The Agency Model

Even before COVID shone its ugly light on an extremely fragile and broken aged care system I had flagged the “agency model” of staffing in health care a really bad idea.  Yet in many areas from nursing to aged care it is the system of choice.  In order to explore this topic fully, I’ll start by giving you a short history of my experience with the system, the pros and cons and lastly a few other observations before I give you my summation.

 

So, where did I first see the agency model in action?  Well, agencies specialising in health care have been around as long as I can remember and they are important.  They were designed to fill gaps in health care facilities when someone is sick, on holidays or there is an sudden and unexpected gap in the staff roster.  But it raised alarm bells for me when I was admitted to a ward in a Sydney hospital 20 years ago for a kidney stone operation and it seemed that all the ward nurses were employed by an agency, not the hospital.  Interestingly enough, this was not the case in the operating theatres, only on the wards and I’ll explain why I believe this the case later.

 

In terms of pros for the agency model, I have already touched on one and that it makes it easy to keep the roster full in a profession where understaffing is not just problematic, but dangerous.  The second reason is that it is easy.  As any business owner that employs people knows, it is not an easy employing people, there is tax to pay, holiday and sick leave to accrue, superannuation, payroll tax etc…  Outsourcing staffing cuts down on your own administrative needs.

 

Before COVID, I identified two massive reasons why the agency model was a bad idea.  First, patient care.  This should be the most important thing in the running of any health facility.  Sadly it has taken a back seat to administrative streamlining and bureaucratic workload minimisation.  Now I don’t want to make the point that agency nurses are worse than other nurses.  They aren’t.  They are fully qualified and just as competent but they are almost being sent to work with one hand tied behind their back.  Over any given reporting period they can be working at multiple centres at irregular hours.  Being unfamiliar with the individual procedures at a facility and not knowing anyone else or where anything is means they cannot be as competent as other fulltime staff.  This not only decreases patient care standards but can endanger lives.

 

The second point is nurse and carer welfare.  Most nurses and carers would love a full time gig but the truth is when you just start out you have to work with an agency.  This can be daunting if you are fresh to the industry with no experience.  The hospital won’t put any time into training you because you probably won’t be there next week and they expect you to hit the ground running because they paid for a health care professional, not a trainee.  Think about what stress and pressure this puts nurses under and what it does to their mental health.  It’s really quite disgusting for what is probably the most vital, skilled and underpaid profession in our society.

 

However, since COVID another reason has come to light. Infection transmission.  In the age care system, which relies heavily on the agency model, COVID ran through aged care facilities like wildfire because infected workers were working at multiple facilities.  If they had only been working at one, they would have been able to contain the problem far easier if they could limit it to only one or two facilities.  This argument does not stop with COVID either.  Any contagion from flu to staff infections could potentially be spread in this manner.

 

The big question is what do we do about it?  The solution is easy.  The government needs to install a quota for staff in healthcare.  For example, a hospital has to have 90% of its staff as either permanent or fulltime staff.  It also needs to go further than that by saying that any department has to a minimum of 70% full time staff at any time so the 10% agency staff do not simply get dumped into the most undesirable department and shift.  It would also be advisable to disallow any temp from working in more than 3 facilities over a 30 day period.  There would be a lot of backlash against such measure, but the health industry would adapt and patient care would benefit.

 

Until next time,

 

Stay well

Face Masks

Is it a mouth piece?

Is it a chin strap?

No.  It's a face mask!

It's really not that hard to wear a face mask.  I feel that most people that do not follow the instruction do so out of apathy or laziness.  But just in case, here is a really precise 2 minute video by Victorias Chief Health Officer that should clear up any ambiguity.

I know some of you think that being forced to wear a mask is an invasion of civil rights.  There are strong arguments for both sides but if that is how you feel, try and think of it differently.  Don't think of it as wearing a mask because it is required by law but simply as the right thing to do.  A bit like picking up your litter or surrendering your seat on the train for someone elderly.  By wearing a mask you protect yourself, protect others and safeguard the community.

Stay well:)

The Dan Andrews Report Card

Just so you know I’m not going to go easy on him.  Dan Andrews (DA) is a politician with a background in marketing.  He is a master of spin and manipulation so let’s pull back the veil of misdirection and see what he has really done under in.

 

First Lockdown

 

Victoria was the last state to release its lockdown measures and when it did it was the hardest and strictest in the country.  The first lockdown was absolutely necessary but other states with less strict measures managed to deal with the problem just as effectively so was the super strict lockdown really necessary?  The other point I want to make is why were we the last?  For days, Victorians were left in limbo as to what we were going to be able to do and not do.  Is it just me or does it feel like DA simply loves the spotlight and enjoyed the fact that everyone waited for him so he could politically grandstand?

 

Verdict – 3/10

 

Hotel Quarantine

 

What a debacle.  If you live in Victoria and haven’t heard the news you must be in a coma.  What you might not have picked up on is the skill with which DA has masterfully mitigated political damage with well rehearsed rebuttal and spin.  The political manoeuvring he has undertaken would have been enough to save Nixon from the Watergate scandal.  Sure, he set up an inquiry.  But, he kind of had to and it has been his go to answer for all questions regarding hotel quarantine, which is to deflect to the inquiry and avoid giving an answer.  And this inquiry has spent weeks investigating why the system failed.  An answer we already know and giving DA time for the rage to settle and the criticism to dissipate whilst failing to answer the questions that Victoria want answered.  Just for the record, hotel quarantine failed because we had low skilled, low paid and ill-equipped workers with zero chain of accountability being charged with hotel quarantine and the health of Victoria.  The questions needing answered are who’s idea was it to use private security, why it was considered the best alternative and who signed off on it?

 

Verdict 1/10

 

Testing

 

I have blogged about this before.  Click here if you’re interested.  Essentially, when we were in the dawn of the second wave the time for testing blew out to five days.  During the first lockdown we had three months to get our testing procedures as accurate and efficient and exhaustive as possible.  When it came to testing we should have prepared for the worst where community transmission was rife like we have seen in other countries.  We needed to aim for 50 thousand tests a day with a 24 hour turn around.  We couldn’t even manage 10 thousand.

 

Verdict 1/10

 

 

Contact Tracing

 

Just to be clear, this is not a critique of our contact tracing teams that have worked tirelessly and diligently through the pandemic.  This is focused on the DA involvement.  Firstly, with a five day turn around on tests, the contact tracers are on a hiding to nothing as they are starting five days behind.  But, where other states, like NSW, have managed to stay ahead of the curve Victoria has not.  Probably because they are under resourced and DA didn’t accept any federal or interstate help until it was too late.

 

Verdict 2/10

 

Second Lockdown

 

After it was clear that it was impossible to contain the second outbreak and there was too much community transmission to control we had to head back to the only measure that has worked for DA, lockdown.  If you thought the first lockdown was strict, you ain’t seen nothing yet!  No household visits, only groups of two outside of the house, only allowed out for one hour a day, nothing open but the pharmacy and supermarket open, not allowed more than 5 km from home and a curfew of 8pm.  We were threatened with police action and fines for noncompliance.  In some cases, people were virtually imprisoned in their own home.  Victoria was drowning and DA had his foot firmly on our head holding us under water.  The lockdown was necessary, but we, the people of Victoria, were made to feel like criminals.  Like we were the ones at fault when it wasn’t.  We also know that the Victorian chief health officer or the police did not request the curfew.  In fact they both said it was unnecessary.  So why do we have it DA?  The lockdown has worked but at what cost?  The economy is on life support and the community morale is at an all time low.  It could have been handled better. Way better.

 

Verdict 3/10

 

 

Communication

 

DA would have you believe that he has fronted up to the media everyday and answered all questions.  Well, he has rocked up everyday but has he really answered all questions?   You have probably heard him repeatedly say three things.  “I take responsibility”, “It is inappropriate for me answer whilst there is an inquiry going on”, and “I am simply focused on defeating the virus”.  Textbook political answers to deflect difficult questions and leave them unanswered.  

 

The other thing that has really annoyed me is the timing of his press conferences.  He is constantly late and his really big announcements have been constantly vague on the time of his speech.  On the 6^th of September he promised to make an announcement about the easing of restrictions.  He just didn’t tell us what time.  So, we waited all morning for the great and glorious DA to inform us for how much longer he would be suffocating us with restrictions.  You know what, I think he loves it.  I think he enjoys having all of our attention.  I think his only regret is that it is just Victoria waiting for him and not the whole country. 

 

Verdict 2/10

 

The Inquiry

 

Well the inquiry wrapped up yesterday and from Dans point of view it couldn’t have worked out better.  It bought him time for the rage of the people to soften and he wasn’t implicated and his personal inquisition was decidedly soft.  So let’s look at the facts.  The Honourable Jennifer Coate AO was appointed as the chair of the inquiry.  Was this a politically motivated appointment?  I honestly hope not but you can’t be sure.  She seemed to go surprisingly easy on DA and after three months we failed to get an answer to the number one question.  Who decided on Private Security for hotel quarantine?  At the end of the day, DA now has leeway to bury the whole thing, Jenny Mikakos got thrown under the bus and we didn’t learn anything.  What a complete waste of time.  

 

If we study what we know there are simply two alternatives.  Either DA told the truth or he didn’t.  If he did tell the truth and he doesn’t know who greenlighted private security it shows incompetent leadership and he should go.  If he lied he has either protected himself or others close to him that have made decisions that have lead to the deaths of almost 800 Victorians.  If that happened in the private sector someone would be going to jail.  Either way he should go.  This inquiry was a sham and did nothing more than serve the political needs of DA.

 

Verdict 1/10

 

Other stuff

 

During the pandemic we have really only had two big pieces of news worth mentioning.  First, branch stacking in the Victorian labor party.  DA is the head of the VLP and he has had the job for 10 years.  There is no way to deflect the blame, it all comes down to you DA, but I guess you are accountable for nothing.

 

The other piece of news was to silence victims of sexual abuse from speaking out.  Yes, you are the victim and your actions in the aftermath are suppressed.  Fortunately that legislation was removed but it just goes to show the incompetence of the Victorian government.

 

Verdict 1/10

 

Summary

 

Personally, I think DA is a very smart man and I refuse to believe that he didn’t know exactly what was going on.  I think he engaged private security to curry favour with the United Workers Union which was a solid political decision but clearly not in the interests of Victoria or Australia.  He has always played a solid political game and some people actually fall for his spin and think he has done a good job.  Even if he has successfully defeated the second wave, praising him is like rewarding someone for extinguishing a fire that they started or paying half a billion dollars to NOT build a road (Yes, DA really did that too).  As a final word I just want to say, Dan Andrews, you would better serve Victoria if you were on the dole.

 

Total 14/80

 

Civil Rights

 What are civil rights?  According to Britannica.com, civil rights are “guarantees of equal social opportunities and equal protection under the law, regardless of race, religion, or other personal characteristics.”  In a democratic society they include the right to vote, the right to a public education, the right to public facilities and the rule of law.  The rule of law is extremely important as it identifies checks and balances in our political system and means that every citizen governed by the law is equal under it, including government, parliament and the judiciary.

 

Now, how does this relate to COVID 19?  Well, if you live in Victoria and you haven’t noticed, we have been in lockdown in some form or another since March.  Lockdown has essentially been a massive afront to our freedoms and it is important to debate whether our civil rights have been compromised.  Every lockdown measure is a potential infringement so let’s break it down.

 

·      Denial of assembly – Right now, we are not allowed to go to anyone elses house, be in public with more than one other person or congregate in public areas.  The right to assembly is to allow for lawful protest and groups to form strategy to challenge political leadership or influence policy in a lawful manner.  This may sound a little insightful or aggressive but it happens all the time.  The federal opposition is always holding the government to account and it is critical in a free society.  Imagine how scary it would be if the opposition was deemed to be unlawful and scrutiny of the government was an offence?  

 

However, we are fighting a pandemic and the virus loves a large group of people coming together which means a suspension (not a cancellation) of gatherings is a sensible approach but we do need to see an end to it.

 

It is important though to look at this from a compassionate standpoint.  Imagine you are elderly, have a variety of health concerns, live in an aged care facility and are completely cut off from your family.  The restrictions are there to protect you but would you really care.  You would not have many days ahead of you anyway and your quality of life would also be low and to top it all off you would be cut off from your family.  On your list of priorities spending time with the ones you love would probably be the number one and this basic civil right is being denied to you.  I believe it is perfectly reasonable to postpone political and menial social gatherings, but exceptions have to be made on compassionate grounds.  That is where we are really feeling it.

 

·      Border closures and 5km exclusion – As far as the virus goes, this makes a lot of sense.  If someone is positive you know that the have not been able to spread it outside a certain area allowing easier contact tracing and containment.  However, you can’t really call it freedom if you can’t go outside a certain area.  Realistically it is a form of incarceration we afford only to criminals.  It is an infringement of rights but probably necessary. 

 

·      Face Masks – I find this one a little ironic.  People who have demanded people should not be allowed to wear face masks (like a burqa or hijab) are now insisting that we do.  Realistically, you can really only demand that if you have the right to not wear a face mask, you also have the right to wear one.  The issue is should you be forced to wear one.  My view is that if face masks supress the transmission of disease it is a small price to pay.

 

·      Curfew – This one I believe is extremely contentious.  Victorians have had to be back inside their homes by 8.00pm.  This has also meant that everything that is allowed to stay open (which isn’t much) has had to shut at 7.45pm.  Granted, there isn’t much reason for most of us to be out but there is for some.  

 

I know a guy in the public service that has a critically important job.  He is a widower with two kids 16 and 10.  During the day when his kids are normally at school the 16 year old has had to look after the younger one.  Lockdown has meant his support network of family and friends is not available and as a result he has to do everything himself.  Normally he would try to get home from work, help the kids with homework etc, cook dinner maintain the household and when his youngest was in bed he’d do the groceries about 9.00pm.  Now he has to do the groceries on the way home from work meaning there is little to no time for his kids, he is exhausted and has no support.

 

What is most unsettling about this is why we even have a curfew?  It has come to light that it was not recommended by the chief health officer, nor did the police request it.  The premier has been uncompromising and unmoved on this issue and when it comes to the curfew has certainly earned his title of dictator Dan.

 

·      One hour out – Another controversial decision is that Melbournians are only allowed one hour outside every day.  Now this is okay if you have a big house with a garden but what if you live in a unit or apartment.  You can only get one hour of fresh air a day.  You know who else gets one hour of fresh air a day?  US death row inmates.

 

·      Denial of basic services – For the most part, essential services like water, power, garbage collection etc. have been maintained but other nonessential services, such as childcare, libraries and community services have been sadly lacking.  There was also the case where after some nasty weather, certain suburbs of Melbourne were left without fresh water and power for days.  Nothing was done to help the affected people.  At the very least, certain restrictions should have been eased so family members could help those in trouble and people could access safe drinking water and cooked food.  Every effort also should have been made to get the services back.  I cannot believe that in todays Australia while Victoria is in a state of emergency it took four days to fix the problem.  Completely unacceptable.

 

·      The right to health and safety – This is the right that the government dangles in our face to justify the lockdown.  Don’t get me wrong, it is extremely important but could be debated for centuries.  Public health and safety is the reason we have speed limits on our roads or smoking bans in our pubs and restaurants.  At the end of the day everyone has a different opinion and who is right is a question that will never be answered.  It is really easy to sit at home, be bored and complain about the lockdown but the 26 thousand+ people and the families of the 816 who have passed away due to the disease would probably think very differently.

 

The big question is what should we do?  Whether we agree with the lockdown or not, we all need to follow the rules.  We live in a democratic society and any adult has the right to run for office and be involved with the decision making.  We also voted for the decision makers so you have to respect their decisions and if you don’t like it, vote them out at the next election.  It is critical that everyone is compliant because the worst thing we could possibly do is whatever we want.  If everyone did whatever they wanted we would have a massive infection rate, deaths in the thousands and a health care system that would have been pushed past the breaking point and given that the Victorian government has displayed a huge lack of preparedness that would probably be much closer than you think.

 

I think there is one more thing Dan Andrews could do now.  After all, he has claimed responsibility and he is the one that has instituted all the rules that have attacked the very fabric of our freedom and given himself massive powers to do what is necessary by implementing a state of emergency for at least nine months.  His nickname “Dictator Dan” is justified and right now we don’t know when his reign is going to end.  He needs to confirm that once the crisis is over he will resign as premiere.  He has stated that he will not contest the next election, but that is over two years away.  If he resigns immediately after the crisis abates it will confirm that his motives are purely to see out the pandemic and not rule over Victoria with an iron fist.

 

It’s up to you Dictator Dan.

 

Stay well

Vaccine (Part 3)

The fact is that no matter what happens a workable vaccine is not going to eradicate COVID from the world it will merely be another weapon in the battle against the disease.  What is more important is we don’t become complacent about the disease.  As individuals it will still be extremely important to wear a mask, social distance and maintain proper hygiene.

 

Our leaders will also have a big part to play.  Not only will they need to get society moving again it is still really important to that they keep working on other methods to control the disease.  They need to make sure that international travellers are not spreading the virus into or out of the country, public areas are cleaned and maintained to a COVID safe level, all public servants (especially health and aged care workers) are afforded every opportunity to work in the safest possible environment, testing and contact tracing is maintained to the highest standards and other medical research opportunities are explored.

 

I’ll even give you a couple of research avenues that should be explored.  First, a treatment that is given to people suffering from COVID to ease their symptoms which would also hopefully decrease the mortality rate.  There is anecdotal evidence to show that inhaled corticosteroids reduce the severity of symptoms of COVID-19. These drugs are widely available for treatment of a wide variety of diseases including emphysema and asthma.  This is being explored overseas:

 

https://www.cebm.net/covid-19/inhaled-corticosteroids-a-rapid-review-of-the-evidence-for-treatment-or-prevention-of-covid-19/

 

We need to explore it here in Australia.  I just want to add that so far the evidence is anecdotal based on observations of people who should be badly effected by COVID skirting through the disease relatively unscathed and the most obvious reason is corticosteroids.  It does not prove the correlation and proper studies need to be conducted in order to find out if it is ae effective treatment or not.

 

The second piece of research is something I have touched on before and that is the development of a one hour COVID-19 test and guess what, this is something that we can rush as there is no safety concerns as the test requires nothing more than spitting in a cup and the research is being developed right here in Australia at the Hunter Medical Research Institute.  Can you imagine how much more effective our contact tracers would be if we could actively start contact tracing in positive cases after an hour as opposed to the 5 days some people have had to wait?

 

Don’t get me wrong, a vaccine will be a powerful tool in the arsenal of weapons against COVID but it is just one battle that will be won in a long and protracted war.  It is extremely unlikely that a vaccine will eliminate the disease from a country or region completely, let alone have global eradication.  Even with highly effective vaccines, eradication of any disease has been extremely difficult.  In fact, in human diseases we have only managed it once.  Smallpox, and it took almost 200 years from the development of the first vaccine in 1796.  Polio is also on the chopping block but a yearly low of 22 wild cases in 2017 to an increase of 125 cases in 2019 shows that the disease is infuriatingly stubborn.  We can expect nothing less from COVID-19.

 

Until next time,

 

Stay well :) 

Vaccines (Part 2)

 In my last post I went through the clinical trial process and why it is a stretch for are pollies to be promising to answer all our prayers, defeat the virus and return our lives to normality with a vaccine.  Here I will expand on that.

 

As they get closer and closer to the releasing a vaccine, you’ll hear two words more and more.  They are safety and efficacy.  The problem is that those words are not absolutes.  In regards to safety, there is not a medical treatment that is 100% safe. Even putting on a band aid could have risk (you might be allergic to the adhesive).  Essentially, it comes down risk versus benefit and both these change depending on the ailment being treated.  For example, if you’re treating cancer, you would be prepared to endure a much higher risk treatment than if you had a cold.  With a vaccine, you are treating a disease that the patient does not have.  Therefore you could argue that there is no benefit to the patient so the risk has to be zero.  But there is a benefit in preventing the disease if the patient is exposed and the public benefit of herd immunity is massive.  Essentially, it is complicated.

 

The way that our society sees it is that vaccines do need to have very low risk and with a very short development and clinical trial length can that safety be guaranteed?  The answer is both yes and no.  We can comfortably prove short term safety, but can we guarantee long term safety.  For example, the Dengue fever vaccination, where even after exhaustive trials and signing off from the WHO, it was found that vaccinated people were suffering from severe bouts of the disease.  Essentially, they had vaccine enhanced disease.  You can read more about it here:

 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32525-5/fulltext

 

It is also important to note that even with the cases of vaccine enhanced disease, the benefits to the community as a whole were extremely high as there was a marked decrease in deaths and hospitalisations.  The other thing we have to be very concerned about is the fact that the Oxford vaccine is a live vaccine meaning that vaccine is actually a living virus.  Now, we don’t need to stress too much, live vaccines have been used for ages.  The first vaccines were live viruses including the smallpox vaccine which used the cowpox virus to give you immunity.

 

In any case, live vaccines need to be carefully monitored and scrutinised during the trial process as there is a small chance that the vaccine could cause disease.  Live vaccines also provide an extra hurdle as people who are immunocompromised are advised against having live vaccines.  This includes people with certain diseases (such as HIV), cancer patients, bone marrow transplant recipients, people who take steroids or other immune suppression or modulating drugs and the elderly.  That’s a real problem as the people most vulnerable and liable to suffer from serious complications or death from COVID cannot be vaccinated.  Yes, they will have to rely on herd immunity and realistically that all relies on at least 90% of the country being vaccinated.  Approximately 22 million doses to everyone, including people that don’t want to get vaccinated.  See the problem?

 

And then there’s efficacy.  Some vaccines can be amazing.  The smallpox vaccine offered life long immunity and was the main reason that smallpox was eradicated from the planet.  However, other vaccines can only be partially effective or have a limited lifespan like the flu virus that only lasts six months.  We simply don’t know how effective this vaccine is going to be.  Even if the phase 3 trials prove efficacy, we will only know that it remains effective for a maximum of six months because that is how long the trial will have been active for.

In my next post, I'll wrap up my thoughts on vaccinations

Until next time,

Stay well:)

 

Vaccines (Part 1)

Halleluiah.  Praise Dan Andrews.  Praise Scott Morrison.  Praise Oxford University and the University of Queensland because we are going to have a COVID-19 vaccine by the end of the year and everyone is going to be able to get their lives back to normal.  In case you hadn’t noticed, I was being sarcastic.

 

The rosy, triumphant spin that the politicians give you is a big old pile of bull****.  The chances of it all working the way they want it to is a million to one.  Stay with me and I’ll tell you why.

 

The first reason is because it is bloody difficult.  Not running a marathon difficult but accomplishing something that has never been done before difficult.  Think Hillary or Armstrong not your Sunday afternoon fun runner.  Let’s face it, corona viruses have been around as long as humans.  Afterall, the common cold is a corona virus and we haven’t found a vaccine for that but the fact that a cold is not much more than an annoyance means that the desire has not outweighed the necessity.  SARS and MERS are also corona viruses and we started trying to develop a vaccine for them but luckily, the problems seemed to peter out by themselves.  Unfortunately, when they did, so did the necessity for a vaccine.  

 

When it comes to COVID-19, even with an abundance of necessity the task is monumental.  I don’t think that our politicians realise that there is an extremely high chance that the first few attempts won’t work.  It’s really important that we don’t look at these as failures though.  Every attempt is a learning experience and one step further to the result we so desperately need.  I have no doubt there will eventually be a safe effective vaccine, just don’t expect it straight away.

 

Part of developing a vaccine is the trial process.  With any drug or treatment there are a number of phases that needed to be completed in order for a new treatment to be approved.  First is the pre-clinical work.  This normally involves having a hypothesis.  This hypothesis needs to be tested which normally happens by benchtop research or during animal models.  I’ll use the example of a trial I know quite well, HSCT for Multiple Sclerosis, very similar to my HSCT that was for CIDP.  They started with animal models and guess what.  The first experiments failed.  This was due to the selection criteria and once this was resolved, the experiment succeeded. 

 

After this we can move to phase one, which is where we test a small number of people (Anywhere from 5 to 80) normally one at a time to gage safety.  Phase two is a larger cohort and starts to look at the efficacy of the treatment.  If both these trials are successful then a phase three trial would be conducted scrutinising both safety and efficacy.  If that is successful, we have a new treatment that can be marketed to the people.  In the case of HSCT for MS, this process took 20 years.

 

What worries me is that a process that normally takes years is now taking months and that means cutting corners.  When I was a participant it the phase two trial of HSCT for CIDP I had follow up studies every year for five years.  There is simply no way to test the safety and efficacy of a treatment over time, other than to test it over time.  I understand that it is possible to speed up the clinical trial process by increasing sample size, increasing staff to help with lab work and processing results but all the money and resources in the world cannot speed up time.  We’ll effectively be finishing these trials on approved vaccines and if we find any nasty surprises we’ll be in real trouble.

 

Assuming we do tick all the boxes, we then have to worry about mass producing the thing.  If we want to get any vaccine to everyone in the world, we need to make at least 7.5 billion doses.  We can’t even get fresh drinking water to that many people.  In Australia we will need at least 25 million doses and don’t think that we can administer this easily.  We still don’t even have antibiotics available to every Australian community.

 

We also have to acknowledge that we’re not just baking bread.  Developing a vaccine is difficult and upscaling manufacturing to meet demand is even harder, then there are logistical and distribution issues to consider.

 

Next time I’ll be talking about other issues of vaccines.

 

Until then,

 

Stay well 

The Judd Effect

The Judd Effect!  What is the Judd Effect?  Well, honestly I just made it up, but it is a really important problem that we need to address.  Just to inform you Rebecca Judd is an Australian model who is married to arguably one of the greatest AFL stars in the history of the game.  Recently, Rebecca Judd got a whole heap of flack.

 

In a since-deleted video, the radio host, took a swipe at Premier Daniel Andrews while plugging a product for her children from the comfort of her $7.3 million home.  If you want to read about it go here:-  

 

https://www.news.com.au/entertainment/celebrity-life/rebecca-judd-slammed-for-tone-deaf-dictator-dan-instagram-comment/news-story/6be27db42f3e89b0aebae7e563fa370d

 

What she has done is complained about the lockdown and people have whinged about her status and her lifestyle because “she has it easy”.  

 

I want to explore whether the criticism of Rebecca Judd is fair?  To start I want to start you off with a story of my own.  If you read my blog you will know I have had a variety of medical issues.  2006 was my low point but also the time I started turning it around.  One of the reasons I started turning it around was because I stared seeing a psychologist for depression.  I almost felt guilty when I explained my medical conditions and one of the reasons for this was because on at least three occasions when I had complained about my condition to friends, people had told me “Stop whinging!  Think about all the people worse off than you”. 

 

They were trying to help but they weren’t.  I felt guilty and it compounded my depression because I was bottling it up and I wasn’t talking about it.  But the psychologist told me I was perfectly valid to feel upset about my medical conditions and other people didn’t matter when it came to how I felt for me, when it came to me.

 

This was the biggest turning point for me in everything.  I had received validation for my own personal feeling.  It wasn’t fair and I finally felt justified in saying that.  Sure, there were people worse off than me but my feeling was valid, and I had every right to say so.  Once that happened, I started asking a different question.  What am I going to do about it?

 

You know what, like Rebecca Judd, I’m lucky that I do have a privileged background but I would have traded it all to be able to run.  Be able to walk without a stick for ten years.  Be the one to teach my kids how to ride a bike.

 

The question is, is what Rebecca Judd said so bad?  Every Victorian is hurting right now, and yes, some have it worse than others.  But is only the hardest hit and most effected Victorian allowed to complain.  Absolutely not!  You are all well within your right to say “This sucks.  I am bitter and resentful and that Dan Andrews is an @#$%* and a dictator and I am suffering because of it.”  If you haven’t done it, try it.  It is quite therapeutic.

 

Everyone is feeling it at the moment.  Black or white, rich or poor, male or female, gay or straight.  Sure, some are worse off than others but in that respect we are all in this together.  And give Rebecca Judd some credit.  She is playing by the rules and it is essential that everyone does or we will be in this forever.  As a last note, please don’t take this as a message to go easy on Dan Andrews.  What he has done right is superficial, what he has done wrong requires accountability.  Rebecca Judd deserves some credit for calling him out.

 

Until next time,

 

Stay well 

Opportunity Cost

Opportunity cost.  For those of you who have never studied economics you’re probably wondering what is opportunity cost?  And no, it is not some shopping styled reality game show.  Wikipedia defines it as “when an option is chosen from alternatives, the opportunity cost is the "cost" incurred by not enjoying the benefit associated with the best alternative choice.”  In terms of COVID 19, we have to ask what is the cost of this hard lockdown?

 It is a very hard question to answer as trying to predict what would have happened given different choices is like trying to predict the future, and the opportunity cost is far more than just an economic one.  I will list a few of the costs but this list is by no means exhaustive and if you feel like I missed something important, let me know in the comments.

The first cost is mental health.  Australia, and in particular Victoria, has had a massive cost of lockdown.  According to a report released by University of Sydney’s Brain and Mind Centre Australia will have a minimum increase in suicide rate of 13.7% for the next five years. But the problem will go far further than that.  We will also see a marked increase of the amount of people who will need to be treated for depression, anxiety and other mental health disorders and still it goes further.

 

People don’t talk much at the moment and not just because of the restrictions, there is nothing to talk about.  Everybody is bored and miserable and there is nothing to look forward to.  This will lead to in household conflict, family disfunction and domestic violence and the damage could take a generation to fix.

 

Secondly is simply just health.  Elective surgeries have been postponed indefinitely.  This may sound okay, but those elective surgeries aren’t going away and it’s not like the list of people needing surgery is simply going to stagnate.  It’s going to get bigger and people are simply going to have to wait longer and the wait isn’t like waiting for uber eats.  Many of these people will be in pain or discomfort, having to take medications just to get through the day.  It goes further than that too.  The longer people wait, the more chance a minor surgery will turn into a major surgery. 

 

People are also delaying seeing the doctor for minor ailments as well which could lead to big problems later.  For example, I recently went to the dermatologist because I had a mole I was concerned about (don’t worry, it was nothing) but whilst I was talking to the doctor I asked if she was busy at the moment.  The answer was no, not at all.  In fact, appointments were down about 30% with people waiting for lockdown to finish.  I found this concerning.  A mole can go for something easily treatable by a small procedure to something that will kill you in weeks, comfortably less than the lockdown period.  I also heard that some important hospital wards, including bone marrow transplant wards, were either closed down or working on diminished capacity.

 

Third is the sacrifices of life.  Right now, forget going on holiday if you live in Victoria.  You can’t even go out to the movies, for dinner or even see friends.  Personally, I haven’t seen my mother in eight months and that hurts.  Even the most introverted and cautious of us have a need for human interaction and an element of curiosity.  As humans it is built into our DNA and to deny it is retard our development and our progression through life.  

 

Forth, the economy.  For the first time in almost 30 years, Australia is in a recession.  Not just any recession, this recession is set to be one of the biggest in history and there is no way to sugar coat it.  It is going to hurt and that’s a fact, but how much is the question.  The longer we are in lockdown, the bigger the problem is going to be so there is a massive opportunity cost of lockdown.  The issue is we know what the cost of the virus is.  There is a very real cost in terms of sickness and death.  The economic cost is much harder to quantify.  The harder our economy is hit, the harder it will be to respond to other issues that may arise in the future.  We do not know what these issues will be but I can guarantee you, we will have them.  For example, it may impact our ability to respond to future bushfire crises or upscale aged care facilities to allow Australians a higher quality of living during their twilight years.  These issues will also cost lives but the number is impossible to quantify.

 

The economic opportunity cost also highlights by the massive disconnect in our political system.  Right now we have six state and two territory governments calling the shots and a federal government paying for it.  See the problem?  State governments are all about defeating the virus, consequences be damned.  On the other side we have a federal government worried about how the hell are we going to pay for it and how we are going to emerge from the backside of this pandemic.  No matter what, it is going to take us years to pay it back and no matter what the states do now I guarantee you it is not going to stop the states crying poor and ask the federal government for money in the future.  There is an easy answer to this.  100% responsibility and accountability lying with the federal government.  It is logical, pragmatic and cost effective.  Most importantly it is democratic.  Everyone in Australia has voted for the federal government, yet a state like Queensland is making decisions that effect the rest of Australia, yet the rest of Australia didn’t get a say in the Queensland government.  Annastacia Palaszczuk, your arrogant, politically narcissistic and self-absorbed behaviour would better serve Australia if you were on the dole.  Keeping your borders closed is crippling Australia for your own political gain.

 

Lastly, I believe that the lockdown is sacrificing our values.  It is unaustralian to lock ourselves away and not help.  States like Queensland have simply closed their borders as if to say “Bugger off the rest of you, we’re okay and the rest of you can suffer.  Oh and whilst we’re at it we’ll steel your grand final and pretend we’re doing you a favour.”  Annastacia Palaszczuk, you might say you’re here to help and you’ll do what you can and you feel for Victoria but we’re not buying your political rhetoric.  

 

On a micro scale we have also been forced to sacrifice our values.  Last week Victoria was hit with gale force winds. Many suburbs were left without power and water for days, including my in-laws.  My in-laws are also old school so they do not have internet or a mobile phone.  They were isolated and we could not go and check on them because they were outside of our 5km exclusion zone.  We had a choice, do what is right and go and help or obey the rules and let them fend for themselves all alone.  The problem was sorted out eventually and I’m not going to tell you how.  

 

I’ll also give you a macro example.  California is currently experiencing bush fires and they have asked Australia for help.  All the states have been very limited in their response citing COVID19 as the reason.  Victoria is not sending anyone.  Sure, there is an added danger and complication but is that a reason to sacrifice our values?  Are we going to turn our back on helping just because we’re scared of COVID?  The firemen we would send would be fit and healthy individuals who would be at a minimal risk of COVID and each of them would know the risks and have the right to say no.  But, I guarantee you that they wouldn’t because unlike government that can turn there back on Australian values, individual Australians wouldn’t, it’s simply not in our nature.  Sending people to California would also have no impact on our own COVID response and people that went would simply need to quarantine when they got home.  To compromise our values is akin to selling our soul to the devil.

 

Until next time,

 

Stay well

Border Issues

Let me start by saying this.  In terms of pandemic management, geographical segmentation is a really smart idea.  Preventing people from moving from area to area is a really smart idea in controlling the spread.  This means that any outbreaks are contained to a specific area and therefore are much easier to control and also keep people outside the area safe.

Australia has done this but we have not done it well.  Our primary form of geographical segmentation is the states.  In this post I’ll go on to explain why this is a bad idea and potentially even dangerous but first, to give some context, a little history lesson.  Why did the states set up the way they did?  

Originally, there was one colony, Sydney, and this had jurisdiction over all of Australia which back then was known as New South Wales.  Over time, new colonies were set up and given the distance between them and the fact that even any meaningful communication between all of them could take days, each colony was given it’s own jurisdiction.  Way back in the 1800’s it was essentially a huge land grab by each colony to control as much land as possible and long and the short of it was the state boundaries were born with each area being responsible for its own governance.  In all the research I have done for this I not once found anything that has said that the state borders need to be set up with pandemic management in mind.  As a result, it is a really bad idea.

First, the states are too big.  I’ll use Victoria for the example.  At the start of the second wave, all of Victoria were under the same restriction and the only closed borders were on the borders of Victoria.  Melbourne had the outbreak. The fact that Melbournians were aloud to travel to rural Victoria spread the virus around the whole state.  If the border had been placed around Melbourne from the start, rural Victoria would have been able to safely go about their business with only minimal restrictions and those close to state borders would have been able to travel to other states too.  This would have also allowed us to keep more of the Australian economy open and keep our communication links unincumbered which at this moment would be critical.

Secondly, the borders where they lie have caused an absolute nightmare for many border towns.  Essentially, communities such as Albury-Wodonga or Tweed Heads-Coolangatta have been split down the middle cutting people off from family, friends and essential services.  These towns sprung into existence on the border because there was a strategic economic advantage to do so but, they have evolved into single communities.  Dividing them like we have makes about as much sense as drawing a boundary down the middle of other country towns like Ballarat or Dubbo.  The only reason we accept it is because they lie on state borders but the virus doesn’t give a hoot about state borders so neither can we.

Lastly, also in regards to border towns, there are two reasons that the borders are actually unsafe.  First, in order for the border towns to be able to function correctly all they allow local traffic.  This means that the virus would be allowed to gradually spread up to the border town, the local traffic takes it across and away it goes.  Secondly having the borders right through the middle of these towns means there are far more roads to police and far more traffic to monitor.  So much so, that the border towns do not have the manpower to manage the border crossings on their own so they have to bring in police from other areas.  The busy border then becomes much more than a barrier to the virus, it becomes a genuine potential hazard point and the police bought in from other areas of Australia could be infected and inadvertently end up taking the virus back to their home towns.

There is an answer to this.  What we need is a federal response to this crisis, not a state by state response.  If this was the case we could make boundaries where they would be most effective for managing the pandemic.  After all, the virus does not care about our borders, the only thing it cares about is spreading and existing.  It is not discriminatory and it is not sentimental which means we can’t be either.

Until next time,

Stay well :)

   

We're all in this Together!

 We’re all in this together!  We’re all in this together.  We’re all in this together?  Are we?  Being from Victoria I have two ways of thinking about this.  First, if I listen to my friends and family both in Victoria and interstate.  Everyone has been extremely understanding, compassionate and sympathetic and from that point of view I really feel that we are in this together.  This was compounded by a wonderful 30 second filler piece I saw on ABC news that played a string of messages from people all over the country giving beautiful words of encouragement and support.  In this respect, I absolutely feel like we are all in this together.  It gives me energy in this second lockdown.  I feel empowered like I am doing this for the good of the country and the safety of everyone.

Unfortunately, I start to feel very differently when I continue to watch ABC news.  Now don’t get me wrong.  I don’t blame ABC news.  I believe they are the most rational and unbiased news network in the country, but in bringing us the news they also televise all politicians press conferences, press releases, behaviors etc…  And this is where it all breaks down.  Many of the politicians (not all) have made us feel extremely isolated and alone.  Especially being Victorian, I and many of my friends and family feel extremely disconnected from the rest of Australia.

 

Let me start right at the top.  Our Prime Minister Scott Morrison who has said countless times that we are all in this together.  And he said it at the start of Victoria’s second lockdown, moments before he went home, picked up his family and went on to enjoy a couple of nice cold beers at the footy.  As we are all in this together I know exactly how he felt as I went home picked up my family and went off to the MCG.  Accept for the fact that we didn’t go to the MCG, we didn’t watch the football and we didn’t enjoy a couple of beers because we were in lockdown.  Now I don’t begrudge my fellow Australians going to the footy when I can’t because management of the pandemic needs to concentrate on the hotspots.  Some people have said they don’t begrudge the PM having a bit of time out to watch the footy as he has an extremely difficult job at the moment.  I disagree though.  It is a difficult job for a variety of reasons.  One of the main reasons is to represent the Australian people which includes enjoying the good times but also empathising with the bad times which sometimes means sacrifice.  Sacrificing your trip to the footy so you can stand side by side with Victorians in their time of suffering.  But I guess you have set a precedent here by sodding off on a Fijian holiday during the bushfire crisis.

 

Well, it wouldn’t be COVID blog focusing on Australia if I didn’t mention supreme Victorian leader, Dan Andrews.  Again, a leader that has used the line “we are all in this together” in abundance.  In his defence though, at least he hasn’t been to the footy and from an advertising standpoint the Victorian government has a great slogan “staying apart keeps us together”.  He has also fronted up to the media everyday which can’t always be easy, or is it easy for him?  It could be argued that he actually likes the attention and the power that comes from having Victoria in a state of emergency.  I personally don’t think this is the case but his rhetoric has felt dictatorial.  Especially at the start of lockdown the premier kept telling us that we needed to understand how serious the pandemic was.  Well, I’d like to ask him if he knew how serious the pandemic was when he trusted hotel quarantine to private security or when cracks in our contact tracing and COVID testing became apparent?  Instead we were forced into Victoria’s one and only weapon against COVID, lockdown. And as he did it we were made to feel like it was our fault, that we were to blame and we were the all the ones who had let Victoria down and were the shame of Australia.  He also made us very much aware of all the restriction we would face, that they would be enforced by the police and what the punishment would be.  Newsflash people, it was not our fault.  It was the fault of the Victorian government and even though he has taken responsibility he has not accepted the blame or apologised for it.  As a result, the messages from the premier have been mixed which makes us feel alone and that does not make us feel together.

 

Finally, I’m going to focus on the other state premiers and chief ministers with particular attention on my least favourite politician in the world right now, (and that’s a pretty low bar) Annastacia Palaszczuk.  Not only is her name insufferably difficult to spell her demeanour has been smug and arrogant and I for one feel like she thinks she is better than the rest of Australia.  She constantly says she has to put Queenslanders first and when you say that you divide the country.  In this case Queensland is above the rest of the country with Victoria being left right down the bottom nestle uncomfortably beneath fifty feet of your political garbage.  With lines like “Victoria, don’t come here” you’ve made us feel like we come from a diseased, rancid leper colony that deserves the contempt and disdain of the rest of Australia.

I and many other Victorians also take umbrage to your request to host the AFL grand final because Queensland as you put it has done most of the “heavy lifting”.  You might call it “heavy lifting”, I call it cashing in on Melbourne’s misfortune.  The AFL relocation has been a massive boon for your economy with many teams having to pay to house and maintain their players, staff and family in your state as well as the economic benefits of hosting the games.  Could you please use this topic to show a little respect and humility as hosting the AFL is not a burden but a privilege and an economic cash cow in this time of COVID recession.

 

I have to say that although I have singled out Annastacia Palaszczuk she is not the only one as no premier has an argument for total vindication.  However, one of the failing is not just in our political leaders but in our system.  How can we possibly all feel like we are all in this together when we have six state and two territory governments, as well as the federal government, splitting up jurisdictions based on region and responsibility.  We are 25 million people with 9 different governments.  If we were controlled by just one government, regional lockdown would be far easier to deal with and I believe our response would have been far more effective.

 

Until next time,

 

Stay well