Modest Expectations – Round & Round

There was much hype surrounding the 20th anniversary of the Sydney Olympic Games with the spruiking by the ABC of their biopic, Freeman. Given the cloying, hagiographic way many of these biopics are constructed around sporting celebrities, one might have anticipated a certain predictability with a treacly voiceover. Therefore, I planned to give it a miss.

However, the television was tuned to the ABC during the Sunday night meal and it was just left on. I started watching with the eye of the sceptic prepared to switch it off. I did not. It was a fine depiction of an extraordinary woman.

I must say that at a time where the world is devoid of genuine heroes and heroines (if that word is still allowed) Cathy Freeman stands out. Running 400 metres faster than anybody else in the world was the centrepiece, but in relation to the woman herself it is, in the end, incidental.

Yet without this extraordinary talent, she would have been yet another unrecognised good person, one of those who form the spine that anchors this country. She is Indigenous. It marks her out. She provides that sense of grace that was so well emphasised by the beautiful unnamed Bangarra dancer, and as with Cathy Freeman, grace is so natural – more than just a physical attribute.

This artistic portrayal, far from complicating the vision of Freeman winning and thus being a source of distraction, made me realise that this was more than just an expression of the filmmaker’s sensitivity, it demonstrated something rare in the Australian psyche – a genuine unsentimental view of what grace under pressure is all about.

Freeman engendered on that night a sense of optimism in a country which wallows in its veneration of failure – Burke and Wills, Gallipoli and Fromelles immediately springing to mind.

Now, two decades on, she has remained the same determined person dedicated to doing good without constantly reminding us of it – that was one message that I took from this biopic.

Thick as a Plantain

Queensland is a different world, to a point. When I was first exposed to the public service in Queensland, I was amazed to see and feel how centralised the system is. It so closely approximated attitudes in the Victorian public service, which I experienced when I had worked there, that I felt quite at home.

The authoritarian personality dominates the centralised mentality of Queensland public servants. It was almost to a level that paper clip distribution in a Camooweal government office depends on the signature of the Departmental head in Brisbane.

When the authoritarian personality is combined with a healthy dose of xenophobia and lack of intellectual integrity it perfectly describes Pauline Hansen. Yet such a perception of her underpins a preparedness of Queenslanders to elect her – time and again.

Her tearful retreat whenever she is under political fire relies on a cynical appeal to an undercurrent of paternalism. If she were a man, she could not hide behind a veil of crocodile tears. The extraordinary performance of the Queensland Premier last week accusing the Prime Minister of bullying when he was making a perfectly reasonable request shows that in Queensland the Hansen playbook is very adaptable – in this case by the Premier herself.

Then there is her chief health officer, Dr Jeanette Young who, according to the Premier, apparently is running the State – at least in health and in border exemption. She does not have any public health qualifications despite having been in the job for 15 years.

This is the same Jeanette Young who, during the swine flu scare of 2009, advocated for Queenslanders to stock up on food – in essence stirring up panic buying. Well, Queenslanders, there has been another outbreak of swine flu in China, which has been kept quiet. China has just banned pork imports from Germany because also has been the emergence of swine flu there.

Dr Young is unyielding – to a point.

The Premier and her minions may want to blame Peter Dutton for everything, and the Hanks imbroglio allows the State government to spread some of the topsoil, but Dutton cannot be blamed for allowing the polo-playing McLachlan with his flock from descending on Queensland (and a variety of other well-shod Victorians) to serve out their quarantine in the comfort of a resort. If the Premier is to be believed, this is the handiwork of Jeanette Young, who makes the decisions to allow special access. However, in so allowing it, this seems to contravene everything the resolute Jeanette Young says she stands for.

Yet Jeanette Young is not averse to the quavering voice when under media scrutiny. After all the health plausibility of many of her decisions is inversely related to the political expediency. At least with Daniel Andrews, he has now learned that public health considerations must have a scientific basis; and is following a course. He is in for the long term. Sounds familiar. Perhaps he has observed the Chinese devotion to the long term solution at close quarters.

Dr Young has recently acquired a deputy, Dr Sonya Bennett, who has worked in the Royal Australian Navy before joining the Queensland Department of Health to oversee public health three years ago. Given the propensity of professionals in the armed forces to collect post-graduate certificates and diplomas, Dr Bennett has acquired appropriate public health qualifications. She has the credibility of sitting on a government committee to oversee communicable diseases, and presumably is assisting in the flow of exemptions.

However, in the end Queensland with in all its authoritarian rigidity has to find a way out of its completely illogical stance of border closure that demands a rate of community transmission that is absurdly low before the drawbridge is lowered. In a population of 8.129 million, NSW is reporting around five cases a day – that’s 1 per 1,625,800. Maybe the election will do the trick – one way or the other, if Australia can wait that long.

But, Jeanette, batten down the hatches, swine flu may be coming again and Australia needs a unified strategy to deal with a new swine flu outbreak – apart from advocacy of panic buying. Time to start behaving like a country.

But, you know, it is Queensland and do they know how to bend a banana!

The little sparrow 

Having discussed Cathy Freeman, this vignette of another inspiring woman may help ease reaction to the writings immediately above. Sarah L. was a young English doctor when she met me in the corridor of the hospital. She looked so small; even childlike and yet when I met her at Doomadgee, I soon found out her resilience belied her appearance.

Doomadgee is mainly an Aboriginal settlement in the Queensland Gulf country and has had its moments with a police station under siege and Aboriginal riots. The problem with this settlement is that it is the meeting place of various mobs, and in such clusters, there are always underlying tensions, even when there is no violence between rival mobs.

When she greeted me, she apologised for saying she was a little tired. The previous evening, she had been called out to triage a serious vehicle roll-over, and given that nobody wears seat belts, there was a variety of serious injuries. She had to work out the priority in treatment and who needed to be evacuated to Mount Isa or to the coast. They had all survived.

She also wanted to set up an evidence-based treatment for scabies, which was endemic in the community. Scabies is caused by mites (Sarcoptes scabiei), which burrow into folds of skin, are found in children’s hair – and often, in the severest form, the scabies lesions are inter alia infected by streptococcus pyogenes. Scabies spread by contact and older people tend to be “super-spreaders”. There are a number of treatments that work, but they require compliance. She wanted to test ivermectin, which can be administered orally and used topically.

Scabies

Ivermectin’s parent drug was discovered in Japan in the 1970s and was first used in1981. It is the essential agent for two global disease elimination campaigns that will hopefully rid the world of both onchocerciasis and filariasis. These diseases affect the lives of many millions of poor and disadvantaged throughout the tropics. Ivermectin is also effective against mite (scabies) and lice (crabs or pubic lice) infestation. It has a very wide use against parasitic infestation, but for the use proposed by this young doctor there were still unknown elements.

The attack on scabies means ridding the home of the mites and, for instance, the habit of sleeping with dogs, which occurs in Aboriginal communities, can facilitate the spread. The young doctor, who had paediatric training, wanted to clear the children in the community of scabies.

I was impressed by her enthusiasm, and her approach reflected my ideal public health physician – able to have clinical expertise and yet wanting to set up a trial to see what would best suit her community.

This week, I tracked her down to see what happened. Yes, she successfully eradicated scabies, but that was so long ago.

She was pregnant at the time I met her in Doomadgee, and subsequently she had a second child. They all moved to the Coast. Her professional career was interrupted by a couple of major car accidents – one on Magnetic Island and one in Townsville – after she left Doomadgee. She took a long time to recover, and has been left with residual loss of vision in her left eye. She is now practising at Townsville Aboriginal Health Service.

To me, she was an exemplar of a doctor working in a remote community who was able to cope with emergencies but yet with the curiosity and determination of the public health physician. She epitomised the very best of medical practice, but her experience also demonstrated the lack of sustainability of a health system built on the individual worth without there being succession planning. That is a major problem that has bedevilled medical practice, particularly in rural and remote areas.

Before I made contact with her this week, while reflecting on Doomadgee, it reminded me of looking out of the train window and seeing two women tending a colourful beautiful garden alongside the train platform. Then the train moved on, and I did not have a return ticket.

However, on this occasion, I knew the name of the woman and when she rang me back, the voice was still so familiar. It was still the bright, breezy Sarah.

Letter from Victoria

I was talking to a friend of mine in Victoria. He is a consultant geriatrician, one of the best. He is also a member of a nursing home board.

In this State of unmitigated residential care disaster, in this nursing home there have been no cases of the coronavirus, in either residents or staff. He prefaces his comments by saying that luck is always a factor. Nevertheless, what they did from the outset was to ban visitors, allow only essential trades people into the facility and ensured that on arrival the staff had a temperature check and were quizzed on whether there was any sign of COVID-19 disease. Then, all staff appropriately attired themselves, and strict protocols were observed.

I asked how the residents coped with this degree of lock up – and he said they hated it, one saying she preferred to be dead rather than endure such conditions. So it is not just a case of expressions of pious statements about “loved ones” whenever a person in their nineties dies, but perhaps in the eyes of the departed, death was a joyous event. The problem is that it is one technology we have not mastered, that of polling the dead.

Apropos, I asked about Zoom and other means of distanced face-to-face communication. His view was that for the elderly it was no substitute for physical contact.

He made a further comment that it seems that in these institutionalised care environments, aerosol rather droplet spread is the major means of transmission. He cited a case where a particular residential facility was coronavirus free in the morning and by the evening two-thirds of the people were coronavirus positive.

After talking to him, I re-read the Newmarch Report, which shows that if you bring in a competent team that knows what it is doing then you get to the same situation that my friend describes. But it is far from a perfect situation.

I wonder whether the central agencies or the private operators have worked out how much it would cost to comply with the 20 recommendations of that Report.

The Commonwealth government, with an incompetent Minister, is still relying on the private sector, with its record of putting profit before care increasingly being shown to be scandalous. The fact that some Victorian aged care facilities delayed the release of dozens of deaths which were then added to the daily tallies has not been adequately explained, but hopefully the answer is not deceit .

My friend said that government-run and not-for-profit facilities were better in his view. Yet Newmarch is operated by Anglicare, an offshoot of the Anglican Church, and seems to have belied that generalisation as does the apparent gouging of the contaminated St Basil’s Home in Fawkner, a northern suburb of Melbourne, by the Greek Orthodox Diocese.

However, mimicking the home environment but being able to maintain infection control at a level where the coronavirus will be repelled at the door remains a challenge, organisationally and financially.

I know that if and when the time came for me to go into a nursing home, it will be a one-way street. Thus I want to go into a place where my family at least has the choice of visiting me. I do not want to go into an institution, which is kitted out as an intensive care unit, so that I become a delayed statistic dying in a labyrinth of tubes, with a card on my big toe labelled “a loved one”. “Loved One” is becoming the modern day substitute for the black rimmed Hallmark bereavement card.

Coronavirus is an accelerant, and if you are old and contract the Virus, but survive the buggery of being on a ventilator in an actual intensive care unit, you can then become a photo opportunity for the evening news, before dying unnoticed a few weeks later. Is that what I would want – is it anything anybody wants?

Federally-Operated Quarantine Facilities

The comment has been made to me that government building a series of quarantine facilities would very expensive. The problem is that there is no evidence of long term thinking beyond the immediate combat with the current coronavirus. We have the spectacle of the President of the United States denying climate change, a feeling echoed by members of the Australian Government. There is a suggestion that swine flu outbreaks are now reappearing in China and Germany complicating the world disease profile.

Coronavirus infections are out of control in many places throughout the world, where incidence and number of deaths are the indices to measure spread and severity. Yet, unexpressed is the level of morbidity, which at present can be classified at short to medium term. I have yet to see whether the impact of morbidity on the world economy and burden of disease has been assessed. Probably, it could be argued that we are only seeing six-month data.

Our ancestors recognised the need for quarantine facilities but often located them in harsh settings. However, being in a necessarily isolated environment need not be harsh.

It seems that both the Northern Territory and Kristina Keneally among an increasing number of others, myself included, are advocating for discrete quarantine facilities. However the Australian government, with its attachment to private enterprise, appears to prefer to maintain the fiction that hotel quarantine can work in the long term. Frankly as the economy improves and the hotels are required, planning for these facilities should occur now rather than in the usual ad hoc manner. More importantly, we need to get quarantine out of the major population centres, and we need to find an affordable quarantine solution if Australia is to re-enter the international community and not completely destroy tourism for the foreseeable future, particularly if a successful vaccine is not found in the next 12 months.

Howard Springs quarantine facility

In relation to a particular operational Northern Territory facility, the comment is that to get to it “…drive south-east from Darwin Airport for 30 minutes and you will arrive at an old mining camp – the Manigurr-ma Village for fly-in, fly-out natural gas workers. Until recently, this complex was abandoned. Today, it is perhaps the most popular travel destination for Melbourne escapees.”

In other words, facilities do already exist, and it seems a tolerable spot to spend 14 days, especially if the facility is airconditioned. In my last blog, I suggested the Northern Territory as the site for quarantine and singled out Katherine. Creating a so-called bubble around Katherine would allow the possibility of visits to Katherine Gorge, increasing the tolerance levels for incarceration. However, creativity is never a recognised expertise of public service.

Now the Northern Territory First Minister has been re-elected, he can act with more freedom, notwithstanding section 49 of the Northern Territory Self Government Act. This mirrors terms of Section 92 of the Constitution in protecting movement across border. As one constitutional expert has said: “It means the NT is in the same position as a state.” However, the Northern Territory exists under law enacted by the Australian parliament, and is not recognised in the Constitution as a State.

The experience with the repatriation of Australians from Wuhan should have given the few long term planners in government a clue of how to handle quarantine. The Northern Territory is an ideal place. Over time, flight schedules can accommodate the need for incoming quarantine.

The other destination for the Wuhan evacuees, Christmas Island, is to Australia what French Guiana is to France – a place to send people to be forgotten at a great cost, but inconvenient for large scale quarantine.

Kristina Keneally took a direct stance recently when she suggested that the Federal government could provide a set of quarantine resources if they are establish any form of international tourism. Repatriating the clamouring Australians provides a pool of people to test how best to allow people coming from COVID-19 endemic areas to return – or come to Australia.

The model exists in the successful evacuation from Wuhan.

Build or adapt facilities in Northern Australia to enable people to be quarantined for 14 days.

Gradually close down hotel quarantine, as international restrictions are eased but, in the light of the Government’s announcement this week that incoming passenger numbers will be increased, those states and territories that have taken a back seat in hosting quarantine can take some of the load – the ACT is a case in point, with its newly-constructed international airport; there are suitable sites in the ACT – much land around the Fairbairn RAAF base.

However, long term it is undesirable to use hotel facilities, which are not dedicated health facilities, for such a purpose. Thus there is a reason to establish a health-tourism forum so that people in each sector are brought together to develop a common language.

As with any facility designed to attract tourists to this country, each person presenting at a border should have the equivalent of the yellow card – when we needed to show evidence of smallpox vaccination, inoculation against typhoid, cholera – and still yellow fever.

Remember that yellow, even in this world of digital communication, remains the colour of the letter Q – hence quarantine. Data should provide evidence of the time of testing, a temperature check at departure and arrival and a checklist of symptomatology. As a parenthetic comment, the ability to test olfaction may become an important additional marker.

The longer there are no organised quarantine facilities the more policy will be at the mercy of ad hoc arrangements. Quarantine facilities that are recognised and organised with appropriate staff will provide a Security Blanket for the politicians, who are increasingly terrified of opening their borders – and in general Australia.

When we wanted to deal with those poor benighted asylum seekers, we were not at a loss for ingenious methods of inflicting as much misery on them without descending into actual torture. Also, can anybody realise how much hilarity and champagne cork popping there was in the Cambodian government when we wanted to “rehome” some of these asylum seekers.

However, the asylum seekers were at the end of a line of misery, and despite the compassionate cohort of advocates their plight means little to the vast majority of Australians.

By contrast, quarantine, well organised with a border force replete with replacement masks of compassion and a health work force working in conjunction with the tourist industry in all its manifestations would seem to be a simple concept to put an end to the ad hoc actions and the unmitigated xenophobia that some of our governments have developed.

Well, let’s see!

O Panda Alaranjado

I don’t see how we get through to the January 20, 2021 inauguration day without bloodshed.  Ever since James Adams succeeded George Washington in 1797, there has been a peaceful transition of power in this country from one president to the next. I fear that after 223 years we are about to tarnish that record.

So has been written to me by an American lawmaker.

Everybody has been setting out a scenario that this increasingly unhinged person with his band of acolytes could inflict on the USA if he loses.

The following is one is taken from the playbook of the Bavarian house painter, he could contrive to see the White House burnt down, and then invoke the Insurrection Act of 1807. “In all cases of insurrection, or obstruction to the laws, either of the United States, or of any individual state or territory, where it is lawful for the President of the United States to call forth the militia for the purpose of suppressing such insurrection, or of causing the laws to be duly executed, it shall be lawful for him to employ, for the same purposes, such part of the land or naval force of the United States, as shall be judged necessary, having first observed all the pre-requisites of the law in all respect.”

Burning the White House, 1814

Not that it was an insurrection but British troops did burn down the White House in 1814. So there is a precedent, if not a president.

Mouse whisper

One Australian politician who answers to Julian the Lesser has made a statement that more Australian have seen Berlin than Bundaberg. Bundaberg has 93,000 people.

Is Julian the Lesser suggesting that:

  • people who live in Bundaberg are blind
  • there are more people than that to take our breath away.

All in all, a rum statement.

Out of breath

 

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 1st.

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 – Macquarie Island

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cone of silence

The Diamond Princess caused much mayhem in Japan.

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

Are the media asleep? Can nobody join the dots?

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

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

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

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

Not soon enough for the Ruby Princess obviously.

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

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

Training for a pandemic?

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

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

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

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

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

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

A message from Princess Cruises

The Danger of the Hospital

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

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

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

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

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

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

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

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

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

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

Now that is an ordeal

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

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

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

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

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

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

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

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

Skiing in a time of coronavirus

Janine Sargeant – Guest Blogger

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

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

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

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

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

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

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

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

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

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

Mouse Whisper

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

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

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

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

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

Modest Expectations – John 1

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

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

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

Ruby Princess

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

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

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

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

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

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

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

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

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

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

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

I vicoli vuoti

The quote:

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

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

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

But the Virus did.

Memories of Poliomyelitis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Letter from Sweden

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

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

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

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

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

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

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

Back to the Past

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

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

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

Barker Station Melbourne

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

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

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

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

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

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

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

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

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

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

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

Hairdressers  

Janine Sargeant Highlights

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

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

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

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

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

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

Mouse whisper

From The Washington Post (murine edition)

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

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

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

California Hotel Casino

Modest Expectations – Hiroshima

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

Winton Turnbull

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

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

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

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

Bridget McKenzie

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

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

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

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

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

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

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

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

Julia Creek, Colonia and Me

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

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

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

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

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

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

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

Colonia, Uruguay

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

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

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

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

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

Tourism

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

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

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

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

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

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

Another Bridget legacy

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

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

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

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

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

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

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

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

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

A different Turnbull

 I started with Winton and am ending with Malcolm.

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

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

The Grand Poo-bah

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

Mouse Whisper

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

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

Australia’s Medical Incarceration