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

By September 7, 2020 In Focus 9 Comments
Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellingen Shire

7th September 2020

 

Welcome to spring, lots of joyful birds, lots of blossoms on the fruit trees, lots of people getting their Covid19 tests, and still no transmission of virus in the Mid North Coast. (134 days) NSW is doing well with only 7 people in ICU and 4 souls being supported on respirators.

On the last new moon I had the joy of my night walks along quiet roads with the grand shape of the Dark Emu hanging in a spectacular starscape. We are so lucky to be in our bubble. Please make the most of this rare privilege by exploring the outdoors and being active. Open space is the safest place to be in Covid times. The Dark Emu is highlighted by historian Bruce Pascoe in his book – “Dark Emu”. A very interesting, recommended read which gives a very different perspective on our history. – More on this later.

Of course all the news is buzzing about what is happening in Victoria.  The dropping numbers are a relief. The road is still hard for them and it is a pity to see some shrill political voices attacking their government and demanding to bypass the expert advice in order to open up quickly. This would let the virus rip. Remember today’s numbers reflect what happened in the last 2-4 weeks.

Unfortunately the basic information that guided our national and state responses at the start of this pandemic has not really changed. It is still a novel virus. It is still doing what novel viruses have done to humans (and animals) as long as we have been around – ie be overwhelming and fatal to, not all , but significant numbers of the population. The fatality number is still around 1% in best-case scenario and up to 10% if there is no support, or the services are overwhelmed. This is still 10-100 times worse than Influenza. And there are still increasing people getting long-term health consequences.

The reality of unfettered spread of the virus would still be a much more devastating blow to the economy, the nation, the society, made worse by the social and psychological effects of an uncontrolled plague. This is still happening in other countries. Our media have stopped reporting the real life stories of people suffering and losing their families around the world, even though the reported cases and fatalities in USA , Europe and now India, just keep growing. Even if today’s number of cases in USA – around 6.3 million, with nearly 200 000 deaths – is an underestimate because many people cannot get tested and many do not have health care, that still leaves over 300million to go.

Shutdown is still uncomfortable. “Herd immunity” strategy is still catastrophic.

So what has changed??

Fatigue. Patience. Economic fear.

We had another meeting of your local GPs, with representatives of all the practices in the Valley. Once again we are convinced and committed to maintaining our local Covid19 Clinic, to being very quickly on top of any arrival of the virus in our shire. We have tried to make it absent of barriers. We still are very keen to encourage anyone to attend with any small respiratory or fever symptom. Having the clinic separate from our hospital, pharmacies and medical practices has allowed us to continue with all the services we need to provide to the population.

My wife Vicki and I have just had a quick trip down to Canberra to see our Daughter and Son in law. It is currently allowed under the monitoring of Covid19 restrictions. We stopped in few spots, used hand sanitizers after filling petrol and any other interaction. We love Canberra – it is an interesting, and often unfairly maligned city in the middle of a playground of outdoor activities. We met and lived in the ACT for 6 years in the 80s.

Canberra is cosmopolitan and multicultural. Its industry is the business of government. This may be why so many people have observed the rules and managed the transition to work from home, while still engaging in outdoor lifestyles. It miraculously seems still free of Covid19 cases. People there are working hard on maintaining distancing, but are able to maintain their active lives, but are very sensitive about visitors from Sydney or elsewhere bringing the virus. Sound familiar?

One curious thing I noticed for the first time in 38 years of visiting Canberra – homeless people sleeping rough in doorways etc. What does this mean? Hard to say, but the world continues to change. Why is this relevant?   Because, in the Bellingen Shire we are in a beautiful bubble. But outside all bubbles there are prickly things capable of bursting the membrane. I believe it is vital to know what is changing in the rest of the world.

We met up with old friends – wonderfully dedicated teachers for 40 years. They warned that the cohort about whom they most worry, if we need another shut down, are the year ll students. Have you thought about how to better help any 16 year olds in your household?

While in Canberra we visited the national Museum with a new display commemorating 250 years since Captain Cook arrived. There was some amazing “ new” information. Researchers presented the event from both sides of the beach, but also went back to Captain Cook’s actual diaries – just like Bruce Pascoe did with early explorer diaries in Dark Emu.   When I was in school, and when working with school groups in North Queensland in the 80s, there was a very disparaging quote attributed to Cook referring to the appearance of indigenous people in northern Australia. What the histories then left out was that he went on to admire their joy, peace, adaptation to the environment and lack of want. He was also painted as a unique navigator, but they left out the fact that Polynesian navigators guided him across the pacific and ran diplomatic meetings.

So often when there is a political point being made, it is the data that is deliberately left out that carries the weight. When you go back to the primary facts, the picture is very different.

There will probably be a new Meme this week quoting lines to the Victorian Govt – asking to stop the lock down. The facts missing and ignored by most critics of harsh response to Covid19 often allow drop lines like “the cure is worse than the disease”, or “we have more people die from influenza each year and don’t lock down”…

Actually we have had many years recently (precovid) with terrible toll from influenza, but not this year. Hospital Emergency departments are always dealing with terrible waves of trauma. But not this year.   The number of lives saved coincidentally by lock downs may not be counted. With an open early policy, or “herd immunity”, the death toll could still be predicted to be at least 150 000 – more than Australia’s usual annual deaths of all causes. But I am hoping that with vigilance, talking up our stamina, keeping an “all of community” focus, we can still say “not this year, not here.”

 

Dr Trevor Cheney

 

Stay safe. Please remember this is just one perspective and check all details with your GP. The Bellingen Covid19 clinic in Watson St is still opening from 1300-1400, Monday to Friday, but with flexibility depending on demand. We have had up to 50 a day after the Education Dept changed policy but currently seeing only 15-20 most days. It’s easy and not that uncomfortable, and vital to keep alert. Kids are tolerating the swab. We are still just getting lots of Rhinovirus – a common mild winter flu that is initially indistinguishable from Covid19.

9 Comments

  • Heidi Holmes says:

    Thank you for your clear and encouraging words during this Covid19 pandemic.

  • Cynthia Miller says:

    I love Canberra. Raised children there. It is a beautiful and interesting city. The people who live there know how fortunate they are.

    Thank you for your words of encouragement. Your weekly Newsletters will combine to form an historical record of our experience here from the arrival of COVID in the community.

  • Leigh Emery says:

    Bellingen is very lucky to have so many dedicated doctors, nurses and allied works prepared to give up their time to conduct these clinics. They should know that their work is very much appreciated and that the swabs I had taken were neither unpleasant nor painful. Perhaps not everyone has the same experience, but the professionals who conduct these clinics are, in my view, doing a sterling job. Thank you to them all.

  • christina brimage says:

    Thank you and keep on reminding people (those that want to let COVID rip) of the facts. I heard on the radio today a woman who talked about being in NY when it was bad with COVID and she said there was barely a second of the day or night that the sound of an ambulance rang in the background. Do we really want that? I think not.

  • Craig Nelson says:

    Thanks, Trevor, for you knowledgeable and reasoned updates.

  • Great review Trevor and such warm personal notes. Pleasant to read . Thank you…

  • Frances Amaroux says:

    An Alternative Medical Response to Covid-19…………Here is a letter written to Daniel Andrews by now over 500 doctors questioning the scientific validity of Mr Andrews response. in Victoria. The numbers of doctors supporting this open letter to Daniel Andrews is growing – why is the opinion of over 500 doctors not taken into account?

    LETTER:
    31 August 2020
    Mr Geoffrey Wells
    Mr Daniel Andrews
    Office of the Premier

    1 Treasury Place, Melbourne 3002
    By e-mail: [email protected]

    Dear Premier,
    An Alternative Medical Response to Covid-19

    We, the undersigned, are senior medical practitioners of various specialities who practice in Victoria and are deeply concerned with the Victorian government’s management of the
    SARS- CoV-2 (Covid-19) viral pandemic as a public health issue.
    The purpose of this letter is to make you aware that not all medical practitioners are in
    agreement with the Chief Medical Officer and the Victorian government regarding the most
    effective way to control this disease. We believe that an alternative medical response is
    required that reflects what we know about the spread of the virus, those who have died from
    it, and the impact that the stage 3- 4 lockdown restrictions are having on the physical and
    mental health of the general population. For the sake of people in Victoria with other medical
    illnesses, it is vital that Stage 4 restrictions be lifted on schedule in mid-September.
    This letter details our concerns and recommendations. We are ready to offer any assistance
    we can to help create and implement a revised, effective and just response to the Victorian
    situation; to this end we would be pleased to meet with you at your convenience to discuss
    the matter further.

    Government Response to Covid-19 and Available Data
    Focusing on the numbers of cases of Covid-19 is at best an unsophisticated way of looking at
    disease management. Factors such as the side effects of any policy, its cost effectiveness, the
    quality of life years lost, and the cost per life saved are fundamental when considering
    disease management. In addition, any policy to manage any disease must be reviewed in light
    of new data.

    We believe that the government’s initial response to handling Covid-19, via a stage 3
    lockdown to ‘flatten the curve’, was reasonable in view of the limited information available
    at the time on the outbreak in China and the alarming number of deaths in Italy. The initial
    response, though arguably excessive, was still highly effective in preserving medical capacity
    and allowing time to co-ordinate a full medical response, with the community accepting that
    the social and economic consequences were reasonable and for the common good.
    However, we now know that whilst Covid-19 is highly contagious, it is of limited virulence.
    Whilst an accurate cause of death of a person can be difficult to determine, we are told that
    since March 2020, 565 Victorian patients have died either with or from the virus (31st August
    numbers). This compares with annual Victorian deaths of approximately 10,000 patients with
    cardiovascular disease and 11,000 with cancer. Accordingly, the Covid-19 deaths are a
    relatively small proportion of the 114 deaths per day that are normally seen in Victoria. In
    comparison, since the start of March Covid-19 has been associated with 3 of the 114 deaths
    per day.

    Most of the 565 deaths have occurred in nursing homes which according to doctors currently
    working in this environment have described causal factors related not only to the virus but to
    other care related issues, including isolation, loneliness, and related diminished nutritional
    intake.

    However, in Victoria we have had 541 LESS deaths this July compared to July last year.
    (3,561 deaths compared to 4,102 deaths in July 2019)
    In Australia last year, 2019, in the month of July alone we had 71,000 new laboratory
    confirmed cases. And a total of 313,000 laboratory confirmed cases of Influenza for the year.
    This is only a fraction of the actual total cases of influenza, as many cases go untested.

    In August 2017 we had 99,000 new laboratory confirmed cases of Influenza and a total of
    over 250,000 cases for the year.
    During 2017 and 2019 Influenza resulted in 25-30,000 hospital admissions and up to 2500
    ICU admissions across Australia. 3% of hospital admissions were pregnant women and up to
    18% were under the age of 16.

    The deaths from Influenza each and every year is between 3500 and 4000 according to the
    Australian Influenza Specialist Interest Group website and the Australian Bureau of
    Statistics. This is despite recent excellent rates of vaccination in the vulnerable population
    and millions of vaccinations utilised each year. (2020,18 million, 2019 13.2 million, 2018 11
    million, 2016 8.3 million)

    The vast majority of deaths associated with Covid-19 have occurred in frail people over
    80 years, many of whom also had significant co-morbidities. In Victoria more than 73%
    of known Covid-19 deaths resided in nursing homes. (381 out of 524 and 30 out of 52 in
    NSW, as of 30th of August).
    For people who are physically well and under 60 years of age, the mortality risk is extremely
    low. Contrary to what you have said, Mr Andrews, the virus DOES discriminate. See graphs
    below.

    Since June 2020, the death rate has risen sharply in aged care facilities where the risk of
    transmission of Covid-19 has been unacceptably high. However, the government, and the
    doctors advising it, have not reviewed their policy in order to focus on this vulnerable
    segment of the population. Instead, stage 3-4 lockdowns for the whole community have
    continued for no apparent scientific reason.

    Medical and Social Consequences of the Government’s Current Policy
    As medical practitioners, it is our collective experience that patients are presenting later to us
    with their medical complaints. Specialist referrals from GPs, and indeed GP workload, have
    fallen dramatically due to patients’ reluctance to leave home in fear of acquiring the virus. As
    a direct consequence of this delay, many will have poorer prognoses. This has especially
    been the case with consultants who treat cancer. A study in the UK estimated an extra 4000
    deaths from not screening the four main cancers alone and not from lack of treatment.
    In addition, it is our professional opinion that the stage 4 lockdown policy has caused
    unprecedented negative economic and social outcomes in people, which in themselves are
    having negative health outcomes. In particular, it has caused or exacerbated depression,
    anxiety and other mental health issues, as well as contributed to domestic violence, through
    an extreme and unjustified disruption to family, social and work life. Job losses, home
    schooling, the isolation of the elderly and single people and the restriction on the number of
    people who may attend funerals, are but a few examples of how the government’s current
    response is harming the health of the general population.

    In short, the medical, psychological and social costs of the lockdown are disproportionately
    enormous compared to the limited good being done by current policies, and are relevant
    factors to be taken into account by any responsible government.
    Proposed Amendments to the Public Health and Wellbeing Act 2008 (Vic)
    We further note with much concern, that the proposed amendment to the Public Health and
    Wellbeing Act that would effectively allow the government to continue its current policy to
    manage Covid-19 even if there were to be zero cases over a period of time. This is
    unfathomable and certainly contrary to the objects of the Act, which require accountability,
    proportionality and collaboration to be fulfilled.

    Specifically, the legislation explicitly mandates that the government’s decisions on public
    health initiatives must be transparent, systematic and appropriate, with members of the public
    given access to reliable information in appropriate forms to facilitate a good understanding of
    the issue. In addition, the legislation acknowledges that decisions will be enhanced through
    collaboration between all levels of government and industry, business, communities and
    individuals.

    Recommendations
    For all these reasons, ordinary sensible people if properly informed, should inevitably
    conclude that the current government policy is ill focussed, heavy handed, and unjustifiable
    as a proportionate response to the risks posed by Covid-19 to the public’s health.
    As the virus is not going away soon, and an effective vaccine may not be available for a
    considerable period of time, if at all, we respectfully call upon the government to do the
    following:

    1. The State of Emergency not be continued past September 13th with an agreement made for
    parliament to be allowed to openly discuss and debate appropriate medical plans to manage
    the current Covid-19 crisis. A panel of non-politically aligned medical and health-related
    experts be selected by a bi-partisan parliamentary group to provide the transparent and
    active role of informing and advising government decisions and responses to the epidemic.
    2. Ensure adequate measures, testing, and protection of the vulnerable, especially those in
    Aged Residential Care environments and their families and carers.
    3. Clearly communicate to the public the medical evidence-base, objectives and timelines of
    any proposed future management plans, with open disclosure of the processes and negative
    consequences, to inform those discussions and decisions.
    4. A broader focus be given to the health and well-being of Victorians, by utilising all relevant
    available data and by calculating the costs and harms, including the social, economic, family,
    emotional, psychological and spiritual impacts on the community, of any decisions and plans
    to manage the Covid-19 crisis, thereby explaining and justifying the merits of these plans as
    a reasonable and proportionate response.
    5. To review regularly the outcomes of any management decisions and demonstrate a
    willingness to modify plans as new data and insights become available.
    Thank you for your time in reading this letter. We look forward to your early response.

    Yours faithfully,
    Lead Authors:
    Mr Geoff Wells, Consultant Urologist.
    Mr Bob Millar, Transplant Surgeon.
    Mr Jonathan Baré, Orthopaedic Surgeon.
    Dr Eamonn Mathieson, Consultant Anaesthetist.
    Dr Nick Gelber, Consultant Radiologist.
    Lead Signatories:
    Professor John Murtagh, AO Academic General Practitioner, Monash University.
    Professor John Martin AO, Emeritus Professor of Medicine, University of Melbourne.
    Professor Haydn Walters, Respiratory Medicine, University of Tasmania.
    Professor Kuruvilla George, Geriatric Psychiatrist.
    Assoc. Prof Andrew Shimmin, Orthopaedic Surgeon.
    Dr Andrew See, Radiation Oncologist.
    Dr Antonio Grossi, Consultant Anaesthetist.
    Mr Michael Knight, Consultant Orthopaedic Surgeon.
    Mr Peter Denton, General Surgeon.
    Mr William Edwards, Orthopaedic Surgeon.
    Dr Andrew Taylor, Consultant Gastroenterologist.
    Dr John Mathai, Consultant Psychiatrist.
    Dr Suresh John, Obstetrician & Gynaecologist.
    *The signatories do not represent the opinions of their employers.

  • John May says:

    Wow….

    …..not one epidemiologist

  • Laurell Woolhouse says:

    Thank you Trevor…
    “No man is an island entire of itself; every man is a piece of the continent, a part of the main; if a clod be washed away by the sea, Europe is the less,as well as if a promontory were, as well as if a Manor of thy friends or of thine owne were; any mans death diminishes me, because I am involved in Mankinde; And therefore never send to know for whom the bell tolls; it tolls for thee.” John Donne 1624

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