Ian Connellan
The numbers
Global COVID-19 deaths passed one million this week, with WHO experts in Geneva telling a briefing the numbers are certainly an underestimate.
WHO Health Emergency Programs head Mike Ryan said that better treatments and effective vaccines might not be enough on their own to prevent the death toll reaching or passing two million, and called on governments to do everything possible to control the virus.
“Are we prepared to do what it takes to avoid that number?” he asked. “Unless we do it all, the number… is not only imaginable, but unfortunately and sadly, very likely.”
On Tuesday WHO announced a set of agreements to make affordable, high-quality COVID-19 rapid tests available for low and middle-income countries (LMICs).
The agreements will see LMICs receive 120 million antigen rapid diagnostic tests – priced at a maximum of US$5 per unit (about AU$7) – over a period of six months. These tests provide results in 15–30 minutes, rather than hours or days, and will enable expansion of testing in countries that do not have extensive laboratory facilities or trained health workers.
Global
As at 16:28 CEST on Wednesday 30 September, cases confirmed worldwide by national authorities stood at 33,502,430 (242,189 of them reported in the preceding 24 hours). 1,004,421 deaths have been recorded (4240). (Source: WHO Coronavirus Disease Dashboard)
Johns Hopkins University’s Centre of Systems Science and Engineering (CSSE) reported (at 14:30 AEST on Thursday 1 October) 33,880,896 confirmed cases and 1,012,964 deaths.
Australia
The Department of Health reported on 30 September that national confirmed cases stood at 27,078, a rise of 17 in 24 hours. 886 deaths have been recorded. More than 7,637,403 tests have been conducted (0.4% positive).
State by state: ACT 113 total cases (first case reported 12 March); NSW 4224 (25 January); NT 33 (20 March); Qld 1157 (29 January); SA 468 (2 February); Tas 230 (2 March); Vic 20,169(25 January); WA 684 (21 February).
Research
Confirmed: the lockdown lush
American adults have sharply increased their consumption of alcohol during the shutdown triggered by the coronavirus pandemic, with women increasing their heavy drinking episodes (four or more drinks within a couple of hours) by 41%, according to a new study.
A national survey found that the overall frequency of alcohol consumption increased by 14% among adults over age 30 compared to the same time in 2019. The increase was 19% among all adults aged 30–59. The results are published as a research letter in the journal JAMA Network Open.
“We’ve had anecdotal information about people buying and consuming more alcohol, but this is some of the first survey-based information that shows how much alcohol consumption has increased during the pandemic,” says lead author Michael Pollard.
Researchers say that the alcohol spike highlights the need for primary care providers, behavioural health providers and family members to be aware of the risks of increased alcohol use and heavy drinking during the pandemic.
The findings also suggests that future research should examine whether increases in alcohol use persist as the pandemic continues, and whether psychological and physical well-being are subsequently affected.
The nightmare: you’re not alone
Thanks to COVID-19, 2020 has been a nightmare for many people, especially those struggling with health problems, economic uncertainty and other challenges.
Now a team of researchers in Finland has evidence that the pandemic really is a bad dream. They used artificial intelligence to help analyse the dream content of close to 1000 people and found that the novel coronavirus had infected more than half of the distressed dreams reported.
The findings are in a paper published in Frontiers in Psychology.
The researchers crowdsourced sleep and stress data from more than 4000 people during the sixth week of the COVID-19 lockdown in Finland. About 800 respondents also contributed information about their dreams during that time – many of which revealed a shared anxiety about the pandemic.
“We were thrilled to observe repeating dream content associations across individuals that reflected the apocalyptic ambience of COVID-19 lockdown,” says lead author Anu-Katriina Pesonen, from University of Helsinki. “The results allowed us to speculate that dreaming in extreme circumstances reveal shared visual imagery and memory traces, and in this way, dreams can indicate some form of shared mindscape across individuals.”
“The idea of a shared imagery reflected in dreams is intriguing,” Pesonen adds.
The study also offered some insights into the sleep patterns and stress levels of people during the pandemic lockdown. For instance, more than half of respondents reported sleeping more than before the period of self-quarantine, though 10% had a harder time falling asleep and more than a quarter reported more frequent nightmares.
Not surprisingly, more than half of study participants reported increases in stress levels, which were more closely linked to patterns like fitful sleep and bad dreams. Those most stressed-out also had more pandemic-specific dreams.
The research could provide valuable insights for medical experts who are already assessing the toll the coronavirus is having on mental health. Sleep is a central factor in all mental health issues, according to Pesonen.
“Repeated, intense nightmares may refer to post-traumatic stress,” she says. “The content of dreams is not entirely random, but can be an important key to understanding what is the essence in the experience of stress, trauma and anxiety.”
Research bites
A survey of the public in the US has found most people would support guidelines that offer vaccine priority to medical workers, children with serious illness who are at high risk of dying and people over 65. Conducted by the University of Minnesota, the survey of around 1000 people – published in JAMA Network Open – showed that more than 90% identified medical workers as high priority. It also showed that people’s responses were consistent with experts’ emerging recommendations for who should get priority access to vaccine.
A study published in PNAS says new modelling shows that an aggressive eight-week lockdown in the cities most at risk of coronavirus could reduce hospitalisations by 90%. The research team from Tsinghua University, China, propose that 15 high-risk cities including New York and London lockdown first, with many other cities – including central Sydney – on standby to do the same if case numbers rise. The researchers say such a drastic, coordinated strategy may be needed, with new evidence suggesting a global COVID-19 resurgence is likely in coming years.
A study published on Monday in JAMA Internal Medicine revealed that older people are highly likely to be excluded from the majority of COVID-19 trials that seek to establish effective treatments, as well as find a preventive vaccine. This is despite the fact that older people are overwhelmingly impacted by COVID-19. Globally, those 65 and older make up 9% of the population, yet account for 30–40 % of COVID-19 cases and 80% of deaths.
“To be sure, some exclusions are needed to protect the health and safety of older adults – such as poorly controlled comorbidities,” says lead author Sharon K Inouye. “However, many are not well-justified, and appear to be more for expediency or convenience of the trialists. We are concerned that the exclusion of older adults from clinical trials will systematically limit our ability to evaluate the efficacy, dosage, and adverse effects of COVID-19 treatments in this population.”
Cardiac arrest is common in critically ill patients with COVID-19, and is associated with poor survival, particularly among patients aged 80 or older, according to a new study published in The BMJ. The study’s origins lie in anecdotal reports of poor outcomes in critically ill COVID patients who have had in-hospital cardiac arrest. This prompted discussions on the futility of cardiopulmonary resuscitation (CPR) for these patients. But data was lacking. To address this evidence gap, a team of US researchers set out to estimate the incidence, risk factors, and outcomes associated with in-hospital cardiac arrest and CPR in critically ill adults with COVID-19. The findings could help guide end-of-life care discussions between critically ill patients and their families, say the researchers.