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

By September 21, 2021 In Focus, Other News 5 Comments
This week Bellingen's Dr Trevor Cheney was awarded with the Rural Doctors Association of NSW Bowman Cutter Award 2020 to acknowledge his exceptional services to RDANSW and his strong, ongoing advocacy for rural doctors and rural healthcare.

Dear Bellinger Shire, 21 September 2021.

 

We mark anniversaries and points in time.  Maybe it’s because they help give meaning to this finite thing we have in a life. Perhaps because memory is so imperfect that a point has images cluster around it like coral and barnacles on a sunken ship.  Some of those points take on dreamlike subreality, some become worth going to war over, some are like the pidgeon defaecated statues in parks.

Neither is clear and so we have developed ways of preserving memory and learning in written language, song, now video imaging.  All of which are still imperfect.  People often quote a truism that at certain points in history millions of people alive can recall exactly where they were and what they were doing.  Certainly after last weeks anniversary with all the replay of TV documentaries, “never before seen footage”, reanalysis of a certain day in September in 2001, I can recall exactly where I was –visiting aging parent in QLD and getting up to see America being attacked.

I can also remember seeing the moon walk in 1969 on Auntie Margaret’s black and white TV, though of course many “millenials” know that never happened and was another big history hoax.  I wonder how long before the “Twin Towers“ in New York will be debated as never having existed.

The problem is by pretending things don’t or didn’t happen, we are doomed to never learn from them. Perhaps that doesn’t matter since the aftermath of that event and the natural reaction of the USA, ours and other nations has seen us be involved in our longest and least successful wars, the creation of ISIS, another failing state in Syria, millions more refugees, and superpowers again head to head.  Humans succeed in really stuffing ourselves up when we enjoy hot rhetoric and misunderstanding.   Grandiosity ultimately evolves into someone killing or maiming someone else.

Now historians are starting to Imagine how it would be if the response had been different, more measured, at so many points in History, including 2001.  We would probably be even more overpopulated.

 

Imagine…

 

This little dream sequence is prompted by the 50th anniversary of “Imagine”.  John Lennon’s (he was the particularly incisive song writer in the Beatles for those who thought Nirvana was the start of modern music). Imagine was released in 1971 and somehow feels like the last gasp of the peace and love movement of the Hippy era.  I hope some lines don’t offend those with deep spiritual beliefs, but the seminal lines include

“ nothing to kill or die for…. “

“Imagine all the people, Livin’ life in peace

Youuuu, you may say I’m a dreamer,

But I’m not the only one

I hope someday you‘ll join us

And the world will live as one”

 

We forbid it for our kids but so often start shouting at each other in public.  I grew up in Bjelke-Peterson’s QLD  – with aggressive shutdown of dissent (and  corruption), so I respect the right to make protest and march.  But why does it have to be violent? And aggression attracts people just looking for a chance to smash someone or something.  I feel for the poor bloodied police officers in Victoria – deployed to protect the CFMEU offices yesterday.  What a twist of politics.  Unions used to be on the other side of Police lines!

If people still need convincing that the push to get people vaccinated and safe is not part of some super rich world-wide right wing conspiracy, then perhaps seeing the secretary of the ACTU Sally McManus publicly supporting government decisions on pausing worksites for infection safety reasons and insisting workers are vaccinated must make you wonder.

Another point in history is the departure this week of ‘Mutti’ Merkel – Germany’s chancellor who has provided steerage of that rich and wealthy, though conservative, country for a whole generation. She also demonstrated the vital  role of women in leadership – even without being a feminist.  She demonstrated compassion for suffering, and a scientific approach to management.  The transition of power will disrupt German and European politics in a volatile time. But there are less positive assessments. Even so Germany was sadly unable to turn it’s technical expertise to beating Covid19.  I was asked why Australia doesn’t just do it like Germany – going out, giving up restrictions, just doing a rapid test when you enter some venues.  If only it was that easy.

According to the WHO Germany has had over 4 million cases and lost almost 93000 people.  That equates to about 30000 deaths in Australia. We have lost 1169.  We’re doing not too bad.

And despite a fake website’s spouting, they have not stopped vaccinating – indeed they have administered 105 million doses!  Just another 55 million to go.

On rapid tests – this is a hot topic still debated.  The principal idea is a hopeful part of the future.  A 14/9/21 analysis in the Journal “The Lancet” compared 19 different brands of rapid antigen tests now on the market.  An antigen is the thing that is antagonising your body as opposed to antibodies which are Y shaped weapons, keyed to a uniquely shaped antigen sent out by your immune system once it has learned how to make them. Unfortunately at least 4 did not meet any adequate benchmarks. There are studies going on to work out the best way of using them.  Once again we hopefully get to watch and learn from others.

In the same edition of The Lancet was a study of daily testing of 2432 school children with rapid antigen tests and keeping at school, vs isolation of a control 3000 with shutting schools after cases and contacts are discovered.  It was drawn from a variety of school types.  The amount of actual infection cases and sick days were comparable, but the advantage was that the rest of the kids stayed at school.  Lots of hope there.

We have been daily getting questions regarding boosters to Covid19 vaccines. There are studies underway into which, when, how and how long does it last.  Of course that last question will be open for another year or 2 at least.

It is easy to be confused by quotations of falling antibody levels. The finding that antibodies start to reduce after 6 months with the P vaccine in particular had some rabbits running. But that is not the real measure of immunity.  You can have a drop in numbers of the little “y”s flying around but still have their parent memory cells just sitting and waiting for a lot longer, to still be ready to pounce when the virus arrives.  So your foundation course may well last a bit longer than expected.  Watch this space.  Boosters will probably be next year with a different brand than your original immunisation course, or a new one tweaked for the variants still to emerge.

One major topic that this debate raises however is vaccine equity.  The ethical challenge is how can we rich countries claim boosters from a limited world pool when the vast majority of populations in Africa, Asia, and South America have had only a few per cent access a foundation course.

Whilst they remain unvaccinated then more troublesome variants will emerge, returning to bite us. “No one is safe till we’re all safe”, is still a global mantra.

Now this segues into a recent interesting salutary tale.  A patient helpfully sent me some documents purporting to come from the Florida International University (Miami Florida, USA), and the Global Health Consortium somehow associated.  It gave very stern warnings against vaccination and tried to sound like some international jury was ready to condemn anyone wilfully using Covid Vaccines, to be prosecuted by an authority called the Global Intelligence Agency.

So as always I like to test the information.  The character of the writing seemed similar to a Grade 9 science fiction story, contained patent falsehoods, “sciency” and “legalish”  words that meant nothing.   With a good firewall it was clear that the “documents“ were forged using FIU letterhead and forged signatures.  The GIA is a bizarre group, or something, that appears like a dungeons and dragons cult.

The Florida International University does exist, and is sponsoring major conferences on how to address Vaccine inequity, with a view to sponsoring supply to the poorer nations of Central and south America.

The summing up point? Lots of good people have been made nervous about the “official “ responses to the pandemic, because so much white noise comes from hacked, forged, made up stuff that to an untrained eye might look like it is asking valid questions.

However shouting at each other does not make any point clearer. Speaking like adults and constantly seeking reliable sources helps.  Respecting each other enables exchange of ideas.  Mahatma Ghandhi did not achieve an independent India by throwing bricks at windows.  Indeed the opposite.

With over 1400 Australian Covid19 patients in hospital, nearly 300 in ICUs and nearly 200 of those on ventilators, doctors, nurses, and health administrators don’t need to make this stuff up.  We just need to look to the community to work through how we do live with this new presence in our world.  Small businesses are already making work-arounds.  There will emerge ways of accommodating everyone and getting our kids back to full time school, and protecting the vulnerable, and not offending human rights.

If you have chosen to be vaccinated there is no time to be either smug, complacent, or aggressive to someone who has been frightened off.   But being able to explain your reasons and experience helps.  If you have chosen to wait then please respect the imperative that everyone else feels, and keep asking why we have moved on it, and where is the apocalyptic vaccine created disaster that certain bloggers and cults have predicted, and keep yourself safe from infection.

It might also help to spend some downtime reading 2 of the great socio-political treatises of all time – “Alice in Wonderland” and “Through the Looking Glass” to really appreciate why people keep referring to conspiracy, cult, Q-anon, and the sites that a certain rebel member of parliament links to are called “going down the rabbit hole”.

As always this is just one late night musing from a single perspective.  Please check any medical detail with your own GP who is probably imagining a world, a “brotherhood of man”(and wymyn), where they can get back to seeing you easily, in rooms, without masks and without fights, to relieve suffering and try to diagnose your ills before they become something really bad.

Regarding the above peacenik observations of history, well nothing scientific in all that so do what you want with it.  But politely.

 

Dr Trevor Cheney

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