The corona virus COVID-19

 
  djf01 Chief Commissioner

Just a question for my own understanding, am I to believe that no matter which variant of this Covid comes along, the vaccines will be more or less be able to "slap them all down" so to speak, is this correct?
mRNA vaccines, almost certainly yes, non mRNA vaccines, potentially not.
Aaron

"mRNA vaccines, almost certainly yes"

May I ask, why you think that?  AFAIK, the mRNA vaccines have shown efficacy (reduced) against the variants to emerge so far (bar P1 - no published studies I'm aware of).  Non mRNA, not so much.

But "slap them all down?" All variants so far perhaps, but all possible(/likely) future variants?.  We are yet to see the effects of a population mass-vaccinated with an mRNA product and a high COVID prevalence.  This risk I see is it may (much like penicillin resistant TB) foster the emergence of COVID variants that can escape the current mRNA vaccines.

It seems to me we need more than a mass vaccination program.  We need in Australia all the infrastructure (IP framework, mRNA Vaccine production, batch testing, cold-chain *and* walk up immunization centres) to give everyone potentially 2 updated mRNA (or whatever works best) vaccines a year.  And we will still need the ability to rapidly (re-)institute quarantine if/when vaccination inevitably fails.

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  Aaron The Ghost of George Stephenson

Location: University of Adelaide SA
I copped a lot of abuse/skepticism about the effectiveness of Ivermectin earlier on this thread but it appears that Pfizer is now going to conduct its own trials as both a prophylaxis and a treatment. Also there's now 50 independent studies reporting positive effects of Ivermectin on COVID19 - Ivermection meta-study.

Wouldn't it be funny if the answer was a drug that was actually banned in this country as a treatment for COVID19? In fact you and your GP could both go to prison in Queensland if you used it.
The link is dead, but I have been watching the ‘papers’ on Ivermectin for maybe 6 months now, they’re showing ‘interesting’ results for sure, but none of the trials, if they’re even to be considered trials have been particularly large, properly randomised and next to none of them I can see as being peer reviewed.

The results look positive, but it’s like looking at a dice, seeing a 3 and concluding every number is likely to be a 3.
Oh okay - I'll fix that later if I can find it again.

If Pfizer is finally coming around to it then there must be something there - I don't understand the bloody minded position of some state governments in having such draconian penalties for using the drug. Isn't the decision of treatment choice supposed to be between the doctor and their patient?
don_dunstan
Yes, but we also believe in evidence based medicine - though to be fair, sometimes Medicare does disagree that evidence is required.
  Aaron The Ghost of George Stephenson

Location: University of Adelaide SA
Just a question for my own understanding, am I to believe that no matter which variant of this Covid comes along, the vaccines will be more or less be able to "slap them all down" so to speak, is this correct?
mRNA vaccines, almost certainly yes, non mRNA vaccines, potentially not.

"mRNA vaccines, almost certainly yes"

May I ask, why you think that?  AFAIK, the mRNA vaccines have shown efficacy (reduced) against the variants to emerge so far (bar P1 - no published studies I'm aware of).  Non mRNA, not so much.

But "slap them all down?" All variants so far perhaps, but all possible(/likely) future variants?.  We are yet to see the effects of a population mass-vaccinated with an mRNA product and a high COVID prevalence.  This risk I see is it may (much like penicillin resistant TB) foster the emergence of COVID variants that can escape the current mRNA vaccines.

It seems to me we need more than a mass vaccination program.  We need in Australia all the infrastructure (IP framework, mRNA Vaccine production, batch testing, cold-chain *and* walk up immunization centres) to give everyone potentially 2 updated mRNA (or whatever works best) vaccines a year.  And we will still need the ability to rapidly (re-)institute quarantine if/when vaccination inevitably fails.
djf01
I mentioned this some pages back, but I cannot be bothered going back to find it.

I don’t have complete formal training in a relevant field, I do however have some background study in the field, and a fairly solid general science formal training, as such, I used the term ‘almost certainly yes’ because when it comes to science one should almost never be so absolute as to be certain - it is true that the more you learn in science, the more you realise how much you do not know.

That said, a mRNA vaccine should cover you for variants of the virus, since being RNA based, other changes to the virus should be captured in that response ability. That’s probably a certainty, but I am not confident in that claim.

If the virus’ RNA changed to an extent to be not captured in the mRNA vaccine response, then the virus will have changed so much that we would regard it as a new virus altogether.

The resistance you speak of is something different, penicillin resistant TB or MRSA are still TB or S. aureus, they still have the same genetics, it’s just some have learned to deal with some of our drugs. Some people are potentially at risk of death from nuts or illness from milk, most of us can deal with both, but we are all still the same ‘people’ - we are just not that genetically different.
  don_dunstan Dr Beeching

Location: Adelaide proud
I copped a lot of abuse/skepticism about the effectiveness of Ivermectin earlier on this thread but it appears that Pfizer is now going to conduct its own trials as both a prophylaxis and a treatment. Also there's now 50 independent studies reporting positive effects of Ivermectin on COVID19 - Ivermection meta-study.

Wouldn't it be funny if the answer was a drug that was actually banned in this country as a treatment for COVID19? In fact you and your GP could both go to prison in Queensland if you used it.
The link is dead, but I have been watching the ‘papers’ on Ivermectin for maybe 6 months now, they’re showing ‘interesting’ results for sure, but none of the trials, if they’re even to be considered trials have been particularly large, properly randomised and next to none of them I can see as being peer reviewed.

The results look positive, but it’s like looking at a dice, seeing a 3 and concluding every number is likely to be a 3.
Oh okay - I'll fix that later if I can find it again.

If Pfizer is finally coming around to it then there must be something there - I don't understand the bloody minded position of some state governments in having such draconian penalties for using the drug. Isn't the decision of treatment choice supposed to be between the doctor and their patient?
Yes, but we also believe in evidence based medicine - though to be fair, sometimes Medicare does disagree that evidence is required.
Aaron
I dunno, I've seen Medicare (PBS, NDIS) approve some treatments/drugs that have really spurious research behind them... but let's not get into that.
  Aaron The Ghost of George Stephenson

Location: University of Adelaide SA
I copped a lot of abuse/skepticism about the effectiveness of Ivermectin earlier on this thread but it appears that Pfizer is now going to conduct its own trials as both a prophylaxis and a treatment. Also there's now 50 independent studies reporting positive effects of Ivermectin on COVID19 - Ivermection meta-study.

Wouldn't it be funny if the answer was a drug that was actually banned in this country as a treatment for COVID19? In fact you and your GP could both go to prison in Queensland if you used it.
The link is dead, but I have been watching the ‘papers’ on Ivermectin for maybe 6 months now, they’re showing ‘interesting’ results for sure, but none of the trials, if they’re even to be considered trials have been particularly large, properly randomised and next to none of them I can see as being peer reviewed.

The results look positive, but it’s like looking at a dice, seeing a 3 and concluding every number is likely to be a 3.
Oh okay - I'll fix that later if I can find it again.

If Pfizer is finally coming around to it then there must be something there - I don't understand the bloody minded position of some state governments in having such draconian penalties for using the drug. Isn't the decision of treatment choice supposed to be between the doctor and their patient?
Yes, but we also believe in evidence based medicine - though to be fair, sometimes Medicare does disagree that evidence is required.
I dunno, I've seen Medicare (PBS, NDIS) approve some treatments/drugs that have really spurious research behind them... but let's not get into that.
don_dunstan
Well Medicare does rebate chiropractic and acupuncture which I have always found disturbing. I have serious issues with this, and I can legitimately say I have gone to more effort than most to change it.

Pseudoscience being funded by the government was the cause behind me temporarily relocating myself for the purposes of government agencies (especially the AEC) to a colleague’s address in the seat of Sturt ahead of the 2016 federal election.

At the time I was living in Kingston and was dismayed that the local NXT candidate was an acupuncturist. What concerned me greatly was having to be a part of the process of potentially electing him to parliament - he’s got some extremely ‘quirky’ views that lie well outside of demonstrable science, and I actually referred him to AHPRA prior to him even running for election.

After many long and detailed discussions with the NXT candidate for Sturt (a proper, actual, serious, Dr) and an actual meeting with Nick himself, about my local candidate and how I was concerned about having someone like that anywhere near the strings of Medicare I came to the conclusion that my only option for the sensible use of my vote was to enrol myself in the electorate of Sturt, and to try and have a decent science based Dr elected.

Alas, having gone to that effort, shifting my licence, tax and all sorts of stuff, I lost interest in the election in general and didn’t vote at all, then I moved to Boothby, Southcott, also a Dr, had retired, and now it’s just held by another smeg lawyer, who is going to leave parliament, probably resume being a lawyer, have to read her computer screen a lot and decide that acupuncture is required to ‘fix’ her eyes…
  michaelgm Chief Commissioner

Freudian slip?

  Valvegear Oliver Bullied, CME

Location: Richmond Vic
Minister Who? I didn't know he was a country member.
  djf01 Chief Commissioner

May I ask, why you think that?
I mentioned this some pages back, but I cannot be bothered going back to find it.

I don’t have complete formal training in a relevant field, I do however have some background study in the field, and a fairly solid general science formal training, as such, I used the term ‘almost certainly yes’ because when it comes to science one should almost never be so absolute as to be certain - it is true that the more you learn in science, the more you realise how much you do not know.

That said, a mRNA vaccine should cover you for variants of the virus, since being RNA based, other changes to the virus should be captured in that response ability. That’s probably a certainty, but I am not confident in that claim.
Aaron

Fair enough.

My - and I readily acknowledge it's probably flawed - understanding is the difference between the Viral Vector (AZ, Sputnik, Sinovax, J&J etc) and the mRNA vaccines is the delivery mechanism, not the payload.  AZ (and co) uses a Chimpanzee virus that does not replicate in humans, genetically engineered to contain the COVID19 spike protein.  The mRNA vaccines have an RNA wrapper (my terminology, obviously) around the same COVID19 spike protein.

(AFAIK) The reason they target the spike protein is this is literally the key mechanism for the virus to enter the cell it infects, so even if many other parts of the virus mutate, this bit *needs* to stay constant for the virus to remain viable.  All the vaccines attempt to do this, but to date the mRNA vaccines have shown to be much more effective an inducing an antibody response to the COVID spike protein, presumably because they better target the recipients immune system at the spike protein, (and not other elements of the delivery mechanism).

However, the main "variants of concern" have mutations on the spike protein that make it more infections and virulent - presumably at a micro-biological level.  B1351 (SA) and P1 (Brazil) have 2 (based on popular press reports), including a common one that has evolved independently.

This is why I am unconvinced mRNA vaccines are not susceptible to evolved around (for want of a better expression).

However I don't have enough knowledge of microbiology to even understand the terminology of relevant papers on the topic, so I'm (too) heavily reliant on popular press.
  wobert Chief Commissioner

Location: Half way between Propodolla and Kinimakatka
Minister Who? I didn't know he was a country member.
Valvegear
"I remember.".... said the great man
  Carnot Minister for Railways

LOL!

  don_dunstan Dr Beeching

Location: Adelaide proud
Well Medicare does rebate chiropractic and acupuncture which I have always found disturbing. I have serious issues with this, and I can legitimately say I have gone to more effort than most to change it.

Pseudoscience being funded by the government was the cause behind me temporarily relocating myself for the purposes of government agencies (especially the AEC) to a colleague’s address in the seat of Sturt ahead of the 2016 federal election.

At the time I was living in Kingston and was dismayed that the local NXT candidate was an acupuncturist. What concerned me greatly was having to be a part of the process of potentially electing him to parliament - he’s got some extremely ‘quirky’ views that lie well outside of demonstrable science, and I actually referred him to AHPRA prior to him even running for election.

After many long and detailed discussions with the NXT candidate for Sturt (a proper, actual, serious, Dr) and an actual meeting with Nick himself, about my local candidate and how I was concerned about having someone like that anywhere near the strings of Medicare I came to the conclusion that my only option for the sensible use of my vote was to enrol myself in the electorate of Sturt, and to try and have a decent science based Dr elected.

Alas, having gone to that effort, shifting my licence, tax and all sorts of stuff, I lost interest in the election in general and didn’t vote at all, then I moved to Boothby, Southcott, also a Dr, had retired, and now it’s just held by another smeg lawyer, who is going to leave parliament, probably resume being a lawyer, have to read her computer screen a lot and decide that acupuncture is required to ‘fix’ her eyes…
Aaron
Agree strongly, there should be no "allied-health" type services on Medicare whatsoever. No chiropractors, no psychologists, no physiotherapy - nothing like that. The program's long-term viability is already under threat and yet they're putting more and more rubbish 'approved services' onto it all the time. That money should be shifted into reducing the cost of medical specialists, not providing quackery. If the government wants to fund those 'allied health' services then they should block-fund it through community health services or hospital annexes.

I must be getting old - I used to think you were far too right-wing libertarian but now I find myself agreeing with you on all sorts of things...
  ANR Chief Commissioner

Courageous move by the PM to restrict use of the A-Z VAX. He should be congratulated for stopping its use on younger people.
  DirtyBallast Chief Commissioner

Location: I was here first. You're only visiting.
Courageous move by the PM to restrict use of the A-Z VAX. He should be congratulated for stopping its use on younger people.
ANR
I don't disagree, but generally speaking it's not going to affect anyone. Young people aren't receiving it anyway, and anyone in that cohort who deserved the vaccine due to their profession probably received the Pfizer vax in the first place.

This is a free kick for Scotty from marketing. But, did he actually deserve it?
  RTT_Rules Oliver Bullied, CME

Location: Dubai UAE
Agree strongly, there should be no "allied-health" type services on Medicare whatsoever. No chiropractors, no psychologists, no physiotherapy - nothing like that. The program's long-term viability is already under threat and yet they're putting more and more rubbish 'approved services' onto it all the time. That money should be shifted into reducing the cost of medical specialists, not providing quackery. If the government wants to fund those 'allied health' services then they should block-fund it through community health services or hospital annexes.

I must be getting old - I used to think you were far too right-wing libertarian but now I find myself agreeing with you on all sorts of things...
don_dunstan
Didn't know much about Chiro, apart from Dad went all the time.

By chance I watched a number of Youtube video's by various chiros, everyone one of them did the same thing. They say they don't but it was standard. Listen to their problems, spend 10-15min doing an assessment, then spend 20min cracking all the joints, often with various things to basically massage the person if various locations. I'd rather go to a physio and get a good massage.

Physio's for post surgery or other recovery, yes they should be medicare as if you don't do that properly it does come back to bite sometimes.
  Aaron The Ghost of George Stephenson

Location: University of Adelaide SA
Agree strongly, there should be no "allied-health" type services on Medicare whatsoever. No chiropractors, no psychologists, no physiotherapy - nothing like that. The program's long-term viability is already under threat and yet they're putting more and more rubbish 'approved services' onto it all the time. That money should be shifted into reducing the cost of medical specialists, not providing quackery. If the government wants to fund those 'allied health' services then they should block-fund it through community health services or hospital annexes.

I must be getting old - I used to think you were far too right-wing libertarian but now I find myself agreeing with you on all sorts of things...
Didn't know much about Chiro, apart from Dad went all the time.

By chance I watched a number of Youtube video's by various chiros, everyone one of them did the same thing. They say they don't but it was standard. Listen to their problems, spend 10-15min doing an assessment, then spend 20min cracking all the joints, often with various things to basically massage the person if various locations. I'd rather go to a physio and get a good massage.

Physio's for post surgery or other recovery, yes they should be medicare as if you don't do that properly it does come back to bite sometimes.
RTT_Rules
Psychology and physiotherapy are sciences, and have little problem with them being within Medicare.

Chiropractic is not a science, and I have grave concerns about its use.

Today I received notice that my private health is both expiring, and increasing in premium. Tomorrow I am going to have a discussion with my fund informing them that I want a substantial reduction in lieu of omitting my coverage for acupuncture, chiropractic, yoga and all the other smeg treatments.
  michaelgm Chief Commissioner

Ok.






If the travel bubble between us and NZ remains and NZ is exclusively Pfizer, is vaccination tourism a possibility?
A week on the slopes and a jab X2.
  djf01 Chief Commissioner

If the travel bubble between us and NZ remains and NZ is exclusively Pfizer, is vaccination tourism a possibility?
A week on the slopes and a jab X2.
michaelgm

Only if you are under 50.
  don_dunstan Dr Beeching

Location: Adelaide proud
Psychology and physiotherapy are sciences, and have little problem with them being within Medicare.

Chiropractic is not a science, and I have grave concerns about its use.

Today I received notice that my private health is both expiring, and increasing in premium. Tomorrow I am going to have a discussion with my fund informing them that I want a substantial reduction in lieu of omitting my coverage for acupuncture, chiropractic, yoga and all the other smeg treatments.
Aaron
Really my idea is that Medicare should be exclusively for medical interventions and that everything else should reside outside that scheme; block-funded and/or more closely supervised with the aim of reducing cost. I read a while back that the cost of allied health to the scheme had exploded in recent years (particularly psychology) and that the primary goal of the "Better Access" program (to provide rural and remote people with access to psycholigsts) had basically failed and the money was being spent on the urban 'worried well'. We're spending several billion on a program that really hasn't met its defined outcomes and yet ScoMo recently doubled the number of sessions available due to the pandemic.

There's also organizations and programs being funded directly from Medicare that probably need to have better oversight: HeadSpace in particular is costing the Medicare budget around $100,000,000 a year and it appears to be a really particularly poorly managed organization with quite fuzzy, undefined outcomes and a huge number of sites and staff. Another majoirty Medicare funded example is Beyond Blue - costs and staff numbers have exploded under Julia Gillard's stewardship, nearly triple in the last few years - but where are the measurable outcomes that show they're providing value-for-money?

Medicare costs to the taxpayer grew from $461 billion in 2008 to a whopping $731 billion in 2018; it's projected to cost taxpayers $1,300 billion by 2029. It can't keep growing at that pace, it simply won't be affordable. At some stage someone will need to come along and slash these costs or the scheme won't be able to keep going.
  wobert Chief Commissioner

Location: Half way between Propodolla and Kinimakatka
I think your figures on medicare expenditure are a bit out Don.
  don_dunstan Dr Beeching

Location: Adelaide proud
I think your figures on medicare expenditure are a bit out Don.
wobert
Oops yeah your right I was looking at a comparison of America's 'Medicare' - totally forgot their have their own scheme with the same name. The huge numbers should have been my clue.

Unsurprisingly our own scheme is growing quite quickly (not quite as bad as the US scheme though). These figures are from Hansard -

2019-20 expenditure expected to be $81,000,000,000
2022-23 expected cost $90 billion

Currently growing at about 8-9% p/a and will be around $115 billion p/a by the decade's end.

Headspace - on top of its existing funding out of Medicare - will get around $350,000,000 in additional funding over the coming years.
  wobert Chief Commissioner

Location: Half way between Propodolla and Kinimakatka
Another one of the big growing expenses is the private health rebate. From memory it was something like 1.5 billion when John Howard bought it in, and now, from memory, getting towards 9 billion. And at some stage is going to have to be dealt with.
  don_dunstan Dr Beeching

Location: Adelaide proud
Another one of the big growing expenses is the private health rebate. From memory it was something like 1.5 billion when John Howard bought it in, and now, from memory, getting towards 9 billion. And at some stage is going to have to be dealt with.
wobert
Yeah there's some very interesting facts around Medicare spending I've been reading in the last hour - interested to read and discuss more tonight when I get back from work.

That figure that I quoted of $80-90 billion p/a depends entirely on what you count as 'Medicare services' and apparently it doesn't include things like private health rebate, PBS, "Better Access", "My Health Record", block grants to community health services, Red Cross, the Flying Doctor etc etc.

By the time you add in all those extra health spending items the total annual cost of health to the Australian taxpayer is around $180 billion p/a. Interestingly I read a while back that PBS is probably the very best practice globally for getting cheap medicines to Australians, block purchasing medicines for the public ensures the very best price every time (which is why big pharma hates it so much I guess).
  wobert Chief Commissioner

Location: Half way between Propodolla and Kinimakatka
Not tonight thanks, redneck night up at the neighbors shed.
  RTT_Rules Oliver Bullied, CME

Location: Dubai UAE
Ok.






If the travel bubble between us and NZ remains and NZ is exclusively Pfizer, is vaccination tourism a possibility?
A week on the slopes and a jab X2.
michaelgm
Brand of Vax is irrelevant, so long as endorsed by WHO you should be good to go which is what countries like Iceland have done. No vax politics just needs to be endorsed and welcome, no quarantine which is the way I believe Australia will follow.

Currently there are 4 endorsed vax, Sinopharm is expected this month
  RTT_Rules Oliver Bullied, CME

Location: Dubai UAE
I think your figures on medicare expenditure are a bit out Don.
Oops yeah your right I was looking at a comparison of America's 'Medicare' - totally forgot their have their own scheme with the same name. The huge numbers should have been my clue.

Unsurprisingly our own scheme is growing quite quickly (not quite as bad as the US scheme though). These figures are from Hansard -

2019-20 expenditure expected to be $81,000,000,000
2022-23 expected cost $90 billion

Currently growing at about 8-9% p/a and will be around $115 billion p/a by the decade's end.

Headspace - on top of its existing funding out of Medicare - will get around $350,000,000 in additional funding over the coming years.
don_dunstan
Since 2007, Medicare has sat on around 9.5% GDP although it did rise to +10%

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

Provided it remains const with GDP, its affordable although I agree its costs need to be controlled and TA's $10 per Dr visit levy would have helped curtail some of the waste and increased revenue marginally. In UAE we have conclusive medical insurance in that there is no "Gap" and we have no Medicare equivalent and by law all expats must be covered by medial insurance by their employer, but you pay 50 AED or $15 to visit a Dr, each and every time.

In UAE Physio and physco is covered provided its linked to a medical procedure as such. I cannot get a rebate for getting a back rub. Chrio is legal here, but not insurable against unless you have off-shore insurance.

For the lefties, the cost has actually resin faster under LNP, so much for the claims of LNP is anti-medicare.

Personal view is Medicare should be 100% covered by a medicare levy that is linked to gross income with limited offsets to reduce. This would set the medicare levy to around 20%. No other funding. This way the full cost will be viewed by all which I'm sure would help change the "bottomless pit" mentality many have, but if you are privately insured you get a discount on the levy. Medicare levy would also come out of welfare payments.

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