Dear Bellingen Shire
26 October 2020
Je suis Victorian!
From our Covid Cave, it is so lovely to see the decision that it is safe enough, and under control enough, to open life up in Victoria at last. They have taken the hit for all of us. I was speaking to an old friend on the weekend who has had to adjust his business and personal life for so long. He runs a consultancy in business and personal development which uses mostly interpersonal activities, outdoors and intense group experiences to crack open communication. He has somehow adapted, with grace, with patience – such a change from some shrill commentators. He has no medical training but was philosophical as he understood the stakes. This is not political – he is by nature a political conservative. It is about a reality that most of us would prefer not to have to deal with, but who would have thought the universe was not made just for us?
Today as the Victorian Premier announces that businesses there will start to open this week , I can only hope that a degree of cooperative planning can get underway again. Australia is going to need as much careful planning – and then thorough follow through – as we can get over the next 2 years. I felt grandstanding has got in the way. Every time there is an outbreak, we have to allow our leaders to make decisions with the thought in mind that “we have only one shot at getting this right” -every damned time!!
For this week’s news I tried to access the so-called coordinated guidelines that have been made available to us as health workers by the Federal government departments. The link “FAQs for Clinicians” went to an inactive blank page. “National Health Plan for Aged Care” (something very topical and I thought exquisitely honed after 6 months of catastrophe in that dept) informed me that:
A temporary workforce will be made available to help with outbreaks in aged care;
Facilities will have access to some funds if there is infection;
Infection control training and education will be provided to staff of aged care facilities;
and all this will cost $101.2 M
This plan was dated 12 march. It had not been updated. I have no idea if any of it has happened. It is an example of the management style I most hate and have hated for 4 decades. That is, put out a memo, send it to everyone who might think they are relevant , make a link to some page that probably might have worked once, and then walk away saying that you have done the consulting/communicating part of your job.
In the meantime the breaking news is that Victorian Health Dept is only now advising Doctors treating probable Covid Cases that they should upgrade to N95 masks (Like we have had in our local clinic since March), while the Federal Health Dept still says I should only worry about staff protection with the higher grade masks when doing a very invasive procedure like inserting a breathing tube in someone at imminent risk of dying, or dealing with someone who is shouting. Sigh, we have a long way to go.
Speaking of a long way to go, you will probably have heard that some of the vaccine and treatment trials have been paused with possible problem outcomes or concerns. This is as expected. We don’t want them rushed. I saw an interview with the Professor Doshi of Dept of Pharmacy at the University of Maryland who is questioning whether most of the current trials are set up to answer the questions of whether the vaccines reduce bad outcomes (like death), or whether the use of the vaccine will interrupt transmission – i.e. will it stop one person giving it to 4 others. These questions may seem stupidly obvious, but it is not unfair for those to be later in the piece. Researchers fundamentally first must prove a new therapy is not dangerous, then prove it really does what we want it to do, and once again that’s why it takes so long.
Also, on the topic of a long road, Bellingen Shire got famous on Radio National last week! Veteran presenter Phillip Adams was interviewing the Honourable Andrew Leigh – federal member of parliament for Fenner (ACT). He pointed out that we as a community were a positive example to uphold as we had taken a whole of community approach at the outbreak to ensure people were looked after and not isolated, on many levels. Right from the outset. Ok so then they moved on. But the rest of the topic was even more interesting, and I wanted to bring it to front of face. He is a professor of economics and author of books on community. He pointed out some scary facts such as Australians on the whole know half as many of their Neighbours as they did when that TV show first aired, and have half as many friends. Community groups have shrunk or disappeared at a rate faster than the growth of Apple.
We have so elevated the concept of the hectic life that we no longer join clubs, movements, charities, churches or even political parties. Meanwhile we grieve the loss of breathing space, connection, belonging, faith. We often hear ourselves say we just want the world to stop for a bit, so we can get off and recapture life. Well, it did!!
He goes on to discuss a glimmer of hope that this stalling, and reset, is a gap in the wall of noise. But for anything to be useful there again has to be the follow up. The joining and staying. The filling of the roster. The updating of the system or rules, and the sharing of the load for a year’s time – not just the join up day. The being there after 9 months when something difficult has to be worked through and someone needs support.
The beautiful irony is that this is precisely the common phenomena, the “X factor”, that researchers around the world consistently identify when looking into communities/populations/families that enjoy healthy , laughing, longevity. Better than any drug I have in my awesome pharmacopeia.
So, the question , the challenge, to you (being you personally or anyone “out there”) is how have you followed up on your commitments and clear thinking about how you will reset the future, and how you will reap the higher joy of joining something meaningful in the community?
There is a beautiful small book that is far less gruelling and more uplifting than expected – Viktor Frankl’s: “Man’s Search for Meaning.” He was a psychiatrist, but wrote it after surviving, and then being released from, Nazi extermination camps. And he wrote without a hit of vengeance. His argument is that, equal to food and shelter and warmth, humans need Meaning and can find it even in the direst of circumstance. However, it is so much more easily available in the practice of joining and giving to community. We each have a different way of doing this. Viva la difference.
There are many community groups in the Bellingen Shire looking to rebuild members or even hand over the reins , such as Rural fire services, sports clubs, theatre clubs , sailing schools, even the wonderful volunteers at the new Bellingen Hospital café!! So, did you make a resolution at the start of our shutdown, and would you like the gifts of seeing it through?
A quick whip through the Medical mag and Journal headlines – :
There are a few cases turning up around the world of reinfection with different strains of the virus. This is a concern for research into the persistence of immunity – Not sure of the implications yet. A case reported in the US was a young man, and his second episode was worse than the first. There is a theory that some of our antibodies (the Y shaped molecules that stick onto a unique germ and call mates to beat it up), may paradoxically enable the activity of a reinfection. Apparently, this happened with SARS-COV1. Again, reinforcing that “Herd Immunity is not a good deal. Wo!! – just when you thought you didn’t understand the complexity of it all!!!
A UK study in prepublish (not yet fully peer reviewed) suggests that 1 in 20 people with Covid19 will get long term effects. Women aged 50-60 are at most risk but 10% of 18-49 year-olds are in the firing line.
The Australian Medical Association was not happy about the message being perceived of 40 000 football fans in a stadium in QLD for football grand finals. Now I was scathing of football games, Mass church meetings, mass group events when the virus first hit and was first spreading – the risk was huge. However, like the reason for not currently advocating masks in Bellingen shops – Queensland’s risk at the present is so miniscule they can do it. That’s why the NRL and AFL have bunkered in QLD and why the Premier there has been so dogmatic about her borders till now. We need to all understand this dynamic. The risk will go right down and we can breathe, then it will pop up and we need to respond really quick and absolutely where it does. The people of Shepparton have set a brilliant example this month.
The bizarre phenomenon of Covid19 chilblains seems to be associated with a protein called a Cryoprotein. That is a group of proteins that tend to coagulate when body temperature drops below a certain temp. The blood supply is then cut off in small blood vessels. A Spanish research team has found a probable protein -a cryofibrinogen-but we don’t know what to do about that yet.
The Federal government has determined that we will be permitted to continue electronic prescribing – ie speaking to you on the phone for simple scripts, and then sending the script to your pharmacy, until march 2021. Although you may think this is a no-brainer, there are big privacy, safety, good practice issues to be debated.
In a topic only partly Covid19 related – Nicotine fluid for e-cigarettes has been partially approved on prescription as a second line treatment for helping smokers to stop smoking. This is potentially a really big deal. There is a lot at stake. I might discuss this at length in the future as it is likely to affect many of our families and especially younguns. Many doctors are appropriately extremely sceptical about it’s safety and appropriateness. I am worried about it – maybe next time.
We’re six months out from any local infections in the Mid North Coast. Yay. Our hospital staff are still wearing masks however and we are not going to let the guard down in that context.
Our local clinic is opening 0900-0930 at Watson St in Bellingen and will of course respond if there is an upsurge in concern (i.e. outbreak nearby).
Please remember this is just one perspective and check any detail with your GP – but not the remote, anonymous “phone prescriptions” services that have sprung up parasitically.
Dr Trevor Cheney