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

By April 20, 2021 In Focus 3 Comments
Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellinger Shire 20 April 2021

And so the world keeps turning faster and faster, with the news cycle ever more urgent, looking for new controversies.  It has not “ever been thus”, and does not really need to be, but we do consume this intensity and share responsibility for it.  Humans have always been engaged in good news/bad news, curiosity sharing, story telling, news gathering, gossip propagation.  But not in 90 second cycles.

Some folk have been telling me that they have been finding the news overwhelming, leading them to turn it all off!  This sounds like not a bad idea, especially when standards of reporting are diminishing. Yet paradoxically we live in a time and place that our forebears would have imagined deserves gratitude, even enormous satisfaction given our peace, stability and the beautiful environment we are are currently enjoying in this little subtropical bubble, in this autumnal time.

Haven’t the sunrises in the last 2 weeks been magnificent?  Indeed a reason to get up in the morning, with a free art gallery at your door.  But you’ve got to get up! It doesn’t work though a screen.

Being mindful of the minutiae and glory of existence, in contact with oneself seems to be almost always a core of the great philosophers and philosophies, let alone a foundational feature of the great religions.  Whether you consider the first order of life’s search for meaning to be in touch with your god or the natural world.

This is contrasted in the funeral of a certain Dignitary which seems to have distracted the world for lots of  90 seconds, – away from some of the nasty, urgent matters of the day .

I was listening to a discussion between Walid Ali  (Lawyer, Journalist and TV presenter) with Scott Stephens (Reporter, Ethicist.), on philosophy, or the search for meaning.  The topic was about the role of introspection , understanding, but most importantly taking the long time to peacefully find one’s place in the world. But, it cannot be done with a 90 second attention span!

So juxtaposition the Duke’s attention span, or application to his calling, which  lasted about 75 years.  Regardless of one’s politics, he is held up a symbol of  stoicism, loyalty, consistency.  He was a Greek lad, raised in a family of German origin, to become a quintessentially British icon.  He was a true long hauler.

I have to drop in that my wife Vicki and I were in the presence of the Duke and his other very famous partner in the 1980s. While working for Outward Bound Australia, we were sent to represent the “youth movement” to meet them at a Royal reception in Sydney. We went along all bright eyed, imagining that we were in for a memorable fireside chat with the rich and famous.  Vicki was dressed resplendently of course.  I even succumbed to wearing a tie! So we found ourselves in a huge room, taped into a square, with about 1500 other people, all gushing in our corral, while the dignitaries walked around the perimeter looking, nodding.

We did get to see the Duke’s acerbic humour and at times cutting sarcasm as he evidently thought the gushing of narrow attention spans and adulation at that time were just a tad odd.

And then they left, and then the crowd left, and then there were just a few of us left in a huge hall with the most amazing buffet of wonderful seafood , savouries, top tier succulent display, with almost nobody to appreciate it.    We had come from the bush working 10 to 14 hour physical days on bland rations, sometimes not very much thereof! We were faced with an impossible smorgasbord of the world’s best seafood.  “The rest they say is history”, or at least a plausible beginning for my stretched stomach and hiatus hernia.

Anyway back to the news cycle and a particular microscopic invader who also faces a smorgasbord of probably just over 7 billion choices still to go.

The news cycle last weekend reported that there are now over 3 million families grieving someone taken from them by Covid19, with India and Brazil’s accelerating numbers chasing the USA’s, now slowing, tally.

When the Hong Kong bird flu struck in the 1990s I was working in various hospitals in Perth. The estimates then were that the 1919 flu pandemic circled the world in 6 months and ultimately killed 20million people (especially bad in its 3rd wave).  However epidemiologists estimated a similar new respiratory virus pandemic in the 1990s would circle the world in a few weeks and kill 60 million.  Hence over a million chickens were slaughtered in Hong Kong and Macau – as they were found to be the reservoirs.  They were despatched before the virus could adapt.

Now Covid 19 is NOT a “flu”!   Even so, 3 million sounds better than expected.  Of course what is different is that back 25 years ago we did not have genomic technology – to have a analysed the full genetic structure of a new virus within 2 months, then the ability to rapidly design multiple vaccines in response, as well as potentially “designer” antiviral therapies in rocket speed, ready for trials. Hopefully the 60 million estimates will be wrong by an order of magnitude.  We have yet to see.  In reality without the global health response, without the new technology, this virus unfettered would likely have struck down an order of magnitude in the other direction.   While in historical terms this response is amazingly rapid we are still in this project for the long haul.

Speaking of long hauling: There is actually some nice news.  There are rising number of anecdotal cases being reported of people – especially young folk  -who have been debilitated by an extended illness since getting the infection.    They have been reporting symptoms persisting for 2, 4, 8 months or more after the official 4-week viral course, with headache, cough, breathlessness, fatigue and insomnia being paramount.  We have mentioned these phenomena in earlier months, but with little hope and nobody having ideas of what to do about it.

But now there are rising numbers of anecdotal reports of them suddenly getting better!

There was an article in the journal Nature that firstly redefines the syndrome which we are now to call “Post Acute Sequelae of SARS Cod2” , or PASC.  The term “Long haulers” or “Long Covid” are considered not precise or scientific, causing fudgy reporting of the numbers.  Theories abound as to the cause in a variety of publications.   It seems to involve either:

1. Cellular and organ damage;

2.  An inappropriate and unmodulated  immune response continuing to produce inflammatory cytokines – that’s the little chemical messages that cells, especially in the immune system, send out to communicate with each other and literally “turn each other on”;

3. A pro coagulation state. That is a tendency to form multiple inappropriate blood clots –  especially in small vessels in lungs and peripheries.  Please note – the infection causes multiple clotting problems.!

4. Persistent non-replicating viral particles.

Or, it maybe a mix of the above.

A thorough study in Wuhan of 1773 Covid19 survivors found 71% had persistence of at least 1 symptom.  26% had Sleep problems and 23% ongoing anxiety.  Some may have concerns about the reporting from Wuhan given the politics surrounding that city, but the same was reported in the USA and even worse in France.  The problem is there had been no consistent definition, making it hard to know if we are comparing “apples with oranges” or mandarins, or grapefruit.

Anyway the good news is the accelerating anecdotal reporting  (that is somebody reports knowing of a case – as opposed to rigorous scientific investigation of large numbers according to standards and precision) of these people getting better after having a dose of the vaccine!

So they have already had the virus, but the vaccine has either straightened out the immune response or encouraged clearance of residual non replicating virus particles or –?????

As mentioned this hypothesis is not officially reported yet, and ultimately may not hold water, but is certainly starting to generate debate in the medical papers.  And in fact we have a relative in London who has happily reported precisely that response!  Watch this space.

Further good News in the Lancet (one of the top tier Medical Journals) is a report on a study of 25 661 Health workers showing that those who have been infected (and survived without sequellae), did demonstrate robust immunity.  Until now there has been no evidence of how long immunity lasts for, or whether it protects against the emerging strains.  Again, this phenomenon is not fully recognised, and the significance will be hotly debated, but it is more good than bad.

Still, the best way to avoid emerging resistant or hyper virulent strains is to have less people getting sick, therefore harbouring less viral replications.

So, on we go with the vaccine program.  Yes, there have been a handful  (3 out of >800 000 vaccinations) of very unfortunate people with a rare serious adverse reaction.  This is really tragic for those families.  But we gotta keep looking at the numbers just outside our borders.

The standard remains that we are trying to vaccinate as many vulnerable people as we can, now.  It is likely that we will soon be directed to offer the currently available vaccine to all folk over 50.   The advice detail from our experts is that the AZ vaccine can still also be offered to those under 50, but we need to be clear that the risk of the rare clotting phenomena is real – albeit at about 1 in 200 000 -300 000 people depending on which study you read.    The mortality rate of covid19 infections hasn’t really changed – still seems to be around 1% in ideal situations up to 10 %  (that means 1 in 10 people dying) in a major break out overloading health resources.

 

Please remember that this is just one perspective (with no advertising, remuneration, commercial sponsorship, syndication fee, government salary).  Please check any detail with your own GP, and/or register your interest in getting vaccinated as soon as possible.   Of course if there is major new information about this vaccine we will be keen to let you know

 

Dr Trevor Cheney

 

3 Comments

  • Denise Oliver says:

    Hi Trevor,
    I’m curious to know ,why are the over 50 considered not at risk of blood clots?
    Cheers Denise

  • Jo Keers says:

    Hi Denise, I will pass this question on to Trevor. Thanks,
    Jo

  • John Morse says:

    Denise , I had the exact same question as I’m 75. My GP told me its because there have been no recorded cases of blood clots in people over 50.
    Ill also be interested in what Trevor has to say. I trust him completely.

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