Author Archives: Dr Lachlan Soper

Two COVID-19 vaccine candidates the Australian government is ‘banking’ on.

The two possible vaccines the Australian government has signed an in principal agreement to purchase and manufacture in Australia are the: Oxford viral vector vaccine, and the Queensland Uni molecular clamp vaccine.

The below article is a very good 4 minute read about the two most likely vaccines Australia may get (if they suppress COVID-19) why one needs a booster, and how they engender immunity.

Read more in Medical Republic

Two Australian candidates for a COVID-19 vaccine

The “Oxford vaccine” is perhaps one of the most well known candidate for a successful COVID-19 vaccine. Although there may not be success, and if there is “success” it may still be many years until widespread application, there are two groups in Australia making great progress.

The University of Queensland has developed a “molecular clamp” model. Trials thus far in hamsters have shown a strong immune response. In South Australia the Finders University is working with a firm called Vaxine to produce a vaccination called Covax-19, which is looking to get to human trials soon.

For more information read RACGP

The Transition For Children From Paediatric Care

When it’s time to move from paediatrics to adult care, the transition can be difficult for some, particularly for those with significant disabilities who have needed ongoing paediatric care since they were infants. While it may sound as simple as moving from one doctor to another, many parents struggle with knowing the right time or wondering how different it will be for their child. Here’s what to expect when transitioning from paediatric to adult care:

The Right Time for the Transition

When it comes to deciding the right time to transition away from paediatric care, there is no one answer for this. Transitioning from paediatric to adult care usually occurs around the 18th birthday. However, in reality, it is a case-by-case basis. It all depends on the patient, their health history, and much more. When you’re thinking about taking your child out of paediatric care, it’s always best to consult their doctor first to decide when would be the right time. 

The Role of the Pediatrician 

Under their care, a paediatrician will help prepare your child for the transition to an adult physician. As the patient grows older, paediatricians will begin to see patients in private when they’re in their early teen years, depending on the level of disability. As adolescents begin to learn real-life responsibilities such as driving or getting their first job, they also need to learn how to advocate for themselves when it comes to their health. 

The Consent of Treatment

There is a principle called the “mature minor”, it is different from state to state and country to country. What that means is that some point, between the ages of 14 and 16, the doctor determines if the child has the maturity to understand and consent to the treatment they are having. If they are ‘mature’ enough to consent, then their consultation is confidential. As such, when a patient is at the age of consent, they no longer have to disclose anything medically related to their parents. This means that whatever is discussed between the patient and their doctor will stay between them. 

Even if a vaccine is available next year for COVID-19, it could take years to vaccinate the world.

That is a big “IF”. There are many issues with finding a vaccine for coronavirus. In very short some include:

  • There has never been a vaccine for a coronavirus (one of the main causes of the common cold),
  • It usually takes many years to develop a vaccine,
  • For a vaccine to be effective, a large portion of people need to “seroconvert”, that is develop immunity to the vaccine. Recent studies have show that only 60% of people who have acquired COVID-19 through the community develop protective antibodies, and
  • The vaccine needs to produce long term immunity. Some studies have shown that in those who develop antibodies to COVID-19 after infection, that immunity wanes by 23-fold within only a few months. This may require multiple booster vaccinations at 2-3 month intervals.

With the above concerns aside, there are other issues too, like:

  • There are about 8 billion people on earth. At best, if all world vaccination production is switched to producing a viable vaccine, the world vaccination manufacturing capacity is estimated at 6.4 billion p.a. If, those vaccines require 2 or 3 doses, then that is a few years of vaccine production at maximum capacity to vaccinate the whole world.
  • Then there is the challenge with vaccine distribution. Vaccines need to be kept strictly between 2 and 8 degrees C. It is estimated that 50% of world vaccines fail the “cold chain” and so if there is 50% wastage, then world production would need to further double. How do we get the vaccine between 2-8deg C to remote areas of Asia, Africa and South America, just to mention some remote locations?
  • Will vaccine distribution be equitable worldwide? If wealthy countries buy up the supplies of the vaccine, and poorer countries which are in hot spots cannot get supply and not for a long time, then the virus may continue to rage on around the world for longer too.

Getting a good vaccine, with minimal side effects, that produces long-lasting, high levels of seroconversion to the whole world will be herculean effort.

Read more in Medical Republic

Only 60% of patients develop protective antibodies to COVID-19

A study performed in MedUni Vienna showed that just over half of patients develop protective antibodies after they are infected with COVID-19. And, it appears that these antibodies potentially make it easier to virus to infect cells.

This combined with previous studies showing that immunity wanes significantly after 3 months raise significant concerns about the effectiveness of any COVID-19 vaccine and long term human immunity to it.

Read more in MDLinx

The Difficulties with Getting a COVID-19 Vax

Throughout every country, the dangers of the worldwide pandemic, coronavirus, still linger. Although some populations have begun to get back to the way it used to be slowly, many are still worried about the likely second wave of coronavirus, also known as COVID-19. Looking at countries in the Southern Hemisphere that up until late June appeared to have had COVID-19 well under control (like Australia), there has been a large surge in cases in July as the typical winter respiratory infection season arrives. In January 2021, when many are fed-up with social distancing, there may well be a huge rise in cases in the Northern Hemisphere respiratory infection season. Many are hoping for a vaccine to help stop the spread of the dangerous virus. However, there are difficulties with getting a COVID-19 vax.

Developing a brand new vaccine is a significant medical and scientific discovery. It can take decades to finally find a successful vax, even with the urgency of the situation. Remember drug companies are motivated by profits – if a drug is likely to be profitable, they’ll pour more money into trying to develop it. Coronaviruses are one of the main causes of the common cold (as well as rhinoviruses, RSV and parainfluenza). Almost all of us get at least one cold every winter. So there would be a huge incentive to developing a successful vaccine to a disease we all get every year. There has never been a successful vaccine to a coronavirus. Why will it be different with COVID-19? Hopefully, it will be different, but we have to be realists. 

Also, studies have shown that those people who acquire COVID-19 have a rapid drop off in their natural immunity – 23-fold in only a few months! The immune system generally builds a more robust response to “naturally” acquired infections, than to vaccines. So if a vaccine is developed, people may need to be re-vaccinated at least every 3 months. 

Once the corona vax is created, many people may be fearful about getting vaccinated. Even with the vaccine tested and numerous trials are done, it’s difficult for people to trust a new vaccine entirely. These are reasonable concerns. It is wise not to be an ‘early adopter’ of new medications, often side-effects become more well known once the medication has been in broad community use after the initial trial phases. 

Facing the Reality of a Vaccine

While a COVID-19 vax could help billions of people around the world, it’s essential to be realistic. Probably within the first few weeks of distributing a vaccine, there will be countless stories about side effects, medical syndromes, and scary reactions. Even for someone who is pro-vaccine, this could be scary to hear. It’s important to be realistic that many people are going to be scared to take the vaccine, not based on science, but on the horror stories spread around. Many people are probably going to want to wait before getting vaccinated, which is entirely understandable. 

This means if a vax if found and ready to be given to the public, it won’t stop the pandemic in its tracks. It will definitely take time. 

Social distancing, and other measures to combat the COVID-19 pandemic have already saved hundreds of deaths from influenza this year

There have been 36 deaths from influenza in Australia this year – only 1 since the start of April! Over the same April to July period last year, 550 people died.

This suggests hundreds of lives may have been saved by measures taken to halt the COVID-19 pandemic – including social distancing and a very high uptake of the influenza vaccine.

Read more in Medical Republic

Is your facemask fogging up your glasses? Here are some tips to stop them fogging up

  1. wash your glasses with soap and water,  then dry them with a microfibre cloth. Soap reduces surface tension, preventing fog from sticking to the lenses.
  2. apply a thin layer of shaving cream to the inside of your glasses, then gently wipe it off.
  3. use a commercial de-misting spray.
  4. Improving the fit around the curve of the nose and cheeks is the best approach – mould the nose bridge at the top of your surgical mask to your face to reduce the gap that allows warm moist air up to the glasses.
  5. Apply some tape (eg: Micropore that’s designed for skin) to the top edge of the mask to close the gap.
  6. slightly moistening a tissue, folding it and placing it under the top edge of the mask.

Asking Your Doctor the Tough Questions

When it comes to health and medicine, the best person to talk to is your doctor. However, sometimes the tough or even embarrassing questions are not easy to ask. While a lot of people understand that their doctor is there to help them, many still have a tough time working up the courage to speak up about health questions or concerns because it can feel too embarrassing. Take a look at these tips for asking your doctor the tough questions:

 

Prioritise Concerns

Often times, doctors only have about 15-20 minutes to talk with their patients. When you have a line of questions for your doctor, have them prepared ahead of time by writing a list. By preparing, it can help you get used to the idea of asking and make it easier to ask. It’s also a good idea to ask your tough questions at the start of your appointment. This way, your doctor has more time to give you a quality answer and explanation. 

 

Use Your Own Words

Chances are, you tried researching the tough question online already before working up the courage to ask your doctor. While this can sometimes be helpful, it’s important to tell your doctor how you’re feeling or why the concern has been raised in your own words. Using your own words is better than spewing medical terms you read on the internet. You can even write down your symptoms or experiences beforehand to make sure you tell your doctor everything they need to know. 

 

They’ve Probably Heard it Before

Your doctor has spent many years studying the medical field and has probably seen many patients before you. Whatever ever tough or embarrassing question you want to ask, they have probably heard it before. Never be too scared to ask because you’re afraid they’ll judge or think it’s strange. 

 

It’s Their Profession

When it comes down to it, a doctor’s job is to answer any medical question that their patient has. As their patient, you have a professional relationship that allows you to be completely open about your medical concerns and they are there to help you. Being too embarrassed to ask the tough questions can put a damper on your health and do more harm than good. Be sure to always be open and honest with your doctor. 

Resilience – 3 characteristics to help through life’s traumas

Trials, trauma and tough roads, we all will face them in life. Some more often and some in more tragic ways than others. Relationship breakdown, death of loved ones, job loss, financial difficulty, medical illnesses and other life events can all throw us into despair. 
How do we deal with such tragedies and grief? 
Resilience researcher and fellow traveller in the world of emotional trauma, Lucy Hone, believes that developing emotional resilience is one of the best ways to both healthily grieve and live our lives concurrently. She believes that resilient people have 3 key characteristics. She says:

1. “Resilient people get that s#*t happens. They know that suffering is part of life. This doesn’t mean they actually welcome it in…. Just that when the tough times come, they seem to know that suffering is part of every human existence.”

2. “Resilient people are really good at choosing carefully where they select their attention. They have a habit of realistically appraising situations, and typically, managing to focus on the things that they can change, and somehow accept the things that they can’t. This is a vital, learnable skill for resilience. Make an intentional, deliberate, ongoing effort to tune into what’s good in your world.”

This characteristic is fundamental to a famous prayer known as “The Serenity Prayer” which prays to God: “God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.”

3. ‘Resilient people ask themselves, “Is what I’m doing helping or harming me?“‘

https://www.ted.com/talks/lucy_hone_3_secrets_of_resilient_people?utm_source=recommendation&utm_medium=email&utm_campaign=explore&utm_term=newest-talks-4

When you go through life’s traumas, as we all will, find a great counselor or psychologist to get you through, and some good mentors too – some close friends who are not merely “yes” people to help shape and gently guide you on your journey. And on that journey learn to accept that suffering is part of life, focus on what you can change and accept the things you cannot change, and stop doing the things which reactivate your distress.

God-willing these strategies can help you survive, take the next steps, move on and transform in your life.

Dr Lachlan Soper

Influenza cases down by 99% in Australia compared with May 2019

Influenza cases down 99% (no that’s not a typo) compared with May last year.
208 laboratory confirmed influenza cases compared with 30-567 in May last year – and the rate of testing for anyone with upper respiratory tract symptoms is markedly up.
It goes to show the impact that good hand hygiene, cough etiquette, social distancing and avoiding others when sick has.

Read full article on: RACGP

Dr Lachlan Soper

The COVID-19 pandemic has resulted in a large decrease in GP visits. Will those with chronic diseases suffer?

Data from the Medicare Benefits Schedule, analysed by the Heart Foundation, reveals a 10% drop in GP visits for the management of chronic disease in March 2020, equating to 96,000 fewer visits compared to March last year.
Will there be a spike in chronic disease after COVID19 is ‘behind’ us?

Dr Lachlan Soper

Influenza vaccine shortage

Wondered why your GP doesn’t have the flu vaccine in stock?
Around 6.6 million flu vaccinations have been recorded in the Australian Immunisation Register in 2020, compared to 3.4 million at the same time in 2019.
Australia, for now, has run out of influenza vaccine supplies.

Dr Lachlan Soper

Could Australia be COVID-19 free by August?

If you open this link https://www.covid19data.com.au/ and then scroll down to the 3rd graph, hover over the yellow line you’ll see that since Australia hit roughly 600 active cases we’ve gone down by approximately 10 cases a day. With 530 “active cases”, on the assumption that health authorities have tracked down and are following every single COVID-19 case in the nation, and the count dropping by 10 cases a day, there is the possibility that Australia could be COVID-19 free from August. Possibly. Then it would be a matter of extremely strict quarantine, and checking all those people who work with anyone who comes into the country (airline staff, customs, quarantine hotels). We would still be physically isolated from the rest of the world, but there could be some semblance of “life as normal”. Noting that industries that rely on international travel like tourism and education will remain severely affected.

Dr Lachlan Soper

Update to Asthma guidelines coming

For those with asthma in the family it is worth noting that clinical guidelines will be updated in coming months. They will emphasise the importance of using puffers with corticosteroids used in combination with relievers, as opposed to only using relievers.

It will be recommended that short-acting-beta-agonists (SABAs), or better known as blue puffers like Ventolin, cease to be used as quick relief in the treatment of mild asthma. Instead, all adults and adolescents be initiated on the combination therapy of budesonide-formoterol (brand name Symbicort – a red puffer).

Recent studies, and backed by the Global Initiative for Asthma (GINA) have shown that using this combination therapy both if used daily or as needed to relieve symptoms reduces the risk of severe exacerbations by between 1/2 and 2/3 compared with SABA-only (blue puffer) treatment. This because the SABAs only open up the airways, they do not deal with the underlying pathology – the inflammation.

Read full article on: medicalrepublic.com.au

Dr Lachlan Soper

The Roadmap to easing Coronavirus restrictions

Australian Chief Medical Officer Professor Murphy said evidence is growing that the majority of COVID-19 transmission occurs indoors and also said “There’s an absolute risk about gathering size”.

Each state in Australia will implement these stages at different times and slightly differently, but here are the broad brush-strokes:

Stage 1: Allowing five visitors in private homes and 10 visitors in businesses and public places. Restaurants, cafes, retail, libraries, community centres, playgrounds and exercise boot camps will be allowed to open and resume. Travel within states for non-essential reasons will also be allowed.

Stage 2: will allow gatherings of up to 20 people, as well as the opening of gyms, beauty shops, cinemas, galleries, amusement parks, caravan parks and camping grounds.

Stage 3: will let people gather in groups of up to 100, and see the opening of nightclubs, food courts and saunas. There may be the possibility of travel to New Zealand.

These changes will be reviewed every three weeks by national cabinet to assess the impacts and when to move to stages 2 and 3.

Dr Lachlan Soper

Wisdom from Jewish Psychiatrist Viktor Frankl – Success, Happiness and Pleasure

I’ve had the privilege of going through Viktor Frankl’s book, “Man’s Search for Meaning” lately.
Here’s one quote, worth reading twice, on success and happiness:
“Don’t aim at success. The more you aim at it and make it a target, the more you’re going to miss it. For success, like happiness, cannot be pursued, it must ensue. And it only does so as the unintended side effect of ones personal dedication to a cause greater than oneself, or as the byproduct of one’s surrender to a person other than oneself. Happiness must happen, and the same holds for success, you have to let it happen by not caring about it…. In the long run… success will follow you precisely because you had forgotten to think about it”
“Pleasure is, and must remain a side-effect or by-product, and is destroyed and spoiled to the degree to which it is made a goal in itself. Hence the failure of hedonism”.

Dr Lachlan Soper

Six Essential Criteria the WHO says Need to be Met Before Lifting Restrictions

WHO Director-General Dr Tedros Adhanom Ghebreyesus has reminded the world of six essential criteria that WHO argues need to be met before lifting restrictions:
1. countries must have strong surveillance, declining cases, and controlled transmission;
2. the health system must have the capacity to detect, isolate, test and treat every COVID-19 case and contacts;
3. outbreak risks must be minimised in special settings such as health facilities and aged care;
4. essential venues such as schools must have preventive measures in place.
5. the risks of importing the virus must be managed;
6. communities must be fully educated, engaged and empowered to adjust to “the new norm”.
“The risk of returning to lockdown remains very real if countries do not manage the transition extremely carefully and in a phased approach,”

Dr Lachlan Soper

Tracking COVID-19 hotspots through raw sewage

Researchers from the University of Queensland and CSIRO have successfully been able to identify genetic traces of COVID-19 in raw sewage.

‘The hope is eventually we will be able to not just detect the geographic regions where COVID-19 is present, but the approximate number of people infected, without testing every individual in a location’ – CSIRO Chief Executive Dr Larry Marshall

Read full article on: mja.com.au

Dr Lachlan Soper

Another unanticipated consequence of the COVID-19 lockdown – with a silver lining

Major metropolitan hospitals are reporting a 25-40% drop in road trauma, assaults and sports injuries. Even more pleasing, with pubs closed alcohol-linked violence and injury have plummeted!

Infectious disease presentations have also fallen sharply, with dropping rates of influenza, rotaviruses, and other infections meaning fewer hospital attendances.

A question arises regarding the reduction in presentations for strokes, heart attacks, and chronic obstructive pulmonary disease exacerbations. Has there been a real reduction in the incidence of these things because people were at home (and there were not inflammatory or infective triggers for these)? Or is it a problem, where people didn’t attend hospital when they should have?

The latter theory may be backed up by surveys showing that general practices are overall down 30% in revenue (despite telehealth). Also by data showing that 30% and 40% of private and community pathology testing was currently not being done due to people not visiting their medical practitioner and not having their pathology samples collected.

Will there be a surge of serious medical issues once the lockdown eases, as patients who may have put off treatment return to the healthcare system? Time will tell.

Read more in: mja.com.au

Dr Lachlan Soper

Unanticipated consequences of COVID-19 lockdowns: people getting seriously injured with home handywork

CareFlight has noticed a “dramatic” upswing in people falling from roofs. As people are restricted to home, they lose their jobs or they cannot get help, more of them are attempting unsafe home renovation work. Work safely!

“As more people are undertaking home projects that put them at risk, CareFlight urges individuals to take appropriate precautions when performing maintenance around the house.”

Dr Lachlan Soper

How does our nation get through COVID-19? Options: Eliminate or adapt.

How do we balance the prolonged damage to the economy, society and medicine (in other medical issues not being treated) by choosing to ease restrictions vs the potential consequences of further spikes in COVID-19 cases and deaths?

Do we keep the strict “lockdown” until all active cases diminish to zero, and then wait a further 14 days until there have been no new cases – eliminating the virus?

Or do we ease things a little, knowing that COVID-19 will not be controlled and more people will die from it?

The Group of Eight, an affiliation of leading Australian research universities, this week published a report inviting the Australian Government to choose between two contrasting but related strategies: ‘elimination’ of COVID-19, and a ‘controlled adaptation strategy’.

Under the elimination scenario, Australia would continue its nationwide please stay-home order for two further weeks after daily cases reach zero. That means lockdown would last until likely June, given the current trajectory of cases. BUT after that, many social distancing measures could be lifted quite quickly, due to minimal risk of societal spread of disease.

However, in the ‘controlled adaptation’ strategy, the Government would still use extensive “test-and-trace” protocols (to test broadly and trace comprehensively anyone who has come into contact with someone with COVID-19) to keep the number of new cases as low as possible. The positive with this strategy is that lockdown restrictions would be lifted sooner, not fully, but gradually, with continued social distancing measures – in parks, work, schools and shopping areas. These measures lasting for perhaps years.

The advantage of elimination is that people can go back to close proximity sooner (eg: gyms and sitting down in cafes).

The advantage of controlled adaptation is that it may allow less strict travel restrictions later this year or next year. Something which is important for the parts of our economy which rely on people flying in from overseas – in particular the education industry.

Read full article on: theconversation.com

Dr Lachlan Soper

All cause mortality will better evaluate the impact of COVID-19 on deaths

All cause mortality will pick up deaths caused:

  • directly by the virus (eg: respiratory failure),
  • because another disease worsened by the impact of the virus (eg: COVID-19 predisposed to a heart attack), and
  • due to non-presentation or treatment of a disease due to the COVID-19 lockdowns and changes to outpatient and inpatient medical systems

Official statistics are significantly underestimating the true death toll across the world. To calculate excess deaths, the Financial Times compared deaths from all causes in the weeks of a location’s outbreak in March and April 2020 to the average for the same period between 2015 and 2019. The total of 122,000 amounts to a 50 per cent rise in overall mortality relative to the historical average for the locations studied.

The ABC reports that for the UK alone the number of ‘excess deaths’ – deaths above a usual year – have more than doubled in recent weeks, with 22,351 in the week ending 17 April. A normal year would have 10,000 deaths.

https://www.abc.net.au/news/2020-04-30/coronavirus-deaths-likely-higher-due-to-excess-deaths/12200850

While some of these deaths may be due to other causes than COVID-19, the fact the death rate is so much higher than a normal year indicates the pandemic is playing a major role.

The surge in all-cause mortality suggests either an underreporting of COVID-19 deaths, or increases in other causes of mortality because people are avoiding healthcare.

Read more on: Financial Times.

Dr Lachlan Soper

Why do different countries have vastly different death rates from COVID-19?

According to today’s data from John Hopkins University https://coronavirus.jhu.edu/map.html , the United Kingdom has a Case Fatality Rate (CFR) of 15.5%, this means that for every 6 & 1/2 people diagnosed with COVID-19 in the UK, one will die. However, the CFR for Australia is 1.33%. Both of these countries share a similar heritage, wealth and good medical systems. So why the huge difference?

University of Queensland virologist Ian Mackay said that testing is likely to be the key:  ‘My crude presumption has been that in jurisdictions where rates of death are above 1%, there has been too little testing to capture the denominator,’

The Oxford University Centre for Evidence Based Medicine (CEBM) postulates the following reasons that the CFR varies so greatly country by country:

  • The number of cases detected by testing will vary considerably by country
  • Selection bias can mean those with severe disease are preferentially tested
  • There may be delays between symptoms onset and deaths, which can lead to underestimation of the CFR
  • There may be factors that account for increased death rates such as coinfection with another disease, more inadequate healthcare and patient demographics
  • There may be increased rates of smoking in some countries or comorbidities (such as cardiovascular disease) amongst the fatalities
  • Countries with populations that are older get worse hit by COVID-19 (eg: Italy with the 2nd oldest population in the world)
  • Differences in how deaths are attributed to coronavirus – dying with the disease (association) is not the same as dying from the disease (causation)

Another point to note is that COVID-19 may not be as fatal as the “Case Fatality Rate” implies. CFR rates are subject to selection bias as more severe cases are tested – generally those in the hospital settings or those with more severe symptoms. The number of currently infected asymptomatic people is uncertain: estimates put it at least a half are asymptomatic; the proportion not coming forward for testing is also highly doubtful (i.e. you are symptomatic, but you do not present for testing). Therefore we can assume the IFR (infection fatality rate) is significantly lower than the CFR.

Read full article on: cebm.net

Dr Lachlan Soper

Infectious Diseases Epidemiologists advise that it is too early to open up society

Dr Kathryn Snow and Professor James McCaw, infectious diseases epidemiologists at the University of Melbourne advise that it is too early to lift social restrictions at large risk of a large secondary wave of infections.

“Any epidemic is a random, unpredictable process like a bushfire….At the moment we have spot fires, but they have a habit of surprising you.”

“There’s no surveillance system in the world that picks up every single case. We will still need other risk mitigation in place, and for this virus that means social distancing until we have a vaccine.”

Read full article on: medicalrepublic.com.au

Dr Lachlan Soper

What happens when countries open up too early after a Pandemic. A look at the 1918 Spanish Flu

During the 1918 Spanish flu pandemic, “social distancing” was also employed. Like is happening in our time businesses were suffering from the lack of revenue, and so there was pressure to ‘re-open’ society.

The below article looks at Denver, a city which loosened social distancing rules too early. They ‘opened up’ before cases were effectively eliminated or there was sufficient heard immunity and had a second wave of infections that killed even more.

“Premature declarations of victory guarantee defeat. Buckling to protests increased the number of dead.”

It shows that towns, cities, states, countries that socially distanced for longer and consistently did better in terms of the number of infections and deaths.

Read full article on: cnn.com

Dr Lachlan Soper

Testing for COVID-19 available for all people with respiratory symptoms in NSW

New South Wales is increasing testing for COVID-19 by expanding the testing criteria to include all individuals – particularly healthcare, aged care or other high-risk workers – with symptoms of acute respiratory illness including fever, cough, shortness of breath tiredness or sore throat.
This is due to NSW doubling its laboratory testing capacity from 4000 tests per day to 8000 per day.
Even people with mild symptoms are being encouraged to come forward for testing to help identify as many COVID-19 cases in the community as possible.

Dr Lachlan Soper

Ingredients to great conversation. Be prepared to be amazed – Celeste Headlee

In this talk by Celeste Headlee, she outlines the ingredients of a great conversation: Honesty, brevity, clarity and a healthy amount of listening. And most importantly, “be prepared to be amazed.”

Most of us need to be challenged to apply our minds to what we hear, before we engage our mouths to add our opinion.

10 Rules for better conversations:

  1. Don’t multitask. Be present. Be in that moment. Don’t be half in the conversation
  2. Enter every conversation assuming you have something to learn. Everybody is an expert in something
  3. Use open ended questions. Who, what, where, when, why or how? What was that like? How did that feel? It gives a more interesting response.
  4. Go with the flow. If thoughts come into your mind, let them go.
  5. If you don’t know, say that you don’t know.
  6. Don’t equate your experience with theirs. Their loss of a family member, job loss vs your family loss or job loss. Their and your experiences are different.
  7. Try not to repeat yourself. It’s condescending and boring.
  8. Stay out of the weeds. People don’t care about the years, names, dates… They care about you, what you are like, what you have in common.
  9. Listen. Keep your mouth shut as often as you possibly can. Keep your mind open. Always be prepared to be amazed.
  10. Be brief.

 

“Conversational competence might be the single most overlooked skill we fail to teach.

Kids spend hours each day engaging with ideas and each other through screens. But rarely do they have the opportunity to hone their interpersonal communication skills. Is there any 21st Century skill more important than being able to sustain competent confident conversation. Paul Barnwell, High School Teacher

Listen on: ted.com

Dr Lachlan Soper

How near could Australia be to opening the economy and society post our COVID-19 pandemic?

With the number of “active cases” in Australia at 1473 (see 2nd graph in link below) , & the number of new cases in the nation hovering between 8 and 23 daily for the last 6 days (see 3rd graph), could Australia wait for those 1473 to recover and 14 days of no new cases to resume our society & economy with closed international borders?
 

Read full article on: covid19data.com.au

Dr Lachlan Soper

“Controlled Contagion” for getting through COVID-19

Prof Ian Fraser (who developed the cervical cancer vaccine) and others such as Dr Guy Campbell have proposed that IF a vaccine for COVID-19 is developed it is likely 12-18 months away. Therefore we need to think about “controlled contagion” whereby younger (less vulnerable) people are gradually allowed back into society.

The reason for this is the questions that have been rightly asked by many about the negative effects of the social isolation policies (or lockdown as colloquially phrased), including:

  • Deterioration in mental health – increasing anxiety, depression, domestic violence and suicide.
  • Missed cancers in people not presenting to their usual doctor or hospitals as they usually would.
  • Deterioration of chronic diseases such as diabetes and cardiovascular disease
  • Delayed surgery
  • Not to mention the broad and likely long-lasting economic and employment effects of the social isolation policies to combat the COVID-19 pandemic.

The idea with “Controlled Contagion” is to slowly develop a community “heard immunity” in a sustainable way. This could be done by bit by bit allowing those at lowest risk of severe disease and death from COVID-19 back into society. Noting that statistics from Imperial College London, UK, show only 0.06% of those younger than 40 who are diagnosed with COVID-19 require intensive care. The risk of mortality in those under 40 years is less than 0.03%, and so is less than the current consequences of influenza.

However, 23% of those infected with COVID-19 who are over 60 year old will require hospital admission, of which 47% will require ICU. As a result, those over 60 will account for 90% of ICU demand, even though they make up only about 20% of the population.

Nobel Prize winner Professor Peter Doherty is strongly convinced re-infection is unlikely, and “even if it was … your prior infection would give you very rapid immunity and you would recover very quickly.”

By allowing all healthy individuals under the age of 60 to return to work under the present restrictions of social distancing, the virus would be allowed to spread in a sustainable and more controlled manner.

We could start with those under 40, and then under 50, and then under 60, while maintaining self-isolation for those over 60-years of age.

This is a proposal worth reasoned consideration – to minimise the medical, economic and societal consequences of the COVID-19 pandemic (in their totality over the next number of years as all of the consequences play out).

Dr Lachlan Soper

COVID-19 isolation is suppressing the spread of influenza as well.

According to the latest weekly FluTracking report, rates of flu-like symptoms in the community have dropped from a peak of 1.6% in early March to a historic low of 0.3% in mid-April.

This is significantly lower than the 1.8% incidence of flu-like symptoms reported at the same time last year.

Influenza vaccination has also skyrocketed thus far this year. Since 1 March over 2.1 million flu vaccines have been administered and recorded in the Australian Immunisation Register compared to 634,000 at the same time in 2019, and 235,000 in 2018.

For more information see info.flutracking.net

Dr Lachlan Soper

Walkers, runners and cyclists need greater distances apart to prevent transmission of viruses incl. COVID-19

Keep exercising, but stay outside slipstreams.

A research paper by Prof. Blocken et. al. looking at wind and fluid dynamics, shows that greater distances of “social distancing” are required for exercise for no droplet exposure to the person behind. While 1.5 to 2metres apart may be sufficient for people exercising side-by-side, the distance to the person behind varies for different exercises (as studied in wind tunnels) and for different speeds of that exercise.
 
“If someone exhales, coughs or sneezes while walking, running or cycling, most of hte micro-droplets are entrained in the wake or slipstream behind the runner or cyclist. The other person who runs or cycles just behind this leading person in the slipstream then moves through that cloud of droplets” Prof Blocken.
 
The distance to the athlete / exerciser in front should be no less than:
5 metres when walking at 4km/h
10 metres when running at 14.4km/h
20 metres cycling (the cycling data
 

As the paper has not been peer reviewed yet, a link to a journal is not yet available, but he has released his data considering the need for good data in short time with the current pandemic.

Dr Lachlan Soper

COVID-19 template for telehealth consultations

The attachment below is the infographic flow chart that primary health care workers use for telehealth. Although it’s intended for doctors, it gives a good idea what they are looking for. The little circles down the right hand side indicate the frequency of symptoms.

The most common symptoms of COVID-19 in order are:

Cough, temperature, fatigue, sputum with the cough, shortness of breath, muscle aches, sore throat, headache, chills.

Read full article on: health.gov.au

Dr Lachlan Soper

COVID-19 detected on shoes

COVID-19 is spread by our shoes. Consider taking off shoes & putting them in a bag after you leave potentially infectious areas.

Also COVID-19 has been detected in air about 4 metres away from patients, as well as on computer mouses, bins and sickbed handrails.

Is 1.5m enough for social distancing?

Read full article on: cdc.gov

Dr Lachlan Soper

More than 2-000-000 cases of COVID-19 worldwide

Worldwide COVID-19 cases now top 2million with 128-000 deaths.
That’s 6.5% of people detected with COVID-19 dying. The death rate is greater than 10% in the UK, Spain, France and Italy!
On the positive side, worldwide, the number of new cases daily is increasing at a slower rate.
Australia has nearly 6500 cases confirmed, with a 1% death rate.

https://coronavirus.jhu.edu/map.html

Dr Lachlan Soper

Should Australia aim for complete COVID-19 elimination?

“The least-bad endgame is to eliminate the virus from Australia, continue to control our borders until there is a vaccine or a cure, and restore domestic economic and social activity to “normal”, albeit keeping a close watch for new cases” Grattan Institute.

I think this makes the best sense as a strategy. Australia is lucky to be an island, and a long way away from other countries. We can keep our borders locked down. And, if possible, complete elimination enables people to go back to work, school, local holidays etc… (albeit somewhat disengaged from world trade).

Read full article on: theconversation.com

Dr Lachlan Soper

Could Australia ease stage 3 COVID-19 isolation restrictions in June?

A paper from the Grattan Institute, looking at the reduction in new cases of COVID-19 in Australia, using modelling from the Universities of Sydney and Melbourne give hope that Australia could possibly get to 0 cases of coronavirus around June.

As they say “Getting from ‘nearly 0 cases’ to 0 cases is the toughest part of the elimination strategy.”

Read full article on: blog.grattan.edu.au

Dr Lachlan Soper

Simple educational video on COVID-19, worthwhile for discussions with family.

The attached link is an educational piece from Wolters Kluwer who do medical education. It’s a good, simple yet reasonably comprehensive piece on COVID-19. It’s particularly good for those who have not been following the disease closely – like children, teenagers or to give to patients as a starting point for discussions. It discusses things like:

What is coronavirus?

What it affects.

How does it spread?

How long it takes to get sick after exposure.

What are it’s symptoms?

How to get help – call first.

How to prevent it: Good use of hand sanitiser and handwashing technique; social distancing; cleaning surfaces; masks

Read full article on: wolterskluwer.com

Dr Lachlan Soper