Eric Topol speaks of
betrayal to the medical establishment on the part of the government but I would
say that they betrayal the whole country.
The same phenomenon is happening in Mexico. The bozos directing the frontline of the pandemic
(who are not on the frontline) are lying; the same for the ones directing at
the WHO:
The year 2020 started with American physicians, nurses,
and the whole healthcare workforce dispirited, in a deep state of
burnout, with the worst rates of clinical depression and suicides
that have been recorded. Indeed, this was not confined to the United
States; a global epidemic of
burnout had been diagnosed. But things were about to get
considerably worse for the healthcare workforce.
In December 2019 an epidemic of pneumonia, with many
fatalities, erupted in Wuhan, China. The pathogen was sequenced and determined
to be a novel coronavirus on January 5,
2020, and was subsequently named SARS-CoV-2. The first patient in the United
States with COVID-19, the disease caused by SARS-CoV-2, was diagnosed in
Seattle on January 21, which was within 24 hours of the first patient diagnosed
in South Korea, a key country for comparison.
The First Phase: "Silent" US Spread
Unlike South Korea, which quickly started testing for
COVID-19 using the World Health Organization (WHO) test, the United States
refused the WHO test, opting to develop its own through the Centers for Disease
Control and Prevention (CDC). But the CDC test was ultimately found to be
flawed and represents one of many government stumbles.
Without an adequate test, there were nearly 50 days from the first patients in
both countries before the United States started to ramp up testing. Why
was this so critically important?
During this extended phase in the United States, there
were countless numbers of patients presenting with pneumonia and respiratory
tract symptoms to emergency rooms, urgent care centers, and doctors' offices.
Without the ability to make the diagnosis of COVID-19 or even suspect it, these
patients unwittingly spread their infections to healthcare workers. Also,
during this first phase of spread, there was likely — albeit still not yet
validated — a high rate (approximately 30%) of asymptomatic carriers for
COVID-19, which further amplified the chances for doctors and health
professionals to be infected.
For the sake of comparison, during the month of February,
South Korea performed more than 75,000 tests (versus just 352 in the United
States) and adopted all of the WHO best practices, which includes massive
testing, tracing every contact of a person infected and testing that person,
quarantine of all known cases, and social distancing.
The United States did none of these. Instead, officials
repeatedly made bad choices that put public health in jeopardy, along with the
healthcare workers charged with caring for the public.
South Korea, meanwhile, got ahead of its outbreak and
became a model in the world for how that was achieved. But it wasn't just South
Korea that reacted well. As Atul Gawande summarized, Singapore and Hong Kong also adopted
all of the WHO practices, including providing protection for their healthcare
workers. In both places, healthcare professionals were expected to wear
surgical masks for all patient
interactions. That practice turns out to foreshadow the second phase of failure
in the United States.
The Second Phase: The War Without Ammo
Although Seattle is where the first cluster of cases
occurred, it was the unchecked number of patients diagnosed in New York City in
early March that led to the full realization of how ill-equipped the country is
in terms of personal protective equipment (PPE), intensive care unit beds, and
mechanical ventilators.
The dire, inexplicable lack of masks is well recapitulated
by Farhad Manjoo in "How the World's Richest
Country Ran Out of a 75-Cent Face Mask", and Megan Ranney,
MD, MPH, and colleagues similarly describe the profound
deficits in PPE and ventilators in a perspective published in
the New England Journal of
Medicine.
Together, a situation was set up for healthcare workers to
not have masks — or to reuse them for days on end — and lack other protective
gear. And this is about plain 75 cent masks, not the N95s that are better for
blocking aerosol droplets.
But the required sharing of equipment is not just among
doctors and nurses; it even extends to patients sharing a ventilator in some
intensive care units. To put some numbers on ventilators, we will need several
hundred thousand to a million but have fewer than 160,000 throughout the
country.
It's bad enough that the United States was totally
unprepared for a pandemic and has such an unimaginable shortage of requisite
resources. But the situation still gets worse. On a widespread basis, doctors
and nurses are being gagged and muzzled by
administrators for expressing their concerns, and penalized or
even fired when they do
speak out.
Meanwhile, the unconscionable lack of COVID-19 testing has
continued in this second phase. And with that, systematic testing of the
workforce has yet to start, despite being desperately needed.
The Third Phase: Healthcare Professionals Broadly Infected
and Dying
Back in Wuhan, Li Wenliang, a 33-year-old ophthalmologist, was one, if not
the first, doctor to alert people in China of the outbreak. He died on February
7, 2020. But he certainly wasn't the youngest doctor to die in China. Xia Sisi, a 29-year-old gastroenterologist,
also died after a 35-day hospitalization.
Yet on March 11, from the Oval Office, President Trump stated, "Young and
healthy people can expect to recover fully and quickly."
By late March more than 54 doctors in Italy had already
died, and in the Lombardy region of northern Italy, one of the worst hit
regions in the world, 20% of the healthcare
workforce have become confirmed cases. Now, in the United
States, as large numbers of healthcare professionals are getting diagnosed with
COVID-19 in Boston, New York, and other hotspot cities, young doctors are writing their wills and making
provisional funeral plans.
COVID-19 was not supposed to kill young people, but young
nurses and doctors are dying in the United States. There are many theories as
to why this is happening, perhaps the best one is the viral load — the mass of
COVID-19 inoculum.
Because healthcare workers are exposed to the sickest
patients — often without access to the proper protective equipment — the heavy
viral load may be overwhelming even young clinicians' ability to mount a
sufficient immune response to counter the infection.
That doctors and clinicians are succumbing to the virus is
beyond a tragedy, as many of these dedicated individuals are dying
unnecessarily, as a result of the no-testing and no-PPE fiascos.
Yet a far greater toll in numbers is the temporary loss of
clinicians to infections and sickness. This is the other poorly recognized
exponential growth curve: As each doctor, nurse, respiratory therapist, paramedic,
and patient-care person takes care of tens to hundreds of patients at any given
time, the loss of even one of these individuals has a dramatic
ripple effect on the shortage of professionals trained to care for
affected patients, no less the non-COVID-19 usual patient mix. No number of
accelerated medical school graduations (which are being
announced) can compensate for these losses, not just by numbers but
also by experience.
The handling of the COVID-19 pandemic in the United States
will go down as the worst public health disaster in the history of the country.
The loss of lives will make 9/11 and so many other catastrophes appear much
smaller in their scale of devastation. Perhaps what we in the medical community
will remember most is how our country betrayed us at the moment when our
efforts were needed most.
One of my patients told me
that at the hospital she works eight people died, and they went without being reported
because they were not tested. The
diagnosis was pneumonia. The number of
deaths in my State (Oaxaca) is just one digit because they stopped testing. The bozo that directs the policies regarding
the pandemic says that face masks are not necessary because the WHO said so,
and we do not have a valid research to say that face masks protect us. We can see the professional liars when it
comes to see our present reality.
As would more of I will bluntly call adult behavior. We must put an end
to the idea that the best way to get through this crisis is to say things we
know are not true in the hope of getting people to behave a certain way. This
means not saying masks are useless when what you really mean is, "Masks
are in short supply, please consider before you start hoarding them whether you
really need them at present and if so how many." Ditto the painfully
relentless attempts to give young people the impression that they are horribly
likely to die from the new virus. Even in Italy, the country with the worst
measured fatality rate so far, around 86 percent of all the deceased have been
aged 70 or older, and 50 percent were at least 80. We do not need to zero in on
statistical anomalies or otherwise engage in scaremongering. It should be
enough to say, "Even though you are very unlikely to die from coronavirus,
remember that you could contract the disease and spread it to more vulnerable
people without even experiencing symptoms, so please don't revel with 5000
strangers at the beach and then run home to give Grandma a hug."
We depend on the viral load and our immune system to survive this
virus. We know what we should do as
triathletes, rest, eat well and follow a training plan according to our ability
to tolerate it (time training); our immune system will respond
accordingly. The “but” would be the
viral load. What can we do to decrease
the viral load? Distance yourself and
wear a face mask; the one that is denied by the criminal authorities. If for some reason you got infected, because
you did not wash your hand sufficiently and on time, the viral load must be low
and your chances of dying lower. Wearing
a mask prevent you from infecting others.
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