COVID-19: Missed Opportunities & Misinformation
My experiences in the coronavirus pandemic have two common themes. First, so many opportunities to reduce infections and death have been lost to inaction, mistakes or indecision. And second, poor communication and guidance by our national leadership has led to public loss of confidence and allowed the spread of widespread misinformation by those with different agendas than public health.
Missed Opportunities. We now know the timeline of COVID-19. In the city of Wuhan China, sometime in the latter part of 2019, cases of a virulent viral pneumonia appeared, the significance of which was not at first clearly understood. Because of the clandestine style of Chinese leadership, the local authorities hid the severity of the outbreak until cases had spread well beyond China. Ironically, the authoritarian nature of Chinese leadership allowed that government to suppress the coronavirus more effectively than in democratic countries because of their degree of control over the populace, as well as centralized control of the response. However failure to warn the rest of the world about this virus and continued suppression of how this virus arose in China substantially contributed to the widespread and severe pandemic we have experienced for the past 18 months.
In Western Europe & the United States, both political and medical leadership failed to appreciate the potential for COVID-19 to spread rapidly and overwhelm the medical care system. In Europe, specifically Italy, and also in our country, the public health infrastructure has been slowly dismantled & chronically under funded. Health departments were unable to rapidly initiate widespread testing for infected individuals and trace cases & contacts to limit spread. After the virus had spread throughout our country, widespread quarantines were the only control option, reducing the initial severity of the virus but throwing millions out of work and paralyzing daily life, causing shortages and disruptions for frightened citizens. In my opinion, the trauma of this early policy of mandatory closures and quarantines has contributed to resistance we are seeing recently ("pandemic fatigue") to still necessary policies of indoor social distancing and masks.
Even now, COVID-19 testing is hard to find in our country if you develop symptoms. I tell patients if you wake up with a sore throat, fever and aching, you should think of COVID-19 even if you have been immunized, since there are are breakthrough infections in immunized persons. You should be able to grab a COVID-19 test from your bathroom shelf and find out the results within minutes. Rapid tests can identify over 90% of infectious Covid cases and can guide a person experiencing initial symptoms to seek Regeneron (monoclonal antibodies) treatment to decrease the risk of worsening COVID-19. These so-called antigen tests are widely available in the UK, France, Germany and other countries but are hard to find in the US, more than a year after COVID-19 appeared. The FDA has been slow to approve new tests, although this is slowly improving.
After months of contradictory and changing advice, there is finally general consensus in the medical community on our way out of the pandemic. This includes widespread testing of symptomatic persons as mentioned above, vaccination for eligible populations, and continued protection of those who cannot yet be vaccinated (children) or fail to fully benefit from vaccines (immunosuppressed people) by using masks (see diagram below) and social distancing in certain settings. Regrettably, political realities continue to outweigh public health priorities. Governors in some states are restricting local leaders and defying national health policy as they seek support & financial contributions for future election cycles at the cost of public health.
Spread of COVID-19 infection with and without mask
Misinformation. The Internet has contributed to widespread dissemination of medical knowledge more than any other source. However, as I tell patients, the source of this information is your most reliable indicator of its accuracy. If you get your information from the National Institutes of Health or major medical institutions such as Mayo Clinic and Johns Hopkins, all of which have made major contributions to outreach and education about COVID-19 on their websites, you are likely to have good guidance. If you get your information on COVID-19 from previously unknown organizations with professional appearing websites such as FLCCC Alliance (peppered with "Donate" buttons), you are falling prey to the same scammers who previously told us we owed money to IRS or had won the Nigerian lottery. I am dismayed to report that many of the scammers are medical professionals, such as a California ER physician, and an osteopath in Cape Coral Florida who reportedly has made over $10 million this year alone spreading misinformation about COVID-19 treatments and the effectiveness of vaccines. Our past president took hydroxychloroquine, which medical studies found to be ineffective for COVID-19 and caused several deaths from heart dysrhythmias. To my dismay, this was provided by the White House physicians, which indicates to me the complicity of my profession in misleading the public on the effectiveness of these rumored treatments. In the past few months there has been a run on ivermectin, a medication for parasitic diseases, which has no effectiveness against COVID-19, but has been prescribed by medical practitioners who should know better and act in an ethical fashion. For more information about all the drugs tried and which are effective for treatment of COVID-19 there is a comprehensive database which compiles information from thousands of medical studies.
The most effective method to prevent serious illness & death from COVID-19 is vaccination. Rapid development of safe & effective vaccines is one of the few bright spots in this dismal pandemic. Despite the massive number of vaccinations (in the US over 300 million) with less than 10,000 vaccine adverse effects known, bad actors in the media and on the internet continue to spread vaccine disinformation. False claims of vaccine complications spread on Facebook & Instagram. Russian officials try to undermine Americans' confidence in vaccines. Vaccine opponents coach their adherents on how to fake religious exemptions to bypass immunization requirements. As a result the hospitals and morgues fill with the unvaccinated and the virus spreads & mutates to more communicable and possibly more lethal variants.
Where do we go now? The pandemic seems endless, but there are promising trends. Vaccinations are increasing slowly in our country. The FDA is close to approving vaccines for our vulnerable younger children & grandchildren (much to my personal relief). Developed countries are pledging vaccines for the rest of the world. In June 2021 the US government approved $3.2 billion to develop antiviral therapies for COVID-19 for treatment and to prevent people who have been exposed to the virus from becoming ill or passing on an infection.
Even more important, are there lessons learned? Future global health emergencies like this pandemic seem likely. It is incumbent on us to remember failures and victories. How can disease surveillance and public health programs be improved? Let us remember which political leaders have let us down and served their own interests instead of ours. Hold medical professionals, social media sites, other internet providers and news organizations responsible for misinformation. Learn who & what to trust for the facts. We have to open our minds to different opinions: we tend to selectively believe only information that agrees with our views. We have to do better; the 4.7 million who have died worldwide (so far) deserve nothing less.
