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COVID-19 – An Old Boy Doctor’s perspective

Dr Michael Forrest

As I write this, we’ve just had the NRL Grand Final with massive crowds at Lang Park, but restrictions on venues like The Triffid make opening those venues for events untenable. Much of the country is still under some form of lockdown, and there’s a building sense of fatigue and frustration. Some decisions can be difficult to understand, and reasonable people will have different perspectives, but there’s still lots of misinformation and misunderstanding. I spend a fair bit of time explaining what’s happening from the perspective of a practicing doctor. I’ve had several long discussions with Old Boys, so I thought I’d summarise that here.

How bad is this disease?

In the US, COVID has killed 700,000 and is currently the second most frequent cause of death for 2021. The R number and Reff (“reproduction” and “effective reproduction” numbers) are useful to compare how contagious different diseases are. Seasonal flu usually has an R of 0.9 to 2, the 1918 pandemic’s R was 1.8, and Ebola’s R was 1.5 to 2.5. It took more than two months of lockdown in NSW to get the Reff for Delta down to 1.2 (it’s currently around 0.75), and with its current lockdown, Melbourne (the most locked-down city in the world) has 1.2. In an unvaccinated open community, the Reff is probably at least 6. It is very easily spread.

This why Delta is a ‘game-changer’. For most of the lockdown period in NSW and Victoria, even under the hard restrictions of a lockdown, the spread of Delta there has been similar to seasonal flu, and not that far off the rate of the 1918 influenza pandemic.

Why don’t we just “let it rip”?

Apart from the risk of deaths, a very practical reason to keep case numbers low is to keep load on the health system manageable. NSW has seen ambulance and hospital services swamped. Severely ill patients with COVID need ICU, and often need some of the most sophisticated and intense intensive care available. There is a limited supply of specialist ICU doctors and nurses. Most patients in ICU stay about three days, but COVID patients that need ICU stay an average of 18 days, so it really doesn’t take all that many severely ill COVID patients to completely fill the available capacity of ICU. And the more patients with COVID in hospitals, the more likely that doctors and nurses will be sidelined by the disease as well. Full ICU means there’s nowhere to go when you have your major car accident, or need surgery for your brain tumour or aneurysm. It means health care as you’ve come to expect it would be impossible to deliver.

Vaccinated people are still getting COVID, so why bother?

All the vaccines available in Australia significantly reduce the risk of severe disease, hospitalisation and death. They don’t necessarily stop you catching the virus, although they do reduce your risk, and they reduce the risk of you passing it on.

We hope that enough people will get vaccinated that even a surge in infections won’t overburden the health system, but we don’t know yet if that will ultimately happen or not. I was very keen to lower my own risk by getting the AZ vaccine back in early March. Every single doctor I know has been vaccinated, for the same reason.

What can I do?

Get vaccinated and encourage your peer group, because Queensland will op[en to the wider world very soon. Be respectful, but also understand that there are a range of possible public policy responses. There’s still plenty to argue about without denying the epic achievements the global scientific and medical community have delivered in the last 20 months or so.

And please support affected BGS community businesses when you’re able to.

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