A Surgeon Speaks Out

A friend who is an orthopedic surgeon writes about the coronavirus:

Most doctors I talk to are embarrassed by the actions of those in charge. It is baffling how we have allowed people with massively wide confidence intervals and minimal criteria to change our entire societal behavior.
New drugs and new treatments need to be added carefully and methodically. If added haphazardly, they will exaggerate and create new unusual concomitant conditions and increase the distraction and further distance ourselves from the goals.

Based on the medical literature, my friend is skeptical of remdesivir as a treatment for COVID-19.

Calling this the Standard of Care [as Dr. Fauci did] is ridiculous. Will it become, that is entirely possible with greater numbers of patients, but actions like this are signs of fatigue in thinking. Fauci is relying on a classic technique of pattern recognition. Fauci sees something that looks familiar [from his experience with HIV] and he wants to be the first to say it. Will he be brilliant? Maybe. But he may also be completely wrong and contribute to the morbidity and mortality of millions around the world. What if this drug at its best causes no side effects and is no better than Placebo at preventing severe illness or death? All the resources poured into it will have not been allocated elsewhere.

In investment, it is called lost capital costs. Most doctors are clueless about that until it becomes abundantly clear that the treatment they have been given was the wrong one and they should have been doing something else. However, doctors fail to learn that lesson as it didn’t cause any loss to them personally (investors are keenly aware as they feel that loss). We have already seen this, in NYC during the early pandemic phase, doctors followed the classic treatment, dropping O2 saturation meant the patient was going to die from cardiorespiratory failure if mechanical ventilation was not started acutely. Well, they have been shown to be very wrong. In less than two months, we now know that doctors contributed to the death of thousands around the world by using pattern recognition incorrectly.

But the most embarrassing thing about this pandemic is the actions of our government and Stay at Home orders, along with a complete disregard for targeted protection. There are dozens of examples of missteps that killed hundreds. (Cuomo forcing Nursing homes to take COVID-19 transfers without adequate warning, staffing, or facilities; the 20 plus that die every day in Minnesota because we are not protecting these same people and locations.) Beyond the economic devastation that has been self-inflicted unnecessarily, the complete misdirection of resources away from those that need it most, to control those that do not, is unforgivable.

People are hammering on the idea that we haven’t tested enough. That is beyond silly. If I test negative today, I could test positive tomorrow. A test is a snapshot in time and unless you do this for months or years you learn very little other than that this virus is contagious (BTW, almost all viruses are). We have the ability to test 5,000 a day in Minnesota. That is not enough to return to routine medical care and get a test for every doctor visit (pie in the sky criteria), but what would that do for us other than say at one time those patients who went to a doctor did or did not have the disease? It is not for management of a pandemic, it distracts from the goal of preventing morbidity and mortality.

We know who is at most risk. People over 70>>>>>>> over 60> over 50. Those people need to be protected. Just a peek from today tells you essentially all you need to know to craft a plan to deal with the crisis more effectively:

Minnesota Department of Health Coronavirus data, 5/4/20

People will say if you lift the quarantine, then all the young will infect the old. But if we lift the Shelter In Place order and replace it with a protect those over 50 at all costs order, we can help so many more people not die. And don’t get me started on those who will have suffered from the medical freeze on preventive care.

I hope one day people will look back and say we started off wrong, but once we saw what we needed to do, we changed. Not, this is the way that seemed right because everyone is afraid and “we do not know enough about this problem to do anything else,” and we fail to learn from our own mistakes. Those that do that sacrifice in Minnesota an average of 20 elderly every day, now. It will only get worse.