The last new Covid case in our Mid North Coast Local Health District was 27 April. That is great! And only 1 new case in NSW overnight.
So here we go into a release of restrictions. The governments are using terms like phased or staged relaxation of restrictions. Unfortunately there has been a lot of mixed messaging, and so many – especially in the cities – have taken the first trial of kids at school and softening of gathering restrictions as a release, a free for all. Indeed, even in Bellingen on Saturday the footpaths were crowded and folk were openly hugging in the street. It is very painful as a physician, scientist, carer, and believer in freedom of self-determination to observe this. We need to keep emphasising that we have seen only a preliminary ripple. We have not yet experienced the first wave of this epidemic let alone a second wave, as is already occurring in some countries.
There is a debate in medical epidemiology circles as to whether we try to eliminate the virus off the continent entirely, i.e. lock borders, then prevent its return, or go for “controlled adaptation”. The former is obvious in intent , but we would need another 2 weeks of isolation AFTER the last new case is found – i.e. at least another 4-6 weeks. The government believe we cannot afford that. We also are still getting Aussies coming home (when they can arrange a charter) and over a couple of generations we have traded our self sufficiency for greater wealth and convenience as a global trader.
The latter refers to the staged relaxation, then identification and isolation of outbreaks by sudden return of lockdowns in geographical hotspots – this seems to be where we are at. The principal being that now we have caught up, our health systems will not be overwhelmed, we will be able to care in the best way for anyone who gets sick, and society will not collapse into chaos and potentially violence.
The alternative, thrown out the window, is the herd immunity where we would accept a sacrifice of tens or hundreds of thousands and good luck to the rest who come out of it. This is historically how humans have been forced to face plague and famine in the past. I’m glad, having seen a report that at least 170 doctors have already died in Italy and a less reported but no doubt greater number of nurses!
So as we go into relaxation – only partially controlled – What is vital? Hygiene and distancing. There is NO case for relaxing these vital actions that we have now learned at such cost. And be ready to jump, with good will, into an isolation if we see an outbreak in our region.
We have been asked about the relationship of this infection to weather. The early data suggested that it was a cold weather loving organism. The hypothesis stemmed in part from the fact it started in the Northern winter, but also its related predecessors – MERS and SARS seemed to stutter and fail when the weather warmed up in the initial countries. This theory is being disputed now. There is a lack of evidence to support it, and the contra evidence is that it is spreading gleefully in tropical countries – eg Brazil.
We have been asked “how do you make sense of all the stories flying around?” This is an interesting test to help people understand what to read and believe in an age where expertise, science and research have been trashed by populists and conspiratorialists. Paradoxically, Scientific theory and its positions is always open to be questioned and proven wrong as new information is sought and found. Hence the information will be continuously updated and corrected. And the science is interrogated by people who have spent years studying and testing their knowledge.
In contrast, Conspiracy theorists cannot accept any information that shows their fiercely fixed position to be in doubt.
Is there room for hope? Absolutely!
The challenge has pointed out that not all dysfunctional ways of operating the world will continue. While so many jobs are hanging in the balance there is room for entreprenuers. Perhaps the worst part of the gig economy will be looked at. Perhaps we will look differently at our guest workers – we now have one of the highest rates in the OECD. Perhaps we will reconsider our support of exploitation of poor workers in other countries. If only we can keep the belligerents apart.
But regarding Covid :there is already an advanced, dedicated Australian research repository managed by clinicians and researchers who are beavering away to advance knowledge of this virus and how to help all of us survive its arrival. There are groups of desperately keen clinicians around the world openly communicating what they have found to work, or not, in certain conditions – to try to bring a unified set of information and treatment protocols to offer to us – even here in little Bellingen Shire. This is being rapidly communicated through our emergency physicians and on line journals to those of us at the “frontline”. Much has been learnt quickly. We don’t have the miracle treatment yet. We will have to live with this virus forever now.
The mortality rates will be much more massive round the world before it’s considered over, and it will not be only old people and smokers. But, if we can keep avoiding the catastrophes demonstrated elsewhere, there will be treatments, much knowledge gained, and a greater readiness for the next evolved virus that will surely come.
Please keep flexible and be ready for rapid shut downs if needed. Please stay home if unwell, but present to a Covid clinic for screening if any respiratory disease or fevers.
Dr Trevor Cheney
Please remember this is one perspective and the information and advice