8 June 2020

You are now entering The Twilight Zone

Communicable Disease COVID-19

Modern medical practice is calm and measured. We gather information to reach diagnosis. Treatment options are outlined, and side-effects explained, as well as the possibility of the treatment not working. This happens without use of hyperbole. Informed consent is critical. Failure to follow this approach can lead to legal consequences.

Let’s now enter “The Twilight Zone”. As Rod Serling would say: submitted for your approval. Imagine a medical situation where doctors described a diagnosis as catastrophic, where many actions were taken without  any real evidence, side-effects  dismissed as unimportant and  informed consent not granted?

This could never happen in a consulting room. Yet we have seen it unfold in society worldwide. Now before you all scream, actions needed to be taken swiftly when little was known about COVID-19. Australia has done extremely well. That does not change the stark contrast.

In a Twilight Zone twist the world has been conducting a trial. Different countries (even different states )adopted differing approaches. There has been no clear correlation between degree of lockdown and outcomes. Contrast New Zealand and Australia, for example. Is our success due to the measures taken (beyond personal hygiene and social distancing), our geography, our low population density, other factors, or a combination of all the above?

Or could it also be that the original predictions were wrong?  Like swine flu, avian flu (predicted 150 million deaths, actual 282) and SARS before it, the real numbers are far less than the predictions.

John P Ioannidis of Stanford University  wrote in March that the case fatality rate could be  0.05%. That is below seasonal flu.  It would be higher in certain populations – same as seasonal flu. Yet any calls for a calmer approach were dismissed when others were predicting millions of deaths.

The reflex response to any questioning was that lives matter more than the economy.  Nathan Grills of Melbourne University wrote in MJA Insight (in March) that a financial crisis “…worsens population health and increases poverty, malnutrition and infant mortality”.  The GFC is estimated to have increased cancer deaths by 500,000.

Australia has 1.6 million on JobSeeker and 6 million people on JobKeeper. Unemployment will go into double digits, with health implications.  Ian Hickie claimed a “best case scenario” of a 25% increase in suicides (750 additional per year) over the next five years.   Mental health plans and antidepressants won’t solve this.

There are predictions of a “tidal wave” of disease over the next 12 months, including  7000 cancers either undiagnosed or with delayed diagnosis.

This may also not come to pass. However, we need to face the fact that deaths and morbidity from the response may be significantly greater than that of the virus. This is before considering the long-term impact of disrupted education, (children, university) and the long-term health effects of economic depression.

The economy matters! Countries with stronger economies have better health and welfare systems, better living standards and longer life expectancy.

The worst aspect has been the how many have refused to acknowledge the serious side-effects of our actions. This is easy when you have not lost your job or business nor taken a pay cut. The lives impacted by the response also matter and deserve better than being told “we are all in this together”.

Doctors are risk averse. We have to be. But not getting it wrong is not the same as getting it right. Sooner rather than later we need to re-open society. This involves risk. Society needs both risk-takers and the risk-averse. Otherwise no progress would be made. Risk cannot be avoided, but it can be managed proportionately.

Claims that even one life lost to COVID-19 is one too many ignore the fact that 438 Australians die daily and around 3000 annually with, or in association with, influenza. The elderly see their loved ones each winter. We advise hygiene and staying away if unwell!

Our actions were based on a fear that the health system would not cope. It can!

The virus won’t go away and a vaccine is not imminent. New cases are not a “failure” – zero cases was not the aim. There will be hospital admissions and even further deaths, as occur with viruses each winter. This needs to be accepted. We need to adjust to living with the virus, not living in fear of it.

 

References:

https://www.ausdoc.com.au/news/nation-put-suicide-watch-deaths-expected-surge?

https://www.theaustralian.com.au/nation/suicides-toll-far-higher-than-coronavirus/news-story/25a686904b67bdedbdcd544b1cab7f96 

https://www.wsj.com/articles/the-limits-of-anthony-faucis-expertise-11589392347? 

https://insightplus.mja.com.au/2020/11/covid-19-containment-poverty-and-population-health/ 

https://statmodeling.stat.columbia.edu/2020/05/08/so-the-real-scandal-is-why-did-anyone-ever-listen-to-this-guy/ 

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/ 

https://www.theaustralian.com.au/nation/politics/coronavirus-meaningless-headline-jobless-rate-hides-a-lot-of-hurt/news-story/1af0d2aeb67c71d41c2a0014910ba826

  

Dr Joe Kosterich is a General Practitioner based in Perth, Western Australia. To read more, go to: www.drjoetoday.com

COVID-19 live update
Something to say?

Leave a Reply

2 Comments on "You are now entering The Twilight Zone"

Please log in in to leave a comment


Sort by:   newest | oldest | most voted
RAYMOND Yeow
Guest
2 months 1 hour ago
This is a courageous post by Dr Joe that takes a wider picture than just medicine / health into consideration. The taking of a wider picture is a minority viewpoint and has been heavily criticised esp in social media for being too economically orientated and maybe even stony hearted. It needs to be said that the wealth of a nation underpins its ability to provide health services. If the common wealth of the nation is impoverished, then the ability to provide services by the commonwealth whether it be health, pensions, aged care, education is diminished. Taking a smaller subset than… Read more »
Paul Jenkinson
Guest
Paul Jenkinson
2 months 14 hours ago

Hear! Hear!

wpDiscuz