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An opinion from the front line

September is that happy time that I get to renew my registration with the authorities. I forward them a princely sum, and they forward me a (digital) certificate to say that I am duly registered and fit to practice medicine…hmmm…some may disagree. 

Every year there is a questionnaire asking me if I have completed the obligatory continuing professional development (indeed…I have the bill for that to prove it, another tidy sum to the coffers of the RACGP for counting my numbers and, well, I’m uncertain what else they do to justify the cost, other than nod sagely in my direction, and mark my name off on the roll…), have I been found guilty of any criminal activity, either here or abroad (not guilty, not even likely at present, your Honour), what form of practice do I engage in (fairly conventional, I think), and how much longer do I intend to practice (likely, ‘til I expire, given the current circumstances!).

Interestingly, there was a new area dedicated to seeking responses from practitioners regarding the impact of the current coronavirus measures on medical practice. 

Like a red rag to a bull, I couldn’t resist. Here is a shortened version of my advice to the health authorities.

Mr. Andrews…in your wisdom, you imposed measures designed to protect the health workers. I remember hearing that clearly. How is it then that I, and my colleagues, find ourselves witnessing the greatest escalation of mental health presentations of my long career. It has been devastating to myself, and my colleagues, to observe the utter despair of those whose livelihood your measures have destroyed, those who have been left isolated and with little or no support, those living alone, new mothers expected to cope with telehealth support alone, with family, friends and grandparents feeling they could not break lockdown to offer support. The elderly living independently in the community, their isolation even greater given the fear your message engendered in the population. The dying, doing so alone and isolated, family in many situations prevented from offering support and grieving. The list could go on. This is truly the lowest point in my career, and that is saying something. Over a long career, I have had some impressive lows, but at least I could call on family, friends, and colleagues for support. Mr. Andrews, please don’t protect me anymore, I don’t think I could stand it.

And the message you propound…the ‘killer virus’…Fear has never been a helpful motivator for common sense, as far as I can tell. When you frighten people, you tend to elicit behaviours that border on the irrational. This, I have witnessed in abundance. You publicise the ‘aged care’ related deaths, yet you neglect to mention that those in aged care tend to be particularly frail and likely to perish from the very disorders that rendered them aged care residents! Why did you not qualify the figures by publicising all aged care deaths, to allow the public a perspective on this population demographic. My experience ‘from the coal face’ as you like to put it, is that one enters aged care with a very limited life expectancy. The few figures I could access suggest that the five-year survival in aged care is in the order of single digits. My own experience is that most of my clients who enter aged care (reluctantly!) do not survive 12 months! Many succumb to their illnesses within weeks. They are very ill, that is why they are in aged care! You state you are trying to protect those in aged care, the ‘most vulnerable’, and you adopt measures that devastate the engine room of your population. I’ve not yet seen figures outlining the suicides, the mental health presentation numbers, self-harm numbers, family violence numbers, but my suspicion, from ‘the coal face’, and suggested by your governments hurried response by pouring dollars (that we probably don’t have) into mental health, with extended mental health plans, and the rushed establishment of ‘mental health hubs’, suggests that this particular impact of your strategy has been wholly unexpected, and is an emerging disaster impacting those whose life expectancy would have been measured in decades for the most part.

When I am formulating a management plan, part of my thinking involves an estimation of the expected benefit versus any potential harm. What potential benefits do I envisage from my strategy, and what risks of harm does that strategy entail. Do the benefits outweigh the risks?

At this point in our latest lockdown, in a situation that would appear to have arisen as a result of catastrophic failures in the management of the initial containment measures (and I look forward to hearing your explanations in regard to this in the current enquiry), I would like to hear from you, some sort of estimate of the cost, not just the devastating financial penalty our future generations will pay as a result of your strategies, but an estimate of the human cost of the measures you have taken, and how this stacks up against the lives you propose you have saved. Tough call it may be, but, I suspect over the coming months to years the details will come out. And I suspect they will be every bit as damning as the enquiry into the hotel quarantine fiasco.

For instance, rather than terrifying the population into submission with your daily case numbers and deaths attributed to COVID-19, why not offer some reassurance that, should you contract the virus, as it remains highly likely most of us will over the coming years, it remains overwhelmingly most likely you will fully recover! As my young son has, and as has his partner, her extended family, and their entire social group. Any infective insult has the potential to take life, remember that Influenza – to take one virus alone – causes 1500 deaths in Australia per year on average. What is our current coronavirus tally? I’m unsure, but I don’t believe it has reached this figure. It still might, but, again, I stress, if you are afflicted, keep in mind that it is far more likely you will survive, than perish.

An aging fart such as myself, in the so-called high risk group of men aged 50-70, still expect a greater than 95 %+ survival rate. Reassure people, don’t terrify them! It makes a huge difference to how they cope.

And give people the tools to help themselves. Educate. Viral transmission is overwhelmingly surface transmission. So-called hand to mouth. Touch a surface with viable contagion and then touch your face without hand washing. Most people don’t cough in your face (unless you’re in my job!), so emphasize the value of hand washing with soap and water, or sanitizer if the former is unavailable. By all means maintaining a social distance is appropriate, but seeing people cross the street to avoid walking past me is a testament to some of the irrational behaviours your message has produced.

Tell people that coronavirus is a fragile virus. It is a blob of protein, lipid, and nucleic acid. Outside of human bodies it rapidly denatures and becomes non-infectious. UV light destroys it in seconds (less than two seconds in one report) so it’s capacity to infect people outdoors is likely to be minimal. How then does one justify the mandate of wearing masks outside, walking your dog, or with your significant other (whom one presumes you may have engaged in activities far more likely to spread organisms indoors!). When Brendan Murphy was Chief Health Officer back in March, he stated clearly that masks may have some limited benefit worn indoors, in circumstances where practicising distancing may not be possible, but the evidence even then was very limited and conflicting. I agreed with this position, and it gave people the option of considering this advice and using masks in situations where they may offer some benefit. How did we get from there to the position that masks are clearly of benefit and must be worn at all times out of your house, unless you’re jogging or riding a bicycle! Did I miss something, some new piece of key evidence or landmark study..? What has become apparent through my observational study of one person (myself) is that mask use is so poorly conducted, with people frequently touching, rearranging uncomfortable constricting facial coverings, clearing fogged glasses (and covering their fingers with respiratory secretions) then touching supermarket trolleys, shelf products, fruit and vegetables etc.. There is some evidence to suggest this pattern of behaviour may in fact contribute to viral spread…that makes sense! Mandatory mask use in all situations does not make sense to me.

I am not proposing that measures to protect the vulnerable should not have been actioned. I am proposing that it is my view that the necessary protections could have been actioned with a more considered approach to maximising targeted protections without inflicting devastating impositions population wide…and it could have been achieved…starting with a coordinated, considered response to containment back in March. With that colossal failure, the whole house of cards came down…and so here we are.

To our clients out there who are suffering, those who have been in contact, and those who may not feel they can seek our support…do so, I encourage you. You are not alone. You may not agree with my position, and that is fine. Do whatever it takes to get through this most extraordinary epoch we find ourselves in. Because everyone of you we lose leaves us the poorer, and we have already lost too many.

Even if only to contact me to tell me you think I’m a misguided or ill-informed fool (or worse!), do so. We need to maintain some connectedness through this. The isolation of lockdown, in my view, has been one of the most destructive consequences, and we must break out of this, mandated or not.

I rest my case, and throw myself upon the mercy of the court of public opinion…

Dr Alan Underwood
September 23 2020

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