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

By June 29, 2021 In Focus 7 Comments
Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellinger Shire,

29 June 2021.

 

I hope some of you were able to listen to the Prime Minister tonight in his response to the current sudden turn of events.  There were some critical points to which I must return.  However a much bigger event occurred this month, in case you didn’t notice.  It was the death of Edward de Bono, at 88.  No, he didn’t die of Covid as far as I know.

De Bono was a Maltese born Medical Doctor who went on to obtain an MA in psychology and physiology, a PHD (so a “double doctor”), wrote 85 books, influenced schooling and management in at least 20 countries, and is the guy who thought up – or at least popularised the term “Lateral Thinking”.

Now a little while ago someone commented on the oddity  -that I had been writing into letters about a world wide medical issue, some philosophical observations.  This may seem odd today.  In fact only 200 years or so ago, and back thousands of years, it would have been absolutely expected.

The Cambridge on-line dictionary defines Philosophy as:

the use of reason in understanding such things as the nature of the real world and existence, the use and limits of knowledge, and the principles of moral judgment

Dr De Bono had a somewhat less specific definition in interviews he gave some years back. Hear Robin Williams interview with him on the ABC “Science show”.   The idea of publicly thinking deeply about things unfortunately seems to have gained a bad rep – firstly with the industrial/scientific age where engineering evidence and 120 quoted references are required to publish a thought.  Don’t get me wrong – all power to evidence based advances vs dogma, self-aggrandisement, and assumptions.

Perhaps because originally the term was intertwined with religious life which has been taking lots of back steps in the last century, and the term gets tangled and dismissed by those not religious.  Perhaps the component about Moral judgement has been so tarnished from betrayal by previously unimpeachable institutions, and the concept of moral relativism?

Whatever, the problem ground down is that it is hard to know what is the right thing to do for your next breath. Some folk feel their faith and holy book instructs them on all things – yet even that seems to be subject to so much varied interpretation.  Jewish comedians make a specialty of pointing out Rabbinical debates that can hover on a word for decades.  I have no idea how many Christian denominations there are now – seems about as many as there are Hindu gods.  Even Islam has 2 bitterly divided mainstreams that are willing to go to war with each other in the m=name of the same Prophet, as well as divergent mystic side currents.

I actually don’t claim any qualifications in philosophy or religion, but I just think thinking is fun, and helps.

There are plenty of great names associated with the practice  – Aristotle, Socrates, Des Cartes, Nietsche, Lao Tse.  If you want a quick summary there is a Monty Python song from the 1970s that pulls together lots of ‘em, and accuses them all of being mad drunks!

However I was intrigued to learn recently that Alan Turing – often regarded as the inventor of the modern computer – used a philosophical questioning approach to solve the algorithm needed for his first electrical computer.  Although, Wikipedia and the like state that a guy called Babbage designed a calculating machine in the 19thcentury but never built it, while the real visionary ideas came from a much cleverer woman who did not get credit for it – Ada Lovelace – ain’t that the run of history?

In our public discourse there are lots of opinion, words, “information”, probing, statements, repetitions and calculations, which are all passed off as, or distract us from, thinking.  I ponder how we got to be in a “post truth” world where all facts are negotiable.  A philosophical approach helps in the sieve.

Here is a little Hierarchy of thought that might be helpful.  This again is original, not referenced – just ponderings from living long enough now:

 

Opinion is not Data;

Data is not Fact;

Fact is not Knowledge;

Knowledge is not Understanding;

Understanding is not Wisdom;

Wisdom is not the end, more a destination and doorway.

 

We have lots of time coming for pondering as the State, and potentially the nation, creeps back into tighter Shutdowns.  The urgency is in this new Sydney outbreak being of the “ Delta variant”.

Please don’t get hung up on the word Delta – it didn’t come from Mississippi or the Ganges.  Scientists are always looking for ways to identify things in a shorthand. Unfortunately they keep choosing the same damned group of symbols  – ie the Greek alphabet.  I would love to know what the Greeks think of this.  Unfortunately when you study a cross disciplinary business like medicine it’s frustrating as the alpha , beta, gamma, delta, etc mean entirely different things in maths, chemistry, physics, pharmacology, and biology.  The same symbol could be used in 5 entirely different meanings in the same sentence!

So this Delta stain is the one found after the alpha, beta and gamma versions.   We will probably get to an Omega strain before this is finished (that’s the 24th letter and sounds like a sci-fi novel title).

Why so? Because the more people that get infected and replicate virus, the more mutations – yes we have raised this before.  The answer = less infections.

The big deal is that India’s doctors are telling us this variant is just as deadly. But the epidemiologists are saying that is about 3 times more infectious.  It hangs in the air. With the original strain, 1 person might infect 2.5 others.  With Delta, 1 person infects about 6 others, and they start having symptoms and shedding more virus more quickly. So within a few days the hundred cases we have as of today will have at least a 1000 contacts to trace and may have already infected their 6 before a cluster is noticed.  Epidemiologists tell us that once we get to 100 cases per day an army of contact tracers will struggle to keep up.  Once again maybe 70-90 of those hundred will be minimally symptomatic.  OK, a few will be really, really sick, a big handful will be sick and disabled for months, and only 1 will die. But if 10,000 get sick in a hurry we don’t have 1000 vacant ICU beds, certainly not in our region.

So the government has changed the vaccine rules again.  Partly this is because the calculation has suddenly shifted.  Whereas a very rare side effect looks bad when the chance of getting an infection is also very rare, when the chance of infection is suddenly in your face the benefit of vaccine goes right up.

But some news – report this week is that 99% of new infections now in the US are only amongst the unvaccinated – and yes, the mortality is still occurring, even if you haven’t heard about it.   It’s just old news now.  There are very rarely any severe cases or deaths in vaccinated individuals.

I wanted to go back to Sweden, which again has a similar population and level of wealth as NSW.   You hear diametrically opposing assessments of the consequences of the way that country has approached “herd immunity”.  Reports range from claiming their economy is tanking because of their third wave, to being on the way to rebound better than precovid.  Remember they didn’t have lock downs.

Sweden has had about 1.09 million cases and 14,619 deaths to date – that is more than Bellinger shire population wiped out.  Norway right next door with similar people but different government attitudes, has half the population and had 130,000 cases but only 792 deaths.   Both economies are at about the same stage – suggesting the economists don’t get the argument either way.  The rub is: how many of your relatives are you prepared to lose?

NSW has had 5778 cases and 54 deaths.  In a couple of weeks that may change – we just need to remember why governments have to make hard decisions.

I wrote very nervously some 6 or more months ago that at some stage in this pandemic people will be facing some hard decisions regarding to vaccine or not to vaccinate.    As virus leakages have occurred, in stupidly predictable routes, corporations and governments are going to be led to the situation of saying “no immunity = no work”, or no board my plane, event, car etc.    Well tonight the PM has announced that is occurring.  Aged care workers are now informed that they will be legally obliged to get vaccinated by September.

Some folk will be outraged and kick about this.  There is a philosophical position that weighs up the greatest good for the greatest number, competing against the position of avoiding “tyranny of the majority”.  There is also the position that you can be free to express your rights and individuality and accept risks, so long as it does not endanger or hurt your neighbour. Well, if you carry a potentially lethal disease, which is predictably preventable to those around you, or more seriously, those entrusted to your care, then….

Anyway, that is why there exist the laws for public health orders. They were used in the early days of the AIDS crisis, and earlier in the 20thcentury.  The recent cases of airline attendants getting sick and being unvaccinated will really test the patience of their employers too.  I suspect the rule will, before long, be imposed on all health care workers and similar.  Just putting it out there…

As GPs we can still only offer one of the vaccines – preferred for those over 60. However the PM and Chief Medical officer now emphasised it can also still be offered to those younger who are happy to acknowledge the very small risk of a side effect, but are unhappy to keep on waiting until an alternative turns up.  There is suddenly a lot of debate about the marginal difference in waiting 12 weeks or 10 weeks for the second dose.   We will watch this closely and probably receive advice soon to just get everyone second dosed sooner rather than later.  You may want to check how your GP practice understands this fluid situation. Please note that the risk of side effects in the second dose of the AZ vaccine is way less.

The other vaccine preferred for those under 60 will be rolling out this week to some extent in the government funded respiratory clinics (Nambucca), and in the next few weeks some supplies may be provided to some GP practices.   Please go to the Federal Eligibility checker website to see where you fit and where to try to book in for a vaccine, – if you want to, of course.

Testing clinics are being hammered this week –patience, patience, take a book on tape or something for being in the line.  Yes masks again help – even though some infections can be carried by small airborne particles.  You can choose to be hit by a car at 5km/h or a bus at 50 km/hr.  Neither is perfect but I think I will choose the slow car – ie masking up in all stores in town, at work and inside buildings.

As always this is just one perspective on the breaking news, and life, the Universe, and everything, and all that S(tuff).  Please check any detail with your own GP who is wrangling every day a little bit of des Cartes around a pinch of Nietsche with hopefully a nicely warm baked Lao Tse in the offing.

 

Dr Trevor Cheney

7 Comments

  • Avril says:

    You bring a smile to my face in this scary time with holiday makers still rushing into town thinking if they beat the curfew its ok. No its not ok, we have had a virtually virus free community and we want to keep it that way.
    Thank you Trevor, every week you educate us, amuse as and advise us. Long may you do this.

  • Trevor, you sure are Bellingen’s Renaissance Man.
    We can all do with a large dose of philosophy at this time, and it is great that you have reminded us. Especially Descartes’ and De Bono’s.
    Thank you.

  • Peter Smith says:

    Dear Trevor, thank you again. I remember reading De Bono’s book ‘six thinking hats’. It brought forward some great conversations in my workplace. If I put on the white hat (which is all about information and where we get it, I seem to recall), I have a question, please. On June 25th, we saw a press conference with The Chief Health Officer for the state of New South Wales – Dr Kerry Chant. In that press conference she said “Don’t forget, just because you’re vaccinated, you can still get infected and be infectious”. This makes we worry about the efficacy of the vaccines, when someone so important says something like this. As our go to person in our community, I’d love to hear you thoughts on this? Thanks for what you bring to us each week, loving the philosophy and health info…Pete

  • Anna says:

    Thank you Trevor – I love your hierarchy of thought!!
    On another note, I’d really like to know what you think about the Novavax vaccine if you can weave it into any of your future articles.

  • Michael Mulholland says:

    Thanks Trevor for bringing some philosophy to the virus discourse.
    The media and politicians focus almost exclusively on the biomedical causes of disease forgetting that psychological and social contributions influence a context for our health.
    I have a bone to pick with des Cartes for inadvertently spawning a western medical separation of mind and body that we are now desperately trying to put back together (my personal view).
    Lao Tse and other Eastern philosophers and traditional medicine systems never separated them.
    Where is the discourse about personal responsibility for our immunity and empowerment?
    Stress and anxiety don’t help immunity. Education and taking charge do.
    Thanks for the broader perspectives.

  • Barbara Frost says:

    I signed up to ilovebelloshire in the middle of the gloomiest of days in the UK when the pandemic was overwhelming us as I wanted to be transported back to the glorious Bellingen valley and to recall my days living in Kalang. In fact the piece I found most entrancing was your column Trevor as it’s always so informative, philosophical and thought provoking. I’ve learnt a lot. I look forward to the day when the borders open and I can come back and visit old friends and the lovely shire again. Thank you.

  • tric lee says:

    Trevor I always love your articles but my husband is a little obsessed with some Drs on YouTube. I have had my first vacc a few weeks ago, and he was scheduled to have his first vacc today. He asked the nurse to ensure she aspirated to make sure she wasn’t going to inject the vaccine into a vein. She said she would only do the injection the way she was instructed, and she went back to the doctor to discuss my husband’s request. Of course the Dr stood by the nurse and my anxious man came away without his vacc. Do you have any reasonable, logical argument or any risk stats that would tell him whether it currently makes sense to hold out to wait for a change to the injecting rules, or the option of Ivermectin. He seems to think its safer to wait until the Aus system catches up with knowledge from overseas. I am worried because he is over 65 and prone to hay fever, sinus and throat infections. Can you give me some stats or words of wisdom about the relative risks, please.

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