Between the powerful foe of Covid and the equally evasive phenomenon of misinformation are doctors like Elspeth Frascatore. Here she shares a physician’s perspective.
It’s not an easy time to be a patient. Indeed, it’s a time unprecedented in modern day history – with a global pandemic that to date has claimed 4.67 million lives. One in 500 Americans have died from Covid-19 in the 20 months since the first American case, a figure that is almost unimaginable. Compare that with Aotearoa New Zealand, which has been lauded globally for its response to Covid, with one of the lowest death rates in the world – five deaths per million population.
To put this into perspective, the United Kingdom has suffered 2000 deaths per million population. The people of Aotearoa New Zealand should be proud of the hard mahi that has kept New Zealand a safe haven from Covid until recently. With the vaccination program rolling out across the country at record speed, the future is starting to look brighter.
For doctors, nurses and other health care workers, it’s much needed good news. In Auckland hospitals, GP clinics and managed isolation facilities, staff have spent much of the past month carefully donning and doffing PPE, inspecting their faces in the mirror for marks left by N95 masks, and moisturising hands cracked from washing them countless times and using alcohol gel. We see patients separated from whānau, and desperately try to show our empathy and compassion from behind a stark white clinical mask.
Health professionals have suffered the strain, yet our emotions are made even more complex by the fact that we know that, to date, we have been largely protected from Covid on our shores. We need only look to NSW to see colleagues working long hours in Covid-ridden hospitals.
NSW doctors report patients coming in with devastatingly low oxygen saturations, ‘self-proning’ (voluntarily lying on their fronts) to try to breathe better, and children severely dehydrated from diarrhoea and vomiting. They report hospitals running on dangerously low staffing levels as staff are quarantined due to exposure to Covid, and children needing to be cared for by the state as their parents are both hospitalised.
Patients are forced to monitor their own oxygen saturations at home, because hospital beds are being used by those even sicker than themselves. One hospital in NSW reported that four Covid patients in the district escalated to 1000 in a month.
It would be fair to say, Delta moves fast.
New Zealand would do well to look across the ditch at what “might have been”, or more likely what “might be” if vaccination rates wane and Covid is left to run rampant on our shores. Experience shows us that no country’s health system has been able to cope with a significant outbreak of Delta, and New Zealand would be no different.
Can we breathe a sigh of relief? Yes, and no. Once again, New Zealand instituted a lightning fast lockdown, after just one case of Delta was detected in the community. Despite that, this outbreak has ballooned to over 1000 cases. Delta, it seems, is a formidable foe.
Without lockdown measures, Delta has an ‘R number’ of six. This means that, on average, each patient with Delta will infect six other patients during the course of an infection. It’s easy to see how the dreaded ‘exponential growth’ can take off: Delta finds the unvaccinated. With social distancing, vaccines, hand hygiene, mask use, and the use of lockdowns, it has been possible to get the R number to below one, and our outbreak appears to be slowly dissipating. With that knowledge, it’s easy to see why the Ministry of Health is pushing so hard for vaccination.
Delta is a pandemic of the unvaccinated. To date, 69 percent of eligible New Zealanders have either had or are booked for their second dose of the Pfizer vaccine. Is that enough? Simply put: no. Māori vaccination rates are lower compared to non-Māori: rates in those younger than 35 years old are only 50 percent that of non-Māori in many parts of the country.
The reasons for this are many and the inequity is extremely concerning. As vaccination rates across the board continue to rise, the likelihood of a ‘living with Covid’ model rises, and international evidence shows us that the overwhelming risk of Covid will land squarely on the unvaccinated. Our ‘vaccine coverage’-based decisions must be based upon coverage amongst populations most likely to be affected by that decision. If those unvaccinated are disproportionately Māori, the ‘anti-equity’ result will be devastating. Indeed, Covid has the power to drive inequity not just regionally, but globally. Greater than 98 percent of the populations of low and middle income countries remain unvaccinated, and the economically and socially marginalised are significantly over-represented in the unvaccinated.
It is for these very reasons that doctors watch anxiously as the vaccination numbers rise. Over the past few weeks, a group of more than 5000 doctors named Doctors Stand Up For Vaccination have signed an open letter and released a ‘Frequently Asked Questions’ document to Aotearoa New Zealand in overwhelming support of vaccination.
Why would this be necessary? In some part, this was in response to a growing amount of misinformation available online. The internet is the world’s biggest library, but also the world’s biggest junk yard. For doctors, the mental toll of fighting the ungraspable beast of misinformation is significant. Doctors are used to fighting illness on a daily basis, using well-researched medical knowledge, pharmaceuticals or surgical skill, but find themselves less well equipped to fight a social phenomenon.
A certain degree of helplessness is felt, especially when an anti-vaccination sentiment bounces around social and media echo chambers and eventually seeps into social interactions with family and friends. Doctors are used to the presentation of studied knowledge, evidence-based science and compassion to make decisions, and when this practice becomes inexplicably ineffective, it spurs emotions that are hard to describe. This is amplified by the fact that doctors know that a decision not to vaccinate does not only impact the decider – but the whole population of New Zealand, and especially those most vulnerable due to aforementioned social and economic marginalisation, pre-existing conditions, age or ethnicity.
So, it’s accurate to say, it’s not an easy time to be a doctor. A doctor becomes a doctor in order to advise, help and to heal. When healing becomes hard because of a new and powerful foe such as Covid, or helping becomes even harder due to the equally evasive phenomenon of misinformation – it’s the perfect storm. But, as a doctor, all I can say is that we will continue, every day, to talk to our patients, inform them and share decision-making, don and doff our PPE, care for those affected by Covid, and hope for a better future.
Doctors Stand Up For Vaccination can be found at www.doctors-stand-up-for-vaccination.com or Twitter @NZDRSUV