The Coronavirus Thread (We nearly didn't see City in the 2021 Grand Final)

[belaguttman]

4 hours ago, jw1739 said:

Doesn't it come down to the Constitution itself? As it stands it's very hard to have a "national" response to anything. I don't think too many of our leaders understood their powers at the start of the pandemic.

Yes, that's a problem reflected in so many areas. Different aspects of healthcare involve Council, State or Federal responsibilities, often resulting in either duplication or cost shifting.

[NewConvert]

4 hours ago, jw1739 said:

Doesn't it come down to the Constitution itself? As it stands it's very hard to have a "national" response to anything. I don't think too many of our leaders understood their powers at the start of the pandemic.

I'm not too fussed about having a national response. What is good for Melbourne is not necessarily good for Brisbane or remote aboriginal communities.

It is quite possible (probably realistic) that the political class was not aware of anything other than tax cuts and base politicking. As far as I can tell not many of them have any interest in too many useful things. Be interested to know how many had picked up a science magazine in 2018.

[belaguttman]

3 hours ago, NewConvert said:

I'm not too fussed about having a national response. What is good for Melbourne is not necessarily good for Brisbane or remote aboriginal communities.

It is quite possible (probably realistic) that the political class was not aware of anything other than tax cuts and base politicking. As far as I can tell not many of them have any interest in too many useful things. Be interested to know how many had picked up a science magazine in 2018.

A national response doesn't mean that the same thing should be happening everywhere, in reality we have multiple micro clusters, all at different stages, all requiring a different response, but a coordinated response, all working from the same principles with the same approach to risk management. There are no absolute answers in medicine, its all about probabilities and risk management. We've had no central leadership so each State has been left to do its own thing, like the US Staes under Trumpery

[haz]

 

[jw1739]

Can anyone explain to me in simple terms what it is we are trying to do in terms of the pandemic as it stands at the moment?

I'm totally lost as to what outcomes we are trying to achieve and what rules and regulations (if any) are in place. I'm also hearing all sorts of statements that differ widely on the efficacy of vaccines against Omicron.

It seems to me that we are stubbornly adhering to a "national plan" that was formulated to deal with a situation that now no longer exists, and ignoring what is happening in other countries.

[belaguttman]

Yes, what we are trying to do is to limit the impact on the health system. The health system permanentlky operates at 100% capacity so any significant extra demand will see it collapse, particularly in rural areas. Whilst only a small number of Covid illnesses require admission and a small percentage of those requirte ICU admission, that is all it takes to overwhelm the health system so you need to understand the Government response at a population level rather than an individual level because if the health system collapses, nobody will get timely investigation or care for any significant health condition.

Population level vaccination >90% will effectively limit the spread of Covid and protect the health system and almost every vaccinated individual. Effective vaccination is one of many evolutionary selection pressures on the virus so we can expect continued evolution with new variants, most of which won't be significant. Omicron is one of the latest, the mutations increase the infectivity but, and there's only early limited data at the moment, doesn't appear to increase the risk of serious illness or death over previous variants. Like delta and every other version though, maximum protection (and that is very effective) requires three doses of vaccine on current evidence, two doses is insufficient to prevent infection although, again evidence is limited, may still protect against serious illness.

The problem is that if 10,000 people are becoming infected each day as opposed to 1,000, then the number of people requiring hospitalisation and ICU is far greater, again threatening to overwhelm the health system. The talk of increased restrictions and the plea to get vaccinated is in response to this risk. 

The Victorian Government is more risk averse and errs on the side of caution (as it should), the NSW Government is choosing to take a 'riskier path' as we will see in the next week. Things should improve a little with schools breaking up as school age kids have been driving the rise in infections as many of them have been ineligible for vaccination until recently.

The take hom message is that the vaccines are functioning well and are effective and safe (far safer than getting Covid) and will protect individuals, vulnerable other citizens and the healthcare system. If you get Covid whilst double vaccinated you are still unlikely to end up in hospital, but will have far better protection with three doses, and will protect others who can't/refuse to be vaccinated.

Wearing a mask in public settings is still prudent, I'm wearing one except whilst eating, and then I'm trying to eat outside at cafes.

Edited December 20, 2021 by belaguttman

[jw1739]

Thanks @belaguttman. I don't know how long we can go on putting our heads in the sand and holding out against re-introduction of rules and restrictions. Whether we're supposed to be taking about "cases" or not, they measure the extent to which the virus is circulating in the community, and NSW is not looking too flash this morning.

Like you we are being ultra-cautious, and we don't even go to any outdoor venues except for shopping essentials and exercise. 

[belaguttman]

We certainly are unlikely to get the ICU overload we would have had without mass vaccination, it's unclear about the chances of getting 'long Covid'. Time will tell, but that will result in a large caseload tail and lingering illness for many.

[jw1739]

On 22/12/2021 at 11:39 AM, belaguttman said:

We certainly are unlikely to get the ICU overload we would have had without mass vaccination, it's unclear about the chances of getting 'long Covid'. Time will tell, but that will result in a large caseload tail and lingering illness for many.

Well, you can try and convince me @belaguttman but I don't think you will. "Opening up" just as Omicron takes off is counter-intuitive to me and I'd say at this stage the numbers are with me. And it's not only the numbers - as you will know, members right through our health services have been stretched to the limit, and probably beyond it, for months now, and are exhausted. Not only that, there are now so many cases that essential services such as the supply of food are threatened. In many ways, the present situation is worse than lockdown.

In my view this is the biggest fuck-up in public health in my lifetime. 

[belaguttman]

2 hours ago, jw1739 said:

Well, you can try and convince me @belaguttman but I don't think you will. "Opening up" just as Omicron takes off is counter-intuitive to me and I'd say at this stage the numbers are with me. And it's not only the numbers - as you will know, members right through our health services have been stretched to the limit, and probably beyond it, for months now, and are exhausted. Not only that, there are now so many cases that essential services such as the supply of food are threatened. In many ways, the present situation is worse than lockdown.

In my view this is the biggest fuck-up in public health in my lifetime. 

The risk is that we don't understand the omicron risk with any clarity, however, given its high infectivity and rapid spread around the world, if it was goimg to be a public health disaster, we would already know. That doesn't mean that we should take it easy, however overseas comparisons aren't equivalent, we are far more vaccinated than most, and summer is lower transmission risk than winter. The issue is realy around risk management, there is no option without risk, NSW are probably erring on the side of greater risk taking, certainly more than Victoria, clearly Perotet is dismissing medical advice, however its unlikely to be the biggest public health fuckup, that will be the next pandemic, when we are likely to show that we've learned very little.

[jw1739]

At the moment it seems our governments are hell-bent on relaxing this and that and trying to pretend that the virus just isn't there, and, oh well, the poor sods that do get really sick or die are just collateral damage.

[belaguttman]

13 minutes ago, jw1739 said:

At the moment it seems our governments are hell-bent on relaxing this and that and trying to pretend that the virus just isn't there, and, oh well, the poor sods that do get really sick or die are just collateral damage.

What we need to do to stay safe when there is no vaccine is very different from when we are vaccinated. We'll probably peak around 10,000 cases a day and then quickly drop. Only a small percentage of those will need hospitalisation, most of them will be unvaccinated.

The chance of being exposed to Covid has greatly increased, however the consequences have become far less severe for the vaccinated so the risk is not higher. (risk = likelihood x consequences)

[jw1739]

12 minutes ago, belaguttman said:

What we need to do to stay safe when there is no vaccine is very different from when we are vaccinated. We'll probably peak around 10,000 cases a day and then quickly drop. Only a small percentage of those will need hospitalisation, most of them will be unvaccinated.

The chance of being exposed to Covid has greatly increased, however the consequences have become far less severe for the vaccinated so the risk is not higher. (risk = likelihood x consequences)

Oh, I understand risk, don't get me wrong on that. Spent half my life dealing with it. What I'm not convinced about is that there is a sufficient understanding of the level of protection that vaccination gives against both Delta and Omicron, or the actual level of vaccination if the booster is taken into the equation. 

[belaguttman]

7 minutes ago, jw1739 said:

Oh, I understand risk, don't get me wrong on that. Spent half my life dealing with it. What I'm not convinced about is that there is a sufficient understanding of the level of protection that vaccination gives against both Delta and Omicron, or the actual level of vaccination if the booster is taken into the equation. 

Vaccine protection is individual, but also occurs at a community level. This is why vaccines can be very effective at a populatoion level whilst only providing 60% individual protection, we have good community protection now, it'll improve as more 5-12 yo kids get vaccinated iover the holidays. 

All our current vaccines offer 50%+ protection against infection but ongoing high protection against serious illness (hospitalisation required). The elderly and those with co-morbid illnesses are still at increased risk and that's why they need the rest of us to be immunised, to break the chain of transmission before it reaches them.

Thje booster rstores high level of protection against infection and maintains high level protection against serious illness.

[jw1739]

I don't understand why we are letting the virus rip. People say we will reach a peak in infection numbers and then a drop - where is the science that says that this will occur? What is the point of doing this when we are not yet at the peak but already overloading health services and people are dying. Why not re-introduce restrictions, or even lock down again, to at least slow the spread of infection, and avoid the overload of health services and reduce serious infections and deaths? It was said that we locked down before to allow us breathing space to get vaccinated - doesn't the same apply now with booster injections? I just don't see the logic in what we are doing now.

[belaguttman]

5 hours ago, jw1739 said:

I don't understand why we are letting the virus rip. People say we will reach a peak in infection numbers and then a drop - where is the science that says that this will occur? What is the point of doing this when we are not yet at the peak but already overloading health services and people are dying. Why not re-introduce restrictions, or even lock down again, to at least slow the spread of infection, and avoid the overload of health services and reduce serious infections and deaths? It was said that we locked down before to allow us breathing space to get vaccinated - doesn't the same apply now with booster injections? I just don't see the logic in what we are doing now.

Because both Dominic Perrottert and Morrison are morons and have decided they've spent enough time listening to experts, they want to get back to listening to the familiar vested interests. As we can see, the 'let it rip' strategy is very very bad for the economy, and will kill lots of people that would have otherwise have survived, as well as dangerously degrading the health system that we all rely on for many years. We've already exceeded the most pessimistic Doherty modelling, that was done with delta as an assumption, not omicron, but rather than order new modelling, Perrottet decided to let it rip.

The real criminal part of this though is that there has been no preperation for it, no kids vaccinated, no third vaccine push, no RA testing kits available at any price outside capital cities, overwhelmed PCR testing sites, the brakes released just when many health workers were on long-overdue leave. There's no surge capacity in the health system, but Scummo can go to the cricket and eat his barramundi.

I'm disappointed beyond words as this is not going to go well, and after 2 years of sacrifice, particularly here, where we took the hit to protect the nation, Perrottet has just said a big "fuck you" to all the nation outside Sydney

My suggestion - get your third vax ASAP and pray that you don't get sick in 2022. Remember what the Liberals have done at election time.

[jw1739]

@belaguttman How are they getting away with this? The journos are so piss weak that nobody seems to be questioning the decisions. It's beyond my comprehension. Our "numbers" on a population basis are as bad as everywhere else. As you know, I'm in the vulnerable age bracket - don't worry, I've had the third shot but my wife has to wait because she's younger. We're behaving even more cautiously than ever we did in the lockdowns.

[belaguttman]

2 hours ago, jw1739 said:

@belaguttman How are they getting away with this? The journos are so piss weak that nobody seems to be questioning the decisions. It's beyond my comprehension. Our "numbers" on a population basis are as bad as everywhere else. As you know, I'm in the vulnerable age bracket - don't worry, I've had the third shot but my wife has to wait because she's younger. We're behaving even more cautiously than ever we did in the lockdowns.

Murdoch backs the Coalition, he won't attack them for this. When did you last see an attack on this Government over the size of the deficit, for instance?

Our numbers look worse than the US because we are doing far more testing than they are (but not enough). NSW isn't recording RAT +ves, we started from today, one can only imagine their figures and understand why Perrottet will be in no hurry to implement it, after all, they are the "gold standard".

If I hear that one more time I'll throw up.

Edited January 8, 2022 by belaguttman

[belaguttman]

1 in 10 people who have ever been diagnosed with Covid in Australia have been diagnosed in the past 24 hours. This is what 'let it rip' means, exponential growth.

[jw1739]

https://www.abc.net.au/news/2022-01-12/covid-supply-chain-crisis-economy/100750814

[NewConvert]

8 hours ago, jw1739 said:

https://www.abc.net.au/news/2022-01-12/covid-supply-chain-crisis-economy/100750814

This is a serious failure of everything.

[jw1739]

17 hours ago, NewConvert said:

This is a serious failure of everything.

What we're doing now is utter stupidity. Scummo and Pirouette have lost the plot, and Dandrews has lost his nerve (BTW the poor bugger looks as though his back injury is a lot worse than people have thought, and I wouldn't wish that on anyone.)

At my age I now feel less safe than I did during the Delta lockdowns. And to say that we're "living with the virus" is just lies when so many disruptions are happening.

[marn11]

You blokes need to take a Xanax. #letitrip

[belaguttman]

23 minutes ago, marn11 said:

You blokes need to take a Xanax. #letitrip

better off taking a vaccine booster

[belaguttman]

A helpful way of looking at this is by using statistical risk evaluation using a concept called a micromort. From Wikipedia:

Quote

A micromort (from micro- and mortality) is a unit of risk defined as a one-in-a-million chance of death.[1][2] Micromorts can be used to measure the riskiness of various day-to-day activities. A microprobability is a one-in-a million chance of some event; thus, a micromort is the microprobability of death. The micromort concept was introduced by Ronald A. Howard who pioneered the modern practice of decision analysis.[3]

Micromorts for future activities can only be rough assessments, as specific circumstances will always have an impact. However, past historical rates of events can be used to provide a ball park, average figure.

some daily activity risk levels

Quote

Travel[edit]

Activities that increase the death risk by roughly one micromort, and their associated cause of death:

• Travelling 6 miles (9.7 km) by motorcycle (accident)^[24]
• Travelling 17 miles (27 km) by walking (accident)^[25]
• Travelling 10 miles (16 km)^[26] or 20 miles (32 km)^[25] by bicycle (accident)^[a]
• Travelling 230 miles (370 km) by car (accident)^[24] (or 250 miles)^[25]
• Travelling 1,000 miles (1,600 km) by jet (accident)^[26]
• Travelling 6,000 miles (9,656 km) by train (accident)^[24]

• Travelling 12,000 miles (19,000 km) by jet in the United States (terrorism)^[28]

Chronic risks

Quote

Chronic risks[edit]

Micromorts are best used to measure the size of acute risks, i.e. immediate deaths. Risks from lifestyle, exposure to air pollution, and so on are chronic risks, in that they do not kill straight away, but reduce life expectancy. Ron Howard included such risks in his original 1979 work,^[26] for example an additional one micromort from:

• Drinking 0.5 liter of wine (cirrhosis of the liver)^[26]
• Smoking 1.4 cigarettes (cancer, heart disease)^[26]
• Spending 1 hour in a coal mine (black lung disease)^[26]
• Spending 3 hours in a coal mine (accident)^[26]
• Living 2 days in New York or Boston in 1979 (air pollution)^[26]
• Living 2 months with a smoker (cancer, heart disease)^[26]
• Drinking Miami water for 1 year (cancer from chloroform)^[26]
• Eating 100 charcoal-broiled steaks (cancer from benzopyrene)^[26]
• Traveling 6000 miles (10,000 km) by jet (cancer due to increased background radiation)^[37]

and the Covid risks per event basis compared to other event risks

Quote

• Hang gliding – 8 micromorts per trip^[24]
• Ecstasy (MDMA) – 0.5 micromorts per tablet, rising to 13 if using other drugs ^[29][30]
• Giving birth (vaginal) – 120 micromorts^[31]
• Giving birth (caesarean) – 170 micromorts^[31]
• Infection fatality rate COVID-19 at age 10 – 20 micromorts
• Infection fatality rate COVID-19 at age 25 – 100 micromorts
• Infection fatality rate COVID-19 at age 55 – 4,000 micromorts
• Infection fatality rate COVID-19 at age 65 – 14,000 micromorts
• Infection fatality rate COVID-19 at age 75 – 46,000 micromorts
• Infection fatality rate COVID-19 at age 85 – 150,000 micromorts^[32]

Whether you need a Xanax or a vaccine depends on your age, health and perspective.

Edited January 13, 2022 by belaguttman

[jw1739]

If only the various governments in Australia would listen.

https://www.abc.net.au/news/2022-07-24/queensland-gp-covid-fatigue-deaths-hospitals-pandemic/101215698

[NewConvert]

5 hours ago, jw1739 said:

If only the various governments in Australia would listen.

https://www.abc.net.au/news/2022-07-24/queensland-gp-covid-fatigue-deaths-hospitals-pandemic/101215698

Don't get me started...

 

[jw1739]

17 minutes ago, NewConvert said:

Don't get me started...

 

@NewConvert It really is "ostrich head in the sand" stuff now, isn't it? All sectors of health care are saying that we cannot go on as we are, and, in practice, are being ignored.

[NewConvert]

1 hour ago, jw1739 said:

@NewConvert It really is "ostrich head in the sand" stuff now, isn't it? All sectors of health care are saying that we cannot go on as we are, and, in practice, are being ignored.

Yeah we have crossed the threshold where the public at large are saying let people die, the politicians are let the culling begin, and we have to see whether we draw the short straw. Eventually, the people in health care will say fuck it, they don't give a damn so why should I?

[belaguttman]

As a psychiatrist in private practice, I'm getting 5 new referral calls every single week; that's 250 new patients every year in addition to my existing caseload. I don't even have time to call most of them back.

It's a choice for me over which moral injury I want to suffer from: do I try and see everyone and give everyone crap care, or do I choose to just offer most people no care at all, knowing that they also won't get it anywhere else.

Well, this is the 'freedom' that a small vocal minority were shouting for. Don't expect any improvement before 2025 at the earliest, even when the pandemic is over, doctors, nurses and paramedics will continue to leave the system in large numbers. They won't be coming back.

[jw1739]

On 24/07/2022 at 6:43 PM, belaguttman said:

As a psychiatrist in private practice, I'm getting 5 new referral calls every single week; that's 250 new patients every year in addition to my existing caseload. I don't even have time to call most of them back.

It's a choice for me over which moral injury I want to suffer from: do I try and see everyone and give everyone crap care, or do I choose to just offer most people no care at all, knowing that they also won't get it anywhere else.

Well, this is the 'freedom' that a small vocal minority were shouting for. Don't expect any improvement before 2025 at the earliest, even when the pandemic is over, doctors, nurses and paramedics will continue to leave the system in large numbers. They won't be coming back.

The pandemic took a new twist this week. Like King Canute's nobles who believed that their king could stop the tides, a group of our own "nobles" has decided that we can end the pandemic simply by saying so.

https://www.abc.net.au/news/2022-10-01/scrapping-covid-isolation-periods-impact-on-the-workforce/101493882

[belaguttman]

The pandemic hasn't finished with us. Luckily, the generation 2 vaccines are starting to become available, including a very promising nasal spray vaccine

[jw1739]

https://www.abc.net.au/news/2022-10-04/mickleham-covid-quarantine-hub-closure/101500356

[belaguttman]

27 minutes ago, jw1739 said:

https://www.abc.net.au/news/2022-10-04/mickleham-covid-quarantine-hub-closure/101500356

It's good that it's there, we will need it in the future

[marn11]

On 01/10/2022 at 9:02 PM, belaguttman said:

The pandemic hasn't finished with us. Luckily, the generation 2 vaccines are starting to become available, including a very promising nasal spray vaccine

Silver lining from the pandemic is the remarkable job the science/medical industry has done in developing and distributing a safe vaccine in an astonishingly short time. Kudos.  

[belaguttman]

48 minutes ago, marn11 said:

Silver lining from the pandemic is the remarkable job the science/medical industry has done in developing and distributing a safe vaccine in an astonishingly short time. Kudos.  

The mRNA technology has been in development for 20 years. It was originally envisaged as a cancer treatment technology but it kept generating an unhelpfully high immune response. Research pivoted to vaccine development once the enclosing lipid membrane stability problem was solved.

The future possibilities of this technology are really exciting; there's already a world-first malaria vaccine using mRNA technology in a large scale trial at the moment; that will be world-changing, if effective.

[marn11]

2 hours ago, belaguttman said:

The mRNA technology has been in development for 20 years. It was originally envisaged as a cancer treatment technology but it kept generating an unhelpfully high immune response. Research pivoted to vaccine development once the enclosing lipid membrane stability problem was solved.

The future possibilities of this technology are really exciting; there's already a world-first malaria vaccine using mRNA technology in a large scale trial at the moment; that will be world-changing, if effective.

Nice.