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

Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellingen Shire,

No new cases in the Mid North Coast Local Health District – ie roughly Port Macquarie to Woolgoolga. We have seen none here from the school Holidays, or the big market at Bellingen.   But oh, so many poor souls in Melbourne, and now growing clusters in Sydney.

So many times holding one’s breath will cause headaches! The lesson is that we need to exhale and recognise that the march of Covid19 is ongoing and to some extent the new normal. So why do we bother trying to hold it back? Because a wild uncontrolled disease plague is not inevitable, but the consequences of one would be devastating for each of us – young and old.

If we are successful in controlling this virus not everyone will get it. Remember that in ‘out of control’ situations around the world there is a 10% chance of dying from this disease – especially where health services are overwhelmed – and this has occurred even in health care staff around the world. One might expect them to be the best prepared and resourced and informed. Doesn’t matter. If you are overwhelmed then you go the way nature lets you go.

There has been a return of some nay-saying in the media against any control strategy. I was aghast to hear last week on Radio National’s breakfast program an interview with the CEO of Flight Centre. He talked sadly and matter of factly about the difficulty for his business. Yep, terrible . But then went on (with absolutely no medical knowledge) about how he thought , from his privileged position in QLD where temporarily there is a very low risk, that the whole reaction was unnecessary, the disease is not serious, and that a soft response would be fine – “worked well for Sweden and The UK”!! People in Florida, USA probably said the same sort of thing 3 months ago, while they were clear and New York was escalating.

Just to keep it real, I find it helpful to look again at the statistics in Sweden. Lovely people , similar population to NSW, probably a more technically advanced culture. They have reported >78 000 cases, and >5600 deaths (still more fatalities than NSW had cases). A rate of 566 people per million dying in the last few months. A rate 100 times worse than Australia. If all of Bellingen Shire caught Covid 19 in a rush we could expect easily 1300 deaths – that’s much more than the population of the aged care facilities. That’s the population of Dorrigo and most of the plateau villages wiped out in a few months. That’s our friends and family. That’s before we deal with the young people with a life time of post viral syndrome, immune dysfunction and scarred lungs.

I’m sorry if this sounds alarmist but we need to stand against Covid fatigue and keep saying to each other that this matters. So get your masks on, your hand sanitiser ready, your systems for incoming goods in place. You have been given 5 months more warning that most of the world.

On the hopeful side there are some studies suggesting better recovery in Covid infected people with good levels of vitamin D. Studies and official statements have been reported in Singapore, Scotland and Ireland. There is still a lot of medical debate around this as the evidence is still only at the level of “Correlational studies”. A correlation study shows that “at the same time x happens, then y happens more often – so maybe x is linked to y or vice versa.” So in Europe and Singapore, people who did well also were found to have higher levels of vitamin D in their blood. There are some plausible immunological reasons why this could be important. But this is far from proof. The sceptics point out it is like the fact that 95% of people who die in a car crash have eaten bread in the 24 hours prior. Does this mean bread eating causes car crashes? Or more crudely, every one who heaves on a night out appears to have carrots in their vomit.

Some doctors say there is no evidence that taking vitamins helps, and it may do harm. But you have to take a hell of lot of vitamin D to cause harm. We encourage almost everyone who has weak bones to take vitamin D @1000 units daily. In the meantime we don’t spend as much time outdoors as our ancestors. Healthy skin exposed to sun can manufacture vitamin D , and you get some from eating eggs and dairy. However Cancer doctors discourage more exposure to sun because they call the sun a known carcinogen! So we need more trials and evidence to be sure about this, but while we are waiing, over the counter vitamin D seems a harmless addition to any diet at this stage.

Why does Medicine always need trials now?   Miracle cures are touted and have been for ever. They still popup and induce gullible souls to hand over fortunes, or at worst, sacrifice the chance of good treatments for fake or misguided ideas. I have a 120year old Canadian medical journal picked up in a junk shop on a trip to Canada. The 1899 Dominons Medical Monthly . It contains ads touting all sorts of guaranteed powders and electrical machines, as well as transfusions of bovine blood! That would be of course fatal! It also has a serious report stating that heroin is an effective cure of cough for all causes , with no risk of side effects!! I am not advocating heroin for anything. At least we do have some filters that challenge such assertions and test to see whether the treatment really does what it claims. And that it won’t harm people as much as it helps. The system is clumsy and expensive and slow, but it’s like a quote about democracy attributed to Winston Churchill that – “Democracy is the worst form of government – except for all the others”.

While we prepare for the arrival of Covid 19 into our region, we must not let our eyes off all the other balls. I was reminded with a start this week that there are >1000 cases of TB in Australia each year. There was an exposure of staff to it in St Vincents hospital reported in the medical news last week.

The cancer doctors are very worried that there has been a drop of 30% in reported cancer diagnoses in Victoria over the last 5 months. This is not because social distancing has stopped transmission of cancer, like it happily has with the influenza. Cancer of almost all kinds (with the known exception of cervical cancer and Burkitt’s Lymphoma) is not transmitted by an organism, but caused by an accumulation of other insults to a body. It means that people are avoiding all health care. So vital diagnoses are being delayed. As I would hope everyone knows – early cancer diagnosis offers great opportunity for cures. Especially with the demon of melanoma now we see >90% cure rates in Australia!

Sadly a late cancer diagnosis is a very harrowing course with often limited successful treatment options.

Please don’t hold back contacting your GP or following up with your specialist any lump, pain, malfunction or investigation process. Your GPs will be more often wearing masks and doing telehealth for now, but have systems in place to keep you (and us!!) as safe as possible.

 

Dr Trevor Cheney

Please remember this is one perspective – please check any details , and your health maintenance, and reminders with your own precious GP.

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