Masks, lockdowns and check-ins. These were the defining features of 2021.
Like so much of the country the NSW North Coast had lived in relative isolation until late autumn this year when Delta’s dawn exposed the first cracks in fortress Australia.
It started innocently enough in June when an unvaccinated limousine driver transporting airline crew tested positive in Bondi. The state’s COVID-19 vaccination program had begun but supplies were limited and even individuals at high risk of getting the infection had not begun vaccinations. It did not seem too much of a concern, however. We had done it all before with Ruby Princess and Crossroads and this would come under control as well.
It was not to be. This was the highly infectious Delta strain and NSW Health soon had to inform the NSW public that this time it was serious and more particularly it was going to get worse, not better.
So began the daily 11.00 am news briefings from then Premier Gladys Berejiklian, Chief Medical Officer, Dr Kerry Chant, Health Minister, Brad Hazzard, and others. There was the daily tally of new cases, hospitalisations, ICU admission and intubation, and deaths. It was reminiscent of the nightly news bulletins of the Vietnam war and the day’s body count.
Those opposing vaccination or simply ‘agin the government’ sought exemptions from masks or vaccination on dubious medical grounds, and for GPs the consultations were frustrating for both parties. People had “done their own research”, although this did not entail any double blind, cross over trials.
The doubters were concerned that this (whatever the brand) was a new vaccine and the long term effects were unknown because not enough people had had the vaccinations. While it was clearly true that it was a new vaccine (and the fastest one ever developed) the immunisation program rolled on and total vaccination doses world wide exceeded seven billion doses. In this context it was hard to argue that too few had received the vaccine for clear evidence to begin emerging.
Seeing is believing and in August our region had its first scare, when a man and his two sons came visiting from Sydney. They were said to be looking at properties and had toured the area widely. They tested positive for COVID-19, the only good news being that no cases of local transmission transpired.
There were three short lockdowns of about a week in Lismore and the Northern Rivers more widely over the next two months as sporadic cases imported from Sydney shut down businesses and services.
Medical receptionists learnt the fine art of diplomatic triage. Despite their best efforts there were tears at times. For their part GPs developed skills in telehealth and car park consultation. It was not great medicine but better than nothing at all.
The virus was getting nearer and the government requirements of COVID-19 were focussing people’s attention. The wavering were changing their minds.
The daily NSW news conference changed. We no longer focussed on cases but percentage vaccinated. Targets were set. Some restrictions were set to be lifted at 70% and more at 80%.
It was a master stroke. It made scientific sense since the infection rate and more particularly the incidence of severe illness for the vaccinated was a fraction of that for those who were not.
You could also appeal to people’s sense of duty to others and the community and if that failed you still had blatant self interest. They didn’t like it but they got the shots, downloaded the bloody app and wore a mask (at least around their chin) but at last they could go for a drink at the pub.
After 107 days of Sydney lockdown, October 11 was declared ‘Freedom Day’. NSW was 75% fully vaccinated and 90% single vaccinated.
Pent up demand was unleashed and the hairdressers were busy but you had to be ‘double J’d’. The expressed frustration of the vaccine denialists, turned away from the shops, was ugly at times. A month later the immuno-compromised were being upgraded to “triple J”.
Life was getting back to normal in NSW but the frontier was still closed on the directive of the (highly popular) commanders of Fort Brisbane and Fort Perth. ‘They shall not pass’, they declared unless for a medical emergency with mandated solitary (isolation ward) for a week. Medical care that normally would have gone to the Gold Coast and Brisbane was redirected to Newcastle and Sydney.
With the arrival of Spring and 80% vaccinated we could do things and buy stuff. Our phone became the passport to the world. In fact to all those not in close proximity you were your phone.
Driver’s license, QR code scanner and vaccination certificate verification gets you out of the house and into the shops. You wave your phone or watch at the EFTPOS machine and you’re away. An hour later you got the nag message that you had forgotten to check out. To confirm a large monetary transaction you entered the SMS’d pin code or the number from the authenticator app supplied by the bank.
Even Government services, always slow to adopt IT technology, pushed through a raft of changes. Their websites are notoriously unreliable and difficult to navigate but improvements to My.Gov.au and Service.NSW made them tolerable. An increasing number of people viewed their My Health Record, if only to access their COVID-19 vaccination certificate and perhaps check their last radiology and pathology results.
With Summer upon us we are now entering ‘COVID normal’. We will be ‘living with the virus’ and last year’s novel ‘Coronavirus’ is not so novel any more.
Partnerships are being developed between the Northern NSW LHD, NCPHN and Nordocs to manage the increasing numbers of milder cases. As we go to press the arrangements are being determined, but most healthy patients or those with relatively minor chronic illnesses will look after themselves at home with support from their local GP surgery. Those with comorbidities are at much greater risk of deterioration. They will be managed by the LHD’s Hospital in the Home service, with escalation to in-hospital care if they deteriorate.
It is now thought that only about 5% of the population will remain resolutely unvaccinated. Within the next month the restrictions still in place for this cohort will be lifted, not necessarily a popular move for those who committed to vaccination from the get-go.
Vaccination reduces the rate of severe illness about 15-fold and so the numbers entering hospital next year with COVID-19 will be about half vaccinated and half unvaccinated.
COVID-19 has had a huge impact around the world. Australia has done better than most other countries but it has come at a cost of several hundred million dollars in government support. This debt will be serviced by the next generation or two.
The social and mental health aspects of the pandemic are only now coming to the fore. The 1920s gave us the Great Depression. COVID-19, in the 2020s, has given us the Great Resignation.
Enforced time away from work, locked in the house with spouses and kids, has led to a re-evaluation by many in their mid thirties to mid fifties. The phenomenon has been greatest amongst those under extreme stress during the pandemic, with frontline health workers all too frequently affected. With a skills shortage looming in Australia many in the middle stages of their career have had the chance to re-evaluate their lives and do something different without perilous economic consequences. (Harvard Business Review has written the beginner’s guide to quitting.)
Sea change and tree change has bloomed as the chance to get out of an infected city for many disaffected workers. One side effect of this for the North Coast was that some of Sydney’s housing price inflation came with them. Good news if you are a property owner, or seller, bad if you’re not.
Overseas travel has been restricted for nearly two years and many are desperate to get out of the country for a holiday or for some, permanently. It’s a chance to move to a place with more life, or less, depending on your preference.
The average Australian marriage lasts 12 years. It was initially feared that COVID-19 would cause this rate to rise but at least at this stage that does not seem to be the case. However, for some it has been a significant factor in the breakdown of marriage. Divorce affects all family members and, tragically, it has been lethal for some.
A chance to re-evaluate was the theme behind Brave New World, the November webinar on psychedelics by Bob Lodge. There have been few significant new treatments for depression in the last 40 years and even psychedelics have been around for several millennia. However, after the ‘war on drugs’ in the 1960s curtailed further study, research has undergone a renaissance in the last five years.
This webinar joined three others from the latter half of the year on our new Youtube channel. Subscribe if you want to be notified of new episodes next year.
Euthanasia has been a hotly debated topic in Australia for decades. In NSW the voluntary assisted dying bill has been delayed until 2022. Both major parties are allowing their members conscience votes. NSW is the only state yet to pass enabling legislation in this area but the numbers are tight and the bill may not proceed.
Media figure Andrew Denton has been a strong proponent of euthanasia as a result of his experience watching his father die in the 1990s. Five years ago he founded Go Gentle Australia, which advocates for voluntary assisted dying to be legalised across Australia and more recently he started the Better off Dead podcast on the same theme.
One of the arguments against euthanasia is that palliative care services obviate the need to be active in assisted dying. The experience of many families would indicate that this is not always successful, with patients in distress and suffering. On pages 17 to 19 we report on the AIHW’s findings on Palliative Care Services in Australia and the establishment of two North Coast Palliative Care Services, St Vincent’s Hospital and Lotus Palliative Care, both of which have started outreach services to address local needs.
Psychological stresses have increased with the pandemic and the State and Federal governments have increased funding in this area. Few GPs would be aware of all the available services. On page 11 Nordocs Co-Chair Nathan Kesteven outlines the programs that are available in the private sector as well as those from the NCPHN and the Northern NSW LHD.
Nordocs Magazine welcomes Southern Cross University as a Silver sponsor for 2022. Our cover features midwifery student Rebecca Thorne. Rebecca is the recipient of an indigenous student scholarship and is currently in her final year at the Gold Coast campus. We report on the program on page 7.
After many years in local medical politics, Dr Brian Pezzutti, has retired as Chair of the Board of the Northern NSW Local Health District. On page 15 Dr Chris Ingall pays tribute to Brian’s service. We wish Brian well as he enters his retirement although we suspect that like a super tanker it will take a while for him to finally come to a stop.
Sadly we announce the passing of former Lismore orthopaedic surgeon, Dr Neil Thompson, a dedicated surgeon and the area’s only orthopaedic surgeon for many years. Nordocs holds Neil in high regard for his work in retirement chronicling the first 100 years of medical practice on the North Coast. His book Sawbones, Saddle Burns & Soothing Balms is advertised on the home page of Nordocs and can be obtained from Amazon. We extend our condolences to his wife Elaine and the family.
2021 was a remarkable year that many will no doubt be happy to see fade from memory. Humans are by nature optimistic, so let us, like American sociologist James W. Loewen, ‘look forward to the future, which is a good thing, because it's coming’.
We wish you a safe and happy holiday season, a good start to 2022. We look forward to greeting you again in the New year with our Autumn issue..
