• Dr. Young Lee

Level 3 Deja Vu

Hi all! As everyone is probably aware, Auckland is moving back into Level 3 due to 2 community cases. The reason for the move is that 1 of the cases was moving around Auckland whilst infectious and there is a reasonable risk that there could be more cases due to this. Also - there is no clear link on how he acquired COVID19 as his younger sibling who is a Papatoetoe High School student had tested negative 3 times. So just a friendly reminder about clinic stuff:

  • Opening times move to 9am to 4pm

  • Virtual consults preferred - Video or telephone

  • In person consultations available if urgent/required - please call to be triaged

  • Wear masks if you come in

I thought I’d give my thoughts on what’s going on as it’s quite topical and people have been telling me they have appreciated my opinion on these things. It’s normal to start getting grumpy about these pesky lock downs and to be annoyed at all these people getting COVID19 and not isolating. Let’s try to tease these thoughts apart. Vaccines - what’s happening? MIQ workers are getting vaccinated. Their family members are getting vaccinated next week. Some of you might have heard of friends or family who are healthcare workers in South Auckland getting vaccinated. That is absolutely true. What’s happening is that MIQ workers can’t all take time off to get vaccinated as there would be no one managing the MIQ facilities. So the vaccine role out is staggered. The Pfizer vaccine once reconstituted has to be used in 5 days - therefore in order not to waste any vaccines healthcare workers in South Auckland are given priority. The reason for this is that South Auckland has a higher Maori/Pacific Island population who statistically are more likely to suffer and die from COVID19. It’s quite logical - and I approve. This is a very science led, statistically sound and pragmatic approach. All 3 values which make for sound decision making and that you should be looking for in a potential life time partner. When am I getting my shot? Don’t know - the country only has the 60,000 Pfizer doses so far and that’s 30,000 people as you need 2 shots each. I think realistically the general population will be vaccinated from May/June onwards and it’ll take 6 months to vaccinate most of the country as it will be supply constrained. The latest community case who went to public places while symptomatic and before getting his COVID19 swab test result sounds like an a**ehole - should the government “get tough” with people like this? This seems to be what everyone is saying. My wife is saying this, my mum is grumbling about this, I heard the radio talking about this and keyboard warriors on social media are going ape sh*t bananas about this. Let’s tease this out a bit - we actually have quite a lot of examples of these things from overseas and here. This is NOT a new subject. Firstly, the facts: The latest community case started getting some fevers and aches and pains before his test. It’s not clear how long he had those symptoms. He is likely to be infectious for about 3-5 days before he was tested. After he got tested, he decided to go to a gym and a small mall before getting his result. He should have isolated at home whilst awaiting his result. This is told to everyone who gets a swab. The UK variant of COVID19 produces symptoms which can be less cold like, and more flu like - i.e rather than runny nose, cough, etc, people can get more aches and pains and maybe a fever. The UK variant is more infectious. Most of the community cases have been younger people or adults in their 40s and 50s- so they are much less likely to die but they can spread it more easily as they are more mobile. Imagine if any of the community cases had gone to a rest home or the hospital. It is currently unclear who he got COVID19 from as his younger sister in Papatoetoe high school had tested negative 3 times. His mother has also been infected. The gentleman involved did the right thing when he had gone to get tested. I think it’s great that his GP did the covid19 test on him. However, he did a few things wrong - whilst symptomatic before the test he had gone around and possibly to work. He had also gone to public places whilst awaiting results. Secondly, should people who break the rules be punished? The purpose of punishment is to serve as a deterrent so that the rest of the population are more likely to behave in a certain way that society or the government wishes them to behave. So - will punishing this gentleman achieve a change in behaviour in other people who might be slack and not isolate. We currently rely on people self reporting their symptoms and coming forward to be tested. Here’s the problem. If you’ve been naughty and travelling and working whilst having cold and flu symptoms, why would you pony up and get tested when you might get punished with fines, imprisonment or shamed publicly? Also - if people now refuse to cooperate and reveal where they’ve been (contact tracing) - do we have any other way of telling where they’ve gone. Let’s be honest - if you’ve been going around whilst sick or waiting for a swab result - you’re unlikely to be the type of person who’s going to be scanning with the COVID19 app. Let’s take South Korea as an example for comparison purposes. When South Korea had a huge outbreak due to members of the Shincheonji church refusing to get tested - they had a headache tracking everyone down. The lack of cooperation with contact tracing didn’t help either. Don’t forget that South Korea even have a law change that allowed them to access location tracking of people’s cellphones through telecommunications cell phone towers for this purpose. We in NZ currently do not have this law as the government believe it to be too much of an intrusion in our privacy and that it could be subverted for nefarious purposes. If we punish people - it’ll make everyone feel good for a few days. Then we won’t be able to catch the next outbreak. When we first went into lock down - I had mentioned that it will only be naturally that we will have waves of small little outbreaks as it is impossible to maintain and airtight border. They are just too many people and surfaces involved to be totally clean. The vaccines will help - but we will still probably get little outbreaks. That is the reality until we get herd immunity. That means about 80%+ of the population has to be vaccinated and hopefully there is no further mutation that can pierce the vaccine mediated antibody shield (I like my star trek references). So in summary - it will feel really good to punish this gentleman that did a few foolish things. BUT he did come forward to get tested - which he would have been unlikely to do if he would have been punished. We should not be punishing people for these transgressions. The consequences are severe when they break the rules, but if we punish them we could get an even worse result later on when there is another outbreak. Think about it this way. It’s like having an in law that you really dislike. If you tell them what you really think you will feel good for a few minutes. Then after that you’ll have to pay for it for the rest of your life. Best to just keep your mouth shut and wait for them to die because they are older than you. Why is the lock down for 1 week rather than 3 days? It usually takes 3-5 days after and infection for a test to return a positive result. That’s why casual contacts are asked to test 5 days after a potential exposure. Because of this, we need at least 5 days to make sure that everyone who needs to be tested is tested. Expect this lock down to last maybe 2 weeks if 1-2 cases keep popping up every few days. The reason is that if you wait 14 days the virus is likely to die out anyway even in people who haven’t been tested. Did the government end the lock down too early last time? No. That was the correct decision with the information that they had. None of us can read the future. We can only work with the best information we have. This is where you have to decide what risk level you are happy to tolerate. For example, if you want to be 99% sure that the virus is contained - lock down the whole city for 2 weeks every time there is an outbreak. The virus can run it’s natural course and most of it will die off. However - for a 99% certainty you will seriously impact a lot of people’s livelihoods and it will cost a boat load of money. If you aim for say a 95% certainty - then you can maybe open up in a few days. The government had effectively trace and tracked everyone. There were no more positive cases. It was a logical and pragmatic move to end the lock down. I don’t think we should fault the government. Here’s the thing - if you had the responsibility to make the call - would you call it at 95% or 99% certainty? Imagine if you made the call to lock down for 2 weeks and there were no cases - do you have any idea how much sh*t you’ll get from everyone? I don’t envy PM Jacinda Ardern. She is going to get crap no matter which way she calls it. However there has been no major politicizing of the issue so far, so that’s good. Anyway - I hope all that was interesting and helpful to everyone. If you find this useful - please forward it to friends and family. Let me know if you want me to keep doing this newsletters. Thanks.

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