Dear Bellinger Shire
16 February 2021
At our local Covid19 clinic we are getting a surge of rhinovirus (the common cold – lasts a few days), and RSV (again, in most people a virus that causes a common cold unless immune suppressed or an infant when it can become a more serious bronchial infection), AND … no covid19. Same for the rest of the Mid North Coast. In fact, the same for the rest of the state.
But oh, send love and maybe other stuff to the poor folk of Melbourne. Heartbreaking listening to florists, restaurants, venues as they prepared for, invested in and lost one of their big weekends of the year.
Bellingen Shire residents seem to have a lot of association with Melbourne – seems to be the preferred place for our kids to go and study. This also means that a lot of us have recently been down there, or they have come up to check in. Remember, if you or family and associates have travelled, and have any symptoms, please get tested.
It seems that the breakout in Melbourne is one of the more infectious strains – that is, it more easily transmits to more people and establishes infections more quickly.
So a common question in the media and from patients – “Are the vaccines Australia has bought going to become redundant, with the new strains resistant to the drug?”. Or “ I heard of someone who was vaccinated and got Covid19 a week or 2 afterwards”.
We need to reiterate some realities in health care and, well, life really.
Nothing works 100% of the time.
I mentioned last week that there will be some failures and some adverse events. Especially given the scope of this scientific health endeavour that has never before been done in human history. However on the Beaut side – all the trials have shown 100% protection from Death! While vaccine development was underway and the first trials were being investigated there were 3 possible goals:
1 Making vaccine recipients resistant to getting the disease,
2 Stopping people dying and being really seriously sick (of all ages);
3 Stopping someone who caught the disease then spreading it.
All the vaccines available – except maybe the Sino vac – now have good evidence they reduce 1 and 3. This is good, and better than the natural state. But the big deal is they all stop 2. This is what I want for my brothers and sisters and kids and friends and patients. Really, – for the opportunity to get the society to recover and get on with making a new, better, world. So hard when people are dropping dead, or filling hospitals, or becoming long term disabled.
The first key to not allowing super strains to evolve is to have less people getting really sick.
Even better, as the huge amount of money and research has been poured in, a finding in this week’s medical news is that the researchers and producers are confident that the vaccine technology now available will be able to be very rapidly adapted to show your body how to resist emerging new strains. The vaccines may be switched, from now on, within 3-6 months. That’s half to a quarter of the time it has taken our scientists to get the best guess flu vaccine ready each year.
Yes there will be some reports of someone somewhere having an adverse reaction, but there are now literally tens of millions of people around the world who have had very, very bad adverse reactions to the disease. In Medicine we call this the Natural History of a disease. I.e. what happens if nature takes its course and there is no intervention?
There will be a few vaccine recipients showing signs of disease – they may have got it before the vaccine, they may be the few unlucky ones whose immune system didn’t respond.-That happens occasionally with chicken pox – both with the natural infection or the vaccine. BUT THEY ARE NOT DYING!!
I found an interesting summary on Edward Jenner in the proceedings of Baylor University – a very prestigious school in USA. I first heard of Jenner when I was 6 and thought he was soooo cool. I got a prize of a book for writing an essay about him. Unfortunately his heroism is a bit puffed – he was not the first to invent vaccination – but he published, and pushed it to become widely known.
When smallpox swept through the Roman Empire in the second century AD, about 7 million people died!! Did you realise there were that many people alive round the Mediterranean then? It is credited as a feature precipitating the decline of that iteration of the Roman Empire. It was then a major part of the fall of the Incas and Aztecs, decimation of Native American civilizations as well as Australia’s first nations civilizations. In 18thcentury Europe 40 000 people a year died and 1/3 of the survivors were left blind. That’s all an example of the natural history of a disease as it sweeps though a new population.
However then came the realisation that if you stuck a bit of someone’s smallpox pus into another’s vulnerable arm they would get a weakened version. Some got sick but with only 10% of the mortality of the natural disease. This fact was used as a weapon in the American War of independence.
Then some wily country doctors noticed that milk maids (Not sure why it had to be maids, something patriarchal about the virginal image??) never got smallpox if they had cowpox, and they started scratching cowpox sores and rubbing that pus into someone’s clean skin. Yummy! Then along came Jenner, and famously publicised his use of cow pox (Vaccinia virus from the Latin Vacca for cows) on a small boy and started reporting, sharing samples, and publishing.
Finally in 1967 the World Health Organisation set off to eliminate Small Pox for all humans in a 10-year campaign. They won. It’s gone. Although there are rumours that certain great powers retain samples frozen in case it reappears – most likely as a biological weapon.
It was hoped that Polio would meet the same end by 2000. I remember the campaign. Wars killed that off and it still pops up wherever there is social breakdown and conflict, and the vaccine programs are interrupted.
So back to the first question – have we ordered the right vaccines now? Yep, for now. And the science will continue to evolve. The second as to whether someone might get the vaccine and still get sick – yep. Sick = pity, vs dead= bugger!
Other questions I hear are “This is a new vaccine I don’t want to be a guinea pig.” And “I heard of someone being unwell after the vaccine.”
Lets get some perspective. Already there have been over 110million people vaccinated around the world. Australia has had the privilege of watching it play out. We are already way past the Lab Rat stage. In August last year I was not confident that there was enough evidence of safety. The rest of the world has done the work and taken the risk. We are so lucky. Now, the vaccine that most Australians will be offered will be the Astra Zeneca one. It is a new tweak on an older technology. Given these numbers, fearing that it is risky is a bit like saying you won’t ride in a new model Toyota Camry, which is also a tweak on a long progression of scientific development, which has already been tested around the world in the millions. Except there are a lot more moving parts that could go wrong in a car.
Remember a vaccine is not a chemical to change the chemistry of your body. It is a tiny component of the disease organism that is presented to your immune system, which then stimulates a powerful immune response the next time your protective cells get a whiff of the whole organism.
When medical students study microbiology there was a tradition that great waves of them will become convinced they have a terrible disease, and the world is a dirty, dangerous scary place. Then, they learn about their immune system – an exquisitely complex arrangement of players – like a whole array of armed forces ready to deploy and pounce on invaders. And it is so responsive.
Next the poor overloaded students fear they have rare disease. Hey, sometimes it can be true. As it is Valentine’s Day weekend I am reminded of a guy I once worked with. He went off to South America to pursue a lady who he thought was the one true love. She said “huh, like No.” So he came back with no romance. However he did not return with empty arms. In fact he carried a Bot fly colony in his arm. The Bot fly lays its eggs under your skin. These hatch into maggots as sub skin parasites that then grow and cause an insane wriggling sensation until they pupate and want to eat their way out. He didn’t realise it till he tried to pop an apparent abscess. Out from his arm crawled a fly! So easy for things to creep in under Customs when we all fly about. I just hope that Bot fly did not find a mate or in 10 years we will see some cases as it gets to a critical mass.
Some people fear they are vulnerable with poor health and inadequate immune responses – In fact these are the most important to vaccinate for Covid19 as they are vulnerable to the disease – not vulnerable to the vaccine.
There will be some on immune suppressive medications – we are still awaiting direction from the specialist bodies. The question is more likely will they get enough immune response? There is confidence in that the vaccines available –(except the Sinovac, which we will not see) are not anything live. They are manufactured particles of the virus’s spikes, or RNA, that will stimulate even weak immune systems. Unlike the flu vaccine that is grown on chicken eggs, which means a tiny number of people are allergic to it. So the chance of allergic responses to the new vaccines is even more rare. Nobody will get Covid19 from these vaccines.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists have said, for now, that they don’t have enough evidence that the Covid19 Vaccines are safe for a foetus. Please note: they don’t have any evidence that it is dangerous. They just are super cautious given the stakes. Reports of vaccinated pregnant women are starting to come in from countries where vaccine programs are really underway – with no problems. But of course there is a >9 month delay in assessing the outcomes – so they will observe for longer. So far Covid19 has not been so dangerous to little kids or pregnant women so the urgency is less. Indeed, on current planning we will not get through the vaccine program to the point of vaccinating young people till late in the year, or next year.
Having said that it is amazing that already in the UK they have managed to get through 22% of their population. In Israel they have already vaccinated 74% for at least the first dose. In the USA it’s >50million already.
But of course they have all seen the Natural History up close and personal. We, closeted in Australia, have not.
A little reminder of the beast we are aiming at. Of the things that want to eat you – going down the scale:. There are bears, lions, crocodiles and sharks, and maybe a very delusional quoll. Then there are parasites – complex organisms but smaller, that suck your blood or want to wriggle around in your bowel and get first bite of your meals, or even smaller like malaria that can slip inside your red blood cells.
Then there are bacteria, – single celled (usually), invisible to the naked eye, with a huge range of varieties – good and bad. Indeed we depend on bacteria for life. But some bacteria invade tissues, like staphylococcus– or enter individual cells – like gonorrhoea, and make those cells provide for them but then sicken. Some bacteria have a wall around them – like plant cells, (which is where penicillin acts). Some are really tiny and cell wall deficient so they can invade your cells, but can’t live outside.
Then we have viruses. Viruses are measured in nanometres. They are generally balls wrapped in a fatty membrane with an interior containing their DNA (or RNA), not a lot else. They enter cells by finding a gate, or making a hole in the cell membrane. They then usually take over your cell’s life building system and redirect it to make more of themselves. Unfortunately your tissues break down as a consequence and your immune system tries to blow up the site. This is the worst part of Covid19 – a confused and virginal immune system throwing everything it has at a new enemy. Conventional antibiotics do not treat viruses.
There is also a smaller form of disease called prions. A prion is a particle of protein that is not really alive as such but enters a cell, and simply turns on the replication process indefinitely. It causes a disease called Kreutzfeld–Jacob, which causes a brain rot, and was pretty much only found amongst cannibals who ate the brains of other people. Until someone invented “mad cow disease”! It should have been called “mad agriculture” disease – How did anyone ever think it was a good idea to feed pure docile herbivores with crushed up remains and brains of other animals? That was how the prion disease called Scrapy moved from sheep to cows, and ultimately to humans.
There are even viruses that eat bacteria – called bacteriophages. They will be the future of infection treatments.
Each type of disease -causing life form, and each variation in that type, requires a unique immune response. This is where vaccines come in, and why each one is different, requiring years of research – until you pour into that research a massive workforce and unlimited money.
I am celebrating that it is, this month, 12 months since we last saw an influenza case. Amazing what a little hand washing and not sneezing all over your workmates will do.
I have segued too long and Elvis will wait till next week, to talk about social issues and hopefully sing in the details at last of how the vaccine rollout will really occur.
Some other good news:
The Bellingen Writer’s Festival and Poetry Slam is being planned for June!
This is a very potted history of many more complicated issues. Please check any detail with your own GP who hopefully did not get a really rare disease in medical school, or have any horrors hiding under the skin, but has certainly seen a few.
Dr Trevor Cheney