Weekly Update for 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

4 May 2021

“I’ve seen fire and I’ve seen rain

I’ve sunny days that I thought would never end…”

(apologies to James Taylor)

 

How quickly news items get swept from our view in the world of the 24 hour cycle.

It was only a couple of weeks ago that a very rare weather event hit a small town in WA.  Do you remember the name?  Kalbarri is a lovely, peaceful seaside town on the west coast mainly populated by quirky crayfishers and general fisher people, with some tourism businesses exploring the reefs and the spectacularly carved, striking, Murchison River gorge.  The sea cliffs and bluffs glow warm WA red at sunset. In spring the road in through the park is lined with a curious small tree with spectacular yellow white torches of flowers, which lift your spirits, -until you wind down the window.  The local name is “fishermen’s socks”!

A holiday heaven.

It was nearly wiped out last month.  Category 3 Cyclone Seroja slammed straight across it with winds at 170 k/h.  So, you might have thought, cyclones hit the North of Australia every year – why was that unusual?  What commentators have not noted is that Kalbarri is similar latitude to Brisbane/SEQ.  How often do category 3 cyclones dance straight off the ocean onto Brisbane and south East Qld.  How would those population bases and homes cope with 170 k/h winds?

Karratha (where we worked for 3 years) is built for cyclones. Kalbarri, and Brisbane/Gold Coast /Sunshine Coast are not.  Yet our time is filled with “never before, unprecedented, once in a hundred years” events.

So I hope sceptics about world events (looking for conspiracies) will at last look at what scientists have been saying since the 1970s in an ever louder chorus, and think about whether we need to change some of our behaviours.   That is, in relation to one of the other pandemics we are facing – Climate Change.  In our little Bellinger bubble is there anything any of us can do about it?  – yeah,  lots!

If you own a home you can solar power it, and save money.  If you can afford it you can upgrade cars (and save money in the long run), if you can’t yet you can talk to your political representatives about making it less prohibitive to do so.   If you live in town you can rethink just how much you use your car and how cheaper it is, how much healthier it is, to walk or cycle.  And the fitter you are, the more protected you are from the most severe Covid19 infections.

Oh yes, sorry, I was meant to write to you about the other Pandemic.

The segue is that we have been in an age of politics, cults, and marketing totally annihilating science and knowledge.  I hope this is turning around, and indeed we have seen some amazing turn arounds in the last year.  The enlightenment is, however, still so fragile

So, a quick skim of some interesting articles on the science of Covid19 from NSW Health Critical Intelligence Unit this week…

 

The British Medical Journal  (BMJ) published a meta analysis.   That’s a clever statistical analysis that weights and adds together lots of small trials to see if something is emerging or supported.  Sadly it pretty much closes down the question of hydroxychloroquine.  You may remember a certain billionaire bought the populist line, and bought out most of the country’s supply of the medicine.  It was hard to get for some of our patients.  The analysis found it did no better than nothing, and did some harm when people tried to use it as prophylaxis.  The jury is still out on another drug  -Ivermectin.

We do use prophylactic drugs in other infections.  HIV is an example.  There are now very effective regimes to prevent infection in people who have been exposed to a risk of HIV.   We just need people to come attend their doctor or a clinic if they are concerned. But nothing yet to prevent Covid19, apart from having other conditions well-managed and adequate levels of vitamins.

A slightly concerning report from the Oxford Academic Journal quoting multi site studies in the USA showing there is some risk of reinfection after having a primary infection.  They studied 9119 people and found 0.7% were reinfected by late last year after an average of about 116 days.  The reinfections were mostly milder, but paradoxically 3% mortality.  Yes – even those who have had Covid19 are encouraged to get a vaccine.

An article in The Journal of the American Medical Association (JAMA) found in Pennsylvania School kids are silent carriers.  They found value – when the pandemic is raging – in routinely testing school kids to pick up outbreaks.  The programme faltered though where some families were resistant to the idea of screening their kids, and less helpful when there are low vaccination rates in the adult community .  However the Authors quoted an old wisdom – “do not let the Perfect be the enemy of the Good”.

NSW Health quote that they have supervised (with Police help) 170,956 people returned though Hotel Quarantine.  Wow!

Though this makes it seem even more outrageous that people trapped in India with valid Australian citizenship, are threatened with massive jail and fines if they try to return home. What happened to the responsibility of a national government to look after its own citizens?

There are some reports of suspicions of clots after the Pfizer vaccine – but it is still even more vanishingly rare after some hundreds of millions of doses have been safely given.

We have more precise data from the European Health Agency on the true incidence of the rare disorder after the AZ vaccine.  It is now estimated that up to 10/million occur in up to 50 year olds, decreasing to less than 5/million in over 70 year olds, with reports of mortality rapidly decreasing as more is learnt.  The disease of covid19, as mentioned many times, has a high rate of dangerous clotting.

Flipping the data, it was estimated that in a medium size outbreak -as happened in Victoria – then a vaccinated population would have prevented 1967.5 hospitalisations and about 530 deaths per million, vs about 8 clotting cases per million.  That is before we even look at the long sequelae.

This all adds up to a position that I still believe, and the expert panels and scientists all reinforce, that the benefits of vaccine far outweigh the risk.   The virus sweeping though Australia is a matter of when, not if.   A bit like a cyclone across Brisbane – but at least we have a relatively simple set of ways to prepare and protect against this storm.

It is with some relief that our local GP practices welcome the government’s decision to allow us to start vaccinating all over 50s with the vaccine that we have available. Unfortunately the Pfizer vaccine that is recommended for under 50s may not be available till the end of the year and we are a long way out from having the logistics solved (even though it doesn’t seem that difficult from the ground view).  Supply is the problem, and again too many people are competing for a limited product.  The tragedy in India is testimony to that fact.  I won’t go into the detail except to remind us all  -that is what a real pandemic looks like.  We may not be able to look after you in our hospitals if that level of outbreak gets to Australia before we are vaccinated.

If you have a serious medical condition or the eligibility checker says you qualify for the “1A” or “1B” roll out but have not been offered a vaccine yet, please contact your GPs office.  Remember you have not been neglected, and still have priority.   It’s just that we all are still trying to provide normal health services while we juggle this big addition to our load and we don’t want to be missing cancers or heart disease or diabetes monitoring.

But, otherwise, over 50s please contact your GP for a place in the vaccine clinics mounted by each surgery in the Bellinger Shire. Please be flexible.  The perfect time may not be available for you as we have to hold clinics to withdraw the vaccines in batches of 10, and then set aside a chunk of time in the normal hurly burly of the GP day.

“Don’t let the perfect be the enemy of the good”.

At the same time we need to get moving on getting as many people vaccinated as soon as possible before the inevitable storm gets here.

 

Please remember this is just one perspective. Check any detail with your own juggler, hoop jumper, storm watcher, I mean GP.

 

Dr Trevor, Cheney

 

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