It’s my hope that this blog finds you restful.
We are familiar with projection models in Florida. We’ve all been glued to the Weather Channel starring at “spaghetti” strands representing hurricane projection models. A lot of science goes into generating those models, including measurements from the eye of the hurricane. Rarely are they right. That’s typical of projection models, whether for COVID-19 or hurricanes.
The best data right now has the mortality of COVID-19 around 1%. This puts it somewhere between the 1957 influenza pandemic 0.6% and the Pandemic of 1918 at 2%. This is about ten-fold the rate for seasonal influenza which accounts for approximately 50,000 US deaths per year; so, it’s tracking to kill 500,000 Americans. Another projection, and we know about projections.
A fundamental problem with COVID is how easily it spreads. The average infected person spreads it to 2.2 others. Mildly symptomatic and even asymptomatic people can spread this virus adding to the challenge of containment.
Fortunately, the vast majority of infected patients overcome
this virus without the need for hospital-based care. There are millions of
Americans who have had this and gotten over it. As antibody testing expands, we
will be able to identify naturally immunized people and let them out of
isolation, returning to the community and economy.
Following guidelines and stay-at-home orders is what you do for your fellow man. “Bending the curve” doesn’t reduce the area under the curve. In other words, it doesn’t reduce the number of deaths that COVID-19 will cause; effective therapy and vaccines reduce mortality. What isolation orders do is protect our community resources from being overwhelmed. When you stay at home, you’re helping Sarasota Memorial and all health care workers.
Because SMH is not overwhelmed I was able to admit a patient for non-COVID-19 reasons Saturday night, using ER resources and available hospital beds. This is the capacity that is under threat and the one we are trying to prevent in the collective.
It’s the same thing homemade masks do. THEY DO NOT PROTECT YOU. But they help reduce viral spread from asymptomatic shedding in our community. That, in turn, modulates the stress on our health-care resources.
Dr. Birx and Admiral Polowczk presented data tracking cases
at the county level. Admiral Polowczk said he was using this information to
move supplies to areas of need. After hearing that vendors were holding up
supplies, Admiral Polowczk said vendors would be delivering to the front door
based on his order. Public hospitals like ours receive top priority, then VA
hospitals, then nursing homes. An agile and prudent use of supplies saves lives
in pandemics and this was great news.
It is also good that vaccines studies are currently in animal safety trials. Scientists were able to sequence the entire genome of this virus and develop vaccine prospects. Factory construction has received Federal approval and funding for mass production the moment a vaccine proves safe and successful. A vaccine stops the spread of the virus and allows broad relief of public health restrictions.
Anti-viral medications are undergoing clinical trials. Anti-viral medications transformed the treatment of HIV and today millions can expect to live full lives despite infection. Several drugs are in effectiveness trials for COVID-19. They may become available within months decreasing mortality among the infected.
At long last, the President of the AMA has answered the President’s question: What you have to lose is your life unnecessarily. I exchanged e-mails with Thomas File MD MACP over the weekend. He is the President of the Infectious Disease Society of America (IDSA). He said he understood how I felt about the lack of leadership and guidance by the IDSA and said I’d be happy to know that the Society would be putting out evidence-based guidelines next week and asked that I follow up with him after they are issued. If they’re evidence-based, they will not endorse the use of hydroxychloroquine and azithromycin.
I just finished exchanging e-mails with Lindsey Baden MD. He’s leading COVID for The New England Journal of Medicine along with Dr. Eric Rubin, the editor. Lindsey was one of my professors. I pointed out my concern that no “Position Statements” had been written against the use of dangerous, unproven medications without informed consent. I drew attention to a nationally well-known hospital’s behavior. This was not a Florida hospital.
This hospital has actually instituted a protocol for
hydroxychloroquine and azithromycin to be used outside of clinical trials. In
what will live as one of the most regrettable statements in the history of the
institution, they report a favorable risk/benefit analysis and worse yet a good
cost:benefit analysis too. They have no evidence of benefit to make an
analysis. Success in the lab leads to clinical promise. Clinical promise
presupposes that benefit is still to be determined. You can’t use clinical
promise in a benefit analysis- by definition. This hospital’s protocol is
indefensible.
Lindsey says he appreciated my points and assured me
‘comments addressing these issues are underway.’ We should see something in the
NEJM shortly.
American organized medicine has been slow and stumbling,
while the rank and file medical personnel are in their “finest hour” and in
greatest need of leadership. Toni Morrison said times of dread are “precisely
the time when artists go to work. There is no time for despair, no place for
self-pity, no need for silence, no room for fear..” That’s good advice for artists,
but it’s also good advice for medical leaders and frankly, all Americans.
The coming week will be hard to experience. An exponential
rise in deaths will begin sweeping across the country. Please know that we need
kindness now, more than ever. Help yourself, help your community, help your
hospital and its workers by staying home and using up your supply of compassion
and empathy. If you go out wear a mask and be kind.
Exercise caution and kindness,
Carlos
