Tag Archives: Infection

The Coming Storm

(Clouds over New York City. Photo courtesy C. Lehr)

The COVID-19 pandemic is not over. If that sounds like news, it is. I am not fooled by the hundreds of people walking around my town without masks, nor by the now neglected practice of physical distancing. I am not fooled by the reassurances from Nursing Home directors and hospital administrators who say the virus is controlled, and I am not listening to government officials from any nation who neglect to keep us informed of a possible increase in numbers of deaths.

This is not to say I am not pleased. I am relieved the pandemic has not caused as many deaths as originally predicted. I am delighted that most of the people I know who are over the age of sixty, or those with past medical histories such as heart disease and diabetes are choosing to wait and see, rather than attend public gatherings and eat in restaurants. 

I am glad that some health care personnel have taken responsibility for their own safety and well-being, rather than trust all decisions to an all too often incompetent, hierarchal leadership with different agendas. But I am sad that according to at least one recent report, more than 600 health care workers in the United States have already died from SARS-CoV-21

The US Centers for Disease Control says that in California, where I reside, about 6% of all hospital beds are occupied by patients with COVID-19. Overall, patients with and without COVID-19 occupy only 64% of ICU beds2. This leaves our hospitals with a small safety margin in case a second wave strikes in the next weeks.

SARS-CoV-2 is transmissible by individuals who are ill, presymptomatic, or totally without signs of disease. Viral load depends on frequency, duration, and type of exposure (droplets, respirable aerosols, and fomites). Recent events and the opening of our economies create opportunities for infection. If many medical scientists and public health officials advocate physical distancing and mask-wearing, it is because their concerns for public safety are free from most of the constraints placed on politicians, economists, and social policy-makers responsible for the public good.

As health care professionals, we have a responsibility to do no harm. However, to advocate physical distancing adversely affects the economy. To advocate social isolation adversely affects mental health and puts a strain on family dynamics. To advocate precautionary measures in the workplace and not follow our own advice outside makes us hypocrites.

References

1. https://khn.org/news/exclusive-investigation-nearly-600-and-counting-us-health-workers-have-died-of-covid-19/
2. https://www.cdc.gov/nhsn/covid19/report-patient-impact.html

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Truth and Responsibility

Photo by The Climate Reality Project on Unsplash

Medical professionals are traditionally identified as purveyors of truth. In fact, truth-telling has become a cornerstone of doctor-patient relationships. In recent years, the patient’s right to autonomy seems to have trumped the doctor’s ethical obligations to beneficence and nonmaleficence1

In a recent Gallup poll2, nurses were considered the most trustworthy and ethical of all professionals for the 18th year in a row (followed by engineers, doctors, and pharmacists). It seems that patients expect the truth, and it is because health care workers such as nurses and doctors usually comply with this demand, that the profession garners the general public’s respect and admiration.

The COVID-19 pandemic, however, has thrust many health care professionals into a role that is different from that taken in the doctor-patient dyad. Many, by the nature of their profession, are called upon to provide “expert” commentary on news outlets and social media. They are asked to educate, inform, and sometimes convince a trusting public with their opinions on widely different issues such as triage policies for patients needing ventilators, best medical treatments, population-based testing for signs of SARS-CoV-2, and potentially coercive public health interventions such as quarantine or social distancing.

The potential dilemma is obvious. Cognizant of having the public’s trust, yet soulfully aware they may not possess the communication skills or critical expertise necessary for a truly informed opinion, “medical experts” on the public stage must negotiate a minefield. Frequently, there is a lack of evidence to justify their positions convincingly. Furthermore, there is a wealth of misinformation, contradiction, and uncertainty circulating in scientific as well as mainstream and social media. Scientific backgrounds are diverse, and not everyone can be everything: a competent patient care provider, a well-published intensivist, a knowledgeable public health official, credible virologist, and judicious medical ethicist. 

Thrust onto the stage of public deliberations, colleagues who, whether by choice or obligation must comment on such diverse issues have a responsibility to tell the truth. Of course, relevant factual information includes evidence-based arguments as well as judgments based on an assessment of likelihoods and societal values. Ideally, there should also be discussions about guidelines and peer-reviewed evidence complemented by remarks about critical thinking and considerations about the ways and means of medical science3.

But many truths are ever-changing. Therein lies the challenge in the pursuit of truth itself. Each time we learn more about COVID-19, we may need to refute or revise what was considered truth in the earlier days of the pandemic. Such is the nature of the scientific endeavor. “Truth is made,” wrote 20th-century philosopher and psychologist, William James, “just as health, wealth, and strength are made, in the course of experience.”4

References

  1. Swaminath G. Indian J Psychiatry. 2008 Apr-Jun; 50(2): 83–84.
  2. https://news.gallup.com/poll/274673/nurses-continue-rate-highest-honesty-ethics.aspx
  3. www.ama-assn.org/delivering-care/ethics/ethical-physician-conduct-media.
  4. William James, Pragmatism’s conception of truth. In Pragmatism: a new name for some old ways of thinking (Longmans, 1907), 197-236.

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Thoughtless, or selfish, that is the question.

(Personal photos Twitter/WhatsApp)

Shakespeare once wrote, “To be, or not to be, that is the question.” Today, we must ask a different question: “Are people thoughtless, or are they simply selfish?”

Despite orders for social distancing and self-isolation to mitigate transmission of COVD-19 in virtually every country, crowds continue to gather in public places, shop in large numbers, and fraternize in neighborhoods throwing Coronavirus block parties. This weekend, the Municipal Fishmarket at The Wharf, in Washington DC, was packed with hundreds of people until the police intervened to shut it down. Even in Dhaka, Bangladesh, millions returned to work until the government issued an official country-wide lockdown, and at a Walmart superstore in Yreka, California, a woman coughed and spat at an employee who asked her to back away at the check-out counter.

How many deaths does it take before people come to their senses? To paraphrase Bob Dylan, “The answer, my friend, is blowing in the wind. The answer is blowing in the wind.”
 
Dr. Deborah Birx, Ambassador-at-large and Coordinator for US Government Activities to Combat HIV/AIDS, is also a vital member of the US Government’s Anti-Coronavirus Taskforce. “The next two weeks are extraordinarily important,” she said on Saturday, April 4. “This is the moment not to be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe…”

“But I have a family of four to feed,” whined one friend.
“I love food too much,” said another. 
Both are justifying their numerous trips to buy groceries this week.

Neither of my friends is thoughtless. In fact, I have often admired their common sense. This leaves me with only one conclusion; but, what do I do with such information. Do I have a moral duty to persuade them to act responsibly because I am a doctor, or might I simply point out that we are a village, and we will win, or go down together. For all of us, regardless of our profession, this is a defining moment in history. Each and every one of us will recall where we were and what we were doing during this global crisis. Irrespective of our individual roles and responsibilities, we are accountable to each other.

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