Public health requires a broader, longer-term assessment of the pandemic

By | April 30, 2020

Many government officials have begun to lift some restrictions on elective surgeries and procedures for hospitals. This means that some of those of us in medical professions not on the COVID-19 front lines will be returning to a workload closer to the pre-pandemic phase soon.

For weeks, my radiology department has been relatively empty. Some have felt that having fewer personnel in the department has left us unnecessarily short-staffed for patients who may potentially need us or that we are not fulfilling our medical duty, but the reasoning for both our light staffing and our lack of elective procedures has to do with a public health need rather than a medical need. Not only was it necessary to keep resources on the back burner in the event of an unexpected surge of COVID-19, but simply having unnecessary people present in the hospital creates an unnecessary hazard.

In the children’s hospital on my campus, there have been no admitted children who have tested positive for COVID-19, courtesy of efficacious public health efforts. With everyone in the hospital wearing masks, a children’s hospital devoid of known positive cases may be a rather unlikely place to be exposed to the novel coronavirus (though in all honesty, many children are unknowing carriers). As such, the smart money would favor adults to actually want to work inside that hospital, especially those looking for relief from the stress of unintentional homeschooling over the past month. The public health initiative to keep unnecessary adults out of the hospital, in this case, is to protect the patients rather than vice versa. Likewise, the reason that many cities have required cloth masking for the general public is to keep the mask wearer from unintentionally spreading the virus unknowingly, not to protect the person wearing the mask. I thus have an issue with hospital executives in patient care areas. Please, get out. You are a potential hazard if you don’t need to be there.

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With restrictions in place, healthcare professions students have not been able to train. Thinking back to medical school, I still remember all my clerkship experiences vividly. My first rotation was on pediatrics, and those six weeks were the only six weeks I ever spent as a pediatrics trainee. My supervising intern Allison got so tired of me following her around asking her questions that I think she eventually let me sleep through the night so that she could get some peace. It may seem like a nice break for students (and interns like Allison), but the knowledge gained during these experiences is necessary for our careers.

What interests me most in the decision to open some sectors of the economy back up is how people arrive at such decisions. In my health system, the number of daily new positive coronavirus patients has been steady at about the same number it was when we decided to close our outpatient and elective services. So what has changed? A few explanations are possible. The first and most cynical one is that the lack of a surge in cases (again, thanks in large part to the community) and loss in hospital revenue has been determined to be worse than the consequence of potentially increasing viral spread. Another reason is that we now have reliable testing on-site that can be required before patients are approved for elective procedures. We should probably be testing the employees, too, under this thought process. Once we start testing asymptomatic people, we will probably have what looks like a “surge” from the discovery of more asymptomatic carriers. A third argument is that we simply have to get back to some sense of quasi-normalcy. Some feel that Sweden’s relative lack of restrictions could be a viable model for this philosophy.

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Public health is not only interested in physical disease. It is interested in the livelihood of people as well, not just their lives. Front line healthcare workers have been feeling the stress, but the unemployed have also been impacted, arguably more in some cases. The shelter-in-place rules are starting to experience decreased compliance in my perception. In my neighborhood, traffic appears close to normal today. The natives are getting restless.

So many people reap the benefits of good public health initiatives that it is easy to take intelligent public health practices for granted. Imagine a world without measles or smallpox vaccines, for example. We don’t see the devastating consequences of these diseases because so many have been vaccinated that they have exited our consciousness. This allows people to forget (or ignore) the benefits of these programs.

Public health is reteaching us lessons about treating and preventing chronic disease. The highest morbidity and mortality from COVID-19 impacts the most infirmed, essentially accelerating the pathology of these conditions. COVID-19 is yet another reason to eat healthy and avoid stress. We must be clear about what it means to participate in healthy practices. When columnist Andrew Sullivan, a person living with HIV and a self-described chronic lung condition, was interviewed on television, he stated that he was so lonely “doing everything correctly” that he smokes marijuana regularly to manage the anxiety. I somehow think that irritating diseased lungs right now is not within the spectrum of doing everything correctly. After all, athletes have reported contracting the coronavirus in their own homes.

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The basic science of the virus is known, and an effective vaccine is far away. Thanks to you, the curve is looking pretty flat in many places. Toilet paper is back on the shelves. Let’s move on to public health issues. Let’s discuss dollars and cents. Let’s dig into what our trade-offs are so that we can form an educated opinion. I would like to see more “if this happens, then we do that, and this is why” thinking. Let’s start to look at what our next six months will look like rather than merely our next six days.

Cory Michael is a radiologist.

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