October 21, 2021

A Physician’s Perspective on COVID-19 – Part 1, by Doctor Dan, M.D.

Was the Threat Real?

I’ve been asked by skeptical friends whether COVID-19 was a hoax/conspiracy, or if this was a real threat. Based on what I saw firsthand practicing in the frontline medical specialty of Anesthesiology and Critical Care, the threat of this disease is very real. People indeed died, and the deaths were often particularly unpleasant.

The health, psychological, and economic impacts of this virus will be felt for years to come, and may impact the 2020 elections (with all of the subsequent consequences this will carry).

However serious the disease may be, it feels that we have now entered the “political” phase of the pandemic where the threats to our vulnerable populations remain at-risk, but it appears that healthy patients have a higher likelihood of surviving an infection. It has the appearance that it is now being used as a justification in many states to keep the economy shut down until after the November election, while many of the same politicians who issue shutdown orders simultaneously condone mass gatherings of protestors/rioters because of the “social good” that comes from them.

Why was COVID-19 Problematic?

While there were many similarities to influenza, there are several reasons that this virus had some concerning traits:

  • For starters, there was fear of the unknown (it was a “novel virus”) that led to heightened concern….even to the point of inducing mass panic…leading our country to near-complete shutdown for two months. Healthcare workers such as myself had no idea what to expect and found ourselves bracing for the unimaginable. The Chinese government stifled the flow of early information about the disease from their country (hence, why President Trump is engaged in a standoff with China at the moment). When other nations who are more forthcoming, such as Italy, began to disclose the massive die-offs that were occurring in some of their cities, people in the medical community woke up and began to take notice.
  • Its ease of transmission from person-to person, including without direct physical contact of people (ie- through the air and on surfaces) made the virus difficult to repress. This is especially pronounced in groups herded indoors (ie- nursing home residents, NYC urban dwellers, etc).
  • The long latency period of approximately 14 days between infection and manifestation of symptoms led to a lot of asymptomatic carriers who were infectious to others during a time they could have no idea that they were carrying the virus. (This is similar to an HIV+ patient unknowingly carrying the disease for a long period of time, at risk of infecting partners long before they notice symptoms of AIDS.)
  • Finally, the pulmonary, cardiac, and coagulation (blood clotting) effects in certain patients were particularly difficult to treat from a medical perspective and contributed to many of the deaths seen, especially until we learned more about how to appropriately treat infected patients. These patients often presented with “unique pathology” meaning it didn’t follow the textbook patterns of other viral diseases
  • This “unique pathology” and viral behavior led many to question whether this virus could have been modified in a laboratory. Whether this was manmade is outside the realm of this discussion, but I will observe that this virus acted in strangely novel ways and presented with multiple pathologic methods to cause harm (cardiac, pulmonary, coagulation disorders, etc.). I certainly would not be shocked if we learn someday that it was generated in a bioweapons lab, and that a more deadly modification of the virus exists, or will be created in the future.
Were We Prepared for a Pandemic?

ABSOLUTELY NOT. Our governmental agencies…federal, state, and local governments as well as health departments…were largely caught off guard by this event. In the private sector, hospitals and businesses were often in the same boat of finding themselves underprepared for this “Black Swan” event. Sadly, with all the contingency planning and strategic exercises that have been done for other mass casualty scenarios over the years, very few exercises had focused on having our nation ready for a pandemic. Many dedicated people in hospitals, businesses, and governmental agencies worked very hard to scramble into more preparedness, but they were facing an uphill battle.

Compounding this lack of planning exercises was a lack of critical supplies when we most needed them. Our nation lacked the strategic stockpile and/or the ability to rapidly produce appropriate amounts of life-saving medications, ventilators, or PPE (personal protective equipment). Using a “Walmart mentality,” our governments and healthcare organizations had outsourced to China and other low bidders to manufacture critical amounts of these items, which came back to haunt us as the virus began to spread and China was consumed with containment on their own soil. This shortage worsened when China cut off many of the trans-Pacific supply chains once they were caught red-handed having covered up the early warnings about the Coronavirus. Without the ability to ramp up domestic production in a rapid fashion, resources were strained to the point of nearly breaking the entire healthcare system.

The World Health Organization (WHO) and Centers for Disease Control (CDC) frequently issued conflicting guidelines that changed nearly daily and often made no sense from a scientific perspective. The guidelines, which at times appeared to be politically, rather than scientifically driven, often abandoned healthcare workers on the front lines unprotected and vulnerable. This has left a very high level of lingering distrust in the credibility of these organizations amongst the people (healthcare professionals) who had previously relied on them for guidance in the fight against many other infectious diseases. This was especially true for the way the CDC frequently changed PPE advisories in an arbitrary and capricious manner which left healthcare workers unnecessarily exposed to pathogens, or faced with termination from their jobs for questioning these guidelines and bringing their own self-purchased PPE to work with them.

What Was the “Flatten the Curve” Concept All About?

From my observation inside the leadership of a community hospital, the premise of the “Flatten the Curve” mantra had its merits. The goal of allowing the healthcare system to have a chance to see more of a “stream” than a “gush” of patients allowed many systems to not exceed their capacity of ventilators and PPE. Obviously, places like New York City saw their capacity overwhelmed, but hospitals in the majority of the nation kept their hospital census manageable. Flattening the curve allowed the healthcare system to not be overwhelmed with too many critically ill patients all at once. Hospitals routinely care for critically ill patients, but there are finite resources that needed to be expanded to handle a massive surge of deathly-ill patients.6

Different states obviously chose to implement this “Flatten the Curve” policy differently, as they have done with reopening as well. Unfortunately, politics seems to be a large factor in the reopening disparities now. Many “red state” governors were more ambitious about reopening efforts; some “blue state” politicians openly campaigned to keep the economy shut down through the November 3, 2020 presidential election while paradoxically endorsing mass gatherings of rioters and looters for the “greater good of social change.”

A Doctor’s Medical Advice:

Even if we don’t see a second spike of COVID-19, we will probably face another pandemic in our lifetimes. It is very possible we may see another large COVID-19 spike in the Fall/Winter of 2020 when flu season normally hits. There are several things I’d recommend to readers in order to be prepared for a second wave of COVID-19, or any other future pandemic:

  • Maintain your health as best as you can. Many healthy patients have become infected, recovered, and have very few lasting effects from COVID-19. In fact, they may actually be helping to create more “herd immunity” to the rest of the at-risk population. The fact is, the healthier you are, the more likely you are to survive COVID-19, the annual flu outbreak, or any other number of diseases. Schedule the next-available appointment with your PCP if you’re overdue for a health maintenance checkup.
  • If you smoke, please stop today. Smokers have a much higher mortality rate with COVID, flu, and other infections due to their already compromised lungs….not to mention the COPD and cancer that cigarettes can cause. Some folks need a little pharmacologic assistance such as nicotine gum or Chantix. There is no shame in asking for some assistance in the battle to quit smoking and I would encourage you to take advantage of these medications your doctor may be able to prescribe you in this fight while you have that resource available.
  • If you need any elective medical procedures, I would advise taking advantage of the window while facilities are opened to elective procedures. Should we see a second shutdown, this would be a most suboptimal time to be dealing with a meniscus tear in your knee crippling your ability to walk, or an infected gallbladder making you very sick. If you delay care until a second shutdown, medical resources may be scarce, elective surgeries postponed indefinitely, and should you become sick enough to warrant hospital admission or emergency surgery, you will be sharing space in a hospital also housing infected patients
  • If you are due for any cancer screenings such as prostate exam, mammography, or colonoscopy, please go get these as soon as possible. Endoscopy centers were shuttered during the first pandemic shutdown, and are still running with many restrictions as these procedures are viewed as “aerosolizing.” Most endoscopy centers are only allowing half the capacity as they did pre-COVID, so appointments are very tough to come by. An early-detected breast or colon cancer can usually be dealt with very safely and simply in many cases, so this checkup might save your life before this screening tool is more limited once again.
  • Dental and optometry offices were subjected to nearly complete closures during the first shutdown (even though some states allowed abortion clinics, marijuana dispensaries, and tattoo parlors to remain open…scratch your head at that one). If you wear eyeglasses and might need an updated prescription, or if you have any dental needs, schedule appointments and address these while the offices are open.

I know some preparedness-minded folks who are considering LASIK eye surgery to eliminate their dependency on glasses and contacts. I’d also encourage those who have cataracts impairing your vision to consider having these dealt with while elective surgeries of this nature are available.

You cannot afford the risk to your health if you suffer from a cavity or dental abscess during a pandemic; get any broken or rotten teeth addressed now.

  • Stock up on any medications you might need for a prolonged period, especially the ones essential to life (ie- heart medication). Coordinate this with your PCP or specialist. Many doctors who had their offices closed during the COVID-19 shutdown will be more sympathetic with your request than they might have been prior to this societal shutdown. In the pre-Coronavirus era, this request for several months of medications ahead may have been viewed as a “paranoid request from a fringe prepper”…now many physicians have seen firsthand the needs their patients who were on their last few days of medication when the COVID-19 crisis erupted and pharmacies were closed or their patients were medically vulnerable and should not be exposed to diseases by going to the pharmacy in the midst of a global pandemic.
  • For those readers who are immunocompromised or medically vulnerable, I recommend extra precautions. Avoiding crowds or known sick contacts is prudent. I recommend N95 masks in public (which protect much more than a paper or cloth mask) and carrying a bottle of hand sanitizer for frequent use. Statistically, other diseases probably pose more risk to an immunocompromised patient than COVID-19 does, so these prevention measures may save your life from other pathogens as well. One hidden blessing of COVID-19 is that now mask wearing is more mainstream than before, so hopefully the vulnerable no longer feel social stigma when they don a mask in public.
  • Let me address folks with significant underlying chronic medical conditions, such as heart failure, COPD, or diabetes. PLEASE do not let a public health scare keep you from good management of your chronic conditions. If these serious conditions become untreated, they could ultimately pose more risk to your health than COVID-19; your risk of dying if you become infected with COVID-19 is also significantly higher when these diseases are unmanaged. If these are not managed well for even a few weeks at a time, you risk severe health consequences. A cardiologist friend of mine recently told me that he has never seen so many patients in severe, life-threatening heart failure as he has this past month. He attributes this to a lack of the normal management of many patients with heart failure that would have otherwise had an easily treated course. When addressed so late in the game, it is almost untreatable compared to what could have been a chronic manageable condition if things were acted on earlier.
  • Telehealth may be one of the best things to come out of the COVID crisis. It had been used previously in limited applications, but this forced quarantine pushed its use at lightning speed. While I am a firsthand believer in the merits of face-to-face physician-patient interaction, there are many times a patient can probably achieve the same benefit using a telehealth platform, especially when this face-to-face relationship has already been established. Its role in managing chronic disease is particularly beneficial. Residents of rural areas will disproportionately benefit from telemedicine advancements as they live the farthest from many subspecialty medical resources and so their health maintenance visits become easier to attend virtually than if they have a multiple-hour round trip to a large medical center [full of infectious patients] in the distant city.

(To be concluded tomorrow, in Part 2.)

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