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

By December 7, 2020 In Focus 2 Comments
Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellingen Shire

8th December 2020

 

Just a quick round up of reactions to the medical news:

 

Happily, it is felt that the Covid19 risk in NSW is low enough to further relax hospital visiting restrictions this week.  Visitation will be opened up, staff are considered to not need a mask – except for assessment and in certain Emergency Department situations.

225 days since any community transmission in the region is stupendous.

However, there were 2 conflicting pieces of news in the last week that give some pause for thought. You may have heard on the news about a Hotel quarantine worker being infected in Sydney and travelling long distances on public transport to get there.  The second is a family returning into Sydney and then being allowed to travel on, claiming an exemption to quarantine.  I have been asked how that can happen, given all that we’ve learned from the Victorian outbreak.  The simple answer is that I have no idea!  I am just a simple country GP and perhaps the intricacies of managing such big policies are beyond me.

These issues have ignited reporting of calls by epidemiologists and some in the Royal Australian College of GPs to establish a National strict standard for incoming quarantine.  “What? “I hear you shout – “didn’t we already have that??”

Well, it seems not. It seems that we still have federal and state authorities digging in, with some demarcations.  My reading of the Victorian inquiry reporting is that the mixed messaging, interagency miscommunication,  insecure work, poor training, subcontracting and outsourcing, workers attending multiple sites, were all part of the mix that allowed the outbreak to get its critical momentum.  Our leaders should learn from that inquiry.  That’s why we have inquiries, or at least that’s why we say we have inquiries.

Once again science and health get politicised.  In UK/Europe, it was sad to see UK ministers crowing that they were the first to approve a vaccine and so the UK is far superior to the Europeans, and somehow this has become a Brexit issue.   You know, that big messy, unmanaged, dishonest, toxic, divorce spat that is meant to be sorted by the next 2 weeks, but won’t . And now the Covid19 vaccine issue is being beat up into the meringue of international relations.  Sigh……

There is an interesting paradox in that we have all tried hard to be isolated from the pandemic, and been very lucky in Australia.  Our island geography is helping.  And yet the modern world is full of air bridges.  I would love to see people trapped overseas able to get home.  There are many in our shire who have already suffered, and still are, with the dreadful uncertainty of their family stuck in countries that may not be treating our ex-pat citizens any better than our government is treating guest workers here.  And we have people with genuine cases of urgency going through an excruciating process of applying for compassionate exemption only to be told -No!.  I understand the risk assessment decisions to make no exemptions and ultimately support our Health District managers in their final say.

It would just be better if everyone knew there are no exemptions, – all in the same boat, or plane, or Hotel.  So – can’t explain how that breach in Sydney airport occurred.

On the upside it is reported that 130 000 people have successfully returned since March, many sick with covid19, but recovering and no longer a risk!  That is phenomenal!

Regarding the staff member who got sick working in hotel quarantine.  As I read the opinions and comments in the medical press, it seems the best advice for a pandemic is to arrange these hotel quarantine staff to – work in bubbles; to reduce their need for public transport; to ensure they have reliable, adequate work, so attend only at one site; have top line training and PPE.  There is also advice to the Victorian Government that the sites should not be in the middle of the cities.

None of this is new – as the same discussions have been aired for months.

This week NSW leadership had the position that people should be allowed to work wherever they want, as they might just as easily get sick from the community – where there are no cases?

Well if we do get a local outbreak we will need to remember that for our local high risk services – eg nursing homes,  and support the workers in such places.

The vaccine news, despite all the politicking, is still heating up in line with our southern hemisphere thermometers.  A controversial debate is about whether we are lucky, or disadvantaged, by the Feds sticking to a start date of vaccination Rollouts in March.

On the one hand, some doctors are saying that such a delay is bureaucratic incompetence and puts us at the end of the line.  The alternative position is that we are at an advantage as we get to see how the vaccines work in the real world, both in safety and effectiveness, given their hypersonic rate of development.

Russia is starting to vaccinate with their own product this month – UK with the American/German RNA vaccine in the next few weeks.    The “Oxford” vaccine is held up a little with some confusion over the best dosing levels.

Actually as you probably would guess from these past months, I am happy with the latter position.  I am happy to wait and see what happens in the real world before I take up the mantle of advocating for the vaccine that we eventually get.  As my old mum used to say – “There is many a slip twixt cup and lip”.

But at the same time the countries moving more quickly have a clear and present danger to their people, so they face a much greater urgency.  It may be quite reasonable for them to take the risk and move, because the reality of uncontrolled pandemic is already hitting them in the face.   This last week there were serious concerns about how the British National Health and Hospital system survives over the next few weeks!

I did not expect anyone to start safely rolling out before the end of this year – even into late next year. As a scientist at heart, it would be great to be proven wrong on this one. After all, there has never been a health issue given so much brainpower, research resource, funding and will – all at once.   Way more than HIV even.  Just imagine how the world would be if a similar energy was put into a malaria vaccine.

In Australia we have the rare privilege of not actually being in the pandemic at present, and don’t face that extreme urgency.  Of course, should we get an outbreak that pours into the wider community then that sense of self-assurance will instantly change.  The key is to not be complacent until then.

I so hope that expressions of good will around the world -ensuring that poorer nations get timely and affordable access to a successful vaccine- is also followed up.  Some companies are starting to redefine their noble offers.

In the meantime we will be planning family Christmas, without much travel.  The state tourism marketers will be working overtime to get us all out and about in our own back yard.  Truly there are so many places to see in Oz.  We will get a lot of city folk visiting the Mid North coast.  We have the great opportunity to welcome them, and we may need to remind them to use the hand sanitizers, and remind ourselves if we go visiting elsewhere.

And I wonder if, for those young folk not getting hospitality jobs, whether now might just be the best year in a long time for school leavers or uni students to get some very different life experience in seasonal farm/orchard work.   Especially as the Australian Workers Union is now doing a bit of “outing” of unscrupulous labour hire companies or farms, hopefully there will be less risk of young workers being exploited.

I think the life experience of heading off with a mate to get tired and dirty and paid, but learn about places and people other than home, is unforgettable. That’s just an old dude’s opinion in wistful reflection, not a scientific treatise.

One of my greatest educational experiences was working on a dairy in QLD, where the oldest other worker was 17, the youngest was 12, and most of them were on the run from Juvie – (we used to call it “Reform School”). We were paid $75 a week and they then took out $50 a week for board – which was a flea-infested pit, in which you would run from the door to leap onto your rickety bed to avoid  a leg full of bites. The food was saveloys and tinned spagghetti.  The manager was drunk.  The job was riding out on a pony to start bringing in the cows from 4am to returning them again at 5pm, with a couple hours rest in the middle.  The farm was essentially modern slave labour and was owned by a high profile Brisbane barrister.  That was in 1982.  At least I didn’t have to stay, but got an irreplaceable first hand taste of the reality of the world.  Some of those boys were truly lost, and some really solid characters. Makes one wonder how many survived till now.

But hard jobs carry fond memories.  They form a foundation, even if it is to teach oneself exactly what you never, ever want to do again!  You can’t pay for that kind of learning experience.  Conversely I fear that not getting out into the world after a year trashing ones plans, can be permanently disabling to an evolving personality.  I know it sounds clichéd, but I believe Netflix is a numbing nanny.

 

Please remember- this is all just one perspective on the Covid19 and medical news of the week., the state of life , the universe and everything.  Please check any details with your own GP who might have a fresher perspective, a bigger universe.

 

Dr Trevor Cheney

 

 

 

 

2 Comments

  • Ruth Holmes says:

    Always enjoy your Covid 19 Newsletter.. How lucky are we in the Bellingen Shire to have so many caring and competent GP’s and Health workers. Our Dorrigo community has also been very fortunate to have such wonderful shopkeepers and Library staff who have been strict during Covid 19 and taught us well about hand hygiene and social distancing. I try to keep away from the big shopping centres on the coast where it appears to be more relaxed. We are lucky to live in small caring communities. Loved your piece about working on the dairy farm. A lot of us dairy farm country kids grew up picking potatoes or cutting Corkwood for pocket money. When I was at the C of E Girls’ Hostel in Armidale doing Leaving Certificate at Armidale High we went Cherry picking. A beaut time. We were fit, had to walk from hostel to farms, and it taught us a lot of skills. We got paid by the full containers so we worked hard. At this time of the year the Cherries fill me with fond memories of those days! Thanks again and our Congratulations on receiving the Rural Doctors Award for service to Rural Communities, well deserved!.

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