COVID-19 Reigns as 2020 ENDS

We began writing in this space eight months ago. At that time, we were appalled by the over 33,000 Americans dead and 650,000 people in the USA infected.  It was clear then and even more apparent now that the social determinants of health have resulted in massive disparate impact that this virus, and our nation’s response, have had on communities of color.  The mere numbers of 2.6 times the African American deaths reinforce that if “Racism is a killer; a pandemic is a mass murderer”. Currently, an unconscionable, over 334,000 Americans have succumbed to this virus. The already expected winter surge will be fueled by the Christmas travel, against CDC advice, and by unwise, yet expected, New Year’s gatherings. Despite CDC recommendations, air travel over Christmas was such that a pandemic record 1.3 million people were screened by TSA at the airports on the Sunday after Christmas. We are being warned that the number of ill, hospitalized, and deceased Americans will increase in January.  There have already been over 19 million Americans infected. Only five states are below the 5% infection rate, 27 states are above 10%, with 6 of those being above 35%. Hospitalizations in the US have reached a record 119,000 with ICU capacities being exceeded in southern California and other areas of our country. Multiple mutations of the SARS-Cov-2 have shown up around the world but so far scientists are confident that the available vaccines will provide immunity against these new variants. 

Two still unresolved issues from early in the pandemic were the inadequacy of the personal protective equipment (PPE) and the lack of accurate rapid-result testing.  There are still not enough masks, face shields, gowns, and gloves necessary to care for the sick and carry out the upcoming massive vaccination campaign. Tests for COVID-19 remains woefully inadequate at 1.9 million per day. We need 6 million tests per day to stop outbreaks, protect the most vulnerable, surveil the asymptomatic, and allow a much-needed return to more normal work, school, and leisure activities. We continue to call for the full implementation of the Defense Production Act, a unique tool of the Presidency, to address the PPE, testing, and vaccine production supply chain. 

Vaccinations are the key to our recovery from this pandemic.  Eleven million doses of the Pfizer and Moderna vaccines have been distributed in the United States but only 2 million vaccinations have been performed to date. Our government’s target is one million vaccinations a day and we are not even at the one million injections per week. Even when we will reach the daily vaccination target, it will still take 9 months before we have 80% of Americans vaccinated thereby reaching herd immunity.  The current rate of daily vaccination is particularly bothersome since we know the next phases of vaccinations will be performed on a population outside of hospitals and congregate care facilities. This general population will be much harder to reach. It is therefore clear that relieving the pain of this virus requires a heretofore absent national approach to this pandemic.  Otherwise, vaccine administration will be disparate, inefficient, chaotic, and cost the unnecessary loss of lives and livelihoods. Fortunately, there are three other vaccine candidates in the developmental pipeline.  These include products by Johnson & Johnson, AstraZeneca, and Novavax. Hopefully at least one of these will become available by late January 2021. 

As healthcare providers we continue to encourage everyone to get vaccinated against COVID-19.  We clearly understand the reluctance of African Americans to get the vaccination based on the historical and ongoing mistrust of the healthcare system. We ask that those who remain skeptical consider that the safety and benefits of the vaccines far outweigh the minimal number and severity of side effects. 

With the new year, we hope that we the people have a new resolve to continue to WEAR, WASH, and WATCH, and WAIT for vaccination.  Getting our kids back to school, people back to work, and small businesses on the way to recovery is dependent upon us being patient.  We all want to see us back to a reasonable semblance of normalcy, travel, and leisure.  If we feign not, we shall reap! Happy New Year!

Help Save US, Take A COVID-19 Vaccine

Since we last wrote in this space, a mere 9 days ago, another 26,000 Americans have lost their lives due to the SARS-CoV-2 virus. This national tragedy caused by this COVID-19 pandemic is obviously a still accelerating catastrophe that unfortunately is likely to worsen over the next six weeks.  The hospitalizations and new case daily numbers in the USA hit record numbers of 113,000 and over 232,000 respectively, yesterday, contributing to the total death number of over 313,000. The depth of our health despair is compounded by the 8 million Americans who have fallen into poverty since June, giving the US an 11% poverty rate, and the continuing rise in the new weekly jobless claim to 885,000 this week.  

Based on the above, we therefore need to do everything we can to stem the tide of this devastation. Our organization, the Cincinnati Medical Association, is recommending that each eligible American take a COVID-19 vaccine when their time comes.  The Pfizer vaccine was approved for Emergency Use Authorization (EUA) last week and vaccinations started this week.  The Moderna vaccine was approved for EUA today, with distribution to begin early next week. Both vaccines have been shown to be 95% effective at preventing disease and hopefully will be proven to help prevent the spread of this dreaded virus. Both have been proven to be safe with very few serious side effects. These vaccines represent the beginning of the end of this pandemic, BUT we are not there yet!  Our eliminating this scourge from our country, and the world, depends on all citizens being willing to become vaccinated. Unfortunately, there is vaccine hesitancy or resistance with a variety of explanations. These are political, cultural, and historical and are present across many ethnicities. 

As African American physicians we are particularly sensitive to the apprehensions held by many in our communities. We have always believed that providing information will allow people to be armed to make their own decision.  Some say, “that these vaccines were developed too fast”. It is true that it has typically taken years to develop a vaccine whereas these two COVID-19 vaccines have gotten EUA in only 11 months. It needs to be understood that their new underlying technology has been studied for about two decades.  An African American female scientist named Dr. Kizzmekia Corbett, who works at the National Institute of Health, has made the development of this technology her life work since 2014. Further shortening the time to development is that the production of actual vials of these vaccines began before the phase II and III trials were completed. The drug companies were relieved of the financial risks of any possible failure by American taxpayers footing the bill for the production, and some development. 

Another concern is that one might develop the disease from the vaccine. Because no part of the virus is injected into the body, a person cannot develop COVID-19 from the vaccination. Because they were sure of the safety of the vaccines, three of our member physicians were participants in one of the trials. The substantial numbers of people of color in both trials proved that the safety profile extends across ethnic backgrounds. Furthermore, millions of individuals outside of the trials have now gotten the Pfizer vaccine.  The most frequent, yet still only occasional, vaccination side effects have been arm soreness, slight fever, fatigue, or headaches, all which typically resolved by 36 hours after injection.  The rare, statistically 1 in a million, allergic reactions have been recognized and easily treated. 

 Last, but certainly not least, many African Americans have a profound mistrust for America’s healthcare system based on the well documented, inappropriate at best, experimentation such as the Tuskegee Experiment and the Ms. Henrietta Lack cancer research.  Additionally, there are ongoing healthcare disparities, cultural incompetency’s, implicit biases, lack of access, etc. which understandably elevate suspicion.  We recognize that we cannot change the history of our country but understand that overcoming this pandemic will only come about when 75% of Americans have been vaccinated.  In that the lives, health, and livelihoods of people of color are disproportionately affected by this virus, it is our fervent call that all Americans, particularly those in our communities, get vaccinated. WEAR your mask, WASH hands, and WATCH your distance, while you WAIT your vaccine turn!

Vaccination... The Light at the End of the COVID-19 Tunnel

The SARS-CoV-2 virus continues to rage across our country as we suffer through this third wave of COVID-19.  The USA has 15.3 million diagnosed cases of COVID-19 with one million cases occurring in the last FIVE days. By comparison, it took 99 days to reach the first one million cases in the US.  Hospitalizations reached a record 105,000 yesterday. Over 287,000 families will not be blessed with the presence of their deceased loved one during this Holiday season. We hit a tragic record of over 2,600 deaths yesterday. This is the human toll on those sick and dying but we must be reminded that there is a severe physical and emotional toll on our healthcare providers. Field hospitals are reopening, and ICUs are filling up around the country. Lastly, we cannot ignore the livelihood and societal consequences of this plague. Congress is stalemated even as the governmental supports to individuals and small businesses are on the verge of expiration. Unemployment and job losses are no longer on a steady course of improvement. Our pastimes and traditional means of entertainment are still limited. These problems will worsen as more focused shutdowns are being implemented. 

Our best reasonable hope of ending this pandemic is by extensive vaccination.  The world’s scientific and epidemiologic community has worked tirelessly to rapidly develop a variety of vaccines which are geared at fighting this virus.  One of those vaccines, which was developed by Pfizer and a German company BioNTech, was injected into arms in the United Kingdom (UK) starting yesterday.  This vaccine has been evaluated by our FDA and a decision regarding Emergency Use Authorization for the United States is scheduled for December 10. The data released by the FDA thus far shows a 95% effectiveness with few serious side effects. It has been noted that a frequent number of people in the study developed minor side effects which lasted usually around 24 hours. The early experience in the UK has reinforced the need for people with a history of severe allergic reactions should avoid getting this, just like other vaccines. 

People of color are impacted disproportionately by COVID-19. African Americans are up to 3 times more likely to die and 4.7 times as likely to be hospitalized.    A greater proportion of Black businesses are shuttered, non-essential jobs lost, and the education of Black children is more severely affected by being out of the classroom. It stands to reason that those who have been disproportionately affected by COVID-19 should be able and willing to have access to vaccines. Unfortunately, African Americans have a historical understandable distrust of the healthcare system. There is also a profound mistrust of this government that has overseen this rapid development of the vaccines.  A Pew Research poll from October 2020 revealed that only 32% of African American adults would take a COVID-19 vaccine. Convincing the skeptical will require transparency, the silence of any politician not promoting the public health good, and a monumental public relations campaign led by trusted community members. It will take extraordinary effort to overcome mistrust and convince the vulnerable of the benefits of vaccination. 

Yes, Americans see the light at the end of the COVID-19 tunnel. We must be willing to do our part to survive the journey through the tunnel. As healthcare providers we must see and study the data so that we may confidently and convincingly provide the information and encouragement for patients to become vaccinated. As citizenry, we must listen to the information being provided by trusted sources and hopefully put aside historical and contemporary fears so that we may take advantage of the medical technology to end this scourge.  We all need to be reminded that light travels a long way and the beacon that we see is “farther than it appears”. It will optimistically be late Spring 2021, before widespread vaccination is achieved. Even this will not signal a sudden return to our old normal. In the meantime, we must keep ourselves ALIVE while we journey toward vaccination and normalcy.  Staying healthy, alive, working, and kids being educated still requires that we WEAR our mask, WASH our hands, WATCH our distance, and avoid large crowds.

COVID-19 Changes Holiday Family Times

December brings not only the traditional American holiday season but in 2020 it is heralding the worsening of the much expected COVID-19 Fall surge.  Clearly, the warnings of this surge being worse than the devastation of the Spring and Summer of this year were accurate. Infections are exploding as evidenced by the over 205,000 new infections diagnosed yesterday. Hospitalizations in the US reached a pandemic high record of 101,000 yesterday. The lives of over 277,000 Americans have ended due to this virus, including over 2,700 snuffed out yesterday. This number represents the deadliest day since the pandemic began. We have lost more Americans in the last two days than the total number of our soldiers killed during our two-decade conflict in Afghanistan. An infection rate of less than 5% is present in only seven states. The White House taskforce is predicting another surge on top of this current increase due to this past Thanksgiving travel. We are likely to see another dramatic rise in cases, hospitalizations, and deaths 2-3 weeks after the recent Thanksgiving weekend. These health impacts are in addition to the severe economic devastation associated with this viral pandemic. 

There is some good news! Two vaccine manufacturers have requested Emergency Use Authorization (EUA) from the FDA.  Pfizer says that its vaccine is slightly over 95% effective and Moderna is reporting 94.5% vaccine effectiveness. If the EUA’s are granted these two vaccines will be available to health care providers and nursing home residents during the latter part of December 2020. It is projected that vaccines will be available for the public, depending upon people’s severity of risk, beginning in January 2021. It is further expected that every citizen will have the ability to be vaccinated by the end of June 2021. Because we are in “the most difficult time in the public health history of this country”, according to the Head of the CDC, we must still mask to save tens of thousands of lives.  

African Americans continue to be disproportionately impacted by this dreadful disease. People of African descent, compared to Caucasians, are 2.6 times as likely to contract the disease, 4.7 times as likely to be hospitalized, and 2.1 times as likely to die from Covid-19 infection.  If the death rate from COVID-19 was the same for African Americans as for Caucasians 25,000 more Black Americans would be alive today.  A greater proportion of Black businesses are shuttered, non-essential jobs lost, and the education of Black children is more severely affected by being out of the classroom. It stands to reason that those who have been disproportionately affected by COVID-19 will be assured the appropriate benefit of vaccines. Unfortunately, the historical understandable distrust of the healthcare system is superimposed on the politicization of this rapidly developed vaccine. A Pew Research poll from October 2020 revealed that only 32% of African American adults would take a COVID-19 vaccine. Convincing the skeptical will require data transparency, the silence of any politician not promoting the public health good, a monumental public relations campaign, and buy in from trusted community members. It takes extraordinary effort to overcome mistrust. 

No matter your ethnicity or religious identification, family and friend gatherings are the hallmarks of this American holiday season. The CDC advice for us not to travel over Thanksgiving was not adequately heeded. The USA is about to see the ramifications of these individual decisions.  We healthcare providers hope and encourage all Americans to heed the CDC recommendation over the remainder of this season (CDC.gov/covid19).  Do not travel, but still celebrate this Holiday season with those who live in your household.  The CDC also recommends that we wear masks when outside of our homes, or even at home if someone visits who does not usually live there. New data shows that if 95% of Americans wear masks, 66,000 American lives will be spared by April 1, 2021. 

Because of the emotional stress caused by COVID-19, Americans assuredly anticipated this Holiday season as a respite from isolation and despair. Yet, we must dig deep as Americans and wait a little longer. Get your flu vaccine, MASK up, WASH your hands, WATCH your distance, avoid crowds, and WAIT to get vaccinated.

MASK and TEST to Limit COVID-19

The long-predicted Fall surge of COVID-19 is unfortunately living up to the dire warnings of infectious diseases experts. The total number of cases in the USA is up to 13.2 million, more than one million per week for the last four weeks! The total number of COVID-19 deaths recorded in our country is 266,074.  Less we become numb to these numbers, we must recognize that this increase represents pain and upheaval in over 14,000 families in the last 10 days. Daily records continue to be broken as we saw 206,000 new cases yesterday and 91,635 Americans hospitalized because of this SARS-CoV-2 in the last 24 hours. Twenty-six states reported record numbers of hospitalizations this past week, ICUs are filling up, field hospitals are reopening, and worse is our brave healthcare providers are becoming overwhelmed. Fortunately, many Americans heeded CDC advice to stay home for Thanksgiving. Air travel was down 60% compared to last year, yet automobile travel was down an estimated 4%. For those who decided to travel, it is recommended that travelers and those exposed quarantine for at least 7 days then get a negative test before safely resuming COVID-19 safe activities.  For Americans over the age of 65 and any individual with a co-morbidity who becomes symptomatic, be tested ASAP so that the therapeutics that have been developed can be implemented early enough to be effective. If the US sees rising cases, hospitalizations, and death numbers in the next 10-14 days then the prediction of Thanksgiving travel and Black Friday shopping being super-spreader events will be confirmed. 

On the news front, the FDA granted Emergency Use Authorization (EUA) for a treatment called monoclonal antibodies.  EUA is a process by which the FDA, which in the context of healthcare is responsible for giving government approval for treatments, testing, medications, and devices. The EUA is granted when the FDA deems, based on scientific documentation, that a presented item is likely to have benefits that outweigh the risks.  In the case of these two monoclonal antibodies the EUA is granted for them to be administered intravenously and simultaneously. They are to be used in patients who have tested positive for the virus, have mild to moderate disease, not yet requiring oxygen treatment, and are at high risk of progressing to severe COVID-19. The long-term effects of these treatments are still being evaluated, thus the EUA as opposed to outright approval for their utilization. 

On the vaccine front, the CDC is meeting this week to decide on protocols for determining the priorities for vaccine administration.  The US citizenry will require over 600 million COVID-19 vaccinations, so a fair and objective sequence of vaccination needs to be established. Pfizer has requested an EUA for its vaccine. A meeting for consideration of this request is scheduled for December 10.  A vaccine developed by Moderna, which also has a nearly 95% effectiveness, will be considered for EUA soon as well. Lastly, the vaccine by AstraZeneca, which is less expensive and easier to distribute around the world, is closer to viability. 

In this space back in May 2020, we emphasized the importance of testing to save lives and keep our economy open.  A new study from Harvard and U. Colorado details why the accuracy of a COVID-19 test is not as important as there being frequent, nearly immediate results available. One scenario detailed involved the testing of three out of four people every three days. This could be achieved by widespread testing in public places as well as home testing availability. This scenario achieved an 88% reduction in the number of people infected and enough disease detection, and resultant isolation, to “drive the epidemic toward extinction within six weeks”. The incoming Administration has widely advertised the use of the DPA to solve the testing inadequacies. 

It is estimated that 100,000 lives can be saved by March 2021 if we would just MASK up!  This measure represents individual responsibility for individual and public good. We need to recognize that even after vaccines become available, masking, hand washing, and social distancing will still be required because widespread vaccination will not have been completed until the latter part of 2021.

COVID-19 Changes Thanksgiving Family Times

November brings not only the beginning of the traditional American holiday season but in 2020 it is heralding the emergence of the much expected COVID-19 Fall surge.  We have been warned that this surge would be worse than the devastation that occurred during the Spring and Summer of this year. Hospitalizations in the US reached a record 79,000 Americans yesterday. The lives of over 251,000 souls have ended due to this virus, including over 1800 yesterday. Infections are exploding. We have seen over 100,000 new cases diagnosed daily for the last 16 days and over 180,000 daily cases for each of the last 7 days. Over one million of our children have been diagnosed as positive. An infection rate of less than 5% is present in only six states.  Community spread is astronomical in multiple states, specifically 91%- WY, 56%-SD and ID, 51%-IA, 44%-KS. Our infection rate in Ohio is 12.7%. Recall that a rate of 5% is felt to represent a level of community spread which would still allow most activities to still be conducted. 

On the news front, two huge items need to be discussed.  First, we know that the SARS-CoV-2 virus is spread by the droplets and aerosols that people produce when we cough, sneeze, breathe, talk, cough, or sing etc. It has been long known that masks protect the people from the wearer of the mask by controlling the source of the virus.  The CDC is now coming forth with analyses of multiple studies and epidemiologic data that demonstrates that masks also help the wearer of the mask from those around her or him.  This protection comes about because of the filtration effect of the mask that is being worn. The effectiveness of the filtration depends not only upon the number of layers (two-ply is better than one, and three-ply is superior to two), but also the type of the fabric. The CDC recommends the use of non-valved multi-layer cloth masks. Essentially masks provide “source control” from the wearer and filtration to the wearer. Research is ongoing regarding fabrics that deactivate exhaled viruses (Northwestern University).  The bottom line is MASK up because it protects you from others, and others from you!

Some particularly important, much awaited, news has come forth regarding vaccines. Two vaccine manufacturers have provided preliminary information regarding their vaccines.  Pfizer says that its vaccine is slightly over 95% effective and Moderna has revealed that its vaccine is 94.5% effective. Both will be requesting Emergency Use Authorization (EUA) from the FDA before the middle of December.  It is hoped that the initial doses will be available to health care providers during the latter part of December 2020. Unfortunately, it is likely that the widespread availability for the general public will not be until the Spring of 2021. Dr. Brett Giroir from the current White House Coronavirus Taskforce states that we will lose “tens of thousands of lives unnecessarily unless we use MASKS”!

We still have life to live and we must do our parts to keep safe during the approaching holiday season. The CDC (CDC.gov thanksgiving) has provided excellent, all-encompassing guidance for the holidays. We must modify our plans for gathering with family and friends. It is recommended that we celebrate virtually instead of gathering households which do not live in the same residence. A strict 14-day quarantine for convening household lowers the risks. If we decide to gather in person then MASKS should be worn by everyone older than the age of 2 except when eating and drinking.  Maintain 6 feet of distance between guests, always. Outdoor gathering, though preferable, may not be practical. If celebrating indoors then crack windows/doors to maximize ventilation. Different households should use different serving utensils and should be seated in separate groups. It is best to avoid singing. Many more specifics are available on the CDC web site.

Because of the emotional stress caused by COVID-19, Americans assuredly anticipated this Holiday season as a respite from isolation and despair. Yet, we must dig deep as Americans and wait a little longer. Get our flu vaccine, MASK up, WASH our hands, WATCH our distance, avoid crowds, and WAIT to get vaccinated.

COVID-19 Took No Presidential Election Break

COVID-19 continues to infect, affect, and kill many Americans. It has been recently fueled by political rallies conducted by the current President according to researchers at Stanford University. These researchers estimate that the eighteen rallies evaluated resulted in an increase of COVID-19 cases by 30,000. Johns Hopkins University reported that on the day after election day we reached another peak in case numbers of over 102,000 and there were 1047 deaths. Unfortunately, the daily case count rose to 126,000 four days later. Hospitalizations continue to rise in the majority of states. This disease has infected over 9.8 million Americans. Now that the election is behind us, we will obviously have fewer public gatherings for political purposes and people will not be waiting in lines to vote. Hopefully, during this presidential transition, the incumbent President will govern and encourage all people consistent with the best public health practices.  Political ramifications and past “policy” stances should be put aside for the sake of the public welfare. The Defense Production Act (DPA) can be used to improve testing, PPE availability, and vaccine distribution.

In the news is a CDC report regarding COVID-19 and pregnancy. The study evaluated 400,000 COVID-19 symptomatic women, aged 15-44. The data showed that pregnant women in the group were more likely to require ICU admission, ventilator use, special lung oxygenation techniques (ECMO), or to die when compared to non-pregnant women. Counseling about the increased COVID-19 severity risks during pregnancy is necessary. Clearly, it is imperative that we all be diligent to lessen the possible exposure of future mothers. WEAR your masks!

The federal government has not only failed to consistently encourage mask wearing and social distancing but has also failed to adequately implement the DPA.  Contact tracing and isolation policies, which are time-tested measures proven to be effective in fighting pandemics, have been inconsistently applied. We the people, must therefore be steadfast and protect our own health. Ohio weather is getting colder and people are forced indoors. We are tired of not seeing our friends and not hugging our relatives. Yet we will not be keeping our family and friends safe if we gather with them indoors for the holidays.  Dr. Fauci (Head of NIHAID) said in a recent interview, "These innocent family and friends gatherings: six, eight, 10 people come together in someone's home, you get one person who's asymptomatic and infected, and then all of a sudden four or five people in that gathering are infected."

Secondly, if you are in close contact with someone who is diagnosed as COVID positive, then you should self-quarantine for 14 days. The countries which have lower case and death rates than the USA have taken this quarantining requirement more seriously. Also recognize that when someone you live with becomes positive; you have a 53% chance of becoming infected as well.  Next recognize that if you are exposed, you need to wait 5-7 days before getting tested. You are not likely to test positive before 5-7 days. Also be aware that you may be faced with deciding whether you should participate in a specific activity.  Everything that is allowed is not necessarily wise nor safe. Note that things are just going to be different for a while.  Recognize that everyone is not as careful as you. Lastly, if the infection rate is high in your area you are in more danger of being exposed.  

Let us physicians repeat, Americans are not powerless! We must properly WEAR a mask (covering your nose and mouth) when out of our houses and around people with whom we do not live. Note that a multiple ply paper mask is preferrable, although a cloth mask is better than no mask.  WASH your hands twenty seconds or use hand sanitizer after touching surfaces.  WATCH your distance by maintaining at least 6 feet between you and those with whom you do not live. Develop a safe gathering plan, which may to be virtual, for the holidays. Avoid large public crowds, meaning no more than ten people.  Get your flu shot and keep your hands away from your face and mouth.

One American is Dying every 107 seconds from COVID-19

It has been ten days since we last updated this space. The SARS-Cov2 virus is running rampant in the USA. The measures taken and those neglected have not depressed the number of daily cases to a plateau low enough to avoid fueling widespread disease increase. There were over 98,000 cases of Covid-19 recorded today, a number which represents the highest daily number since the pandemic began. We have experienced 5 out of the 6 worse pandemic days in the last week! Ten states, including Ohio, are in the mist of record hospitalizations. Forty-three of Ohio’s 88 counties are classified as being in the “red zone”. This means that there is “very high exposure and spread”.  ICU capacities are being reached in multiple locales including El Paso, TX and the states of Utah and Wisconsin. Indoor dining has been banned again in Chicago due to the dramatic increase in cases. We have lost 1,000 Americans for the last two consecutive days. There have been over 229,000 deaths and 9 million Americans infected since the beginning of the pandemic.  We are not “rounding the curve” as declared by the President, according to Dr. Anthony Fauci (Head of the National Institute of Health Allergy and Infectious Diseases). Doctor Fauci declared today that “we’re in for a whole lot of hurt…You could not possibly be positioned more poorly”. Unfortunately, multiple European countries are experiencing surges so severe that economic lockdowns are being imposed.  The history of COVID-19, albeit brief, tells us that the USA trends behind Europe by a month or so. This history does not bode well for November and the holiday season. As the result of the extensively predicted increase in spread, families need to give a lot of forethought to our traditional holiday gatherings.  Remember that 40-50% of infected people are without symptoms and we must consider avoiding gatherings where susceptible older relatives and those with preexisting conditions are potentially exposed to this coronavirus. It is better to plan holiday gatherings for next year than to plan hospital visits and possible funerals after this year’s holidays.

Other items in the news include that the antiviral drug, Remdesivir, has now been approved for the treatment of hospitalized patients. The drug company Regeneron has requested emergency FDA approval for its antibody cocktail which was reportedly given to the President when it was still considered as experimental. Although our expert physicians are learning more effective means of treating this disease and the death rate is declining, there remains no cure. There are long term consequences of Covid-19 involving inflammation in the blood vessels, heart, lungs, and other organs. One study recently published in the Journal of Neurology found that 82% of patients hospitalized for COVD-19 suffered from a neurologic problem at some point in their disease.    

Our hope for real relief from the scourge of COVID-19 rests in the availability of safe and effective vaccines. The two phase III vaccine trials which had been paused were both restarted on October 23.   These pauses collectively account for one of the reasons why the quest for viable vaccines authorization are going to be delayed. Two others are the trials’ difficulty with recruiting ethnically diverse volunteers and a lack of COVID-19 illness in trial participants.  Therefore, our expectations about when the vaccines will be available for wide distribution need to be reset.  Many experts from the pharmaceutical industry, infectious diseases specialty, and the FDA are cautiously optimistic about initial availability in the first part of 2021. 

People, we are not powerless, but we must do the right things to protect our health.  Get your flu shot. Mask wearing (cover your mouth and nose) is essential when you are around others not living in your household.  WASH your hands (20 seconds) or use hand sanitizer after touching any surfaces outside of your home.  Watch your distance and stay at least 6 ft from others and avoid large crowds.  We believe that the USA needs a national plan which leads by exampling mask wearing and social distancing, assures adequate accurate rapid-result testing, and depends on science for guidance.   This will reduce death and despair from COVID-19 while we await vaccines.

COVID-19 Is Not Tired of YOU!

Many people are tired of wearing masks, washing hands, and social distancing.  This phenomenon even has a name, “pandemic fatigue”.  Unfortunately, this deadly virus is not weary of plaguing us.  Granted we cannot eliminate the virus, but we have not even done our part to knock this virus down. So, the USA has seen at least 221,000 deaths and 8.3 million infections. We are now averaging 56,000 new COVID-19 cases per day over the last week. Hospitalizations are at record highs in sixteen states.  A field hospital has been opened in Wisconsin to handle the overflow of patients requiring Covid-19 patient overflow. The infection rate (positive infection of those tested) exceeds 5% in 29 states, 10% in sixteen of those and 20% in eight of those states. Experts surmise that the reopening of schools and colleges has also contributed to this surge, although the predominant factor is our failure to follow proper public health measures. A huge problem is that the cooler weather, which drives us indoors, and the peak of the flu season are not here yet.  These two conditions will fuel the upcoming devastation which is projected to result in the worse 6-12 weeks of this pandemic. Additionally, in the news is that two of the four vaccine trials and one of the antibody trials are on hold.  It is not unusual for vaccine trials to be placed on hold, so this may not mean a significant delay in availability. There are also emerging reports of several people becoming reinfected with a different strain of the virus. 

With these terrifying numbers and projections as a backdrop, this presidential administration is driving not only the pandemic fatigue message but also promoting an extremely dangerous and deadly concept referred to by many as “herd immunity”.  The President outwardly states that he and people are “tired of Covid-19”. Thus, he holds mostly maskless political rallies and events around the country including the known “superspreader event” (where he possibly became infected) at the White House several weeks ago. These large gatherings are not only in violation of local regulations but are clearly averse to the tried and true public health measures of mask wearing and social distancing. Proper public health policy dictates a dogged adherence to proven pandemic fighting methods and not surrendering to a path of less resistance. Doctor Scott Atlas is a neuro-radiologist and relatively newly added member to the president’s Covid-19 Task Force.  He is the advocate of policies akin to herd immunity and he minimizes the usefulness of mask wearing and surveillance testing. He is at odds with most experts who have had much more extensive experience with infectious diseases combat that he. By way of explanation, herd immunity is concept by which a large enough percentage of individuals in a population (herd) have developed resistance to a disease (immunity) so that spread is not possible to those who have no resistance.  This herd immunity is best achieved by vaccination and not by being exposed to the actual disease, since the latter means the individual could likely be ill.  Even in the case of COVID-19, having the infection could mean short- and long-term consequences and even death. Practically speaking, allowing the disease to “just rip” would mean that millions of Americans would die before we reached the 70% exposure necessary to reach herd immunity. Safe and effective vaccinations is a much better approach.

We must “not be weary” with WEAR, WASH, and WATCH! These are the sacrifices that we must continue to make if we are going to fight this virus while we await a safe and effective vaccine. Please get your seasonal influenza vaccine.  It is also time to begin to think about holiday gatherings.  Family gatherings are notorious for driving the spread of this virus particularly when they are indoors. It is hard to say but we need to make the choice between Thanksgiving celebrations in November and having our healthy relatives around next year.  Remember you may be asymptomatic so do not take this virus home to your parents and grandparents.

VOTE! The person who is President has a huge influence on your health and very existence.

YES, a president can contract COVID-19

Among the now nearly 7.9 million Americans infected with Covid-19 we can include the President and First Lady of the United States. More on this later.

Unfortunately, the ravages of COVID-19 are increasing in our country. Forty-one states are experiencing rising case numbers with nine states recording all-time high numbers of daily cases.  There were 56,191 new cases yesterday. Dr. Anthony Fauci stated yesterday that the daily case counts need to be under 10,000 for him to feel comfortable about limiting spread. The infection rate is over 5% in thirty states, with 11 of those being over 10%, and Idaho and South Dakota being over 20%. We have lost 213,360 of our fellow citizens to this virus. 

On the news front, science has won two battles over political White House influence, at least for now. This is evidenced by the CDC finally posting that this virus is indeed spread airborne by aerosol and the FDA has passed rules preventing COVID-19 vaccine release before adequate testing. Several universities, sports organizations, and some airlines have demonstrated that adequate, rapid results, accurate testing facilitates safer operations. We can only imagine where life in America would be if the President had, or would, use his unique authority to fully implement the Defense Production Act to doggedly address testing and PPE shortages. Of course, testing alone will not keep us safe. Yet it is the gateway to contact tracing and isolation of those who are contagious.  We must still WEAR, WASH, and WATCH. Secondly, in the news front is a Northwestern University study that reveals 8 of 10 hospitalized COVID-19 infected patients suffer from neurological complications. Approximately 10% of the patients had symptoms so severe that they were unable to care for their own affairs. Thirdly, in a study published on October 8 in the New England Journal of Medicine, the antiviral drug Remdesivir was shown to shorten the time to clinical improvement in hospitalized patients with Covid pneumonia from 15 days down to 10 days. Unfortunately, its use did not change the number of people requiring ventilators nor the risk of death in the study patients. Lastly, the news is that two companies have requested Emergency Use Authorization from the FDA requesting that their monoclonal antibodies be made available in appropriate circumstances. These disease fighting antibodies are still being studied but are showing promise in small numbers of people with COVID-19.  Ironically, their development has utilized fetal tissue research which the Trump administration severely limited in 2019. 

The shortcomings of testing alone are apparent considering that a “superspreader event” apparently occurred at the White House. This presidential administration is known for touting its testing program allows them to disregard mask wearing and social distancing during its daily work and gatherings.  It is now also known for 22 infections amongst staff and personnel. It is reported that the much relied upon Abbott rapid test has produced up to 30% false negative results (meaning the test is negative although the person actually has COVID-19).  Secondly, any diagnostic test cannot be blamed IF it is not actually being conducted! The White House has declined to reveal when the President took his last negative test before the positive test was announced on Friday October 2nd. From a public health standpoint this really matters since the science states that a person is most contagious up to 2-3 days before testing positive. Those people who attended events or who were in close contact with the President deserve to be notified and contact tracing implemented to prevent further spread.

 Since the doctors who know are not telling the public the severity and duration of Mr. Trump’s infection, we as physicians, cannot scientifically comment on the usage of experimental monoclonal antibodies. They were heretofore only used in a handful of COVID-19 patients outside of clinical trials. We know that Remdesivir and the steroid Dexamethasone, which he reportedly received, are approved to be used in moderate and/or severe COVID-19 disease. We also know that, except for the steroids, those treatment which he received are not available to every citizen, even if necessary. This demonstrates another profound inequity in our healthcare system.

VOTE! The person who is President has a huge influence on your health and very existence.

No DEBATE…..Covid-19 is still with us!

Our country is amid the 2020 presidential campaign which magnifies profound candidate differences regarding the ongoing health, economic, and educational impact of Covid-19.  Nevertheless, the data shows that this plague continues to impact every aspect of American life. The USA has recorded 7.2 million cases and nearly 208,000 deaths.  The infection rate is still above 5% in twenty-nine states, above 10% in fifteen of those, and above 20% in Wisconsin, South Dakota, and Idaho.  Recently, a 19-year-old Appalachian State college student succumbed to neurologic complications of Covid-19. Two NFL teams (Titans and Vikings) closed their facilities this week and the Titans vs. Steelers game scheduled for October 4th has been rescheduled for later in the season. Northeastern Wisconsin (Green Bay and La Crosse) is suffering a huge surge not only in cases, but hospitalizations and deaths. Unfortunately, we have plateaued at nearly 40,000 new daily cases in the United States with thirty-one states reporting increasing daily case numbers. This baseline is “unacceptable high” according to Dr. Anthony Fauci (NIH Director and taskforce member). This level of plateau provides a very fertile baseline for dramatic case increases and transmission.  10% of the new U.S. cases since July have been in citizens under 21 years old. It is also clear that African Americans are disproportionately affected in every age group.  Over 22,000 more African Americans killed by Covid-19 would be alive today if the death rate was the same as our fellow Caucasian citizens. 

We can only identify new cases through adequate, accurate, rapid results testing. We are again being promised by the White House a massive infusion (150 million doses) of a 15-minute tests (Abbott) beginning in October 2020.  It has been projected by a Harvard group that we need 5 million tests per day so that we might adequately and safely reopen schools, businesses, places of worship, and other aspects of the American way of life. By now, 6 months into the pandemic, we would be closer to the necessary testing and by the way personal protective equipment if the President had fully implemented the Defense Production Act to address these shortfalls. The initial focus of the distribution of these millions of Abbott antigen tests will be for victims of recent hurricanes, schools, nursing homes, and assisted living and senior day care facilities.

We continue to see erosion of confidence in the agencies tasked with protecting our health. One recent example of this is that the CDC issued a “no sail” order for cruise ships in March 2020. They recommended that the order be left in place, but this has been overturned by the White House. Additionally, reports are that the CDC’s school reopening guidelines, testing guidelines, and meat packing plant recommendations have all been changed at the orders of the White House. Secondly, the image and trust in the FDA is being tarnished by political pressure regarding testing and therapeutics. The organization must restore its status if our country is going to able to benefit from a safe and effective vaccine. The FDA strengthened the requirements necessary for general usage approval of the anticipated Covid-19 vaccine. Despite what we have heard during this week’s 2020 Presidential Debate, both Moderna and Pfizer, which are in phase III trials for a Covid-19 vaccine, have stated that their vaccines will not be available by election day. Moderna states that widespread availability of the vaccine will not be before Spring 2021. Pfizer is emphasizing the need to cease the political conversations about their vaccine because it adversely affects the public confidence in the eventual vaccine. 

At this juncture, we find it critical to re-emphasize that there are available actions which can maximize our safety.  While we wait for a safe and effective vaccine get the flu vaccine NOW, WEAR your masks, WASH your hands, WATCH your distance.  

VOTE! The person who is President has a huge influence on your health and very existence.

200,000 Americans DEAD from Covid-19

The USA has tragically reached the unenviable milestone of having lost more than 200,000 of our citizens to this still raging pandemic.  This number represents more than three times the number of US soldiers lost in the Vietnam War. Covid-19 cases diagnosed in our country are approaching 7 million.  The new cases in many states remain unacceptably high with twenty-six states showing positivity rates greater than 5%; twelve of those have positivity rates above 10%. Texas has a positivity rate of 65.4% according to Johns Hopkins Covid-19 dashboard.  African Americans continue to be disproportionately impacted by this dreadful disease. People of African descent, compared to Caucasians, are 2.6 times as likely to contract the disease, 4.7 times as likely to be hospitalized, and 2.1 times as likely to die from Covid-19 infection.  New information has emerged regarding this disease in children. Although it is rare in children under 2 years old, they tend to be more severely affected than older children (Mayo Clinic). It is surmised that this is due to the airways being smaller and the immune systems of the under two group being less developed.  It is also documented (CDC) that Hispanic, non-Hispanic Black, and non-Hispanic Native American/ Native Alaskans make up 78% of Americans under the age of 21 who died from Covid-19 before July 31, 2020. 

In this space, four months ago, when we had lost 76,000 Americans, we asked the question “Why are they willing to accept so much death?”.  As the numbers of our families mourning the loss of loved ones continues to pile up, Americans see more ongoing mixed signals and insufficient responses from the top of our government. Our healthcare agencies (FDA, CDC) have thus been misdirected and extreme mistrust of these vital organizations has increased among the American people. It has been widely reported that the White House wrote the CDC guidance, issued several weeks ago, that recommended non-symptomatic individuals not be tested, even if they had been is close contact with a confirmed Covid-19 individual.  Amid widespread backlash from the medical community, the CDC reversed the recommendation just last week. The mistrust of the CDC reached an even higher level when the agency stated today that the new guidance regarding airborne transmission was placed on its website three days ago “was posted in error”. 

A second federal shortcomings that leaves healthcare workers, essential workers, and citizens at risk is the ongoing shortages of personal protective equipment (PPE).  Specifically, the very protective N-95 masks remain in short supply and we are now six months into this pandemic. Large companies such as Honeywell and 3-M have been engaged to increase production, while smaller capable companies, if guaranteed a market by a national game plan, could have made up the tens of millions of N-95 mask shortfall that exists to this day.  We have ongoing shortages of disinfectant wipes, flour, paper towels, toilet paper, etc. 

Inadequate antigen testing, solvable by a coherent national plan, has resulted in a world highest daily COVID-19 case count, many of our children still getting education remotely, thousands of our businesses and places of worship partly or totally shuttered, travel limited, and sporting events without speculators. The NFL and Big-10 announced reimplementation of fall football after they came up with their own plans for daily testing of athletes and staff along with contact tracing and isolation of those positive cases.  If we had a national plan promoting testing, adequate PPE, and public health guidelines, many fewer infections would be present and our lives in 2020 would be much different. We, as a medical organization, have called repeatedly for the President to use his unique authority to implement the Defense Production Act to solve shortages which would help to save American lives. 

We are physicians whose mission is to serve and service the health of those with whom we are entrusted.  We find it exceedingly difficult to manage our jobs when political influence is imposing itself on the science. Nevertheless, we continue to give the best advice based on that science.  Let us therefore reiterate that it is highly recommended that you get your seasonal flu vaccine as soon as possible.  Please continue to WEAR your masks when out in public and not able to socially distance by at least six feet; WASH your hands (20 seconds) or use hand sanitizer when soap and water are not available; WATCH your distance from individuals with whom you do not live (6ft); and avoid large crowds especially indoors.

Will YOU take the COVID-19 Vaccine?

Americans continue to become infected and die from COVID-19 infections.  The new USA death toll is over 191,000. New projections from Washington U. (IHME) are for 410,000 US deaths by January 1, 2021. Approximately 6.4M cases have been diagnosed in the country, about 500,000 of those being children. Thirty states have infection rates higher than 5% with 13 of those states having infection rates of greater than 10%.   Although daily cases have fallen to just below 40,000 per day, this is still an extremely high plateau and will lead to significant increases as we relax social distancing recommendations.  Recent evidence of the adverse effect of abandoning social distancing can be gleamed from the Sturgis, South Dakota motorcycle rally four weeks ago. The rally drew an estimated 400,000 people and resulted in an estimated 250,000 cases of COVID-19. 

Our K-12 schools are reopening varying between virtual, in-classroom, or hybrid models.  The $200 billion dollars recommended by the American Academy of Pediatrics, which is estimated to keep these schools safe, has not been given by the federal government.  Therefore, many school districts are lacking proper PPE, accurate and fast-result testing, ventilation upgrades, or adequate space of instruction and isolation.  The reopening of colleges has coincided with outbreaks, not unexpected because college life is not typically associated with social distancing. Several major universities have implemented aggressive testing programs, often involving the testing of ALL students, faculty, and staff.  Remember that 40% of the cases are asymptomatic and they have been found to be responsible for the spread of 50% of the cases. This universal testing allows the identification of asymptomatic individuals, appropriate contact tracing, and isolation.  This is the scientific manner to fight this dangerous virus.  It truly remains a dangerous threat to American lives, education, and livelihoods.  Young people are not immune, and they are thought to be responsible for the recent summer surge. Concerns are that the reopening of colleges, superimposed on a remarkably high daily case count, will be responsible to a second wave in the fall. Additionally, we see today a 20-year-old Division II football player has died from complications of COVID-19. In recognition of this ongoing threat, several major college athletic conferences had already postponed fall athletics. The University of W. VA. changed from in classroom to remote learning after an outbreak of 500 cases amongst its students. Iowa State has abandoned its plans to have 25,000 fans in the stands for fall football games.   

There are actions that we must take as responsible citizens to protect ourselves and those around us. WEAR a mask, WASH your hands, WATCH your distance, and avoid large crowds. These measures, touted in the COVID-19 age, are likely to lessen the impact of the seasonal flu which typically runs from October to May. 

Unfortunately, people who contract influenza have lower general immunity resulting in a higher susceptibility to COVID-19.  It is thought that a person can contract both at the same time. The “CDC recommends that everyone 6 months of age or older be vaccinated every flu season”, preferably before the end of October.  The American Academy of Pediatrics recommends two doses for children 6 months to 8 years old. We should all get our seasonal flu vaccine, so that the typical yearly thousands of deaths from seasonal influenza will possibly be lessened. 

Americans are quite skeptical about taking a COVID-19 vaccine if it becomes available this year.  A CBS/U.gov poll reveals that only 21% of voters say they would take a COVID-19 vaccine as soon as it became available. This low level of compliance is due to the plummeted trust in the CDC and FDA.  The perception of political influence over these organizations has ruined the public’s confidence that those organizations will rely on the science, not political expediency, when making decisions regarding protecting our health. Because of the floundering confidence, nine pharmaceutical companies, which are competitors in the COVID-19 vaccine race, have issued a joint statement that they will not seek “authorization or approval” for a vaccine until they have proof of safety and effectiveness.  Even with this unprecedented measure, designed to restore confidence, there must be transparency and independent analysis regarding the trial data to help ease concerns. If there is no confidence, there will be an inadequate number of citizens sitting for a vaccine and there will be no widespread immunity.

Mixed Messaging Impedes the COVID-19 Fight

This first wave to COVID-19 is slowing down from its second peak.  It remains to be seen whether this represents a temporary dangerously high plateau or a trend toward truly reduced numbers. We have still lost 3,700 Americans in the last four (4) days and the USA death toll is now approximately 182,600.  Diagnosed cases in our country number over 5.9 million.  The infection rate remains over 10% in 12 states and over 5% in a total of 29 states. The CDC has projected that we will reach 200,000 deaths by September 19 and the IHME (Washington U.) estimates a tragic toll of 317,000 by December 1.  The latter organization further estimates that 67,000 lives come be saved if 95% of Americans would wear masks when they are outside of their homes and not able to socially distance.  

At our last update we reported that the use of convalescent plasma had been placed on hold by the FDA due to a lack of proven effectiveness. This potential therapeutic has become a political football in that convalescent plasma was given an emergency use authorization (EUA) four days ago, with glowing reviews, after the President had voiced dissatisfaction that it had not yet been approved.  The following day the Commissioner of the FDA, Dr. Stephen Hahn, backtracked on his 24-hour old characterization of the benefits, though not rescinding the EUA. This reversal of course came on the heels of objections to the EUA by the Infectious Diseases Society of America.  This physicians group, which represents the infectious diseases medical experts, noted that the President’s and Commissioner’s  characterization of the data in terms of effectiveness was one, overblown, and secondly the EUA will make it more difficult to complete the scientific studies necessary to actually prove the effectiveness. 

A second potential politically driven controversy regarding one of the agencies responsible for protecting our health involves the CDC and its newly issued (8/24/20) testing guidelines for COVID-19.  These new guidelines say that if a person has no symptoms then they do not need to be tested, even if they have been in close contact with a person with documented COVID-19 disease. This is scientifically the wrong approach according to many epidemiologists and infectious diseases specialists.  They akin this change to “flying blind’ as it disregards the science that has been proven to be effective at fighting this dreaded disease. We know that asymptomatic and pre-symptomatic people make up about 40% of the COVID-19 cases.  If you fail to test, then these folks will not be identified, and they can spread the disease unimpeded. The push to get citizens to wear masks is based on the need for each of us to protect those around us just in case we might be one of those unbeknownst spreaders. Not to mention that contact tracing is worthless without the testing of people without symptoms. Again, medical experts raised their voices and the Director of the CDC, Dr. Robert Redfield, issued a clarification stating that “testing may be considered for all close contacts of confirmed or probable COVID-19 patients”.  This explanation did not get policy back to the previous position of testing all close contacts.  Multiple states have announced that they will disregard the new CDC “guidance” and follow the direction of their own healthcare experts which adheres to the previous guidelines. 

Unfortunately, public confidence in our government is being strained by the politicization of our public health organizations.  At this time, we do have some power over this virus if we will just WEAR, WASH, WATCH, and avoid large crowds.  We await a safe and effective vaccine. The problem is that the trust that the public has in our public health agencies responsible for delivering us this vaccine has been eroded by interference by a political agenda.  We can only hope that the medical scientists stay true to their oaths and give us a vaccine that has been adequately tested.

Schools are opening…and then closing

 Since our last update nine days ago, deaths in the USA from COVID-19 have increased nearly 10,000, close to the tragic number of 173,000.  Positive tests in the US have increased to 5.5 million (This may be skewed downward by decreased testing deployment).  Thirty-three states still report a positivity rate (% of tested people who are positive) of greater than 5%, with eleven states still above 10%.  Fortunately, Ohio’s positivity rate is 4.4%.  Unfortunately, coronavirus testing has decreased 13% in the US over the last two weeks according to The Covid Tracking Project.  COVID-19 outbreaks have occurred on educational campuses of 22 states since they have resumed in-person instruction. University of North Carolina-Chapel Hill has sent students back home and Notre Dame has suspended in person instruction for at least the next two weeks.  Michigan State University has changed course and moved to continue online learning, instead of the previously planned September 2 reopening. The FDA has put a hold on the use of convalescent plasma for treatment of COVID-19 as its effectiveness has been brought into question. The FDA has issued an emergency use authorization for a saliva test to be utilized to detect the virus responsible for this dreaded disease. Lastly, the quest for developing a safe and effective vaccine continues but may be delayed because insufficient numbers of Latino and African Americans have been recruited as volunteers. Clinical trials must include minorities according to federal law and National Institute of Health policies, yet only 10% of the potential volunteers who have registered online are Black or Latino. 

 Although it is unclear as to why testing has decreased, what is truly clear is that good public health policy amid a pandemic would dictate that testing should be increasing.  It is also very clear that testing has never been a true priority of this President as he has consistently refused to implement the full authority of the Defense Production Act and repeatedly and openly downplays the value of this basic epidemiology tool. A slowdown in testing makes it much more difficult for science-based policymakers to generate recommendations that balance public safety with relaxing restrictions. When testing is inaccurate, unavailable, under-utilized, or has delayed results, person to person transmission rages and contact tracing is of little value.  The consequences are more lives lost and more livelihoods destroyed. 

It remains an inconvenient truth that Blacks and Hispanics bear a disproportionate share of the adverse impact of COVID-19.  We have known and reported on the disparate impact on adults, but it is now clear that children of color are not immune to the ramifications of healthcare disparities. A recent CDC study confirmed that Hispanic children are eight times, and Black children are five times more likely to be hospitalized from COVID-19 than their white counterparts.  Similar disparity is seen in the occurrence of the rare, but extremely dangerous, multi-system inflammatory syndrome. A recent study by an organization named amFAR quantifies that the prevalence of COVID-19 is much lower in counties that are predominantly white. The social determinants of health need to be recognized and measures taken to mitigate. These findings are additional justification for increased testing and resources in the areas where our kids reside so that their schools can safely reopen for the preferable in-person instruction.  

While we await the development of a safe and effective vaccine, we must WEAR masks, WASH our hands, WATCH our distance from each other, and avoid convening in large groups.  These measures are the actions that WE can take to save our lives and livelihoods.  We cannot emphasize enough that the simple act of 95% of our citizens wearing masks will save tens of thousands of American lives. A recent viewpoint in the Journal of the AMA recommended a federal mask mandate, with justification consistent with the national seatbelt requirement. 

 The public, especially those who are most impacted, deserves a commitment to a national strategy and resource allocation to include testing, isolation, tracing, and treatment which would help to get and keep our schools and lives open as we navigate through this pandemic.  The abdication of management down to the state level has resulted in this summer surge and will allow for a fall tsunami when flu season begins.

America Needs a COVID-19 Reset

We are more than 6 months into this pandemic caused by this SARS-CoV-2 virus and yet the USA continues to struggle. Over 5 million Americans have tested positive for the COVID-19 disease (the actual number is up to 13 times higher). US deaths are more than 163,000 which represents 22% of the worldwide deaths.  Our country has only about 5% of the world’s population. Since July 21 there has been only one day when the US deaths have been less than 1000. Five states (NY, CA, FL, TX, & GA) account for 40% of the US virus cases. The 5% threshold for community infection rate, sufficiently low to allow resumption of schools opening, is being exceeded by thirty-six (36) states! Thirteen of these states actually exceed a 10% infection rate. The state of New York, which was the previous epicenter of the virus, now has an infection rate of 0.78%. They have endured the pain of adequate lockdown and the payoff of a low infection rate is allowing the schools to be opened for in person instruction. One projection (IHME) is that US deaths will reach 300,000 by December 2020. The good news is that this number could be reduced by 70,000 lives if 95% of our population would just wear a face covering in public. Arizona, Texas, Florida, and California are already seeing improvement in their dismal numbers because of local mask mandates and the closure of bars and restaurants.  

As we have stated before, the optimal educational situation for our children’s education is in the classroom, but it must be based on safe science-based criteria. The American Academy of Pediatrics is reporting that 97,000 children have tested positive during the last two weeks of July. We have learned that kids under the age of 10 do not become ill from COVID-19 as frequently, nor as severely as adults, but they are clearly not “immune”. Those children who become ill and hospitalized are disproportionately Black and Hispanic according to the CDC. A 7 yr. old Black child just recently died in Georgia and we know of the unfortunate death of a 5 yr. old in Michigan this past Spring.  These children did not have pre-existing conditions. Georgia has lost a total of seven children including two teenagers to COVID-19. A huge concern is that children under 5 have been found to have viral loads in their nasal passages five-times that of older children and adults. Youngsters under ten may not become ill but the teachers and staff at school, as well as the relatives and friends at home are much more susceptible. 

If we are going to reopen schools and businesses most safely, we must have a reset in our course. It is not that the WEAR, WASH, and WATCH strategy cannot be successful (as it is in other countries), but our federal government has inconsistent, contrary messaging. This has contributed to a significant number of our fellow citizens not executing this optimal 3-W strategy. We continue to call upon the President to adequately implement the Defense Production Act (DPA) so that we have PPE for schools, essential employees, and our healthcare facilities in anticipation of the upcoming flu season. The DPA should also be used to improve the availability of accurate and fast COVID-19 testing. We believe that the current lack of accuracy of the “rapid tests” and the excessive delay in results reporting of the more accurate PCR test can be overcome by presidential leadership that directs industry to solve these problems. Secondly, there must be a concerted and honest push for everyone to wear masks in public. The science is clear that they prevent virus spread. Once we knock down the virus rate of infection below 5%, contact tracing can be used to put out fires of increased spread. While these measures are being taken preparation for the development and distribution of a safe and effective vaccine should be under ways. This certainly involves convincing people that they should take the vaccine. 

Turning around our anemic response to this virus is dependent upon public health policy free of political motives.  The medical science and data, even though some consider them an affront to their personal freedom, must become the guiding light to navigate us to a virus-controlled existence. New Zealand has not had a new case of COVID-19 in 100 days!

CDC School Return Guidelines, An Incomplete Prescription

The World Health Organization (WHO) reported a record daily high number of COVID-19 cases worldwide of 284,186 on July 24.  The United States continues to contribute a disproportionate share to this number.  The virus clearly continues to rage in our country. The WHO has advised that the positivity rate (meaning the percentage of individuals tested who have positive tests) be no more than 5% for 14 consecutive days to safely reopen.  Today, thirty-four of our 50 states have positivity rates above 5% with 12 of those states with rates above 10%. The US number of deaths is starting to rise again showing more than 1, 000 daily deaths for each day from July 21- July 24. Our total number of deaths is over 146,000.  Based on antibody testing, our CDC is reporting that the number of infected Americans is 2-13 times higher (depending on the geographic area analyzed) than the recorded number of cases, which by the way has reached roughly 4.1 million. Researchers are now saying that the death rate of infected individuals is 0.5- 1.0%. This is at least five times higher than the seasonal influenza but lower than Ebola.  An extremely important update by the CDC is that the duration of quarantine for people with mild and moderate disease, who have tested positive, is now TEN days instead of 14. This timeframe applies after the onset of symptoms and requires that any temperature elevation has resolved for 24 hours without the use of fever reducing medications if symptoms have improved. People who test positive and have no symptoms should remain quarantined for 10 days after the test, as well. The need to retest individuals who have previously tested positive has now been eliminated. If you have been in close contact with someone who has COVID-19 then your quarantine is 14 days because of the potential incubation period of the disease. To stem the tide of this resurgence, fortunately several new states have implemented the mandatory use of face coverings.  This viral surge in the US has also caused numerous states to roll back or delay of phased reopening of their economy.  The economic devastation manifests itself as 1.4 million new US jobless claims this week.  

The CDC school return “decision tool” https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/decision-tool.html was released this past week.  This decision tool fails to provide an even-handed recommendation for online instruction. In our opinion the option of not being in the classroom is one that needs to be explicitly available because of the science and reality of too much disease in many school districts. The CDC position misses the mark as it fails to clearly designate a specific minimal positivity rate above which the well-established benefit of in classroom instruction is outweighed by the risk of increasing the spread of the virus. Not opening the school was a clear and unambiguous recommendation in the initial guideline that was suppressed by the White House a few weeks ago. In this new tool it is stated that “limited data about COVID-19 in children suggests that children are less likely to get COVID-19 than adults”. This ignores a study out of S. Korea of nearly 65,000 people which concludes that children under 10 have a lower risk of spreading this infection, albeit not zero risk.  Children age 10-18 were shown to spread COVID-19 at rates like adults. Ironically, this study is to be published in a CDC journal in October 2020. For those who might question the S. Korea relevance, note that the US and S. Korea had the same number of fatalities in mid-March and they have less than 300 people now!  Lastly, our children’s needs for school resources to allow facilities to reopen more safely are not being addressed.  Congress and the President have left town without addressing the $200 billion price tag (American Academy of Pediatrics) needed to make our schools open more safely, once medically acceptable criteria for return is reached.   

The medical science tells us that a treatment plan needs to be followed to completion. As a country, we did not accept the diagnosis and prognosis, WEAR masks, WASH hands, WATCH the distance between us, or have a coordinated unified message prescribed for effectively fighting this virus. This current resurgence is the unnecessary price that we are paying.  We need to follow a science-based prescription for getting our kids back to school and not a revised version based on perceived political expediency, lest history repeats itself. 

Our Kids Need to Go Back to School, BUT…

This new virus named SARS-CoV-2 which has plagued the USA since late January 2020 is still running increasingly rampant. We have lost over 139,000 citizens and we continue to lead the world in COVID-19 caused deaths and the total number of cases. Thirty-eight states show increasing case counts.  Hospitalizations are rising dramatically, and deaths are ticking up. These grim statistics prove that the still woefully inadequate increases in testing is not the source of the increased number of cases. Some ICUs are operating at 120% capacity. Active duty military medical personnel have been dispatched to assist overwhelmed hospital staffs in Florida, Texas, and Arizona. More refrigerator trucks have been ordered to serve as temporary morgues in Florida, Arizona, and California. The disease remains out of control thus jeopardizing more lives as well as livelihoods.  It is a harsh reality that our country has not yet emerged from the first assault from this virus.  We continue to needlessly suffer because of a lack of a coordinated federal effort and mixed messaging that contributes to people not following simple proven advice of WEAR masks, WASHING hands, and WATCHING your distance!

Because this pandemic is still roaring, our clear knowledge that our school-age kids need to be back in the classroom and our desire to make it so, is tempered by our concern for their safety. Their well-being and the safety of the teachers and staff must be considered first.   Unfortunately, the educational disparities which preexisted COVID-19 are magnified by the school closure mandates and by the measures being proposed to put our children back in the classroom. Those schools with more resources have more flexibility for reopening. In fact, there are private schools which plan to reopen full-time whereas public schools in the same communities are forced to provide part time instruction.  Even though schools have been shuttered since March, federal resources and CDC guidance which should have been disseminated to state and local governments, has been thwarted by the White House, so school districts have had to go it alone as they plan on when to reopen schools. The American Academy of Pediatrics states that the feds need to provide schools with over $200 billion so that schools can be opened more safely. The medical community has learned as the pandemic has progressed that children are not infected as frequently as adults, they generally experience less severe ailment when they contact the disease, and children do not drive the spread of COVID-19 as they do with seasonal influenzas.   Nevertheless, in situations where there is extensive community spread of the disease, as is the case in much of the United States, placing children back into classrooms is a recipe for increased spread among students, school staff, relatives at home, and thus the community. Reports are that up to 25% of our K-12 teachers have preexisting health conditions which make them more vulnerable to the hazards of COVID-19. As healthcare providers, we recommend that school reopening be delayed until community spread is at an acceptable level. 

Returning to school safely requires multiple changes to the traditional classroom.  These changes, just as all that we do to live with COVID-19, do not eliminate the risks of contracting the disease, but are designed at lessening that possibility. Conducting instruction and activities outside and improving the ventilation and air exchange in the school buildings would be helpful. Reopening schools more safely can be fit into the three W’s (Wear, Wash, and Watch) that we use to manage COVID-19 in other scenarios. All adults and older students should wear masks. Hands should be washed frequently with soap and water, using hand sanitizer as an alternative when necessary.  Disinfecting all high-touch surfaces on a frequent schedule should be completed. Physical distancing means reducing classroom size, increasing spacing between desks, alternating shifts and/or days, as well as changing break and lunchtimes and locations. Communities must plan for and be willing to go virtual if the virus surges.  All specific measures that are implemented need to consider the needs of marginalized children. 

The physical and mental health of children and adolescents is very much interwoven into the fabric of a society. Getting the kids back to school more safely must depend on pertinent public health data and requires the commitment of leadership, resources, and putting the children above the politics.

Try as You May, COVID-19 Will Not Be Ignored!

The health of America is in serious jeopardy as COVID-19 rages in various areas of the country that were not as severely affected during the initial surge in April and May. The number of US cases identified has risen to approximately 3.2 million and there have been over 134,000 deaths.  People under age 45 are driving the rapid acceleration of the number of cases. The death rate is starting to tick up as they increase community spread and take the infections home to their vulnerable older relatives. African Americans represent about 25% of the fatalities although we represent only 14% of the US population.  Daily USA case count records have been broken multiple times over the last week (50,000 on July 4th and 70,000 on July 10th according to NBC News).  The healthcare systems in Florida, Arizona, Texas, California, and South Carolina are becoming overwhelmed.  Multiple states and municipalities are backing off their opening of the economy. ICU beds are filling up in multiple states and extremely ill patients are being transferred between states. Refrigerator trucks are being used as temporary morgues, AGAIN, due to funeral homes being overwhelmed. The National Guard is being called in to assist in South Carolina hospitals. Many of our very dedicated healthcare workers are struggling with shortages in personal protective equipment (PPE), AGAIN, because the President failed to implement the Defense Production Act (DPA) during the 2-month lull in COVID cases.  Testing capacity remains woefully inadequate, STILL. People are waiting in lines for 13-hours to get a COVID-19 test which will not be resulted for sometimes up to 3 weeks. We healthcare providers have been calling on the President to use the DPA to address this problem, yet many Americans can still not get a test even when one is needed. Contact tracing, which has been effectively used in other pandemics, is of minimal value because protocols and people were never put in place before the disease became out of control, AGAIN!  Things are getting worse folks! 

The President and those others who ignore COVID-19 to focus on the out of context economic news, preserving Confederate statues, destroying the Affordable Care Act, commuting prison sentences of felonious associates, and a political presidential campaign are doing so at the expense of more American lives.  The data shows that a disproportionate share of the lives affected are people of color. People with preexisting ailments, those who live in crowded conditions, and who are uninsured are affected by COVID-19 with greater frequency. Our organization continues to call for the strengthening, not the tearing down, of the ACA. The southern states are now being affected by this current surge and notably 91% of the counties with Black populations greater than 13% are in the South. The “Color of Coronavirus Project” has been able to document the ethnicity of 91% of the COVID-19 deaths. That research reveals that Black folk are killed by COVID-19 at 2.3 times the rate of White Americans and the disparity increases to 3.8 times when it is age adjusted.  To put it in more stark terms, if Blacks were killed at the same rate as Whites, we would have nearly 13,000 more African Americans alive today.  

Two months ago, we asked the question “Why are they willing to accept so much Death”?  Though the answer to this question remains unclear, we remain extremely concerned that our patients represent a disproportionate number of people infected. Since we posed that question it has become clear that COVID-19 can cause immediate and persisting affects even on those who do not die.  Among these problems include strokes, blood clots, extremity amputations, chronic kidney and lung ailments, and involvement of other systems of the body. The President erroneously stated that 99% of people diagnosed do well.  People of color are disproportionately represented among those who survive and suffer persisting problems. 

As we continue to plead with the government to do more to protect people, we encourage citizens to do their parts.  If you are in the vulnerable group (those with preexisting conditions) Stay HOME as much as possible.  For all of us, Wash your hands (20 sec) frequently. Wear a mask when you must go away from home. Watch your distance and stay at least 6 feet from other people. Avoid indoor gatherings with people with whom you do not live as much as possible. 

COVID-19 Denial is Not a Lifesaving and Economy-saving Strategy

This coronavirus does not go away because it is being ignored by even the most powerful. We have now lost over 125,000 Americans to this viral scourge.  The number of Americans diagnosed as infected is over 2.6 million.  The CDC estimates that the actual number of Americans infected is ten times that number based on antibody testing.  Unfortunately, the US has repetitively reached daily records as far as the number of Americans infected.  Today, the diagnosed number was a record 43,122! Thirty-two of the 50 states are demonstrating rising case numbers, independent of still insufficient testing increases. Experts from the U. of Washington project that there will be 180,000 deaths by October. That number can be reduced by 33,000 if 95% of Americans will just wear masks!  Other experts project a fatality number of 250,000 by the end of 2020. Although the northeast was the epicenter for the virus in March and April of this year, the south and west are responsible for the current dangerous and dramatic increases.  Most of these areas that are driving the current resurgence chose to close-down their economies late and/or they reopened early without ever reaching the guidelines outlined by the CDC.  Citizens in these areas have irresponsibly disregarded social distancing and the wearing of masks. The economic impact of this ongoing catastrophe is alarming as well.  The age range of the people infected is still trending toward people younger than 45.  They survive, but their parents and grandparents do not fare as well.  Unemployment claims have reached between 47 and 50 million, with 1.5 million new claims this past week.  The US gross domestic product (GDP) declined 5% in the 1st quarter and it is projected to be worse for the 2nd quarter. Managing this public health crisis which is responsible for health and economic difficulties requires focused leadership.  The CDC is frequently providing guidance (CDC.gov). Unfortunately, our federal government leadership fails to follow those recommendations and minimizes the impact of the disease.   

If you have been watching this space over the last two-plus months, you will say what follows sounds like a broken record, it is.  We healthcare providers say that our country will manage COVID-19 by social distancing, wearing masks, washing hands, testing, contact tracing, isolation, and treatment while we await therapeutics and a vaccine. This message is not getting across and the impact of the virus is clearly becoming worse.   We need social distancing, not political rallies that result in Whitehouse staff and over a dozen Secret Service agents having to quarantine, not to mention, a number yet to be known of infected attendees. Governors from several states have either slowed down or reversed the phases of reopening!  We need everybody to wear their masks when in public according to the CDC and health experts on the Coronavirus taskforce.  In regards to testing, Senators Cruz and Cornyn have objected to the Trump administration striping federal support from 13 testing centers across the USA. Fighting this pandemic requires testing that is multiples of our current levels. Contact tracing remains woefully inadequate and therefore we are not able to benefit from a proven tool which has been used to control and eliminate contagious diseases. Lastly, though we have learned a lot about treatment, our healthcare system is again becoming overwhelmed. Hospitalizations are up in multiple states and deaths will follow. In Houston, TX. , only 2 out of the usual 1300 ICU beds remain available, the Children’s’ Hospital is primed for admitting adult ICU patients, and all elective surgeries have been banded (also in 3 additional Texas counties). In the face of the dire need for health insurance the Trump administration just last night filed a brief to totally eliminate Obamacare. We are appalled at this effort which would eliminate pre-existing conditions coverage for EVERY American and result in 23 million people losing insurance coverage.  It is extremely cruel that 500,000 of these have been added to the Obamacare roles as a result of employment loss due to this pandemic. 

CoVID-19 is destroying our health and livelihood because too many people are following the administration’s message of denial.  Our country is not getting the federally support which would allow successful state administration, and local execution of an actual plan. The public health policies that are essential to fighting this disease must be supported, not sabotaged by the top of the federal government. 

Wear Your Mask, PLEASE!