Dr Gary Payinda Profile picture
May 3 11 tweets 4 min read Twitter logo Read on Twitter
Measles kills roughly 1 in 1,000 cases. Mostly unvaccinated kids. (Also cancer patients and pregnant people).

109 countries
(plus many more territories, regions, and states)
require childhood #vaccination.

NZ does not.
🧵

@nzherald @NZStuff Image
NZ does quite badly on childhood immunisations, even compared to many lower-income countries. Image
Australia, by comparison, has very high childhood vaccination rates.
94% of children age 5 are protected.
It's only 80% in NZ.

You need 92-94% to achieve herd immunity to measles.

They've protected their vulnerable patients. And their kids.

We, however, will face outbreaks. Image
109 nations across the world have compulsory childhood vaccinations.
It's a policy choice that reduces unnecessary death and disability across much of South-, Central- and North- America, Europe, Asia, and Africa.

In NZ, 33% of 18-month-olds are not fully vaccinated. Image
109 countries require children to be# immunised, to prevent death and disability from vaccine preventable diseases like measles, pertussis, polio, and diphtheria.
Not NZ.
#nzpol Image
In fact, in many parts of New Zealand, our rates of childhood coverage are downright abysmal.
As low, or lower than, the childhood vaccination rates of many impoverished nations. Image
It's not rocket science. We could do better in protecting New Zealanders' public health.
But it seems like we're moving backwards.
Waiting for the next measles or polio outbreak...
inevitable because our vaccination rates are so low.

then closing down schools out of panic. Image
Measles, mumps, rubella, pertussis, and polio outbreaks are pretty much inevitable when you have vaccination rates as low as ours are in New Zealand.
And if you drill down deeper, you'll see almost unimaginable regional (mostly poverty related) differences in childhood vaccination rates.

Rates as low as 49% in some poor rural areas.
Truly third-world levels of protection...
... compared with Aboriginal Australian childhood (5-yr-olds) vaccination rates of 96%.

rnz.co.nz/news/te-manu-k…
We can do better.
TBH, as a wealthy country, it's not likely we could do much worse.
Requiring childhood vaccinations is an option that's used by 109 other countries.

Unvaccinated kids, repeated outbreaks, and school closures is not a healthy response to an ongoing problem.

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More from @GaryPayinda

May 5
A summary thread from the great Emergency Medicine Australasia issue I finally read on the plane; @EMAJournal #foamed

Thom study in EMA: patients with unstable cervical #fractures can sit (29%), walk (63%), lack midline tenderness (27%), and have delayed presentation (20%).
@EMAJournal #emergencymedicine

surf injuries were mostly lower c-spine

NEXUS underperformed compared to Canadian C-spine.

#drowning and cervical CTs are not inextricably linked: don't automatically image unless signs of axial loading/very specific concerns
@EMAJournal [my $0.02 on immobilising (virtually) anyone prehospitally: cervical immobilisation is a myth: collars don't actually immobilise, and 'immobilisation' doesn't actually prevent neurological injury...it *does* however harm (eg aspiration and other harms)]
Read 31 tweets
Mar 6
There is virtually no comparing the harms of tobacco/cigarette smoking and vaping.
Cigarettes are a one-way trip into a world of emphysema, heart disease, stroke and cancer.
I treat these conditions every day.

That we allow corporations to profit off this is repulsive.
At the same time we have a teen vaping explosion.

It's an 'adult only' product but of course that's just fiction.

Youth, especially teenagers (and even younger), are a vast and avid market for one of the fastest growing business sectors in New Zealand: vape sales.
If you spend any time around kids, you will have a stunning exposure to the extent of nicotine addiction in teenagers.
The growth of nicotine vapes marketed to kids (and used by them), is the #BusinessOpportunity of the decade.
Read 5 tweets
Mar 6
I'll offer up one possible answer.

But first, some comments 😀 For-profit health care will always neglect poor and working class folks.

Pvt biz will suck up health money treating the profitable patients. They'll avoid the sick, elderly, poor, and infirm like the plague.
🧵
So any health system that is predicated upon turning sick people into profits is doomed to failure.

The smart, profits are not in treating people with actual health needs.
Once we accept the basic truth that for-profit health care is about making as much profit as possible, and delivering as little health care as possible, we're getting somewhere.
Read 12 tweets
Mar 6
It's probably worth people learning about Epstein-Barr virus (human herpes virus 4).
It's a virus that pretty much everyone gets, the one that causes glandular fever, also known as #mononucleosis. 🧵
For many it's a simple cold, but for others it causes hepatitis, immunosuppression, autoimmune disease, and sometimes, several decades later, the neurodegenerative condition known as #MultipleSclerosis...

healthline.com/health/epstein…
It's worth talking about because it could easily be blown off as just a cold or a flu-like illness. Just like covid.
It infects white blood cells, lymphocytes, just like covid.
And it can cause a litany of acute and chronic medical problems, just like covid...
Read 12 tweets
Feb 19
Guideline summary for #ED docs on early pregnancy loss/miscarriage:
acog.org/clinical/clini…
10% of all #pregnancies end in #miscarriage, though the rate approaches 80% by maternal age 45yrs.
Half of early pregnancy loss (AKA miscarriages) are due to chromosomal abnormalities. 🧵
Crown-rump length (CRL) 7mm or greater and no heartbeat. Mean sac diameter (MSD) 25mm and no embryo.
Each one is an #ultrasound feature diagnostic of early pregnancy loss.
#POCUS
#medtwitter
80% of patients with early pregnancy loss can be safely managed with an expectant management (watch and wait) approach.
Relatively few miscarriages will require ED care; most of these will involve significant and symptomatic haemorrhage or infection.
Read 15 tweets
Feb 16
Ok, so he owns or part-owns investment companies, and private medical practice Whangarei doctors, and Primecare.
I'd really like to know that he does not own a stake in White Cross urgent care, who get taxpayer $ directly.
Maybe he'll address that. He's a recent follower.
In the past, Whangarei GPs have part-owned White Cross urgent care corporation. Is that still the case?
And ED patients get 'free' white Cross vouchers (paid for by your tax dollars of course) to go to (private corporation) White Cross when ED is understaffed/underresourced.
This takes away tax dollars from your public health service/ED/hospital.
Read 4 tweets

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