Strange Times in Public Health

By ANISH KOKA, MD

A number of politically tinged narratives have divided physicians during the pandemic. It would be unfortunate if politics obscured the major problem brought into stark relief by the pandemic: a system that marginalizes physicians and strips them of agency.

In practices big and small, hospital-employed or private practice, nursing homes or hospitals, there are serious issues raising their heads for doctors and their patients.

No masks for you

When I walked into my office Thursday, March 12th, I assembled the office staff for the first time to talk about COVID.  The prior weekend had been awash with scenes of mayhem in Italy, and I had come away with the dawning realization that my wishful thinking on the virus from Wuhan skipping us was dead wrong.  The US focus had been on travel from China and other Far East hotspots.  There was no such limitation on travel from Europe.  The virus had clearly seeded Italy and possibly other parts of Europe heavily, and now the US was faced with the very real possibility that there was significant community spread that had occurred from travelers from Europe and Italy over the last month. I had assumed that seeing no cases in our hospitals and ICUs by early March meant the virus had been contained in China.  That was clearly not the case.

Our testing apparatus had also largely been limited in the US to symptomatic patients who had been to high-risk countries.  If Europe was seeded, this meant we had not been screening nearly enough people.  When I heard the first few cases pop up in my county, it was clear the jig was up.  It was pandemic panic mode time.  There was a chance that there were thousands of cases in the community we didn’t know about and that we were weeks away from the die-off happening in hospitals in China and Italy.  So what I told the staff the morning of March 12th was that we needed to start acting now as if there was significant spread of COVID in the community.  This meant canceling clinic visits for all but urgent patients, wearing masks, trying to buy masks, attention to hand hygiene, cleaning rooms between patients, screening everyone for flu-like symptoms before coming to the office, and moving to a skeleton staff in the office.  I left the office that day wearing a mask as I headed to the ER.

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The Best Defense is a Good Offense: Why Public Health Officials Need to Get Tough on Vaccination

BY RICHARD M. CARPIANO and JASON CHUNG (12)

Measles are preventable with vaccines so why are vaccination rates going down?/Dave Haygarth via Flickr

It’s a scary time for many parents and their children in Washington, Oregon, and New York, which are currently experiencing measles outbreaks. The vaunted herd immunity that has kept Americans safe for the past few decades is being eroded—via lower child vaccination coverage in communities throughout the US due to an increase in vaccination exemptions.

For years, fingers have been pointed at discredited doctor Andrew Wakefield for starting the spread of the now-debunked link between autism and the measles vaccine. Likewise, social media misinformation campaigns from so-called mommy blogs and anti-vaccination (often termed “anti-vaxxer”) activist groups have been effective in propagandizing pseudo-science ignorance among parents and politicians alike through websites, online ads, phony-expert panel talks, celebrity allies, online and in-person “word-of-mouth,” and aggressive political lobbying.