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

Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellinger Shire

2 February 2021,

 

Damn that mole!

I mean the Whackable one. UP He’s popped again in WA, just when it felt good to be cocky and relax.

Now, the WA folk who we know so well, will be taking this very, very seriously.  I his Coronacast, Dr Swan was worried that they might not be “Game Ready”, having been spared the concern for 10 months.  However, I think they will have all the passion they need to dive into and endure a hard lockdown to recover their Covid-Clean image.  So, I think good luck to them.

As you would have no doubt gathered from previous letters, my understanding from reading and speaking to the people who really know epidemiology and viruses is that the quickest and safest way to deal with an outbreak is to “Go Early and Go Hard”.

This is a slogan that could probably win a politician an election, though I fear is more at home in current Russian politics – Let’s not go there!

We’ll probably get a new 3 line slogan or 2 soon enough.

But what does this mean for the rest of Australia? Well initially I’m really glad this mole came all the way across the ocean rather than from across the Nullarbor.  The latter would have stirred up a whole lot of ugly federation politics that gets in the way of the real game – ie keeping people safe so we can get on with the job of keeping society going.

Unfortunately, in case you haven’t heard on all the blitzkrieg news, the person with the new “community transmission” is a hotel quarantine worker, who has also travelled around a lot of suburbs, and as of tonight, is confirmed to have the new, more infectious, UK strain of the virus.

Now the term “more infectious” is a bit confusing. It doesn’t mean that everyone looking at your nicely shaped hair across the room (note -gender neutral!), or talking to you on the phone, or walking down the same street is going to transmit the virus directly to you.

To try to make sense, some simple numbers may help. In uncontrolled normal conditions the original Wuhan strain would be passed on to 2.5 people before the index case gets over it – most probably in the first week-, and then those 2.5 pass it on to another 2.5 each.  So that means in a few days to a week now there are 1 +2.5 +6.25 =nearly 10 people with the virus.  Of course we know that not all are sick, and only a few get really sick, and in worst-case scenarios of poor care, 1 of those will die.

Now if the infection rate is 3.4 then in that same time – by that third generation of infection – numbers are around 1+3.4+11.56 = about 16. And by the same simple multiplying maths by about 2-3weeks you have nearly 190 with this virus, with 2 people on the road to dying, dozens heading for hospital, a hell of a job for contact tracers, and our doctor’s and nurse’s nightmare scenario under way.

Again, just because someone has been infected we don’t have to panic that everyone in the vicinity will get sick, and even less if the protocols are being used – eg, masks, distancing cleaning hands and surfaces.  As mentioned last month, even though some scientists have been calling for more research into airborne spread, the lack of cases in areas where it should have been a huge cluster is reassuring.

Obviously these numbers are my back of the envelope maths and lots of things can intervene.  Indeed that’s exactly what we need – lots of things intervening – by governments, by you and me, by our employers.  Ah – here is a tender topic to come back to.

The fact of virus mutating is of concern and needs a little extra understanding.  One can be a Creationist in faith and still recognise that organisms adapt and evolve with replication (and under pressures) in the environment.  Cane toads have adapted as they moved across the Kimberley.  RNA viruses tend to be a bit unstable in their genetics so that mutations (ie mistakes made in the rapid copying of their genetic code) happen all the time. Most mutations cannot survive – that happens in all life forms.  Then it becomes a numbers game.

I went hunting in the literature for a bit of precision to interpret what that means. There are kilometres of articles already written; yet it was not easy to get a simple answer. So lets talk generally.  RNA viruses tend to mutate more easily than DNA life forms – maybe 1 in a million or even 1 in 100million, and most mutations will not survive. Some papers suggest Covid19 is actually mutating more slowly than the Influenza viruses.    But then each time someone infected sneezes they are shedding a few million droplets, each droplet containing hundreds or thousands of viral particles.  And that person has been replicating billions of particles.  And there are now hundreds of millions of people with the virus.  Suddenly only 1 in a hundred million does not seem very rare at all.

So turning that around we come a full circle back to the one effective way of not allowing mutations to occur  – is to not let a lot of people get sick in the first place.

ie Go Early , Go Hard. This is still the most successful way of removing the evolutionary pressure on viruses to become more crafty and resistant to our defences.

Unfortunately we can see that was not the case in the UK.  Shutdowns were delayed until the health service was already collapsing, despite the agonised screams of the medical profession.   By that time huge numbers of people were incubating and manufacturing huge numbers of particles – both perfect and flawed.  Just like us.

Happily there are still no cases in our region.  We still seem to have pristine Poo.

BUT we are entering a time where we cannot be complacent.  We do not have a vaccine.  We do not have a reliable treatment. And even when we do have a vaccine starting to roll out it will take months to get enough people vaccinated to prevent the virus getting a lethal foothold should it’s little mole head pop up in out midst.  We don’t have a bat quick enough or big enough to whack it, yet.

The vaccine producers, and new products elbowing their way onto the massive Covid19 Vaccine market are making hopeful announcements to share holders, oh and governments, too.

Please don’t get too caught up in the minutiae.  We may still end up needing multiple vaccines over the next few years.  The vaccines will make Covid19 more like the common cold rather than a lethal infection for up to 10% of certain large groups.

Indeed, versions of Coronaviruses have been causing around 30% human colds for a long time.  In most animal species there are corona viruses, usually very species specific.  One causes dysentery in cattle, one will give chickens pneumonia, while newborn piglets cop it with a systemic illness when their viral special friend breaks out.

I still can’t comment on how the vaccine rollout will occur.  GPs have only last week been invited to submit interest in being able to provide the vaccines that do become available. I was surprised that the Health Minister was surprised that a lot more GPS than expected put their hands up to participate.  We will be informed soon where people will be able to go to get vaccines and when.  I suspect the arrival will not be exactly as hoped for, so lets wait and see.

A couple of important issues do seem clear.

Firstly, major Hospitals (this includes Coffs Harbour Hospital) will be the site for the first responders and aged care workers to get the first round of vaccine.

Next, to my great delight and relief, “non citizens” – ie people on working or back packing or relative visas etc who don’t get Medicare – WILL be able to get a free vaccine – through the hospital centres. AT NO COST!  This is a very intelligent public health measure.  Please reassure your back packer or international friends who are caught here.

The rest we will discuss once it is clear.

Now one more stormy and controversial topic that I fear I must acknowledge and allow into  the conversation.  Ee…. this is with trepidation.  So what happens for people who refuse vaccination for Covid19??

Well.  The vaccine cannot be made legally mandatory and the government says they do not want to start that fight.  However, I suspect there will be no grounds available for “conscientious objection”.  It wil have no meaning.  If someone makes that decision, for whatever reason, it is theirs and they will own it.

But …. by the end of the year ( and now this is a bit of crystal ball gazing ) I expect that transport companies, airlines, venues, big employers etc might start making hard headed commercial and  Workers Compensation calls as to how vital it is to have a team fully vaccinated.  In other words those who exercise their democratic right to disbelieve everything they have been told and move in the opposite direction may have some really hard arguments to face with their employer and lifestyle.

There will no doubt be cases before the Industrial Relations and Antidiscrimination Courts before the year is out.  The thing is, an employer is obliged to consider the safety of their whole staff first, and then the safety of all their customers.

How does one rationalise that against an individual’s political beliefs who is at odds with all the evidence and expert advice, (and for multinational companies, their lived experience of the disasters unfolding overseas) yet remains by choice at risk, especially in a work place that deals with the public.  A business may not have a right to refuse entry on the basis of race, religion, ethnicity, physical disability or sexuality, BUT they can refuse a health risk, Airlines do so all the time.  Ask any pregnant lady who has been refused travel in her last trimester.

Or, even more hard headed, an employer may decide that anyone who is not able to resist Covid19 would be considered not fit to perform a job.  That will be absolutely the case in health and aged care, security, and meatworks,.  They may deem that a person at risk can close down the whole enterprise, and bankrupt a business, once the rest of society is moving on.

Please help your sceptical friends and family consider this inrushing reality.

 

Please remember, this is just one late night  (and morning and day and dreaming) perspective.  Check any detail with your own clever GP who is also trying to work out how to be part of the “Biggest public logistics exercise in Australia’s history”.   Or at least is hoping like hell we can just hold the line and get there before a real big breakout occurs.

 

Dr Trevor Cheney

 

 

2 Comments

  • Kerri Moss says:

    hi trevor. so are you saying youbelieve the vaccines to be effective and safe? im hearing stories of people coming down with covid19 two weeks after getting their 2nd shot. And what about kids and child bearing women? apparently some have concern long term genetic effects. Im 69 and have auto immune disease. im also allergic to heaps of medications so the thought of this vaccine is incredibly scary for me.

  • Carolyn says:

    My Aunt nearly 90 in the UK was admitted to hospital 3 days after first dose, ‘having a turn’ was the diagnosis. What about people like us with allergies and over 60, will our freedom to travel be completely gone because we are higher risk for covid 19 as well as vaccine side effects.?
    I was planning to wait and see if any long term side effects emerge, there is a possibility I could have a vaccine and still be able to pass the virus on.
    The experts are saying they don’t know how long immunity will last thats if your in the percentage of people that the vaccines works on.
    There seems to be alot of unknowns, why inject my body with an unknown experimental cocktail when there have been serious mistakes made in medicine in the not so distant past. Will we have to sign a form releaseing the powers that be from any responsibilitiy if things go wrong? Will there be compensation available?
    Thanks for your updates and contributions Dr Cheney, but I’m not going to be a lab rat.

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