How to decide on whether or not to Vaccinate

 When I started writing my blog it was mainly to document my journey through medicine from a patient’s perspective.  As it developed it became somewhat of a commentary on medicine from my perspective, trying to keep it sensible, intelligent and thought provoking.  Never did I think it would have to become political, yet thanks to COVID19, medicine and politics have never been more intertwined.

 

Sadly, the reason that it is a political is because our decision makers have decided to play politics rather than make decisions in the best interest of their country.  But today, I’m going to talk about vaccines.

 

To start I want to just clear up exactly what my personal opinion is on vaccines is:-

 

1.     I am pro-vaccine.

2.     I am pro COVID19 vaccine.

3.     I am anti mandatory vaccination.

 

So what am I trying to achieve in this blog?  Even though I believe everyone that can be vaccinated should be vaccinated I don’t want to try and convince you of that.  What I want to do is try to get you to think critically about the information in front of you and available to you and then make an informed opinion.  So I won’t be giving you a link to check out or asking you to read a certain article.  If you truly want to be informed you have to find the information yourself, not simply what someone gives you.  It is also perfectly okay not to inform yourself.  Just know that your opinion is uninformed and you should just keep it to yourself.

 

What should you do to inform yourself?  First, it is important to find the primary data sources.  If you are listening to someone that said they read on the internet that…..  You are at least three degrees separated from the original data.  First degree, the journalist interpreting the data (which you’re not sure whether it is the primary research or not), second, your mate reading the article and third, your friend telling you.  Three points where the information could be distorted or manipulated.

 

When it comes to the vaccine the primary data is what the biotech companies publish, so make sure that what you read is also in a reputable journal and it has been peer reviewed.  Unfortunately, there is always going to be an element of trust that the company has conducted their research ethically and truthfully but that is why it is important to make sure that the data is extensively peer reviewed.

 

When you review the data, the hardest thing is to divorce yourself from any preconceived opinions you might have had.  You need to try and be as rational and impartial as possible and once you start developing an opinion you need to thoroughly scrutinise it because nobody can objectively and forcefully argue that they are right until they have seriously considered that they might be wrong.

 

Once that process is finished, you may wish to discuss this with family and friends and provided you can do so in an amicable and cordial manner with people that may disagree with you.  If you cannot find anyone to discuss this with you can always go and see your GP.  They are more than willing to discuss this with you in a safe and rational environment.

 

Lastly it is okay to change your mind.  Information is changing and being updated all the time and this is normal.  As time goes by, more data is added, and this changes what we know.  As this natural process happens we have to adapt with our knowledge.  If our firm belief based on what we knew is no longer viable given the introduction of new evidence we have to change our mind.  This is not a sign of weakness or failure.  This is actually a sign of strength.  To admit you were wrong and be able to move past it is a sign of great intelligence.  And this is why we have to keep scrutinising our beliefs no matter how intrenched and firm our beliefs are.  

 

Next time I’ll be a little more opinionated and take you through my thought process when it came to the COVID19 vaccinations.  

 

Until then, 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 :) 

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

Hope for the Best, Prepare for the Best?

In my last post, I gave Daniel Andrews and the Victorian government a scathing rebuke of their handling of hotel quarantine.  Honestly, it was justified but I could have forgiven them for that if that was where the mistakes ended.  I mean, the NSW government led by Premier Gladys Berejiklian, severely bungled the Ruby Princess cruise ship outbreak but since then I believe their response to the pandemic has been the best in the country as they have managed small outbreaks effectively whilst keeping the economy open.  In stark contrast, the Victorian government kept making mistakes which only exacerbated the problem.

In this post I will outline what I believe is the biggest mistake made so far and relates to the heading, “Hope for the Best, Prepare for the Best?”  I know, everyone knows the saying is hope for the best but prepare for the worst but that is not what we did.  Before we went into the first lockdown Australia got lucky.  We knew what was going on in China but we were not sure how it was going to go spreading to other countries.  Australia could have easily got stung by this as we have direct flights to and from China and if we had been the first country to get badly hit we would be facing huge repercussions.  But, the virus chose Italy and Spain and we had the benefit of going into our first lockdown whilst the problem was relatively small.

And from there we enjoyed what seemed like the governments one and only weapon against COVID 19.  Lockdown.  For the best part of 3 months we stayed home, binged on Netflix and got fat whilst COVID cases diminished and we awaited freedom.  Doing what the Victorian government had instructed.  Little did we know, the Victorian government was leading by example and also doing nothing.

The government had three months to prepare for the worst and I actually got to experience first hand how badly they had failed.  Back in May, I personally knew two people who had been tested for COVID19.  Both results came back negative, within 24 hours.  Fast forward a month and Victoria is suddenly faced with the second wave.  Testing is ramped up and the government is congratulating itself on how many tests are getting done.  There is just one problem.  It took far longer than 24 hours to get the results back.

Now, how did I manage to experience this first hand?  Well, back in June one of my sons teachers had been tested for COVID19 and that test had come back positive.  My son was a close contact.  I do not know when the teacher was tested so I do not know how long he had to wait for his results.  What I do know is that my sons contact with the teacher happened on a Thursday.  We understand the school was informed on a Monday.  The school informed us via email that night but we didn’t read the email until Tuesday and we were not informed by the authorities until Wednesday.  If the school had not informed us we could have been letting my son interact with society for six whole days whilst being infected.  48 of these hours were since the teacher was confirmed positive.

Anyway, my son seemed remarkably nonplussed which was good but I was frantic.  What if he was positive?  What if he’s infected others? What if the rest of the family get it?  What if… What if… What if…  I had hundreds of questions and I had to wait over a day to get answers.  I also started trying to contact trace my sons whereabouts.  In the four days he had before notification, he had hung out with friends both in and out of school.  He had seen his grandparents and aunt and uncle.  I had taken him to have his hair cut and taken him for a hot chocolate and we also went to the supermarket.  If you think about it, that is only just more than one thing a day and if I remove his school friends from the equation that could be as many as 30 close contacts.  Anyway, I cannot say how long the gears were turning before our notification but I do know that the official contact tracing took two days.  This is way to long.  It needed to be the same day but this is not where the story ends.  

As soon as we find out that was son was a close contact we took him to get tested.  That happened on the Tuesday.  As he was a close contact we were told his result would be prioritised.  We got his “priority” results five days later.  Five days of worry.  Five days of concern.  Five days his close contacts could be running around the state unknowingly spreading the virus.  Luckily, the test came back negative.

One month later, I developed a sore throat.  Normally I’d think nothing of it but given the pandemic and the instructions from the authorities I went and got tested.  When I got there they simply told me that the results would take five days.  In five days my result came back negative.

My question is during the first lockdown we had three months to prepare.  Three months to streamline contact tracing protocols.  Three months to ramp up testing so why do our capabilities seem almost exactly the same on day one of the pandemic as they do now? In the absence of a vaccine or any effective medical treatment quick, accurate testing and fast, effective contact tracing should be our first weapon against the virus.  Instead it seems to be a strict lockdown that attacks our economy, our freedom and our civil rights that is our only effective measure against COVID19 in Victoria.

You might say though that staying ahead of the contact tracing is too difficult.  I’ll grant you, it is hard.  Even with 24 hour turnaround on testing contact tracers seem to always be chasing their tail but it is possible.  NSW have been effectively managing a small number of cases for weeks without letting it get out of control.  If the most populous state with the largest city can do it then why can’t Victoria?

Until next time, stay well :)

Ps.  Why does testing even need to be 24 hours?  Why can’t we get a test done in an hour or less?  How much easier would that make it for contact tracers?  As it happens, the Hunter Medical Research Institute are close to just that so why aren’t governments supporting it?  I will talk about this more when I give you my thought on the COVID19 vaccine.

COVID19

 Hello fellow readers.  It has been years since my last blog and so I feel I owe you an apology but life gets in the way, priorities change and I felt that my material was getting a little stale.  But, good news, with weeks upon weeks in lockdown and a COVID pandemic I have lots of new material.  This will have a mainly Australian focus with particular attention on Victoria as this is where I live and happens to be the epicentre of the Australian problem.

Currently, I have a series of posts, or chapters, in the works that will take us through all the issues associated with COVID19 and to do this I’ll start back at the point when Victoria entered “the second wave”.  Of course, this means talking about hotel quarantine.  

The is currently an investigation going on as to what happened in hotel quarantine and whilst this is happening we aren’t going to know exactly what happened until it is completed.  However, we do know a few facts:-

• Most, if not all cases of COVID19 in Victoria can be traced back to hotel quarantine.

• Private security agencies were used to monitor and control hotel quarantine.

• Premier Daniel Andrews rejected offers from Prime Minister Scott Morrison to enlist the Australian Defence Force (ADF) for this task.

It is easy to look back with the benefit of hindsight and apportion blame so, to be fair let’s ask three questions.  First, was it a reasonable decision to allow private security to monitor hotel quarantine?  Second, why was private security used over other options? Third, would it have made a difference?

So, was it reasonable to use private security?  Back in February when the seriousness of the pandemic really started to come to light there was very little, if any, community transmission and almost all cases could be linked back to overseas travellers or the Ruby Princess cruise ship.  Knowing this, returning travellers should have been of the highest priority for monitoring and control, so was private security up to the task.  We know that the answer was no but was it reasonable to have predicted that back in March?  

Private security is important in Australia, they provide private business the ability to protect and safeguard their interests in a cost effective manner.  But in order for it to be cost effective wages are low and the work is often menial.  As a result, most of the workers have only a basic level of education.  Also, private security has a large number of part time and casual workers and the recruiting process can be extremely informal.  This makes accountability hard to trace, so essentially we had a random workforce of poorly educated not providing security, but being asked to be on the coalface of pandemic management.  It was never going to end well, the authorities should have known that and I refuse to believe that Daniel Andrews and the Victorian government followed the best medical advice when making this decision.  Medical specialists would have thought about pandemic monitoring needed to be handled by professionals.

Secondly, why did we use private security over other options?  Before answering that question let’s ask what the other options for hotel quarantine were.  There was the ADF, an option that was rejected by the Premier, the police force, as was used in NSW or Corrective Service, as has been employed in Victoria after the issues of private security were bought to light.  

There were other options so why did we not use them instead of private security?  I don’t know the answer to this, only the Premier does but I can give you some theories.  First, cost, private security is a cheap option but a bad one as the cost of lockdown 2.0 is far greater.  Second, every other state refused federal assistance (ADF assistance) for hotel quarantine.  The Andrew’s government didn’t want to look like the “weak” state that couldn’t handle it by themselves.  Third, the trade unions representing the private security workers saw an opportunity to get people back to work in a time when there was a huge surge in unemployment in the sector due to the forced closure of pubs, clubs and sporting venues.  They used their leverage in the Labor Party, who currently hold government to make this happen and the state government buckled to their demands.

Last question, would using a different option to private security make a difference.  I’ll compare this to an ADF option as this seemed the most likely alternative at the time.  First, I have already alluded to private security having low levels of education and training.  This is far less than the ADF.  The ADF has qualified doctors and nurses on staff who have training in infection control and even pandemic management.  There is a need this because if the ADF is deployed to an area where there is an outbreak of disease, they need to know how to manage it.  

Second, ADF staff, even at the most basic level of rank are drilled in discipline and following orders.  In complete contrast private security does not.  Everyone in Victoria has heard the stories of security staff fraternising with the quarantined and disregarding protocol for infection control.  Finally, the ADF has clear structures and lines of accountability that have been tried and tested over decades of conflict and chaotic situations.  It has been proven to be flexible in adapting to an almost infinite amount of different situations yet doggedly rigid in maintaining the highest standard.  Private security on the other hand is completely different.  The inquiry is trying to piece together the structure and lines of accountability which still remain a mystery.  One thing we know for sure.  It didn’t work.

Until next time,

Stay well :)