{"id":274724,"date":"2020-09-03T16:50:21","date_gmt":"2020-09-03T06:50:21","guid":{"rendered":"https:\/\/southburnett.com.au\/news2\/?p=274724"},"modified":"2020-09-03T16:54:53","modified_gmt":"2020-09-03T06:54:53","slug":"confused-about-covid-19-terms","status":"publish","type":"post","link":"https:\/\/southburnett.com.au\/news2\/2020\/09\/03\/confused-about-covid-19-terms\/","title":{"rendered":"Confused About COVID-19 Terms?"},"content":{"rendered":"
\"\"<\/a>
Associate Professor Anita Heywood . . .\u00a0 “eradication” of COVID-19 is unlikely, but “elimination” is possible
(Photo: UNSW Medicine)<\/figcaption><\/figure>\n

September 3, 2020<\/strong><\/p>\n

Confused by some of the terminology you are hearing in all the COVID-19 updates by politicians and medical officers?<\/p>\n

University of NSW infectious disease experts have tried to explain what some of the terms mean in their precise medical definition rather than in popular understanding.<\/p>\n

Disease management terms such as “elimination” and “eradication” have been used in press conferences and media coverage since the start of the pandemic.<\/p>\n

Associate Professor Anita Heywood said while these terms seem familiar, they are technical public health terms which mean something very specific in an infectious disease context \u2013 and misuse of the terms can be at best confusing, or at worst, misleading.<\/p>\n

\u201cA lot of the confusion comes from these terms being thrown around \u2013 sometimes interchangeably,\u201d she said.<\/p>\n

\u201cEradication means no global cases of a disease, except samples in laboratories.\u00a0We achieved this for smallpox in 1980.<\/p>\n

\u201cElimination, on the other hand, means no sustained community transmission in a specific region or country.\u201d<\/p>\n

Assoc Prof Heywood said eradication was not likely for COVID-19 given that there isn\u2019t a vaccine yet and some infected people are asymptomatic (ie. have no symptoms). <\/strong><\/p>\n

The fact that the disease is also “zoonotic” (ie. originating from animals) also makes eradication unlikely. Eradication might only be possible if humans were the only host.<\/p>\n

However, Assoc Prof Heywood said the concept of “elimination” shouldn\u2019t be easily dismissed.<\/p>\n

\u201cWhen most people hear the term \u2018elimination\u2019, they think zero cases,\u201d she said.<\/p>\n

\u201cBut occasional cases and small outbreaks can still happen once a disease is eliminated, due to imported cases.<\/p>\n

\u201cThe key feature of elimination is stopping these cases from leading to sustained community transmission.\u201d<\/p>\n

Australia\u2019s official COVID-19 strategy, “suppression”, doesn\u2019t have an epidemiological definition.<\/strong><\/p>\n

\u201cSuppression isn\u2019t a known technical term,\u201d epidemiologist Prof Raina MacIntyre, head of the Biosecurity Program at the Kirby Institute at UNSW, said.<\/p>\n

\u201cIt\u2019s either elimination or disease control.\u201d<\/p>\n

She said “disease control” meant reducing the number of cases to a locally acceptable level, but community transmission may still occur.<\/p>\n

“Suppression” could be classified as “disease control” but the unclear definition had implications for the type of goals set, such as what a locally acceptable level of COVID-19 was.<\/p>\n

\u201cYou need a technical definition so that people know what they’re working towards,\u201d Prof MacIntyre said.<\/p>\n

\u201cYou also need specific goals and ways to measure those goals.<\/p>\n

\u201cFor example, when we have achieved zero community transmission, when do we say we have eliminated COVID-19? We need an agreed definition \u2013 either a specified time period or a number of generations of transmission.<\/p>\n

\u201cDeclaring elimination after one month of zero community transmission is meaningless and may lead to complacency with all the disease control measures we still need. The majority of Australians remain non-immune to SARS-COV-2, so we may see more epidemics until the time we can vaccinate most Australians.\u201d<\/p>\n

Prof MacIntyre said that when people say “suppression”, they often include the concept that we’ll live with a certain level of disease.<\/p>\n

\u201cBut COVID-19 isn\u2019t a chronic disease that will remain at the same level. It\u2019s an epidemic disease, which means if you\u2019ve got a certain level of disease, it\u2019s just going to keep growing and getting bigger,\u201d she said.<\/strong><\/p>\n

The rate of infection \u2013 or reproduction number called “R” \u2013 is the average amount of people someone with COVID-19 is likely to spread the disease to.<\/p>\n

R figures greater than one can quickly lead to exponential growth.<\/p>\n

\u201cSaying we accept a certain level of disease is a huge risk,\u201d Prof MacIntyre said.<\/p>\n

\u201cThat\u2019s exactly what we saw in Melbourne. In a matter of weeks, it went from around 15 cases a day to over 700 cases a day.<\/p>\n

\u201cCOVID-19 infections won\u2019t stay at small levels without strict measures, like the current lockdowns in Melbourne.\u201d<\/p>\n

Given there is no COVID-19 vaccine yet, non-medical public health measures \u2013 called non-pharmaceutical interventions or NPIs \u2013 are being used to manage the disease.<\/p>\n

Australia\u2019s current disease control measures include stopping clusters from spreading – such as isolating active cases, conducting contact tracing, and testing and quarantining contacts of known cases.<\/strong><\/p>\n

It also includes preventative measures, such as enforcing border controls, implementing physical distancing requirements (such as lockdowns and mass gathering restrictions), and reducing transmission via face masks.<\/p>\n

\u201cThe measures they\u2019re using to suppress are the same as what you would use to eliminate,\u201d Assoc Prof Heywood said.<\/p>\n

\u201cIt\u2019s just how much pressure \u2013 the strictness and duration \u2013 is put on those measures.”<\/p>\n

To make matters even more complex, the definition of “elimination” isn\u2019t static, but changes according to the specific disease and how it spreads.<\/p>\n

For example, for measles to be considered eliminated, there needs to be no evidence of community transmission for three years. After the three years, there can be outbreaks, but they can\u2019t last for longer than a year.<\/p>\n

Other diseases have their own elimination requirements, which largely vary by the amount of time needed with no evidence of community transmission.<\/p>\n

Given these varying definitions, it\u2019s important to be specific when speaking about COVID-19 elimination.<\/p>\n

The problem is a definition of COVID-19 elimination doesn\u2019t exist yet and the World Health Organisation has not set a goal.<\/p>\n

Assoc Prof Heywood and Prof MacIntyre have suggested a possible definition of at least three months without any new cases of community transmission or at least three generations of transmission from an index case.<\/strong><\/p>\n

\u201cPeriods shorter than three months might not be meaningful, and declarations of elimination might result in a false sense of security for the population,\u201d they said.<\/p>\n

Assoc Prof Heywood said occasional cases don\u2019t mean elimination is impossible \u2013 the key is to stop them leading to sustained community transmission.<\/p>\n

\u201cUnless we have a 100 per cent infection control practices for return travellers, there\u2019s always going to be a chance of the virus escaping,\u201d she said.<\/p>\n

\u201cThe recent spike in New Zealand can teach us the need to stay vigilant.\u201d<\/p>\n

Prof MacIntyre said elimination would be a bigger challenge for places with a high number of international arrivals, such as Sydney and Melbourne.<\/p>\n

Other parts of the country were in a better position.<\/p>\n

\u201cIt\u2019s feasible for some States that have no known cases to keep it like that,\u201d Prof MacIntyre said.\u00a0\u201cBut they have to keep their borders shut or tightly controlled with quarantine.<\/p>\n

\u201cNo matter the strategy, we will be walking the COVID-19 tightrope of waxing and waning epidemics until we have an effective vaccine.<\/p>\n

“Everyone needs to play their part in stopping the disease spread \u2013 social distancing, wearing a mask, hand washing and getting tested if required.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

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