Dear Bellingen Shire
17th August 2020
Previet! The Russians are coming! More on bears with needles later.
Firstly of course: 113 days with no cases in the entire Mid North Coast Health district. Though of course a similar number was exciting in NZ, till last week.
I was asked by a patient last week who had seen a meme suggesting it is all a publicity stunt and people are not really getting sick. For the record NSW is doing pretty well at present. But we still have 7 citizens in ICU and 5 surviving purely on ventilators. In Victoria…. Watch the news.
USA – around 5.5 million cases already. That only leaves 325.5 million to go. At a death rate of 500/M, if that was to occur in NSW we would be losing over 4000 people in our state already. No family would be unhurt. We will keep up the Covid testing and will keep advocating for precautionary behaviour. Hand washing, social distancing, cough hygiene, masks.
Questions raised – Ivermectin is an antiparasite medicine that is claimed to have “in vitro” (ie in glass tubes) activity against Covid 19. Same deal as others – too early to say. Notably the Australian rolling Covid 19 guidelines now formally forbid the use of hydroxychloroquine in Covid treatment. (Remember it was beloved of certain presidents and billionaires), But there are another dozen medications in trials . These trials are our best hope.
Masks. A question has been asked as to how masks with a 0.4-5micron size (a micron is a millionth of a metre) and larger in the case of cloth masks, are expected to filter out Covid particles with a size of around 0.12 microns. Again memes will circulate on this, but miss the point.
Firstly the N95 masks that are being used in hospitals with active cases (and at our Covid pop up clinic) filter down to 0.1 micron. Next the concept of filtering is misleading. A mask does not have to be like a kitchen sieve with holes to go through. Your nose is not like that.
When you sneeze stuff comes out at up to 100-150km/h!!! And the particle sizes can be big and heavy -dropping straight to the ground, or small – <5 microns and hang in the air a bit. There is a lot of controversy now about this.
The chewy gummy bear stuff that little kids like to pull out of their nose is a mixture of mucous and a whole load of particles out of the air – the nose works but does not filter per se. There are shelves and twists in your nose called “turbinates” that make the air – turbulent. This causes material heavier than gas to deposit. As does multilayer material in a mask. Hence the advice from people who research this stuff is that a multi layered home made mask works pretty well and it is within your power to obtain.
Please look up a video demonstration of speaking , sneezing and coughing through free mouth, single layer, double layer, and common surgical mask. The Australian epidemiologist Professor Raina McIntyre (yes you saw her on TV) published it in the Prestigious British Medical Journal, but also in the online news agency “The Conversation” a couple of weeks ago. The reality is Eww!!
When I wear a surgical mask I protect you from me. But also when we all wear a mask mine does protect me a bit from your … snot!. It is a lot better than nothing. Masks are not THE answer. They are a great part of the whole mix. Treat ‘em like your underwear. Change if it if is wet, uncomfortable, you’ve had it on for the day, or looks dirty,
Back to Russia – a magnificent land of art and culture and the spawn of Tchaikovsky, Rachmaninoff and their like, beloved to our own local hero David Helfgott and the world over. A land of science, and contrasts, and the first human in space. But also a nation with which our Anglophone world has been in conflict for centuries. Through out the 19th century Australian colonies panicked about rumours of a Russian invasion. They actually never thought we were worth it.
Now there are researchers and politicians in a fizz about Mr Putin’s announcement that the “Sputnik V” Covid19 vaccine is fantastic – already being administered to teachers , soldiers etc, and will be manufactured en masse to be the first in the world. This sounds great, considering I have joined other doctors warning that vaccine talk is a puff story and don’t expect anything within 18-24 months. Are we just extending the imperial jealousy?
To the science brain it is a disaster. The announcement was made after a phase 1 trial of about 70 participants. A phase 1 trial of a medical treatment only establishes that it won’t initially kill or maim people, and might have some effect. And the trial data has not even been released for peer review or to the world health organisation. So it may yet be proven to be dangerous. Many readers may be old enough to get a shiver down the spine with the mention of the word “thalidomide”. If it was before your time then please look it up. There have been enough catastrophic early release of drugs in the 20th century. If it is a disaster then the world will move on a little more cautiously. Poor bloodied Russians.
If it proves to be successful -great, good on them. We won’t be confident about that till next year at best. Don’t buy sputnik shares.
If it proves to be weakly effective it may push evolution of the virus and create an even more potent version.
But really the worst of all worlds is if it is only a little bit effective. In the 80s I was working for Outward Bound Australia as Logisitics , Operations and Safety Manager. And studied OH&S principals. A core principal of safety is that faulty or non-functioning safety gear is worse than no safety gear at all! The false sense of security drops the guard on anyone relying on it, and sabotages your natural sense of risk assessment and care. But worse still it turns the population to contempt for the gear and the idea. For vaccines this would be a catastrophe.
Now in the interests of disclosure I am known to be unashamedly a passionate advocate of vaccines. Except for diphtheria, I have worked with and witnessed horrible death and maiming from every one of the diseases we have vaccines against. I watched a friend’s 4-year-old drop from healthy and strong, to choking and dying in his own spit in just a few hours with Epiglottitis. We got him to Canberra Hospital -blue. He was intubated on his last breath. He now is a PHD graduate and a very clever ophthalmologist. In the 90s the HIB vaccine came in, and this absolute regular dread Emergency presentation (along with septicaemia and meningitis caused by the same germ) almost overnight vanished from our hospitals.
I have also read the Antivax network stuff. The risks of vaccination – from the smallpox innoculation in the 18th century, diphtheria serum in late 19th century, through the vaccines for paralysing polio, brain rotting measles, deforming rubella, deadly pneumonia, lung scarring whooping cough, are all wildly overstated. And compared to the actual diseases almost invisible. I know this is going to upset some readers in the Bellinger Valley. For those offended I happily invite you to take a turn volunteering in a MSF or Red Cross unit in countries that don’t have enough vaccines, and talk to real people, on the real ground, in real grief at the loss of their child, rather than paid speakers, book writers and bloggers.
So, all this aside, I am dreading any vaccine that is rushed, poorly tested, committed to with a potential for huge waste of funds, and worst might appear to support conspiracy theorists fears. Let researchers do their work! And set your expectations realistically.
On the prevention – go hard, go early. On manufactured treatments including a vaccine – go carefully, go slow, do no harm.
So, no bears with needles here please. Let’s be patient. The great advantage our island has is the time to learn from the rest of the world, if we open our minds to it.
Dr Trevor Cheney
Please remember this is just one perspective and your own GP, who knows you will have lots of other perspectives and information.