Showing posts with label Hero's. Show all posts
Showing posts with label Hero's. Show all posts

Monday, December 14, 2020

ER Doctor Gives Assessment On COVID-19 Situation

The true heroes here are the people who have been suffering economically the last 6 months. Restaurant workers, hairstylists, musicians, hospitality worker and small business owners all deserve [credit] more than I do.

It has been a few months since my last post on the pandemic and my perspective as an ER physician in a small ER in Western Wisconsin, just outside the Twin Cities. I have thought about doing this earlier, but sadly it has been difficult as a physician to speak out about anything lately without being subject to criticism and harassment, especially if you have an opinion that goes against the mainstream narrative. For what it is worth, these are my observations and opinions. As someone who has been dealing with this daily at work for the last 9 months, I think it might be useful to share my observations. You have my permission to share what I am writing if you so desire. If you have other observations and opinions, I would be happy to hear from you.
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As most of you are aware, COVID-19 is a serious illness and the number of cases and deaths have risen sharply since the fall. At my ER and hospital, we have been seeing cases regularly, but most have been relatively mild cases. The main problem for me in my ER is finding beds for other patients with critical illness that are unable to be managed at a small hospital. Normally, we can easily transfer patients to our referral hospital in St. Paul. Now they are often full and cannot accept any more patients. We are forced to look for beds elsewhere in the Twin Cities or even Eau Claire, Duluth or even further. This obviously delays necessary care.
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Certainly, this is partly due to the increase in COVID-19 patients. However, that is not the whole story. Back in the spring, many hospitals and clinics basically shut down for a month or more. As I wrote, in my earlier posts, this prevented many people with chronic medical problems to delay medical care. I pointed out that this would have dire consequences later. Now that people are coming back into the health care system with poorly controlled diabetes, heart disease, kidney problems and hypertension. This makes these illnesses harder to manage, but also makes these patients more susceptible to Covid-19. Furthermore, trauma patients do not stop coming in because of the pandemic. We also must have room for these patients. In addition, room need to be made for semi-elective procedures, such as colonoscopies, surgeries.
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Part of this problem is not just physical space for these patients. It is mostly a staffing issue. When hospitals and clinics shut down in the spring, the financial losses were devastating. Staff, nurses and even physicians were furloughed or had their hours cut. Many were unable to wait and found other employment or changed careers. Now that we are back at full capacity and even over capacity, many facilities have had trouble finding staff to work. This is compounded by the fact that many front-line workers are themselves getting sick and are unable to work for weeks or even months. And this is not just doctors and nurses. We have support staff such as nursing assistants, cleaning people and front desk workers who are vital to us being able to provide care. They have been working harder, too, and when they are gone it makes our jobs more difficult.
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As a physician, I am dismayed that we did not do as much as we needed to prepare for this in the last 6 months. We were constantly being warned of a second wave coming in the fall, just when flu season hits. Why did we not do more to make sure we had room for these patients, PPEs for the staff taking care of these patients and adequate staff available so that people do not get burned out? This could have and should have been avoided.
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Staff at many hospitals taking care of the extremely sick patients are seriously over worked and burning out. At my hospital, we have not been impacted in this way as much, but clearly things have been much more difficult here. We are seeing more patients and our hospital, and our nurses and ancillary staff are working just as hard (or harder) than the physicians. They deserve a great deal of the credit. Still, I personally do not consider what I am doing heroic in any sense of the word. You can’t drive past a convenience store now without sign offering free coffee or some other giveaway for health care workers. This is a nice gesture, but to me an unnecessary one. I am truly fortunate to be able to do a job that I love and be able to help people on what is often the worst and sometimes that last day of their lives. I get paid to do this and have been able to support my family. I have a great work family and could not do my job without each one of them. I chose this line of work and would never want to do anything else. I am one of the lucky ones.
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To me the true heroes here are all the people who have been suffering economically the last 6 months. Restaurant workers, hairstylists, musicians, hospitality worker and small business owners all deserve free coffee more than I do (I don’t like coffee anyway). These are the people who are having trouble getting by and who will not be able have a nice Christmas for their kids. Many small business owners, especially restaurants may not be able to open again, losing their lives work and savings in many occasions. I encourage those of you who are able, to support these people and their businesses. It is a shame that we put these people in this position yet have been unable to give them the help that they need and deserve.
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Now for the controversial stuff. How do we get rid of or get past this epidemic? One way is hope the virus mutates and become less virulent. This is not likely to happen in the near future. The only other way is to have enough of the population become immune to the virus either by getting a good vaccine and giving it to enough people to achieve what is called herd or population immunity. I don’t want to turn this into an epidemiology lecture but going over a few basics I think is important. A virus can only continue spreading if it has enough new people to infect. If it can’t find them, it will die off. The percentage of people in a population that need to be immune varies, and is calculated by determining the amount of others one infected person spreads the virus to. This is sometimes difficult to calculate, but we are getting more data about Covid-19 every week. I have read many of the studies I have seen put this number at between 40 and 80 percent of the population. No matter what the number is, there IS a number that will achieve population immunity.
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What is the best way to do this? One way is to do nothing, let the virus run wild, affect whomever it is going to affect and let immunity develop and the virus goes away quickly. This is a horrible plan as the number of deaths would be staggering. This is basically what happened in the medieval plagues and even the 1918 flu epidemic where mitigation strategies were non- existent. The other end of the spectrum is if you could magically stop the world in a instant, test everyone with an accurate test, and have the results immediately. Those who are positive, go to quarantine or a hospital and stay until they recover. For everyone else, it’s business as usual. This is obviously not possible and a ludicrous idea.
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So what should we do (or have done)? The best analogy is can come up with is to imagine you get a bottle of soda from the refrigerator. Before you can drink it, you drop it on the floor and it is shaken up. You know that if you open it right away and completely, it will spray all over you and your clean floor. This will work and you can drink what’s left of your soda right away, but it will be a huge mess. This is the 1918 flu epidemic plan. Quick, messy but effective. No one would do this. You could get a new bottle of soda, but that ruins my analogy. Alternatively, you can let a little air out of the bottle slowly, tighten the lid quickly and repeat 2 or 3 times. This takes a bit longer, but you will get to drink most if not all of your soda and won’t have to clean the floor.
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How does this relate to Covid-19? This is what I and many others advocated back in the spring. Selective isolation of those more vulnerable, quarantining the sick, good hygiene practices and cutting down of unnecessary travel, but let others go on about their lives. Massive, far reaching shutdowns were counterproductive and caused wide spread economic devastation that caused as much or likely more damage than from Covid-19. Let the air out of the soda bottle slowly, steadily but surely. We just put the bottle back in the refrigerator but kept shaking it and expecting it not to explode when we finally tried to open it up again. Not a good idea either.
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Let’s now hit another hot button issue: the vaccine. Let me state unequivocally that the quick development of this vaccine, if it works and it looks like it will, will go down as one of the greatest scientific achievements in human history, perhaps only eclipsed by the moon landing. (If you actually believe that was faked, please stop reading this now.) At the onset on this pandemic, just about every credible expert said this would take 2 to 3 years if it was able to be done at all. And no, Bill Gates did not insert a microchip in it. Furthermore, of course they was also a huge financial incentive for drug companies to develop the vaccine. Who cares? Name me one other huge technology advance that was not motivated by profit. I’ll wait…. There are none. People complain about the vast wealth accumulated by people like Steve Jobs and Jeff Bezos, yet that have no problem ordering the latest iPhone and having it delivered by Amazon.
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To be sure, it is of some concern that not enough time has passed to ensure the safety of these vaccines. With many medications that we use, it is not until years of use will problems be seen. We don’t have this time to waste. I have looked at the available data from many of these studies and I feel comfortable getting them myself and having my patients and family get them. I encourage you to do the same. I will hopefully be getting my shot next week. And please get a flu shot, too, as seasonal flu is also deadly. We don’t need to be dealing with that in addition to Covid-19.
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Another positive, I can tell you is that since the pandemic started, we have made great strides in treatment of Covid-19. Despite the recent spike in cases, death rates have dropped considerably. We are leaning more and more every week, so length of stay in the hospital and death rates are both dropping. But, you would never know this if you turned on a TV or picked up a newspaper in the last 4 months. The amount of media misinformation that has been disseminated and a great disservice to our country.
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Our local papers have been one of the worst offenders. Every day is a new headline to the effect of XXXX amount of new cases yesterday and XXXX people died. Only if you bother to actually read the article, will you see that most of those people who died were in long term care facilities, had other significant underlying illness and the actual death rate from Covid-19 is steadily dropping. Every TV and cable outlet does the same thing. They also kept saying we need a vaccine. Great, we have one now. You think they would be happy. No, of course not. Every article about the vaccine highlights some of the few adverse reactions or side effects occasionally reported. The 95 to 100 percent effectiveness is only mentioned in paragraph 3 if at all.
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To give you a perfect example of this I will relate an article from the front page of the Pioneer Press in St Paul last week. I linked it in a FB post also. Basically, it asked the legitimate question, “if I have had Covid-19 or get the vaccine do I need to continue to wear a mask?” They state correctly that if you have had the infection or the vaccine you are highly unlikely to get it again or be able to pass it on to others. The mantra of all our governors and the press is always “we follow the science”. Ok then, if these facts are true, and you “follow the science”, then if you have had Covid-19 or got the vaccine there is literally no reason to wear a mask or social distance. You can certainly debate these facts, but they did not do that. There conclusion was “just wear a mask. Its no big deal” But what about, “follow the science”. I guess science doesn’t matter if it doesn’t fit your narrative.
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Another media deception is the amount of people dying from Covid-19. I, and others, have brought up this repeatedly. Very few people died from Covid-19 alone. I am certainly not downplaying the seriousness of this disease and the devastation it has caused. But Covid-19 in the vast majority of people is a unpleasant but often short-lived illness. Every day there is a headline that so and so famous person died of Covid-19. Only if you read the article to paragraph 4 will they mention his Stage 4 lung cancer or the fact that her severe kidney disease. Recently, I read that a governor changed his opinion of Covid-19 after a friend died from out. Ok, so I read the article. Was he hospitalized for weeks? Did he have other underlying problems? Not according to the article. He was a 71 yo male found suddenly dead at home. I can assure you that people do not drop dead suddenly from Covid-19. I’m sure he was diagnosed but was being treated at home and died suddenly of a heart attack or stroke. Did he have Covid-19? Sure. Did he die from Covid-19 alone? I doubt it. I encourage you all to look at media critically and make your own conclusions about what is best for you and your families.
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I will conclude this rant with what I think are my most important messages. If you remember anything that I have discussed remember these last 2 items: We need to open up our business and open up our schools now.
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I have discussed extensively in other posts the huge impact from these unnecessary lockdowns. I see every day in my ER the mental health problems, suicides, drug and alcohol abuse, domestic violence and crime caused by the financial burdens placed on many in our society. Take restaurants for example. Many were allowed to reopen at limited capacity after spending thousands of dollars on plexiglass, sanitation equipment and other safety items. Three weeks ago our governor suddenly closed all restaurants and gyms. Does anyone actually feel more safe in a Walmart , a Target or a jammed packed mall as opposed to a small socially distanced restaurant or a gym. I hope you don’t. This is despite any documentation of any significant outbreaks of Covid-19 from a restaurant or a gym. What happened to “follow the science”? Again, it doesn’t matter if it doesn’t fit your agenda. Furthermore, I live right on the border of Wisconsin where restaurants and gyms are open. Downtown Stillwater MN is a ghost town, but Hudson WI is packed with Minnesotans out to dinner and some gyms in Hudson have stopped accepting new members and guests because of all the people from Minnesota crossing the border.
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And lastly and most importantly, schools need to be reopened immediately. The devastation on our kid’s education and mental health is unquestionable and will have consequences for decades to come. I have 3 high school kids at home and their lack of quality education is undeniable. Kids are losing motivation and are struggling without the interaction with their friends. I recently talked to a therapist who works solely with kids. She told me her practice has never been busier and only a few of her clients are not failing in most of their classes. This is despite that I have seen no evidence anywhere of a significant outbreak traced to a school or daycare center. Kids, especially younger ones are at very low risk of Covid complications and unlikely to pass it on to others. Again, we are told that “we are following the science” until it doesn’t fit the agenda. Teachers should be considered essential workers and should be in class teaching. To keep our kids out of school for over a year, would have permanent consequences that after the last remnants of Covid-19 are stomped out.
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I’m sorry that this was so long, but I have a lot to say and I think it is important that my observations and opinions are heard. I hope you find them useful and insightful. You have my permission to share this post if you so desire. I welcome any feedback and discussion you might have.
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For those of you who couldn’t make it all the way through, here is the Cliff Notes version (or TLDR for those of you savvy in internet slang.)
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1. Covid-19 is serious and real.
2. Cases are increasing.
3. Death rates are dropping.
4. Staffing is a big issue at hospitals.
5. We did not do enough to prepare over the last 6 months.
6. I don’t want free coffee.
7. We need to help those people struggling financially.
8. Protect the vulnerable.
9. We need to achieve population immunity one way or another.
10. The vaccine is a great scientific achievement.
11. I don’t care if someone makes money off the vaccine.
12. The vaccine is safe and not a plot from Bill Gates or the mole people.
13. Get the Covid-19 vaccine and the flu shot.
14. Newspapers and TV news suck.
15. People don’t often die from Covid-19 alone.
16. Lockdowns don’t work.
17. Open small businesses safely.
18. And for the love of God, open schools now!
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I hope you all have a great Christmas and New Year. I know that 2021 will be better; it for sure can’t be any worse than this year…. --David Lang, ER Physician,
Stillwater, Minnesota


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