Modest Expectations – Melbourne

There is no doubt about NSW; by far and away, the most cases of coronavirus in Australia are there. Granted that it is the biggest state, but the cavalier way that public servants and at least one of the politicians have behaved has exacerbated the problem.

Gladys Berejiklian has one very great ability and that is to talk without saying “um” or “ah” without taking a breath.

It makes it is very difficult to interrupt her, and when anybody succeeds in breaking into the flow, her mouth becomes a tiny moue and her dark eyes those of the avenging disapproval. Such a countenance belies the actual situation that she is a weak leader. And now six months to sort out the Ruby Princess fiasco. Really?

Wait a minute, the Premier has adopted the Chant approach of “zig-zag”. She has asked Brett Walker SC to have a look at it as well – a “special commission of inquiry” in the same litany as “loved ones”.

What next – The Premier’s astrologer?

One despairs of any justice in NSW. This confusion gives a number of people time to muddy the waters, and already Ms Sherry seems to have slid away. Predictable! And the same cruise ships with different titles with all their verminous cabins will be back next year scratching the same political backs and contributing nothing to our economy except grief.

Premier, you are always using the words “Loved Ones”. Tell me how many of those with the sobriquet of your favourite words have died because of the Ruby Princess fiasco. No urgency to know, Premier, no need to know. Six months will do. Hiding behind a special commission? No, I am sure you are not, as you already have a good idea of what has flowed between Carnival representatives in Sydney and your Government.

Can somebody get Ms Sherry to front an interview with her sommelier boss? After all, she has a wonderful residence in Annandale as a backdrop.

The Ruby Princess fiasco testifies to a Premier who not only tried to deflect the behaviour of her Health Department but also failed to sack those responsible for its behaviour. After all, the fiasco has led to how many deaths? Instead the Premier has filibustered. Asked specifically whether she would apologise to those whose COVID-19 is due to the Ruby Princess, or to the families of those who have died, the Premier – in time-honoured fashion – just answered a different question. However, at least the media are finally onto it – they took their time.

Now the barbarians are at it again. They are those whose natural constituency is in the dystopian world of Trump. The irrepressible Chant is at it again inadvertently aiding the dystopians, as she advocates a “zig-zag” approach. Are you seriously advocating going off on a tangent and then backtracking, and then going off on another tangent and the backtracking to a different position? Zig-zagging, as I interpret it, is all about confusing everybody. Really, Dr Chant, do you really mean that?

However, the person to watch now is Mr Barilaro – you know, the man who wanted to close the ABC, the bushfire station so important for distributing information in his electorate – and then was overseas initially when the bushfires were ravaging his electorate. You remember the man?

In the background he is a cheerleader for re-opening the Rugby League, presumably because of its precarious financial position which, like the berthing of the Ruby Princess, the financial situation of a badly run organisation being more important than the health of the Australian population.

Perhaps it is a prelude to Barilaro bobbing up on another front. As he said in his maiden speech to the NSW Parliament:

The New South Wales ski fields have been forced by successive governments to compete with one hand tied behind their back. My vision is to make the New South Wales ski fields number one again, by removing barriers, aligning government policy and industry opportunity, creating a level playing field and engaging all stakeholders to develop a strategic plan to deliver a world-class alpine experience to rival the best ski resorts in the world. 

In our last blog but one it was pointed out that ski fields are a potent source of community spread of the virus.

As Mr Barilaro said in this same maiden speech, quoting Jack Lang:

Always back the horse called self-interest, it is the one that is trying.

You highlighted this quote, Mr Barilaro. It must have made an impression. 

Primrose Pell

From the 13th century onward, it’s easy to see how secretly gay men found in the church, and the church alone, a source of status and power. Marginalised outside, within they could become advisers to monarchs, forgive others’ sins, earn a stable living, enjoy huge privileges, and be treated instantly with respect. Everything was suppressed, no questions were asked in seminaries, and psychological counseling was absent (and even now is rare). Scarred, scared men became priests, and certain distinct patterns emerged.

This quote was written by Andrew Sullivan, an openly gay commentator a Roman Catholic and a follower of the great English conservative philosopher, Michael Oakeshott. The full article appeared on 21 January 2019 under the title of the Gay Church in the New York magazine.

Is Cardinal Pell gay? What does it matter if he is? I have no problem with homosexuality that is not predatory. I had a fellow medical student, a good friend, who dropped out of medicine and was subsumed into anglo-catholicism, became an Anglican monk, and I heard that he died of AIDS some time ago.

I have written extensively about Alister Brass, who was an inspiration for me, and whom I miss greatly, even though he has been dead for 34 years. As a teenager I read Peter Wildeblood’s account of being criminally charged with homosexuality and then spending time in prison for what was ultimately bad law. I was appalled on reading his book Against the Law.

As a boy, I grew up when the “confirmed bachelor” culture was transitioning into open avowal of one’s sexual preference. To me it seemed an innocent pastime for blokes who preferred other blokes, whatever the euphemism.

I have always hated the word “closet”; it may just as well be applying to a confessional box or any dark and secretive environment where homosexual activity is possible. However, homosexuality should not be stigmatised. After all, Tasmania, the last state to do so, expunged it from the criminal code 20 years ago.

Celibacy once may have been a means of survival of the intellectual tradition, but now seems to be a honeypot for communal homosexuality. What is distressing is the level of denial and hypocrisy with which the Roman Catholic hierarchy surrounds this association.

Thus celibacy and homosexuality are uneasy companions, although at one end there is Saint Augustine who was openly gay, and at the other end St Thomas Aquinas to whom homosexuality was an abomination.

Now Australia has seen George Pell acquitted by the High Court for historic sexual offences. In the background, there is a heavily scrubbed report of the Commission into Institutional Responses to Child Sexual Abuse.

So as not to misstep in the quagmire of the High Court, below is essentially a compilation of quotes, including from those advocating Pell be freed.

Now the High Court judges say that is not enough. Other witnesses who gave evidence that they thought the Cardinal would not have had the opportunity to commit the lewd acts ought to have been taken into account, even though they could not give a first hand or personal evidence of what happened to those boys on that day.

Bizarre. One witness swears on oath: this is what happened to me at this place on this day. Other witnesses say: I do not know what happened on that day but that is not what usually happens – and that creates a doubt and voids the conviction. Compounding improbabilities become “reasonable doubt”.

It was argued that because Pell’s assistant, Portelli, didn’t have a specific memory of standing on the stairs on the chosen dates of December 15th or 22nd, 1996, that his testimony about Pell’s practice of being out front could not be relied upon.

 Justice Patrick Keane replied: “I can say I shaved last Friday and I don’t have a recollection of it, not because it didn’t happen but because I shave on work days”.

His point? Do you have specific memories of things done out of routine?

No, we remember things out of the ordinary. Therefore it is unreasonable for Portelli to have a specific memory about two dates in 1996.

The judges also made the point that the accuser’s recollection of the sacristy wasn’t actually proof of the abuse, only proof that he had been there.

Let me tell a story – perhaps a parable. Let us say it was the early years of the last century. Let us say it was Lonsdale Street in Melbourne. In this parable, there was once a junior barrister who used to be shaved by a barber, as was the custom of the day prior to going work.

At the same time of the day early in the morning there was a judge, a man of distinction, who would come in to the same barber shop and be shaved also. The younger and older men would exchange pleasantries and talk about legal cases while they were shaved and perfumed. Most days, they would leave together and walk to Chambers. However, there were some days the judge would leave before the young barrister. One day, the young barrister, the judge having left earlier, decided to take a short cut up a quiet lane, and turning the corner, he perceived a familiar person – it was the judge, who seemed to be adjusting his trousers. In front of him against the wall was a young boy not more than 13 or 14 clutching a newly-minted shilling.

The young barrister uttered a cry, the man who was the judge turned, his expression one of power. What was the young barrister to do? After all, he and the judge regularly shaved together; how could he in retrospect possibly ever remember the day years on what had happened on that particular day – unless he had openly accused such a respected member of the community then; a man of power, a man who wore a wig, a man who could pronounce life or death on a personal career?

Perhaps, just like all your hypothetical speculation, Mr Justice Keane, there is always a confounding storyline – fable or parable – however you define it.

Especially in a real life situation getting away from our exchanges of parables, if it emerges that there was a history in a person’s background of systemic cover ups, the law is presented with a dilemma. Men of distinction do not lie under oath. Axiomatic?

Of course, that is only non-admissible speculation to the collective mind of the High Court, but still enough for a jury to convict in a Victorian court. However in the Court of Courts, there is this reasonable doubt, because no other has come forward to dispute the man of power’s testimony. The child is in essence disbelieved.

It will be interesting if Pell, despite all the travel restrictions, suddenly turns up in Rome on his way to a new closeted life in the denizens of the Vatican, away from a succession of the civil cases, which threaten to follow.

However, there was one touch I loved about wee Georgie Pell, the prisoners cheered in Barwon prison when they heard of his release. I remember that the prisoners cheered when Johnny Cash played for them in Folsom prison – but then Johnny Cash had a guitar.

I have one last quote from the porter in Macbeth as he opened the gates – this for the departing Pell, who has had a life of power so eloquently portrayed in the initial quote from Andrew Sullivan.

I had thought to have let in some of all professions that go the primrose way to the everlasting bonfire. 

Boris

He is the type of Pom who reminds me that England is a nice place to visit but not be infected by the culture – by a product of the Eton boot camp – that nurtures the professional buffoon with the razor sharp mind.

Maybe he has now learnt a lesson that will resonate in his future actions. The buffoon, who boasted he was shaking hands with all and sundry in a hospital, while COVID-19 lurked. Hopefully that buffoon will be replaced by a less arrogant and more compassionate person who does not run the country in the same slapdash manner as we have seen him washing his hands – otherwise, God help the United Kingdom.

There is nothing more humbling than looking into the eyes of the person who has saved you. I know from personal experience.

However, the community is sick of spin doctors who aid and abet the culture of lying; Johnson revealed how really sick he thought he was. It was far sicker than the public was led to believe. Those in charge determined that Boris should not die. The fact that he had two staff constantly caring for him showed how intensive his care was. Otherwise he would not have survived. There must have been fear that a secondary cytokine storm may have intervened and finished him off. It must have been close.

Therefore, can we but cast this spinning vermin out from the Temple No 10? Almost Johnsonian?

And for God’s sake Johnson, grow up. There are many unseeing eyes watching you. 

The World that Boris Missed

A lot of radio stations in Europe will collaborate this Friday (March 20th 2020) at GMT 07:45 to sound the track of Gerry & The Pacemakers – You’ll never walk alone. Please join this collaboration to show gratitude to the people that are doing their best to help us survive this pandemic. And to have our thoughts by the people who lost their loved one.

When I first saw this announcement, it triggered a number of conflicting memories. The song originally came from the Rogers and Hammerstein musical “Carousal”, which in turn had been adapted from a French story about a fairground rouseabout who had difficulty declaring his love for his girlfriend; nevertheless she gets pregnant; he is killed in an accident before his child is born; but is permitted to return to earth for a day to see the child.

“You’ll never walk alone” is a highly sentimental song, which nevertheless moves me. It is just one of a number of good songs in this musical. However, the musical’s recognition was dwarfed at its release by some of Roger and Hammerstein’s other musicals: “Oklahoma”, “South Pacific”, the “King and I”. I saw the film as a teenager.

Some years on I was persuaded to go to hear a group of Liverpudlian bands that were touring Australia in the 60s in the wake of the Beatles phenomenon. One was Gerry and the Pacemakers. Gerry Marsden, the lead singer, was one of those Tommy Steele lookalikes – all teeth and quiff.

I went because a friend had free tickets and while I remembered “Ferry cross the Mersey”, the West Melbourne Stadium was not the best place for romantic ballads. My memory of it faded from view, until the late Paul Lyneham, the ABC personality with that somewhat crooked personality, revived memories with a band he called sardonically “Pacemaker and the Gerries”, which as it turned out in a macabre way foreshadowed his death.

Another fragment many years on – I was in the Melbourne Cricket Ground, the night Liverpool played there in 2013. It was one of the last nights, before I was stricken with my illness – a night I remember clearly walking to the ground and then dodging the traffic to catch a tram back to the apartment – almost my last night of freedom.

In any event, the fans as one had erupted into their Liverpool Football club anthem “I’ll never walk alone.” In the bellowing it loses the romantic lilt of Hammerstein’s words and the melody itself is drowned. However, the intensity remains.

All the pieces have come together with that simple announcement above and the accompanying video of ordinary people singing or miming or whatever – there is something about British working class optimism that makes up for all the Boris buffoonery. 

Opening Australia Too Soon

We now appreciate the Tasmanian Premier closing his borders so none of his Tasmanians can cross to the mainland. However, his action in quarantining the Mainland from the outbreak in Tasmania shows great foresight. We always thought it was the reverse. What cunning!

The “Burnie Incident” is unsurprising, given the demonstrated level of incompetence in the health service, proof of what happens when all the rules that the Commonwealth government put in place are ignored or flouted. Strange things happen when discipline is lax – generally such laxity teams up with incompetence.

One of the problems with many, but by no means all, small hospitals is that administrative capacity of the hospitals is deficient. In particular medical administration is often problematical as incompetents are shuffled between these health services, often with glowing references. This a general comment and not one specifically assigned to either the Burnie or Mersey hospitals, which have a conjoint administration.

Tasmania is lucky it has so many hospital beds. Some years ago, the question was always raised as to why the Mersey Hospital needed to be built, but then there must have been a seer in their midst who saw virus in the mist.

In Burnie, the virus has been let out of the bottle – infection control has been such that COVID-19 has been let loose in the community. One of the Ruby Princess passengers has been blamed for being the first case in the North-West. However ascribing actual blame is for others.

What is important now is that there is a real life situation to follow the out-of-control virus, not some abstract model. Australia can now witness from its falling rate overall what happens in a region where it is easily out of control and to see if the Australian remedy can be reinstated and indeed works.

Burnie in its population makeup is not unlike a western Sydney suburb. There are a string of small towns along the coast from Wynyard, abutting Burnie to Devonport like an attentuated suburban Melbourne and Sydney. I mention Wynyard and Devonport specifically because they are the two travel hubs for north-western Tasmania. Rex flies to Wynyard and Qantas though Qantaslink to Devonport. Devonport is where the Spirit of Tasmania berths, and given the current history of boats and the virus, there is a certain vulnerability I would have thought.

With such restrictions the north-west provides an opportunity to see how quickly the virus can spread and how quickly this underprepared community reacts. If the virus escapes the enforced isolation of the 5,000, then every community in this part of Tasmania is at risk. Possibly viral spread could engulf Tasmania.

Wynyard

The next two weeks will tell all, but it is to be hoped that the introduction of the Army, AusMat, and emergency supplies of equipment and trained staff will halt the spread. There is the complication of the FIFO miners, who are flying in through Devonport but are moved immediately to the mines down the West Coast and thus avoid Burnie. Further, there is always the follow up question of how many miners come from Burnie or other north-west coastal towns?

Hopefully, the police will continue to conduct comprehensive surveillance not only along the coast but also the three main ways south. The first is across Cradle Mountain (from the guys who went from the topiary town of Railton to Strahan – they must have got a shock to be apprehended). The second is the main route down the Murchison Highway, although there is a possible diversion through Hellyer Gorge. Finally, for those who really want to take the COVID-19 virus on a scenic trip South, there is a third route along the Road to Nowhere down through the Tarkine and across the Pieman River at Corinna; hopefully the ferry is still running.

I only mention these routes as apparently there has been an allegation of a COVID-19 carrier, known to have infected a number of health workers, who has vanished from the north-west. Cannot be found. But then there a myriad of unmade roads and forest tracks impossible to police.

It is the problem of Tasmania. One of the most beautiful places on the planet, yet its inhabitants demand much while disregarding their responsibility to conserve and preserve; they could give back more. In this case together with the rest of Australia they may watch how this snafu is corrected.

Mouse Whisper

Hairdressers and barbers take a bow. Excoriated because you were allowed to remain open while others were not, you have plied your trade without being a school for scandalous conduct.

But like all mice I fear a Trim.

Trim

Modest expectations – Tom Waits

From the Carnival playbook as reported by The Washington Post:

More than 20 passengers were still too ill to leave the ship (Coral Princess), along with 38 crew.

Of the 1,020 passengers on board, about 993 were expected to be declared fit to fly, he said. They will be taken by bus straight to Miami International Airport, where most will avoid terminals and take charter flights. A minority of the passengers, he said, would take commercial flights; those passengers would be brought to a terminal that is not being used until they board.

As with the above Washington Post report, it is now 4 April and the number of COVID-19 cases has just reached 5,548 in Australia. If it had not been for the cruise ships, it would be considerably less than 5,000, and fortunately not the 10,000 Dr Greg Kelly and his fellow petitioners prophesised for 4 April.

Fortunately, at the centre of this activity federally we have a cohort of knowledgeable, calm public health specialists that you need in a crisis and obviously they are not going to release the models if the assumptions are wrong. The world is not a TV reality show. It is a planet at war. Therefore getting the strategy right is everything.

The Carnival is over?

As the Ruby Princess saga grows, my recommendation to sack Dr Chant appears mild now that all of the NSW Government seems to be in a state of self-preservation or that of hazard reduction. It was so obvious from the start that people being hurried off the boat meant something was afoot. Only too true – 10 per cent of the positive cases in Australia and 11 deaths as of 6 April.

However, the media were dozing – but not now. The Australian Financial Review at last discovered the media demure Ann Sherry. The Australian is calling for governmental scalps.

Now three weeks later, it is the NSW Government trying to weasel out of its responsibility. Carnival is the culprit shipping line that has the dubious honour of having two firms in Miami that specialise in launching legal actions against it – that includes all the shipping lines owned by the Miami-based Arison family. Mr Sture Myrnell is their local head and has sparingly fronted the media. Mr Myrnell, born in Bergen, was once the sommelier on the QE2 and although he has been promoted to dizzying heights, he has probably not lost his taste for a good sherry.

Which reminds me.

Now Ann Sherry was replaced by Mr Myrnell as CEO in 2018, but is still the Executive Chair and it was pointed out that she was responsible for external relations – aka lobbying.

Once Ms Sherry was not afraid to front the media. In an interview, she made the point that thinking big was crucial. She was quoted as saying in this 2018 interview:

I think it’s important not to lose touch with what’s happening in your organisation. One of the great challenges of leadership is that you’re busy and there’s a million things people demand from your time. So, it’s easy not to know what’s happening on the frontline of your business, and just let people tell you. My view, though, is that it’s better to find things out yourself rather than rely on layers of organisational filtering to tell you what’s going on. I think this is especially important in a customer-centric business. It’s crucial to be visible and to communicate to people on the frontline that you understand how important their jobs are.”

After all the above interview started with the following “Coming off a high-profile, extremely successful tenure as CEO of Westpac New Zealand…”

The report in the NZ Herald 5 December 2008 begged to differ somewhat:

Sherry was chief executive for four-and-a-half years and resigned from Westpac after she was moved sideways to head up the group’s Pacific banking division on the back of poor performance from the New Zealand division.

She earned more than $3 million per year in the position.

Maybe the word was not “profile” but “profitable” – and an interesting definition of “extremely successful”.

The situation is serious – very serious – not just because of the number of additional COVID-19 cases and deaths directly attributable to the Ruby Princess, but because the NSW Government somehow lost control of its public health measures during a worldwide pandemic when cruise ships had been identified as one of the most effective vectors for the virus. That is unforgivable.  

Therefore every link in the communication chain needs to be examined. I believe that Ms Sherry’s role as Executive Chair, irrespective of her belated attempt to escape the title, in influencing the decision-making process now and over the time of her stewardship should be critically examined as part of this review.

Now that there is a full police enquiry underway, in the end there may be the prospect of criminal charges. This review must be comprehensive and nobody should be shielded; equally, innuendo should be confirmed as fact or any particular person exonerated.

And finally Prime Minister this cruise ship behaviour has not been an isolated example to flick away. It has been happening for years.

Hibernation

I have been chipped for not looking forward to predict what we might look like after the virus has passed.

My predictions on the future are based on the proposition that there will no vaccine against this virus in the near future. The second is that immunity to COVID-19 is not life long. In other words, one infection will not guarantee that the individual will not be susceptible to other attacks. The same applies to a vaccine; some common colds are due to coronavirus and come back in a different form year after year. There is no vaccine that works.

The problem with the hibernation analogy is that the animal sleeps through its time of food deprivation. Its life is about foraging for food to be converted, and here the brown fat accumulation is an important factor up over many generations – not an immediate fix, but one essential to sustain the slumbering animal.

However, when the bear emerges from hibernation, the external factors have been at work providing the bear with sustenance from the very time it comes out of its den. The hibernation cycle does not factor in a continuing winter because spring always comes.

When the government uses hibernation as a metaphor it should realise hibernation it is not a one-off aberration of nature. It is not for everyone. However for some creatures, it occurs year in year out – the word itself is derived from the Latin word for wintry – hiemalis. Thus Prime Minister, you are not the head bear, although many of your sloth of bears may be somewhat grizzly.

Australia must emerge into a new world, which prizes personal and public hygiene. It is a world where everyone including the police force carries hand sanitisers. It is a world where coughing without shielding your mouth becomes as unacceptable as spitting. Every restaurant has pepper, salt and sanitiser on the table, and before food is served the patrons are politely asked whether they have used sanitiser.

At home as I was in the days before antibiotics lulled the community into a false sense of security, children always washed their hands before a meal – but then we said grace. As we grew up, with the advent of the fast food industry with the disposable society, washing hands before meals then lapsed.

Meanwhile, hygiene in hospital has improved immensely, and that is largely because it has been recognised that washing one’s hands between examining each patient is essential. It was a simple manoeuvre as was the abandoning of wearing ties and the improvement of the attire of staff – particularly those archaic nursing outfits. It is now as different a world as the time when surgeons operated in their frock coats in the nineteenth century and more recently when I was a junior doctor, when the anaesthetist’s monocle fell into the sterile neurosurgical site. Why, because this particular gentleman was peering over the neurosurgeon’s shoulder. Bad form old boy.

It is time to transfer these hospital lessons to the community. One measure of this is the standard of public toilets. As I have written before about how these are diminished in number in the major city centres. However, the technology is evident to establish a clean safe environment in those facilities.

Thus, when the virus passes for the moment Australia needs investment in hygiene – in public health – so that it is the aim to generally reach hospital grade level. In so doing this should evoke a cultural change in this country where nobody is exempt – and that means settlements like Utopia or Soapy Bore, Toorak or Byron Bay – yes you! Not singling you out, just reminding everybody that we are a nation with mutual obligation – it applies equally to you as it does to the smallest outstation.

One Labor Minister in Whitlam’s government once made the astounding observation “Australia is an island surrounded by water.”

The Terra Australis face that was turned towards the original adventurers and buccaneers was very unappealing and they left and those who were shipwrecked died in the harsh climate or were absorbed into the local aboriginal people.

Then our border control need be mindful of the unseen, not spend time hounding the vulnerable and looking in the mirror of this nation and seeing Pauline Hanson.

However the underlying premise is that the Federal government should take the original power allotted in the original Australian constitution – that of quarantine and thus assume national control of public health.

Australia has emphasised biosecurity in relation to fauna and flora, which has been moderately successful, but in terms of spread of human disease less well.

After this last episode it is not the poor unfortunates awash in the Timor Sea, but cruise ships with their crowded cabins and archaic air conditioning. Huge floating cesspools no longer should be allowed to berth in Australian ports. It is an industry that needs urgent review. As one correspondent has written:

Long ignored by cruise lines seeking to sell older tonnage are air conditioning and plumbing issues.

Ships built after 2000 are suspected of having air conditioning and plumbing and sewerage problems, some of which problems are major. 

The older ships will not survive nor are resaleable as they’ll be seen as potential health problems. Why? Breathing the same recycled air in every cabin or room will no longer be acceptable to paying passengers.  

The cruise industry must be re-evaluated, and Carnival and all its affiliates banned indefinitely – or should it be said that any ship owned by the Arison family. In other words, nobody begrudges a well-run shipping line, one that does not evade taxes, does not fly flags of convenience, does not use underpaid staff – and if the arcane Maritime Law needs to be repurposed for Australian conditions let the government assure that is so.

The other major area of potential infection and violation of the borders are the airlines. However, biosecurity in relation to plane passengers has always been lax – handing out pieces of paper is no substitute for targeted testing.

The question must arise as to the level of hygiene on planes where people are packed together and the air conditioning is dodgy at best. Should the passengers be handed sanitiser along with bottles of water; should passengers be handed out masks at the same time as headsets.

Once the country had quarantine stations; once Australians going overseas carried yellow books to assure that we had been inoculated (or vaccinated in the case of small pox) against typhoid and cholera and, if we were going to endemic areas, yellow fever. Until this pandemic, only the latter has survived as mandatory. However, given there is no vaccine for COVID-19 then having a yellow booklet does not apply except for yellow fever.

However, there are past measures that worked, but reminding the passengers of basic hygiene becomes as important in the training of cabin staff as being able to serve meals. Toilets on planes are a potential source of infection given how poorly the hygiene is policed and on long flights used to change into sleep wear.

However, it is also air conditioning that needs to be assured at “hospital grade”, not continually recycling stale air but providing clean air at all times. As one source with more knowledge in the air ambulance sector where there is liable to be more exposure to infection has written … It has not yet been disproven that exhaled droplets are not aerosolised by the cabin conditioned air flow, and some planes may not recycle enough air to effectively dilute aerosol pathogens, or they don’t pass recycled air through HEPA (high efficiency particulate air) filters.

Therefore, the future Australia as it emerges must have a different approach to hygiene. Once this is assured then it must have a continuing impact on the economy, and not be forgotten by government with a strangled budget.

The Long White Shroud

In this time of COVID-19 crisis, a farce is being played out within the Royal Australasian College of Physicians. Once a prestigious body responsible for overseeing the qualifications and hence the quality of consultant physicians and paediatricians it is rapidly becoming the Ruby Princess of the medical profession.

The Royal Australasian College of Physicians (RACP) was founded in 1936 as the Australian College aping its British counterpart, because our medical traditions have always been linked to the Old Country, fob watch and chain. Two years later, the New Zealanders accepted the invitation to join. Between that time and 2010 there had been only three Presidents from New Zealand.

Then Dr John Kolbe emerged. A respiratory specialist at Auckland Hospital, his wife a prominent surgeon who had been President of the counterpart surgical Australasian College and one who has publicly listed herself as a consultant for Siggins and Miller, a consultant firm based in Brisbane which is entangled in the current college mess. This is a slightly complicated situation since one of the principals of which, Ian Siggins died two years ago, but Mel Miller is still lurking around. Her role and ongoing involvement, if any, is for others to investigate further.

And indirectly, another Queensland connection lingers around as the Commissioner of the Australian Charities and Not-for-Profit Commission (ACNC) which is the middle of this imbroglio has as its Commissioner, Garry Johns, a former Labor member for the Brisbane seat of Petrie but now a darling of the right. He has been, as reported, experiencing his own internal problems within the Commission. His original appointment in 2017 was described as bizarre by certain of those familiar with the charities field, especially in regard to statements ascribed to him about indigenous people.

Following Kolbe there has been another New Zealander, currently the incumbent, Mark Lane. Two of three aspirants in the current election for President-elect are New Zealanders. There is thus this select pack of All Blacks. There were three New Zealand Presidents over 72 years; now the prospect of three within 15 years. It suggests that there is now enough confidence among the New Zealand physicians to form their own College; never tell a New Zealander that they should be a State of Australia. Let us guarantee a fond farewell.

The next problem is that with time, the active elements of the consultant physician workforce have formed their own specific societies based on subspecialist skills and technology.

Some of them drifted completely away and formed their own collegiate enclaves, such as the psychiatrists and dermatologists. At the same time, the paediatricians, whose governing body had been separate although existing under the same certification, rejoined the College.  Faculties were created in public health, occupational and rehabilitation medicine, and the consultant physician element in the college was further diluted by the creation of College Chapters.

While this dilution effect was progressing, the College undertook a review of the “collegiate relationship” with the then “specialty societies of the RACP”; the upshot has been that the relationship was effectively severed. The societies were relegated to distant cousin status, while at the same time the College took all their existing curricula as part of upgrading its own responses to AMC requirements. The specialty societies were left delivering training within an increasingly bureaucratic and unresponsive college structure that, in the view of the societies, was unwilling to provide resources to those societies for their contribution.

If it were not for the fact that the letters FRACP certify their members a meal ticket, many sub-specialties would have broken away, but government unwittingly, through regulation and connivance, have allowed this monopoly to continue. Therefore the College, irrespective of its current intrinsic hollowness, has been allowed to continue in its current unchallenged form.

Over the past 20 years since the time that the ill-starred late Craig Paterson was appointed the CEO the internal troubles have grown. However concurrently the level of farce has grown, fuelled by the presence of another New Zealander and would be physician rangatira, Dr John O’Donnell.

I was once on the Council of the College in a saner time when its impact on the community, apart from being a certification mill, was evident. However, what has stirred me to write this was a ridiculous set of propositions put to an extraordinary general meeting (EGM) held fittingly in New Zealand in 2019. The intent of the propositions was to create a select group to be known as “respected Fellows” whose role was to create a quasi-theocratic model superseding the current College democratic elections.  One young female college Fellow asked whether passage of these motions meant that all other Fellows would not be respected. Enough said. This takeover attempt by a small cabal was soundly defeated.

But now they are at it again. Presumably the same crowd with the same would-be rangatira is leading this pack of All Blacks. They want to convene an EGM at a time when this country and New Zealand are locked down in crisis. There is no valid reason given for this action, but apparently they have the numbers to pursue this self-serving, totally unnecessary course of action.

Perhaps it is linked to a document produced by a Brisbane-based firm Effective Governance. Their review purported to describe what is wrong with the College, but the endless list of recommendations revive some of the very problems identified in 2019 – e.g. a nominations committee to select Board candidates to ensure they have the “right set of skills” for the Board and essentially to remove the concept of popular election by Fellows of candidates who don’t necessarily have such skills. At the same time the proposed number of Board members is 6-8; that, combined with the “required skill sets” will make it increasingly difficult for a College Fellow to be elected to this Board. Is this what the College Fellows really want? On reading the document I raise the question of whether the report should have been consigned to the garbage can long ago, and incidentally what did this Review cost?

If I were a conspiracy theorist, I would be asking how much of this advice on governance over the years has emanated from a limited number of sources in Queensland. What of the direct Kolbe connection to Siggins Miller?

And why are certain people so seemingly keen to cover up about those who have requisitioned the EGM? And as for this EGM, especially at such a perilous time with COVID-19 and both countries effectively isolated, why are the usual suspects pushing such a destructive line?

However, I am not such a theorist, but I do like Kolbe to Bolitho to Talley to Yelland to Lane – what a sparkling daisy chain of “respected fellows. Once they were Presidents, and now…?

Last year I wrote to the RACP President, the New Zealander Dr Lane, asking for the release of the list of signatories to the 2019 EGM request. His dismissive reply relies more on legal smartness rather than common sense. Why was the list of signatories withheld? What did Dr Lane, as the President of the College, want to hide – a preponderance of NZ signatories?

The problem presented by this year’s EGM is that it ultimately will become an exercise in unexpected consequences, which may lead to a totally new organisation to guide the training and ongoing guidance of consultant physicians and paediatricians.

Maybe it is about time for consultant physicians to dispense with the current structure altogether with its over-regulation and expensive payments to a band of rent-seekers.

Maybe it is the right time to let the New Zealanders go and we revert to a purely Australian college. Our health systems are so different, our training is different; we may speak the same language but our cultures separate. Yes it is a good time to flag – once we are on the other side of the current health crisis – that we need a debate about this College of ours being purely Australian; after all, such a proposition is based on a purely utilitarian approach. It is totally ridiculous that this College could be run by a NZ rump.

And further, what about a breakaway College prepared to look after the interests of Australian consultant physicians and paediatricians, and not be burdened by the vestments of yesterday?

And as a footnote, almost as an afterthought, does having New Zealand Fellows compromise the charity status of the College in Australia. I cannot see the College’s New Zealand element being ascribed charity status in its own country. Just asking for clarification. Nothing more.

But first, in the interests of decency, those behind the resolution should withdraw their request for an EGM immediately. Otherwise every politician in Australia will know about this unnecessary distraction in this time of coronavirus. 

Mouse Whisper 

From a riverine relative, I am indebted for the following

Hydroxychloroquine costs around USD90 per 50x200mg tablets in the US for those who have insurance, or USD650 for those who don’t.

By contrast 100x200mg tablets cost AUD16.50 on a private script in Australia – a 40-fold difference before taking account of currency differences.

Make America Rich Again!!!

Modest Expectations – Macquarie Island

“Australian state and federal police routinely carry firearms. While on duty, most officers’ duty belts consist of a handgun, Taser, expandable baton, pepper spray, a set of handcuffs, ammunition magazines, gloves, torch, and a two-way radio.”

When the Queensland police were bailing up people at the Queensland border checking on their status, there was not the slightest indication that they were observing any of the rules explicitly set down to minimise the spread of the virus – no gloves, no masks, leaning on car doors, no evidence of hand sanitiser as they handed the documentation and pen to the driver … and as for keeping the requisite distance from their fellow officers, what a joke.

The police are so used to walking virtually hand in hand, nobody has seemed to have told them that just because they are a member of the police force, the virus will not quail at all the ironmongery jangling from their belts. It is far more likely that the belt and the attached items will attract the virus especially as unwashed hands fiddle with them. Where, Madam Commissioner Carroll are your COVID-19 virus protocols and where did you gather your officers together to be briefed on the importance of following the guidelines before they were let loose on the motorists?

It is salutary to remind the Australian police forces that 500 members of New York police force are COVID-19 positive, and there have been a number of deaths. Thus, at the very least each police officer should have a bottle of hand sanitiser placed between the gun and the Taser – and use it.

As for the air conditioning in these lock-down hotels, it is as important for the guards to be especially conscious of the health guidelines and not congregate, as police tend to do. Most of the air conditioning in the hotels is not hospital grade, and therefore there is no guarantee that the virus will not spread.

The last thing the hapless NSW Premier wants is police officer(s) or for that matter an army staff member testing positive in the next two weeks.

Her performance and that of the even more hapless Dr Chant is shaped by their failure – even up until 28 March – to quarantine the arrivals at Sydney International Airport. The Garuda flights where it was reported to ABC radio by a passenger that there were coughing and spluttering passengers allowed to pass through the country’s borders without any checking. If true, this just adds another entry into the charge sheet.

But back to the police – the incongruity of the social distancing in relation to the police force is shown in the images of their patrolling. Presumably the police are now ordering paddy wagons, which provide each recalcitrant with 4 square metres of space.

However jokes aside, the most impressive figure this past week in NSW has been the police commissioner, Mick Fuller – firm, decisive but compassionate – and incorruptible. He was prepared to take the community into his confidence by indicating he had a 90-day supervision delegation from the government to continue to do what the police were doing.

The images are now changing of some of the police force now with gloves and masks. But viruses ride on gloves and there is no evidence that they are being changed regularly. I still could not see the bottle of sanitiser at hand, so to speak.

By the way, where has the NSW Health Minister been? He was last seen coughing a week ago but popped up again on Sunday still looking congested. I hope he has not being doing a Boris, and got impatient with isolation.

The strange case of the Premier and the Fourth Saturday in Lent

One has to give it to the Queensland Premier Palaszczuk. She has a compliant Chief Health Officer, who is not a public health physician. She has closed the borders and at the same time allowed local government elections to proceed, even though they could have been deferred. The images of the voters not “socially distanced” and effectively gathered in large groups could not be reconciled with the health warnings currently agreed by the National Cabinet, of which she is a member. It is even reported that the electoral staff walked out of one voting place stating that they felt at risk.

However, by this questionable activity, the government could cover up the two by-elections being held to replace to members. One was in Bundamba, held previously by one who had said that the Queensland Treasurer was a four-letter word as she resigned. That is true, she is Treasurer Trad, but I am not sure whether this disaffected female member meant that word.

The second case was the long-standing LNP member for Currumbin, who had the temerity to vote for the abortion bill and was hounded by the trolls that seem so part of the LNP right wing so that she resigned. She was replaced by someone who had been a member of the LNP for a month and once appeared on a show featuring ‘”Australia’s Worst Drivers” – a trait among the politician class, yearning to be the centre of attention. The electorate seemed unimpressed, but that person seems heading for a narrow win – just a normal day in the politics of the Sunshine State.

Under cover of the local council elections, it is postulated the Palaszczuk government wanted to test the waters before the State elections due later in the year. If that postulate is correct, and in the 93 member unicameral Queensland parliament the ALP would have retained power whatever the outcome, it seems reprehensible to have held these by-elections at this time. But this is Queensland, the home of progressive health policy and One Nation (which incidentally polled very well in Bundamba). As if to highlight stuff-up, the Electoral Commission stumbled badly and most of the results were still unclear on Sunday afternoon. As will be the long term consequences of this essentially political preservation action by the Palaszczuk Government.

Obviously the Premier has not given up political machinations for Lent.

Cone of silence

The Diamond Princess caused much mayhem in Japan.

The Ruby Princess has since caused much mayhem in Australia. At least ten per cent of Australians infected with COVID-19 as of this week came from that one cruise ship.

Are the media asleep? Can nobody join the dots?

Why have there being no interviews with Ann Sherry, the Executive Chair of the Carnival Shipping Lines, asking how this all occurred. Why was the Ruby Princess allowed to berth? Why were the passengers herded off without even a passport check? Look, you gullible NSW voters, no hands! Surely no political pressure – beggar the thought.

But then the media, over the years, has performed a series of gushing tributes to this former bureaucrat and adviser to the Federal Government.

After the Diamond Princess fiasco in Yokohama, the CEO of Carnival Cruises, Arnold Roberts, was quoted as saying

We have hundreds of cruise ships, very few had cases on them. The one that had the most cases was very early on when no one understood hardly anything. With 20/20 hindsight, could everyone had done something sooner? Perhaps. But it was an evolving, learning situation.”

Not soon enough for the Ruby Princess obviously.

Now Mr Roberts made his first fortune playing blackjack on cruise ships by counting the cards it would seem and used this astuteness to run both weedkiller and sweetener enterprises. He was brought to the Arison owned shipping lines in 2014 because as was quoted:

It’s been a rough two years for the company. First, its Costa Concordia sank off the coast of Italy, killing 32 passengers. Then an engine-room fire on its Carnival Triumph left the ship without power. For five days, passengers lacked air conditioning, hot food and use of most toilets. Cable news was fixated, dubbing it the “poop cruise.” 

Training for a pandemic?

Now, Ann Sherry, what have you got to say about all this and especially in regard to the Ruby Princess and it berthing in Sydney with infection on board?

As for Dr Chant, Chief Medical Officer of NSW, you read this about the Carnival ships and especially look at the dates and tell us “mug NSW punters” why you should still be in your job:

Shared swimming pools, compact and enclosed spaces and quarters, frequently touched surfaces from handrails to slot machines, and meals shared with hundreds create an “increased risk of infection of COVID-19 in a cruise ship environment,” according to a warning issued by the Centres for Disease Control and Prevention (CDC) on 8 March.

(At time of publication)There have been at least eight cruise ships with confirmed coronavirus cases across the entire industry, including the Diamond Princess, Grand Princess, A Sara, MSC Meraviglia, Costa Luminosa, MS Braemar, Silver Shadow, and the Silver Explorer.

Carnival and other major cruise companies, halted all travel only after the State Department advised Americans not to travel on cruise ships and the CDC published a no-sail order of March 13.”  

The Ruby Princess berthed in Sydney on March 19 – without any quarantine intervention from you Dr Chant. Turn off the light as you leave.

A message from Princess Cruises

The Danger of the Hospital

I was asked whether I wanted to help out in Queensland. There were no immediate problems, which arose at the time of the first request. Then came the escalating restrictions and the changing job description.

Having to negotiate the border and being accosted by a police force, which were exhibiting doubtful levels of hygiene, especially in the transfer of documentation was the first problem.

The second was that the first job indicated it would be restricted to providing COVID-19 and public health telephone advice only, and then as I have been used to in any jobs relating to Queensland, the job description changed to one of face-to-face contact. As I am of the age where the government have suggested strongly I be confined at home, which I take to be a domestic situation, telephone advice was feasible and something that, as a public health physician, felt I should undertake.

The one particularly important thing that Australia has done, undoubtedly having Paul Kelly and Nic Coatsworth with their extensive knowledge of public health to back up Brendan Murphy, has helped establish the testing regime. The messaging has come a long way since the time early in March when a member of my family resisted the determined attempt to turn him away from Box Hill Hospital and insisted on being tested despite then having to wait one and half hours, despite there being no-one else there.

Coupled with closing the borders with China the testing regime has probably saved Australia. Early testing means that fewer people have had to go into hospitals. Testing has improved with a faster turnaround time for results. I for one, if tested positive, would have stayed at home as long as possible as opposed to hospital admission.

If you read the list of health workers dying in Italy it is reminiscent of reciting war casualties. The headline in the Italian newspaper early this week read “Coronavirus, morti altri dieci medici. Dall’inizio dell’epidemia sono 51.” You do not have to be fluent in Italian to know that 10 doctors died on one day earlier this week, bringing the total to 51. This number has continued to rise.

Despite the shroud waving led by the ubiquitous Professor Talley in the MJA and the intensivist petitioner Dr Greg Kelly and his collection of medical jeremiahs, Australia is not tracking Italy. I have already expressed my disgust at the NSW Department of Health in regard to the cruise liners, and there should be appropriate retribution at an appropriate time.

If you read the Johns Hopkins Centre for Systems Science & Engineering (JHCSSE) modeling this week, according to JHCSSE’s modeling when there were 3640 cases (about right) in Australia, we had 460 deaths; the modeling is based on Italy given this prediction of 460 deaths would be close if the case and death rate was similar to what has happened in Italy,

So much for modeling; and I wish that everybody would stop printing these hypothetical figures, which may as well have been got by reading the tea leaves. The problem with the media is that, over the years except for a very few people like Norman Swan, it is totally gullible in relation to health, reporting every bit of public relations fluff that is put out about so-called medical “breakthroughs”. That is particularly dangerous when there is a pandemic and the hucksters are abroad.

However, this does not mean even at my vulnerable age, that I would want to be admitted to hospital if I developed a fever and a tell-tale cough. I would hope to tough it out; but then again I hope I won’t have to make that decision.

Now that is an ordeal

We have been seeing a flood of returning passengers from ill-fated travels, many of whom commenced these travels at the wrong time when the portents were there of gathering clouds – 16,000 left Australia after 18 March when the Government’s Level 3 travel advisory was issued (Reconsider your need to travel because there are serious and potentially life threatening risks).

Those who have been able to return should count themselves lucky. Complaining about their situation in five star hotels reminds me of a time, of my father’s generation and of a place called Singapore. Here were a number of involuntary travellers called soldiers who were deserted by their leaders, with their braid and red banded caps called generals and brigadiers. The soldiers were confined, not for two weeks but for three years – if they survived – as guests of the Japanese. Their first place of confinement was known as Changi.

Therefore the younger members of the currently 5,000 in confinement in Sydney hotels, would never have been contact with some of those soldiers, who eventually returned. I was taught by some of these men – they never had a sense of entitlement; they had not been locked up in a hotel room for two weeks with three meals a day, phones, internet, television and new towels every day. They had a slightly different experience over three years.

They never moaned; very few wrote about it. Very few ever talked about it. Some of my generation – people I knew – never knew their fathers – today a word lost in the slush of that term “loved one”.

There was no TV series called “Survivor” with inane presenters and faux battles. Maybe after you are released there will a scramble for a media contract to tell all.

In contrast, in my youth I remember there was the man who always dined alone on Christmas Day away from his family because that was the day his mate left his quarters for the last time, not to the streets of Sydney but to an unmarked destination.

So take a powder, you lot, turn off your Skype; stop making yourselves look totally selfish on Facebook, and just deal with it.

As for the media giving these people oxygen, what about the Biloela Four locked up on Christmas Island – a sort of Changi without the cherry blossom. Forgotten them?

Skiing in a time of coronavirus

Janine Sargeant – Guest Blogger

The media have been reporting on the now infamous Aspen 9 who are reported to have brought more than a ski tan back from their recent trip to Aspen in Colorado.

Burnished with schadenfreude the reports have followed members of this group through birthday parties in Melbourne and Noosa and a visit by one couple to their beach shack at Portsea; the reports have included tallies of the number of confirmed cases among the ski party and those apparently directly attributable to the two birthday parties. The Noosa party resulted in many positives among guests, but also among the restaurant staff. There is talk of legal action. The 14-day mandatory self-isolation for overseas arrivals was introduced the day after the ski party returned.

More broadly the Aspen 9 saga raises the question of what plans there are for the Australian ski season, which normally opens on the long weekend in June. The skiing might be out in the fresh air two ski poles apart, but the ski lift transport, aprés ski scene and accommodation is not.

Having spent quite a bit of time on the skifields, skiing, running a ski shop and working a bar at a lodge – my version of a well-spent youth – I still remember a case of tonsillitis that sent everyone into a spin because the close-living environment of ski lodges was so conducive to the spread of illness. However, if even the well-heeled in their plush accommodation are catching COVID-19 in record numbers, then there’s really a problem. Without knowing the denominator (how many there were in the Aspen group) there’s no way of knowing what the incidence of infection was, but there are enough cases to raise alarm.

One of the highest COVID-19 infection rates per capita in the USA has been reported by “The Washington Post” as being in Idaho’s Wood River Valley – 192 cases in a county of only 22,000 residents; there have been two deaths so far. Why is this? Idaho has some of the best skiing in the US and is a well known conference destination. Skiers fly in from around the country and around the world and no doubt have brought in COVID-19.

The source of the infection in Blaine Co, home of Wood River Valley and Sun Valley, was almost certainly skiers from Seattle, from which there are direct flights. Washington State had the first confirmed positive case in the US and up to mid-March, had the highest absolute number of confirmed cases and the highest number per capita of any state in the country. That has now changed with the epicentre shifting to New York.

However the counties surrounding Vail and Crested Butte in Colorado and Park City in Utah – all skiing hotspots – are now also COVID-19 positive hotspots.

Wood River Valley’s small hospital has been partially shut down because four of its seven emergency doctors were quarantined. The fire department that also operates the ambulance is relying on volunteers. One of the doctors who has tested positive said he thought he had caught the virus because of close contact on ski lifts.

All State Governments in Australia have effectively banned recreational travel within the State, and absolutely banned travel between states except where a permit is in place or a resident is returning home – but 14 days of self-isolation are required. Everyone is supposed to stay home, but for how long? The June long weekend is eight weeks away.

Faced with the experience of the US, which has spilled over into Australia with the Aspen group and around 50 positive cases, presumably NSW and Victoria should be putting skiing on hold for 2020 – and without any intervention from Master Barilaro, the local member, especially after the Ruby Princess fiasco.

Mouse Whisper

Paul Barry brought this to my attention as I was gnawing my way through my late night supper 

What is this constant mention of Petri Dish in relation to coronavirus?

Viruses need living cells to propagate, not Petri Dishes containing blood agar, upon which bacteria and fungi party.

Fortunately, my relatives are less exploited now as a medium in which to grow viruses, but embryonated eggs have always been a favourite culture medium. However, now most viruses are grown in cell culture.

Nothing to do with Petri Dishes. Today’s tip for the journalists, if you want to sound knowledgeable at least check the details; a Petri Dish isn’t something from “My Kitchen Rules”. So drop the Petri Dish metaphor. Even a simple mouse like me knows it has nothing to do with viruses.

Modest Expectations – John 1

Public health experts and academics — who have the luxury of not having to ever be elected, and who don’t need to care about the consequences of a prolonged economic crisis — have been demanding Italy-style quarantining from the get-go. The pressure to shut schools from media commentators and worried parents has been enormous.

A quote from Crikey, and yet … I have just added a footnote, which seems to fly in the face of the above. However, it is about time the highly paid individuals in the public health community takes responsibility and stand up to the politicians.

It’s late Saturday afternoon on 21st March and I am angry – very angry. Why was that cruise ship, Ruby Princess, owned by one of Trump’s mates, allowed to dock in Sydney and the passengers hurried off without being quarantined?

Ruby Princess

I would have asked that question at the Hazzard press conference if I had been there on Saturday, except for him coughing all over the place. Nobody asked that question. The media present did not. So Saturday’s spectacle was of NSW having at least 48 people off the boat infected with coronavirus roaming the community as the signature for the NSW health system. “Self-isolation” – what a joke if there is nobody to enforce it. Who at the media conference was the journalist who asked about that action of the Health Minister coughing and infecting NSW wantonly?

Kerry Chant, I remember you as a promising young public health physician. What were you thinking letting this occur? It flies in the face of all public health logic.

I know your Minister is well named, but Dr Sheppeard, who was at the press conference deputising for you, should have told the Minister to step away the requisite number of metres and “do unto himself as he would do unto others” what he had been spruiking. Did anyone do that? Did the Minister use hand sanitiser after he coughed into his hand? What measures were taken to shield those there from this hazardous coughing fit? Dr Sheppeard, Director of Communicable Diseases, was there to ensure that the Minister did conform…not!

Border measures in place whether by ship or plane were non-existent as the Minister blustered.

Watch the curve rise, Dr Chant, and weep for the contribution of the spread that the lack of border surveillance under your watch. You have been in the job for 12 years – too long – time for you to go, Dr Chant. After all, you have had a long time to develop a plan that would have avoided the current border chaos.

But before you go, Dr Chant, the reason for these ships dumping the passengers and repatriating most of the crew? It has been speculated President Trump wants to reveal that he has commissioned a number of these cruise ships to be used as hospital ships to lie off the US Coast – and guess what he will be using? But then, Dr Chant, you may have passed it off as only a rumour. If you read the American media, it is no longer a rumour.

And of course, there are the other four cruise ships allowed to berth. They should have been stopped from berthing. If a modicum of time had been spent in doing so, I presume that was your role.

The NSW Premier announced on Tuesday morning that 149 new cases turned up in NSW overnight, but failed to credit the decision on how many resulted from the failure of border control – and of course there are the other States to be unimpressed.

Overall as reported there are at least 133 cases from the Ruby Princess with three known deaths – the number of cases is still rising. Did I hear the Minister for Health asking whether someone would pass him the Sherry? Or was I just hearing things?

And, by the way, the collection of people on Bondi beach, which occurred at the same time as the cruise ships were berthing, and received condemnation. Is it about time that if COVID-19 was being spread through that congregation it should be manifesting itself? We know those testing positive in the cruise ship but what are the positive results from those who were on Bondi Beach that day?

As an important afterthought, could all States inform us daily not only of the number of positive cases and the number of deaths, but also the number who are in hospital and of those, the number who are in intensive care, together with the number of people who have already recovered. We need to stop the dazzling modelling and deal with reality on a daily basis.

I vicoli vuoti

The quote:

The neutron bomb is a nuclear weapon that maximizes damage to people but minimizes damage to buildings and equipment. It is also called an enhanced radiation warhead. The neutron bomb is a specialized thermonuclear weapon that produces a minimal blast but releases large amounts of lethal radiation, which can penetrate armour or several feet of earth.

Nothing like what the coronavirus has done to the streets of Italy. Barely a piece of paper floats along the lanes of the closely packed cities and towns, most unchanged since the Renaissance or before.

The neutron bomb, the development of which commenced in 1958 as a by-product of the atomic bomb, was eventually abandoned as too dangerous. Even though it protected the architecture, the radiation effects were lethal on the population. There were debates around cities being devoid of population – literally dead cities. It was a consequence that the then leaders could not tolerate. The image of beautiful sights where no-one walked was just too terrible to contemplate. The Duomi, their massive doors open, but nobody came.

But the Virus did.

Memories of Poliomyelitis

There was a polio epidemic each side of WW2 in Australia. I remember one; and my cousin who is 94 remembers the other, when she was in her first year of high school. My mother-in-law, who is the same age would today have been at high school but in those days my country cousin was the exception. Girls left at the end of primary school to work on the farm. It was the Depression, and to her family my mother-in-law was unpaid labour.

However, it was the 1937-1938 polio epidemic and in a way closure of schools in the country was somewhat academic. They both remembered the permit system. Everybody travelling from Victoria to NSW needed a permit because there were more cases of polio in Victoria than NSW. In fact, Victoria was seen to be the “villain” of the epidemic. Tasmania had restrictions on travel but that did not prevent the epidemic invading the island.

As one extensive thesis by Anne Killalea on this Tasmanian epidemic written some years ago concluded;

The greatest poliomyelitis epidemic of all time has left its mark on survivors, however well they have accepted their disabilities and built successful lives. Its mark also shows on those who themselves escaped the scourge, but lost beloved family members, or patients, or school pupils. Volunteers unceremoniously dismissed when no longer required also feel the hurt to this day. Many, if not most – patients, professionals and volunteers alike – expressed surprise to think that anyone after so long would be interested in their story.

As their story is so much part of what Tasmania is today, no one should forget.

They were prophetic words, and they did not only apply to Tasmania. A generation passes, and another polio epidemic was upon Australia.

My and my friend’s memory of the 1949-50 epidemic was of school closures. Our preparatory school was not closed; but there was a death of a young boy in our companion preparatory school. However, I did remember we didn’t play inter-school sport. Swimming pools were closed. My friend’s preparatory school was closed down for a period because one teacher’s son developed poliomyelitis, one of 760 reported in Victoria that first year. We were sent home straight after school, no chartered school buses in those days. The poliovirus is a gastrointestinal virus and for me, a boy living in an unsewered area where the nightman cometh, and where travel from school was on public transport entailing two trains and a tram, it was not exactly social quarantining.

However, I remember no panic; I remember children of my age with those unwieldy leg irons; thirdly I remember that we were told not to eat ice cream – and being an obedient child, I did not eat more than one ice cream a day – there were the penny and three penny cones. I always dismissed the penny cones.

Obviously, I was too young to follow the vaccine debates, but when the liberating vaccines came – first the injectable Salk and then Sabin in a spoon. In a few years polio became rarer and rarer. Even then there were the anti-vaxxers who refused their children the vaccine, often with calamitous consequences.

The epidemic provided the physiotherapy profession with a great boost, and I well remember the physiotherapy team at Fairfield Hospital in Melbourne concentrating on the rehabilitation of the chronic cases.   By the mid-1970s the number of chronic cases had declined to such extent that the physiotherapists were re-deployed into the early childhood development community health program.

However, remember, polio was a disease that disproportionately struck the young, and while there were closures, there was a different mindset in Australia then. When faced in Australia with an incurable disease caused by this virus, one epidemic in Australia during the Great Depression; the second just out from a horrendous wartime.

I am not sure now whether the stoical survival of that virus said something about resilience or resignation that it was just God’s Will.

However, schools were not closed, unlike during the 1918-1919 flu epidemic when the death rate among school age children was low compared to the older age groups – as far as I can estimate 3 per million – but then school attendance was far different from today.

I listened to one of the younger medical brigade expressed in public that “those of us had not experienced anything like that”. Not quite right, Dr Kidd.

Letter from Sweden

A Swedish medical friend sent me this data from Stockholm as of 24 March. Currently Swedish deaths from COVID-19 are 2 per million. It is calculated that Sweden is 15 days behind Italy, where there are 91 deaths per million. Nevertheless, it is a very big gap, and appeared similar to the situation in Australia. However, a subsequent communication indicates that the deaths there may have moved up to 4 per million – a little more than one per day.

The restrictions in place in Sweden include gatherings of 500 or more being forbidden, voluntary quarantine and an intense propaganda campaign to wash hands; and not to go to work if any – and they mean any – symptoms are present. Sounds familiar, and apparently as my friend described it, “a cosy après-ski party” had a significant role in spreading the virus.

Nevertheless, the Swedish government is pushing ahead with increasing the number of intensive beds, and using military hospital beds. The problem is that we are monitoring Italy with a ferocious thanatopsis; but from a more relevant public health point of view, maybe monitoring Sweden would make far better sense for Australia.

As directly reported in (and translated from) the local Swedish media:

A total of 2,016 people have been reported infected with covid-19 in Sweden (20 cases per 100,000 inhabitants), 54% of the reported cases being men. The cases are available at all ages (median 52). Half the cases notified so far has been infected abroad, but of the cases reported last week, the majority have been infected in Sweden

Some of the victims in Sweden have been infected by people, who have fallen ill after traveling abroad. Nationally, 25 of the cases have died.

In total, 80 intensive care patients with laboratory-confirmed Covid-19 have been listed in the Swedish Intensive Care Register’s special reporting module SIRI. The median age is 64 years (26-84 years).

Back to the Past

It is interesting to see how society copes with a catastrophe. My maternal great grandfather, a prudent and wealthy wood merchant, had his money in the Bank of NSW during the Depression of the 1890s, which was entwined with a major drought. He was cashed up, and survived.

On the other hand my paternal grandparents lost a substantial property when they were foreclosed in the 1920s. It was a financial disaster for the family as the property, “Oswego”, later became the Waverley Golf course, nearly 100 acres on the country fringe and long since subsumed by housing and light industry. These case histories were repeatedly drummed into me as a boy, so that I am a person who always wants to be debt free and I cannot stand having no cash.

We all have our foibles and for me, no less than any other. However, the world in which I grew up after WW2 was far different from today. Australia had managed to avoid being massively indebted because of the use of the taxation power, which the Federal Government assumed from the States and never gave back. Government bonds were sold locally and industrialisation, commenced seriously in the late 1930s including defence industries, occurred behind high tariff walls. The backbone for our prosperity was our primary industries – living off the sheep’s back, but not completely.

Barker Station Melbourne

However, there was a great deal of stress, there was rationing and with rationing comes profiteering. There are always good stories. During the war my Aunt Chattie, who lived in the country would send eggs, cream and butter to her daughters in Melbourne. She used to put the parcel on the train at Beaufort; the parcel was addressed to the stationmaster at Barker station, with instructions that my cousins would pick it up.

However those were frugal times – cash or cheque, which had to be signed in ink, only. The nearest one got to a credit card was to put it “on the tick”; but I was always bought up to pay.

Now we have a community loaded with debt, and the economy is shot to pieces. There have been multiple responses from government to COVID-19, each time increasing the pain – but it is confined to the ordinary people; there is no application to the elite.

All the over-paid need to do is to take a pay and perks cut –from the Prime Minister downwards, all those with inflated salaries and perks, including the inflated retirement packages – they should be reduced. All have been built up by sophistry to justify patronage, greed and corruption.

Superfluous political staff need to be pared back; lobbyists put on the same list as the beauticians. Given that the Parliament has voted the current Government a great deal of money, with its culture of handing it out to its mates, then it is all the more reason for Parliament and Government offices to cleanse themselves of rent-seeking vermin and put an end to rampant mercantilism which has been underpinned by our woeful taxation system.

It is thus a good time for levelling out the income scales – those who have been on the government mammae need to be forced to stop milking the system. Once the community went into debt to ape the lavish lifestyle of the seductive lifestyle magazines. Now this social tear in the societal framework with its long lines of inequality may change the attitude to one of disgust at the pampered life of an elite reinforced by these same lifestyle magazines. In the end the fuel is being accumulated for community uprising, especially when there are a large cohort in the community who face death, suicide being an obvious option, rather than from a virus, which seems to act like the common cold. That situation may change if the population is unable to maintain itself with a consequent weakening of the immune system.

However, this virus is wily and in each country is revealing the vulnerabilities of the health systems. America is reaching its moment of truth as already Italy and Spain have.

It is all very well for insulated politicians to tell us all to stay inside our houses, but as The Economist said this week “Suppression strategies may work for a while, but there needs to be an exit strategy…if the governments impose huge social and economic costs and the virus cuts a swathe through the population a little later…there will be hell to pay.”

Especially as there is a clown who perpetuates the distrust in politicians by lying about the reason the MyGov website fell over – a blatant lie. Does the Federal Government do anything about him? No, nothing. And his apology? An adolescent “My bad”.

Dangerous, even revolutionary times. Australia now has the population to sustain a popular uprising.

At present the Government’s solution appears to be to set up a “distinguished group” to advise, with the Messrs Gaetjens and Pezzullo as the bureaucratic conduits. Inspire anybody?

Hairdressers  

Janine Sargeant Highlights

Amid the rubble of businesses closed this week, hairdressing is still surviving as an essential service, but with strict adherence to “social distancing” and hygiene together with a curious debate about whether a haircut can be achieved in less than 30 minutes.

Some hairdressers, like mine in the Sydney suburb of Rozelle, had already instigated special hygiene measures, like handwashing on entry (here’s the basin, we’ll sing along for the 20 seconds), regular cleaning of all chairs and surfaces and the card reader, maintaining “social distance” and close attention to staff health with regular checks – they all have families. But what about this 30 minutes rule?

In 30 minutes I can still get a hair cut, but the foils are foiled for the foreseeable future and you can easily skip the blow dry and the colour for the present time. But tell me, Dr Murphy, what is the evidence for 30 minutes, or was it initially done with a roulette wheel.   And then, just a day or so later, all time restrictions off – not that you could have policed it anyway.

I did have my hair cut this week and I dreamed of that past time when one could find out easily how many people had tested positive and had subsequently recovered (that’s the problem of public health training, always thinking of the denominator). Increasingly it seems the community is now not allowed to have a complete overview. Just try to find out how many people have been hospitalised. There are some data – very little – on the number of patients in ICU, but difficult to find out. Dr Murphy, so why are you hiding this data? We are really not wanting to see any more of the horror photos from Italy. Are they really relevant to Australia?

But back to that 30 minutes, that became 90 minutes or whatever … and I’m still wondering what is going on in hairdressing.   Listening to the very loud calls for all hairdressing to be closed down immediately it becomes clear where the friction is – if Government closes down hairdressing then the salons don’t have to pay out the staff they stand down – Mr Just Cuts didn’t say this, but that was the underlying argument; it was made very clear on Sydney radio on Wednesday. Economics underpins everything, but it still doesn’t explain why hairdressing received special attention in the first place.

And one more brief lowlight before the mouse takes the stage … it was reported this week that a man in Italy contracted COVID-19; his wife and daughter caught the virus from him. But in two degrees of separation, 70 – yes that’s 70 – relatives caught the virus from those three at a family funeral. The normal disease pyramid pales into insignificance in the face of this sort of transmission.

Mouse whisper

From The Washington Post (murine edition)

It could only happen in America under that old Fox, Trump?

As of six days ago, my wife called up her former co-worker, one who dwells in Fox news so much that she has to rush home for certain Fox shows.  She was still intending to drive from San Jose to Seattle in order to visit her son and daughter-in-law.  They planned to stop and stay at gambling casinos along the way.  I betcha they had to change the plan.

The point here is that in the Fox news bubble, an awareness of the situation had not sunk in.

California Hotel Casino

Modest Expectations – Year

What a time to reach the anniversary! 

Given there are so many competing voices, one has no expectation that there is any audience but it provides the discipline of writing a diary. As instanced two weeks ago, I addressed the problem then presenting to a potential overseas traveller. The horizon was cloudy, but in two weeks, the world has battened down to ride out the coronavirus torment. The mixed messaged irrationality of the initial responses, plonked on a world inured to a social media prepared to publish blatant lies and worse the next level – “Trump lies” without intervening to insert evidence based comment.

Remember, it was not so long ago that according to Trump, this viral pandemic was a “hoax” and he blamed it on everyone except himself.

In my first blog, my first piece was about Prime Minister Ardern. I wrote:

“Now I am an old man, and seeing this woman, the Prime Minister of New Zealand, she is the first politician since Kennedy to cause me to believe, perhaps that to me she an exemplar against the fear and loathing that has characterised so much of what passes for political debate. I, like many, am just frustrated by the low level of debate. There is no longer any consideration in this Me All The Time rent-seeking political crop for policy discussion.

Yet Jacinda Ardern gives me hope. Her words – her demeanour of grace, compassion, resolve, her ability to call out the bully – the courage of making herself a target for all the “unspeakables”. She is indeed a paragon.

Just as I learnt from Alister, watching him succumbing to AIDS; now at a distance and not knowing the woman I think I have now adapted. Taken a long time, I must say. However, Prime Minister if I have the privilege of ever meeting you, please do not hug me. I am not a hugger.”

I see no reason to change my view a year later; especially in these viral times.

Her action in relation to this virus pandemic was decisive. It provided certainty for her people.

The headlined comment in Time this week said it all to its readership. In large letters, they reprinted Jacinda Ardern’s admonishment of Scott Morrison: “Do not deport your people and your problems.” This was a blunt response at a press conference in regard to this country’s “smart-ass” insistence on deporting foreign-born offenders, who have grown up in this country and have no relationship to New Zealand even though they may have be born there. They did not print the Morrison reply.

However, if this country wanted to deport a New Zealander of no particular merit to this country, why not add Brian Houston to the list? However, that probably would be the last straw for Prime Minister Ardern.

The Meaning of the Blog

So what is the point of the blog? It is more than just vanity press; it is the discipline of committing oneself to a particular position, or in the case of the overseas trip soliloquy two blogs ago, a testimony to how quickly the world changes. We didn’t have to make the decision about our trip. It was made for us, and the one thing to be learnt is not to attempt to “jawbone” the problem and immediately panic and cancel, with all the attendant costs; these don’t occur if the transport company does it for you.

The problem is that Australia is experiencing a community panic attack which, until this week, was fuelled by the uncertainty of the messaging, and therefore it also provides a chance to see if one’s opinion of a few weeks ago was right – and if not, it is in stark relief which no amount of bluster can expunge.

Looking back at my blog with its very select audience, it is a diary through my eyes enabling me to reflect in a contemporary setting on my life for what it is worth.

Babbler or Bubbler

Tower of Babel

The tower of Babel has been alive and well. Everywhere the publicity-shy “experts” on coronavirus have been pontificating, many of the vacuous statements suspended in the ether. Many messages are heavy on gravitas but confusing in fact.

I have suggested that in terms of the media, we should take a lesson from how we handled the bushfires by having single information source, as the ABC provided during the bushfires. It showed very clearly how many magnificent communicators the ABC has and who reported without any hysterical overlay.

The problem in this community is the lack in trust in whatever comes out of a politician’s mouth. So when the Prime Minister delivers a reasonable speech on Wednesday, it was at the end of a very confusing trail of information in relation to the epidemic. Whatever has happened to the “pop-up” clinics, a thought bubble from the week before?

Dr Brendan Murphy in this midweek media conference with the Prime Minister was far better after his disastrous appearance on the ABC program “Insiders” last Sunday where he looked uncertain, rumpled and his muttered response of “the situation is evolving” was a classic statement of uncertainty.

He has had a haircut and been generally tidied up, but even though his comments were far better, he is not an intuitively good communicator. There are all the unseen media coaches which can paper over the cracks but if you are a poor communicator having spent your life as an eminent nephrologist and esteemed medical manager, where bothering to learn the trade of communication has been seemingly irrelevant, then what should we expect. He comes from a world where patients and staff are told. It is not a criticism of Brendan Murphy himself; it’s a fact of being a doctor and a product of the systemic arrogance of the profession. In these stressful times you may need a good doctor for your patient, but if it is the community you need to be a good communicator.

The Prime Minister, during that same media conference, dropped his guard when reporter suggested the government website was not very good, to which the response was “that’s your opinion” rather than seeking constructive advice – and for an instant he was back into the “gossip, bubble,” defensive palaver, which has characterised his stewardship.

Ita Buttrose has been so right in criticising the response and comparing the current mess with the ordered response that occurred with the AIDS/HIV outbreak in the 1980s, with which she was involved. The way that infectious disease was handled, given how much underlying prejudice and stigma was rife in the community, was a model. At that time it was successful in getting the message across to the vulnerable and yet reassuring those who were not vulnerable. There were flaws but the messaging from the Committee chaired by Ita Buttrose and David Pennington provided a strong veneer of certainty.

The ABC has many excellent communicators and this was highlighted by some of performances in the bushfire. Norman Swan has an incomparable knowledge of health, which he communicates well. However, constant exposure to him without a counterpoint is liable to make one want to go to bed and, if there was such a drug, take enough to wake up in 12 months, such is the underlying pessimism of his message.

One doctor, in a letter signed by a couple of thousand of his medical mates suggests that by 4 April 2020 there will be 10,000 cases in Australia. However, are they 10,000 cases still in care? The acquaintance, whom I mentioned in my last blog, has now tested negative after 18-20 days. Freed from quarantine, and a journalist who kept a diary his writings may provide some reassurance. Because at this stage how many in the community know a person who has been infected and has become well again.

I think we should emphasise those who have tested positive and now are negative and publish that data, instead of the headline of how many deaths there have been worldwide. Knowing the number of cases is useful data, but just as there are more being tested positive, how about those like my acquaintance who now are negative – in other words do not have an active infection.

The big unknown is how long the immunity lasts. Having a cold, a suite of other coronaviruses, does not confer immunity for life. However, what this pandemic may do is to improve the overall hygiene in the community. It was thus excellent to hear both the Prime Minister and the Chief Health Officer reinforcing that message.

There is now a need to monitor the school closure situation – a fluid situation and one where false information will just compound the community uncertainty.

Also the community is now being inflicted by the term “modelling of the disease by experts”. As one knows from experience, such modelling is only as good as the assumptions, and I for one would like to see the assumptions.

The Premier of Victoria, among his comments on Thursday on opening up emergency beds and stocking the hospitals with the requisite equipment, stated there were only six people in hospitals in Victoria despite the increased number of cases overall. Six? What is going on? I would like to see the curve in relation to the number of hospitalised patients against time; the curve of those who have recovered.

Nevertheless from the sidelines, the ABC is without a national debate providing up-to-the-minute information; and Norman Swan being a regular feature provides the community with reliable lucid consistent information, irrespective of whether one totally agrees with him or not.

May I insert one small suggestion? Norman Swan is not going to be around forever; he is 67 years of age, already in what the Italians call “vecchio”; I would hope the ABC has a succession plan for Norman given how valuable a resource he has been before it reaches the next level of Italian old age delightfully termed “anziano”.

Already TV ratings are supporting the view of the ABC having that designated role.

However think about it, the ABC as the coronavirus station – it may cost more money but then it would well worth it. After all, the ABC is a public service.

Time to call Time

A pack of well-heeled Australian doctors and dentists on the 500 person M.S. Roald Amundsen off the coast of Chile is marooned in the ice floes of coronavirus. They cannot land in any Chilean port, and while one should not indulge in a dose of schadenfreude, it highlights one of the tax rorts, which should addressed by government.

I have no worry about these prosperous people taking holidays, and if they want some lecturers along the way to stop them from having the first whisky before noon, well and good. However, this is primarily a holiday. The taxpayers should not be asked to subsidise wealthy people’s holiday, even though confinement on ship has provided them now with learning about the physical and psychiatric consequences of being stuck in Paradise. They must be getting loads of Continuing Professional Development (CPD) points.

However, I hear one solution proposed is to dock in the Falkland Islands and be flown home. This may be a helpful quote: “For most commercial flights, passengers are directed to the British Air Force base RAF Mount Pleasant. While the Air Force base is home to a small squadron of Boeing Chinooks, Eurofighter Typhoons and a single Airbus Voyager KC2, commercial operations are also welcome at the airport. Utilizing the airfield’s 8,497-foot runway, British-based AirTanker provides nonstop service to the United Kingdom for military members utilizing 300-seat Airbus A330-200s from the RAF.

The only commercial flights to South America from the Falkland Islands have been provided by LATAM, the Chilean based airline, which does have a non-stop flight to Australia in normal times, but conceivably if a plane of sufficient size could be chartered and could stop in Easter Island if there was a fuel problem in flying non-stop.

We shall see – but we, the taxpayers should not be footing the bill to get them back in Australia with the enforced quarantine period. The tax break for their conference should be more than enough if coupled with insurance taken out for such a contingency.

As they say, a meat worker in Wuhan was scaling a pangolin in China which results in 500 people of different nationalities being quarantined off the Coast of Chile – catastrophe theory at work.

I would hate to be in this predicament, but it would have been unlikely as (a) I believe these so-called education programs should not be tax deductible, and (b) I am opposed to Antarctic tourism anyway – it should not be an ecological plaything for the affluent.

Thus, when we Australians are faced with hardship, it is bordering on the obscene for the government to allow this tax rort to continue. Full stop! End of story. 

St Patrick’s Day

  fhéile Pádraig sona dhaoibh!

I always enjoy celebrating St Patrick’s Day even though I am not a tyke, as my great uncle Frank used to describe a Roman Catholic. As a Christian, I do not subscribe to the Irish version of Roman Catholicism nor for the Church of Ireland, which is so well represented within the Sydney diocese of the Anglican church. As I have reported earlier, on my mother’s side I come from a line of Co. Clare Egans and McNamaras. The family was all Roman Catholic until, as has been told to me, the priest was so drunk he did not come and give the final rites to a dying Egan child. This was in the first decade of the 19th century, and the whole family changed to the Church of Ireland overnight. The Egans have been known for their unswerving determination, whether logical or not.

However that is what I love about Ireland, it is the predictable unpredictability, and ultimately their successful struggle for independence. I’m sorry dear Uncle Frank, or Ponky as he was known, I don’t subscribe to your solution to the local Irish question – whenever the Roman Catholic Church and in particular Dan Mannix, the Archbishop of Melbourne, was mentioned you would growl: “they should all be boiled in oil.”

So this week I did not miss the Day despite the Virus. To support local industry, we went to lunch at the local pub with sanitised hands and social distancing. May I say my meal of a dozen rock oysters with Irish soda bread on the side was a brilliant start. They were an excellent substitute for Dublin Bay oysters; much better even though they were cloaked in that Kilpatrick concoction.

Why “Kilpatrick”? I love the apocryphal story rather than the actual one. The story goes like this. A fisherman called Patrick went out to sea and his haul of oysters was so large that in trying to bring them on board, he fell into the water and was drowned. The headline in the local paper next day said “Oysters Kill Patrick”. Silly!

However the main course was a generous beef and Guinness pie with a splurge of colcannon – mash of potato, kale and spring onion – on the side. Needless to say the meal was washed down by Guinness, which I realised is the right accompaniment on days like this when you have to sit apart and wait to hear the sound of the hoofs of the black steeds coming to get us.

St Patrick

If St Patrick was able to rid Ireland of snakes, what about asking him to do a job on the virus?

However, we eventually made our way back home, there – horror of horrors – no Irish whiskey. So, being an Egan, from the traditional brehon clan we issued the decree that our household – to wit the dining room – be designated an area where St Patrick’s Day was formally extended to midnight March 18. This enabled the bottle of Black Bush, as it is affectionately known, to be ushered in the next day and drunk with a Munster relish.

Mouse whisper

Even Topellino in his nest washes his hand with mouse sanitiser –three parts absinthe to one part pure alcohol – before he sits down for a meal of gourmet scraps and “micewine”.

Two reliable studies from mousenet:

A Chinese woman arrives late in the evening in the Tasmanian west coast town asking for a bed because the pharmacy was closed. What was she was doing in this remote location and yes, of course the pharmacy was closed, it was the weekend. She replied she was scouring Tasmania looking for clinical face masks to be sent back to China.

The second involved a lakeside town near Melbourne where a couple of blokes in a van drove up to the local grocery outlet and started emptying the store of toilet paper. This was a bit much for the locals, who surrounded the van, retrieved all the toilet paper except for a reasonable amount for the blokes’ personal use. The toilet roll raiders were then told to be on their way and they promptly did so. I am not sure whether they paid or received any monetary recompense for their exercise in black-marketeering.

Modest expectations – J.J. Lyons

The problem is that, over the years, the community has become inured to the laughing mother in the advertisement with a gaggle of inanely smiling children showing how some disinfectant or other has rid the kitchen countertop of 99 per cent of germs.

If we lived in a sterile world devoid of all viruses and bacteria then like them we would all be dead.

Therefore we have to be reasonable, but when we have a media fuelling the hysteria that is not easy. There is a talk about the “surge” in infection and highlighting the number of deaths from the “killer virus”, rather than highlighting those who have recovered. The basic fact is that in a population of 25 million there have been less than 200 reported cases – i.e. as of today, an infinitesimal percentage of the population. The number is small, and it is important to maintain perspective. This is a prime function of government in the face of the irrational community response. Such a reaction dwarfs the other responsible response, which is building an evidence base as to what this coronavirus actually does.

Thus currently the rate of increase has hardly been a “surge” despite its attraction as a media headline – or even the milder use of “tide”. And if you use “surge” as a faux-dramatic metaphor then eventually the metaphor will “abate” as a tide will ebb.

Take Dr Higgins: how is the contact tracing going? It would useful if we were told how many of the people, including patients, with whom he came in contact have returned a positive test. However what we have is some State Health Minister attacking him and the AMA responding, rather than getting together and using this case to obtain useful information about the spread or otherwise of COVID-19.

Dr Higgins was on a United Airlines flight from San Francisco. I know somebody who was on the same flight who has the “sniffles”, all very mild. However, when my acquaintance’s partner became ill with a fever, an attempt to see the local general practitioner, resulted in an immediately referral to the relevant Hot Line which, having established my acquaintance as a resident of that State, then referred my acquaintance back to the general practitioner.

So much for consulting your local general practitioner as the front line defence, as the AMA have been telling the community. My acquaintance went off to a newly-designated centre for coronavirus testing. It was so new that the staff provided a good imitation of not knowing what to do. Waiting, my acquaintance and partner were alone, but it took an hour and a half for my acquaintance to be seen.

Despite my acquaintance’s history, the hospital-based centre was reluctant to undertake a test. Initially, the triage nurse wanted to send them away. Eventually my acquaintance was tested, but not the partner because at that time there was no proven contact with a confirmed virus carrier.

Ultimately they both tested positive and my acquaintance’s partner’s substantial workplace has been locked down for a week. They have children at school and university. The children tested negative.

It should be appreciated that the coronavirus tests for virus RNA being excreted at the time of the tests. There is no serology test to tell whether the person has had the coronavirus. Young people clear their system very quickly because in the main their immune response is very strong, a fact having being confirmed elsewhere. So it is quite possible that the children had been infected but have been asymptomatic and were no longer excreting the virus.

My acquaintance and partner no longer have to fight for attention. They have their own personal doctor contact available and visiting nurses. That is fine when there are so few cases, but this is a government that tends towards engendering fear rather than soothing concerns, when the number of cases are primed to increase.

Already the reluctant-to-test-centre of a week or so ago has a queue of the mostly worried well.

When winter comes is everybody going to receive such personal service? The answer is in the ability of general practice to develop a more hygienic environment this winter – not having waiting rooms filled with coughing adults and children would be a good start.

And what about the United Airlines flight? My acquaintance wasn’t sitting anywhere near Dr Higgins. So what is the evidence basis for the “same row plus two rows in front and two rows behind” exclusion zone? Almost everybody goes into the bathroom on a long flight, and from observation the level of hygiene in the bathroom is generally appalling. Tissues everywhere, an unclean basin and taps, water left in the bowl, used hand towels poking out of the waste bin, handrail and door locks not cleaned between usage.

In the meantime the United Airlines flight had been merrily going everywhere presumably continuing on with the scant hygiene measures which have been characteristic of  airlines.

It may well be that America may prove to be the biggest problem and the irrational behaviour of the President, most recently in a blanket ban on flights coming from “Europe” (senza the UK) and at the same time a reluctance to be tested himself, does not help.  Will America be added to the Australian exclusion list? After all, viruses do not respond to ideology.

I suspect that this scenario which is going on all over America with an unprepared and totally under-resourced public health system. As I’ve just said, Trump’s measures are irrational, and hard to follow, but that is nothing new.

Yet here, summer has been and gone; summer is not conducive for coronavirus spread and a containment strategy based on excluding nationals from an ever expanding list of other countries is in place. So currently it is a good time to be in Australia, and if the medium term strategy is based on a belief that with summer in the Northern Hemisphere the coronavirus epidemic will abate, then the current strategy has a modicum of sense.

The underlying problem is whether the political declamations are actually being carried out. Some of the state governments websites giving advice are very good, but why not consolidate this information into one web site – this is where the federal Government should be the single voice.

One of the problems highlighted by the 1918-1920 influenza pandemic was the destructive effect of the lack of public health co-ordination between States. Ostensibly, the Commonwealth is in control, but with each State seemingly disseminating its own information, it calls into question what is the actual level of coordination.

However, the tipping point is to know how far the government’s policies can go to effectively close the country down before wrecking the whole societal fabric and not just the economy. Having everyone in two-week isolation is ultimately unsustainable.

So a greater number of people who have to work will ignore the ban or not be tested; or the government will relax the ban. The evidence is that the older population are disproportionately affected, not school children or young adults. So why close the schools? We don’t do that if children catch the common cold, a coronavirus relative.

Look at the mixed messages. No wonder the community is perplexed.

Mixed message one: There are the media appearances of politicians elbow bumping and contorting themselves. However, what does the Prime Minister do in a forum where the spread of coronavirus is being discussed? He shakes hands with the guy who introduced him, does not use any hand sanitiser and goes to a lectern where there is no indication that it is to be cleaned between speakers. As far as we could see it certainly was not cleaned in this case.

Mixed Message two: There is a full house at the women’s cricket final – so much for the empty stadium scare that some of the muppets in the football codes seem to be mouthing.

Mixed Message three: There is the spectacle of the women cricketers jumping all other one another, high-fiving, potentially contaminating one another.

Mixed Message four: The Victorian Premier is threatening to close down the education system while at the same time giving an exemption to Ferrari for the Formula One exercise in air and noise pollution. No crowds, Mr Premier, after all it is school but of a different sort.

It was wonderful to see the publicity-shy Dr Mukesh Haikerwal in his medical practice car park collecting specimens for testing in a strapped pathology system. Presumably he continued to do this once the cameras stopped and continued to flood the local pathology laboratories with specimens. But what was his protocol for offering testing? Close contact with a person with who was confirmed positive? Or the worried well? Not clear. But the next day, having put on the show for the TV, his clinic was overwhelmed.

Now pop-up clinics; I suggest the government consider using the expertise of Dr Haikerwal with his car park technique to ensure that the Health Minister’s promise of the having all these clinics popped up by the end of May can be met. After all, he looks good in a suit.

Then as Australia enters the winter unless there is reliable health surveillance, it may be expected the pop up clinics are going to be inundated by people with that other coronavirus, the common cold, or those who are suffering influenza.

It is always disappointing that the first thought of governments is the authoritarian solution. Australia has always been quick to press that button. Such a solution resulted in the misguided lock hospitals of the past on Dorre and Bernier Islands in Sharkes Bay. Aboriginal men and women suffering from venereal disease were sent there. Australia has a dark history of isolation of people with disease and community panic attacks.

It seems at this time the greatest risk group is the elderly. However, they are not all congregated in nursing homes. On the other hand, they are not, by and large, in the workforce. Many roam in the freedom of being child-free and comparatively well off. One has to know where the mobile “grey nomads” will congregate in the coming months, and where they will roam in remote Australia. Perhaps that is why there is a run on toilet paper and disinfectant.

For the sedentary aged care population and their housing, just assure hygiene and that someone is checking on them to ensure they have supplies. Places for the aged should conform to the level of hospital hygiene. After all, we are the vulnerable group, and let me say that this raises very strong questions about the workforce’s ability to communicate with an increasingly deaf population and with its significant demented cohort.

In the end, China may be able to impose Draconian provisions in the short term but will it effect the cultural changes vital to prevent this sort of disease outbreak happening again? And the experts still don’t know whether this infection confers life long immunity. The common cold recurs and it is contained in a set of coronaviruses.

As somebody very wise said to me, the aim of all the actions taken in the public and private sector should be directed to creating a new appreciation and behaviour in relationship to personal and community hygiene. Conceivably then we may be able to blunt the inevitable winter season coming up where we are beset with the common cold and influenza, as well as this COVID-19.

We are already seeing this with the proliferation of hand sanitiser stations in public places, offices, banks and shops. I hope it continues to grow so, for instance, washing your hands before eating which I was taught to do as a child, becomes the accepted norm again.

Rollin’, rollin’ rollin’ – Raw Hide

The problem with toilet paper is that, while it is considered an essential, it is a topic we normally do not discuss.

The picture of three ladies wrestling over toilet paper in the Chullora Woolworths may be appalling for the pious commentators, but there would be a sizeable populace who found the spectacle as mildly diverting as watching mud wrestling.

This toilet paper imbroglio reminded me that a number of celebrities including Magda Szubanski, Merv Hughes and Ita Buttrose, all making fun of themselves, have appeared in toilet paper commercials. However, the prize paper seller was Lleyton Hewitt in his memorable commercials.

Perhaps Government could use these toilet paper spruikers to use their talents in calming the hysteria induced by a country afraid of being quarantined with dirty bottoms.

By the way, when we were young, there were always squares of newspaper hanging on the hook beside the dunny door. Even then we favoured the Daily Telegraph as the paper most worthy of use because we knew that it had been pre-tested.

Nevertheless, we did a trial this week – 15 minutes in tap water at ambient temperature (a) toilet paper, (b) ordinary tissue, (c) paper towel and (d) newspaper of same size – at this time that water agitated to simulate flush. The result, toilet paper and tissue disintegrated, the paper towel dehisced and the newspaper was unchanged and still readable; so much for newspaper and paper towels.

Mount Quilton, a new Tasmanian landmark

Leprosy

Leprosy is endemic in the Kimberley. When I first went to the Kimberley in the 1970s there were obvious signs of past leprosy in elderly aboriginal people, particularly men. This was characterised by loss and deformity of both fingers and toes, and the leprous discolouration of the skin.

Randy Spargo, whom I have mentioned in a previous blog, has also commented on the destruction of cheek bones and the nasal septum as a characteristic Randy remembered – the so-called “lion face”.

The Aboriginals in the early days of the 20th century who were found to have leprosy were rounded up in an appalling manner, put in chains, taken away and confined. Originally there was a leprosarium at Cossack, now a ghost town near Roebourne which, when the patients were moved to the new Derby facility in 1935, was burnt to the ground as a public health measure – such was the fear of the disease.

Bungurun

The was managed by an Irish order, St John of God nuns from the mid 1930s, and the conditions improved so much so that the leprosarium had outlived its usefulness by the time I visited Derby. In the 1940s a treatment had been found, and the public health measures of contact tracing for those with the disease was well in place. I remember one of the nurses saying that they had only one whitefella on their list; all the others were Aboriginals allowed to move around – but their movements were traceable, which was no mean feat.

I met some of the last nuns. They were caring, admirable women who had worked much of their life bringing a more humane way of caring for lepers. Soon the leprosarium would be closed. Contact tracing was maintaining oversight and facilitating care for a diminishing population of lepers.

The Kimberley is strongly Roman Catholic and there were tales of the then Bishop of Broome, John Jobst, who was reputed to have been a panzer commander in World War 2, terrifying everybody with his fierce approach to flying – tales of Aboriginals scattering as he unexpectedly would come into land.

However, the 1970s in the Kimberley was a time of great change there. Its Wild West characteristics as described above began to fade.

For those suffering from leprosy thankfully change had started earlier.

However, there are lessons to be learned. The mere mention of the word “leprosy” incites fear in the average person. Leprosy is a mycobacteria like tuberculosis. Both are contagious diseases.

Tuberculosis was particularly common before antibiotics became available, but in the Western world it was realised that there was a “herd immunity” – in other words we, as a white race, had a better immune response than other people, such as Aboriginals.

The first response of the community is to isolate the infectious ones, these days in more humane ways than in the past. However, a person is isolated, how long is the sentence – and when these poor people try to break out from their isolation our first reaction is to punish them.

Punitive powers exist under current State legislation, but true to form when you have a government such as ours that tends to prey on community fear it’s not unexpected to turn public health into incarceration. After all, the other name for this is “border control”.

We don’t want to end up with armed police patrolling the street to stop people coming out of their houses – and why not a curfew for good measure?

Before the Attorney General, who seems to be a reasonable character, goes further into this murky Duttonian world, he should see what his West Australian forbears did to the Aboriginal population in the name of public health.

After all, recommending 14 days in isolation from an indeterminate starting point when the coronavirus infection possibly occurred is just an informed guess. Why not 40 days as the Bible exhorts, Mr Morrison.

And why this stupid term “self-isolate”? In those days before the Age of Fear” I just stayed away from work when I had the flu and thought it inconsiderate to go out while coughing and presumably infective. Why not retitle the play “Self-isolating for Godot”?

Mouse Whisper

When Marie Curie visited the United States in 1921, interest in radium surged as reported some years ago in one of those journals hoarded by mausmeister. “Americans were flocking in their thousands to buy bottles of radioactive water, believing it would cure their aches and pains.”

Never fear, there is a spa in an old uranium mining area on the border of Germany and the Czech Republic, which advertises the anti-inflammatory effects of radon-infused water. How many, Topollino wonders, are fruitlessly flocking to this spa to escape the virus?

Radium Palace

Modest expectations – On Golden Pond

This is my 50th blog without missing a week – 2,500 words a week plus my Topolino’s contribution. This week I have written about a dilemma, presumably it is a dilemma being faced by a great number of us Australians.

Plague

I am writing this, not as a last will and testament, but as somebody who has booked to go overseas in less than a month, visiting Morocco, West Africa, taking a 250 person Ponant cruise berthing at a number of Atlantic island ports from Dakar to Lisbon and ending up in Portugal for a week.

I am one of the Government’s older Australians. This blog represents my ruminations on the current situation – in no way a manifesto for anybody to necessarily follow. Therefore it is just my reaction to yet another viral disease emanating from China.

First of all, it is risible to hear journalists talking as though they know anything about public health. I am watching Monday on the ABC Drum, which without Norman Swan or anybody who knows anything, has descended into the farcical. The problem is that these “opinionista” are there to fill in time not to help with the dilemma by providing evidence based in science, and consequently not any worthwhile advice.

News bulletins talking about “deadly” outbreak and “killer virus” and front-page photos of someone stockpiling food, does not help alleviate community anxiety. Most of the journalists producing these stories are economically literate, but when they talk about public health they are on unfamiliar ground.

Every year we face an influenza epidemic, for which we can get injected with a vaccine; in the case of recent outbreak, not particularly effective. That is because there are multiple strains and they mutate. And people die, but we do not go into a funk and close Australia down.

However with his “doomsday comments”, the Western Australian AMA President has been the winner in the escalation stakes. He said Australia had not seen anything like this since Spanish influenza in 1918-20, when 30 million died worldwide and 15,000 in Australia. I beg to differ.

Take this quote from the Centres of Disease Control (CDC):

Currently circulating influenza A(H1N1) viruses are related to the pandemic 2009 H1N1 virus that emerged in the spring of 2009 and caused a flu pandemic. This virus, scientifically called the “A(H1N1)pdm09 virus,” and more generally called “2009 H1N1,” has continued to circulate seasonally since then. These H1N1 viruses have undergone relatively small genetic changes and changes to their antigenic properties (the properties of the virus that affect immunity) over time.

The common cold is due to coronaviruses. Like influenza it tends to be a winter disease. That is why we all line up in May for an injection. Is there any reason to suggest that this coronavirus is not aided in its spread by a cold climate – just look at where it is rife.

Will this “pandemic” just fade when the weather gets warmer in the northern hemisphere? I believe there have been some muted voices suggesting that will be the case. SARS virus, another disease with its origin in China from bats, caused problems between November 2002 and July 2003, and no cases appear to have been reported since 2004. In other words it disappeared in the Chinese summer. The bats are still in their caves in Yunnan and there is no vaccine after 15 years. Amazing what happens when the spotlight leaves a disease.

And by the way as we all know there is no vaccine against the common cold which is caused by other coronaviruses.

However after the SARS epidemic, the Chinese authorities did not do anything about curbing the sale of wild meat in markets. The underlying problem is “traditional Chinese medicine” that uses the products of wild animals; and inroads into wild life availability would strike at the core of Chinese cultural beliefs.

Xi Jinping has issued a declaration to ban the trade and consumption of wild animals, but how long will that last – how many exotic viral disease outbreaks will it take for the Chinese to see sense and feeding misinformation? Eating wild meat has a long history in China and it is a source of income in many areas; any ban will only be as good as its enforcement so do we just wait for the next animal to human virus to occur? Tiptoeing around reality is a nonsense because we worry what China can do to our economy. For God’s sake, China is already stuffing up the world economy with initiating the coronavirus outbreak.

When the data suggest a mortality rate of about 2 per cent, which is tolerable given the level of underlying respiratory disease in the community, then when Iran reports a much higher death rate, it may be because this community may be basically more unhealthy – more likely it is a question of underreporting. Therefore, it was convenient initially to slap a ban on travel from Iran because of an alleged higher mortality rate.

Also in order to show everybody that people “are taking the outbreak seriously”, the government is advocating a number of measures.

Washing your hands regularly is a simple but effective way to reduce the odds of getting sick, the CDC recommends scrubbing your wet hands with soap for at least 20 seconds, then rinsing them with running water. If water is not available, the CDC recommends using a hand sanitizer made with at least 60% alcohol, but warns these solutions do not kill all germs.

I remember being the foyer of a large teaching hospital in Melbourne waiting for somebody and to while away the time, I watched how many people used the hand sanitiser dispenser prominently displayed with an invitation to use it. Maybe one in 20 then stopped to use it.

One of the most remarkable advances among hospital staff is the use of hand sanitiser between touching patients; very simple. After all, in the operating theatre sterility has been one basic reason that operative infection is relatively low. In the recent evacuation of Australian citizens from overseas, it is understood that Qantas used the same level of background hygiene as you would expect in a clean hospital including hospital grade air filters. In fact all airlines, all cruise ships should assure that same level of cleanliness.

To counter this disease if everybody, including children, washes their hands regularly then the public health of the community will benefit.

CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.  

The doyen of hand hygiene, Professor Grayson has said, particularly as there is minor evidence of secondary infection (in other words transferred within Australia), that “it’s not a practical option for the average person to walk around the street in an N95 mask…or worse a product whose effectiveness has not been scientifically tested.”

Hospital staff can verify their protective clothing, but there is already some suggestion of both price gouging and fraudulent products being produced, at least in the United States, where the Surgeon General incidentally has also come out against wearing masks.

However, one reason for wearing a mask has not been discussed and that is the cultural habit of spitting as a body purification ritual. A mask makes it difficult to spit, and spitting is not a habit that has been highlighted in the list of preventative measures. It should be.

Surface disinfection with 0.1% sodium hypochlorite or 62–71% ethanol significantly reduces coronavirus infectivity on surfaces within one minute exposure time.”

Conversely, solutions of a biocide called benzalkonium chloride produced conflicting results; and finally chlorhexidine digluconate, which people use as a topical antiseptic, was ineffective.

The sight of people in white clothes spraying disinfectant indiscriminately in public places does not particularly reassure (although the television cameraman in the middle of the group of sprayers was filming happily without either a mask or goggles or white suit in a recent television item). I well remember when we landed in Australia, the quarantine staff would come onto the plane and spray the cabin before the passengers could disembark. It does not seem to happen now.

If you are going to regularly disinfect areas apart from food handling areas, then make sure the door handles and any button which needs to be touched, are wiped. After all how many grubby hands open doors leading into the workplace without a disinfectant in sight. One is unable to pat the door handle or lift button on the back, Mr Minister.

Also presumably all parliamentary offices should have hand sanitisers wherever there is a door handle or lift button. The penalty: 14 days in quarantine with other offending politicians or staff members for failing to do so. Maledetto inferno, Parliament in lockdown. Something might get done.

Also, as an anti-hugger and who as a young boy watched Lindwall take a wicket, and then walk back to his bowling mark without being deluged by his jubilant teammates, I shudder. Our society thus is now a very “touchie-feelie” one among which the viruses can perform their own danse macabre. Cultural traditions are very difficult to change.

The new coronavirus first appeared in Wuhan in December. By January, officials had quarantined the city — halting planes, trains, subways, and most private vehicles. As the virus spread beyond Wuhan, so did quarantines that shut down businesses, stopped travel, and curbed emissions. A map of the country before the quarantines (from January 1st to 20th) is covered with orange and red splotches, while those splotches are noticeably absent in another map depicting China after quarantines were put in place (from February 10th to 25th).

The cleaner air will hopefully provide some relief as China copes with a novel coronavirus that affects the lungs. On its own, nitrogen dioxide can inflame airways and make it harder for people to breathe. It also reacts with other chemicals to create soot, smog and acid rain.

However, just a few comments that may be relevant when we have a tribe of climate change denialists: Wuhan seemed to have been a very polluted environment, and the one positive thing is that the level of air pollution there has been shown to have fallen dramatically as elsewhere. The photos of Wuhan in lockdown did not seem to recognise how very polluted the atmosphere has been. Lombardy in Italy is the industrial heartland – and South Korea and Japan are highly polluted high population density areas. Our upcoming travel itinerary fortuitously avoids these areas.

The other factor, which needs to be recognised, is the countries where the virus is prominent and where the level of cigarette smoking is high and hence there is an underlying respiratory vulnerability greater than countries which have kicked the habit.

Vaccines have historically taken two to five years to develop. But with a global effort, and learning from past efforts to develop coronavirus vaccines, researchers could potentially develop a vaccine in a much shorter time.

That sums it up. There is a great amount of activity, and there is the usual public relations-inspired media blurbing. We however shall not hold our collective breath. Here Trump is really a menace saying that a vaccine is almost here.

Now to weigh up all of the above – and make a decision. Watch this space.

Bean there, dung that

First of all, I must acknowledge the New Scientist for this rather clever heading, when it ran an article on civet coffee back in 2004. It was a time when the coffee cherries run through the bowel of the mongoose relative, the civet cat, produced an astronomically expensive distinct coffee. At that time the price of a kilogram of the coffee beans was US$1,000.

A civet with his coffee cherries

Known as kopi luwak across the Indonesian archipelago, it is available in East Timor now, given the wealth of coffee and the presence of wild civets. There are stories about how civets are caged and force-fed coffee cherries. Who knows in East Timor? The price has dropped to US$100 a kilogram. Given that was an exotic product, which I had heard about, I bought 250 grams when I was there. Topolino heard about it and he produced a joke in an earlier blog about catpoo-cino.

Now eating civet was implicated in the SARS virus that also emerged in China. Civet is traditionally roasted in hoisin sauce, garlic and many spices or as an ingredient in one of those Chinese cauldrons blended with cobra and chicken – Tiger, Serpent and Phoenix soup. This is still able to be served “under license in China”, since like many of these concoctions it is all about stimulating the Chinese libido, as though China needed more of that.

The civet coffee I bought back to Australia, (where you can bring in a kilogram without having to declare it) proved to be disappointing. I thought it very nondescript and bland with a “very muted” coffee taste. As quoted in the article however, “educated drinkers can detect an syrupy, chocolate, earthy, musty with jungle undertones (whatever that might be)”. One supposes that comment is like the wine sommelier who can detect the complexity of honeysuckle, vanilla and violets with just a tincture of feral cat in the grape.

Ah, what a multicultural world we live in! But the lesson from all this is that “bush tucker” has now been banned in China. However, as the South China Morning Post has pointed out, the sheer size of the wild animal foraging and breeding means effective policing on any useful scale will require far greater resources than made available up to now.

Pig slaughter as a result of the swine flu outbreak means a serious loss of income as does a putatively effective wild meat ban – obviously now a necessary follow up to this novel coronavirus, especially in the light of a previous outbreak emanating from other viruses able to traced to animals.

And before you have any sympathy for the Chinese diner…

Before the first squeak …

Consider for instance the three squeaks dish – the first squeak, when the embryonic rat is picked up alive with your chopsticks; the second, when it is dropped into a hot sauce and the third squeak when you crunch it between your teeth.

Now that is civilisation!

And I’ll pass on the civet coffee in the future.

And as a final tidbit

The inspiration for this tidbit comes from the same 2004 New Scientist. It is just an interesting scrap floating along one of the information byways. The civet is not unique in providing human food where the flavour derives from an encounter with its digestive tract. Honey bees pass their nectar through an enzymic process before they vomit up; and then there is another Chinese delicacy, bird nest’s soup made from the dried saliva of birds called swiftlets.

Finally, there is the Moroccan goat, which climbs the argan tree and eats the fruit. Until recently, the fruit seed had been extracted from the goat excrement and traditionally turned into cooking oil. However, the argan trees are under threat. The goats kill the juvenile trees, so the Berbers have substituted their own seed grinding for the goats’ bowel.

Moreover its properties as a cosmetic have meant that the beauty industry has “monstered” the market for the oil. There is a conservation program in place to preserve argan trees. How effective will this be in the face of demand, the land being swallowed up in housing development and climate change? Familiar story?

As with the argan tree, the honey bee and the swiftlets’ nest are all in danger of dropping into the endangered zone and then into the sunset of extinction.

How much of this was on the community’s radar 16 years ago, when these three were mentioned in the New Scientist?

They then were singled out because of the digestive feats; not because of their future viability.

Is it only viruses that will wake our community from its hedonistic torpor and pay attention?

Mouse whisper

This caption was placed on a certain cartoon. The subject surprisingly is not Morrison.

“I believe I heard from the back of the room, someone failing to ask me the question I will now answer.”

The figure in the cartoon? General de Gaulle.

You can still learn from the great and famous, Morrison.

Modest expectations – The Forty-Niners

They come in their work clothes and their steel-capped boots, climbing on board the QantasLink plane at Devonport; or disembarking at the same airport. They are the FIFO miners who work on the ore rich West Coast of Tasmania. They have living quarters on the edge of Zeehan and in Rosebery while they are on work down the mine, since 50 per cent of the miners choose not to live permanently on site. Interestingly one per cent of Tasmanian miners are listed as working in the East Pilbara in Western Australia.

Paradoxically, the Mt Lyell mine at Queenstown, the largest settlement on the West Coast, has been closed down for nearly five years. Its Indian parent company in the same period closed its copper smelter in India, but claims there is no connection between the two decisions. However, Queenstown exists as the local government centre amid denuded hills, a settlement desperately clinging to its existence. The beautiful King River, polluted for over 70 years by the mine tailings from Mount Lyell, is said will take 200 years to restore, but at least a start has been made to cover the riverside that was yellow with sulphur with sedge and other littoral plants. Over the last 20 years you can see that change.

King River gorge and Abt Railway track

It’s a bit sad to see that the old anti-climate change warrior from Tasmania, Eric Abetz remains solidly behind the coal lobby given how little coal mining contributes to the Tasmanian economy – less than 100 jobs. Eric moreover was outed for spending $3,000 on a trip to go to an Australian Mines and Metals Association conference in 2018 in Melbourne. He is reported as saying his travel was appropriate “given the undisputed importance of the sector to Tasmanians. Tasmania’s Mt Lyell mine has been the sole continuous AMMA member”, Abetz said. As the report noted as a postscript, as Eric should have known, “it was no mean feat, considering the mine had been mothballed four years before the gala dinner.”

But then Eric comes from Hobart and I wonder how often he has visited the West Coast – if ever. There is much mining – zinc, iron ore, gold, tin – but no longer from Mount Lyell. There are mines near Zeehan, Rosebery, Tullah and up on the Savage and Henty Rivers. However, if you live in Hobart, the Tasmanian West Coast may as well be on the moon.

I have been going regularly to the West Coast for more than 20 years and yet those towns look the same as they were then, except for the increase in hostel-like accommodation for the FIFO. In other words, these towns have not boomed in population as Queenstown did after the discovery of copper and silver in the late nineteenth century. The need to transport the ore resulted in Strahan on the Macquarie Harbor becoming the conduit port (again the population reached 2,000 then) and the revolutionary Abt railway was the means to transport the ore over the mountains and through the rain forest along the King River from Mount Lyell.

Strahan is now a tourist resort and the Abt Railway, which was closed in 1963, has been rebuilt as a tourist attraction. Strahan also still functions as a fishing port – crayfish and abalone – and in the harbour, salmon farming. There are the leatherwoods, the flowers of which provide the nectar for the distinctive honey found here. Even with the mining, there is still this extraordinary temperate rainforest of myrtle, native beech, sassafras, blackwood and the remnant clumps of pine unique to Tasmania – huon, king billy and celery top pine.

Because the changes in the mining industry from the stereotype beloved by those who never go to a mining town, it is difficult to imagine a settlement to have a life once mined out. But people like Abetz would throw money at Mount Lyell in the mistaken belief that it would result in more jobs, irrespective of the return. In most part the company would probably just pocket the subsidy.

As I said, there is still a healthy mining industry – the whole of the West Coast is a mineralised area, and taking just one mining industry, that of zinc mining at Rosebery (population 713) and Zeehan (population 708), it yields about a third of Australia’s output in zinc; and Australia produces about 30 per cent of the world’s zinc. Unlike coal, zinc is unlikely to be replaced because of its recognized use not only in sunscreen but more importantly in galvanizing iron and in the development of electric batteries for cars.

However even with such important mining activity, the resident population of these two mining towns on a rough calculation is equal to the number of FIFO. It should be added that 30 per cent of the zinc is recycled and here, in employment terms, the Swiss-owned smelter near Hobart at Risdon has played an integral role. The problem with mining in Tasmania is that the West Coast is the last area of untouched temperate rain forest in Australia, brought into stark relief – literally – by the bushfires along the east coast from Queensland to the Victorian border. So mining is a case of treading carefully, having learnt from Mount Lyell as an example of what not to do to the environment.

Wind turbines being placed at Granville Harbour are providing 200 jobs during construction, but for maintenance only 10. That, together with the FIFO, means that in the end it is not the technology nor the resources which provide the essence of life anywhere.

Tourism brings 300,000 to the North-West and West – people are the life blood, especially as the Macquarie Harbour boat trip and the reconstructed Abt Railway are the prime attractions, with Strahan the prime place to stay.

Oh, by the way, dear Eric, you should witness the huge wind turbines being moved down the Murchison Highway, round the corner through Zeehan and on up the road to eventually reach Granville Harbour. Wind and rain are the West Coast’s resources to be exploited, and soon the mighty wind resource of the Forties gales will be added to the Tasmanian power grid.

However, given how irrelevant coal is to the economy of Tasmania, I presume your time as a “coal war warrior” will soon be over, your task completed, but as you drive your Tonka tip truck off into a smoked filled sunset, remember your West Coast and its wonderful diversity.

The Martini

I enjoy a gin martini. My wife makes a very good martini and this blog was prompted by an article on the (alleged) best martini maker in the world opining on how to make the best martini. However the Best Martini was somewhat different from that of the expert.

First of all keep the gin in the freezer. This ensures that you’ll know if the gin has been watered down, because if it partially freezes you know there is dilution. Also if you keep the gin in the freezer, it makes the question of shaken or stirred irrelevant.

Next, “vermouth” the glass with green Noilly Prat; here there is no disagreement with yon expert, but it is a question of the amount. The Best formula calls for one in eight and then the gin from the freezer is poured into a chilled martini glass. And again in agreement, the lemon twist is the best addition to this opulent drink, but if you want to fiddle then if you must use three olives on a gold stick. Gold is important as it gives the olives a certain je ne sais pas quoi dire.

However, the problem is the cost of such a drink and the level of sobriety after two if you forsake the ice. There is no dilution if you pour straight from the freezer.

Which reminds me of that hoary old joke beloved by Latin teachers: Cassius Brutus clanks into the Vinum Bar in Rome and asks for a Martinus. The bartender responds: “surely you mean a martini?” to which Cassius Brutus said: “if I wanted two I would have ordered so”.

The best martini apart the uxorious one described above I ever had was a cucumber infused martini in New York. It was not the faintly cucumberish Hendricks, but a more full flavoured version. The nearest I could find was the Gordon’s cucumber infused gin in the green bottle, but I think I must have bought the last bottles in Australia. You garnish with a partially peeled piece of cucumber.

Have not seen any sign of the Gordon’s Green; only its seeming replacement of pink gin…only in Raffles in Singapore please, as I slightly shudder. 

Bernie Sanders Heartland

A 78 year old who has had a heart attack, who now won’t release his medical notes – bad sign, Bernie. In the information vacuum, the obvious first thought is that he has irreversibly damaged cardiac muscle and therefore a heart at risk.

Then we have a President who mysteriously disappeared into and out of the Walter Reed Hospital. Nobody knows what incantations were said while he was in the hospital. However, Trump’s cupboard is probably the most comprehensive collection of skeletons known to man or woman such that another one as the grim reaper would feel at home.

These old crocks are the marvels of modern American medicine – particularly cardiac care where investigative procedures, stenting and improvement in medication are first rate. American health care (as distinct from the system in which it exists) at its best is probably as good as you would get in the world, if you can afford it and go to wise doctors.

You see modern medicine has enabled an obese, insomniac narcissist with a poor diet and the other who looks madly stressed as if he going to blow a fuse every time he speaks, to be President of the USA.

Just as Nixon thrashed McGovern in the 1972 election, if they survive until November, Trump should win the battle, even though Sanders may appear to be a better bloke.

The other man Joe Biden is just a broad grin, which hides a mediocrity clearly demonstrated by his propensity for plagiarism. His major advantage is he seems physically fit, but old age is not a fair hand in the card game of life.

They said how poor Bloomberg was in the recent debate and how politically incorrect he had been in the past. He does not have the populist orator skills that the others have, with their confected outrage. He is old but he wears his age well without panda eyes or comb overs.

His responses where he was allowed to answer were sensible given that the moderators were appalling. He brings a sense of surety, that on the major policies he will see them through. Like many quiet men he carries a big stick, and Trump just will be no match for him, the longer the campaign goes. He knows how to deal with serial grifters like Trump, and if he secured the nomination he will drive Trump mad with his quiet probing, and as he may say if he was as vulgar to Trump – the fact is that, Trump ol’ boy, I have a bigger one than you have – war chest I mean.

But Bloomberg also is no spring chicken, although he has the gravitas that even in four years he may be able to resurrect America from its policy shambles. It is all very well to have a world economy built on gambling , even if there are fancy names for it, such as stock markets, hedge funds plus all those indices, which may as well be on a bookmaker’s chart. Of course, Bloomberg has built his empire as the steward of these goings-on.

If the Democrats come to their senses, and if Bloomberg is selected, then Pete Buttigieg should be considered for his Vice-President running mate, to test whether an openly gay married man will be acceptable to the majority of Americans. Buttigieg is smart and personable, but not this time, brother.

They who read the blog may say I’m a “typical male who has ignored the two women”. Simply put, America needs a different woman prototype to appeal to the whole electorate. Warren, with her artificial outrage would gain votes, but she suffers from a lack of sense of humour and her candidature is now on life support. The problem with the plethora of women who thought of doing a “Hilary” and have progressively dropped out is that their presence has obscured how impressive Governor Klobuchar is, but she too is in danger of disappearing.

To me on the stump if Trump and Sanders are the 2020 presidential combatants they are equally repellent, but then I do not have a vote, only an opinion. That doesn’t get you anywhere; but the prospect of candidates dying on the campaign trail is too macabre – and frankly, just a bit too close to reality. Moreover, it is not the time for old men.

They will not be around to be cheered or booed at the end of 2050 if the world is still belching the same level of pollution and progressively destroying the world that we have known, but will not live to see. The same can be said for all those old men, as well as Elizabeth Warren.

The Price of Never Being Wrong

The problem with epidemics is they thrive on ignorant national leaders, who have no idea of public health, suppressing inconvenient information. This increasing government secrecy is coupled with the modern version of the courtier castrati, people without ideas but with perfumed phrases whispering into the ear of national leaders who have lost the ability to apologise.

I once wrote a small monograph entitled “The Dilemma of the Public Health Physician” in which I attempted, as I said, “to help public health physicians to work through the situation which confronts many professionals when they are in possession of information which others perceive as ‘sensitive’ or valuable in any respect.

I went on to argue that all public health information should be freely available. The problem is that many public health physicians exist for the collection of data and not for the best way to make it available to the community. But communication skills have never been emphasised as they should be, because even over 20 years ago I wrote; “there is an increasing tendency for the political walls to be daubed with the graffiti of misinformation”.

This current epidemic will test those countries, especially China and Russia, whose leaders’ powers lie in secrecy and misinformation, to become more open. This epidemic will not be the last, given that the world with rising temperatures throughout, is increasingly becoming an incubator for exotic diseases.

Added to this viruses jumping from one species to another, mutating, being always ahead of the game … so no more pangolin penis eating in the restaurants of Asia, please. I assure you it doesn’t help virility only the possibility of a new virus – that is if the pangolin revenge is not already been enacted across the world.

On reflection am I just succumbing to daubing those political walls? Well, that is the point – public health expertise is being allowed not only to languish but to be ignored as an inconvenience. But as many politicians have found out in the past, “wishing an inconvenience would go away” is not a solution.

Having said that it seems we are fortunate in Australia not only to have the calming influence of Brendan Murphy, but also his unheralded deputy Paul Kelly who, unlike his boss, is a public health physician. Their influence on the government where there is a high level of ignorance is, and will continue to be, important. After all, as I wrote they have an imminent dilemma, which I have previously canvassed, which is when is Australia going to lift the ban on unrestricted entry into this country?

That is why the public health physician is as important as members of the police in enforcement of the basic requirements of public health, even down to all Australians washing hands as a matter of course.

Mouse whisper

I am sorry but I cannot let this recent comment by Sanna Marin, the Finnish prime minister, go by without applauding:

“We Finns have our sauna. And traditionally, it is where we make decisions. So now we have five women in charge, we can all go into the sauna together and make the decisions there.”

“Ei vain miehet vapauttavat kuumaa ilmaa”, says my old Finnish great-grand father mouse Aarvo.

That is the last comment he will ever make. They will be after him with birch branches.

Mickey Finn

Modest Expectations – Hiroshima

I have always been a great admirer of Winton Turnbull, who was Country Party member for first the Federal seat of Wimmera and then Mallee for over 26 years. Turnbull was among a number of parliamentary members such as John Carrick and Tom Uren, who spent time in Japanese Prisoner of War camps – he was in Changi.

Winton Turnbull

Turnbull was the member who, in his slightly stuttering voice (not bellow as elsewhere sneeringly reported), announced in Parliament that he was a “count-ry member” at which the quicksilver Gough Whitlam interjected “I remember.”

He was also the butt of an Eddie Ward interjection. Turnbull was holding up a bunch of skeleton weed, when Eddie inquired which was the weed. It is a pity that there was nobody quick enough on the Labor side to emulate Mr Ward when Morrison came into the House that day brandishing a lump of coal.

Turnbull was such an assiduous local member, that he was known as the member for “currants and raisins” such was his advocacy of the dried fruits industry. He was well respected despite being the butt of some memorable interjections.

However, what distinguished the member was that he never took a perk, never took an overseas junket. He never missed a sitting of Parliament and thought his time was better spent traversing his huge electorate looking after his constituents rather than cavorting at The Ritz or the George V. He was a person of the utmost probity; a pity that his legacy has been supplanted by the National Party pork barrel. 

Bridget McKenzie

And now by contrast is Senator the Honourable Bridget McKenzie, characterised somewhat briefly early this week in her entry in Wikipedia as Minister for Pork Barrelling.

So much has been written about her that even if she survives, as Minister without Portfolio, her parliamentary life will not be a happy one. As the current Minister for Agriculture, the pressure from the farmers will grow for the Government to develop an objective policy both for the short and medium term as climate change alters the viability of various primary industries. The whole dairy industry with the advent of climate change appears to be one such industry. Cotton and almond growing are others because of their voracious appetite for water. And these are just three of the problems that are afflicting primary industry, especially as climate change has underpinned the ongoing drought and integrity of the Murray-Darling Basin.

However, if she substitutes the pork-barrel for policy, this Annie Oakley from Alexandra will reinforce the fact that she looks at home with a double-barrelled musket – and not much else.

Yet Agriculture is the portfolio of McKenzie, the ridiculed former sports minister, where every day there is another nose discovered in this particular trough. Obviously she did not do this on her own as some vicarious quirk. The more the Minister is defended the more vocal is the disgust and the more one realises how many other Ministers have been to the trough.

However why do we, the cynical populace, single out this particular rort? It is just de rigeur for the way this country has been governed since rum was the currency.

Probably the brazenness and the particular arrogance of the central player, especially at a time when so many people are doing it hard – and the media images are of her laughing – as if she is mocking the Australian community.

The National Party is essentially a Queensland and northern New South Wales party. It hangs on in Victoria at the extremes of the State, but Victoria is centred very much around Melbourne and regional centres and eventually the National party seats seats will be distributed out, and with that the entitlement to be on the Coalition ticket.

However, even before that happens there will pressure from Queensland, and obviously if he has got the numbers to be the new Deputy Prime Minister, Littleproud will challenge the hapless McCormack. And if Littleproud wins, then McKenzie can retire to a lucrative “consultant position” in the footsteps of Pyne, Bishop et al. The pension would be greater if she retires as a Minister not as a backbencher, where her final salary will be halved if that was her final position. Watch this space! 

Julia Creek, Colonia and Me

I read where this cattle station family from Julia Creek had just relocated to running a B&B outside Colonia in Uruguay. That was quite a shift I thought, but having been to both places, I thought that this family migration could anchor a yarn about my time in both places.

I remember when I was working at Mount Isa I used to go out to Julia Creek which was a respectably sized speck on the map east of Cloncurry, but part of the territory that I was working in at the time. I went to meet the local doctor, and there they were, direct from central casting for a “Country Practice” not the tripe, which roams around TV currently under the name “Doctor Doctor.”

The then local doctor was a tall young English doctor, whose military bearing and quiet reserved manner was what the community perceives as the good doctor, which he was. The director of nursing was Scottish born and she was vivacious, unconventionally good looking and highly competent as well as being popular with staff and patient. When I met them at the hospital, my instinctive reaction was that both being from the United Kingdom, they were “an item”.

How wrong could I be, and fortunately I did not put my foot in it, but I was subsequently introduced to the doctor’s wife. Attractive, vivacious, she was running the public relations for the world women’s tennis from Julia Creek. When she needed to go somewhere, she would exchange her check shirt and jeans for a tailored suit and taking her laptop, fly from Julia Creek to Brisbane via Townsville and then onwards wherever she had to go in the World. They were meat for a TV series, but what soap opera writers would have thought the scenario credible at that time.

However, like all magical situations it eventually ended and that bugbear of lack of succession planning intervened, and Julia Creek went back in its health services to square one.

The problem is that no small country town where the economic justification from a reasonable Medicare reimbursement point of view is a population of 1,000 per doctor, and the community expecting 24/7 year in and year out service without burnout, is wishful thinking.

That was over 20 years ago and as I wrote then about Julia Creek: “flat savannah country: pubs, railway station, hospital, this is travelling the outback, along the song lines of the bush troubadours past the turnoff to McKinlay where the pub scene for the first Crocodile Dundee film was shot.” Nothing much has changed, except for those flooding rains and intervening drought.

Colonia, Uruguay

However, turning to Colonia, where the Julia Creek couple with their family have recently migrated. Colonia is a town in Uruguay. Uruguay is a place I consider in three parts in regard to population. The population is about 3 million, a third who live in Montevideo and a third of the Montevideo live in condominia alongside, if not overlooking the River Plate.

Montevideo is at the same latitude as Sydney and along the River Plate towards Punta del Este there are endless sandy beaches. The river Plate resembles Port Phillip Bay in so far that due to its width Buenos Aires in Argentina is over the other side of the estuary, but not visible. At Punta del Este you can see where the River Plate empties into the Atlantic Ocean. It is like having the Gold Coast just up the road.

However if you go the other way from Montevideo you end up in Colonia. Alongside the River Plate, it is all cobblestone alleys and low-slung adobe houses, and the church dominating the square. You can almost feel that somewhere there is a Ramona listening to the mission bells. The town was contested at one time between the Portuguese and Spanish, and the influence of each can be detected in the layout and town architecture. Again the sandy beaches are not far away.

I went there last year and had a memorable grilled steak Uruguayan style for lunch at the El Viejo Barrio, which fortunately given it was winter was very cosy inside. Nevertheless, like Sydney it has a mild winter, and now that the South Coast of NSW has been devastated by fires, Uruguay is an attractive alternative spot for a summer vacation. It is cheaper than Australia, and if you as a foreigner use a credit card, you get 15 per cent off the bill. Their currency has been buffeted by the international situation, but not as much as the Argentinian and Chilean currencies have been.

I hope the Australian couple make a go of it, and finally it is tragic that I have to say this, but I am in no way benefiting financially by this recommendation. I paid my way across South America without there being any need for a barely visible acknowledgement at the foot of this blog that I received sponsorship. I thus recommend Uruguay without any thought of financial consideration for a smoke-free holiday.

Tourism

I have always thought Tourism Australia has been stuck somewhere in the mid-secondary school years where bedrooms are coated with pinups and memorabilia relevant to the school year heroes and heroines. However, how relevant is it to project those teenage images for Australia as a whole when you are encouraging visitors to Australia.

Australia had barely recovered from that ludicrous advertisement shown at the Super Bowl in 2018 of some American dill as a supposed American love child of Crocodile Dundee and then that “PhilAusophy” essay in smug meaningless.

The latest opus whose release was aborted by the bushfires featured – predictably – Kylie Minogue, whose home for the past 20 years has been the UK and Adam Hills, who has lived in the UK for the past decade.

By contrast in a recently shown episode of Griff Rhys Jones’ Griff Off the Rails: Down Under, with a background of the Opera House, there was Ross Noble, the British-born comedian telling us viewers how much he loves Australia. His enthusiasm for being one of us should be tempered by the realisation that his home in St Andrews, north-east of Melbourne was burnt down in the bushfires of 2009; he had to regroup, and here he is, optimistic about Australia, ten years later, the best Ambassador Australia could have at this time. He has come back; he has more than survived

You know, it is extraordinary but here we have a raft of well-known Brits: Julia Bradbury, Jane McDonald, Griff Rhys Jones and now Michael Portillo all at it – selling Australia, mostly concentrating their efforts on Australian railways, but not solely. Their efforts have seemingly been ignored by the character, our Prime Minister, also known as Scotty from Marketing, which is somewhat surprising for someone who needs every straw he can find.

It is a little known fact that Morrison learned his marketing skills growing up alongside the Poseidon Adventure and the Towering Inferno – two of the best disaster movies ever made. He has this exquisite sense of timing of being able to advocate calling the military out in emergencies at a time when one of the military helicopters has just started a bushfire. The apologists say they are not trained for domestic emergencies, but that hardly excuses the defence forces setting fire to the ACT.

Another Bridget legacy

When she was Minister for Sport, Rural Health and Regional Communications in the Turnbull Government, she signed on the appointment of a Rural Health Commissioner, and an academic general practitioner, Paul Worley, got the job.

He was re-appointed in late October 2019 until 30 June 2020 by another National Party stalwart, Mark Coulton, the member for the NSW drought stricken electorate of Parkes, the Minister for Regional Services, Decentralisation and Local Government, hardly a ringing endorsement despite all the hype, and “rural health” has disappeared from the title.

I am not sure that just reeling out a number of rural generalist positions to be absorbed by the Queensland regionalised health system is the answer. From personal experience some rural general practitioners are first-rate teachers and they integrate teaching seamlessly into the practice. Others are not; and training is minimal. Very hit and miss.

However, the advocacy of rural generalist positions has suited the vested interests that have pursued the rural generalist model for years. Essentially, this initiative is a fancy title for training general practitioners in the country to deal with emergencies, and getting the Queensland Government to pay specialist rates for these doctors.

It is unclear whether this model has enhanced retention rates of general practitioners in rural practice. From personal experience, the program has minimal effect in Victoria, and it is unclear whether Professor Worley’s photo-opportunities that would have rivalled the travel of Bill Peach, has yielded any change in behaviour.

The other Worley report concerns allied health professionals, and while it is clear that they do not want a counterpart of the Australian College of Rural and Remote Medicine, preferring to maintain the status quo in regard to infrastructure, there is special pleading, which I have become accustomed to read. In the end it is all obtaining access to Medicare benefits, which I have argued elsewhere is on the face of their argument unconstitutional, but then who would argue against it politically. Only the central agencies have stopped entitlements under Medicare becoming a flood of pork barrels.

Having had a close association with the development of the successful rural medical school, rural clinical school and university department of rural health program – both before and after the publication of my Rural Stocktake report in 2000 – I am well aware of what does not work, but one of the problems I have encountered in public administration is a basic tenet of same.

If it does not work, don’t do it again.  

In your remaining time, Professor Worley you may wish to reflect on that dictum.

A different Turnbull

 I started with Winton and am ending with Malcolm.

You have had your time, Malcolm. Your recent bleat in the Time magazine makes uneasy reading. Complaining about your own failure is not a pleasant sight, anymore than reading about a quixotic Rudd tilting at the Murdoch windmill.

However, your grand entrance once into an airport lounge with your entourage gaining attention by singing snippets from Gilbert and Sullivan gave a clue to your future. Light, mildly entertaining, trivial.

The Grand Poo-bah

However, I suppose it’s better that “Nessun dorma” which rang out nightly when Rudd was Prime Minister.

Mouse Whisper

I shudder to think what Dutton’s advice would have been if he had been around during the poliomyelitis epidemics. Christmas Island would be very crowded I suspect. Thank God, he never read about “lock hospitals”.

My Blogmaster was a small child then. He stopped inter-school activities but still went to school – but one thing we had no ice cream. He said he was never fearful; just accepted the risk, as his parents did, heightened by living in an unsewered area, as much of outer Melbourne was at the time.

Australia’s Medical Incarceration

Modest expectations – Montana

This is a story about the unexpected – an unremarkable story on the face of it, but like many stories of its ilk, instructive.

In August, as I have recounted several times in my blog, I was in Chile and in particular Valparaiso. As I was hobbling down a flight of stairs and across a doorway in the restaurant, my hand caught on something sharp. Whether metal or wood, it created a spectacular gash over my fifth metatarsal right hand. It as not particularly long, but it bled. My canes clattered to the floor. As I had nothing immediately at hand except paper serviettes to staunch the bleeding, and rudimentary Spanish to say “Ayuda”, it continued to bleed profusely. It took some time for my companion, who was sitting by the window in this upstairs-downstairs configuration, to come and put order into stopping the bleeding, by pressure.

Eventually Chilean band-aids were produced and these reduced the bleeding to an ooze. The wound was not stitched, but there was a bit of debridement and the edges of the wound were roughly opposed – without seeking outside medical help. I thought that was one reason it took a long time to apparently heal, but the skin remained pink as the scar tissue started to form.

One day about a month after I had returned home a lump appeared at the site of the scar. It grew relatively quickly, but the skin did not ulcerate. I went to my long time plastic surgeon in Melbourne. I thought there must have been some retained fragment – a foreign body that had been missed. The surgeon who has operated on me on a number of occasions said nothing except after a little hesitation, that he would take it off immediately.

Jean-Nicolas Marjolin

I was surprised by the length of the incision and its depth; I should not have been so surprised when the pathology came back – squamous cell carcinoma. Sometimes in wound tissue an aggressive skin cancer can erupt. That had occurred in my case – Marjolin’s is the eponymous name for it – normally these cancers appear as an ulcer, and this would probably have occurred in a few days if it had not been removed.

That was a month or so ago, but now the area has healed and the scar from the incision is barely visible.

A very good astute surgeon, now onto my next experience…

The Surgeon Never Replied

Below is a letter I wrote to a surgeon just prior to a proposed operation three years ago. I have still not had the operations, and although I have a few mild symptoms I have not had to endure the morbidity or my family the funeral costs which could easily have resulted from operative intervention. I am writing this blog to provide an informed consumer perspective on my doubts about spinal surgery.

The other problem with surgery, especially with severe osteoarthritis in the shoulder joints, is that when you are being moved about during cervical surgery the anaesthesia will mask any incidental damage being done in the shoulder. One does not feel the pain of tearing a ligament or muscles or the rotator cuff of the shoulder joint until one comes out of the anaesthesia, and suddenly there is another centre of pain. In the aftermath of proposed surgery, pain relief for me is always going to be tricky because of my sensitivity to opioids. That does not matter to the orthopaedic surgeon – the surgery itself is the centrepiece, not the subsequent morbidity nor the rehabilitation. After all, I was facing three major orthopaedic operations in short order – nearing the end of my eighth decade.

The following is my letter to the surgeon appropriately de-identified sent in the days before the operation.

I thought I would explain the reasons for deferring my operation. I am sure you respect that the choice I have made has not been undertaken without much deep consideration of balancing the risks and benefits. My response was largely generated from our last consultation and your subsequent letter to Dr A. 

I note you made a comment that if I stressed my spine that there was a possibility of worsening the condition but I recently spent nine days in Malawi on a number of extremely rough terrains in a four-wheel drive without any apparent change.

Currently I have very mild numbness in my little and ring fingers intermittently in the morning on waking – not every day!

If one reads my latest MRI report it demonstrates that I have significant pathology in my cervical spine, yet I am virtually symptom free. You list the risks associated with the procedure without setting out the probability of any them occurring. Hence I take the paragraph in your letter to Dr A to mean that they are considerable risks. I thought it preferable to have the MRI at JHospital well before the operation rather than the day before – and there is no doubt that JHospital runs a very professional operation. However, so does the Diagnostic Imaging Department at IH, with which there appears to have been an unfortunate failure in communication (with yourself. I am sure you did not meant to criticise the IH nor the fact that at that time it was more convenient for me to have my imaging undertaken there.  

In addition you intend to take iliac crest bone which, as you rightly point out, is better than cadaveric bone for the putative operation on my cervical spine

However I have chronic polymyalgia rheumatica, the aetiology of which condition remains obscure, but there is one observation I would make which is that any shift in the dose of cortisone (currently 4 mgs a day) has a far more marked clinical effect than would be expected – manifested as stiffness and muscle weakness. There is no mention of the possible impact of operative trauma on such a condition, but you would have more information than I do. Therefore, that is one matter that needs to be resolved. The other of course is the effect that the cortisone has had on my bone given that I have been on the drug for three years, despite taking Vitamin D regularly.

I am nearly 77 years old, which is a factor, and the fact is that my cervical spine has significant pathology. The question that is raised is whether there is any guarantee that intervention would not have a cascading effect requiring more operative intervention for diminishing returns.

In relation to my lumbar spine, I do have symptomatology of mild spinal claudication as you have noted as 5/10, but as one senior physician said to me the other day, the major problem is my right knee – and knowing the success of such an operation would it not be preferable to do any operative intervention starting with the knee?

The question then arises of whether the operative schedule should be in reverse, and would a laminectomy guarantee relief of my symptomatology – particularly my ataxia and loss of proprioception? Your letter would seem to suggest otherwise. Is the fact that even if I had a lumbar spine operation I would not be helped? What are the odds of improvement given my age and lumbar pathology. 

I walk with two sticks for social reasons not because I need them invariably. For instance, I challenged myself the other day to walk without sticks but accompanied for three blocks to the coffee shop. There was some pain in my knee, minimal pain in my back and no symptomatology referable to my neck. The pain did not stop me at any stage, there and back.

I continue to do hydrotherapy twice a week and find it very helpful and, so as to clarify your comments in the letter concerning “Panadol Osteo” dosage, I am taking 4 tablets of Panadol (625mg) a day in divided doses and not six as previously. Do you think that a significant observation?

There are a number of other matters in your letter to Dr A, which could be better put. The comment concerning my heavy smoking history is totally ambiguous given that I have not smoked for 36 years, and it was taken not from any direct interrogation but lifted from my “confidential note”. The fact that I produced those notes to inform you so that it saved time and helped you to take a comprehensive history. I am sorry to have to make that point, but in providing such information it should be attributed and not just “noted”.

A copy of the letter was sent to Dr P who retired at the end of June and my doctor is now Dr Q locally. Given that the letter was sent to Dr A, who made the initial referral I am at a loss to understand how that occurred. The copy to Dr P has been archived at NHospital with certain agreed caveats. I believe that any copies of correspondence should not only be sent to Dr Q but also to Dr R, who has been the rheumatologist responsible for my treatment for PMR since 2013, when Dr A referred me to him, Dr A having made the initial diagnosis.

You have not referenced my severe shoulder osteoarthritis, which would be a consideration in any cervical spine surgery? (Here a confidential matter relating to another person has been excised from my letter.)

There are there other matters that puzzle me and that, given all the potential complications set out, I understand you will be away the week after the proposed date of surgery – and if that is true who would undertake my post-operative care, should any of the dire consequences set out in your letter occur. 

The second source of my puzzlement is an initial comment you made that you would be prepared to operate on my back four days after my cervical spine operation. Does that still hold true? 

The third matter is your comment that “ agreed with your need to alter the plan on the day before”. I must have misheard but I do not remember agreeing to a change in plan –especially as it would appear that a substantial part of my cervical spine is affected and yet I am virtually asymptomatic. My cervical symptomatology is better than it has ever been given the problems I had with it 20 years ago, and which were relieved by some excellent physiotherapy.  

Those cervical symptoms were resolved a long time before I first presented to Dr A. It is certainly not a decision I would take the day before the operation, given the seriousness of the complications you have listed. Hence this was my reason for undertaking the imaging a substantial time before the proposed operation.  

The underlying question is would it not be better to reverse the operative schedule on the basis of relief of symptomatology and enabling me to walk pain free, with a reasonable gait and with an improved ability to negotiate stairs, reverting to what I could do in early 2013 before the onset of the PMR, which seems to have acted as the tipping point for all this? 

As you foreshadowed in your letter you have awaited my further advice –and my basic response is the question above couched against the previous consultation, but not with the benefit of you reviewing the MRI and spinal X-rays

I asked for a number of second opinions. The average elderly person who is suffering from degenerative disease does not have that option because information in the health sector is so asymmetric.

To me the non-response to the letter reflects on the person. Here there is an arrogance characteristic of some of the medical profession. They do not see it, especially when they have only patient contact and are acting like a high paid tradesman, who comes in does his job, gets paid and moves on. From my experience very few tradesmen ever come back to view their work. Unfortunately, I was brought up to be a doctor and now as a consumer my perspective has only shifted to the other side of the desk. There should be debate, including this doctor who has remained silent for over three years. 

Boeing Sub-Max

In a investigative piece on Boeing at the time that it was amalgamating with McDonnell Douglas to monopolise the American plane construction in 1997, Boeing’s warts were well and truly revealed. McDonnell Douglas had some very good planes, but inter alia fell over because of its failure to build economic wide-bodied airliners, despite in 1995 receiving US$334m in rebates from kindly Uncle Sam.

Meanwhile the Pentagon was awarding Boeing US$1bn for “restructuring costs” and so eager was Export-Import Bank to ease any problems that Boeing might have, was renamed by some in Congress as the “Bank of Boeing”.

If you want to blame the Republicans for allowing this monopoly to occur, well that’s just not true. Increasingly when the truth of this has emerged, since there in the centre of these appalling decision, smoking a cigar in his Oval office was Mr Teflon – Bill Clinton.

He agreed with the advice that the Boeing position was legal because of the pressure it faced from Airbus. As the1997 correspondent said: “Using this logic all the US automakers could merge because the ‘Big One’ would still face foreign competition. Too bad the Detroit lobbyists can’t figure out a way to hide price hikes in the airline tickets and Pentagon procurements.”

Now Boeing is being confronted with a major problem – its latest airliners appear to be duds – and dangerous duds at that.

I have flown on most types of Boeing: 707 through to 747 internationally, 727 and 767 domestically, and even the 717 and 757 although not as commonly as the workhorse, the 737. They have all been good aircraft, although the Qantas 747s are becoming creaky and by preference I try to avoid them.

A former retired Boeing engineer and policy analyst has been reported recently as saying: “(There has been) a shift in the culture at Boeing from one which strove for engineering excellence to one focused on cost cutting. This deliberate strategy from the very top of the company led to massive, ill-thought-out outsourcing and the discarding of engineering talent as work was moved out of the Puget Sound region…(and in turn) has led to major failures on Boeing’s latest two major airplane development programs — first the heavily outsourced 787 Dreamliner and then the minimally upgraded 737 MAX. Both planes had to be grounded over safety issues.”

This failure has left companies in the supply chain in tatters. Fiddling and tweaking has not worked. Other airlines are running out of patience and are ordering planes from Airbus. As the airline fleets age then attention turns to maintenance; and if cost cutting takes over there as at Boeing, then air travel becomes not just an atmospheric pollutant but also a health hazard.

As has also been reported locally in the Seattle media “Boeing hopes for its first good-news event: the long-delayed first flight of the new 777X, with its massive composite wings. In late January, Boeing’s new leadership will reveal the latest tally of the cost of the MAX grounding, updating the $9.2 billion estimate through October. The rest of the year is likely to be a long slog, getting the MAX program restarted and slowly ramping back up again. No one can yet foresee the long-term impact.”

Boeing 737 Max engine

It sounds forlorn, since many of the mistakes Boeing has made in the 20 years interval have been glossed over by Government not holding them to account and the accompanying high profitability of the 737 until the MAX version came on line.

There have been failures such as not exploiting the 717, which, as one our own Alan’s choices, was particularly shrewd. There is now an increasing requirement for jet airliners with 100-150 seat capacity to run on regional services. The 717 fulfilled that need, but it was given the cold shoulder at Boeing because it was essentially a McDonnell Douglas enterprise and Boeing stopped making them. Only Delta, Hawaiian and Qantas have the plane in any numbers, and they are not selling them. Now through its Bombadier subsidiary, Airbus is filling the need. In the end the 717 will suffer as we all do – it will need spare parts that are no longer there.

However, all is not lost on the bottom line. There are the cost-plus projects where the Defence force chiefs inflate their budgets with expensive projects. Because they are seen as symbols of military might, it is interesting to reflect on the giant transport plane, built by Boeing, the C-17. With a budget of between USD200-300m a year for each one, one official labeled it the Golden Turkey because of its cost and its vulnerability to being blown apart by $22 mortar shell. Perhaps it has been made less vulnerable, especially after one crashed into an Alaskan forest in 2010.

Nevertheless more recently than that, someone who had experienced the joys of travelling in a C-17 said despite all the hype of being long range and being able to be refuelled in midair, it was more like a “stopping all stations conveyance” between the United States and Afghanistan, even including a stop for repairs.

Despite all the rending of garments, the Defence establishment continues to pour money into Boeing. In 2018, Boeing won contracts to build a new pilot training jet for the Air Force, an in-flight refueling drone for the Navy, and a fleet of the Airforce security helicopters.

As reported, Boeing’s “Defence revenues” had fallen by more than one-third over the timeline of a decade: from USD32.1 billion in 2007 to USD21.1 billion in 2017. But, President Donald Trump’s higher defence spending and three new military contracts put Boeing back in the game in 2018.

Still, to put all of the boondoggle in perspective, the Boeing commercial division in 2018 before the Supermax crisis billed USD60bn by airlines around the World.

Cap in hand to the Government you would think can go only so far, but Boeing has shown it has a capacious chapeau.

Mouse whisper

Just a message for the Nimbin anti-vaxxers …

Your child about two years old gets chicken pox; has a high fever – starts fitting – you prescribe one of those herbal remedies that incidentally has aspirin hidden away in it. Child severely incapacitated mentally – or dies.

Remember the name Reye, who first described the mixed brain and liver symptoms and signs as a syndrome in small kids.

Chicken pox plus aspirin; vaccinate against chicken pox. Reyes Syndrome no longer. QED.

Ralph Reye incidentally was an Australian pathologist – normally they are the doctors who deal with the dead.

Like polio, Reye’s syndrome was nearly eliminated until your mob came along.

Reye’s Syndrome