Dear Bellingen Shire
5 January 2021
We live in interesting times. (As the fabled old Chinese curse would have it.)
I have breathed a little since last week. Our physios say this is important. We need to allow ourselves to breathe, but more with the diaphragm. I am told that Anglo Caucasian people have a cultural tendency to breathe from the intercostal muscles (the short broad muscles between each rib that pull your ribs up and outward -they form the meat in spare ribs) and as a result this draws tension and compensation into the upper spine, causing back and neck pain. Learning to breathe with your diaphragm into the belly and to the sides allows some release of the tension in shoulders and neck. Especially important for all of us at screens – which is nearly all of us!
Certainly this breathing is a technique that is a starting fundamental of most meditation, yoga, even exercise programs. It is done naturally in many Asian cultures. I recall a senior doctor lecturing on evidence-based benefits of meditation practices at a conference, who happened to be a Sikh:
“You Westerners think we Asians are lazy sitting at markets and talking. We are working on peace and harmony. We think you are lazy because you breathe poorly and run around with scrambled thoughts in your head and don’t make the effort to sort and clean them”.
I know I have to work hard on releasing the cultural imperative of puffing a chest, ramming back shoulders, and instead breathing into the abdomen – but it pays off. It is quite remarkable with a patient who has breathing difficulty. When we can relieve the pressure to brace the chest and gulp air, then upper back pain often diminishes.
But this is just a rambling segue of the tortured metaphor of holding our collective breath to await the outcome of the State government’s decision to manage a “soft“ restriction of the latest Covid 19 outbreak. It seems that, according to most epidemiologists in the country who are writing or speaking on this topic, (and the Australian Medical Association, and much of the Royal Australian College of GPs) a great time to do a hard fast lockdown to prevent this spread will be … 18thor 19thof December. That included the AMA official position on cancelling the fireworks. Ah well, we will see how this gamble rolls.
The very real consequences of spiking mental health and police events in a hard Christmas lockdown for Sydney were no doubt major factors in the Premier’s decision. So is the economic activity. I certainly don’t like the idea of “Policification” of Health issues. But I do wish we could have clear and concise messaging. It is exceedingly difficult to see how a large sporting event of any size can be justified at this time.
So, as predicted for months, we are in the “Wack a Mole “ game of trying to hit an elusive and invisible taunter.
Just to catch up, the strain in the outbreak in Northern Beaches of Sydney is different to the one now spreading in the Western suburb of Berala. As of yesterday on the NSW Health site there were nearly 150 venues in Sydney reported to be contaminated, and carrying warnings to get tested if one attended on certain dates. If you, or anyone staying with you, have come up from any part of Sydney, Wollongong, Central Coast in the past 3 weeks please look up this list.
Even so and even with the huge influx of visitors in the region – Urunga, Bellingen, Dorrigo, you know how to help prevent infection and spread, even if our visitors on whom so many businesses depend don’t seem to. The Australian Academy of Health and Medical Sciences (a group of 400 or so health specialists who claim to be a select group of experts) has published a new report restating that 1 isolation, 2 contact tracing, 3 quarantine, 4 distancing and 5 masks are very effective in halting a pandemic, with 6 Lockdown being the last resort. The key is that 1,3,4,5 all are ahead of the game – preventative. 2 (into which NSW seems to have poured most faith) and 6 are catch-up strategies – chasing a bolting horse while twirling the lasso.
It was also great to see that the AAHMS also elevated the idea of “ Long Covid” as a real and serious condition that requires avid attention.
I know that I have seen too many patients who have suffered long-term consequences of other infection events, but who feel ignored by the research and specialist medical fields, usually being told “it is all in your head”.
Recognition on a large scale of such a phenomenon may get these written-off souls some interest and reinvestigation.
We have a 20-something relative living in London in a share House. All 5 have now had covid19. One is still sick and very incapacitated 4 months on, while the rest have still not recovered taste or smell or any of their previous 20 something vitality!
Get your masks out!
The vaccine issue continues to bubble in the medical and General News. I still think we are lucky to have a time for the Therapeutic Goods Authority to look hard at the emerging evidence of safety around the world, and provide our citizens with the best path for vaccination.
Of course, not everyone is so excited about the prospect of vaccines in our shire. The sensational reporting of the occasional side effect does not help. Usually all the research into medicine or vaccine candidates goes on without public interest as scientists wade their way through failures and blind alleys. However this time we see every move – such as the withdrawn Queensland Uni candidate.
The TG A is working with other groups to tightly monitor the vaccine roll-outs (or rolls out??). When they are satisfied with the reports from the mass population trials oversees they will allow importation and release. But then TGA will demand feedback and be monitoring for any reports of side effects or problems. You may not know that, as well as the 3, 4 or 5 phases of formal trials, once a therapy is allowed to go to the general population, doctors have ways of reporting any perceived adverse event to the TGA, which then collates reports and decides to investigate to see if it is an isolated, unrelated event or a real trend. Doctors also constantly write case reports to the medical Journals to raise alerts or see if anyone else has seen such a problem.
Of course I don’t’ know if a doctor in Geelong in Victoria is worried that she has a patient with an adverse reaction to a blood pressure medicine. But I do see when her colleague in the isolated town of Esperance WA reports to the Medical Journal of Australia on a rare but serious side effect of a combination of diabetic meds, and can then check the risk for my patients. Indeed we notified the TGA just before Christmas of a case of a local serious allergic event to a well-established medicine.
I know that other GPs in the shire have had vigorous reporting habits when a possible risk is perceived. This is a proud tradition of the profession, which I believe still is paramount in this country. Lets hope we can maintain it.
In case you’re not breathlessly catching every news break –
We will probably get first the Astra Zeneca Vaccine started in Oxford University. It is a more standard/ familiar vaccine technology and will require 2 doses a month apart, though they may be different strengths. Some reports suggest it may not have as great success percentages initially, but when it does take it may be more likely to reduce transmission of the virus as well as the seriousness. It will be made initially in UK and I believe is also already being made in Australia.
We will also get the Pfizer Biontech vaccine. It is a new technology and is a little trickier, as you’ve probably heard, as it needs to be stored at -70*. It is reported as being more effective in reducing harm but we have more contentious opinions on whether it can stop transmission. However, it can be kept in a special container for 10 days and then in a vaccine fridge for 5 days. It also needs 2 doses a month apart. It will come from US, Belgium, Germany.
I have seen brief reports of Indian and Chinese developed vaccines – but I have not seen any reports on their evidence or efficacy. They may be great, or may be rushed. Unfortunately the major medical press is (rather embarrassingly) culturally biased to Anglophone and European developments.
A key point that needs to be stated is that no one yet knows if you could have 1 brand of vaccine and then be boosted by a different one. We may in future even have a case for people with immune problems getting recommended to have both. This is somewhat a strategy that has recently been introduced with the pneumonia vaccine.
Pneumonia (or deep lung inflammation and infection) is a very common reason for people over 70 being in hospital, with then scarred lungs and subsequent decline in their quality of life. There are many types of organisms and substances that can cause pneumonia, and dozens of different strains of the main cause – “pneumococcus”. We now are doubling up the vaccination with a new set of strains, and the “bean counters” have figured it is much cheaper and safer to fund free vaccines for this type of double up than allow people to be sick and in hospital! And it is nicer not to be sick too.
But with the emerging new strains of covid19– No one knows. It will probably be a lottery to some extent which of the vaccines is available to us in the Bellinger Shire.
The second key point is that the whole process is going to take months from March, and many will not even have access to a first dose till later in the year. So, no complacency with the 1,3,4,5 please.
Our local covid19 assessment and swabbing clinic at Watson St in Bellingen is open again after a desperately needed break. Hours are 9-10 Monday to Friday, with a view to flexing the time if there is less or more demand.
I understand the clinics at Coffs Hospital and Macksville were very busy over the holiday times.
As always please check any detail with your beloved own GP, (though take it a bit of restraint with the beloved bit as there are ethical and legislative rules) who may have just read a much more recent and informative paper.
Dr Trevor Cheney