Child vaccination

As I write this in mid-October 2021 we are anticipating a ramping up of COVID-19 case numbers in paediatrics. I am on call today and as I look down my list of patients I see I have around 30 COVID-19 positive children in the community on the books, hopefully essentially well at home and receiving a daily phone call from the Hospital in the Home team here at Lismore Base Hospital. 

We anticipate this number will rise into the hundreds over the next month or two and then hopefully fall. The vast majority of them will have symptoms of a cold or less and will have contracted the disease from their parents.

We do not know why children under twelve have such mild disease, and adolescents have only mild respiratory or gastrointestinal symptoms. Perhaps it is because it is a coronavirus, like the common cold, and children and adolescents are primed by this very frequently, like Jenner’s milkmaids with their cowpox. 

What is known is that children are underrepresented in terms of known COVID-19 cases, which probably means we’re not testing them because they are well, even when they have the virus. As with adults, it is only the children with at least moderate comorbidities who seem to have any chance of becoming unwell or even to die. They do not pass it on very effectively either, so they behave as a vaccinated adult.

Dr Neil Thompson speaking at the NorDocs Unconference in June 2019.

Dr Neil Thompson, 7 March 1940 - 30 October 2021

Dr Neil Thompson, Lismore's first orthopaedic surgeon, passed away peacefully in Byron Bay with his wife Elaine and his children by his side. Neil was a devoted and respected doctor in Lismore for more than 25 years, serving this community and surrounds with great skill, care and compassion.

Neil's opus magnum in retirement was his book, Sawbones, Saddle Burns & Soothing Balms: Medical Practitioners in the Richmond Valley, 1866–1986, a valuable history of the local medical fraternity from 1866 to 1986. 

Normag editor, Robin Osborne reviewed the book in February 2015. The launch at the Alstonville Historical Society was attended by hundreds of his friends, acquaintances and colleagues. At the 2019 Nordocs Unconference Neil recounted tales of some of our more colourful predecessors. (Default nordocs password)

Covid vaccination

As Australia moves towards a high percentage of adults being fully vaccinated for COVID-19 the vaccination rates for Aboriginal and Torres Strait Islander people, the most vulnerable population, still has some ground to cover.

The disappointingly low COVID-19 vaccination rates cannot be attributed to one single cause. Undoubtedly, the roll out of, and access to, the preferred vaccine, this being Pfizer, is one factor. Vaccination hesitancy, fuelled by widespread misinformation and hearsay, is another. Additionally, some communities of faith have perceived contradictions between their beliefs and the health advice.

In Northern NSW, Bulgarr Ngaru Medical Aboriginal Corporation (BNMAC), estimates the total eligible Aboriginal population for COVID-19 vaccination to number 4,500 adults but by mid-August 2021 only nine per cent of this population had received the first vaccination dose and seven per cent were double vaccinated. 

However, a vaccination drive and the increased availability of the Pfizer vaccine nearly doubled this figure within the next fortnight, resulting in some 16 per cent receiving a first dose and 15 per cent being fully vaccinated. 

This surge in vaccination uptake coincided with the spread of the Coronavirus in the Aboriginal populations of Wilcannia and Walgett  – living proof of the devastation that the virus could cause. The first, unfortunate Aboriginal death in Dubbo, of an individual who was not vaccinated, was a wakeup call for many. 

Photo by Mary Eineman on Unsplash

The COVID-19 pandemic has shifted perceptions of the health system. With virtual healthcare, some acute conditions can be treated at home.

This article by Martin Bowles, former Northern Rivers Area Health Service CEO and former Secretary of the Commonwealth Department of Health first appeared in John Menadue’s Pearls and Irritations in September 2021. 

I have long believed we need to see a shift from our fixation on beds in hospitals. We have seen successive governments focus on beds as a proxy for the healthcare system.

We have also had a very structured view on how we pay for healthcare. We have a transactional approach to care. While this is fine for my broken leg or a simple viral infection (not COVID-19, of course) it is not appropriate for someoneThe COVID-19 pandemic has shifted perceptions of the health system. With virtual healthcare, some acute conditions can be treated at home.
with a long term chronic condition. Where we need multidisciplinary care, we need a different payment structure to support that care.

In one of the most famous lines in American literature – uttered by Nick Romano in Willard Motley’s long-forgotten novel Knock on any Door – the advice is to “Live fast, die young, and leave a good-looking corpse.” 

A number of rock singers and others have heeded this advice, although the state of their corpses has often fallen short of the mark.

In the opposite corner stands Rheumatologist and Stanford University Professor Dr James Fries who more than 40 years ago coined the term ‘compression of morbidity’, meaning to minimise the duration of chronic disease suffering before death, the aim being to improve the quality of our older years. For budget watchers such as politicians this wise advice also relates strongly to the subject of health costs.

Although compression of morbidity has now become a key goal of healthy ageing and longevity it may be easier to express than to achieve, unless appropriate strategies are put into place.