“Join Flutracking” Prof Paul Kelly urges Australians

On 6 April 2020 Professor Paul Kelly, Deputy Chief Health Officer, encouraged all Australians to join Flutracking to help track the spread of COVID-19.

Following this  Dr. Craig Dalton, co-ordinator of Flutracking.net reached out to ACSA and asked for our assistance in spreading this message far and wide.

Participating in this citizen science project is easy, and will provide incredibly valuable information that can help us track COVID-19 and other illness in real time.

Join Flutracking at https://info.flutracking.net/ and complete a simple 30 second survey once a week.

Join Flutracking now.

One comment

  1. Professor Paul Kelly
    A/Chief Health Officer
    Canberra ACT 2600

    Dear Professor Kelly

    It is heartening the Premier of Queensland has now reopened the borders of that state. In view of the present number of COVID-19 positive contacts in Victoria not constituting a “second wave” it appears to be an over-reaction for that border to remain closed. Premier Daniels appears to be no longer accepting the expert advice from the expert committee established to deal with COVID-19. Sporadic outbreaks are inevitable and appropriate means to deal with them have been put in place.

    I would like to respectfully say that this has been a highly successful short-term solution but we must have a strategy that acknowledges and deals with the fact that the vaccine is at least one year away and effective chemo-pharmacology is highly unlikely at any sooner date.

    The longer it takes before the economy recovers the more financial and emotional stress on our population and, very importantly, the intergenerational effect of increasing public and private debt. This could prove extremely damaging economic effects to Generations X and Y, and most likely to generation Z as well, depending upon how effectively our economy can recover from the pandemic shock.

    And this is the reason I am writing. A proposal to re-establish economic activity as far as possible to its previous level. Please accept this, as outlined in the attachment, is a strategy which provides simply the “bare bones” of what is required. I also attach a note relating to the importance of real-time longitudinal health records on all our citizens, except those who choose to withdraw from any such national program. My Health Record is but a shadow of what is required in this country and I hope that you, with all your experience at the Austin and your highly successful clinical career, fully appreciate this.

    One of the benefits of the pandemic could be the establishment of an electronic health record system which is the envy of the world, allowing the diagnosis and effective treatment of conditions very often before clinical symptoms are apparent. I was speaking to John Mattick three weeks ago, recently returned from Oxford. It seems the UK genome project is way behind its expected time for completion. As well as the UK, the United States, France and China all having strategies to carry out genomic sequencing on large numbers of people none have demonstrated the immense potential of such a strategy; the universal provision of personalised care of the highest quality within sustainable fiscal parameters.

    There is a unique opportunity for Australia to invest in a similar project and bring it to its potential before any other nation. I am, of course, referring to the insights that will flow from the effective analysis of large health databases. Eventually, in conjunction with genomic sequencing, predictive medicine will evolve to the extent that the optimal treatment of diseases will be carried out considerably more cost-effectively than is the case currently. Real-time monitoring of positive COVID-19 contacts, as detailed in the “Re-establishing economic activity” is an example of this and can only be achieved with a suitable electronic health record system (also attached).

    I can assure you that presenting this proposal to re-establish our economic activity to as near to normal as the international situation will allow is not a criticism of the public health initiative that has so far been so successful. However there is no doubt this is a very ubiquitous virus and the establishment of herd immunity with adequate precautions to protect the vulnerable is our best option, despite the likelihood that contracting the virus does not necessarily develop the immunity to prevent second and even third infections. Perhaps the only thing that can be said in its favour is that the overall mortality in Australia, with adequate tracing, social distancing, frequent hand washing and isolation of positive contacts, has reduced mortality to < 0.2% level, relative to the number of positive contacts. This is a wonderful result with the global overall mortality being 5%.

    But now, with considerably more known about this virus, particularly with mortality overwhelmingly being confined to the elderly and those with significant known co-morbidities, the establishment of herd immunity is the correct path to follow. It is interesting that in the 1918-19 pandemic that affected families were confined to their homes and food was delivered to their doors. That pandemic was different in that it particularly targeted the young and healthy. Fortunately infection with the SARS-CoV-2 virus does not have that predisposition but the same isolation strategy, combined with monitoring devices as per the above attachment, would be feasible and highly effective.

    A similar strategy was commenced in Sweden, but the problem appears to have been the vulnerable were not isolated soon enough nor with adequate precautions. The isolation of the vulnerable from those highly unlikely to develop serious complications, for a six – nine month period, is a small price to pay for preserving the lives of the elderly and vulnerable and allowing the economy to return to its previous level.

    In summary, what I'm suggesting is to effectively isolate the vulnerable and return the able majority to the workplace and the schoolroom without worrying about sporadic outbreaks and reactively closing these sites for a two week period in the hope that a vaccine will be found in a few month’s time to solve all our problems.

    Kind regards
    Yours sincerely

    Henry Glennie

    Henry R Glennie, FRACS, FRCS, MBA, MPP
    Chief Executive Officer and Senior Medical Advisor
    Medilink Australia Pty. Ltd.
    P O Box 150
    TOOWOOMBA QLD 4350
    Mobile (61) 417 600 876

    P.S Attachment 1: RE-ESTABLISHING ECONOMIC ACTIVITY IN AUSTRALIA WITHIN THE PARAMETERS OF THE COVID 19 PANDEMIC

    The prospect of a vaccine or effective pharmacotherapy to the SARS-CoV-2 virus is at least a year away and it is likely, even at that time, that it will be no more effective than the current 70% efficacy of the Influenza vaccine. The present containment policies in Queensland and Victoria are causing huge fiscal problems, with lesser but still very significant effects in other states and territories.

    The effects are likely to require job keeper and job seeker benefits over the next 12 months, probably longer. Without them we are likely to have a 30%+ fall in residential and commercial real estate values and large-scale bankruptcies. The overseas tourism market shows no prospect of returning to its previous levels for at least two years and opportunities have to be created within the economy to open up alternative areas of employment.

    The present strategy is to continue to lock down the economy because of the number of positive COVID-19 contacts. But, as Dr Brendan Murphy has said, these are to be expected and can be effectively contained without an ongoing disastrous effect on the economy. He considers that it is only if “a second wave comprising hundreds of cases” occurs that on-going containment measures are required. Far more is now known about the virus than 3 months ago; the mortality is in the vicinity of 0.4-0.5 percent of the population, this cohort being almost exclusively those aged 80 and over (3.8% of the population, AIHW) together with those with the co-morbidities which have been well-defined from the mortality figures that are now available (an additional 10% is a reasonable estimate).

    It is impossible in the present international environment to open our borders to any nations with active Covid 19 infections unless such incoming persons have 14 days in strict isolation. This is feasible for returning residents and for long- stay students and immigrants but not for tourists. We have to accept that international terrorism cannot be considered until the Australian population has immunity from Covid-19 infection. The only nations where tourists can be accepted from a nation such as ours is where effective measures have been taken to minimise the ravages of this contagious virus. New Zealand and other South Pacific nations are the only countries in this category currently.

    To re-establish the economy to its previous level of work, recreational and social activities, but for continuing to exclude international tourists from “unsafe” areas, we need to remove all isolation and social distancing restrictions.

    There is only one acceptable way to do this. We must effectively isolate the vulnerable 13.8% from the 85% plus cohort of the population who are likely to develop Covid-19 over the next 12 to 18 months if these measures are removed.
    The spectrum of the illness in this 85+% cohort will vary from asymptomatic to severe but none are likely to succumb to the condition, the few requiring intensive care therapy in all probability surviving the disease.

    And, to achieve this, to prevent further economic disruption, we must make decisions which are currently not being made. Respectfully I suggest:

    1. A mandatory risk assessment on all Australians 70 years and over together with all those with co-morbidities known to be associated with Covid 19 mortality. These will include all type I and type II diabetics, those with heart disease with a known predisposition to Covid 19 complications, immune disorders, morbid obesity and all other conditions defined by a government appointed expert medical panel.

    2. This cohort to be divided into low, medium and high risk:
    (a) The high and medium risk group would be in mandatory restriction of activity for a period of six months (home detention, including home schooling and work from home) supplemented with recreational and social activities observing social distancing at all times and 24/7 monitoring with externally applied tracking devices recording GPS location, temperature, respiratory rate and pulse rate, electronically connected to central monitoring sites in each state and territory. Rapid response teams to promptly answer any alerts from these monitoring devices, either from the nearest public hospitals or suitably equipped health centres. Fines to be imposed for any violation of these regulations. This would be in place was six months and reviewed monthly after that time
    (b) The low risk group. The opportunity to attend schools, usual workplaces and recreational areas providing social distancing is provided in these areas. This group must comply with 24/7 monitoring with externally applied tracking devices recording GPS location, temperature, respiratory rate and pulse rate, electronically connected to central monitoring sites in each state and territory. Rapid response teams to promptly answer any alerts from these monitoring devices, either from the nearest public hospitals or suitably equipped health centres. Fines to be imposed for any violation of these regulations. The devices to be worn for a period of six months, with monthly review after that time.

    3. All restrictions on the remaining 85+% of the population to be removed. A mandatory reporting requirement and Covid 19 testing for all those with flulike symptoms (to the carried out on Day 1 of symptoms appearing and repeated on Day 5, Day 10 and Day 15 if symptoms have continued over that period. For those with positive tests on Day 10 a mandatory requirement for 24/7 monitoring with externally applied tracking devices recording GPS location, temperature, respiratory rate and pulse rate, electronically connected to central monitoring sites in each state and territory. Rapid response teams to be dispatched as clinically necessary, with mandatory hospital admission for those exhibiting continued tachycardia, tachypnoea and pyrexia. Fines to be imposed for any violation of these regulations.

    Implementation of this strategy would almost certainly ensure that at least 60% of this 85% cohort of the population would develop clinical or serological evidence of Covid 19 infection within a 12 month period. It is not clear at this time whether evidence of past infection provides significant immunity from further infection and any time that a state or territory has more than 300 positive results in any one day the federal government’s expert committee to take action they consider appropriate, their decision to be binding on each state and territory.

    It is expected that economic activity will quickly return to normal, but for the tourism sector and the likelihood work and school absences will be more prolonged and frequent than occurs in the usual Australian winter from influenza outbreaks. With these measures it is expected that Covid 19 mortality will be confined to the 15% cohort, of whom very few (< 1%) will succumb to the disease with the mandatory monitoring regime and effective rapid response arrangements and must be seen in the context there were 58,847 confirmed Influenza cases and 125 deaths in Australia in 2018 and, the SARS-CoV-2 virus, being more virulent than the Influenza virus, deaths from Covid-19 are going to occur in Australia whether or not the present regulations are maintained in place.

    So far as the frequency of the suggested testing it should be noted that international evidence demonstrates many negative responses are being obtained which are positive on subsequent testing.

    Medilink Australia Pty is pleased to be able to provide the monitoring devices and central monitoring facilities required.

    Finally, the Covid 19 pandemic brings the opportunity to markedly increase the utility of My Health Record. A project proposal to provide full interoperability has been presented to the Minister for Health and to the ADHA by two Australian companies, Medilink and Zetaris. Details of what is required is presented in the above attachment. So far no reply has been received.

    Yours sincerely

    Henry R Glennie, FRACS, FRCS, MBA, MPP
    Chief Executive Officer and Senior Medical Advisor
    Medilink Australia Pty. Ltd.
    P O Box 150
    TOOWOOMBA QLD 4350
    Mobile (61) 417 600 876
    P.P.S Attachment 2: THE SHORTCOMINGS OF MY HEALTH RECORD

    1. Over $2 billion has been spent on an electronic health record system. It started off as the personally controlled electronic health record (PCEHR) of the Labor government and then was revamped as My Health Record (MHR), the responsibility for this being given to the ADHA, with a Federal budget of over $250 million annually +$30 million from the State governments and Territories.

    The ADHA 2018-9 Annual Report lists the following objectives together with their expected timeframe:
    a. 3.2.1 By the end of June 2020: Co-designing a national technology alignment program will place Australia at the forefront of digital health innovation.
    b. A national goals of care collaborative will be launched to facilitate uploading of advance care directives and goals of care plans supporting end of life care.
    c. The Child Digital Health Record and the Digital Pregnancy Health Record will go live at Phase 1 sites.
    d. Phase 1 implementation of the National Provider Addressing Service and service registration assistant will enable seamless, safe and secure addressing.
    e. Delivering a roadmap for health interoperability in Australia and operationalising a community standards development model will enhance data interchange between disparate clinical information systems.
    f. 3.2.2 By the end of 2022: Every healthcare provider will have the ability to communicate with other professionals and their patients via secure digital channels.
    g. The first regions in Australia will showcase comprehensive interoperability across health service provision.
    h. There will be digitally enabled paper-free options for all medication management in Australia.
    i. All healthcare professionals will have access to resources that will support them in the confident and efficient use of digital services.

    Medilink Australia, in conjunction with two data analytics companies, Zetaris in Melbourne and Big Data labs in Europe, sent a project proposal to the Minister for Health to introduce complete interoperability between all health professionals, in hospitals and in health centres, throughout Australia, within six months of obtaining a contract. We have invited the Minister to arrange a time for his health policy analysts to have a virtual meeting to discuss this proposal but nothing has been received. Our proposal includes costing projections which are ridiculously small compared with the present budget of the ADHA.

    Yours sincerely

    Henry Glennie

    Henry R Glennie, FRACS, FRCS, MBA, MPP
    Chief Executive Officer and Senior Medical Advisor
    Medilink Australia Pty. Ltd.
    P O Box 150
    TOOWOOMBA QLD 4350
    Mobile (61) 417 600 876

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