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

30 March 2021

 

Damn! Just when it felt good to be opening the state up and lifting restrictions, we have the Covid19 cases in Brisbane and the tendrils reaching south into Byron Bay for the start of the Blues Fest.

I was on a longed for break in the Sunshine Coast last week when we started to sniff the possibility of the mystery case becoming something more.  We got back into NSW before the finding of further cases and change in regulations. However we went in dutifully to the Coffs Harbour testing clinic early on the weekend.  We have been isolating and finally, as with everybody else, I share the relief to see that negative result. What a funny semantic we share to so exclaim that a “negative” is positive! We will take direction from the Public health officers.  Why even mention this? To remind us that none of us are immune to this challenge.  If the local testing clinic is not open, please don’t hesitate to go the State Health run clinic in Coffs.  Or anywhere else, if you are anywhere else.  “Just a sniffle, it’ll be ok” is not ok.

A week and a bit we will start to have the trickle of Covid 19 vaccines available in our shire’s GP clinics.  The Federal Health Department and various bodies inform us that the phases of 1a/1b will be overlapping. This is not something worth expending thought on.  Your GPs will be wanting to get vulnerable people in as soon as they have the arrival confirmed.

So, instead it’s a little more interesting to look again at the backdrop. That’s an old theatre term for the cloth or wall behind the stage that gives a sense of place and relativity to the scene being performed.  It’s movable, changeable, sometimes rotates suddenly, breaks, or is lost in the killing of a spotlight.  So much can be portrayed – even with minimal forms and images, and so much can be hidden. I always love looking at the backdrop, as the director often hangs messages there, if you look at the context. We have seen in the past some brilliantly clever backdrops and set constructions that set the mood for the Bellinger Shire Writer’s Festivals, (coming soon if the world doesn’t fall over again).

And it has been a while since I took a look at the World Covid backdrop for our position in the pandemic. Still no cases that we know of in the Mid North Coast, but the rapidly evolving situation in QLD reminds us that we are a long way from being over it, no matter how much everyone is “over it”.  The health Services around Byron Bay will be super alert now.

Simply, the WHO dashboard reports >126 million covid19 cases confirmed and reports so far >2.7M confirmed deaths worldwide.  We can expect that both these numbers are underreported.   WHO reports that numbers are going down in Spain, UK, Russian Federation, and static in USA.   Hooray!  Sadly all the other numbers seem to be on a rising wave again in most other jurisdictions in Europe. The Indian Subcontinent and other Americas show worrying upward slopes.  And right on our doorstep is PNG, with limited access to health care and resources but a rising tide on infections.  How I wish well the gallant health workers heading there to help, and I hope Australia is able to provide more vaccine doses to them.

In terms of vaccines – WHO reports that over 462 million doses of Coronavirus vaccines have been administered so far.  Think about that number!  That is a pretty amazing backdrop too.  It is a reliable figure, and puts a denominator under any reports of suspected adverse events.

The Critical information Unit of NSW Health has published some further updates on the clotting issue in Europe.  The evidence is reinforced that there is no confirmed association, but they will still watch carefully.  They have published a recommendation that only a handful of people per million should defer their vaccine until a little more data is reviewed.  These are patients who have experienced the rare “Heparin Induced Thrombocytopenia” (A poorly understood deficiency of low clotting cells -called platelets – in people who have needed a lot of the anti clotting medicine Heparin, mainly in hospital) , and the very rare “Cerebral Venous Sinus Thrombosis” or blood clot in the big pool of blood that drains slowly and efficiently from your brain. Again the emphasis is that these are only a few people per million, and really, if you had these conditions you would already know about it. Therefore don’t work too hard on remembering or pronouncing these names.  You will not be tested on this later!

There are some articles on severe Covid 19 in children – by researchers in countries with a big case load so that they can gather a significant number to study, and publish in the famous science journal “Nature”.  They were trying to find common features to predict which kids need sharper attention. The point of mentioning this is really only to point out that, yes, severe Covid is less common in Kids for great reasons,  (In fact only about 12% in full flowing pandemic conditions is a one quoted figure). But not zero.  So if we had the best of all reasons to get to herd immunity with a safe vaccination program – they would have to be up there.

There are further inconclusive articles on the still controversial role of vitamin D, and “Post Acute Covid Sequela”  I think this is an attempt to get a more precise sciencey sounding name for the syndrome of  serious numbers of people staying too sick for too long even after the virus has passed.

On a totally different but relevant issue. There is a health warning about other often forgotten diseases. Hopefully you would have to live under a rock to not have heard the frequent pleadings to stay out of floodwaters. It’s because nasty things flow in floodwaters.  Like raw poo from overflowing septic tanks, dead animals, strange dormant soil germs, razor sharp bits of debris like torn iron, cows that never learnt to surf wondering what to do on a beach!.  Anyway even though the flood waters have gone down and the Bellinger Shire had an uncharacteristically easy time this time, there is serious concern about  nasty disease showing up 5-14 days after exposure. There is particular concern for a disease called leptospirosis starting to turn up.  It is particularly spread by rodents’ urine, and the state -especially over the range- is seeing an explosion of mouse numbers.  The little beasts also carry a germ called Murine Typhus, which is transmitted by little critters that bite them, then us.  If you have stranger rashes, nasty headaches and fevers/chills please talk to your GP quickly  – they might want you to have a Covid test first, but don’t hang about ignoring it.

Leptospirosis used to be called cane cutters disease.  Last century the cane cutters traditionally worked barefoot and bare backed in tropical heat. The sharp sugar cane stalks would frequently cut them, and the one thing that loves sugar cane more than kids is rats.   It is one of the main reasons that farmers started to burn cane before harvest  – to chase out rats and sterilise the cane. Fortunately big green cane harvesters machines don’t work barefoot.

Lepto and some of its co travellers are old and adaptable germs that produce nasty diseases with well-known organ damage as their sequellae (that’s cool word for consequences). But, at least they can be treated – especially if you get it early.

You may also want to go around and kick over any garden trays or buckets, now!  There is a fear of a big season for Ross River Virus and Barmah Forest Virus – both spread by mosquitos.  We don’t have antibiotics for them.

 

As always, this is one perspective on the emerging details and health stuff.  Please check with your own GP, who is likely gearing up to participate in offering you vaccines – not because they are obedient automatons, not because the government is offering any attractive financial reward (it’s going to be break even for us), not because they want to make you some corporation’s guinea pig, or get any kick back for it.  Simply because they are worried about this disease and want to see the end of the risk to the people they have dedicated their careers to helping to be well.

 

Dr Trevor Cheney

2 Comments

  • Patricia Reed says:

    Great article and easy to read and understand for the lay person! Thank you for taking the time to collate such useful and relevant information

  • Linda Dudgeon says:

    Thank you Trevor for your interesting, informative reports ~ most appreciated.

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