The Weekly Report from The Bellingen Covid-19 Clinic: Dr Trevor Cheney

By June 15, 2021 In Focus 2 Comments
Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellinger Shire,

15 June 2021.

It would be improper not to mention, right up front, something associated with the very successful Bellingen Readers and Writers Festival from this past weekend.
Beautiful weather, Great attitude, Some really interesting presenters.

If you didn’t get to go, then think about the next one – here or elsewhere.  When the borders open they have a real beaut one at Ubud in Bali.

One author asked an audience for some feedback “Why do you read?“

Yeah, why do you, or I, read?

Dismissing the obvious stuff you need to read for work, and streets signs, recipe books, the apologetic message from someone who just sent another distorted cat picture, etc., I think the question is directed more to why someone would pick up a book (or tablet thing, brand not mentioned, or whatever) and read a  long story, be it fiction or non fiction.

I had to think for a while, and here is a metaphorical literary response.

I think our inner selves are like a building site of ideas.  We know we are in constant construction, sometimes rapid and flawlessly, sometimes with big site issues. Reading is a way to see new tools, gain new perspectives on problems both universal and personal.  We see how other people use tools on their own self-building, but much more important are the techniques to use those tools.  Even a simple hammer in the hands of experts carves a beautiful arc, but in ignorance is a brutal weapon.  When we read we get to experience a variety of imaginary blueprints, materials, visions, and techniques for living, all in the form of ideas being communicated.   When it is well written, there is a story in which one can reside, and be guided by – in the way humans have learnt best for millennia.

There is also a place you can run away to – in your own mind.  No two people see the same vision in a book –it is yours alone.  Conversely – we are all obliged to recognise the same faces in a movie, but we are not obliged to so invest therein.

In good non-fiction there can be a lot of interesting well-presented information, presumably leading to greater knowledge of the world around and an “Ah Ha!” moment.  In fiction good authors may still include data – real or imagined, leading you to more freely explore deep truths and dilemmas, but they don’t have to supply references.

In light reading you might find a bit of refreshing escape to utopia – it’s the only chance we get.

Historical cultures have survived really well without reading, but always needed strong stories. This continent is the source of all the world’s original song birds, and the oldest of living stories.

We have many citizens who have been deprived of this beauty of reading.  I hope we can continue to be sensitive while encouraging them to learn as adults.

Without stories our internal “building site” is more like a glacial moraine.

Still and all, our Western philosophical canon includes an argument by Socrates who thought the “new” technology of writing meant that people no longer would maintain good memories.  Even worse, ideas and thought are necessarily alive, but once written, lifeless words could no longer be owned or defended, instead could be taken up and misused or misread by others, while their critical thinking was dispatched.  (a very abbreviated, interpreted summary from translations of Plato’s “Phaedrus”).

Jeez, have we given tortured life – like Frankenstein – to all Socrates’ fears with the creation of Twitter and Q-anon?

Anyway, reading on….

Some interesting picks from government Covid19 advice and the Critical Intelligence Unit:

The advice to separate a Covid19 vaccine from any others by more than 14 days has now been adjusted back to 7 days.  There is actually no real concern; it’s just thought that if we are looking for adverse events it might be difficult to differentiate them.  This is good news when we are trying to plan flu vaccines, or if someone gives themselves a tetanus prone wound a few days after they had a Covid vaccine.  By the way, there are still  -ie forever- tetanus and very closely related germs in the soil in this region (and everywhere else).  I have lost healthy cattle to them.

Eligibility for Covid19 vaccines has been updated and expanded–:

All 40-49 year olds, all Aboriginal and Torres Strait islanders 16-49, all NDIS participants>16yo, all NDIS carers, are now allowed and encouraged to get a vaccine.

This means if the local distribution vaccine hub in your area has the Pfizer vaccine – it is preferred for these groups under 50.  If it is not available then the AZ is available to them through the hubs and GPs. All over 50s are still being directed to the AZ.

In our local region, as far as I am aware the Coffs Harbour hospital vaccine centre is the only place some P vaccine is available.  We don’t know when that will change; given the arrival of the first supply of those vaccines to our region was 3-4 months behind the originally stated time scale. Locally, we still have no control over a supply chain that is buffeted by the winds of politics, hubris, desperation and expectations.

Our Therapeutic Goods Administration reports that, as of last Friday there have been 35 confirmed cases of the clotting disorder –TTS.  Possibly another 15.  Most are reported to be mild, while treatments are now well established. These are out of >2.5 million AZ doses administered in Oz.

This is a change in the information – Shock Horror! It means that an adverse reaction is more common than thought.  Look at the scale – this makes it a bit less than 1:50 000 chance of a serious adverse reaction.  So, we had better be honest and reload the other side of the see saw.   The chance of dying from the infection (frequently from clots) is now down to…..1 in 100 in the best circumstances, or 1:10 if it gets rough or you have chronic disease risk factors.  Ah, Damn! Yeah, boring, -that hasn’t changed.  It certainly hasn’t got any better.

There are some preliminary trials of new Covid19 antivirals in aged care workers to see if they could be better protected when working in an outbreak.  There was a statistically significant reduction in cases but the real numbers were not so big.  There is a long way to go.

Last year when vaccines started looking viable, I tried to emphasise that we need to be ready for adverse events that will garner spectacular news excitement.  There will always be someone, somewhere, reacting badly to innovations.  The danger is of losing perspective.  A Case series of teenagers with perimyocarditis (that is inflammation of the sac the heart sits in and some cardiac muscle) is reported  in the BMJ from Israeli sites (that’s that country on the Mediterranean who in a short few months vaccinated virtually their whole population, ..and they have had some other stuff going on too).

The lads – all male – presented with chest pain after they had the P vaccine.  All the cases were mild and they will be following up closely. Could it be something special about Israel, or people of Jewish heritage?  Could it just be that someone in their paediatric hospitals was sharp and picked up a pattern? Given that it has not been reported elsewhere in countries where hundreds of millions of doses have been administered?

This is why health professionals – even your own doctor – go to meetings and conferences to share ideas and observations.

Bottom line is that we need to acknowledge some adverse events, look hard for them, and not be spooked when they are reported.  It also offers a bit of a chill to some lopsided arguments around.  Both vaccines we have in Australia now are continually getting reinforcement from data that they are pretty close to equal in doing what we need them to do, are both really safe for the vast majority, and both have a few rare events in some unlucky souls – just different events.

There is a literature review (that is a scientific paper that looks at a bunch of papers on a topic to again find a pattern and sum up the knowledge on that topic to date) on progress in trying to differentiate which patients with SARS – covid19 are likely to do worse.  They have found the marker called IL-6 whose rise predicts deterioration.  This will be very helpful to ICU specialists.

When your immune system senses there is an invader, lots of things start to happen.  Once again we can use the analogy of a national defence force with it’s many specialist parts.  The key to all those parts knowing something is up, and where to run – is in communication.

Cells can pass on messages and cause another cell to react by irritating a nerve, or by sending out a chemical, or even by touching a button on another cell.  Mostly immune cells send out little bursts of chemicals called cytokines and interleukins (“inter” =between, “leukins” =white cells). Each type of cell has lots of specific receptors ie buttons or locks, for these signals.  Some of the interleukins tell their receptor cells to go bezerk and start throwing around weapons, while others are peacemakers whose job is to tell their mates to calm down before the house is wrecked.

Cells can even follow a trail of chemicals released – a bit like a dog sniffing a scent trail, or a shark following burley.

Il-6 promotes inflammation – it is a “hawk”

Anyway medicines that either interfere with these messages or promote the ones that will achieve a beneficial effect are part of the new wave of super specific medicines being invented.   They are often called “biologicals”.  There are biologicals now in use for rheumatoid arthritis, multiple sclerosis, psoriasis, and even severe asthma/allergy.

Many drugs we have historically used are fairly blunt, though not as blunt and the natural history of untreated diseases.  Sometimes it’s a bit like trawling blindly through the ocean, while the biologicals are a bit more like a spear fisher-person – targeting just enough of the big fish.  At least that is the hope looking forward.

 

So please remember again that this is just one perspective on life, the universe, and pandemics.  So keep reading – good books and ideas but remain wary of twittering and angry cult sites – or listen to your own GP, who was at times probably taught or humiliated by lecturers using techniques called  “Socratic Questioning”  and  has still read lots of stuff.  Lots and lots. And remembers lots too.

 

Dr Trevor Cheney

 

2 Comments

  • Pete Smith says:

    Hi Trevor, I’ve lost some faith in the main stream narrative regarding all this. Thanks for your advice to keep reading and researching. Lots of alternative sites have some well sourced statistics and aren’t all ‘angry cult sites’. The greatest gift we all have is our intuition. If something doesn’t feel right, we must back that and find our own answers. Good to meet you at the festival.

  • Peta Coe says:

    Hi Dr,
    It’s great to READ that the TTS treatment is “now well established”. Can you address this issue perhaps in your next report? In particular, what is the treatment and does it involve antibiotics?

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