Medicine Will Not Look Back Kindly on COVID-19 Response

Doctors are learning many things from this pandemic.  Unfortunately, a lot of the things that we are learning have little to do with medicine and a lot to do with politics, government bureaucracies, and the media.  While many of us are forced to sit at home, quarantining from the very patients we have pledged to treat, we know that scientific breakthroughs will come as a result of COVID-19.  In most instances, however, answers will come later than they should or could.  And the economic payback for the government over-reaction will overwhelm any benefit accrued by their recommendations.

Years of federal bureaucracies spending countless dollars in attempting to prepare us for the next pandemic have demonstrated two things.  One: They are stuck in medieval, dissociated thinking with little respect for the consequences of their actions.  Two: They left us inadequately prepared. 

This is the year 2020, and our society is interrelated and complex.  The overarching destruction to our economy caused by scientific experts believing that only quarantining could save us from utter "bring out your dead" consequences reflects a Monty Python "Holy Grail" perspective.

The CDC was not using known, modern methods to establish available and accurate testing for COVID-19 in anticipation of the spread of this disease.  It relied more on quarantining and fear-mongering, admitting that the available testing was inadequate and frequently inaccurate.  Additionally, the CDC was not prepared with enough of a supply of masks and ventilators.  Viral pandemics are respiratory illnesses, and these should be baseline items.   

Politicization of the possible COVID-19 treatment options will not withstand the "retrospectoscope," either.  Doctors on the front lines of the most heavily impacted areas of our country are having inconsistent results with the anti-malarial medication hydroxychloroquine, the macrolide antibiotic azithromycin, and the anti-viral medication Remdesivir.  Many of the hard-hit communities are in areas that are politically vehemently anti-Trump.  Trump has been trying to let the nation know that efforts are being made to medically treat COVID-19.  Because of poor results in their own patients with these medications, many doctors have chosen not to use them, looking down their noses at politicians they hate promoting treatments they feel don't work.  They publicly voice concern because there have not been double-blind, prospective studies, a valid issue whenever a new treatment is being discussed.  But the additional, unhelpful political bias that is blatantly obvious to most of us may be adding to the problems encountered with these medications.

 Even lay people should know that viral illness, unless treated early on, is famously refractory to medicines.  (That is why the prescription antiviral Tamiflu is almost worthless if given more than a couple of days into the course of influenza.)  Throwing an anti-viral medication at an already ventilator-dependent patient is nearly pointless.  Similarly, the way people die from COVID-19 is usually from drowning in their inflammatory secretions.  Doctors know that in this illness, cytokines (mediators of inflammation) are the major culprit, filling the lungs with fluid.  Macrolide antibiotics such as azithromycin and clarithromycin are well known as inhibitors of these cytokines.  Again, once the patient is on a ventilator because of respiratory insufficiency, azithromycin is often too late to be effective.  And, as with the medications above, doctors who have had unquestionably good results with hydroxychloroquine stress that early administration and adequate dosing of this drug are important.   Using too little too late is predictably going to fail.

One consequence of this pandemic is the glaringly poor performance seen with the use of ventilators attempting to help people survive COVID-19.  At some very reputable hospitals, choosing to intubate a patient for respiratory insufficiency from this disease is resulting in a 70–80% mortality rate.  This is not acceptable for any health care provider.  Early studies are very heartening, however, regarding the use of oxygen delivery using CPAP or BiPAP machines, items a lot of people otherwise use for treatment of their sleep apnea.  Studies elucidating the reasons for this may help with many respiratory illnesses in the future.

It should be important for the media to tell the truth when addressing the successes and failures of these medical treatment options.   It isn't really a failure in treatment if the drug is not given in time or at adequate dosage.  Similarly, if the people who are doing the worst when contracting COVID-19 are diabetic, prediabetic, and morbidly obese, it shouldn't be surprising that poor blacks have trouble.  This population suffers asymmetrically from these issues.  We shouldn't let political agendas, especially trying to highlight race, color reporting.  Our political preferences shouldn't hide the truth or result in withholding life-saving remedies.

Doctors need an effective CDC.  They don't need to be told to sit on the sidelines during an epidemic.  Their businesses shouldn't fail because of antiquated and detrimental recommendations.  The entirety of government shouldn't be asked to rescue us because this one agency didn't exercise good judgment, politicians saw it as a means to expand their power, and the media used the fear to sell airtime.

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