The Rotary Club of Pinjarra welcomed Doctor Tim Inglis as Guest Speaker at last Thursday (17th September) evening's weekly meeting. Doctor Inglis, accompanied by wife Heather, addressed his topic "What can we learn from COVID about sepsis in regional Western Australia".
Tim is from the Division of Pathology and Laboratory Medicine, University of Western Australia's School of Medicine. He also works at PathWest Laboratory WA's Department of Microbiology at Queen Elizabeth II Medical Centre, and is a member of Lab Without Walls Inc. Tim has an interest in germs, in particular, those that cause emerging infectious diseases or might even be used in biological weapons.
The impact of the COVID pandemic is not over – the delta strain will very likely hit us here in WA at some time. When that happens, any response to an outbreak of community COVID infection is time critical. And the ability to perform rapid community testing is critical; especially so in regional areas of this State as the locations are so far from the sites of the big pathology laboratories.
Rapid Antigen Tests (RATs) may be part of the answer. Rapid antigen testing is a screening tool to help detect COVID-19 in people without any symptoms of COVID-19. Rapid antigen testing involves a nasal swab (using a small nylon bud) that is placed into a chemical solution. The result displays within 15 to 20 minutes.
While RATs don’t have the accuracy of the definitive lab tests, they are a key part of the process of controlling COVID and can be used at State and International borders. There is work being done on alternative testing for the future. Meanwhile, the deep swabs need to continue for now. RATs help support the health care workers (including nurses and pharmacists), especially in the more remote places, to make decisions regarding the possibility of COVID in their patients.
There are a number of considerations health authorities have at the forefront of their minds in the event of future potential pandemic threat events.
Emerging Infectious Diseases (EID)
Emerging infectious diseases have increased in the past two decades and threaten to increase in the near future. These diseases, which do not respect national boundaries, can challenge efforts to protect people as public health prevention and control recommendations may not be immediately available. As humans, we have a tendency with unseen threats to underestimate the danger they represent to community health. Rapidly changing situations involving EIDs lack standard responses and can  result in chaos – as happened at the beginning of the COVID outbreak.
Sepsis is a serious condition resulting from the presence of harmful microorganisms in the blood or other tissues and the body’s response to their presence, potentially leading to the malfunctioning of various organs, shock, and death. A Sepsis Alert is a method of rapidly triaging patients in order to reduce delays introducing appropriate antibiotics to an affected patient, with the aim of reducing mortality and the length of hospital stay. Authorities fear that this pandemic will bring a new drug resistance pandemic in the aftermath of COVID; it is believed that Drug Resistant Sepsis will kill more people than COVID in the long run.
Long Term Aims
There are few (and currently ineffective) ways to combat drug resistant sepsis. One must bear in mind that although COVID is a virus (and unaffected by antibiotics), the bacterial infections which affect the COVID-affected patient are potentially controlled by antibiotics. And therein lies the danger from drug resistant bacteria to cause a sepsis event in the affected patient.
The standard method of treatment requires the clinician to finds answers to some basic questions:
    Rapid Tests – determine the presence of bacteria in blood or not?
    Accelerated follow on: What type of bacteria? Which antibiotic will work?
    Regional Capabilities – Is rapid COVID testing available, and how rapidly can other testing results be obtained?
What are some of the ways we are trying to bridge the gap in preparedness for the future problem of Drug Resistant Sepsis? 
The reality is that some progress has been made in the State's preparedness – we now have the ability to cope with regional outbreaks of COVID in WA because of technological advances such as our Mobile COVID lab, Blood test data mining, FASTtrack in the SCGH emergency department and the rapid FAST method.
Tim then answered Questions from the floor of the meeting:
What’s your answer to Vaccine Sceptics?
Tim and all his colleagues were very early adopters of the vaccine. He provides information to those who are sceptical and will concentrate on alleviating their specific concerns. Tim and his colleagues don’t even try to convert those who energetically oppose vaccines. Tim's colleagues do extensive reviews of safety before adopting new vaccines – they found that much attention to safety was put in to COVID vaccines than for the yearly Flu Shots.
We know that the vaccines reduce the risk of Long COVID – there may be subtle differences between the different vaccines but they all show signs of benefit. 
Poor messages from those in positions of authority rather than straightforward messaging from those with the correct information, has played a part in the hesitancy of some of the public to embrace vaccination. Some of the states have multiple health regions – which has made it difficult to provide consistant messages from these sources. WA has one chief health officer – we have much better, more straightforward messaging here.
Why not let COVID run its course and have survival of the fittest?
The reason is not just about the number of deaths and number of people that would be needing hospitalisation – the problem would be the over-running of hospitals and the health care system. Additionally, some previously healthy people, including children, who have become ill from COVID, may be left with lifelong complications of the disease. A good plan is to have your flu shot as this will also give you a bit of a boost against COVID, especially if you’re worried that you’ve had your COVID vaccine a while ago and the effect may be waning.
Is one vaccine better amongst the Different COVID Vaccines?
All of the vaccines that have been cleared for use in Australia have similar impacts on protecting against severe COVID infection. The safety profile is also similar between them. It is fair to say that so much choice of vaccines has caused confusion around the suitability of one or other manufacturer's vaccine – despite all of the choices having over 90% efficacy against severe disease.
Is there any vaccine or drug without side effects?
Every medication has recognised side effects. To be accepted and permitted to be used in Australia, the Therapeutic Goods Authority (TGA) must determine that a medication's safety and efficacy outweigh any negative side effects – essentially, a risk benefit analysis is made.
What of the Variants of COVID?
The new variants come out of places where the disease is most widespread. There are already variants coming out of NSW. This is one reason why we need to be prepared for an inevitable outbreak here, and to get on top of the local spread of COVID as early as possible following the outbreak.
Rotarian Andrew McCormack thanked Tim for his very informative and interesting talk, and presented him with a memento of his visit to our Club.