Dear Bellingen Shire
14 September 2020
Doin’ well. NSW doin’ well. Qld Ok but on alert , Victoria at least looking better.
The horrible infection rates in the rest of the world are hard to imagine with rising infections in Spain and Britain rebounding, but poor India now trailing only the USA in rates of infection.
Only 4 cases identified in NSW in the last 24/24, none in our region, and 3 of those new cases are still in returning travellers in quarantine. All the locations where there is a risk of contacting the virus are currently 13 zones in greater Sydney. So if you need to go to Sydney then I suggest you look up the health department website and check if your destination is near those areas.
With a notification in my email on the restart of the bush fire season and “time to get ready” meetings, a reflection has arisen from my recent experience that I mentioned a couple of weeks ago, on the ease with which small catastrophes spread. At the time I thought I was prepared to manage a small burn-off fire, but clearly not prepared enough – especially when the winds change. I think I would like to create a meme. It was a lesson that was a great metaphor for life. I intend to share it with trainee doctors, as the message is universal.
Everyone else has a meme!
So, After the Rural Fire Service heroes helped douse my paddock, what remained smouldering? Poo! The cowpats smouldered on and on, along with some logs.
Therefore the meme for life is that “Just when you think you’ve solved your crisis, (in the office, relationship, patient care etc) never turn your back on the fallen logs and piles of Sh…! “
In a tortuous way this relates to this week’s covid19 monitoring.
Firstly, I suspect it’s partly why the Victorian government is holding fast on their conditions for releasing the tight restrictions. They have already seen what spot fires in infection can do, and they certainly had smouldering lumps that got away. Once again I feel for the people on the decision making frontline, especially as news now that the QLD chief health officer is getting death threats! As if carrying the burden and working 18 hours a day was not enough.
An alternative way of taking this lesson is the observation that smouldering piles can attract your attention. In a more tortuous link to the analogy I want to revisit a couple of ideas mentioned a few weeks ago. This is the repurposing of medicines.
There has been a lot of news about chloroquine (an anti-malaria drug), and recently ivermectin ( an antiparasite drug used extensively by vets). I have urged caution in the public getting excited about news reports of easily available drugs being used to treat Covid19. However on the positive side there is a place and opportunity for our researchers to pursue this line.
I mentioned the dread story of thalidomide a few weeks back in the argument for not rushing development of drugs. When it was invented and used in pregnant women thalidomide caused physical deformities in the foetus, leaving babies, and now adults, missing limbs. And yet the very aspect of this drug that was so devastating, that it stops blood vessel growth to certain tissues, actually makes it now an effective treatment for some cancers.
So this process of revisiting substances discovered for a different purpose will go on, and is perhaps one of our better options. Sometimes it is through serendipity. There is an apocryphal tale that one of the current artificial sweeteners on the market was invented as a treatment for high blood pressure, but the chemist working on it tasted a tiny bit of the powder and found it was very sweet. The company saw a much bigger market!
The key is that repurposing must be done just as slowly and carefully as a new invention. The advantage is that drugs that have been around a long time have a lot already known about how the body absorbs, uses, breaks down and excretes the substance , as well as much of how our organs respond to the presence of that molecule on our bodies. Excretion is very important as we don’t want anything to stay permanently in the body and accumulate – that is what happens with lead and mercury.
Ivermectin in a test tube may inhibit the Covid19 virus, but does it do the same when the virus is in a live person with an immune system gone mad attacking the heart and lungs? Or maybe it works initially at the start of infection, but then the effect is reversed in the famous stage 2 at 8 days when many patients suddenly collapse with severe heart and lung disease. And how do we know that right time to turn it on or off.
There are many drugs that work brilliantly, but kill too many patients! The broad spectrum antibiotic chloromycetin is an example we use everday for eye infections – in this role it is unsurpassed and very safe. But in the past the same chemical has been used intravenously as a powerful antibiotic, but in that form has an unacceptable rate of causing bone marrow failure.
In fact, the same conditions need to be applied to some herbal medicines. I am not against well-researched herbal therapies, but you cannot assume everything “natural” is safe. Stinging tree and Hemlock are natural herbal drugs, as is box jellyfish venom. Our First Nations people had millennia to work that out in the Australian environment, and their learning may yet be elevated.
So, once again we need to be patient, keep hopeful, adjust to the changes, not expect everything to rebound to some past “normal”, take the risk seriously, but keep preparing better.
NSW Health on our email feeds is a little concerned that testing rates fell a bit across the state last week. It is lovely that we are having local tourism picking up. We still need to be alert that someone could inadvertently bring this invisible invader through our little bubble. This is everyone’s responsibility.
The wonderful Dr Olivia Bell has made a short video on how tests are done at a covid19 clinic – hopefully to demystify and make it a little less worrying for kids. Please view on the I Love Bello Website.
Dr Trevor Cheney
Please remember this is one personal perspective and is not meant to give direction on any treatment. Check any questions with your own dedicated GP.