Covid: The disease pollies want you to get
04 January 2022
NOOSA – Dr John Gerrard is the chief health officer of Queensland and there are two unusual and important things about this.
One is that, under Queensland law, it is the chief health officer, not the premier, who has absolute power to give public health directions.
Professor Evelyne de Leeuw of the University of NSW says the role has more clout than any other CHO in Australia and “even internationally [as the] final decision-maker on public health.”
And what’s the premier’s role? The chief health officer may act “in consultation” with her.
The other unusual thing about Gerrard is his propensity to make insensitive remarks about the spread of the coronavirus in Queensland, his opinions having the appearance of official policy:
“Not only is the spread of this virus inevitable, it is necessary,” the ABC quoted him as saying.
“In order for us to go from the pandemic phase to an endemic phase, the virus has to be widespread.
“We all have to have immunity [and] there’s two ways you can do that – be being vaccinated or getting infected.
“Once we’ve done that, once the virus is spreading, once we all have some degree of immunity, the virus becomes endemic and that is what is going to happen.”
Aghast at sentiments that sounded more like a threat than an explanation, and which seemed to ignore how safely such transition should be made, blogger Ikonoclast wrote that “these statements are astonishing and a complete abrogation of his responsibilities as a medical professional and chief health officer.”
Ikonoclast was on point in analysing the consequences of Gerrard’s approach, emulated in other jurisdictions:
“The spread of the virus has been made inevitable by deliberate acts (and refusals to act) of public policy.
“There was nothing intrinsically inevitable about it. It was a set of policy choices by Australia’s governments and officials plus the foolish actions of an indulged section of the population.
“To claim that it is necessary to spread a dangerous disease to go from pandemic to endemic is to turn upside down all the precepts of public and preventive medicine developed from about [the year] 1800 onwards.
“Yes, we all have to acquire immunity (realistically partial immunity) if we can, and preferably by vaccination [but] the absolute or near absolute acquisition of immunity by all is impossible.
“There are many immune-compromised people in our Australian community. The number of people with comorbidities which increase the risk of severe illness and death from Covid-19 number in the millions.
“Here are a few examples: 1.2 million people with diabetes in Australia; 600,000 with coronary heart disease; 1.7 million with chronic kidney disease.
“Then there is the weakened immunity of the elderly and the people who can’t be vaccinated at all for medical reasons or who develop no immunity after vaccination.
“The spread of the infection is NOT necessary. The suppression and eradication of Covid was and still is necessary.
“The new variants are making natural immunity and vaccination immunity seriously leaky.
"Indeed, it is looking like Covid might acquire extensive immunity evasion capabilities unless there are further vaccine and medicine developments.
“This is a watershed moment. Late-stage capitalism has given up on public and preventive medicine. It leaves vulnerable people to die.”
Strong words. True words.
Gerrard has an unfortunate characteristic of seeming to look pleased or self-satisfied as he makes statements that leave other people feeling hopeless.
I get the sense that he has set aside the compelling and illuminating words of the ancient Greek physician, Hippocrates (460-370 BC).
First. Do. No. Harm.
In his book, Of the Epidemics, Hippocrates wrote:
“The physician must be able to tell the antecedents, know the present, and foretell the future — must mediate these things, and have two special objects in view with regard to disease, namely, to do good or to do no harm.”
The Hippocratic Oath, one of Hippocrates' most significant contributions to medicine and still an important step in the formal process of becoming a doctor, echoes these words:
“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”
Dr John Gerrard is no Hippocrates.
He was quoted in the Naracoorte Herald last Thursday warning that the number of infections in Queensland would be in the “tens of thousands”:
“That's what a pandemic is about," he blurted with some enthusiasm, "a very large numbers of cases.
"The number of people we expect to get infected with the virus is very large. We are not going to stop the Omicron virus.”
What a remarkably defeatist statement. It offered no indication of his responsibility to seek to manage the outbreak, not merely comment on it.
And on Tuesday Gerrard doubled down, as cited by the Canberra Times: “The numbers of cases we are expected to see through January will be very high, certainly in the hundreds of thousands.”
Tens of thousands had become hundreds of thousands in four days.
And not so much as a word about how the steeply climbing infection curve might be restrained by more effective disease management.
It really is appalling. Having tossed out of the window or thoroughly vandalised basic challenges like planning, ordering, delivering and thorough testing, governments across Australia seem to have decided that people are the problem.
The ultimate deflection, finger pointing and blame shifting. The people's fault. Those dreadful voters.
"We are as prepared as we can be," health minister Yvette d'Ath announced untruthfully tonight. The people are unprepared for this. They are fearful and confused.
And the public communication, never capable, is more confused and contradictory than ever.
Allowing people to die or develop chronic disease seems to be the way out of the Covid management wreckage that Australia's politicians and health bureaucrats, including Palaszczuk, d'Ath and Gerrard, have created.
There’s no way of knowing, but I reckon that down the centuries bureaucrats have been responsible for many more deaths than generals.
As for bureaucrat-generals, of which we have one who disgraces his uniform - our uniform - by freelancing at public relations on national television.…. no words.
The guy at our local Woolworths who puts my regular delivery together every couple of weeks has more supply chain and logistics nous.
And then there’s another critical matter. Gerrard, D’Ath and premier Annastacia Palaszczuk seem to not want to know about - Long Covid.
This is the dirty underbelly of the relentless claims of Omicron being 'very mild', short-term, the final variant, easy on rats’ lungs, a great way to build immunity and good for asthmatics (I made up that last one).
The politicians and doctor-bureaucrats rarely, if ever, discuss Long Covid.
In about 60% of cases, people know when they’ve caught Covid because they have symptoms.
Disease experts, including the great Dr Anthony Fauci, chief medical advisor to the US president, agree that, when it comes to Long Covid, Omicron is like other variants.
This means that between 10% and 30% of people who have had symptoms will develop Long Covid.
A recent groundbreaking Australian study followed 212 intensive care patients for six months after their unpleasant brush with Covid.
The patients were drawn from 30 hospitals across the country.
Unhappily the researchers lost 57 (27%) of the participants, who died during the study.
At the six-month mark, just four (2%) said they were fine and had no further symptoms thanks very much.
But 151 (71%) had acquired some new, persistent and unwanted health problems post-Covid.
Most said they were frequently short of breath and experiencing pain, mobility issues, fatigue and loss of strength.
Let me give you an understanding of what Long Covid may infer for the State of Queensland (population 5.2 million), which would – according to Gerrard’s ‘everyone’s gonna get it’ mantra - be expected to have 2.6 million symptomatic cases.
Fauci and other experts say between 10% and 30% of these cases will end up as Long Covid. That suggests 260,000 and 780,000 Queenslanders.
Let’s take the midpoint and project that, unless there is an intervention to slow the present exponential growth of the disease, about half a million Queenslanders will end up with Long Covid.
In many ways, Long Covid is similar to the neurological disease that brought my career to a halt 20 years ago and which still assails me, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
According to guidelines issued by the US Centres for Disease Control and the UK National Institute for Health and Care Excellence, my ME/CFS is considered to be of a moderate level.
At this level, people are mainly housebound and very restricted in what they can do, including normal leisure and social pursuits.
They can have serious cognitive problems, constant fatigue, reduced mobility and poor quality sleep.
A saving grace is that there are peaks as well as troughs in symptoms and, should these people have a good doctor, as I have, there may be the pharmacological and case knowledge to develop a cocktail of medications that can help alleviate some symptoms.
But Long Covid is worse than ME/CFS, because generally speaking ME/CFS does not cause organ damage.
Any public health policy that ignores Long Covid and does not aim to limit the spread of Covid is flawed and must be ditched.
Last September, health minister D’Ath, defending new government powers to contain the spread of the virus, announced that "these measures are available to allow us to respond rapidly before one case of Covid-19 becomes an outbreak that we can no longer contain.”
Well you failed, minister. Do you want me to draft a resignation letter for you?
While I’m at it, I could pen one for your chief health officer.
What will happen to Queenslanders over the next two months is shaping up as a shocking failure of governance and planning.
It will be measured in terms of deaths and the lingering, debilitating illness that will affect tens of thousands of people.
Welcome to the chronic disease, Long Covid, for the rest of your life.
Earlier today, Gerrard announced 5,699 new Covid cases in 24 hours. Testing showed a 23% positivity rate indicating the pandemic is out of control in Queensland. (Anything over 5% is considered out of control by the World Health Organisation.)
There were also 170 people in hospital, 11 in ICU and two on ventilators.
“We are not going to stop the Omicron virus,” Gerrard declaimed last week as the white flag fluttered.
“Not only is the spread of this virus inevitable, it is necessary,” he said. “The virus has to be widespread.”
Words I never dreamed I’d hear from a doctor. Was he a mortician earlier in his career?
Well, doc, we Aussies are known for having a red hot go when things get tough. That’s what we do in Australia. We have a go.
It’s about time you tossed down a couple of rums and had a go as well.
It is probably the natural innate immunity generating event needed to change the course of this pandemic.
Unfortunately, events like this will result in some deaths but more good is done in the long term.
The high infection rate appears worrying but slowly we are seeing less deaths as a percentage of total infections in Southern Africa and now a few European countries including UK.
It is probably better we have omicron now than in winter.
Posted by: Kindin Ongugo | 09 January 2022 at 11:26 PM
Phil makes a good point: a new variant may once again confound decision makers at every level.
As for letting 'er rip, it is far too late to stop exactly that from happening. We all are now just going along for the ride.
I cannot help but note that the RAT debacle is how the market handles a crisis: finding a way to make wads of cash from the hapless punters, preferably augmented by generous government subsidies in various forms. Hoorah again for 'can do capitalism'.
Posted by: Chris Overland | 05 January 2022 at 06:24 PM
Phil isn't the only one having difficulty 'laying his hands on a RAT', (pun intended) You don't have to look too far or turn on the news to see and hear that there are plenty of rats around, but it's very hard to pin any one down.
It would have been far better to have been honest with the public from the start rather than downplay the dangers and dismiss the incompetent and then attempt to obfuscate any responsibility.
Whatever happened to the sentiments expressed in the old wartime speech: "I have nothing to offer but blood, toil, tears and sweat?"
No one likes being lied to especially by people who are paid to do a job that is clearly beyond many to even comprehend. Our political system has morphed into an old boy and girl network that looks after those who don't make waves and rock the the boats of the owners.
Rats are easy to identify. They will always desert a sinking ship. Apply that in today's political context. It's far easier to make populist statements that you can never be able to deliver on or be held accountable than to work within an organisation to improve the situation for everyone. It just means you don't get any personal recognition. That then raises the real question of why some so called politicians are prone to publically play on people's frustrations rather than work at trying to fix the cause of the problem.
Chris is spot on when he suggests that the real problem is that the voting public only takes an interest in their politicians when it starts to affect them personally. (Sori tumas olgeta).
Who you vote for will always affect future decision making. Start taking a real interest now in who you vote for and challenge them to say what they believe in. Then hold them to account if they are elected.
Posted by: Paul Oates | 05 January 2022 at 09:09 AM
The federal and NSW governments have created another shambolic mess, as Dr Kerryn Phelps points out.
“Letting it rip” will not end the pandemic, nor will it help business or the economy. “Letting it rip” will not turn this into an endemic disease with herd immunity. There will be another wave of another variant.
Posted by: Philip Fitzpatrick | 05 January 2022 at 09:07 AM
While I can understand Keith's concern and apparent anger that the authorities have effectively given up fighting Covid 19, the distressing reality is that we can only live with this virus when it ceases to be a pandemic and becomes endemic (much like influenza or malaria). This necessarily means that we will all get it eventually.
Dr Gerrard is merely stating the plain facts, albeit in a rather insensitive way.
However, as Keith rightly points out, even if mass vaccination minimises the overall death rate, the incidence of Long Covid seems unlikely to be markedly reduced, if at all.
The situation is rather like road deaths, where lives lost get the headlines whilst the number of lives ruined by traumatic injuries is largely ignored. In the case of road trauma, for every death there can be anywhere from 7 to 10 serious and life changing injuries.
So it will be with Covid 19.
The various misjudgements by our politicians, notably those who lead the Federal government, have been well documented and continue. The latest debacle relates to the availability of the so-called RAT (Rapid Antigen Test) for Covid.
Once again the Federal government has been unable to foresee the blindingly obvious and failed to buy a huge quantity of these tests. It then compounded the disaster by declining to exert any effective control over the supply and distribution of these tests, preferring to leave it to the market to sort it out. Predictable price gouging followed. Hoorah for neo-liberal capitalism!
I note that the redoubtable Senator Simon Birmingham seems to have suddenly become the Federal government's chief spokesperson on the pandemic. Poor Simon gets trotted out when the going gets tough because he has a knack for making the government's actions seem reasonable even if they are, in fact, an error ridden mess.
Our PM, whose gift for inserting his foot in his mouth grows by the day, appears to have dropped out of sight, as is his wont when things go awry. His relentless proselytising for his 'can do capitalist' mates on the supply and price of RAT tests has succeeded in annoying virtually everyone.
That said, the political class are powerless to prevent the mass infections we are now seeing, as the disease inexorably works its way through the entire community.
While my family members are all triple vaccinated, my wife and I both have underlying chronic illnesses and so know that we stand a better than average chance of being casualties. This is a bit depressing but there is nothing we can do about it: we must just take our chances along with everyone else.
So, here we are again, in year 3 of this apparently endless pandemic, still confronted with the unavoidable reality that this blasted disease will eventually get us all.
May your god bless you and keep you safe.
Posted by: Chris Overland | 04 January 2022 at 10:56 PM
This evening's interview with Professor Sharon Lewin, the Director of the Peter Doherty Institute for Infection and Immunity on the 7.30 Report by Laura Tingle was instructive.
Along with Professor Mary-Louise McLaws, Professor Lewin is a sane voice amid the covid clamour.
Professor Lewin would probably agree with a lot of what you have written. She also agrees that Scomo has stuffed up the supply of the Rapid Antigen Tests and that they should be free to all Australians. On the same program the Leader of the Opposition, Anthony Albanese, agreed with her.
The reason Laura was talking to Albanese was because 7.30's requests for an interview with a range of Coalition members from the prime minister down has been comprehensibly knocked back twice.
As an immune compromised elderly diabetic in regional Australia I'm having trouble getting the booster and laying my hands on a RAT.
From feeling relatively safe tucked away in the middle of nowhere I'm starting to get nervous. Omicron is now here and spreading.
Posted by: Philip Fitzpatrick | 04 January 2022 at 09:12 PM
Maybe Uncle Fester should review the following:
Good medical practice: a code of conduct for doctors in Australia:
2.1 Professional values and qualities of doctors
While individual doctors have their own personal beliefs and values, there are certain professional values on which all doctors are expected to base their practice.
Doctors have a duty to make the care of patients their first concern and to practise medicine safely and effectively. They must be honest, ethical and trustworthy.
Patients trust their doctors because they believe that, as well as being competent, their doctor will not take advantage of them and will display qualities such as integrity, truthfulness, dependability and compassion. Patients rely on their doctors to protect their confidentiality.
Doctors have a responsibility to protect and promote the health of individuals and the community.
Good medical practice is patient-centred. For individual doctors, it involves working in partnership with your patients, understanding that each patient is unique, and adapting what you do to address their needs and reasonable expectations. Good medical practice also involves practising in a way that is culturally safe and respectful; being aware of your own culture and beliefs and respectful of the beliefs and cultures of others, and recognising that these cultural differences may impact on the doctor–patient relationship and on the delivery of health services.
Good communication underpins every aspect of good medical practice.
Professionalism includes self-awareness and self-reflection. Good medical practice requires doctors to reflect regularly on their practice and its effectiveness, consider what is happening in their relationships with patients and colleagues, and look after their own health and wellbeing. It requires doctors to learn from what has gone well and what hasn’t. Doctors have a duty to keep their skills and knowledge up to date, to develop and refine their clinical judgement as they gain experience, and contribute to their profession.
2.2 Public comment and trust in the profession
The community trusts the medical profession. Every doctor has a responsibility to behave ethically to justify this trust.
While there are professional values that underpin good medical practice, all doctors have a right to have and express their personal views and values. However, the boundary between a doctor’s personal and public profile can be blurred. As a doctor, you need to consider the effect of your public comments and your actions outside work, including online, related to medical and clinical issues, and how they reflect on your role as a doctor and on the reputation of the profession.
Posted by: Bernard Corden | 04 January 2022 at 08:40 PM