from Anne in Adelaide, South Australia: Herding Cats … or … It’s Coming your Way.

Rottnest Island off Fremantle, Perth, West Australia. Wouldn’t you come here just to stay in this Quarantine Village?

February 8, 2021

This week our Prime Minister, Scott Morrison, hosted a ‘National Cabinet’ meeting. This is his extra-political Covid-19 group, an ‘intergovernmental decision-making forum’ including the State and Territory Premiers and Chief Ministers. It is apparent that this is a challenging business for the Prime Minister and one where decisions in a time of pandemic are important to get right – for our country and for his political future. Eleven months have passed since this group was formed and the various state leaders are getting more and more techy and determined in their self-opiniated ways of dealing with Covid-19. (5 Labor, 3 Liberal politicians) . For the PM it must be like herding eight feral cats through a narrow door.

Obviously, Prime Minister Scott Morrison would like the gathering of premiers and ministers to discuss the issues relating to the pandemic in a reasonable, if not rational way. Everyone, of course, says they are following the science of medical advice. The trouble is there are various medical advisors and interpretations.

The issue of quarantining returning Australians from overseas (and various other travellers) is one that divides and stresses our states’ leaders. The press calls these differences, ‘deep rifts’. The Labour Premier of Queensland, Annastacia Palaszczuk, and the ultra-cautious West Australian Premier, Mark McGowan, would like the federal government to be more proactive in the face of the new more contagious strains of Covid 19. Everyone loves to have someone to blame.

The numbers of travellers are small. Over 210,000 international travellers have gone into hotel quarantine in Australia. 1.4% have returned a positive Covid test. 82 hotel staff involved in the quarantine process became infected. At the moment, just over 6,000 Australians (and tennis players!) are arriving per week directly into the various major cities. The states are responsible for their own quarantine systems and have thus reacted in different ways. Recently, Western Australia had a severe five-day lockdown after a single worker in the Sheraton Hotel contracted the virus – perhaps through airflow. He had a second job as an Uber or rideshare driver. Victoria and NSW recently each had single quarantine workers infected and those states used ‘hotspot’ strategy, finding out where the individual had travelled while infected.

The sporadic infections in quarantine continue. There is the story of how one quarantined family opened the door of their hotel room to gather in their meal, deposited in the corridor, and managed to infect the family across the hallway. So now we are becoming aware that the virus is far more airborne than previously thought. It is likely to travel through air conditioning systems in large establishments like quarantine hotels.

So the question is: should quarantining decisions be delegated to states? Are hotels suitable quarantine facilities? It appears that hotels have multiple gaps in their infection prevention systems. For example, corridors need separate ventilations systems; quarantine workers should not have second jobs and should wear masks even in corridors (perhaps double masks as they are recommending overseas).

So now our federal government is in process of investigating whether to organise remote quarantine stations outside of our major cities – more like refugee villages. Perhaps in Toowoomba outside of Brisbane or remote islands. Thus, our cities would be protected and we can lessen the impact on our lives in 2021-2022-2023. The support staff and health staff would be isolated in these camps as well. The Prime Minister compares this idea to fly-in fly-out remote mining camps where you stay for two weeks at a time. Rottnest Island has aleady been used for Vasco da Gama cruise passengers in March last year. Remember that Australia is a country of a few major cities and lots of space. (16 out of 25 million live in the 6 major cities).

Hardly a mining camp! Rottnest Island off Fremantle, WA

I think that all countries should take note. This is probably the way of the future. Can you imagine the situation when most people are vaccinated, but, with international travel, people arrive from across the world and require quarantine? We will have sporadic outbreaks for years to come. Maybe new strains will be arriving having bred in the countries that could not get access to enough vaccine. Maybe the virus will become less deadly, maybe our vaccines can be adapted fast enough and given out fast enough to dampen down the world threat. Reading about how wealthy countries are hoarding vaccine supplies and how third world countries are struggling to get access, I am not optimistic.

My daughter in Seattle was told by a friend working in childcare that they were advised that this situation may continue for years to come. Up to 2025. We could be living in a world of social distancing, sporadic outbreaks, new strains with strange numbering systems, reduced local and international travel and concern about all sorts of flu-like symptoms.

Our PM is now talking about vaccination rollout starting at the end of this month. Bearing in mind that the AstraZeneca vaccine is now in question.

‘On Monday morning South African authorities said they would suspend use of the AstraZeneca shot after clinical data showed it gave minimal protection against B.1.351, a variant of SARS-CoV-2 which contains several mutations that cut the ability of antibodies to neutralise the virus. (Sydney Morning Herald – Monday 8 Feb, 2021).

‘Know your virus variants

Three mutant varieties of COVID-19, first spotted in the UK, South Africa and Brazil, are more resistant to vaccines than the original strain.

The British B.1.1.7 variant was first seen in September.

  • There is some evidence, although not concrete, that the new variant may be slightly more deadly.
  • At this stage, evidence suggests the variant slightly reduces the effect of vaccine-generated antibodies but not enough to pose major problems.
  • The variant has several mutations that seem to make it significantly more transmissible. It has rapidly spread through the United Kingdom and is now emerging across the world.

South Africa’s B.1.351 is also known as N501Y.V2.
It was first spotted in South Africa in October last year.  

  • It concerns scientists because it has picked up a large number of different mutations. 
  • These mutations may make it more transmissible. It is not known if they make it more deadly. 
  • Human data suggests, but does not prove, these mutations allow the virus to reinfect people who have natural immunity to COVID-19. 
  • Early data suggests the variant’s mutations cut the efficacy of COVID-19 vaccines, by varying amounts depending on the vaccine.

Less is known about the  P.1 variant first spotted in Brazil.

  • It bears similar mutations to the South African variant, which scientists suspect may give it the ability to evade antibodies.’

(Sydney Morning Herald – Monday 8 Feb, 2021).

From Brenda in Hove: Give a Little, Get a Lot

3 February

Four days ago I had the AstraZeneca vaccine. I didn’t hesitate one second when I got the text from our medical practice and booked the first available (day-time) appointment in two days’ time. The Brighton Race Course is not a place one would associate with medical activity (except maybe heart attacks) but there it is, fitted out with desks and cubicles and an ‘observation area’ where you are required to sit for 15 minutes after the jab.

The parking arrangements are not immediately obvious nor is the one-way system of getting people into the ‘production lines’ and the howling wind and rain didn’t help. We didn’t go up the right road the first time but I was anxious to not be late so my husband dropped me and I squeezed myself around a gate and through an unavoidable puddle and ran the last 100 metres. There were people directing you at every junction – even outside.

When I clocked in I asked the woman at the desk if she was a volunteer. “Oh, we all are, dear! Every single person here.” So mostly because I wanted to thank people who were giving their time like this but also because I was interested – and sure enough, every one told me they were volunteering. Doctors, nurses, secretaries, every kind of person taking on even the most menial tasks. Not much fun standing outside in that foul weather and directing people, not much fun scrubbing down the seats and tables, not much fun filling in the same forms over and over again, not much fun plunging needle after needle into arm after arm – yet every single one said things like “what else could I be doing that is more important?” or “the least I can do” or “much more cheerful here than stuck at home by myself” or “there is such a good spirit here that I enjoy it all very much” (nurse who works full-time at our practice and has a family but still gives two of her three days off to this exercise) or “best thing I could do with my days off” (doctor). As of today 10 million people have been vaccinated in the UK and counting. Extraordinary.

When my husband found a parking place he was worried as to how he would find me and  asked one of the parking attendants. She said not to worry because there was a one way system and he couldn’t miss me in the observation area. And so it came to be. When we were leaving James leaned out of the window to thank her for her help and she said “I am sorry to see you found your wife!” Hilarious laughter followed – even from me – but I couldn’t help wondering what he had told her. He is not to be drawn!

The last few days since the vaccine have not been easy. 24 hours after the jab I felt as if lead had been injected into my limbs. I could hardly move and felt dizzy and nauseous. As if that were not enough, I cannot sleep. The doctor tells me it will wear off in a week.

Then I will see if I can volunteer myself to do something useful in this national endeavour. Inside the building – not outside.

From David Vincent in Shrewsbury, UK: Corrigendum

On this my hundredth diary entry, I begin with a correction.  On August 7, I wrote: “It is generally accepted that the only way of ending the pandemic is the discovery of a vaccine and its manufacture and distribution on a global scale by multi-national drug companies.”  A day later, a study conducted by King’s College London and Ipsos Mori reported that only 53% of the British population was definitely or very likely to accept being vaccinated, whilst one in six said they would definitely be very unlikely to go ahead with such a treatment.

This finding is in fact very similar to a survey I discussed on July 6, based that time on a YouGov poll.   

At face, the finding is deeply depressing.  It suggests one of two things.  Either the community spirit that has carried us through is decaying just when it matters.  The widely-observed initial lockdown depended on an act of collective altruism.  Those unlikely to suffer greatly from an infection controlled their social lives on behalf of the elderly, and those with co-morbidities, who were much more vulnerable.  In the new study the young (16-24 and 25-34 year-olds) are twice as likely to refuse a vaccine as the old (55-75).

Or the proportion of the population prepared to disregard medical advice is much larger than we supposed.  It is not so much a matter of disputing a particular scientific finding.  There will always be argument about which remedy is most appropriate, even amongst researchers themselves.  Rather we are faced with a Trumpian disdain for science altogether as a mode of advancing the truth.  It is a wholesale rejection of the Enlightenment project, the notion that the natural world could be progressively understood through evidence-based rational discourse. 

There is, however, a caution against despair.  The opinion poll surveys are asking a hypothetical question.  There is no vaccine, merely encouraging reports of several clinical trials.  Conversely there are any number of bogus cures being widely discussed in books and online forums.  John Naughton in his Observer column on Sunday column traced in convincing detail how the algorithms on sites such as Amazon are promoting anti-vax literature with little to counter it.

As and when the vaccine is found, manufactured, and distributed to doctors’ surgeries, then the whole debate will shift.  Governments will stop issuing vaguely optimistic promises and get behind a determined programme of mass vaccination.  If it is seen to work not just in random trials but in real populations, the proportion of refuseniks will surely shrink to a marginal though possibly damaging fringe (at least in the UK; all bets are off in the States, whoever wins the presidential election).

It may be that the poll findings are not so much a cause as a reflection of a collapsed optimism.  I have been writing entries every weekday for nearly five months.  During that time public spirit has made a transition from panic contained by collective endeavour to weary disillusion with every aspect of the official effort.  We come to the end of the first period of the pandemic with the highest per capital death toll in Europe and the deepest projected economic recession.  Whether it is a second phase or a renewed surge, there appears no end in sight to the level of infections, which in England climbed back over a thousand at the weekend. No-one believes the assurances of any part of government, from face-masks to care homes to test and trace to reopening schools.  Dominic Cummings’ Flight to Durham in late March and subsequent non-apology in the Downing Street garden is held to mark the turning point in public confidence.  He’s still inside Number 10.  It will take a real vaccine, actually and widely available, before spirits change.

But by that time, we will be in the throes of Brexit.

Enjoy the rest of your summer.  I’m taking a break.   

from Anne in Adelaide, Australia: a world with and without antibiotics

April 15. Memories of Contagion 2: a world with and without antibiotics – all in 80 years.

1941. Kings African Rifles from Nyasaland in Somalia. My father, Mervyn Smithyman, on the left.

I fear we have become complacent about the power of science to discover ways to deal with diseases that attack us: bacteria that are evolving all the time. What makes us think that we will discover a safe and effective vaccine for Covid-19?

In 1941, My father’s life was saved by the use of one of the first antibiotics, Sulfapyridine, which was called M&B (May and Baker). It was also used on Winston Churchill in 1943 when he contracted pneumonia.

My father, on the other hands was a lowly officer with the Kings African Rifles (a battalion of Nyasaland askaris) stationed at Zeila on the Gulf of Aden in British Somalia.

He said, ‘When I was on that line at Zeila, the conditions were very poor, the town had no latrines. When the tide went out the miles of sand were exposed. The tide would come in and clear out the mess and rubbish.’

‘In Zeila I contracted bacillary dysentery, and I was very sick. The Colonel sent an ordinary two-seater plane to evacuate me. I lay next to the pilot. They landed me at the Dire Dawa army hospital, in Ethiopia. I was in a coma. Apparently, they dug my grave. In my coma it seemed as if there was a man up there with a machine gun directed at my stomach. The doctor was a fellow from Durban. He told me afterwards that he had these sample M & B pills, May & Baker. He said to the nurse, “I’ve had these samples and they may be useful in dysentery; this poor chap is going to die, we might as well try it.”‘

‘Well, I was obviously very fit and strong at the time, very resistant, so with a few pills I was OK. I woke up one morning and there was no pain. I saw the most beautiful thing I had ever seen: it was the blue sky and a small cloud out of the window of the hospital tent. But I had a terrible pain in my shoulder and, as I slowly got better in the hospital, they said that I had a ‘winged scapula’. So I was not fit for army duty and had to be sent back south with the wounded.’

In the book Pandemic by Sonia Shah, I read that we are currently close to the situation where antibiotics will be ineffective against the superbugs that armouring themselves against attack and are spreading throughout the world. The internet is full of stories of super-resistant bacteria that are found in farm animals and people across many countries. One called the mcr-1 superbug is causing concern, ‘Health officials fear the mcr-1 gene, carried by a highly mobile piece of DNA called a plasmid, will soon be found in bacteria already resistant to all or virtually all other types of antibiotics, potentially making infections untreatable.’

Part of the problem is the overuse of antibiotics in farm animals which has allowed bacteria to develop resistance.

https://www.the-hospitalist.org/hospitalist/article/121560/antimicrobial-resistant-infections/superbug-infections-rise-no-antibiotic

Most frightening of all is the NDM-1 (New Delhi metallo-ß-lactamase-1) gene that was found in bacteria in 2008 and is now widespread in India. With this strain the bacteria becomes resistant to the most powerful antibiotics. ‘The NDM-1 gene allows the bacterium to produce an enzyme that neutralizes the activity of these antibiotics … The World Health Organization is concerned that NDM-1 could see in “the doomsday scenario of a world without antibiotics.” ‘

https://www.medicalnewstoday.com/articles/197616#what-is-ndm-1

If NDM-1 crosses to other bacteria, further diseases will become extremely difficult to treat. Medical operations will become almost impossible to perform safely.

Eighty years ago, antibiotics were like a miracle in the world, going on to save millions of us. But we have abused this most amazing medical discovery and now we are facing a possible pandemic that will make Covid-19 look like a side-show.

I owe my life to M&B. My father travelled down Africa to the army hospital in Pietermaritzburg, South Africa. While convalescing, he met and married my mother.