CORONAVIRUS: THE TRUTH AND SOLUTIONS

The real truth about coronavirus is that it is not being put in proper context and perspective.

Compared to other causes of death in the United States, there has been an overreaction to coronavirus(Covid-19). While it is true, that the virus can be deadly and we need to confront it in the best way medically in order to decrease the number of hospitalizations and deaths. But, by overreacting, there are real and unintended consequences.

The real consequences are a devastating effect on the economy with loss of jobs, businesses and savings. The unintended consequences include an increase in anxiety/ fear/ stress and depression and cancer and other chronic illnesses with subsequent deaths from both the stress of constant attention by the press on coronavirus and the economic,social and civil liberties negative effects. We know these unintended consequences occur and are supported by a study in Lancet 08/13/2016 examining the economic recession of 2008 and 2009. There was a significant increase of over 260,000 cancer deaths over a 2 year period from the recession in Europe which had caused poverty and anxiety and depression resulting in the increased cancer cases. Extrapolating this data worldwide, the article states that there was over half a million  more cancer deaths from that recession in the world. 

In order to put it in its proper perspective and context; one must keep in mind that we have approximately 36,000 deaths a year from the flu and tens of millions of Americans that have the flu every year. In 2017-2018 flu season- there were 79,000 deaths with 49 million Americans having contracted the flu..We also have over 100 deaths from motor vehicle accidents every day, but we do not stop people from driving cars in order to save lives. These are examples of “accepted” risk in order for a country to continue to prosper and our quality-of-life to improve. We do not overreact to the fact that over 100 suicides are committed daily and over 100 people die from drugs or opioid abuse daily in our country. We try to address these issues but our economy does not stop as a nation. One must also keep in mind that we lose over 7,000 people each day to death in the US.

Now what are the best solutions.

In my opinion they are:

1. Travel Restrictions. The most effective method is what President Trump did by not allowing people from China and subsequently other countries and Europe to come into our country because these areas had a significant number of infected cases.These travel restrictions should also apply from state to state and county to county in areas where there are hot spots. The most likely hot spots will obviously be the ones that are the most populated and where there is a high tourist industry with many travelers and foreigners from infected regions. This means that the number of  hot spots will be less than 100 counties of the 3000 counties in the United States.

2. Restrict large gatherings of people by encouraging people not to travel and by putting on hold the entertainment and sports business and other leisure activities.  Most nonessential public jobs can be put on hold since those employees will continue to get paid. 

3. Allow private business to continue in 90% of the counties in the United States that are not hot spots or have less than one percent of its population infected with coronavirus. They would continue to operate with social distancing but not be out of business. This could save over 30 million jobs and many businesses and keep the economy going in over 90% of our counties in the US. By having them close down completely, unintended consequences as mentioned above will result in other illnesses and deaths that were not anticipated initially by those in charge. Therefore, the cure may be worse than the disease.

4. Allow doctors to prescribe medicines such as hydroxychloroquine in an effort to save more lives and keep more people out of the hospital. Under no circumstances should public officials who do not have a medical license be allowed to restrict the use of a drug that is prescribed by a physician. It is the politician's job to make sure there is enough medicine to help the people of their state, not to dictate prescribing methods. When governors do that, they are practicing "unethical malpractice" and causing great harm to the public.

 5. Besides the preventative measures of social distancing and self quarantine in the hot spots: there is a need to recommend to providers to treat at an earlier stage of the disease process. For example, the goal should be earlier treatment in order to decrease the number of people hospitalized and consequently decrease the need for ventilators and decrease the amount of people that die from Covid-19. This would also decrease the risk to our wonderful healthcare workers who are caught in the middle of this crisis.  

When a person is symptomatic and tests positive for Covid-19, they and people living with them who are at high risk should be immediately treated, That is BEFORE they are hospitalized. The best treatment at this time is Hydroxychloroquine. Even though there are no definitive controlled studies as of yet, preliminary data shows tremendous promise. The side effects are minimal in properly selected patients who are not on certain medications and do not have a prolonged QT interval.  By not treating these patients in this early and timely fashion, I believe this delay will result in an extra ten to twenty thousand lives in the US alone. As, physicians, we frequently use drugs off label to help our patients when we determine that the benefits of treatment outweigh the risks of treatment or no treatment or treatment given too late.

There are other treatments which can be added on as we know more about the effects of adding Zithromax or other antiviral agents. We also know that plasma from recovered patients can be beneficial. Also, there are others in the private sector, working towards developing an antibody that can be given to allow immunity before actual vaccines come out later this year. 

                                   

Consequently, if we are more aggressive in the earlier phases of this disease, we can decrease the hospitalizations and more significantly the suffering and deaths by allowing doctors to do what they do best, that is, assess the risk and benefits of a treatment and appropriately help patients where the benefits outweigh the risks. Hydroxychloroquine may cause an extra 20 or 30 deaths from a reaction to the drug, but may actually work in the majority of selected patients, thus saving as many as  20,000 lives when used appropriately and in earlier stages of the disease.
Having data and models have their purpose, but sometimes, we must act when the benefits outweigh the risk in individual patients for treatments that are promising. Waiting too long  in this case most likely will result in more hospitalizations, ventilator use and deaths.

We as a nation need to be practical and compassionate. We will save more lives with better treatment options that are not hindered by politicians. We also have to take into consideration unintended consequences which causes suffering and death later on, thereby making the cure worse than the disease.

Please America, let’s do the right thing and help our fellow citizens in a way that keeps America healthier and stronger by using our common sense and putting Covid-19 in its proper perspective and context. 

We will get through this, but let's do it in a way that saves more lives and decreases the number of people hospitalized, thereby, helping our citizens, our health care workers and our economy as we get back to health and work sooner than later in our great nation.