Former Kaitaia GP Dr Lance O'Sullivan has a ringside seat as coronavirus threatens to take hold in China.
He's been in Shenzhen since January 19 with a Māori delegation, as guests of Huawei, to look at how G5 and digitech capability might be used in the MaiHealth container clinic programme that is under development "back home".
Shenzen, 1100km from Wuhan, which last week went into lockdown as Chinese authorities strived to contain coronavirus, had already had its fair share of pandemic viruses, he said, and its 12.53 million residents were taking stringent precautions to keep safe.
The seriousness of the coronavirus outbreak was rapidly becoming clear: people were dying.
"The Wuhan strain of the coronavirus can cause pneumonia.
"At the time of writing this, 547 people have tested positive and 17 have died. It has a 2.25 per cent mortality rate. Most of those who have died are elderly and/or with pre-existing health problems," he said.
"There are queues of people lining up outside drug stores here in Shenzhen to get the latest and greatest masks to protect themselves and their families.
"What we know is that protecting people in advance of being infected is the most effective strategy in the fight against virus menaces like this. The problem is it would take over a year to develop a customised vaccine for each strain that appears. What we should do is engineer a white label vaccine that has all the components of the different viruses that allows us to customise it quickly when virulent pathogens like the Wuhan virus appears.
"We should have the infrastructure to support rapid modification and deployment of these bespoke vaccines, particularly to the countries that are most at risk, like Samoa, that have limited infrastructure and under-developed health systems.
"Measles killed over 70 people in Samoa, most being children under five years old. Globally 140,000 people died in 2019 from a disease that the World Health Organisation was close to claiming had been eradicated from the world until a dickhead from the UK (stuffed) it all up.
"So, what will I do?
"Well I have travel insurance as a standard practice and carry hand sanitiser with me. I am not at the point of wearing a mask yet, as I am of the belief that in a country of 1.4 billion people the chances of someone who is healthy, young(ish), fit and practising good hygiene — I don't touch handrails in public, elevators or trains, use my knuckle for eftpos, sanitise after shaking someone's hand — getting sick from this is low. These are things we could all do to prevent viral infections that are in circulation.
"And if there was a vaccine available, I definitely would have got it before I travelled."
Antibiotic resistanceThe biggest problem he had noticed in China was that some of the most potent antibiotics could be bought over a pharmacy counter.
"This will be causing significant problems with antibiotic resistance, which will be contributing to people having bacterial infections on top of viral infections (which we have limited weapons in the arsenal to treat). Also, antibiotic-resistant bacteria will be weakening people's immune systems in advance of coming into contact with viruses," he said.
"Essentially, we need a global regulatory body that manages the development, distribution and use of antibiotics.
"This is something all the drug companies would hate. We can start by doing something in New Zealand that limits the use of antibiotics in our own health system — but that's another drama for another day."
Dr O'Sullivan followed that up on Thursday, saying he and his fellow delegates were now wearing masks, which was "best practice" among the locals, and reiterating the need to control the use of antibiotics.
"Withholding antibiotics from patients who don't need them can be done very easily right now. However, there are barriers to this being achieved, and not all the problem is due to pushy patients demanding antibiotics," he said.
"Firstly, we could have tighter controls on the prescribing of these. I and many infectious disease specialists in New Zealand would like to see the infamous Augmentin only available on special authority. There are only limited instances where this potent medication should be prescribed.
"The next step is to use technology to improve the ability to identify who will benefit from antibiotics and who will not.
"As we were travelling in China I came across a thermal scanner in a railway station that uses CCTV cameras to identify those with a fever so they can pull them aside and check if they have the Wuhan virus. This technology could be used in a clinic to detect patients who have a fever, and then could allow us to triage them quickly and efficiently, therefore increasing our response to effective clinical care.
"Adding to this would be the use of point of care (POC) diagnostics, a technology that allows previously time-consuming and expensive tests to be done while the patient is sitting in the clinic. It looks like a pregnancy test, and is just as easy to use.
These tests in some cases only require a drop of blood, and will allow us to determine if someone has a bacterial infection or not. It's a perfect weapon to combat antibiotic resistance and overuse.
"The hardest thing to do is not discovering the technology — this already exists. It is getting our health leadership, and actually their masters, the government, to look past the horizon and see that we can deliver faster, safer, more economical and higher-quality health care today. Let's stop being followers with a limited mindset and start being leaders with a global view."
On Friday Dr O'Sullivan told Newstalk ZB that the coronavirus outbreak was causing significant concern in China, but, internationally, he believed it had been blown out of proportion, prompting an unwarranted degree of hysteria.