US records 290,000 Covid-19 cases, a new daily record The United States has set a new daily record for new coronavirus cases, with 290,000 cases reported in 24-hours, according to the Johns Hopkins global tally. Some 3,676 people in the US died with the virus in the same period. There have been 21.8m cases and 368,685 deaths in the US since the pandemic began. Mexico has reported 14,362 new confirmed cases of coronavirus and 1,038 deaths. It is one of the highest daily case increases and brings the total number of cases in Mexico since the pandemic began to 1,507,931, with 132,069 deaths. The real number of infected people and deaths is likely significantly higher than the official count, the Health Ministry has said. Coronavirus border restrictions are also causing problems at the border between South Africa and Zimbabwe. Zimbabwe has reintroduced movement restrictions following a surge in Covid-19 infections, which have doubled to 18,000 cases since the start of November. South Africa is the worst-affected nation in Africa, with more than 1.17m infections and 31,800 fatalities since the pandemic began and unprecedented daily figures of more than 20,000 cases reported several times this week. More on this from AFP: Zimbabwean truck driver Wallace Muzondiwa queued four days in his vehicle to enter neighbouring South Africa after thousands of people rushed to the border to escape new Zimbabwean movement restrictions this week. The surge overwhelmed immigration authorities at the Beitbridge border post, South Africa’s second-busiest entry port, where angry crowds were stranded by the backlog. “The situation is very, very, very hectic,” said Muzondiwa, desperate to get back on the road after officials finally approved his coronavirus test and additional pandemic-related paperwork. “The line is going very, very slowly and the sun is very hot,” he complained. Flustered travellers hurried past with their luggage, hopping into minivan taxis parked alongside sizzling barbecue stands selling chicken wings on the go. Coronavirus has complicated cumbersome land border crossings in southern Africa, where trucks can sometimes wait days to get through sluggish customs. “What causes the delays at the borders are the documents,” explained South African driver Sinki Tshangise, 44, who has criss-crossed between Botswana, Malawi, Zambia and Zimbabwe for almost a decade. Negative Covid-19 certificates often expire before arrival, he added, forcing drivers to pay for more testing on the road. “I don’t think I can afford to pay at each and every border,” said Tshangise. “It’s a real struggle.” Foley says people arriving from the greater Brisbane area to Melbourne are being met by health officials at the airport. My advice is flights from any of the five local government areas are being met by authorised officers and representatives of [the Department of Health and Human Services] and being advised as per the now applicable orders now in place arising from national cabinet, that is, go home, get tested, and stay at home until 6pm on Monday, when further advice will be provided. That was the outcome of national cabinet and I know, from personal experience, that that precisely has been what has been happening at Melbourne airport today. But he says people can fly to Victoria from airports in Queensland which are outside the greater Brisbane area, but if they were in Brisbane from 2 January onwards they are required to comply with the lockdown order, wherever they are. There’s no specific ban on people from greater Brisbane coming to Victoria, but the lockdown means no one currently in greater Brisbane should be travelling anywhere. If you are in Queensland outside those areas, you have still got every ability as far as Victoria is concerned to come home in the normal arrangements – Coolangatta, Townsville, all those airports are covered by this arrangement. Victoria will not declare any exposure sites over Queensland woman with UK variant Foley says Victoria campaigned for the change to the AHPPC guidelines for releasing people who test positive to Covid-19 from quarantine. This is the procedure that has been in the news today because a woman who went into hotel quarantine in Victoria, tested positive on day one, was released from quarantine after being asymptotic for three days on day 10 in accordance with that protocol, and then caught a domestic flight to Brisbane, has since been found to have been carrying the UK variant of the virus. She was tested again for Covid-19 by Queensland yesterday and returned a positive result. Foley describes the case: She was in quarantine in Victorian hotels for 10 days. Tested on day one, returned positive that next day and through the processes of checking symptoms was released in accordance with those to go home on the end of that, with at least three days of being asymptomatic ... That system has now changed as a result of Victoria’s advocacy and I’m pleased that Victoria has for a few days now, before AHPCC’s decision and national cabinet’s decision, put that system in place. He says Victoria will not declare any potential exposure sites at the airport or on the Jetstar flight the woman took to Brisbane on 5 January in relation to this case. Queensland authorities are contacting everyone on that flight. That flight, I don’t believe so because the person wasn’t infectious, however due to an abundance of caution as the chief officer of Queensland has pointed out now the person is up to day 15 and has shown no signs of infectivity we are cooperating with them to make sure they have all the data they need and the manifest from the Jetstar flight is provided and followed up. I commend Queensland for the extraordinarily thorough approach to this, to make sure every avenue is being run down, to make sure Queenslanders and all Australians are safe. Because an issue in any state is an issue for all Australians. To Melbourne now, where the Victorian health minister, Martin Foley, has been speaking. He says the Victorian government is “very pleased” that national cabinet yesterday adopted a Victorian proposal around hotel quarantine arrangements and requiring pre-flight tests for people travelling to Australia. He says he is also pleased that the Australian Health Protection Principal Committee has updated its advice around management of people who test positive to Covid-19 in response to the new, more infectious variants of the virus. Guardian Australia reporter Luke Henriques-Gomes has spoken to South Australian woman Nicole Clark, who had a miscarriage by the side of the road while trying to get home from regional New South Wales, after state border restrictions were introduced in response to the Covid-19 outbreak in Sydney. It’s a tragic story, made more difficult for Clark by the intense public backlash from people who incorrectly believed she was blaming state government border policies, particularly the Victorian government’s border policies, for her miscarriage. She told Guardian Australia: I ended up defending myself and trying to fill in the gaps. Some of the comments from some of the women, they blow me away. Clark said she decided to speak publicly about her experience because of the way she was treated by police, particularly police in South Australia. She does not blame her miscarriage on border closures, nor the bumpy ride on the unsealed road that she and her partner were directed to after being turned away at the Victorian border, en route from NSW to SA. She is seeking an apology from police. I want an acknowledgement of the fact that I was a woman in distress. I had a miscarriage and I was grieving. And I was humiliated. You can read her full story here: An online tool that can identify Covid-19 patients who are at highest risk of deterioration is being made freely available to NHS doctors from Friday, AP reports: The new risk-stratification tool, developed by researchers from the UK Coronavirus Clinical Characterisation Consortium (known as ISARIC4C), assesses data collected from hospital patients along with some standard laboratory tests. It then calculates a percentage risk of deterioration based on the information, which is known as the 4C Deterioration Score. The new tool builds on the scientists’ previous work – the 4C Mortality Score – which predicts the percentage risk of death from Covid-19 after admission to hospital. The researchers said their work, published in the journal the Lancet Respiratory Medicine, could help improve patient outcomes and may save lives. Mahdad Noursadeghi, a professor of infectious diseases at University College London’s faculty of medical sciences, who is a co-senior author on the paper, said: “Accurate risk-stratification at the point of admission to hospital will give doctors greater confidence about clinical decisions and planning ahead for the needs of individual patients. “The addition of the new 4C Deterioration Score alongside the 4C Mortality Score will provide clinicians with an evidence-based measure to identify those who will need increased hospital support during their admission, even if they have a low risk of death.” To develop their online tool, researchers used data from 74,944 adults with Covid-19 who were admitted to 260 hospitals across England, Scotland and Wales between 6 February and 26 August 2020. They said it can be incorporated into NHS trusts’ Electronic Health Record System – used to manage all patient care – so that risk scores for patients can be generated automatically. The NSW chief health officer, Dr Kerry Chant, has provided a bit more information about that case of a woman released from hotel quarantine in Sydney, after completing her isolation period with the UK variant of the virus. It is exactly the same situation as the case in Victoria – the only difference is this woman did not travel interstate once she was out. Chant says the woman was released from quarantine according to guidelines, “but for the utmost of caution we’ve tested her again and as we have for others that have been released”. She has a high CT value. We are doing further tests but for the abundance of precaution, we have listed some venues that she has been out and about in. I can say at all times wearing a mask, and if anything, she is unlikely to be infectious, but we are taking a very precautionary role as we learn about this disease. It is important to note that we have no evidence that this disease acts any differently in terms of clearance and when you become infectious. But again, because of that uncertainty, that scientific uncertainty, we are acting very precautionary (sic) and that’s why we are announcing those venues and following up and doing further testing on the individual. And I stress the fact that we have strengthened those guidelines in accordance with communicable disease advice, which has just come out over recent days and that will now mean that no patient ... no one will be released without exit swabs or clear understanding of their genomes and their genome sequence results. She also provided some clarity around the quarantine timelines. Australia has mandatory hotel quarantine periods of 14 days for international travellers. But if you test positive to Covid-19, you move out of that system into a system which requires you to isolate for three days after your last symptom or 10 days after your positive test, whichever is later. That means that in some circumstances, a person who returned a positive test could be released earlier than a person with negative tests. Chant said: The guidelines require that you have 10 days in isolation after your symptoms. So you flip from the quarantining 14 days to when you are a case. If you have mild illness, the guidelines that were present at the time was that you were – 10 days off your onset of symptoms, when you were symptom-free for 72 hours and that was the guidance for mild disease. Obviously there is a different set of criteria if you have been hospitalised, there is much more stringent guidelines. This person was in isolation for around 13 days since her symptom onset. The rules have now been changed to require at least 14 days isolation since symptom onset, and exit testing. Berejiklian is asked if the current restrictions in NSW – which are not especially onerous, particularly on a global scale – will continue until there is widespread vaccination. She says they will continue for as long as the health advice says they should, and not a moment longer. The pause we’ve taken for a month in relation to overseas travellers gives us more time to learn what the virus is doing, what new variations of the virus is doing, and that’s important. That’s why in March last year we had the stay-at-home for all of the state so we could make sure we understood what the virus is doing until it’s time to build our resistance and resilience. Now there is a similar setting where the restrictions remain in place for the foreseeable future, but it’s important for us, especially in relation to managing our quarantine system, that we take a pause for a month, that we reduce the burden of processing so many people every week and take that time to learn and understand what the variations of the virus are doing, and whether we do need to step up or down any of our settings. I think the next few weeks will be really important in that process. It’s very much relieved that pressure on our health people, the police, anybody working in the hotel quarantine system for a month, to help us determine and change the settings going forward. The NSW premier, Gladys Berejiklian, was asked about the case I mentioned earlier, where a woman who quarantined in Victoria travelled on a domestic flight to Queensland after completing the required 10-day isolation but before authorities knew that she had the UK variant of the virus. Berejiklian said: I can only comment on what happens in NSW, and I’m sure the deputy premier and the minister will attest that we are often floored by the work that our contact tracers do overnight, and the more quickly you can get on a case and remember all the places they’ve been to, the better it is for managing outbreaks. Information is key, real time is key, we can’t stress that enough, and quick contact tracing has been part of the reason why NSW has been able to weather the virus as we have, and that is how we will continue. Information is key in this process. NSW to introduce daily testing of all staff working in hotel quarantine The NSW health minister, Brad Hazzard, said NSW would now be doing daily testing of everyone working in the hotel quarantine system. That’s the model Victoria adopted when it relaunched its hotel quarantine system last month and pushed at national cabinet yesterday. Hazzard said: I want to make clear that we have already introduced daily testing for some of the staff in the quarantine hotels, but we are now progressing to all staff in the quarantine hotels. We will have daily testing. That’s an important step forward, particularly to manage the increased issues related to these new variants coming from, as the premier said, up to 30 countries at the moment that we know about across the world. That will actually see all of the staff, totalling around about another 10,500 tests a week going to our pathology staff. In addition to that additional 10,500 daily tests of staff working in the quarantine hotels, there will be up to about 3,000 airline crew, international airline crew who will be tested on arrival here in Sydney. Of course, that is in conformity with the national cabinet’s direction. Chant said NSW authorities had identified one person who had been released from quarantine and does still show remnants of the UK variant of the virus. We have identified one case that has been tested and does still show remnants of the virus. Assessed as very, very low infection activity, but we are arranging for additional testing under way today and we are taking a precautionary approach by announcing some of the venues that that person attended. Those are the Burwood locations, listed here.