Professor Josh Davis is a clinician researcher, and divides his time between clinical work as an infectious diseases physician in Newcastle, and research work as a senior principal research fellow based at Menzies. He is also the President of the Australasian Society for Infectious Diseases (ASID).
What are your thoughts on how this threat has developed throughout the world?
This is the most extraordinary disease outbreak I have seen in my 20 years as a clinician working in infectious diseases. The scale and pace of this pandemic is unprecedented in my lifetime. And equally the pace of scientific discovery and progress in our response to COVID-19 has been really exciting and an order of magnitude faster than even a decade ago. For example this virus was identified and sequenced within weeks, and a clinical test (PCR) developed and made widely available within a month. For SARS in 2003, this took about six months.
Has Australia prepared enough?
Australia has the advantage that the epidemic is affecting us weeks to months after most other countries, so we can learn from their experiences. Two weeks ago, Australian hospitals were bracing themselves for an onslaught that thankfully has not yet arrived – hence we have had time to get a lot of measures and planning in place.
Many lessons have already been learned about how things could be done better: one is that we need better national co-ordination of responses to infectious diseases, through the formation of a national centre for disease control.
The second is that Australia is too dependent on overseas manufacturing of key goods. For example, most surgical and P2 masks were previously imported from Wuhan China, and most viral swabs (used to test for the virus) were imported from northern Italy!
Are the issues unique in different states and territories?
Yes and no. While each state and territory has different population demographics and hospital set ups, most of the key issues are relevant across the country – hence the messaging to the public would be much better if co-ordinated by one central authority such as a national centre for disease control.
From your research and clinical background, who do you believe are the most at-risk people should the virus not be contained by measures currently in place?
The potential impact of COVID-19 on remote Aboriginal communities is a real worry. We know that the flu pandemic in 2001 (“swine flu”) affected Aboriginal Australians much more severely than Australians as a whole with higher rates of hospitalisation and death, and we will need to work very hard to prevent the same thing happening with COVID-19.
Social distancing will be very difficult in most communities given the crowding of housing. Chronic conditions such as diabetes and kidney disease are common and these increase an individual’s risk of severe disease.
The Northern Territory government’s policy to ban non-essential travel to remote communities is an important and necessary move. We need to keep this virus out of remote communities as much as possible, until we get a safe and effective vaccine – at which time Aboriginal and Torres Strait Islander Australians should be prioritised for vaccination.
How do you feel about so many arm-chair epidemiologists providing expert advice on social media and in many cases mainstream media?
There is a lot of misinformation (well-intentioned but wrong) and disinformation (purposely misleading) circulating about COVID-19. Much of this is actually more infectious than the virus itself. I think people should stick to their own expertise, and the media should report in a more open and balanced way.
Can you provide an overview of your current work leading the development of the Australasian COVID-19 Trial?
Along with Associate Professors Steven Tong, Justin Denholm (Doherty Institute, Melbourne) and David Paterson (University of Queensland), I am leading a large randomised trial investigating antiviral treatments for COVID-19, called ASCOT – the Australasian COVID-19 Trial. This trial has gone from concept to first patient in a about four weeks; this process normally takes at least six months. It has involved a lot of late-night teleconferences and protocol writing.
Collaborators from around Australia have pulled together to help, including key Menzies researchers Professor Ric Price (who has provided expert advice on dosing of the antimalaria drug we are using) and Professor Alan Cass ( who has provided expert advice about involvement of patients with kidney disease).
Patients hospitalised with COVID-19 will be approached for informed consent to participate in the trial. If they consent, they will be randomly allocated to one of four groups:
- Current standard care alone or standard care plus
- Lopinavir/ritonavir (an HIV drug that works in test tubes against this virus)
- Hydroxychloroquine (an antimalaria drug that works against the virus in test tubes)
- Both these drugs together. We do not know if these drugs are effective in people with COVID-19 and it’s vital to conduct properly designed and powered clinical trials to find out for sure.
What are you doing to relax?
Unfortunately, not by watching the Sydney Swans play AFL (my favourite team)! I have been running a fair bit, which is a great way to stay calm and get perspective, while still maintaining social distancing (see my blog post on how to run safely).
How has COVID-19 affected you and your family?
Like everyone in Australia, my family and I have been directly affected by COVID-19. My four kids have been doing school/university from home for the past few weeks, which makes “working from home” a lot less productive for me.
My regular trips up to Darwin to work with collaborators at Menzies as well as visiting my parents and sisters are on hold. My wife is an anaesthetist and she and I have both been spending a lot more time than usual at the hospital working on COVID-19 preparedness. I was there all last weekend seeing COVID-19 patients, which causes a bit of anxiety for my family.
The bottom line is we need everyone to contribute to Australia’s public health response by staying at home as much as possible and practising social distancing – this will prevent our hospitals from being overwhelmed and will change this from a chaotic disaster (like in Italy or New York) to a well-controlled but hugely inconvenient problem (like in South Korea or Singapore).