June 15, 2020

magical thinking

The big news today is that the FDA revoked the emergency authorization to use hydroxychloroquine for COVID-19, for both prevention and treatment. Data from studies do not show benefit but does show dangers. Interesting development, but I am not surprised. It’s use was a long shot, but in the beginning scientists and doctors were willing to try anything to help. That is why data and formal studies are important. We can have feelings and hopes about things, but that is often just magical thinking. And why it is important to not push unproven treatments. They can do more harm than good.

So far there is no magic bullet. The virus is not going away and we still have no cure. We do know better how to manage infections, which will help. What we do have, also, are recommendations that work. Face masks, eye protection, and physical distancing. that I explained about last week. Organizations like Kaiser have road maps that includes our old friends, testing and contact tracing, among other techniques. They want to prevent hospital ICU’s from being overwhelmed, which increases risks to health care workers. The CDC has guidelines on community gatherings and minimizing infections, acknowledging that size of the crowd, size of the facility and time being important factors. Political rallies are usually held indoors with lots of yelling and talking, which can lead to a super-spreader event. Not a good idea to attend one.

We all want to re-join society and see our friends and family. We are aching to enjoy each other’s company and play tunes together again. We are sad for the loss of many of our usual summer gatherings. But we are still here! At the beginning of March, I so feared the losses we would have by now. Ya’ll done good. But how can we start to get out and live again? Here are some considerations in this ER doctor’s view.

Our bigger problem as a nation is the skepticism and shutdown fatigue that is so widespread. People are ignoring recommendations, even with rising numbers of infections. Magical thinking is just as widespread. Some people haven’t been personally touched, many are burned out from being isolated and at home, some believe the virus is just the flu, some are influenced by the behavior and talk from our leaders. Some think it won’t happen to them. Yes, the protests may increase risk of exposure, but at least they are outdoors and many are wearing masks, The American Thoracic Society came out with a statement that requests police have a moratorium on tear gas because of the risks of increasing spread. So far in Seattle the numbers are reassuring, maybe because almost everyone wears a mask.

What are we to do? Convincing people is hard and difficult. As infections rise in areas that haven’t had them yet, many will start to understand, we can offer resources to learn, maintaining patience and compassion, without putting yourself at risk. But some will never be convinced, so protect yourself. I am grateful to live in an area where mask wearing is accepted. So much harder for you in areas where it is not. But we do know how to protect ourselves, with real data and not just wishful thinking.

Wash your hands, cover your nose (really!), and keep safe six.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-revokes-emergency-use-authorization-chloroquine-and

https://www.today.com/health/do-face-masks-work-against-coronavirus-study-finds-masks-social-t183018

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext

https://www.cdc.gov/coronavirus/2019-ncov/community/large-events/considerations-for-events-gatherings.html

https://www.reuters.com/article/us-health-coronavirus-who-breastmilk/who-recommends-breastfeeding-says-no-live-coronavirus-found-in-mothers-milk-idUSKBN23J2OZ

https://catalyst.nejm.org/doi/full/10.1056/cat.20.0187

https://slate.com/technology/2020/06/advice-on-reopening-activies-er-doctor.html

https://www.washingtonpost.com/health/coronavirus-recommendations-ignored-as-case-numbers-rise/2020/06/15/0c112bdc-af3a-11ea-8758-bfd1d045525a_story.html

https://www.rollingstone.com/politics/politics-features/n95-masks-trump-covid19-coronavirus-health-care-workers-ppe-1013132/

https://www.thoracic.org/about/newsroom/press-releases/journal/2020/tear-gas-use-during-covid-19-pandemic-irresponsible-moratorium-needed,-says-american-thoracic-society.php