Waimate doctor’s words of wisdom


As New Zealand has moved to alert Level 4, people have a lot of questions about Covid-19. Waimate doctor Steven Fish shares some insights with Oamaru Mail reporter Gus Patterson.

Q What is the difference between Covid-19 and a bad flu?

Influenza, or flu, is a virus that’s been around for many years. It generally attacks the nose and throat and can bind to blood vessels, too, making you feel generally unwell, giving you a fever, achy muscles and often a headache. It can infrequently cause pneumonia, which is an infection that clogs up the air sacs in the lungs, making it hard to breathe. There are different strains and these periodically become more or less prevalent each flu season. There are usually less than 500 hospitalisations throughout New Zealand each year because of flu. If you are feeling “fluey” and unwell, stay away from others and from work until better.

The strain that is likely to be prevalent can sort of be predicted each flu season and a flu shot can be manufactured in advance. People with chronic health conditions are most at risk from the flu, as well as the elderly. The vast majority recover.

Covid-19 is a virus that humans have never been exposed to before. It has mutated, and been able to jump species to humans, probably from bats in an illegal animal trade market in China.

That means that no-one has any natural immunity to it and so everyone is susceptible to infection. It is called Covid-19 because it is a type of Coronavirus disease and first presented in 2019.

Covid-19 enters the body by binding to certain surface receptors, in the upper throat but also mostly in the lungs, causing a sore throat, cough, shortness of breath and fever. The worry with Covid-19 is that a significant proportion of those infected develop really bad pneumonia. About 10% to 15% of those infected with Covid-19 require hospital help to breathe because of pneumonia; 4% to 5% will need an intensive care bed.

And whereas the number of people each infected person could transfer the virus to is about one for flu, it appears to be about three for Covid-19 – so it appears to be more infectious.

The young are less troubled by symptoms, but they can infect more vulnerable people in our community. It is very important that young people, such as school pupils and students, take this very seriously – having big parties makes contacts of cases impossible to trace and isolate.

Q Have you experienced a pandemic like this before?

No. Never. Nobody has. It is unprecedented, except maybe for the Spanish flu of 1918-19.

Q What does it mean to “flatten the curve”?

The virus has the ability to infect a lot of people in a very short period of time. If uncontrolled, the numbers infected in a population could double every four to five days. The numbers needing hospital treatment all at once would very quickly overwhelm services. Many would not be able to access their normal specialist care, many others would not have access to important intensive care and many would die. If we reduce the number of infections – by hand-washing, maintaining physical distance, reducing unnecessary travel and stopping mass-gatherings – we can prevent many infections from happening all at once. Our important medical and emergency services will still be able to cope.

Q How do we know this?

Compare the actions of Taiwan and South Korea with those of some European countries. Britain talked about supporting a strategy of natural herd immunity to start with. As a result of this lack of control, the Imperial College Covid-19 Response Team estimates that at its height of infection, the UK will require 100 to 220 critical care beds per 100,000 people, far outstripping its current 6.6 to 14 critical care beds per 100,000 people.

New Zealand is now at a critical point in terms of case numbers and control. Everyone has to do their bit to prevent this virus spreading catastrophically.

I have been very impressed and reassured by our Government’s announcements and response to the pandemic. Director General of Health Dr Ashley Bloomfield has been particularly informative.

Q There seems to be a lot of misinformation appearing online – have you noticed this?

Yes. For example, drinking plenty and gargling with vinegar will not stop you getting it and will not stop you transmitting it to others. It will not save lives and is no substitute to physical distancing, hand-washing and avoiding hand-to-face contact.

Q Is advice like that dangerous?

Most certainly. These sort of posts distract from effective measures that do make a huge difference and have the potential to increase the spread of the virus. They downplay the severity of Covid-19 infection and may suggest the important interventions mentioned above are unnecessary.

Q Where should people get their information from?

The one true source of all effective and useful information in this country is from health.govt.nz and covid19.govt.nz.

Q What are some simple things people can do to protect themselves and others?

Physical distancing – maintain, as much as possible, a 2m distance from others outside your family. Hand wash regularly – normal bar soap is as good as, probably better, than anything else. Stop touching your face, especially if out shopping. Hard surfaces can be cleaned with 10ml to 20ml of bleach in 500ml of water, wiped and left to dry. Hand-sanitiser must be at least 60% alcohol, but is still second-best to hand-washing.

Q If people feel ill, can they get tested for Covid-19?

If you have recently returned from overseas or you know you are a contact of a case and are symptomatic – yes, you absolutely must get tested. Do not walk into your GP surgery, call ahead or phone Healthline on 0800 358 5453.

Avoid calling Healthline just for advice – they are very busy. Look at the website instead.

If you are feeling unwell and are not sure if you fit the categories above, your GP will help you decide. Some areas have community based assessment centres for assessing and testing potential cases. At the moment, only those that have been referred and meet case criteria will currently be tested.

Q What about repeat prescriptions? Can people collect them from the surgery?

All surgeries are now limiting all face-to-face consultations and foot traffic. Regardless of your health needs, your GP surgery needs you to phone first rather than walking in.

  • Dr Fish is originally from the United Kingdom. He has a varied medical background, from working with national sports teams to working in intensive care medicine. He has been a general practitioner for 20 years, 12 of which have been spent in New Zealand. At present, he is a general practitioner at Waimate’s Oak House Medical Centre.

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