As the novel coronavirus remains a global threat, the foreign viral adversary is highlighting weaknesses in our fragile inpatient health care system. The leading concern regarding this virus once it breached our borders was whether our hospitals would be able to deal with the big increase in patients that would soon follow. The short answer has become glaringly obvious: no.
The number of deaths from COVID-19 – the respiratory disease caused by the coronavirus – has begun to peak in hot spots throughout the U.S., while the number of hospitalizations is leveling off and even decreasing in some areas. This is happening because the American people are taking responsibility for their actions and heeding warnings to socially distance in order to mitigate human-to-human transmission of this virus.
However, the longer America remains shut down, the more long-term economic damage we will see. As we continue to focus on treating and saving the people who are currently ill, it is essential to determine in parallel how we can reopen the country while also preventing future spikes in cases and possibly even deaths if we lessen the social-distance measures.
TUCKER CARLSON: VITALLY IMPORTANT CORONAVIRUS QUESTIONS REMAIN UNANSWERED – HERE ARE SOME
A highly contagious virus – like the coronavirus – that can possibly be aerosolized will wax and wane throughout the seasons and is likely here to stay, at least for the next couple of years. So while there are numerous research studies being performed throughout the country to determine which medications have the best treatment outcomes against the virus, we can’t wait for the large randomized-control studies to conclude. And we can’t wait for a vaccine to save the day.
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Rather, we have to look at the evidence before us, albeit limited, in an effort to improve our treatment outcomes and decrease the rate of hospitalization with COVID-19. The shift in how we deal with COVID-19 needs to go from the inpatient setting in hospitals to bring outpatient physicians to the frontlines for our future progress.
Our outpatient medical practices have been forced to cancel "elective procedures" even if postponing the procedures potentially holds a greater fatality rate than COVID-19 would. This was done to lessen the burden on the hospital system, but it has left us with a largely untapped resource to fight the coronavirus: outpatient medicine.
Resources – including testing kits, personal protective equipment, medications, personnel and even government funding – have been focused on inpatient hospital settings, leaving other medical specialties and patients out.
In a state of emergency like the one we have been in, this may have been appropriate. But to stay in such a myopic state would be futile to long-term efforts.
As we reopen business while the novel coronavirus still circulates, we will need to streamline outpatient care to decrease the number of people who may require hospital care so we don’t need makeshift hospitals set up in convention centers and even Central Park in New York City.
The way to do this is to increase outpatient care and redistribute resources. We will do this while allowing people who have been exposed or presumed to have been exposed to the coronavirus to return to work while adhering to the White House recommendations of wearing a mask in tight-fitting spaces, temporarily lowering maximum capacities of small spaces, and continuing to encourage some form of social distancing.
Yet we cannot begin to think of opening the country unless elected officials remove their hands from health care and allow the transition of resources to point-of-care sites in order to prevent spiking of the curve.
This will only be done by allowing testing and treatment to be provided by outpatient doctors, with the resumption of home visits and allocation of more funding for outpatient management.
There is a continuous discussion about fast-track antibody testing. However, if it rolls out the same way the molecular nasal swab test rolled out, state legislators would likely dictate and restrict the antibody testing as they have already done with the nasal swab test.
Physicians across the country are even being slapped with subpoenas from U.S. attorney offices for prescribing medications to people with COVID-19 in hopes of treating their illness. State legislators are restricting doctors from prescribing certain medications to only established patients with a COVID-19 positive test.
Except, if you haven’t noticed, getting tested is not the easiest thing to do. There are reports all across the country of physicians applying to have testing in their offices – given high patient populations – only to be denied repeatedly by government officials.
If doctors can’t get tests for their patients – and are not able to prescribe potential treatments for them once symptomatic – how are they to help prevent the patients from needing hospitalization?
When patients are showing symptoms of COVID-19, doctors should be able to prescribe the best weapons at their disposal – including home oxygen, pulse oximeters, intravenous fluids and medications. It is indefensible for states to withhold any such measures while patients wait days or weeks for a positive coronavirus test to come back or while symptoms worsen to the point the patients require hospitalization.
The acting director of the Division of Consumer Affairs in New Jersey contradicted himself in his own statement about the order saying: "Medical professionals have a duty to make conscientious prescribing and dispensing decisions that ensure every patient is able to obtain their medication. This includes only issuing prescriptions necessary for the treatment of patients, and in reasonable quantities to ensure continuity of care for all who rely on them."
Yet state government actions directly inhibit medical professionals from making conscientious prescribing decisions for their patients coming to their offices with symptoms of illness. Isn’t that what a physician is supposed to do?
Governors across the country, including Phil Murphy of New Jersey, have issued executive orders threatening doctors with punitive measures if they prescribe certain medications for their COVID-19 patients.
While COVID-19 usually presents as an acute respiratory infectious illness, it can damage multiple organ systems – including the heart, lungs and blood.
Most adults with COVID-19 experience fever, cough and fatigue, and then recover within one to three weeks. However, some develop severe illness, typically manifesting as pneumonia and respiratory failure, with continued progression to acute respiratory distress syndrome and death.
Currently, no specific treatment has been confirmed with robust clinical trials to prevent the progression of COVID-19 to severe illness. However, several medicines available in the United States have been proposed as potential therapies.
A continuing discussion about one of those medications – hydroxychloroquine (HCQ) – has consumed news organizations since President Trump mentioned it during a White House press briefing several weeks ago.
In the last month, several small studies have found that hydroxychloroquine showed promise in a lab setting against the virus that causes COVID-19, with preliminary reports suggesting potential effectiveness in small subsets of human patients. Because of this glimmer of hope, the medication – among many others – is undergoing clinical trials in patients in an effort to decrease the devastating effects of the global coronavirus pandemic.
An opinion piece recently published by the Association of American Physicians and Surgeons highlights the basic science and clinical outcomes reported from more than 10 countries that show HCQ working both before and after COVID-19 enters the cells.
It is the viral replication process once inside the human body that triggers the "cytokine storm" that is wreaking havoc on various organ systems – especially the lungs – leading to acute respiratory distress syndrome (ARDS) and sometimes death. The addition of a particular antibiotic has demonstrated a synergistic effect as reported from France China, and several clinical outcomes studies in the U.S.
An international survey conducted by the global health care polling company Sermo showed that out of the 2,171 physicians surveyed, 37 percent rated hydroxychloroquine as the "most effective therapy" for combating the potentially deadly illness COVID-19.
Outside the U.S., hydroxychloroquine is being equally used for diagnosed patients with mild to severe COVID=19 symptoms. The U.S Food and Drug Administration (FDA) issued an Emergency Use Authorization for HCQ to treat COVID-19 – but restricted this approval to hospitalized patients only.
We live in a country with the most economic and privacy freedoms, yet our health care professionals are being restricted more than anywhere else in the world by not allowing treatment to prevent hospitalization. This is a reactive and backward approach to caring for the patient.
The data we have suggests the use of hydroxychloroquine as a first intention therapy for COVID-19 patients may help shorten the duration of illness and possibly reduce the severity. We won’t know for certain until we have longer-term randomized control studies telling us.
But when we are dealing with people rapidly deteriorating and dying by the thousands every day, decisions based on anecdotal evidence may actually be good enough. This is especially true when those decisions involve medications that have proven safe from decades of utilization for other ailments. Would this drug combination have been considered too brash and controversial if anyone other than President Trump mentioned it? Probably not.
And it’s not just governors substituting their judgment for those of doctors that pose a threat to front-line medical responders. Sen. Lamar Alexander, R-Tenn. – who has been the beneficiary of campaign contributions from insurance companies – is callously trying to use this crisis to cut physicians’ pay.
Instead of holding insurance companies accountable for their draconian methods, Alexander – along with Rep. Walden, R-Ore., and Frank Pallone, D-N.J. – is carrying their water by concocting an out-of-network reimbursement plan that is akin to government rate-setting
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At a time when doctors and other front-line responders are risking their lives to combat the coronavirus pandemic, it is unfathomable that any politician would attempt to hurt them financially.
But here we are – robbing Peter to pay Paul – except Peter is too busy saving lives to fight the battle on Capitol Hill. That’s why, just as we need to remind governors to /stay out of medicine, we need to demand that elected officials in Washington stay out of health care providers’ pockets.
Government officials should remove the red tape from physicians and allow us to deliver on our oath to care for our patients. We have spent decades pouring through literature and academic studies in an effort to make appropriate decisions for our patients regarding their care.
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Those in government should not tell us what an "elective" surgical intervention is, or which treatment is best for our patients. The last person who needs a say in patient care is a politician who has never seen a patient suffer.
So my message to elected officials who believe they know best is simple: remove the shackles and let health care professionals do our jobs.
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