Quarantine Archives - Page 4 of 4

Modest Expectations – Barry Marshall & Obey

Pauline has parked her grandstand in the News Ltd car park, where she is advocating a High Court challenge to border closure. This is a normal Pauline stunt, unsurprising given that the Queensland elections are imminent -and there is nothing like a confected confrontation magnified by that shrill tone of hers.

One concession you have to give to this lady, she plays “victim” very well. One of the ploys when I used to be an official visitor to psychiatric hospitals in New South Wales was the way the inpatients could produce someone who had been “victimised” and ask me to help “save”, usually, a “her”.

My companion visitor was a wise woman, who unlike myself had long practical experience as a psychiatric nurse. She warned me not to be “sucked in’’, but listen to the complaint and investigate. However, she said – maintain rationality –don’t be get caught up emotionally as these people are very clever, since it was a practised scenario, and they try you out.

Whenever I watch Pauline, I am reminded of this advice, since whenever she is pushed into a corner the voice becomes quavery and the tears well up.

The one hand clap, Pauline.

But back to reality.

How much is this High Court challenge going to cost, Pauline? $300,00? More? For what, Pauline? A failed challenge? Of course, the victim.

However, who is going to pay? You, Pauline? No way. I’m afraid it is going to be us mug punters, of course; the real victims.

Telehealth – Look Mother! No hands

I was brought up as a medical student to believe that the essence of being a doctor was to take a full history from the patient and then to do a full examination.

That was a message. The face-to-face consultation was the basis of consultative medicine and the skill was to make the correct diagnosis – or if unsure, to provide a set of differential diagnoses based on what you had elicited as symptoms and signs of the patient’s condition.

However over the course of my medical career technology has intruded upon the “maestro” doctor able to diagnose the patient before he or she sat down. Observation to me remains a very important element as it was to Dr Arthur Conan Doyle, who invested his sleuth, Sherlock Holmes, with the same or enhanced degree of observation he had as a doctor.

The astonishing array of technology and increasing differentiation of care has been something I have witnessed through my long career. Sometimes I have watched and sometimes I have been closely involved, for example with the introduction of Magnetic Resonance Imaging (MRI) into the private sector and its recognition by Government – not always the most tranquil moment of my career.

There has always been agitation from the medical profession for reimbursement for non-face-to-face consultations. With the corporatisation of medicine, where the bottom line is everything, this agitation has not lessened. “Money for jam”, as the old saying goes, many jars of which will inevitably be transferred offshore.

Having watched telehealth progress through phone conversations to uncertain video links through to more reliable technologies such as Zoom has meant that technology has challenged traditional ways of medicine.

My only hope is that the government, which is increasingly strapped for cash, monitors it use.

I have used telehealth as a patient, and for a person with limited mobility it has been particularly beneficial. I have found that the doctors have been more punctual, but that anyway may be because of the lower volume. Telehealth acts as a screen. For the plastic surgeon, you can send a picture of the lesion, and get an opinion over the phone and in my case, yes it looked as though it needed to be removed; then a regular check up with the rheumatologist reviewing my pathology, a critical aspect in my ongoing chronic disease. More importantly in talking to my neurologist, he listened to my history, and said yes, it was important to see me, but I should have a cervical spine MRI first.

Two of the three telehealth consultations required subsequent face-to-face consultation. My general practitioners friend said that with the modern video technology, it is possible to diagnose simple conditions, such as a strained muscle, by observation and prescribe a treatment without seeing the patient in the rooms.

My appointments to see specialists could only be undertaken by face to face consultations – removal of a lesion from the face, assessment for cataract removal, neurological examination for the particular set of signs.

As someone who developed an auto-immune disease insidiously, after my diagnosis it was apparent that I needed not only a good general practitioner but also one who would provide continuity of care.

Being a doctor myself, I am in the worst category in regard to regularly seeing a doctor. I can do all that general practitioner stuff – but of course I cannot. It is impossible to have an objective view of yourself until, as I found out one night, I knew that I was dying. Hypochondria is one thing; a sense of impending death is another.

I survived the night, and because of the pain and stiffness and overall weakness, I went back to my orthopaedic surgeon whom I had consulted a dozen years earlier for my acute painful knee.

At this time, I had no regular general practitioner although most days I was surrounded by them at work. However, the orthopaedic surgeon knew what it was, but orthopaedic surgeons treat by operation and not by drugs and so he flicked me over to his trusted rheumatologist. Now rheumatologists are gentle ruminative folk, but have long lists of patients; so waiting for up to six weeks is not uncommon for an appointment.

Miraculously I saw the doctor that afternoon. He prescribed tests and drugs, but I was not to take the drugs until the test results came back.

The starting line could not have come sooner; within 24 hours after taking the first tablets, my condition improved dramatically.

Unfortunately dramatic improvement didn’t equate to immediate cure, but that’s another story.

What is interesting however, in a story about telehealth, is how do you diagnose this sort of disease. As one of my general practitioner colleagues said to me that this is a GP diagnosis – you ask: “Can you roll over in bed?”

This was very much after the fact. I had already been diagnosed and was being treated. However, I had not noticed it before; he was right, I could not roll over in bed.

Theoretically, if the doctor had been as astute as this Scot, who had seen cases before, a telehealth diagnosis might have been made.

But then again I still would have had to see him in a face-to-face consultation. Telehealth is not a panacea and I would caution government and suggest once the COVID-19 pandemic is controlled, to review its application closely, especially the biggest users and then ask why? As I know too well, governments are reluctant to wind back largesse for fear of vested interests squawking about compromising people’s health.

Telehealth is a bonanza for the corporate health business, where throughput is everything, and health care a by-product.

Nevertheless, far more insidious is the large health conglomerates where the owners are dependent on government payments to profit, inevitably providing donations to political parties to keep the tap turned on. Donations after all have a wonderful effect of assisting politicians to roll over – not necessarily in bed.

Hey, Pellegrini, whatcha doing with that test tube?

A new study shows coronavirus patients who took hydroxychloroquine to treat COVID-19 had a higher risk of death than those who weren’t given the drug.

The study, published Friday in the medical journal The Lancet (22 May), also found that COVID-19 patients were more likely to develop serious heart arrhythmias if treated with hydroxychloroquine, or its closely related cousin chloroquine.

Arrhythmias can lead to a sudden cardiac death, the report said, but researchers did not associate the study’s fatalities with adverse cardiac affects.

Even though it’s only an observational study – not the gold standard double-blind, randomized, controlled trials – experts say the enormous sample size makes it compelling.

The study comprises of 96,000 coronavirus patients from six different countries who were hospitalized between Dec. 20, 2019 and April 14, 2020. Nearly 15,000 patients were treated with hydroxychloroquine or chloroquine alone or in combination with an antibiotic.

When I heard that the Walter & Eliza Hall Institute for Medical Research (WEHI) were about to embark on a trial to enlist 2200 health workers into a trial to test the efficacy of the drug being a preventative agent against the virus, I checked the date. No, it was not April 1^st.

Professor Marc Pellegrini is employed at the WEHI with one of those expansive titles, which suggest he is important. On television, his justification for the trial is that the drug kills the virus in the test tube. So, I might add, does bleach.

I wondered how this experiment has come about.

This modern day Lancelot has given his project a grandiose title – COVID-19 Shield. Here I wonder whether you need a diploma in public relations rather than a science degree in this modern world purporting to be medical research.

I have not the seen the protocol except it seems to be a randomised controlled trial; but one important report I would like to see is that of WEHI Ethics Committee on the proposed study and the reasons for approval.

In the latest bulletin of WEHI, there is a coy mention of this trial without naming the drug and the brief comment that it is being funded by the Australian Government. There does not seem to have been the award of a peer-reviewed grant as one would expect for such a potentially dangerous activity.

The problem for the Australian government is that there is pressure coming from the non-medically qualified – especially from such a medical expert as Clive Palmer.

In response to the above Lancet article, the WHO is reported to have put on hold the hydoxychloroquine arm of review. However, the report has all the hallmarks of the WHO walking away (or should I say “crabbing” away), without losing face.

But WEHI seems defiant. At least Professor Pellegrini is. May I suggest it is time you retire the Shield, Sir Lancelot.

Finally, as The Washington Post noted – as I have – who says Trump has been taking the drug. Has anybody seen him take it? This person who lies, lies and lies. Why would his statement of putative self-administration be any different? In any event, he now says that he has stopped taking the drug. Come on, Donald, which is the lie?

The time I under-dosed with Chloroquine (Plaquenil)

It was about 30 years ago and we went on a tour of Africa. Among measures to be taken were the mandatory yellow fever vaccination and a prophylactic antimalarial, then hydroxychloroquine, which was marketed under the name plaquenil.

It was a wide-ranging trip, which excluded South Africa, then in the grip of the apartheid Afrikaans. However, in many ways it was defining as it led to us, especially my wife, returning almost yearly to the continent.

We had previously been to North Africa – Morocco and Tunisia – but this was a month long roam through Southern and Eastern Africa. The trip incorporated the island of Madagascar, the French Département of La Réunion and then finally the Seychelles.

We spent some time in Madagascar, both in the jungle near Antananarivo, the capital, and the island of Nosy Bé looking for lemurs and indris. After leaving there, we flew to Saint-Denis, the capital of La Réunion, where the intention was to climb La Fournaise, the volcano at the end of the island. The year previously we had reached the summit of Yasur, on the island of Tanna in Vanuatu. This is one of the only active volcanoes in the world where you can stand and look down into its fiery cauldron. La Fournaise presented another opportunity to do so.

Le Piton de la Fournaise, Reunion Island

However, while having a drink at the bar of the hotel on arrival, I started to feel unwell. I went to bed, and then passed out. As described to me I began to get very hot, and my temperature was apparently swiftly rising, and as my wife said I became quickly delirious. She did not know quite what to do except keeping sponging me to try and reduce my temperature. She told me that her plan was to phone a public health physician acquaintance in Paris, in the event that I needed to be admitted to hospital because, as she said, her French wasn’t up to an emergency admission. However, about one in the morning, suddenly I was a bundle of sweat. I woke up; my temperature was dropping. My pyjamas were absolutely soaked with perspiration

How could this be; I was taking the plaquenil regularly, but then I reviewed my dosage – it was below the prophylactic dose. God knows even to this day how this happened, but it was obviously my mistake. Fortunately, my wife did not succumb. So even though I felt lousy and confused, I increased the dose to therapeutic. The worst residual symptom was a terrible headache behind the eyes. I have never had one like it before or since.

That was it, except I felt lousy for over a week, but I did not have another crisis – nor have I had a recurrence since that day.

However, I always take Malarone, the current anti-malarial drug of choice whenever there is the prospect of contact with a malaria-bearing mosquito overseas.

But back to La Réunion, we did see around the island, including the Cirques, tropical remnant of extinct volcanoes but we never did climb La Fournaise.

No, I did not have a test to confirm – not malaria – confirm my anserine status.

But at least after that experience I can swear by hydroxychloroquine – for malaria!

Just a lurk

COVID-19 causes massive inflammation boosting cytokines, which increase the liver’s production of clotting factors, explains Beverley Hunt, medical director of Thrombosis UK and a practising clinician. For example, fibrinogen levels in a severely ill COVID-19 patient are 10-14 g/L, compared with 2-4 g/L normally and 5-6 g/L in a pregnant woman. “A COVID patient’s blood is enormously sticky,” she told The BMJ.

“All patients in critical care are at increased risk from clots because they are immobile, and when you are sick you have sticky blood,” says Hunt. Studies of venous thromboembolism rates among non-COVID patients in critical care show that rates of thrombosis can be as high as 28% if patients are not given any prophylaxis. Among patients given prophylaxis the rates are halved. So, we seem to be seeing significantly higher rates of thrombosis in COVID patients.

“Thrombosis is definitely contributing to the high mortality rate from COVID,” says Hunt. “Not only can it lead to a pulmonary embolism, which can be fatal, but there are also higher rates of strokes and heart attacks.”

In this report in the British Medical Journal, a United Kingdom medical specialist is musing on COVID-19. Now at the outset one would have thought that the only experts interested (or consulted) would be emergency physicians, anaesthetists and respiratory specialists. However, this is a doctor expert in blood clotting which has arisen as a major COVID-19 complication, especially as the amount of anti-coagulant to be given seems to be unsettled. Moreover, there there are reports of late onset deep vein thrombosis. My Swedish correspondent mentioned COVID-19 toes, which appear to be a severe form of chilblains, pointing to this being the virus being an instigator of widespread disturbance in blood clotting.

What is further intriguing and indicates the widespread effect of the virus is loss of the sense of smell as an early sign. In humans, the olfactory cell location measures 9 cm² and lies on the roof of the nasal cavity.

With the common cold when there is swelling of the nasal epithelium non-specifically, sense of smell is impaired. However there are reports that this COVID-19 virus infiltrates the sustentacular (supporting) cells which, together with olfactory cells, constitute the pseudocolumnar epithelium underpinning the nasal cilia and microvilli. Among other functions these cells have an effect on how odours are perceived by the olfactory cranial nerve.

It was interesting looking at the histology of the nasal lining, and its complexity. The olfactory nerve and its connections are one of the most neglected areas in medicine, because the sense of smell is more related to lifestyle rather than considered a major marker of disease. However, if it is indeed an early marker of COVID-19, attention should be paid to the way the nasal swab is taken to assist early detection, especially if the olfactory area of the nose is where the virus may lurk first. This infiltration indicates how profound this virus may be in invading the body.

This virus is not going away soon and while Australia has, up until now, done an excellent job in suppression, “lurk” is probably the most concise way to describe it.

The Hungerford Games

We camped on the Queensland side of the fence, and after tea had a yarn with an old man who was minding a mixed flock of goats and sheep; and we asked him whether he thought Queensland was better than New South Wales, or the other way about.

He scratched the back of his head, and thought awhile, and hesitated like a stranger who is going to do you a favour at some personal inconvenience.

At last, with the bored air of a man who has gone through the same performance too often before, he stepped deliberately up to the fence and spat over it into New South Wales. After which he got leisurely through and spat back on Queensland.

Henry Lawson wrote thus about his experiences in Hungerford in 1893, when he had walked there with his swag from Bourke. The expectorating man’s name was Clancy, that familiar ‘loveable larrikin” character alienated from officialdom. Sorry, that is my ironic interpolation, and on the contrary Henry Lawson was not impressed by him.

There was no Pauline Hanson around in those days, and anyway she would not have been able to vote or stand for any of the colonial Parliaments in Australia at that time.

The Royal Flying Doctor Service (RFDS) periodically does medical clinics in Hungerford – this population speck, which straddles the border of New South Wales. This settlement is about a three hour drive along the Dowling Track from Bourke. I have always hankered to go there since I worked with the RFDS, for no other reason that it is there and like so much of western Queensland it epitomises my image of the laconic yet irreverent stoicism of the Outback.

We have years ago thought to drive there, but there had been heavy rains and the road beyond Bourke was impassable. The road is still unmade, but even though it is not the first place one would think to cross the border, my hankering is still strong. So I thought I would find out more.

The problem is that the Royal Mail Hotel is on the Queensland side of the Queensland-New South Wales border, which is defined by the wild dog fence. There is a border gate at Hungerford.

To get more intelligence on the current situation, I rang the publican at the Hotel. The news was grim. The gate is locked; the coppers have the key and even if I could he said it would inadvisable to try and climb over the gate. Anyway we would be aliens from New South Wales – waratah cockroaches invading the land of Cooktown orchid cane toads. So we could not stay at the inn.

So Premier Palazczuk, I promise I won’t make a High Court challenge if you open the Hungerford gate and allow us to stay in the pub. I’m not sure about the High Court challenge – however I believe there is a class action being mounted by a consortium of wild dogs to remove the fence between the two States. And it is only an unsubstantiated rumour that Clive Palmer is funding their challenge.

Muri Succursus

Mus Virgilis “destillat ab inguine virus”

We mouselings, as you know, pay homage to our celestial creator, Rodentia Nora. So we have knowledge of Latin – one of the greatest bard being one Mus Virgilis.

Given how much used the word “virus” is, we had a peep at its derivation.

“Virus” is a rare second declension neuter word for “poison” or “slime” and that attracted me to see if there was a plural form, “vira”. But the word has never been found in a plural form in Latin literature. Thus “viruses” is acceptable – even though the “es” suffix is generally associated with third or fifth declension Latin words.

And certainly do not say “viri”, which is Latin for “men”.

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.

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 21^st 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?

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.

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.

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

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

Lá 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.

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.