Recently, the New England Journal of Medicine, “Journal Watch” carried commentary on the question of how doctors felt about the expiration of the COVID-19 Public Health Emergency. This question raises heath concerns at two levels: public health and personal health. Public health in this setting, involved doctors pulled into the street, airwaves, and the print media to provide essential medical information on the current COVID-19 developments and the important role of vaccinations in stemming the spread of infection and the death rate. Providing essential personal health information in a contentious political environment brought heretofore unparalleled criticism to the doorstep of physicians having the temerity to contradict congressman, governors,…and the other guy. One comment came from a family doctor that addressed the ongoing splintering relationships between doctors and our governing bodies; doctors and lawyers; and doctors and their patients:
"One of many significant challenges that gained traction for the purposes of purely political power, 'identity' and as being revealed, money, reaching our highest court, the Supreme Court, are the continuing antivaxxer misinformation campaigns. These groups are still actively attacking the ability of whole communities including public health departments, school district, doctors’ offices and more, to protect themselves via mandates for vaccines. They are doing so with attorneys in the courtroom…We are going to find ourselves with our hands tied behind our backs by the politicians, and the attorneys who can make a buck at the expense of the lives of all the rest of us."
Later the doctor describes the chilling effect of the interference of misguided activists in medical care policies. Doctors know their patients, she says, and can devise personal plans of care, including a vaccine and whether vaccination is truly riskier than the disease. Politicians, lawyers, and the courts, she emphasizes, cannot.
The lawyers I know are immune to criticism for taking a fee to represent a client, even those clients whose conduct is unspeakable, but I take umbrage at being thrown in with the current batch of disingenuous politicos, masters of half-truths, and spin. Scholars have noted that Aristotle believed that politics is a vital and noble human activity. But money and the desire for reelection has brought this noble calling to its knees. For the medical community, statistics, and facts of the human costs of the denial of medical care are forceful lessons of the danger of politicians at the bed side.
Johns Hopkins, Bloomberg School of Public Health: Center for Health Security has a free link to weekly updates of news articles, publications, and research devoted to the latest developments on COVID-19, entitled COVID-19 Situation Reports. As of the spring of this year, they stopped collecting raw data on COVID-19. As of May 2023 updates, it provides useful information for enlarging our perspective of what has happened up to now and the challenges ahead.
As of May 4, 2023, the CDC reports that in the US there have been 1.13 million COVID deaths. In the week of April 26, 2023, there were 88,330 reported cases and 1,052 deaths, though the CDC notes that infection rates and deaths continue to trend downward. To me, the most interesting data compiled by the CDC is the implications of the vaccinated individuals versus unvaccinated people on morbidity and mortality. Here in Ohio, the Ohio Department of Health compiled data from the Ohio Disease Reporting System and the CDC Covid-19 Vaccine Breakthrough Project. Since January 1, 2021, 27,084 not fully vaccinated Ohioans have died from COVID-19. In contrast, only 1,534 fully vaccinated Ohioans have died from COVID-19. It would appear that vaccinations prevent death in COVID-19 infected patients. The actual number of preventable deaths has not been quantified in Ohio, but a couple of academic centers have claimed that numbers extracted from the CDC show that hundreds of thousand people across the US lost their life because they failed to heed the advice to get vaccinated.
In May of 2022, the Brown School of Public Health, T. H. Chan School of Public Health, and Microsoft AI announced their recent analysis of national and state by state data showing that “vaccines could have prevented 318,000 deaths between January 2021 and April of 2022.” Their analysis reported that there was a large variance among the states. "West Virginia, Wyoming, Tennessee, Kentucky and Oklahoma lead the list of states where the most lives could have been saved by vaccines.” The state-by-state comparison underscores the “correlation between states that continue to see lower vaccine uptake and states that have a larger share of vaccine preventable deaths.”
In April of 2023, Johns Hopkins Center for Health Security disclosed that deaths and infections, even after accounting for age and comorbidities, “clustered in states with lower education, higher poverty, less access to quality health care, and lower levels of interpersonal trust. This set of traits, in turn, tended to exist in areas where large proportions of the population identified as Black or Hispanic, and in states where the majority voted Republican in 2020 presidential election.
Unfortunately, the US government and the medical establishment are not blameless in the failure to curb the spread of COVID. In the June 1, 2023, issue of This Week at NEJM.org, Harvey Fineberg, MD., former Dean of the Harvard Chan School of Public Heath had this to say:
“…we failed at the outset to do many of the things that we had to do in order to get ahead of the curve of the pandemic. We failed to organize properly a leadership array with clear guidance, a clear line of authority, clear responsibility, and a clear strategy. We absolutely failed early in diagnostic test…We did not mobilize the private sector to work together with government to produce the number of tests that would be required. We were flying with blinders on…unable to track accurately exactly where it was going, how quickly it was spreading, who was being affected… It became a very great challenge across the states, with a lack of coordination, states competing with one another for equipment, and we had many missteps around communication with the public. …On all fronts we fell short.”
The lessons seem obvious. In times of a pandemic, the government must improve communication, educate better, and provide emergency medical treatment to save the lives of everyone. There are two problems here: first, some people can’t be persuaded no matter how much information by way of facts and statistics is put in front of them. All lawyers have been there, and tried and failed to persuade some people who need our help the most. This means in the next pandemic, and there is no dispute there will be a next one, we will see people die unnecessarily. Second, and less obvious, a new virus has invaded the seamy side of politics. I’m not talking about dark money or baseless campaign attack ads; I am talking about misinformation spread by politicians and political operatives, and even popular talk show hosts. Unless you trust science, the only hedge against medical misinformation is trusting local doctors and one’s family physician. TV doctors, despite spectacular credentials, were not as persuasive as hoped because they appeared on networks aligned with a political party. It turns out that local physicians and our sports heroes were the most persuasive. Thank you Lebron, Tom Brady, Serena, and Simone Biles.
The CDC’s current recommendation for people over 65 who have received 1 dose of a bivalent vaccine have the option of receiving 1 additional dose 4 months after the first dose. Why? Because research studies show that the bivalent vaccine loses its effectiveness against the Omicron variant in the elderly population after 4-5 months. However, the current vaccine may not be effective against the new dominant variant XBB 1.5. Check with your physician to see whether another booster is right for you.
One of the persistent problems of COVID-19 is the lasting effects of the virus. Long Covid is a condition where Covid survivors suffer fatigue and brain-fog that interferes with daily activities and seems to get worse with physical activity and mental effort. I have a friend who is a nurse. A year after contracting Covid she still takes a nap in the afternoon, and she ultimately quit her job because she was too fatigued. Of some consolation, in July of 2021, Long Covid was added to the list of disabilities under The American with Disabilities Act.
