QED

A Doctors’ Open Letter to Daniel Andrews

Dear Premier,
We, the undersigned, are senior medical practitioners of various specialities who practice in Victoria and are deeply concerned with the Victorian government’s management of the SARS-CoV-2 (COVID-19) viral pandemic as a public health issue.

The purpose of this letter is to make you aware that not all medical practitioners are in agreement with the Chief Medical Officer and the Victorian government regarding the most effective way to control this disease. We believe that an alternative medical response is required that reflects what we know about the spread of the virus, those who have died from it, and the impact that the stage 3-4 lockdown restrictions are having on the physical and mental health of the general population.

For the sake of people in Victoria with other medical illnesses, it is vital that Stage 4 restrictions be lifted on schedule in mid-September.

This letter details our concerns and recommendations. We are ready to offer any assistance we can to help create and implement a revised, effective and just response to the Victorian situation; to this end we would be pleased to meet with you at your convenience to discuss the matter further.  

Government Response to Covid-19 and Available Data

Focusing on the numbers of cases of COVID-19 is at best an unsophisticated way of looking at disease management. Factors such as the side effects of any policy, its cost effectiveness, the quality of life years lost, and the cost per life saved are fundamental when considering disease management. In addition, any policy to manage any disease must be reviewed in light of new data.

We believe that the government’s initial response to handling COVID-19, via a stage 3 lockdown to ‘flatten the curve’, was reasonable in view of the limited information available at the time on the outbreak in China and the alarming number of deaths in Italy. The initial response, though arguably excessive, was still highly effective in preserving medical capacity and allowing time to co-ordinate a full medical response, with the community accepting that the social and economic consequences were reasonable and for the common good.

However, we now know that whilst COVID-19 is highly contagious, it is of limited virulence.

Whilst an accurate cause of death of a person can be difficult to determine, we are told that since March 2020, 565 Victorian patients have died either with or from the virus (31st August numbers). This compares with annual Victorian deaths of approximately 10,000 patients with cardiovascular disease and 11,000 with cancer. Accordingly, the COVID-19 deaths are a relatively small proportion of the 114 deaths per day that are normally seen in Victoria. In comparison, since the start of March COVID-19 has been associated with 3 of the 114 deaths per day.

Most of the 565 deaths have occurred in nursing homes which according to doctors currently working in this environment have described causal factors related not only to the virus but to other care related issues, including isolation, loneliness, and related diminished nutritional intake.

However, in Victoria we have had 541 LESS deaths this July compared to July last year. (3,561 deaths compared to 4,102 deaths in July 2019).

In Australia last year, 2019, in the month of July alone we had 71,000 new laboratory confirmed cases, and a total of 313,000 laboratory confirmed cases of influenza for the year. This is only a fraction of the actual total cases of influenza, as many cases go untested.

In August 2017 we had 99,000 new laboratory confirmed cases of Influenza and a total of over 250,000 cases for the year.

During 2017 and 2019 Influenza resulted in 25-30,000 hospital admissions and up to 2500 ICU admissions across Australia. Three per cent of hospital admissions were pregnant women and up to 18 per cent were under the age of 16.

The deaths from Influenza each and every year is between 3500 and 4000, according to the Australian Influenza Specialist Interest Group website and the Australian Bureau of Statistics. This is despite recent excellent rates of vaccination in the vulnerable population and millions of vaccinations utilised each year. (2020,18 million, 2019 13.2 million, 2018 11 million, 2016 8.3 million)

The vast majority of deaths associated with COVID-19 have occurred in frail people over 80 years, many of whom also had significant co-morbidities. In Victoria more than 73 per cent of known COVID-19 deaths resided in nursing homes. (381 out of 524 and 30 out of 52 in NSW, as of August 30).

For people who are physically well and under 60 years of age, the mortality risk is extremely low. Contrary to what you have said, Mr Andrews, the virus DOES discriminate. See graphs below.

Since June 2020, the death rate has risen sharply in aged care facilities where the risk of transmission of COVID-19 has been unacceptably high. However, the government, and the doctors advising it, have not reviewed their policy in order to focus on this vulnerable segment of the population. Instead, stage 3-4 lockdowns for the whole community have continued for no apparent scientific reason.

Medical and Social Consequences

As medical practitioners, it is our collective experience that patients are presenting later to us with their medical complaints. Specialist referrals from GPs, and indeed GP workload, have fallen dramatically due to patients’ reluctance to leave home in fear of acquiring the virus.  As a direct consequence of this delay, many will have poorer prognoses. This has especially been the case with consultants who treat cancer. A study in the UK estimated an extra 4000 deaths from not screening the four main cancers alone and not from lack of treatment.

In addition, it is our professional opinion that the stage 4 lockdown policy has caused unprecedented negative economic and social outcomes in people, which in themselves are having negative health outcomes. In particular, it has caused or exacerbated depression, anxiety and other mental health issues, as well as contributed to domestic violence, through an extreme and unjustified disruption to family, social and work life. Job losses, home schooling, the isolation of the elderly and single people and the restriction on the number of people who may attend funerals, are but a few examples of how the government’s current response is harming the health of the general population. 

In short, the medical, psychological and social costs of the lockdown are disproportionately enormous compared to the limited good being done by current policies, and are relevant factors to be taken into account by any responsible government.

Proposed Amendments to the Public Health and Wellbeing Act 2008 (Vic)

We further note with much concern, that the proposed amendment to the Public Health and Wellbeing Act that would effectively allow the government to continue its current policy to manage COVID-19 even if there were to be zero cases over a period of time. This is unfathomable and certainly contrary to the objects of the Act, which require accountability, proportionality and collaboration to be fulfilled.

Specifically, the legislation explicitly mandates that the government’s decisions on public health initiatives must be transparent, systematic and appropriate, with members of the public given access to reliable information in appropriate forms to facilitate a good understanding of the issue. In addition, the legislation acknowledges that decisions will be enhanced through collaboration between all levels of government and industry, business, communities and individuals.

Recommendations

For all these reasons, ordinary sensible people if properly informed, should inevitably conclude that the current government policy is ill focused, heavy-handed, and unjustifiable as a proportionate response to the risks posed by COVID-19 to the public’s health.

As the virus is not going away soon, and an effective vaccine may not be available for a considerable period of time, if at all, we respectfully call upon the government to do the following:

1/ The State of Emergency not be continued past September 13 with an agreement made for parliament to be allowed to openly discuss and debate appropriate medical plans to manage the current COVID-19 crisis. A panel of non-politically aligned medical and health-related experts be selected by a bi-partisan parliamentary group to provide the transparent and active role of informing and advising government decisions and responses to the epidemic.

2/ Ensure adequate measures, testing, and protection of the vulnerable, especially those in aged residential care environments and their families and carers.

3/ Clearly communicate to the public the medical evidence-base, objectives and timelines of any proposed future management plans, with open disclosure of the processes and negative consequences, to inform those discussions and decisions.

4/ A broader focus be given to the health and well-being of Victorians, by utilising all relevant available data and by calculating the costs and harms, including the social, economic, family, emotional, psychological and spiritual impacts on the community, of any decisions and plans to manage the COVID-19 crisis, thereby explaining and justifying the merits of these plans as a reasonable and  proportionate response.

5/ To review regularly the outcomes of any management decisions and demonstrate a willingness to modify plans as new data and insights become available.

Thank you for your time in reading this letter.  We look forward to your early response.

Yours faithfully,

Mr Geoff Wells, Urologist, Box Hill Hospital, Private Practice.

Mr Bob Millar, Transplant Surgeon, Royal Melbourne Hospital

Mr Jon Bare, Orthopaedic Surgeon, Monash Hospital, Private Practice.

Professor Nathan Grills, Public Health Physician, University of Melbourne.

Professor John Murtagh, Emeritus Professor AO Academic General Practitioner

Professor Haydn Walters, Respiratory Medicine, University of Tasmania.

Professor Kuruvilla George, Psychiatrist,

Mr Peter Denton, General Surgeon

Mr William Edwards, Orthopaedic Surgeon, Private Practice.

Dr Andrew Taylor, Gastroenterologist, St Vincent’s Hospital

Mr Michael Knight, Orthopaedic Surgeon, Private Practice.

Dr John Mathai, Psychiatrist,

Dr Eamonn Mathieson, Anaesthetist, Private Practice.

*The signatories do not represent the opinions of their employers.

19 comments
  • gareththomassport

    Great letter, and as a fellow doctor practicing in the relative freedom of NSW I fully support the sentiments, though the reason for Chairman Dan’s harsh shut downs is surely politics and not public health.

  • Tony Tea

    Dan has painted himself into a corner and his only plan is to keep painting.

  • rod.stuart

    Excellent work, but it might be prudent to consider revising this statement “the outbreak in China and the alarming number of deaths in Italy.”
    Deaths attributed to influenza in 2015 in Italy ……………134,000
    Deaths attributed to influenza in 2017 in Italy ……………134,000
    Deaths attributed to SARS CoV2 in 2020 in Italy ……………134,000
    Estimate of deaths singularly attribuitable to SARS CoV2 in 2020 in Italy………between 1 and 4 percent.

  • irisr

    Are these doctors going to be rounded up and charged with the new crime of “incitment to protest” ?????
    It all depends on their intentions! as deciphered by the Authorities.
    See the famous video clip of the police attending in numbers at the lady’s home because she put up a Facebook post announcing her intention to go for a walk in the park. Transcript of what the policeman says to her:
    “in relation to your post, if your intention was to just to go for a walk, no problem, but if it can be shown that your intention was to promote having a group of people attend the park in contravention of the lockdown orders right now, you can actually be charged with an offence called ‘incitment’ OK?”
    We’re talking “intentions” here. Thought crimes.

  • pgang

    ‘We believe that the government’s initial response to handling COVID-19, via a stage 3 lockdown to ‘flatten the curve’, was reasonable…’

    Didn’t see much point in reading any further.

  • Ian MacDougall

    “A broader focus be given to the health and well-being of Victorians, by utilising all relevant available data and by calculating the costs and harms, including the social, economic, family, emotional, psychological and spiritual impacts on the community, of any decisions and plans to manage the COVID-19 crisis, thereby explaining and justifying the merits of these plans as a reasonable and proportionate response.”
    Sounds reasonable enough to me, although it can be taken as code for the Donald Trump approach.
    “Everyone is going to get it,” now appears to be the Trump administration’s policy objective. At the current American case fatality rate of approximately 3%, the United States can expect a death toll somewhere north of ten million people. Which is more than they lost in all the wars of the 20th C.
    And THAT might just have a braking effect on the economy. Time alone will tell.

    https://en.wikipedia.org/wiki/United_States_military_casualties_of_war

  • Elmo

    Could the good doctors recommend a travel kit of basic medications? I’ll be leaving this sad, corrupt and decaying state as soon as humanly possible. Please, NSW and SA, open your borders to us would-be refugees. Please

  • STJOHNOFGRAFTON

    I agree with Tony Tea. The question is how much longer the Victorian Premier is going to wait for the paint to dry. A plan to save face may be the catalyst. The Transplant Surgeon may be an option. In the meantime, the Gastroenterologist could assist with the gut feeling of the general public.

  • Lawrie Ayres

    pgang. It always pays to give some credit to even the worst offender before eviscerating them. Praise before beheading just to get their favourable attention.

  • ianl

    The open letter would be better addressed to Sutton and the MSM in my view. The MSM in particular, although those people believe their jobs are essential – and they have been told so.

    The bulk of the population are well and truly panicked. I suspect this won’t abate (the fear will remain beyond dropping “case” numbers – 3rd wave ?) until the Federal JobKeeper money stops. Then Morrison loses the next election, of course.

  • Stephen Due

    The lock-downs were never a good idea. Epidemiologists warned against lock-downs from the beginning. John Ioannidis, Professor of Medicine and of Epidemiology and Public Health at Stanford, recently said: “Lock-down is a nuclear weapon that destroys everything”. Other leading epidemiologists have given the same message. The correct strategy with this virus was known in February/March i.e. protect the vulnerable, and allow the infection to spread like influenza in the rest of the population. Ioannidis estimates herd immunity to this virus occurs in communities where there is social mixing when about 10% -30% are infected. This figure is confirmed by other epidemiologists. It is attributed to non-specific cross-immunity from exposure to other coronaviruses, and some measure of natural immunity, Therefore herd immunity was and is the correct objective.
    By way of contrast the irrational policy of the current Victorian CMO and Premier has no defined objective and no foreseeable endpoint. The Swedish epidemiologist Johan Giesecke, when asked recently what should be done in Victoria, said “you need an exit strategy”. But Victoria does not have one.

  • Stephen Due

    About Professor Brett Sutton (from health.vic website):
    “Professor Sutton has extensive experience and clinical expertise in public health and communicable diseases, gained through emergency medicine and field-based international work, including in Afghanistan and Timor-Leste. He represents Victoria on a number of key national bodies including the AHPPC (Australian Health Protection Principal Committee). He is also Chief Human Biosecurity Officer for Victoria. Professor Sutton has a keen interest in tropical medicine and the incorporation of palliative care practice into humanitarian responses.
    Professor Sutton is a Fellow of the Royal Society for Public Health, a Fellow of the Australasian College of Tropical Medicine and a Fellow of the Australasian Faculty of Public Health Medicine (AFPHM). He is also a member of the Faculty of Travel Medicine.”
    This lightweight professional person with a “keen interest” in this and that currently has enormous powers in the State of Victoria, and is using them in very destructive ways. His qualifications and experience seem to be commensurate with his evident sex appeal to mid-30s females but not commensurate with his current responsibilities. Mediocrity like this has been the hallmark of the Victorian public service for years. One of the difficulties with mediocrity is that when there is a real problem it produces bad results.

  • ianl

    And there we are Wednesday morning:

    The Vic Upper House endorsed another 6 months of “emergency” control … and JobKeeper is extended by the Federal Govt another 6 months. The MSM has completely ignored the letter above from the distinguished medical group.

    So tediously predictable. Observe the Victorian opinion polls.

  • rosross

    It is good to see. I am bemused that when I post similar data many people become angry. Do some enjoy living in fear? Perhaps.

    And the good doctors are also pushing the Flu vaccine, as they must, but also admitting, although I am sure without conscious purpose, that it has made little if any difference to death rates.

    I would like to see a study showing how many Covid deaths had been previously vaccinated against the Flu given research showing Flu vaccines predispose people to other respiratory diseases. It won’t happen because vaccines are sacred and people still get burned at metaphorical stakes for challenging religious dogma, and vaccines have become a religion.

    But, great to see doctors speaking out. Let’s hope they do more of it for the sake of science, medicine and humanity.

  • Pablo07

    never before have so many cared so much about so few..
    comes to my head after daily cov19 deaths reports
    (no mention of the numbers of deaths due to other causes)

  • Wyndham Dix

    Deaths from COVID-19 in Australia 22/1/2020 to 2/9/2020:-
    2 Aged under 40
    2 Aged 40-49
    10 Aged 50-59
    26 Aged 60-69
    108 Aged 70-79
    242 Aged 80-89
    190 Aged 90 and over
    580 Total
    https://www.health.gov.au/resources/covid-19-deaths-by-age-group-and-sex
    No mention of co-morbidities.

  • Wyndham Dix

    Deaths from influenza and pneumonia in Australia in 2018:- 3,102
    Median age at death from these respiratory diseases:- 89.3 years
    https://www.abs.gov.au/ausstats/[email protected]/mf/3303.0
    Based on data in my previous comment, the median age at death from the current corona virus might be lower but still in the mid- to high-80s.

  • aftermath

    I am bemused that Adjunct Professor Brett Sutton (Monash University) is now using his honorific “Professor” to add weight to his opinions. We are still not told about his real area of academic expertise, deemed necessary and sufficient to justify his advice.

  • Jenny Lu

    Donald trump said to public Covid-19 is just like flu, before 100,000 people die we will manage it in March news. Now they have 160,000 people die and 5,140,000 People get Covid-19 on 8 August 2020. The number of people get Covid-19 is what Melbourne population.

    How can we stop ? Are we doing it already? Why number of affected people not between 1-9?

    Australia is so privilege far away from other countries, we have so much space at back yard. Why people lives in crowded place like Melbourne city and East South people has Most zero case. What’s wrong with other area? Can you stop traveling and find excuse to go out? New Zealand can do so well, everyone wants to zero down the Covid-19. Then Life can all start again. Just four weeks of lockdown. So now how many weeks of lockdown? Why our number does not go down? Does not mean Andrew is bad apple want to lock us up. Can we ask ourself what’s wrong people ? Few people still party, Freedom no mask, freedom black man, freedom no lock down protest. Protest.
    Do you know pregnant woman has low immunity? If she goes out and Unfortunately get Covid-19, Who suffer first? Then Who else Go out suffer as consequences? One rotten apple spoils the barrel. If more people lost their mind to go out to protest, now you become rotten apple ruin each individual Freedom and financial future cause most wisdom people Stayed in Melbourne who try to make effort to stay home to protect our love one. Most of us Wants life back too. We have wait so long, can we cooperate more just few more weeks all stayed home and report all the symptoms seriously. If you feel you are unwell, like light head, headache, sudden weak, or weird feeling, no energy, Difficult breathing, Fever, redness of feet, can you Please go to test.
    This affected number shall be single number in between of 1-9 now. Can you take this time self -reflective, meditation, core muscle strength from YouTube or other channel. Can we do zoom class see your friends party at home at once ? Creative, peaceful mind is what we need now to help calm to single numbers. Please. Please please
    In Jesus name amen. Jenny Lu

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