Covid Is Not Over

Covid is not over and anyone who thinks it is, is ignoring the reality around them.

I live this chronic illness life. I’ve lived it for eight years now. Every. Single. Day. My biggest concern is the increase we are seeing and will continue to see in the numbers of chronically ill people worldwide as a result of Covid-19 infection or infectionS – yes, plural – with multiple infections: researchers are telling us in no uncertain terms, the chances of unfavourable long term outcomes increases with each infection.

This is NOT just a health question. In broad terms, we hear arguments of economy versus health, or health versus economy, whichever you prefer. The simple fact that the health of the population impacts the health of the economy seems to escape many people. There is no healthy economy without healthy people. Let’s be very clear on that. The economy needs workers and it needs customers. Without sufficient numbers of both, businesses close. End of story. Yes, I am sorry, it IS that simple.

Let us look at some facts, but agreed facts are hard to come by. Current estimates are varying. A CDC study estimates 20% of Covid-19 patients end up with Long Covid. Other estimates are higher, some are lower. The one thing that is certain, it is a problem.

Whatever long Covid’s toll turns out to be, it will be too many people. However you gather or analyze the data, experts told STAT, the proportion of people whose troublesome, sometimes disabling symptoms linger after their acute Covid-19 infections clear is sizable and worrying. It’s the cruelty of large numbers: Even if the actual prevalence of long Covid is much smaller than recent estimates, a small percentage of a large number is a large number.

https://www.statnews.com/2022/07/06/understanding-long-covid-estimates/

Covid-19 should be a serious operational consideration for any business, large or small. In very simple terms, sick people who can’t work don’t have money to spend. The economy, including your business, will suffer as a result. It is a double whammy, as there is the risk of lack of workers and lack of customers. We already see supply chain disruption when any of us visit our local supermarket.

A healthy economy is dependant on a healthy population. A person suffering severe fatigue and/or malaise does not go out for dinner at restaurants. A person no longer able to work does not buy new suits. A person no longer able to pay their rent or mortgage may end up homeless.

The risk is not people simply catching Covid-19. Yes, some people are asymptomatic. Or their case is mild. The risk is under the current lack of protections, those people continue working. While working, they are spreading the virus to other workers, potentially to customers. Spread, as we well know, leads to new variants.

We already know the latest variants are evading existing immune responses (from prior infection or vaccination). That potentially leads to more cases. That leads to less workers and less customers.

This is where the economic hit comes. One study estimated 5% to 12% of people infected with Covid go on to develop Long Covid. Long Covid can affect the brain, heart, lungs, pancreas, and other organs, with common symptoms including weakness, general malaise, fatigue, headache, concentration impairment, hair loss, shortness of breath and coughing. We are already seeing waiting lists for Long Covid rehabilitation clinics blow out to more than five months.

As noted earlier, in some jurisdictions the estimates are higher (emphasis added):

That 20% figure, from a recent CDC analysis of millions of health records, implies that tens of millions of Americans — a fifth of people infected with Covid — have at least one lingering post-infection symptom that is seriously affecting their daily life. Compared to other estimates, like an April meta-analysis that puts global long Covid at closer to 50% or a June household survey from CDC saying 1 in 3, it’s even on the low side.
Source: https://www.statnews.com/2022/07/06/understanding-long-covid-estimates/

Given we have a range of estimates, let’s go with the middle ground and use 12% for illustrative purposes. Remember, there are leaders in various fields who are trying to sell the idea that we will all get Covid in the end so just let it rip and be done with it. If we are stupid enough to accept that proposition, then we can estimate 12% of the population will ultimately suffer from Long Covid. At this point in time we don’t know how long Long Covid actually is. 6 months? 18 months? 2 years? Life? The time may vary depending on the type of Long Covid. We don’t know enough yet to make any firm calls on this.

The accounting profession likes to forecast income and expenses using the conservative approach – i.e., we don’t forecast on “best case” scenarios. What is the cost to YOUR business if you lose 12% of your employees because they can no longer function in their role? That’s an increase in casual staff costs while your permanent staff are on sick leave. Or you lose 12% of your customers because they are now chronically ill or disabled and can no longer work? Or 12% of your customers can now only afford to spend 50% (or less) of what they used to be able to spend because they can no longer work their usual hours and their discretionary expenditure is now severely limited?

Then there is the occupational health and safety aspects. At some point in the probably not too distant future an employee will contract Covid-19 at work, become disabled, and sue due to an unsafe work environment. The first case may not win, but the costs involved to defend the action could be considerable. Think back to asbestos as an example of something that was once considered safe but ultimately proved not to be. No employer would expose their employees to asbestos without safety protections in 2022.

Businesses will also suffer from loss of customers because many people do not want to catch Covid-19 because of their own specific health risks. I am one of those people and was interviewed as a vulnerable person by SBS News.

She hasn’t been to a large shopping centre such as Chadstone or Fountain Gate in Melbourne for more than two years, and still schedules her grocery shopping trips for quieter periods.
Source: https://www.sbs.com.au/news/article/the-australians-still-putting-their-lives-on-hold-to-avoid-covid/nom62hc2y

Attendance at venues drops with each wave. Theatres, pubs, clubs, gyms will all suffer. People shop on-line rather that venture into shops. When does a business decide to close an outlet and retrench the staff? Is this good for the economy? No, of course not, because now those retrenched people have less disposable income too. It becomes an ever-increasing problem. An ever increasing health problem due to more Covid infections, more Long Covid patients, new variants. An ever-increasing economic problem die to increased health care costs, less disposable income, less spending, worker shortages.

Mitigations against spread are necessary to ensure we maintain a healthy society and a healthy economy. These mitigations include clean air, mandatory isolation of the infected, masks indoors and vaccines.

Covid-19 is not just a health issue. Do not be complacent.

Dr David Berger has been vocal on the topic.

The pleasing notion that COVID has now been vanquished, however, that it has been turned into “just another seasonal upper-respiratory virus” by vaccination, “hybrid” immunity from repeated infection and natural attenuation of the virus itself, is not supported by the facts.
Source: https://www.smh.com.au/national/the-notion-that-covid-19-has-been-vanquished-is-not-supported-by-the-facts-20221031-p5budz.html

Dr Berger points to reports of new variants.

A “variant soup” of coronavirus has arrived in Victoria and experts warn the new Omicron offshoots will be better at evading immunity and will soon drive up infections….

… Doctors warn they are increasingly treating people who have been infected with coronavirus “three or four times”. Infectious diseases physician Associate Professor Paul Griffin said the emergence of new, more evasive subvariants, posed an increased threat to both vaccinated and previously infected people.
Source: https://www.smh.com.au/national/coronavirus-variant-soup-arrives-in-victoria-increases-risk-of-reinfection-20221031-p5bu88.html

There are two petitions seeking the reinstatement of mandatory isolation for those infected with Covid-19.

The first is an parliamentary epetition with an end date on November 23rd

Petition EN4520 – Reintroduce covid isolation mandates

The second is a Change.org petition with no end date.

Reinstate Mandatory Covid Isolation

I strongly recommend both be signed. Let us protect both our health and our economy.

leg press

I Am Angry

I’m not just angry, I’m sweary angry. However, because I am publishing I am behaving and resisting using the words I am using in my head. Those of you who know me personally can imagine, I am sure.

Recently I was interviewed by SBS News as a vulnerable person in relation to Covid-19.

Robyn Dunphy, 67, has psoriatic arthritis and is on immunosuppressive medication. She is at risk of severe disease. She still takes precautions such as avoiding shops, only buying takeaway coffees and even wearing a mask in the gym if there are other people there.

The Australians still putting their lives on hold to avoid Covid

I later learned it was said about me that “vulnerable people don’t go to the gym“. That is paraphrased. I was like WTF??? My immediate reaction was along the lines of, “Well, that is one person’s uninformed opinion, it doesn’t matter, don’t let it worry you”. Then I thought about it. No, it won’t be only one person’s opinion. There will be others thinking similar, if not the same.

I’m here to tell you why vulnerable people go to the gym. It is a question of risk and return. Of wanting to live a life worth living.

If I do not exercise, my condition will worsen. That is 100% guaranteed. By comparison my risk of catching Covid-19 is lower. Yes, I have four risk factors which mean if I catch Covid-19 I may not fare well:

I mitigate risk as much as I can:

  • I have had five Covid-19 vaccinations including the new bivalent Moderna shot.
  • I mask anywhere indoors – see gym masking below for variation to that rule.
  • I choose my times to go to the gym very carefully.
  • I am retired so I am not exposed to a work environment.

I have a choice. I already know my health deteriorates without the required exercise. I have experienced that, especially over the last two years. I need the weight training in order to retain my physical independence. My rheumatologists words? “Exercise, eat right, good sleep.” We are about to clock up three years of this pandemic – if I had not persevered with my exercise regime as much as I could during that time, I’d be in trouble. I’d be in pain I don’t want to be in.

This attitude of “vulnerable people don’t go to the gym” is very similar to the Invisible Illness issues I addressed in a recent article. People who don’t know make assumptions, make judgements. Unfair and incorrect judgements. Am I being accused of “making it up”?

I mentioned above my masking rule variation for the gym. I’m currently lifting 115 kilograms on the leg press and yes, I do find that level of exertion difficult with a mask on. At lighter weights I can lift with a mask, but as I progress (hopefully back to my personal best of 160 kilograms) it is harder. So I personally do the following.

  • Make sure I am going to the gym at an off-peak time. May only be two other people there.
  • Wear mask into and through the building,
  • Depending on the weather I may do my warmup by walking around the outside of the building rather than on the treadmill.
  • I take my mask off for my 30 minutes of weight training, pop it straight back on when finished lifting.

Swimming is similar. I will take my mask off immediately before putting on my cap and goggles, mask is straight back on when I step out of the pool. I wear the mask in both the hydrotherapy pool and the spa.

Even if I am exposed to the virus during that 30 minutes in the gym, I will have minimised the viral load.

Yes, I am clinically a vulnerable person.

Yes, I will continue to go to the gym to maximise my health by adequately managing my psoriatic arthritis condition. That is a risk I calculate is worth taking given the potential cost to my health of not doing so is high.

Do not make uninformed judgements about what is right for vulnerable people. Do not call our integrity into question by voicing those uninformed judgements.

If you have questions, ask those questions.

Would I prefer we still had protections in place to mitigate the spread of Covid-19? Mitigations like mandatory isolation of infected persons, clean air regulations and masking indoors. Of course!

We All Get Those Weeks

Perfectly healthy people get “those weeks”. Chronically ill people get them too, even us retired ones. My purpose in sharing my week is to assure other chronically ill people, you are NOT alone. Things just go nuts sometimes.

For a few weeks I had been experiencing a recurring tightness in my chest, off and on. Then I was getting spasmodic nausea episodes again. Occasionally I was feeling lightheadedness. My gut feeling was along the lines of my actual gut playing up, BUT to be on the safe side, I called Nurse On Call. Because of my medical status and my symptoms, the nurse called an ambulance, so I ended up in the Emergency Department (ED). This was Thursday, October 20.

Why did I call Nurse On Call? Well, last time I tried to walk off left upper quadrant abdominal pain and ended up taking myself to ED, my GP was not overly impressed with my self-care solution, so I thought this time I’d be more sensible.

Even so, I felt like an absolute fraud – I was convinced someone else needed that ambulance more than I did. In ED they did the appropriate blood tests, which all were, thankfully, negative. They organised a NM Myocardial Perfusion stress test for the morning to categorically rule out my heart as the cause of my symptoms. I was allowed to go home.

Specific grabs from the paperwork

Prior to my trip to Nuclear Medicine the next morning, I prepared my breakfast (I had checked I didn’t need to fast) and made my coffee. I then re-read the paperwork (luckily). For 24 hours before the test, NO caffeine. The cup of coffee went down the sink. Water it was.

The stress test went without a hitch and despite my known nocturnal AV block, my heart is functioning very well.

The general consensus was at this point back to my gut (after we had discounted gall stones on the basis I have no gall bladder). So I have doubled my Somac (Pantoprazole) as per previous gastroenterological advice.

Missed my weight training on the Thursday. Not happy. Given I now had the heart all clear, I was back lifting weights on Saturday. However, I was modifying my workout because that morning I had woken up with VERY painful hands and fingers. Took 15 mg of Prednisolone per my rheumatologist’s instructions for situations like that. If it wasn’t one thing, it was another. The inflammation in my hands was not going to impact my lower body!

I took Sunday as an active rest day.

Yesterday (Monday) I lost my grip on the coffee jar. It hit the coffee mug. The coffee mug hit the floor.

My coffee mug!

Later in the day I went to cut some cheese. Cheese is soft, right? My right wrist was so painful I could not cut the cheese. The wrist wasn’t sore just hanging around doing nothing, but I could not cut cheese. So 15 mg Prednisolone again this morning (yes, could have taken it last night, but it interferes with sleep, so this morning it was). THIS time I will take it for three days.

Also yesterday I had to venture into dangerous territory – public transport. You see, as well as the above, I had noticed my gums were receding slightly. I needed a trip to the dentist and public transport is the only real option as parking is a nightmare in the city.

I’m masked for public transport!

Virtually no-one was masked. Going in wasn’t so bad as there were not many other passengers: coming home was a crowded carriage and I counted only two other people wearing masks and one of those two was clearly a health care worker. Now mandatory isolation has been done away with, I can only imagine how many Covid-19 infectious people might have been on that train. Hence the full force mask! That is not a typo, by the way – I do mean full force!

To digress slightly, I have been working with a team on a petition to reinstate mandatory Covid-19 isolation. My suddenly having these personal health glitches was not helping as I was not contributing as I wanted to. As you are reading this, please visit, read, sign and share the petition! We have over 12,300 signatures so far!

All the while my guts were not exactly behaving, but I’m not going into details, that is more than enough information! As I am typing this, I have needed another nausea wafer, but at least there is improvement from last week!

Today it was back to the GP to confirm I am doing all the right things. Then it was off to the gym, again being careful of my hands and adapting my workout. When I came out of the gym, I looked as red as my lipstick, but sadly the darn camera did not capture the redness! I was annoyed at my camera!

After my workout

Despite all of this, I have still kept up my step count, except for the Thursday. I’ve still found flowers, including the great foxglove which reminded me of my childhood.

My walking flowers

So that is my week so far. Some of us will get much worse weeks. After all, I’m just juggling sore hands and a grumpy gut. Even when “mildish”, these weeks can be disruptive. I’ve had difficulty concentrating. I haven’t got the things done I wanted to do this week. I’ve been very grateful I am retired as the fact I’ve been below par hasn’t impacted work colleagues or work deadlines. I still managed to paint my nails (of course).

To friends and family members of chronically ill people, please be aware that even though we may essentially have our conditions under control, well managed: we will still have “those weeks”. Make your patient a cup of coffee, take them out to lunch if they are up for it. Be gentle.

Reminder: this also links into the topic discussed in “We Don’t All Look Sick! Invisible Illness“. Please read that too if you have a moment.

The Right to Die at a Time of Our Own Choosing

I am aware some people may find this article confronting or disconcerting, so I caution readers to consider whether they are ready for this topic. If in doubt, perhaps revisit at a later date.

Western society in particular seems to have a very unrealistic approach to death. There is a tendency to avoid death at all costs. We have no choice about being born, at least grant us the dignity to control our end of life.

When I was about 12 I watched my grandmother spend the last years of her life bedridden and with dementia in a care facility. I thought this was a very sad ending to her life. When I was about 16, a partner in a local legal firm passed away at his desk, almost but not quite mid-conversation. By comparison to my grandmother’s suffering, I thought what a wonderful way to pass. He was doing what he loved, retained full mental capacity to the end, not a day in hospital. That was the sort of death I have envisaged for myself most of my life. I would be swimming or walking and the it would just happen. I suggest many of us do have similar thoughts, if we think about it at all in our younger years particularly. It is perhaps only when we have health challenges (which can be any age) or later in life that we think about the realities of what might happen.

In 2018 I read the best article I have ever read on this topic: The doctors who think it’s become too hard to die. It is a beautifully written article and while I do share some quotations herein, I highly recommend you read the article.

From the article linked above – Professor Hillman’s family experience

In some respects, this article has a connection to two other recent articles of mine.

In Victoria we have Voluntary Assisted Dying (VAD) legislation which was a wonderful innovation, long overdue, when introduced. HOWEVER it is very restrictive. The patient and ONLY the patient can request VAD at the time it is deemed appropriate. In addition the patient has to be terminal (within a specified timeframe) and experiencing unacceptable suffering.

You can only access the voluntary assisted dying medication if you meet the conditions set out in the law. These conditions are:

  1. You are in the late stages of an advanced disease and expected to die within weeks or months, but not more than six months (or 12 months if you have a neurodegenerative disease, such as motor neurone disease).
  2. You are experiencing suffering, which you consider unacceptable.
  3. You have the ability to make and communicate an informed decision about voluntary assisted dying.
  4. You are making a voluntary, continuing and fully informed decision about voluntary assisted dying.
  5. You are an adult, 18 years old or over.
  6. You are an Australian citizen or permanent resident.
  7. You live in Victoria and have lived in Victoria for the last 12 months.

If you do not think you will meet these conditions but are thinking about voluntary assisted dying, you can still discuss this with your doctor.

https://www.health.vic.gov.au/patient-care/do-i-meet-the-conditions-for-voluntary-assisted-dying

This means we cannot plan ahead. People, whether 100% healthy at the time or already patients, cannot put in place, in advance, instructions to be carried out under certain future circumstances. Our agency, our control of our own life, is denied us by social convention. Admittedly, people often don’t think of such circumstances in their younger years – it isn’t until the likelihood becomes apparent that any of us start thinking “what if….”.

The desire to keep sick people alive for as long as possible, he says, is reinforced by doctors who are “programmed to make you better”.

“Doctors hate saying, ‘I can’t do anything’. We’re curers, healers, miracle workers,” he says.

The outcome, he says, is that it’s hard for us to recognise when a life is better left to end.

https://www.abc.net.au/news/2018-07-28/rethinking-our-approach-to-death-and-having-a-plan-for-dying/10014582

Interestingly, the above quotation was paraphrased unprompted by one of my own doctors when I was talking to her about the topic I cover in my Will Society Adapt? When? How? article. She emphasised the same sentiments re “curers, healers, miracle workers” and “programmed to make you better” expressed above. At what point does “first, do no harm” become contradicted by trying to prevent death? Well, you see, that phrase actually isn’t in the Hippocratic Oath at all. If I have tweaked your curiosity, visit https://www.health.harvard.edu/blog/first-do-no-harm-201510138421 at Harvard for a discussion on the topic.

If (as I have) we appoint a Medical Treatment Decision-Maker, that person can request the cessation of treatment on our behalf, but they cannot request intervention to proactively end life.

Any number of medical situations could arise where I might be suffering but ALSO be deemed cognitively incompetent. Another quote from the VAD link above: “This means that you cannot request it in an advance care directive, because voluntary assisted dying is not available to you once you have lost the ability to make a decision about it“. The very situation I personally fear most, that of lying in a hospital or aged care home bed in pain from my arthritic conditions AND with severe dementia, being kept alive merely so I am not dead, cannot be dealt with in a manner that allows me agency over my death. I find this horrifically cruel. I was quite surprised when a psychologist said to me “but you won’t know”. No, I might not (are we 100% sure of that?) but personally I would rather the costs and health care resources involved be used to help a person with a more favourable prognosis.

Many of us have a family history of dementia. I’m participating in a study at the moment which is looking at ways to slow or even prevent the onset of dementia, but being part of a study doesn’t mean I won’t ultimately develop a form of dementia. Studies have recently indicted that those of us with underlying chronic health conditions in middle age (oh, yay, lucky me) are two and a half times more likely to develop dementia. Another ramification of us being able to keep people living longer, as discussed in previous articles.

Having two or more chronic health problems in middle age more than doubles the risk of dementia, according to a study that researchers say underscores the importance of good health earlier in life.

https://www.theguardian.com/society/2022/feb/02/two-chronic-health-problems-middle-age-double-dementia-risk-multimorbidity-study

Other life events could leave any of us declared to no longer have decision-making capacity. I could have a car accident, I could fall and suffer brain damage. I could catch a virus that leaves me with brain damage (looking at you, Covid-19). It may not be dementia.

Yet should such a situation arise, we are trapped. Literally trapped. For many conditions, if treatment is withheld the conditions may become terminal quite quickly. For many other conditions, however, that is unlikely: we could be lying there for years because we do not have conditions that are terminal in and of themselves. Ceasing treatment may simply mean higher pain levels – I’ve already had a taste of that in I Sat in My Car and I Cried. I can only imagine how bad that could get.

The media has been alive lately with horrifying stories of the state of care in privately run aged care homes, yet clearly if I were in the state described above I would be unable to be cared for at home by my offspring (my daughter is only 24 years younger than I) or via My Aged Care. Nor would I want to be – I would want to be allowed to say my time has come, I’m leaving now. Irrespective of the quality of any aged care home (a topic for a future article), many of us don’t want to spend our final months or years in insufferable pain or other circumstances and unable to “check out”. I do understand that doctors would manage the pain, but that seems rather pointless doesn’t it? Just managing the pain with no prospect of any quality of life, just so I’m not dead.

Under NO circumstances would we have let a farm animal suffer in such a state when I was growing up on the farm. My father would have been horrified at the thought of putting any of his animals though such a situation. Yet humans are happy to force other humans to suffer, simply so we can say they aren’t dead.

I understand completely the ultimate decision can be painful for relatives and for the doctors. I believe this can be traced back to our culture’s unwillingness to accept the simple fact that there is nothing guaranteed the day we are born – other than the fact we will die. That is the cycle of life. Other cultures view death quite differently.

Allowing us to legally set out clear, concise instructions ahead of time would be the compassionate approach. Not everyone will make the same choices. A contact on Twitter related the case of their parents the other day. The mother wanted to go when she considered the time was right given her health state, yet the father wanted to do anything possible to extend his life. It is an individual choice.

Dr Corke says medical practitioners also need to be honest with patients and their families when certain interventions might be futile.

“We’ve come to a point where there’s always something more that we can do and we can never stop,” he says.

https://www.abc.net.au/news/2018-07-28/rethinking-our-approach-to-death-and-having-a-plan-for-dying/10014582

Yes, there is always another medication we can try. Or another surgery. A friend of mine had pelvic exenteration surgery – this is very invasive surgery I have specifically stated in my Advanced Care Directive I will not have. That is my choice.

Even though I can’t currently ask for VAD ahead of time, I have done everything I can do to take the guess work out of my treatment, should such a time arise. I’ve expressly given examples of treatments I do not want. I’ve even mentioned VAD just in case the legislation changes. As the legislation currently stands, this is the best we can do. I hope, in time, we see more compassionate provisions in the legislation. We should be allowed to specify, well ahead of time, our choices.

There is a two episode documentary on ABC iView, Laura’s Choice, which you may find of interest and comfort. Laura travelled to Switzerland to avail herself of VAD.

Laura Henkel has decided she wants to end her life on her own terms, and describes why she has asked her daughter Cathy Henkel and granddaughter Sam Lara, both filmmakers, to make a film about it.

https://iview.abc.net.au/video/DC1917W001S00

I’ll leave you with Dr Corke’s empathetic words.

Photo credit M Bryson Photography

Underlying Conditions

In 2017 I wrote Why Do Our Bodies Attack Us? Like many of us, I wondered WHY did I have a chronic condition (otherwise often known as an underlying condition). Most of my working life has been about root cause analysis – naturally I apply that to myself! It is a bad move, I don’t recommend it, you can drive yourself nuts!

More recently, December 2021, I wrote Will Society Adapt? When? How? looking at society’s lack of acceptance of chronically ill people. I specifically noted I wasn’t looking at environmental impacts in that article, but we can’t ignore the impacts we ourselves, as a species, have created in the same span of the last 100 years or so. In that article I proposed society has yet to adapt to this new chronic state of health, and I referred to my generation as being the first generation of chronic people in any great number. I essentially attributed our survival to improvements in medical science keeping us alive, but why do we fall sick in the first place, in ever increasing numbers?

Regular readers will know I am a big supporter of the work of Julian Cribb, an Australian author and fantastic science communicator. He has recently released Earth Detox – How and Why We Must Clean Up Our Planet.

Every person on our home planet is affected by a worldwide deluge of man-made chemicals and pollutants – most of which have never been tested for safety. Our chemical emissions are six times larger than our total greenhouse gas emissions. They are in our food, our water, the air we breathe, our homes and workplaces, the things we use each day. This universal poisoning affects our minds, our bodies, our genes, our grandkids, and all life on Earth. 

https://www.cambridge.org/us/academic/subjects/earth-and-environmental-science/environmental-science/earth-detox-how-and-why-we-must-clean-our-planet?format=PB

I did refer to chemicals in my 2017 article cited above. I’ve also looked at plastics in Packaging Our Pills in Plastic which includes some videos – visit that article if you are interested.

So while some science is keeping us alive, our tendency as a species to misuse other science for selfish reasons is potentially, at the same time, making us sick. Why did I choose selfish in that sentence? Let’s take plastic as a classic example. When I was a child plastic was not really a thing. Shopping bags weren’t plastic. You didn’t put your fruit and vegetables in plastic at the shops. Glad Wrap? I do remember plastic bags for freezing meat. Pills were still in glass bottles.

But plastic was convenient and we started using it for EVERYTHING! Our wild life has been paying the price for years, but it seems we have too. We just didn’t want to acknowledge that fact because that would be inconvenient and if there is one thing the human species hates, it is being inconvenienced.

Of course, all of this ties in with our population growth: if there were less of us, we’d use less of all the “stuff”. Less MIGHT be manageable. That is a big “might”.

I’m going to turn 67 this year. In my first ten years of life I lived on a farm in the middle of nowhere, BUT I was still exposed to many chemicals. Sheep dip. Top dressing. Weed killers. All before the many safety tests and regulations of today were in place.

Later I moved to the city: car fumes, plastics.

“It would be naïve to believe there is plastic everywhere but just not in us,” said Rolf Halden at Arizona State University. “We are now providing a research platform that will allow us and others to look for what is invisible – these particles too small for the naked eye to see. The risk [to health] really resides in the small particles.”

https://www.theguardian.com/environment/2020/aug/17/microplastic-particles-discovered-in-human-organs

Yes, I have psoriatic arthritis (PsA) and a wonky thyroid (plus a few other things) and yes, there is a genetic component to PsA. What triggered the expression of the condition? After all, genes or no genes, my disease hasn’t been active all my life. What triggers any number of the conditions now prevalent in the chronic illness community, even if there are genes playing a role (in many cases, not yet proven)?

We have to stop blaming our chronic illness patients for being chronically ill, when it is very likely it is the path humans have chosen that has created many of us in the first place.

In our current situation in 2022, chronic illness has suddenly risen to the surface as a “reason” people die of Covid-19, so more people are aware of our existence. I myself am in four Covid-19 risk categories, the most dangerous to me being that I have an underlying inflammatory condition (PsA). We know Covid-19 can cause lots of inflammation: I’ve already got that going on, so I have this image in my mind of Covid-19 entering my body, running into PsA and my PsA saying, “Mate! Great to see ya! Let’s party!”

According to Professor Jeremy Nicholson, there are only about 10% of people in Western society that are “really, genuinely healthy”. You can find that quotation at 31:40 in the second video on Better Health, Together: Living with COVID in 2022.

I’m not suggesting 90% of us are at high risk of imminent death from either our conditions alone or our conditions plus Covid-19. We DO need to know which underlying conditions place us at higher risk of severe Covid-19 in order to be able to adequately take whatever additional protections may be necessary. The fact we are at a higher risk cannot be ignored. I see many on social media particularly suggesting the underlying conditions are irrelevant. They are relevant. We can’t ignore reality because we find it unpalatable. I most certainly think the politicians could separate the sad news of deaths from the statistics relating to underlying conditions. This is where the 90% really comes in – as in, it is potentially most of us!

As I am known to do, I have digressed – or have I? Covid-19 is perhaps a wakeup call. As a species we have created a state of ill-health as “normal”. Because we want our pollution and our chemicals and our plastics – but as Julian writes, we are paying the price. We’ve been somewhat quietly paying the price for a while, now Covid-19 has highlighted our vulnerability.

I know I have a chronic illness – many people do not yet know they have one. Conditions can take a while to be evident enough for the person to seek medical help. I am quite sure my PsA was active at least two years before I was diagnosed. In other situations, many people struggle to get a diagnosis of various conditions for years.

I am NOT suggesting that had Covid-19 come along in 1819, or 1719 that we would have been in a overall healthier state as a species. There were other considerations back then. However, we have changed our world, our environment, our living conditions, massively in the last 100 years. We’ve solved old problems, but created new problems.

I am a massive fan of science generally and medical science in particular, however I am also very aware of the human tendency to misuse anything we can if we see a personal advantage in doing so. Covid-19 gave us a shock: we were the Gods brought to our knees by the invisible.

We are not just destroying the environment of the planet we inhabit. We are not just destroying other species. We are possibly also destroying ourselves.

As Covid-19 Overwhelms Health Systems, What of Non-Covid patients?

While the Omicron variant may be less severe than Delta, the sheer numbers are seeing hospitals and related health services overwhelmed. Health care staff themselves are in isolation/quarantine.

The wait time for a hip or knee replacement in the UK has blown out dramatically. The situation was bad before the pandemic – now it is worsening.

Patients are facing five-year waits for hip replacements as backlogs reach crisis point, according to an orthopaedic surgeon who quit the NHS.

https://www.scotsman.com/health/patients-face-five-year-wait-for-hip-op-says-ex-consultant-3457505

Almost 6 million people are on waiting lists for hospital treatment in England.

I booked a mammogram here in Melbourne in early August – the appointment was in November. In some jurisdictions in Australia, mammograms were not being done at all during parts of 2021, due to Covid-19. How many cases were not detected early enough and this has impacted the outcome for the patient? Will we ever know? While Covid-19 has no direct effect on the performance of mammograms, the changes required to minimise spread of the disease do.

The term “elective surgery” SOUNDS, well, elective – as in not really necessary. Having been through a total knee replacement and watched my boss wait for his hip replacement (he was only fifty, by the way) I can assure you there is nothing “not necessary” about joint replacement surgery. The pain and loss of quality of life can be horrific. The difference is an excruciating knee won’t kill me, so it is considered non-urgent.

“Our health system is at a very different place than we were in previous surges,” emergency medicine professor Dr. Esther Choo said. “This strain is so infectious that I think all of us know many, many colleagues who are currently infected or have symptoms and are under quarantine,” said Choo, associate professor at Oregon Health and Science University. “We’ve lost at least 20% of our health care workforce — probably more.”

https://edition.cnn.com/2022/01/02/health/us-coronavirus-sunday/index.html

The above is the USA. Here in Australia we have changed our isolation guidelines for health workers due to the shortage of staff.

Doctors say a decision to exempt health workers in New South Wales from self-isolating if they are close contacts reflects an “extremely desperate situation”, with warnings the policy change will increase the Covid risk to hospital patients.

NSW Health announced late on Friday night that in “exceptional circumstances”, frontline workers who are asymptomatic close contacts will be exempt from having to self-isolate for seven days, to avoid disruption to key services.

https://www.theguardian.com/australia-news/2022/jan/01/decision-to-exempt-nsw-health-workers-from-covid-isolation-reflects-hospitals-desperate-situation

We have even suggested flying in nurses. Where from, I’ve got no idea as many countries are just as short of health care workers as we are. This is, after all, a GLOBAL pandemic: a point some of our politicians seem to conveniently overlook.

Critically understaffed public hospitals in New South Wales are planning to fly in nurses from overseas, a leaked memo reveals, as managers beg staff to cancel leave and take on extra shifts amid surging Covid cases.

https://www.theguardian.com/australia-news/2022/jan/01/nsw-hospitals-resort-to-flying-nurses-in-from-overseas-as-staff-are-begged-to-take-extra-shifts-amid-covid-crisis

Early in the pandemic, when the scientific and medical communities were still learning much about how to handle this new challenge, I had my own health case disrupted and affected by Covid-19. In early 2020 I was booked for a total knee replacement. That was cancelled due to an early lockdown. Thankfully, I was rescheduled for late May. While I waited I lived on non-steroidal anti-inflammatory drugs (NSAIDs) and Tramadol. Despite ramping up my Pantoprazole under medical advice, the sustained use of NSAIDs still saw me in hospital some time later for gut issues.

When I did end up in the emergency department some months later with excruciating left upper quadrant abdominal pain, due to Covid-19 restrictions gastroscopies were not allowed unless there was evidence of internal bleeding. I joke I was diagnosed the old-fashioned way!

Sara shares she is currently waiting, in extreme pain, for some of that elective surgery.

Non-Covid patients in many hospitals can’t have visitors, with some exemptions permitted.

From a Melbourne hospital web site

Being unable to have visitors can be traumatic for patients, especially if they are in hospital for a considerable length of time. This can affect their recovery.

We talk mostly about the Covid-19 patients themselves: do we have enough ICU beds, enough nursing staff, enough tests and medications to cope with the explosion in numbers. Yet the impacts on non-Covid cases are not being widely reported in the mainstream media at all. This links in with my earlier article where I discussed health systems are FINITE.

We, the people, yes us, we cry out for more doctors, more nurses. Where, exactly, are these health care workers supposed to miraculously appear from? It is not possible. There are limited trained health care workers in the world – not just here, in the world. Not enough to care for WAY too many sick people. We have to accept that as a fact.

https://limberation.com/2021/12/30/pandemic-practicalities/

The Covid-19 patients take priority everywhere as their need is certainly super urgent, but that means non-Covid cases have to be sidelined and a backlog develops (or existing backlogs worsen).

There are long term costs. The cases worsen, are therefore more expensive to “fix”. In some cases, unfortunately, death may ultimately result from delayed treatment.

On New Year’s Day I was in a lot of pain. Just about every enthesis in my body (except hips and TMJ) decided to go haywire. I thought about taking myself to the emergency department, but the concern of exposing myself to a hospital environment made me stay home. Now, my entheses aren’t going to kill me: but what of other cases, such as a suspected stroke or heart attack, where the patient stays home for similar reasons (avoiding possible Covid-19 exposure)?

Here is a thread on Twitter about a man who collapsed in a carpark, Type 1 diabetes. The closest ambulance was at least one hour away. While the ambulance delay may not have been directly attributable to Covid-19 use of resources, it is indicative that the extra load on the system places non-Covid patients at risk.

I don’t have a solution. After all (again), health systems are finite. I do expect to see better media coverage of the risks to all of us. What, if anything, is being done to manage the global crisis facing non-Covid patients?

Pandemic Practicalities

The Covid-19 Pandemic is horrible, frightening, life-threatening. Ignoring the very real practicalities does not solve the problems we face.

Health Systems Are Finite

Early in the pandemic we witnessed China build a hospital in ten days. I’m not aware of any Western nation that has even attempted similar. Even so, a hospital is bricks and mortar. No hospital runs without staff. While we can perhaps employ a secondment strategy to provide cleaning, food preparation and laundry staff, we cannot manufacture doctors, nurses, lab technicians, radiologists, pathologists and other health care staff overnight. Or, for that matter in ten days. It takes a good ten years to train a doctor and even then that doctor is not a specialist in pandemic related disciplines.

We, the people, yes us, we cry out for more doctors, more nurses. Where, exactly, are these health care workers supposed to miraculously appear from? It is not possible. There are limited trained health care workers in the world – not just here, in the world. Not enough to care for WAY too many sick people. We have to accept that as a fact.

Rapid Antigen Tests Need to be Manufactured/Distributed

We want more rapid antigen tests made available. Those have to be able to be manufactured in sufficient numbers. We don’t wave a magic wand and the tests just appear in pharmacies nationwide for purchase. The tests have to be manufactured under strict controls, packed, distributed. Staff are needed to run the production – do we have enough staff to run a 24/7 operation? Even if a 24/7 manufacturing process is running in existing production facilities, do we have enough of those? How long to build more?

Should the tests be free? I personally think so given the circumstances, but how is that managed?

There have been cases of price-gouging. Now it appears there is even more confusion, detailed well this afternoon by Luke Henriques-Gnomes in this thread on Twitter:

PCR Tests to be Collected and Processed

Again staffing issues apply when the sheer number of people needing testing are greater than ever anticipated. SHOULD the number have been anticipated? That’s a whole other question I’ll deal with later. At least the training requirements are not as onerous as for doctors and nurses. We could potentially increase testing capacity, but there will always be the physical constraint of staff availability. That is a fact we can’t change quickly.

More Infectious but Less Severe

The numbers game. Each variant comes with unique characteristics. The general population can be confused if the messaging isn’t clear. As the scientists reiterate, a small percentage of a larger number may be larger than a large percentage of a smaller number. The below quote is Dr. Abdul El-Sayed, epidemiologist and former Detroit Health Department executive director speaking to CNN.

“Just because the per-individual risk of severe illness may be lower, that doesn’t mean on a societal level Omicron doesn’t pose a real risk,” he said. “Even a small proportion of a relatively large number can be a relatively large number.”

https://edition.cnn.com/2021/12/28/health/is-it-cold-flu-or-covid-wellness/index.html

This is a simple example I whipped up to illustrate what this can mean. The percentages used therein are for ILLUSTRATIVE purposes only. As we can see, triple the cases with half the requirement for hospitalisation still results in MORE patients needing hospital care. The new case numbers jumped 30.78% from December 28 to December 29. Yes, there are reporting delays and all sorts of other variables to the reported numbers of cases on any given day, but they are indicative of what is happening. The most important variable is these are only the tested people: how many globally are not being tested? How many do we not know about at all?

I do note that as of December 30, 1.1% of active cases in Australia are hospitalised. I have been unable to confirm whether this includes Hospital In The Home numbers. Note the source below updates daily.

Edited January 8 to add: now some days later, compare the same data. We can see we now have three times the number of people in hospital, but that is a lower percentage of currently active cases.

The Science, NOT The Politics

Yes, the damn politics. The politics has got to stop and stop now. Right now. This is a global disaster and there is no place for politics. If you aren’t part of a SAFE solution, you’re part of the problem. Point scoring off the other side isn’t helpful: and that applies across the board. Personally, I’m not interested in what political colour you are, you are elected to represent us.

As for threats of war and similar “business as usual” inter-nation “disagreements”: THIS IS NOT THE TIME.

LISTEN TO THE SCIENCE. That’s all I ask you to do. Listen to the science.

There is also a simmering question of a particular religious ideology impacting political decision making. I am avoiding that topic today, other than noting yes, that question quite legitimately exists.

Like it or Not, it IS a Numbers Game

During the last pandemic, the 1918 Pandemic, the global population was less than 2 billion. Now it is 8 billion.

https://ourworldindata.org/world-population-growth

During the 1918 Pandemic one third of the world’s population was infected. It is estimated the population in 1918 was 1.8 billion. Everything is relative: in 1918 our population was much lower, but we also likely had less health care workers per head of population than we do now in 2021. It was also a different type of illness. Covid-19 puts people in hospital for long periods. People technically recovered from Covid-19 remain very unwell for long periods or are permanently disabled with Long Covid.

Back to the numbers. One third of our current population is 2.66 billion people. We already know people can catch Covid-19 more than once, that alone increases the numbers. Yes, we have vaccines and those vaccines have been shown to reduce the severity of the disease. On the other hand, Covid-19 has variants. Those variants may evade vaccines and be harder for current tests to detect.

Are we safe to assume that Covid-19 will not infect a greater proportion of the global population that the 1918 Pandemic did? I don’t think so. SO FAR we have been fortunate. In the two years of 2020 and 2021 our reported total cases are only 284,906,146 which for those into numbers is just over a quarter of 1 billion or 28.49% of 1 billion. That is a long way from 2.66 billion.

Oh, but we have better science now than in 1918? True, we do. Very much so. We managed to get vaccines up and running in basically 12 months, give or take. An astounding achievement. We have dramatically improved treatments of Covid-19 patients and continue to learn. However, there are far more of us, living far more densely and travelling far more widely than in 1918. Those factors work in Covid-19’s favour. Not to mention the anti-vaxxers who risk not only themselves, but society in general.

Then we loop back to the Health Systems are Finite aspect. The health care workers we do have cannot work 24/7, it is not possible, none of us can. If the number of cases requiring hospitalisation or Hospital In The Home or whatever care type might be developed in the future, exceed our health care system resources, we have a problem.

I’m not being alarmist but I see way too much lack of understanding of the numbers.

  • “Just get more health care workers!” – WHERE FROM?
  • “Triage the patients to another hospital.” – And when/if all the hospitals are in the same boat?
  • “Provide free tests now!” – Where is the supply coming from? It takes time…..
  • “Fix the overloaded PCR testing, stop the queues!” – How? Where are the staff coming from? Are there enough test kits?

What IS needed is an acknowledgement by politicians and understanding by the general public, globally, that in a worst case scenario we could be trying to treat an INORDINATE number of people. Australia’s population is 26 million in round numbers. One third of 26 million is 8.66 million people. Of that 8.66 million people, up to 37% could be left with some form of Long Covid. That equates to 3.2 million people.

I certainly hope we don’t reach the levels of the last pandemic – but I suggest it is a very dangerous assumption to assume we won’t.

Close Contact Definitions

I refer readers to the OzSage report linked below, where this point is discussed.

Today the Queensland Chief Health Officer stated the definition of close contacts had to change or the state would cease to function, everyone would be in quarantine.

Not much will function too well if too many people are sick, either. New South Wales discarding spread mitigations and protections when they did was grossly irresponsible.

Long Covid

Then there is Long Covid to consider. So much is as yet unknown, but the more I read, the more concerned I become. I’ve written other articles about chronic illness and society, so I’m not going to repeat myself here. Suffice to say the same problems will exist, but for more people. What are the politicians doing about modelling the social, health and economic costs?

A Guardian article today addresses the issue well: Long Covid is the elephant in the room, but it seems invisible to Australian politicians. The existing chronic illness cohort seem invisible to many politicians, so I’m not surprised they’d have to be dragged kicking and screaming to acknowledge what could be a major increase in numbers.

This UK Long Covid patient has detailed his struggles on Twitter. One of many.

The OzSage Report: 10 Key Points

I implore everyone to read the OzSage Report. Here is Point 5 to encourage you to click on the link below.

The rhetoric that case numbers ‘do not matter’ is incorrect – particularly in the face of the Omicron variant. Daily case numbers are now 10 times higher than during the Delta wave and may be 100 times higher in January. Even if hospitalisation rates are lower with Omicron compared to Delta, a halving of hospitalisation rates with a 10-fold or 100-fold increase in cases will still translate to a high burden on the health system. This is likely to overwhelm the health system, with regional services at particular risk.

The trajectory of observed data suggest that hospitalisation and ICU occupancy are on a steeply rising trend and anticipated to exceed earlier peaks quite soon. In other words, optimistic assumptions about the impact of the Omicron variant on hospital admissions are unrealistic.

https://www.theguardian.com/australia-news/2021/dec/30/the-ozsage-report-10-key-points-from-its-critique-of-australias-covid-response

Should We Have Seen This Coming?

The answer is yes, we should have. Humans got too wrapped up in The Economy and Growth (I wrote the below article in August, 2020) and forgot we are really just another species of animal on the planet.

Humans are Earth’s chronic condition. We destroy at will. We see our species as the pre-eminent beings on the planet. Although many believe in a God or Gods in the heavens, here on Earth the human species is all-powerful.

The Gods Brought to Their Knees by the Invisible

Scientists have been warning us for years, but we didn’t listen. We didn’t prepare. In fact, in some ways, we deliberately de-prepared: sold off the Fairfield Infectious Diseases Hospital, for example.

In many ways it would be impossible to plan for the sheer numbers. We can’t have excess trained health care workers sitting around idle for generations, or hospital buildings lying idle. Equipment becomes outdated, supplies pass their use-by dates. Vaccines and tests have to be developed specific to the pandemic. The logistics of it all are difficult to grasp.

But we should have seen it coming. For the politicians to act so surprised is ridiculous. We should, as a species, globally, have been prepared to some degree. Not perfectly prepared, for that would be impossible. Yes, in a pandemic there will be unavoidable loss of life, there will be economic losses, there will be disruptions to travel, education, trade, life as we knew it… Yet we could have been better prepared, not only by having plans at a macro level, also psychologically at an individual level, for the disaster that is still unfolding.

There are no miracles.