Thread by @FlynnKirby

1/ cw: COVID-19 Talk (a 🧵)
On Saturday evening, Wangaratta Hospital had its first positive COVID-19 patient.
The level of disruption this caused to the ED was not insignificant, and I watched with admiration as my ED work-family sucked it up and did what we needed to, to keep

2/ ...each other and our patients safe.
Tier 3 PPE is no joke and has become a part of the ED get-up. I can tell you that running around in a busy rural ED in all of this brings new meaning to the term “working up a sweat”. We have been lucky to avoid much of what our colleagues

3/ ... in Melbourne have been dealing with throughout this pandemic, and the last few days at work have built a whole new level of respect in my mind of what healthcare workers in Sydney and Melbourne are currently going through.

4/ Recent rhetoric from the Federal Government has been around our need to adjust our mindset to the “new normal” and “living with COVID”… I don’t disagree with this position, with the current evidence suggesting that COVID-19 is likely to become an endemic disease amongst human

5/... populations (like influenza), with eradication of the virus probably impossible (at least in the short to medium-term).
The impact of lockdowns on the mental, physical and economic well-being of individuals and populations is huge, and has been an important focus of

6/...public health officials and governments so far. Making decisions in order to balance the risks of an explosion in case numbers and the associated strain on the health system, with the need to prevent the detrimental effects of ongoing lockdowns is not a task I envy.

7/It can be easy to criticise our political leaders and public health officials on their management of the pandemic so far, but we must keep in mind that this is an unprecedented problem that requires considered and nuanced decision-making.

8/However, this does not mean that decisions made in the management of the pandemic are above reproach and that we shouldn’t be critical of advice coming from our public health and political leaders.
This week, there has been a push from certain State and Federal leaders about

9/...the need to reopen once we reach vaccination thresholds of 70-80%. These thresholds come from modelling completed by the Doherty Institute which can be found here (doherty.edu.au/.../DohertyMod…...).
There are a few problems with this modelling:

10/ 1. It has not been formally peer-reviewed, and is not without it’s academic critics. The Doherty is a prestigious and well-respected institution with many very smart people involved in it’s work. However, I would hope that any data or models used to inform a national strategy

11/... that has potential for serious ramifications on population health undergo a rigorous academic critique.
2. The 80% threshold targets do not include the paediatric population. Whilst we cannot currently vaccinate children due to a paucity of data on vaccine safety in these

12/...groups, there is mounting evidence that infection, disease and transmission amongst children is not insignificant, particularly with the Delta-variant. Excluding children from vaccine targets makes the targets more achievable, but ignores the fact that this disease can

13/...infect and be transmitted from children, and can cause serious disease in these groups.
3. The Doherty modelling is based on the assumption of a single national epidemic, with no account for the disparities that exist for rural and remote populations, and First Nations

14/...communities. These populations have more restricted access to vaccination, and health service delivery, placing them at unnecessary risk once the Nation ‘opens up’ following the achievement of the national 80% threshold.

15/4. The Doherty modelling finds relatively low estimates of morbidity and mortality based on its model, when compared to other estimates made by the Burnet institute, and the Grattan institute. This is due to a variety of factors including a short time horizon (180 days);

16/ An assumed low proportion of symptomatic infections; an assumed low transmission rate amongst children; and assumed effectiveness of public health measures including testing, tracing, isolation and quarantining even with high daily case numbers.

17/ Many of these assumptions easily fall into question based on recent experience, particularly the capacity of public health systems to effectively trace infection of the delta variant which is especially infectious at a high daily case-load.

18/5. The Doherty modelling and recent rhetoric from the Prime Minister have failed to acknowledge the realities of ‘Long-COVID’, and the ability of current health systems to cope with the COVID-19 caseload associated with reopening our economy IN ADDITION to the existing

19/...health care needs of the population. The recent lockdowns have meant a significant reduction in health service access for many people, and delays in health interventions for people with existing chronic health conditions. This will have ramifications on future

20/...health service provision for these groups. In addition, there is the ongoing mental health epidemic, that is only being made worse by the COVID-situation and barely being dealt with by an already stretched and over-worked and under-resourced mental health workforce.

21/ None of this has been discussed by our Prime Minister, or the Doherty modelling.
6. The Doherty modelling mentions, but does not account for the emergence of ‘vaccine-escape variants’, or variants of the virus that are less susceptible to the protection offered by current

22/...vaccines. Current slow vaccination rates provide optimum evolutionary pressure for the selection of such variants, and it’s likely that we will probably see the emergence of an Epsilon strain in the future. Whether current vaccines work against such a strain is an unknown,

23/...but has obvious ramifications from a public health perspective.
I'm not suggesting that these issues with the Doherty modelling make it an unreliable model or that I know better. But I do believe that we should always analyse advice critically, and work towards improvement

24/ The Doherty modelling has issues, and these should be acknowledged and dealt with, especially when it is being so heavily relied upon by our national leadership in decision making.
Sadly I think that our lives pre-COVID are a thing of the past and we do have to adjust to a

25/...new life of ‘living with COVID’. When and what this looks like remains in question and should be scrutinised by our public health experts. This should be both to minimise the number of people being infected with, dying of, or dealing with the long-term sequelae of COVID-19,

26/...but also to enable our health systems to be able to cope with the looming pressures of an increasingly ageing population, and the associated chronic ill-health that has been significantly under-served over the last 18 months due to the pandemic.
Lastly, vaccination is one

27/...of the biggest tools in our public health ‘bag of tricks’ for fighting this virus. The current vaccines available are very effective, extremely safe (despite what we hear in the news or on social media) and probably our only real way out of the seemingly endless lockdowns

28/...we are enduring. If you haven’t been vaccinated yet, I implore you to give it some thought, and if you are still unsure, reach out and let’s have a conversation about your concerns.
You can find more information about vaccination at (health.gov.au/initiatives...…)

29/Stay safe, be kind to yourself and others around you, and keep questioning things…
#auspol #ruralhealth Ping @helenhainesindi