick Casey Briggs’ brain as well, when you look at them there is still a lot of healthcare workers being infected, maybe 60 yesterday, maybe 20 yesterday in regional Victoria. And I could well be wrong about these numbers because it’s just so hard to get behind them.But let’s say it is 60 healthcare workers, that’s 25% of yesterday’s numbers, and let’s be kind and say it’s 60 and more in aged care, so that’s maybe 50% of the numbers are aged care and healthcare workers. So the real question in Victoria is; is Victoria going to continue to be locked down beyond this period because hospitals and aged care facilities have not got infection control under control?Tegan Taylor: But we’re still hearing the Health Minister saying that there is only 10% or 15% of healthcare workers who are actually catching it at work.Norman Swan: The Health Minister may well be right but it’s just hard to believe because it’s a disproportionate number of people in an occupational group across a lot of facilities. Frankston Hospital I believe has now got a cluster of 50. I know that healthcare environments are places where it’s high risk, but it just doesn’t make sense that they are catching it outside and 50 people in Frankston Hospital have caught it outside. Have 50 people in the local newsagent caught it? Have 50 people in the local Woolies caught it? They are catching it in the healthcare facility.Tegan Taylor: Well, like you said just now, Norman, what are the chances that it is aged care and hospital or healthcare setting transmissions that keeps Victoria in lockdown for longer?Norman Swan: Well, I think we need to call upon Victoria to be much more transparent about their numbers than they are so that we are clear and we can actually see the breakdown, not just by facility and outbreak but by occupation. Because I think if Victorians expect us to go down to zero spread, and it’s going to be very hard to get down to zero spread if the tens of thousands of healthcare workers across Victoria are still at risk. So I’m not prepared to put a number on it but with lack of transparency of numbers it’s very hard to actually see what’s going on, particularly if there is political pressure on to not show the problems that they’ve got in hospitals, if indeed they have those problems. I think we need reassurance through sunlight, in other words shining a light on this and just being able to see it, and hopefully we on Coronacast will be proven wrong.Tegan Taylor: Another thing that we are getting a lot of questions about is a vaccine, and specifically the Oxford vaccine because that is one of the ones that is being held up as a frontrunner. We’ve got Kylie asking us, Norman, whether we, you and me specifically, would have the vaccination as soon as it becomes available. And I’m happy to share my answer to that, but let’s just start by talking about the vaccine itself a bit and just demystifying exactly what it’s made up of and where it’s at in the development process.Norman Swan: So the strength of the Oxford vaccine is that it’s a technology platform, and when I say technology platform, I mean it’s like the combustion engine or an electric engine, it’s basically a technology that drives the vaccine. And what has been the international push over the last few years particularly with Ebola outbreaks and the potential for future pandemics is that the international community got ahead of the game here. It’s a great success story, is that they predicted there would be another pandemic and they looked around the world and actually created a bit of a competition between different research groups as to what could be a flexible technology platform for a vaccine that would allow them to make a new vaccine to a new virus very, very quickly. And this in fact is a technology platform that was developed a few years ago, and it’s a chimpanzee adenovirus called ChAd which the Oxford group have modified, and it has been used on a variety of viruses over the yearsLassa fever, Nipah, MERS, Ebola and so onso in other words it has been tried out in other vaccines. And what it does here is it’s a virus that’s not a human adenovirus, it doesn’t replicate in humans, and it takesit’s like, if you like, a taxi or an Uber that takes the genetic material from in this case the COVID-19 virus, inside the cell. Although humans don’t get sick with it, they actually can get infected with it and the infection takesbecause what happens with any virus is the virus has got to get inside the cell. So viruses are really good at getting inside the cell, so this is a harmless virus that has the COVID-19 genetic material attached to it, so it’s good at getting inside the cell, and when it gets inside the cell it does what viruses do which is turn the genetic machinery of the cells in your body to producing the genetic material of the COVID-19, in this case the spike protein part, and then it gets outside the cell, and the body recognises that as a bit of a virus and generates an immune response to it. In some ways it’s similaryou may have heard of the mRNA vaccine, the Moderna vaccine, it does the same thing except it doesn’t use a virus to get inside the cell, it has found a way of putting the genetic message inside the cell by itself, the mRNA. But this uses a virus, takes the genetic material of COVID-19 in, this is the Oxford vaccine, the ChAd vector, and then stimulates the cell to produce that genetic segment of the virus, and that gets outside the cell in the body produces an immune response. That’s how it works.Tegan Taylor: So one of the other questions that we’ve had about this is from someone who is on immunosuppressive therapy and is concerned about having a live virus, but that’s different to the sort of live virus vaccines that we might have seen in the past for something like polio, because the live virus in the Oxford vaccine isn’t actually a virus that can infect us, it’s not a live version of the Covid virus, it’s a different virus that the Covid spike protein is just piggybacking on.Norman Swan: And knowing this was coming, I tried to look up to see whether or not it has been tested on immunocompromised populations, and I can’t find convincing evidence that it has. So there is still a potential risk in immune suppressed populations that even though it’s a harmless virus, that it may not be harmless in people who are immune suppressed, but I haven’t been able to find the evidence of that. But the point here is that it’s not a brand-new technology, it’s a technology that actually has been around for a while.Tegan Taylor: So to answer Kylie’s question, Norman; would you get it as soon as it’s available?Norman Swan: If it has been tested in around 30,000 people and no serious side effects, yes I would.Tegan Taylor: Me too, I think we are only going to see this on the market in Australia once it has passed phase 3 trials, and that’s absolutely good enough for me, I’ll be at the front of the queue if they will let me be there.Norman Swan: And it helps to answer another of the questions that we’ve got that I saw somewhere, which is what about children’s vaccines, developing vaccines for children, that’s going to be really important, to be able to immunise children as well. So you’re going to want to know that elderly people, people with multiple diseasesso it’s important that an immune deficient group of people get immunised against this successfully because they are vulnerable to COVID-19, so there is safety in that group. And children do indeed to be able to be immunised because they are a reservoir for COVID-19. And the evidence to date is that this ChAd virus is actually good in children, it does work in children, and they’ve done that using it for malaria vaccines. So there is some evidence in malaria vaccines, not that we’ve got a great malaria vaccine around, but that works in them.I think the bigger problem in people who are a bit immune deficient is will the virus induce enough of an immune response to be resistant to COVID-19? I think that’s more the issue than the safety of it.Tegan Taylor: Well, yesterday we put out the call to you Coronacasters to see how long it was taking for COVID-19 tests to come back where you live, and we got so many responses, thank you so much for that, from all over the country.Norman Swan: And there was a big range, wasn’t there, Tegan, and according to place as well.Tegan Taylor: Absolutely, so it really varied across the country, and no prizes for guessing which place had the longest wait times at the moment, so Victoria, obviously with a huge push for testing there and a huge demand for testing, it’s taking about five days to come back in Bendigo and in other regional Victoria, and about five or six days in Melbourne. But in contrast it was interesting to see Queensland, Brisbane and also the regions was taking overnight or 24 hours or so, the same in Tassie, the same in WA. But basically anywhere outside of Melbourne, a day or two, but in Melbourne five or six days.Norman Swan: Obviously that’s anecdotal because it’s our Coronacasters, but I’m sure it’s an accurate reflection of what’s going on. Unfortunately I think what’s happening in Victoria is that 85% is being done in the private sector, and I’m not sure that they are improving their turnaround times, but let’s hope they are.Tegan Taylor: And thank you so much for everyone who took the time to let us know how it’s going where you live.Norman Swan: And were people having a good experience with it?Tegan Taylor: I mean, is good of an experience as anything when someone is shoving something up your nose, but I think most of the people outside of Victoria seem to be pleasantly surprised by the length of time. But yes, in Victoria it seemed to be a source of frustration because people are required to isolate until they get the results back, which puts pressure on their ability to earn money.Norman Swan: Yes, although there is financial compensation available. But it’s nice to hear that the testers are smiling and being polite as they stick something up your nose and into the back of your brain.Tegan Taylor: Absolutely. Before we go, Norman, I need to take you back to something that you said last weekNorman Swan: Oh no, oh no, what did I do wrong this time?Tegan Taylor: We had a question from one of our toughest critics, a four-year-old who was asking if you were in fact a real swan, and you said something like when you float you don’t float on your bottom, you float on your tummy. And then someone has pointed out on Apple Podcasts (where anyone can leave a review if they like) that swans do swim on their tummy, and that they are disturbed by the idea of them swimming on their bottoms. But it kind of sounds like what you’re saying is what a swan would say who was trying to distract from the fact that you’re actually a real swan. What do you have to say for yourself?Norman Swan: Okay, I’ll come clean, so to speak; I prefer floating on my back. And if that makes you think I’m not a swan, so be it, I’ll live with that.Tegan Taylor: Do as those people did and leave us a review on Apple Podcasts, if you can.Norman Swan: And if you want to ask us a question, go to abc.net.au/coronavirus, go to ‘Ask Us Your Questions’ and fill in the form. I hope you all have a wonderful weekend but I hope you in particular, all our Melbourne Coronacasters, I hope you can have as good a time as possible, I know you’re in isolation, but I hope that you are in contact with your friends and family via online means and getting your friends up on video and so on, and let’s hope it’s not too much longer. And if you want to leave us a comment, go to that website as well, we’d love to hear from you. And we’ll see you on Monday. Tegan Taylor: Absolutely, take care everyone.

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