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

By August 10, 2020 In Focus 17 Comments
Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellingen Shire

10/8/2020

 

Sorry to miss last week – I was working too late and missed the submit deadline. Lots have happened, lots of points to raise.

Yep, still no cases in the Shire, none known in the Mid North Coast Local Health District.

Point 1.

We are worried as we see, each week, tendrils of this virus creep north.   The wonderful staff and management at your hospital are ramping up responses in anticipation. You will note that staff are wearing masks when attending patients now, visitors are severely restricted into the hospital, anyone with the slightest symptom (staff or visitor) is asked to leave. This fits with advice we were given much earlier on by infection experts – “go hard and go early”. Yes this might feel severe or inconvenient. It sure isn’t fun, but what have we got to lose? – thousands of lives.

Remember one of the key lessons of each outbreak is that when a case does pop up with a positive diagnosis, the virus has already been spreading in that community for up to 2 weeks. There is also a natural delay in the mortality reports. The sad tallies of people succumbing are the consequence of what happened 1-2 months ago.

Viva La Masks!!

Point 2.

I watched slack jawed in horror as Premier Andrews in Victoria announced that up to ¼ of the people who had tested positive – i.e.: sick; spreading virus; in danger to themselves; and dangerous to others – were out spreading when called on. Clearly so many people still don’t get it. This is not a training run.

Keep it simple and clear. If you have symptoms – isolate and get to a testing clinic ASAP! Having had a test – get straight home and touch nothing else and no one, isolating and ordering in deliveries to the gate if necessary, until a negative Covid result. BUT anyone who is unlucky enough to get a positive result MUST stay in absolute quarantine – home or hospital – no physical contact, no spreading to your family, friends, neighbours. Remember in the Bellingen Shire we have a community support network sponsored by council for those stuck in home.

In contrast, a worrying aspect of mob response has arisen in QLD, – the “name and shame” approach.   Firstly, Public Health experts warn us that it just does not work! If someone is unwell or exposed we want them to step forward and get tested, then quarantine (as our only local case so far did so nobly and early). We don’t want anyone to hide in fear of mob reactions. The angry publicity has another nasty side. Remember the Victorian society couple who flouted all rules and spread the virus after returning from a Hotspot a couple of months ago – their identity was protected for “legal reasons”, and the press respected that. The 2 young women in QLD had their names and faces all over the media, now with threats and harassment on social media.

So what’s the outstanding difference? The Victorians – white and wealthy, the Queenslanders black and poor. Such a crass discrepancy has been highlighted in the medical press. Is this really how we want our society to evolve??

Point 3.

So now >19000 cases in Australia, >200 have lost their lives and >900 health care workers are amongst the sick in Victoria, including 13 GPS with Covid 19 and 3 in ICU. That makes a nurse or aged care worker (and me) much more at risk than most of you. So we will still take it seriously. Viva la mask!!

That’s an interesting little statistic. Some of us are old enough to remember the 80s when the threat of mutually assured nuclear destruction seriously hung over the skies. A very powerful statistic emerged with antinuclear campaigners – when you let war break out and bomb cities, remember that you also lose all the health workers that you would rely on to recover.   A Melbourne senior doctor made that point in an interview last week, stating that while they moved quickly to get up to speed with equipment, they have been blind sided by staff losses.

In our local Covid 19 clinic we were very lucky to be donated enough Personal Protective Equipment initially, and now have a pretty tight model to protect us, and all who come through. It seems quaint now that in our first days in March we had NONE and were making protective gear with garbage bags!

Point 4.

The Asthma Foundation this week made a really important point. Pollen season is on us. The lovely wattle is flowering all up and down the highway, my nectarine tree has gone nuts (to make up for last years smoked out disaster), and so have all the weeds.

The advice is for all of us with seasonal allergies -> Now is the time to get moving on your preventers – before the season hits peak. Nasal sprays and asthma preventers – get ‘em out now, dust ‘em off now and get into using them. If you’re not sure, get into your GP now. Apart from the fact you might be less likely to get the immune complications from Covid19, you will also avoid being sent running out into the rain in the current climate of hyper vigilance, when you sneeze!

Now, I fear today I am about to go out on a limb and be at huge risk on 2 topics.

Point 5.

First, and probably the most dangerous – Beards. Big beautiful, bushy Beards are incredibly cool (or warm), playful, fashionable, desirable, and ultimately masculine. Now, a true declaration of conflict of interests: I am pathetic at growing a beard, always have been. The only time I managed one it was scraggly and vapid. I do hate shaving though so hover in between smooth to slight bristle. I might have beard envy.

The problem is that masks don’t fit on beards. You don’t get a seal; the bristling hair does not filter out virus particles. Indeed it is well known to store little treats from lunch for later enjoyment. In emergency departments a fella with bushy beard is a nightmare to resuscitate. The resus masks don’t seal, it is hard to see critical recovery signs, and equipment falls off. Fortunately mouth-to-mouth is completely banned in the era of Covid anyway.

It is notable that many health care workers are trimming down to neat little goatees that leave their cheeks smooth.

I don’t pretend the slightest idea on fashion, but, y’know, just sayin’…

Point 6.

The second piece of professional quicksand is the incidence of “a post viral syndrome.” There are emerging reports of mysterious post viral conditions that drag on for months or more. Post infectious syndrome has been a hotly debated “thing” for decades. It has been merged and separated from another mysterious entity called Myalgic Encephalitis, or you may recognise “Chronic Fatigue Syndrome”. It has been particularly associated with Glandular fever, Ross River virus (and related viruses), some trauma or surgery. It is a polarising concept, with some doctors and researchers believing it to be a psychological state. Others are convinced there is a persistence of some difficult to find infection, or a long term change in your immune system’s behaviour – as if the immune system forgets how to turn off, lazily and callously throwing out random chemical bombs in one’s blood and tissues to keep joints inflamed, bodily processes suppressed, brains clouded, in a diseased state.

There is evidence for both, or all, positions. The reality is that significant numbers of people who were previously well and fit suddenly, after a viral or similar infection, see their lives ratchet down to half speed or worse, with problems in memory, thinking, fatigue, pain. Historically a similar phenomenon was seen after the 1919 flu pandemic with young people developing anything from severe Parkinson’s like disease to learning problems.

Last week an Australian GP published a report on his experience as a super fit competitive cyclist. He got Covid 19 in April and now has epilepsy and carditis (inflammation and scarring of the heart), with an irregular heart rate and fatigue. All as a consequence of his meeting with Covid19.   He now cannot ride his bike.

This happens to young people!!! Relevant talking point with your teenager/ 20-something – 2 years of no surfing, no party, no sport!

We have been asked by a local (who knows this syndrome first hand post SARS1) about how to prevent it, how to treat it.     The overall answer is that: we just don’t know!         Don’t get the virus!

Nevertheless there are theories and projects under way. There are studies on the immune and recovery role of adequate vitamin D.   Another showed the timely (early) use of a cortisone medication to turn down the accelerator of the immune system. This will be available for anyone who is seriously ill.

There are decades of studies on the role of vitamin C. Some show vitamin C enhances certain chemotherapy drugs while some show it interferes with others. Some show “normal doses” of vitamin C make no difference to common infections, yet we know for 200 years that a lack of vitamin C reduces healing and the ability to fight infections – ie scurvy. There have been studies that show high dose vitamin C in severe circumstances encourages much higher rates of recovery, and lower rates of post infection syndromes.

An example is in sepsis, a condition where an overwhelming infection causes a lethal shock, with collapse of all bodily functions to a point of almost self-destruction. (sounds like Covid).  A seminal American study showed a spectacular increase in lives saved out of ICU with sepsis after the addition of high dose vitamin C, thiamine and a cortisone. But that study is dismissed by some incisive medical minds as biased and “too good to be true”. So again, we don’t know.

Some of us have seen remarkable improvements in post viral syndromes using nutrients, where medicine has nothing else to offer. It does need to be timely – early in the event.   But this is anecdotal, and needs to be approached with cautious scepticism.   Of course most doctors, including myself, have also seen patients suffer needlessly and be desperately misled down rabbit holes of miracle cures, avoiding treatments that might have helped, while spending their savings on unsuccessful promises.

Still, I believe there is nothing to beat optimising your nutrition. Most of us just don’t do that! I’ll be taking zinc, vitamin C and vitamin D (in safe doses).

Point 7

We have been asked about the significance of Blood type in one’s experience of Covid 19. Yes, there is emerging evidence of a coincidence that people from blood groups A or O have a different level of illness. This gets folk pretty excited but, in fact, at this stage is not really helpful. Firstly, what most don’t realise is that there are actually about 34 different aspects of blood types in various combinations. The almost incalculable variability is why the blood bank will not accept someone’s claim of blood type, except in dire circumstances.   Every single time a doctor requests blood to be used on a patient the blood bank will test, in real time, every single bag against that patient’s fresh blood. It also is why doctors are actively discouraged from adding blood type to a routine test.   It is a distraction –except when you are pregnant and have Rh-negative blood.

You’re not going to be able to change your blood type, except by getting a bone marrow transplant, and that is not a desirable strategy.

Finally, a coincidental mean increase or decrease in severity of infection with blood type is a statistical point, and offers no help to the individual who is sick. Better that everyone does all the distancing, hand cleaning, hot soapy washing, mask wearing, avoiding of hot spots and unnecessary travel.

 

You know the stuff, but we have to keep saying it – until everyone gets it.

 

Dr Trevor Cheney

 

Remember this only one perspective. Check with your own GP who knows you, who is also keeping up to date, and reading, and being exposed to a whole array of other good information

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