Doctor and activist


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Category: COVID19

COVID19 Viral Shedding is unrelated to Symptom Severity

8 March 2022

A new, rather bold study involving health infected volunteers has shown that the severity of symptoms experienced is unrelated to how much virus is shed.  In other words, even someone with minimal symptoms can shed and spread the virus a lot.

The bottom line of this is that people should wear masks to stop them spreading the virus.

Here is a cut-down version of the Nature Medicine article in Australian Doctor.

COVID-19 symptom severity ‘no indication’ of viral shedding

A world-first study offers insight into a key public health question about transmission, researchers say

4th April 2022   By Reuters Health

The world’s first ‘human challenge’ trial in which volunteers were deliberately exposed to SARS-CoV-2 has found that symptoms have no effect on how likely an infected person is to pass the infection on to others.

The UK study showed that among the 18 participants who developed COVID-19, the severity of symptoms, or whether they displayed symptoms at all, had nothing to do with the viral load in their airways.

Viral load was measured by a focus-forming assay (FFA) and quantitative polymerase chain reaction (qPCR) in the project led by Imperial College London and contract research company Open Orphan.

“There was no correlation between the amount of viral shedding by qPCR or FFA and symptom score,” the researchers said in Nature Medicine.

“Furthermore, our data clearly show that SARS-CoV-2 viral shedding occurs at high levels irrespective of symptom severity, thus explaining the high transmissibility of this infection and emphasising that symptom severity cannot be considered a surrogate for transmission risk in this disease.”

The trial exposed 36 healthy young adults without a history of infection or vaccination to the original SARS-CoV-2 strain of the virus and monitored them in a quarantined setting.

Since two volunteers were found to have had antibodies against the virus after all, they were excluded from the analysis. 

Slightly more than half of them contracted the virus.

No serious adverse events occurred and the human challenge study model was shown to be safe and well tolerated in healthy young adults, the research team had said earlier this year.

“With virus present at significantly higher titres in the nose than the throat, these data provide clear evidence that emphasises the critical importance of wearing face coverings over the nose as well as the mouth,” the study team wrote.

A key unresolved question for public health had been whether transmission was less likely to occur during asymptomatic or mild infection compared to more severe disease, the researchers said. 

More information: Nat Med 2022; 31 Mar.

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Djokovic goes to Gaol or exile while Hillsong goes Scott-Free.

16 January 2022


Today Novax Djokovic is in Court trying to stop Immigration Minister Alex Hawke deporting him before the Australian Open Tennis starts tomorrow. For those who don’t follow tennis and have been sleeping under a rock, he is the number one seed and if he wins, he will be the first player to win 21 Grand Slam tournaments and as such, the Greatest tennis player Of All Time (GOAT).


Last time he went to Court he won, because the issue was whether the government or Djokovic had done the wrong thing in the visa application process. He won with costs and the government was heavily criticised by the Court (not to mention the rest of the world).


This time is different. Minister Alex Hawke, a young ambitious religious Conservative right-wing numbers man has excluded him in that he is a danger to the population from an infectious point of view, and because he is known to be anti-vaxx and will give publicity to that view. The Court decision is totally stacked the Government’s way because it only has to decide whether the Minister has the power to do this, and the legislation is written so that he would have this power and the meddlesome courts could not interfere. So what is likely to happen is that the government’s position will be upheld, Djokovic will be deported and Australia’s appalling immigration policies will be seen for the arbitrary farce that they are- beyond the rule of law.


The fact that ATAGI (Aust. Technical Advisory Group on Immigration) said that previous infection within the last 6 months could be a reason for vaccination exemption, that Djokovic had had such an infection and that a blind medical panel said that he was safe to come has been ignored. (‘Blind’ in the sense that the panel did not know the name of the person whose file they were reviewing). The point is that he is very unlikely to infect anyone, not to mention the fact that the virus has already escaped and there are few preventive measures in place. Anyone in Australia can fly into Melbourne and go to the tennis with no tests of anything and case numbers of omicron set new records every day. Djokovic has not trumpeted his anti-vaxx views, though one could argue that these are already well known. There is a whole industry telling us what famous people do and think, and that was before the anti-vaxx lobby.


Djokovic is not as popular as the ever-smooth Federer or the rougher battler Nadal, but his public image seems that he is a nice guy, if occasionally misunderstood and pretty ruthless in his quest for the top. Darker mumblings about his unsportsmanlike use of injury rules and mind games have surfaced from a few columnists recently, and one might wonder why. But this is all irrelevant. The government is excluding him ostensibly because he is a risk of infection (absolutely minimal), or that he will stir anti-vaxx sentiment (where the controversy has already done more for the anti-vax cause than his winning of the Australian Open would ever have done).


The real reason is that this government wants to look tough on border control and quarantine, having made a complete mess of the COVID epidemic, with outbreaks due to ‘careless’ border policy, (were there Hillsong groups on the Ruby Princess?), lack of purchase of vaccine, poor management of aged care facilities, and now a ‘let ‘er rip’ policy supposedly to help the economy. Today’s Sun Herald front page announces that ‘71% want Djokovic sent home’. So some hairy-chested populism is the order of the day.


On page 6 of the same Sun Herald (see below) NSW Police decided not to fine Hillsong church after videos were seen of people singing and dancing at a Hunter Valley religious camp. NSW State Health Minister Brad Hazzard is quoted as saying that the singing and dancing ban does not apply to religious groups, though it does apply to recreation facilities, nightclubs etc. Presumably a religious recreation camp is OK, but a non-religious one is a big problem. The fact that the same article notes NSW had 48,768 new cases, 2,576 in hospital, 193 in ICU and 20 deaths yesterday presumably is also irrelevant.


Is it relevant that Scott Morrison and Alex Hawke are members of Hillsong and NSW Health Minister Brad Hazzard is in the same Liberal party?

Craig Kelly has called Djokovic a ‘political prisoner’, and for once I agree with him.

If the Court agrees to deport Djokovic because the Minister said so and they cannot appeal it, it will show the world the arbitrariness of Australia’s immigration laws and the government may win a populist victory at the cost of further damage to our international reputation.

As a tennis follower who saw the US Open final, I am of the opinion that Medvedev will beat Djokovic in the tennis if they play, but it looks as though political stupidity has game, set and match.

Hillsong let off as NSW posts 48,768 new cases and 20 deaths
Sally Rawsthorne, Sun Herald, 16 January 2022
NSW has recorded 48,768 new COVID-19 cases and 20 deaths on the third day positive rapid antigen tests are included in the daily infection numbers.Of the new cases, 21,748 were self-reported from at-home tests and 27,020 were from PCR testing.There are 2576 people in hospital with the virus, of whom 193 are in intensive care units. Eleven men and nine women have died from COVID-19 in the past 24 hours.Yesterday, police confirmed they had decided not to issue a fine to Hillsong church for a camp in the Hunter Valley, after videos of attendees singing and dancing without masks sparked public outrage.‘‘NSW Police have attended an event in the Newcastle area and spoken with organisers. Following discussions with organisers and after consultation with NSW Health, no infringement will be issued,’’ said police in a statement.‘‘Event organisers are aware of their obligations under the Public Health Orders, and NSW Police will continue to ensure ongoing compliance.’’NSW’s Public Health Order prohibits singing and dancing at music festivals, hospitality venues, nightclubs, entertainment facilities and major recreation facilities.Health Minister Brad Hazzard said while the order does not apply to religious services, it does apply to major recreation facilities, which is defined as a ‘‘building or place used for large-scale sporting or recreation activities that are attended by large numbers of people, whether regularly or periodically’’.‘‘This event is clearly in breach of both the spirit and intent of the order, which is in place to help keep the community safe,’’ he said.Hillsong said the camp differed from music festivals and the organisation was committed to a COVID-safe plan.‘‘Our camps involve primarily outdoor recreational activities including sports and games. We follow strict COVID procedures and adhere to government guidelines,’’ it said.‘‘Outdoor Christian services are held during the camp but these are only a small part of the program.’’It said the video of attendees singing and dancing represented ‘‘only a small part of each service’’.Yesterday, the state government announced its rent regulation would be extended by another two months to March 2022. ‘‘Small business is the engine room of our economy and we need to make sure we support impacted businesses through this latest Omicron wave,’’ NSW Treasurer Matt Kean said. ‘‘With staff shortages and reduced foot traffic, many businesses are struggling at the moment but the ability to negotiate rent will give them a buffer so they can keep the lights on now and recover more quickly.’’Business tenants can access rent relief if they have an annual turnover of less than $5 million. Rent relief has the same eligibility criteria as the discontinued JobSaver and Micro-business Grant programs.It comes as almost 1000 NSW Health workers have resigned or been sacked after refusing to be vaccinated against COVID-19, placing further pressure on the hospital system that has seen coronavirus patient admissions almost triple within a fortnight. As hospitals and general practices are overwhelmed with surging cases and almost 6000 healthcare workers are isolated across NSW due to COVID-19 exposure, the state’s health department on Friday confirmed 995 of its 170,000-strong workforce had resigned or been stood down after refusing the vaccine.

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COVID Day 4- a non-PCR Day

5 January 2022

I did nothing today- it just took longer than usual.

I felt much the same, a sore throat, not much energy, a bit of a headache and bouts of a dry cough. I did not feel like exercise and I thought that I had better try to get a PCR test and some Rapid Antigen tests in case we needed to prove we were not infectious, or had other people who were concerned contacts.

I researched online where the PCR (Polymerase Chain Reaction) tests were being done. The site I used 2 weeks ago, a 4Cyte drive through test that had taken an hour to do and 3 days and 16 hours to get results from was closed Wed-Friday. It was not clear why this was but the Laverty Pathology group at 60 Waterloo Rd near Macquarie Centre was open till 4pm. I took a novel in case of a long wait and drove there.

As I approached from the google direction cars in the left lane were not moving from the major intersection as far as one could see to the next hill. Many of them had their tail lights on, so I reflected that they were sitting in a line with the engines on. Bad for the environment, but it at least told me that his was the queue. I turned off the engine and started to read. After a while I was wondering why no progress at all was being made, and I thought I might ask if I was under some misapprehension. As I looked up, a pleasant looking woman in her mid-30s got out of the small car ahead, and went to her boot.

I called to her out the window, ‘Is this the PCR test queue?

‘Reckon so’, she said, ‘I’ve brought some snacks to get through it’. She took some biscuits, grapes and a drink and got back in.

We advanced glacially slowly, and I noticed that there was a side road a little way down the queue. Space had been left so cars could go in and out of this side road, but cars had also started to queue there, and of course the two queues merged at the intersection. I had not thought of this until I was nearly at the corner, and I suppose the woman in the car hadn’t either. Some on the side road were shouting abuse or tooting as if we were somehow pushing in to their queue. There were no signs, no guides and nothing online, so it seemed that the only fair thing to do was to take alternate cars. My young friend had recognised this before I had and moved her car across the middle of the side road, so that cars exiting or entering could go in front or behind her, but she could be sure that the side road queued cards did not just push in. There was a cacophony of abuse from the side street.

The queue moved forward a few cars, so I followed her closely, letting one car in as seemed fair. A large 4WD with a man screaming obscenities at me tried to push in, but I kept him out. I wondered if he would get out and make trouble but he did not. The passenger in the car I had let ahead of me had got out and was remonstrating with the woman who had been in front of me. It was tense. I was very glad we were not in America with some people having guns.

We continued our glacial advance, then a car coming in the other direction stopped. The driver stuck his head our and was shouting something to those in the queue ahead of me. I could not hear him, but he did not seem abusive, so as he passed I called to him to ask what he had said. He said, ‘They have closed early; I was second in the queue and they told me to go away’. It seemed likely that he was right, but most people had waited so long that they were not willing to drive off, so we moved quite slowly till everyone had driven past the ‘Closed’ sign that had appeared in the driveway. It was 2pm. The testing site was advertised to be open till 4.

No test and a couple of hours wasted. I have COVID. It is not recorded in the system. It seems that I will recover. Will I waste another few hours tomorrow? And if I do will I have PCR results anyway? I am scheduled to see my patients again 9 days after the onset of symptoms- presumably I will be non-infectious. Luckily I got some RAT kits.

It is not hard to see where anger and frustration comes in all of this.

‘Personal responsibility’ has a very Darwinian edge.

Thank God I am not very sick.

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COVID Up Close

2 January 2022

I have tried to stay COVID safe, but we had a house guest, a friend of my son, Mike who had been stranded overseas for a year and came back to Brisbane and then to Sydney last Tuesday.  On Thursday he had a cough, so I asked him to Rapid Antigen Test (RAT), and he was positive.  Mike and I were negative, but the separation was minimal.

I was feeling a bit of a sore throat, headache and cough like an early flu and I managed to get another RA Test kit today (Sunday) and got a positive result.  Luckily, I had my 3rd vaccination 10 days ago, which is just long enough for it to start to work, so I am hopeful it will be a mild one.

It is ironic that I have had lots of requests to go back into the hospital workforce and resisted.

I will keep you posted. 

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It is Hard to get COVID tests and likely to get Harder

1 January 2022

The numbers of COVID cases are rising dramatically, many of the clinics have closed for Christmas, and Rapid Antigen Tests (RATs) have sold out from most chemists. You might wonder why this wasn’t anticipated, but it seems that the strategy of ‘Let ‘er Rip’ was meant to stimulate the economy as everyone assumed that either COVID was over, or that the Omicron variant did not matter, (not that Delta had actually gone away).

In fact the people have been mostly quite sensible and are not going out and are wearing masks and isolating, which of course means two things.

1. The ‘Let ‘er Rip’ strategy is not getting the economy back to normal and

2. The government can say that it is not their fault if people choose not to go out and spend, so they don’t need to support business or anyone else.

Here is an explanation of the PCR test unavailability from Kim Hatton:

‘Some people today have been wondering why the Feds are pushing so strongly to reduce PCR testing for COVID and shift to RAT. Yes of course the path labs are overloaded but there’s more to the story than that. Currently Medicare pays $110 for a PCR test, split between the path lab and whoever is collecting the sample. With tests reaching 270,000 a day that’s basically $30million per day out of fed budget.

The plan is to reduce PCR tests down to around 50,000 a day saving $24 million a day.To fill the gap the plan is to use Rapid Antigen Tests which cost around $10 in bulk. The Feds will fund 50% of whatever the states buy. In theory the states would buy enough to bridge the gap ie 220,000 per day costing them $1.1 million and the Feds the same. Meaning fed expenditure drops from $30m per day to $7million.

However that assumes the states buy enough which they haven’t. NSW has placed an order for 2 million which won’t even last 2 weeks assuming infection rates don’t increase – which of course they will.In practice what is more likely to happen is the the public will fund the majority of RATests themselves saving the Govt at least another million a day.

That million a day then becomes part of the economy which comes out as economic growth the federal government has achieved and will use to argue how good a job they’ve done.’ End Quote

This seems quite plausible to me- I will chase the source.

The other aspect is that if you do not have a PCR test and do not go to hospital, you are not recorded as a COVID case, so the statistics look better.

I personally had a contact and did a PCR at about midday on Friday 24th and got a text with a negative result at 4am on Tuesday 27th- 3 days and 16 hours later. If this blows out much more the test is virtually useless, as you would have had to isolate anyway.

It seems if we do not have a PCR test, and/or everyone does their own Rapid Antigen Test (RAT) and then monitors their own health with or without a $20 oximeter to make sure that their oxygen saturation is normal and over 95%, the whole epidemic can be ignored except for the ones so sick as to go to hospital.

This seems to be the effect of the new guidelines as in the SMH. Here is the ‘Do It Yourself’ article from the SMH:

More COVID cases told to manage themselves at home as tests hit ‘bottleneck’

By Mary WardSydney Morning Herald December 28, 2021 — 6.38pm

Private pathology companies have warned that NSW’s rising coronavirus cases are creating a “bottleneck” in the testing system as more people who catch COVID-19 are being directed to manage their infections from home.

On Tuesday, NSW Health updated its advice for people who are COVID-positive, directing that most people aged 65 and under are considered able to recover from the virus without medical involvement.

Under the new rules, people in this age group who have had two doses of COVID-19 vaccine, do not suffer from any chronic conditions and are not pregnant are considered able to safely manage an infection at home.

Previously, this was only the case for people aged under 50.Of the 42,600 COVID-19 cases reported in the state over the past seven days, fewer than 7 per cent of infections were in people aged 60 and older. About 3400 were aged in their 50s.

Those managing an infection at home should also not expect to be “cleared” from isolation by NSW Health. Instead, they may leave after day 10 of their isolation, even if they do not hear from NSW Health in a text message on this date, provided they have not experienced symptoms in the previous 72 hours.

NSW Health advice for managing common COVID-19 symptoms at home

• Cough: Breathe in steam and sip on fluids. Avoid lying on your back. If you are coughing up mucous, it is important to continue to do this as it reduces risk of a chest infection.

• Nausea, vomiting and diarrhea: Eat plain, low fibre foods. Have six smaller meals instead of three. Do not drink alcohol or caffeine. Stay hydrated.

• Fever: Take paracetemol. Put a cool, damp washcloth on your forehead. Wipe your arms and body with a cool cloth.

Source: NSW Health

“It is important that this information is provided to people who are at lower risk of severe illness to allow NSW Health to focus on those who have the greatest risk of poor outcomes, this includes people over the age of 65,” a NSW Health spokesperson said.

“Regardless of age, people are also provided clear advice about what to do if they start to feel worse or in the case of a medical emergency.

”People who have a chronic condition – such as obesity, a severe, chronic or complex medical condition, diabetes – are immunocompromised, have severe mental illness or are pregnant are urged to contact the COVID-19 Care at Home Support Line on 1800 960 933 if they return a positive PCR test to receive further medical assistance.

Last week, Australian Medical Association NSW president Danielle McMullen warned that doctors would struggle to cope with thousands of patients needing virtual care as health authorities flagged they would increasingly rely on the GP network to manage COVID-19.

Tuesday’s public holiday again meant some testing clinics were forced to shut within hours of opening, as wait times for PCR results blew out to more than four days despite the system processing fewer tests than it had previously.

There were 93,581 COVID-19 tests processed in the 24 hours to 8pm on Monday, down from the previous day’s total of 97,241 and nowhere near upwards of 150,000 tests done in September. NSW Health’s Christine Selvey said testing in the state was “under enormous pressure”, urging people to only have a PCR test if they had symptoms, were a household contact of a case or had been advised by NSW Health about attending a high transmission venue.

Premier Dominic Perrottet said he believed up to 30 per cent of tests were for interstate travel, as he and Health Minister Brad Hazzard urged the Queensland government to ease requirements for people to return a negative PCR test before crossing the border, after it scrapped a day five test for people who had already travelled to the state due to pressure on its own system.

“If we can move that PCR requirement to a rapid antigen test requirement that will significantly alleviate some of the pressure on the testing over summer,” Mr Perrottet said.Mr Hazzard said he had asked NSW Health and the federal government to reconsider whether two tests completed by returned international travellers who come through Sydney Airport needed to be PCRs, in light of the delays.

He also asked the ministry to look into recommending rapid antigen tests were used to screen pregnant women ahead of birth after the Herald revealed women had been queueing for tests every 72 hours on the advice of some hospitals.

But while private pathology labs said so-called “tourism testing” did account for some of delay, a higher volume of positive tests was also to blame. More than 6 per cent of tests reported on Tuesday were positive, up from about 2 per cent the previous week.

Greg Granger, director of strategic operations at Histopath, said the proportion of tests which were positive had created “one of the biggest bottlenecks” in the system.

Mr Granger said the method of PCR testing large volumes of samples – where samples are pooled and tested in groups – worked well when fewer than 1 per cent of tests were positive and most “pools” of tests could be cleared as negative.

“When there’s a positive in the pool every single time, you essentially have to double or triple test the samples,” he said, noting laboratories were now needing to figure out, with their available instruments, what a more efficient method would be.

“Obviously in an ideal world, you don’t pool at all. But with these sheer numbers you just can’t … it’s about finding where the balance is.

”A spokesperson for St Vincent’s Hospital, which operates the SydPath clinics, agreed positive tests took longer to confirm in its laboratory than negative ones.

They said the process of reporting a positive case to NSW Health was also “more significant” than the administration needed for a negative test.Despite the high demand, SydPath clinics will operate at reduced hours “in order to maintain the quality of [its] testing”, after more than 800 people were incorrectly sent negative test results over the weekend due to human error. The provider asked people to not attend its clinics, including the Bondi Beach drive-through, seeking a test for interstate travel.

Australian National University infectious diseases expert Associate Professor Sanjaya Senanayake said the state’s high positivity rate meant it was likely more infections were being missed by testing. However, he said, an upside of this was that the hospitalisation rate of Sydney’s Omicron wave was likely even lower than reported.

“At this stage, it does seem like the current infections are resulting in significantly fewer hospitalisations than we saw with Delta,” he said.

There were 557 COVID-19 patients in NSW hospitals on Tuesday, including 60 in intensive care, compared to 168 in hospital a fortnight ago. NSW’s COVID-19 hospitalisations reached a peak of 1266 in mid-September, including 244 in intensive care.

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‘Government Responsibility’ is needed, not just ‘Personal Responsibility’.

22 December 2021

The huge, systemic and ongoing cop-out approach of the Federal and now the NSW State governments seems to be based on the hubristic belief that governments can set the agenda and influence the media to the extent of creating a perceived reality conducive to their interest. This is often successful, as the news becomes ‘What Mr Morrison did or said today.’

The narrative is changed slightly, so unless you are watching carefully, it always seems OK.

As in Animal Farm, ‘You may not sleep in a bed with sheets’. People did not remember the ‘with sheets’ bit of the slogan, but, hey, you do forget things.

But neoliberalism likes to stress individual responsibility. It allows small government, which advantages bigger players who can move into monopoly positions in an unregulated situation. It allows governments to have the perks and trappings without having to do too much as not much is expected these days.

The Federal public service is actually too small to do much except tell the States what they should do, and even this function is increasingly left to the politicians and their minders, those ambitious political science (or mainly art-law) graduates (with no scientific expertise). Hence the need for the Army when anything actually needs to be done.

But the key aspects of the current policy of getting rid of masks, social distancing restrictions, QR codes, and limits on people numbers in groups is a foolish populism and an assumption that business will do better if commerce returns to normal. This is right out of the IPA playbook.  ‘Let ‘er rip and if a few oldies and sickies die off, that is the price of society continuing’.

It also has the advantage that nothing is the government’s fault any more. If the omicron variant gets out of control, that is obviously because it is so infectious and out of the Government’s control. If the population choose not to go out to protect themselves and the businesses go broke, that is not their fault, they opened everything up (and also saved a motza by not having any more pesky jobkeeper or jobseeker payments).

To say that this non-strategy will not work is to understate the situation. We managed to control the situation when there was no vaccine. Now that there is, the governments wants to throw away all public health norms for infectious disease and rely on vaccination alone. This has conspicuously not worked in Europe.  Look at the Daily Case histograms (see link below) for Denmark, the UK, France, Spain and Italy. It seems that Germany, Belgium and the Netherlands have managed to begin to turn around the latest spike, but I have not researched their latest policy changes. Israel, largely triple-vaxxed is doing better. The US has a rising spike- it will be interesting what happens with their poorly vaccinated population.

But there is no need to look overseas.  The Australian graph is already rocketing up with new highs reached every weekday.  We are not triple-vaxxed and now there is another vaccine shortage.  NSW yesterday was responsible for 3763 of the national total of 5724 (66%) and the percentage is rising.  So Perrottet is as bad as Morrison.  (Figures from covid19data.com.au).

Individuals cannot protect themselves when the virus is everywhere unless they become hermits, and even then they will have trouble getting fed.  It needs mass action. It is a public health problem that needs government action. This is so obvious that it is extraordinary that it should even need to be stated.  But our governments have reached such a low level of effectiveness that we are in grave danger.  The Lucky Country is about to squander its advantages yet again.  We can only hope that the National Cabinet meeting is the platform for a national about face. 

Please protect yourselves and try to get the governments to see reason.

May be a cartoon of ‎one or more people, people standing, suit and ‎text that says "‎We're هll about taking personal responsibility And if this approach turns out to be disaster? Then you'll have only yourselves to blame. wikak‎"‎‎
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Mental Health and Physical Health

11 November 2021

The Health system has a major divide that is not often spoken about- the divide between mental health and physical health. 

Physical health tries to be a science and likes to think that its diagnoses and treatments are based on sound experimental evidence. If someone is sick and there are not enough facilities there is a fair effort from the medical profession and relatives to get more resources and they are mostly successful.  There is a highly respected system and career structure.

Mental health has similar endeavours, but has less of a scientific base for its diagnoses and treatments.  There has been a lot of work on neurotransmitters associated with depression and drugs that supposedly increase the good ones, but no single test is associated with a diagnosis, and diseases are defined.  It gives it a lingering stigma of imprecision.

The workforces in mental and physical health have relatively little crossover, even isolated within the same hospital. When I last worked in the health system 9 years ago in a hospital that had both an active ED and a mental health facility, patients were triaged as physical or mental, different teams saw them, and neither team wanted much to do with the other stream’s patients.  There was a shared waiting room, but different personnel, assessment areas, practices and wards.  Getting one of the other team to assess someone was an afterthought, or only when the pathology was fairly gross.

When I was in tobacco control, there was a lot of reluctance to try to get mental health patients to stop smoking as ‘they needed it’, which was another way of saying that to add the nicotine withdrawal to their generally stressed situation was merely making trouble.  But the public health statisticians said that people with mental health problems had a lot of physical problems and died about 14 years earlier (AIHW).  So glossing over the physical health of mental health patients is not without consequence.

It was interesting to note recently that a COVID-19 infection in a mental health inpatient went undiagnosed for 4 days, and drew attention to the fact that mental health patients had a poor vaccination rate also.

www.smh.com.au/national/nsw/hospital-patient-s-covid-19-infection-undetected-for-four-days-20211105-p596aw.html

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Tasmania Wants 90% of Adults Double Vaccinated before Opening the Border

30 September 2021

Here is a realistic assessment of how to stop an epidemic if you have the choice. Liberal Premier Peter Gutwein has some modelling coming. Bear in mind that 20% of the Tasmanian population are under 16 year of age, so if no kids are vaccinated the actual rate is still only 70%, not 90%. Even you assume that kids will not get sick, which is actually not a reasonable assumption, there are 30% who can spread COVID and 10%, the adults, who are quite vulnerable.

In reality, it is hard to get vaccination rates over 90%, though Blacktown LGA has 95% with first jabs, and presumably Tasmania would also being trying to vaccinate 12-15 year olds and younger if possible.

Meanwhile Morrison is stopping welfare payments to States when they get over 70%, which is actually starving people into unlocking. Even Conservative NSW Treasurer Perrottet is adding some welfare payments from the State budget.

www.abc.net.au/news/2021-09-29/tasmania-wont-reopen-covid-border-before-90pc-vaccination/100500844?sf249931972=1&fbclid=IwAR2NqGfeDQA9rGcnm7XQ6iLiDGK7XH1PNkRsjYs3uL15J31hP7qLbDsby88

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Victorian Government Bites the Bullet and Mandates Vaccination

22 September 2021

At last!  A government that does the sensible thing.  The Victorian government will only open up if people are vaccinated.  Thanks to NSW the Delta variant genie is out of the bottle and spreading nationwide.  Business wants to unlock, some with no care for anyone but themselves.

Victoria wants to unlock but minimise spread among those now having more interpersonal contacts.  The R (Reproduction) number is the number of cases each case infects.  If everyone is vaccinated, less people will get it and those who have it will get it to less people.

Reasonable medical opinion is that the risks of vaccine are massively less than the risks of getting COVID, so the case against vaccination is incredibly weak on medical grounds.  The ‘right not to have your body violated’ etc sounds very dramatic, and makes vaccination equivalent to rape in a semantic sense.   But in a practical sense the two concepts are as far apart as could be.  One is sensible medicine and the other is a crime.

Anyone who thinks that this does not matter should look at the graph of NSW cases that has peaked and is just starting to fall.  Anything that can flatten the curve or make it fall is good. Anything that makes it rise is creating deaths and misery.

I am a member of the Council for Civil Liberties and have spent years working against excess government power. But sometimes it is necessary to act for the common good.  I have no time for smokers’ rights or the right to spread disease.  The Morrison government is as usual missing in action when real leadership is needed.  ‘Let every workplace decide’, is a nightmare for retail business owners, offices and just about every other employer. Gladys is similarly missing.  Dan Andrews has stepped up, despite a motley crew in the streets spreading disease and demanding the right to continue to do so.

What of the Health System?  We are going the way of the Americans by stealth, and the fact that the public system is what has helped us survive is being glossed over, hidden  by subsidies to private hospitals. The Federal government has been quietly trying to kill public medicine for years. The Medicare rebate has fallen from 85% of the AMA rate to 45%, so for the same bulk-billing work doctors incomes have almost halved over 35 years, while subsidies to the inefficient Private Health Insurers continue.  Being a GP is now a little-sought speciality.  (I have a FB page- Fix Medicare that I spend too little time on).

The States have maintained the public hospitals at a minimal level, as all the lucrative work has been siphoned off by the private system basically doing the easy stuff.  There is No slack in the system, not that counting the number of ICU beds should factor.  All our efforts should be to keep people out of Hospital and ICU by prevention of infection. 

Have a look at this article on the anti-discrimination aspects of mandatory vaccination, and also look at the NSW cases, just turning down, but likely to rise if anything, like opening up from lockdown, tips the balance.

www.smh.com.au/national/victoria/here-s-why-no-jab-no-entry-is-not-discrimination-20210920-p58t2v.html?fbclid=IwAR2jrbfGJsq6fD-J-unnAn12j9UyWvdk-do5BpE23bI0z0gQ8kknq5nc39c

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Please Sign the Petition to stop the COVID Lockdown Ending Prematurely

4 September 2021

The Governments, Federal and NSW State, seem hell bent on ending the COVID lockdown.

Morrison stuffed up the vaccine and Gladys stuffed up the lock-down.

Now Morrison is talking about ‘Freedom’ and ‘One Australia’ showing that patriotism is the last refuge of a scoundrel.  Gladys is talking about the need for more deaths as if it is an inevitable consequence of the Delta strain and that nothing can be done to mitigate the situation . She is talking about bed numbers and trying to conjure ICU nurses out of thin air.  The fact that the State public hospital system is always at full capacity with beds in corridors in ED is well known to any health professional who has any dealings with the system and is about to bite us big time.

So what should be done?  The lockdown can only buy time to improve the vaccine rollout, but this is still very much worth doing.  Figures from NSW that I posted last week suggested that vaccination reduced the chance of being in ICU by about 97%. Vaccinated people can still get and transmit COVID as it seems that the antibodies are not in secretions, so it is not until the virus invades that the body starts to fight it.  But as the disease is milder, vaccinated people will cough less, spread  the virus for less time and be less sick themselves.

NSW has given about 7.2 million doses to a population of 8.2 million people.  For everyone in NSW to have 2 doses it would take about 16 million doses.  If we assume that about 4% of people are anti-vaxxers and want to take their chances, and 16% are children under 12 for whom the vaccines are not approved,  then 80% of the total population should be vaccinated, which will take about 13 million doses.  At the current rate of a million doses a week, that should take about 6 weeks from now.

The government already has a huge debt and will avoid a lot of future costs by prevention rather than ‘cure’.  A support package for those who cannot work is naturally needed also. There was a full page ad in the SMH last week with a number of businesses urging the Government to stick to the opening up timetable of the Doherty Report.  Given that the Doherty Report recommendations were based on a far lower number of cases and it was assumed that what cases there were could be traced and were not Delta variants, the report needs to be reconsidered. Perhaps because it is from a reputable research organisation and that it is a long read it has not been seriously challenged, The Government has used it to try to justify the early opening.

One of the disappointing things in my life has been the revelation that some people really do not care a fig about anyone as long as they are personally OK.  I was initially shocked to find that the Tobacco industry really did not care how many people died as long as they could make money.  I found that the asbestos industry was the same, and then that most businesses skimp on safety on the principle that ‘we take the money, you take the risk’  There has also been the worrying trend, which I still link to Harvard management theory  in the 1980s that managers can manage anything, and just need to buy any expertise that they do not have.  Often that do not even know what they do not know, so they neglect to ask, do not know who or what to ask, or find the advice inconvenient.    And sometimes they put ads in the paper.

We also cannot assume that those in Government know or care or that their primary concern will be for the welfare of their constituents.  Presumably their unlikely re-election is what they are focused on.

So please sign the petition to stop the early opening- it currently all we can do.

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