Heroes Don’t Wear Masks, Cartoon Superheroes Do.

I want to start by saying the healthcare responders in Red Zone areas where hospitals were overrun with cases Like New York, LA, New Orleans, etc. are indeed first responders and heroes who risked; some losing their lives. This is not about them I look at them like I look at a combat medic (which I have been because my job in the military required everyone to be combat medic qualified). Like us they ran towards danger without self concern, knowingly risking their lives each and every time. Fireman have always been first responders. Want proof? I have seen it. My alarm went off cooking and the service had the wrong number. 4 minutes later 8 Fireman, fully dressed and equipped in spite of two engines full of equipment. They were ready to break in and attack the fire, just as I opened the door. Keep this in mind as I tell this story!

This is about a massive short sighted decisions both by the government and the hospitals, that have now all consolidated into basically corporations. We all know that with such a change comes a shift from a “patient centered” approach which the medical staff has come to understand, to just one business in a large collection of hospitals. Corporations form to accomplish two things: 1) To uniformly control and operate all incorporated businesses/hospitals; which is accomplished by creating formal policies that are uniform and statistically protective of the corporation at large so they stay corporations where groups of hospitals now have lost the power they had in the rights for action and many other decisions formally made by administrators that either have hospital and practice experience medically, or a successful record of managing their policies for the best interest of the patient (i.e. Recovery rate).

USE COVAD As an Example:

As I said in the beginning, this is not about the major hot spots like New York. I found that between the outbreak release publicly and the government closing the borders 340,000 passengers from the high risk areas in China stepped off a jet not just in America, but according to the government and FAA close to 90% landed in the 5 biggest outbreak cities… Coincidence? Meanwhile the federal and state government instead of enacting the mandates defined by us all 30 or more years ago during the cold war when we actually expected a biological attack (something we obviously shelved thinking we are no longer threatened – The definition of short shortsightedness). Not knowing what to do they worked with state government and created a nation wide emergency plan to be used in every single state an enacted it.

Decision to enforce home shelter and close all but the most critical stores, which quickly emptied them AND NO OTHER STORE WAS OPEN.

At first it seems like a good and safe plan right? Here is the side of this decision that only a few good writers have realized as more than a critically bad implementation to place on all hospitals and most practices. With as many as 10 outbreak cities impacting 7 out of 50 states (estimate), you have 7 states that actually require all their beds and all their medical staff, even those who specialize in things not related to a virus.

CONSIDER THE REMAINING 43 STATES:

Here the outbreak never approached many of these states beyond the capacity hospitals already had and were prepared for viral outbreaks and isolation beyond the capacity they ever witnessed in this pandemic. Yet they were forced to make mandated decisions on the use of the beds, the availability of physicians, even in crisis. Inability to go to the emergency room, struggling to get follow up appointments (they put my wife’s off after radiation treatment to the Larynx, a pretty risky and dangerous procedure; and they put it off 6 months, Which happened to be 2 weeks after she died). Though we did not see the massive outbreak they let go therapists, case workers, and nutritionists, in spite of being a separate building with even less risk. So I know of one patient that was let go with no support, and when she became critical due to treatment as her cancer was totally in remission and could not be detected visually or by PET scan, when I reached out to them, explaining every tie we were there (both times period), in spite of the plea we sent through the medical record portal went unanswered. They were ordered to make, or refused to make life saving decisions, decisions that my being in healthcare were proper and ignoring them entirely was beyond my belief in the esteem I placed in doctors who I have seen ignore policies in the past over the life of the patient, risked their life and the patient is here today. To see them have to follow corporate policy was not just painful, I saw the same pain and shame in the faces of the doctors; whose only concern is saving the patient. Profit/loss was never the slightest concern. After all they already put their physical safety behind them to charge into the trouble, I doubt they once considered the corporate loss of such a physician and until now have ever been held back at the risk of patient BECAUSE HE DID NOT HAVE COVAD. Beds lay empty across most the states, hospitals are prepared and have in-house training constantly on just such an outbreak meaning until we became critical which we never did, there were beds open and they were prepared to conduct every hospital function every single day had they not sent home critical post-procedure staff.

The Cost

By nationally mandating the response to COVAD, How many non COVAD critically ill died not because of COVAD but because of the rules and policies both the government and major hospitals made. One sacrificed American Citizen just to keep beds open is a death of one of your people and you were the cause. Overreaction without full consideration of the impact compared to risk in most states with hospitals forced to follow policies written for the worst case: I.e. “Every bed is taken, 85% are COVAD, 100 beds in tents outside are full, and every doctor no matter the specialty is called upon to suit up)”

In Maryland this never came close to happening. I found this not to be unique at all to Maryland. What I did find was this mandate allowed my wife to die in two months while the help she needed never responded or acted.

“In late March, Zoran Lasic, an interventional cardiologist at Jamaica Hospital Medical Center and Lenox Hill Hospital in New York, was finishing afternoon clinic when he was approached by a nurse colleague seeking his advice. Her husband — a 56-year-old whose father died of sudden cardiac arrest at 55 — had been feeling chest pressure. The pressure radiated down his arms and occasionally to his neck and, the previous day, had been accompanied by dyspnea and diaphoresis, making him worried enough to call an ambulance. The emergency medical technicians did an electrocardiogram, said it looked OK, and told him to call his primary care doctor. He did, and he was advised that given New York’s Covid-19 outbreak, it was not a good time to go to the hospital. (1)

Dr Lasic went on to say “ Lasic, describing a precipitous decline across the New York region in patients presenting with acute coronary syndromes, worries that others won’t be so lucky. “I think the toll on non-Covid patients will be much greater than Covid deaths,” he said.” (1). The one thing this article said that hit close to home is about Cancer treatment, something that usually resides separate from the hospital and operate in an already clean environment: “Cancer care, which often involves immunosuppressive therapy, tumor resection, and inpatient treatment, has been disproportionately affected by Covid-19. Like other oncologists I spoke with, Grossbard, who primarily treats lymphoma, has been tasked with revising chemotherapy protocols to minimize both the frequency of chemotherapy visits and the degree of immunosuppression. For example, though patients with low-grade lymphoma typically receive maintenance therapy, it will not be recommended for now because it requires an office visit, worsens immunosuppression, and improves progression-free but not overall survival. Other protocol modifications have arisen because of cancellations of elective surgeries. For instance, some patients with solid tumors, such as breast and rectal cancers, are being offered systemic therapy before, rather than after, surgery.” (1)

This statement from Dr. David Ryan hit home because it happened to my wife two months ago: “Suspending other aspects of cancer care will have graver consequences. David Ryan, chief of oncology at Massachusetts General Hospital (MGH), told me that three patient groups worry him most. The first are the subgroup of patients with lymphoma for whom CAR-T therapy is potentially curative. More than half these patients receive therapy in clinical trials, many of which have been paused amid society-wide shutdowns; even if enrollment could continue, there’s concern about the need for ICU care in a resource-constrained system. A related concern is for patients requiring bone marrow transplants, given their high risk of infection and potential need for ICU care.” (1)

In a New York Times article “The Pandemic’s Hidden Victims: Sick or Dying, but Not From the Virus” (2) The article begins with this story:

“In January, Mr. Carr, a sociology professor at Rutgers University, suffered a relapse of the blood cancer that he has had for eight years. Once again, he required chemotherapy to try to bring the disease, multiple myeloma, under control. But this time, as the coronavirus began raging through Philadelphia, blood supplies were rationed and he couldn’t get enough of the transfusions needed to alleviate his anemia and allow chemo to begin. Clinic visits were canceled even as his condition worsened…” “On April 7, Mr. Carr began receiving home hospice care. He died on April 16. He was 53. The pandemic “expedited his death,” Ms. Kefalas said. On April 7, Mr. Carr began receiving home hospice care. He died on April 16. He was 53. The pandemic “expedited his death,” Ms. Kefalas said.

The Article Went On to Note

1. Delaying treatment is especially disturbing for people with cancer, in no small part because it seems to contradict years of public health messages urging everyone to find the disease early and treat it as soon as possible. Doctors say they are trying to provide only the most urgently needed cancer care in clinics or hospitals, not just to conserve resources but also to protect cancer patients, who have high odds of becoming severely ill if they contract the coronavirus.
2. Nearly one in four cancer patients reported delays in their care because of the pandemic, including access to in-person appointments, imaging, surgery and other services, according to a recent survey by the American Cancer Society’s Cancer Action Network.

Finally THE AUTHOR NOTED: “And some clinical trials, where cancer patients can receive innovative therapies, have been suspended.”

Let me speak for a second on all this. Most of you know I have been in healthcare over 20 years, and I have been vocal both on the great advances followed by articles on improving the system and pointing out the eventual shortcomings of the cooperation, innovation, and insight into securely sharing patient data nationally so the ER doc can use an unresponsive patient’s thumbprint and receive all that patient’s critical data needed. I warned in 2016 that if we did not get the global data tied together we could not accurately use population data to detect a viral outbreak, track its spread and have continual national statistics aiding the control and research. Ironically the one thing missing on the COVAD outbreak less than 5 years later.

HEROES

In my eyes, being a veteran, if you want to meet a hero in medicine talk to a combat medic that was attached to Special Forces in Afghanistan. Better yet ask their patients. This is the definition of running towards danger, and in that danger they kneel in plain sight of the enemy and focus on nothing but getting their brother stable and out of the line of fire. That is the true definition of a hero when it comes to medicine.

These are heroes

Combat Medic, CMH awarded

THIS IS NOT WHAT SHOWED UP AT MY DOOR

Now for the numbers of increased death due to COVAD where the patient did not have COVAD: This is a graph from the CDC’s article: Excess Deaths Associated with COVID-19 (3)

The data is extensive. Visit https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm and pick your own p arameters. All show increase, none determine cause.

An increase up to 5 years after diagnosis. For these four tumor types, these data correspond with 3291–3621 additional deaths across the scenarios within 5 years. The total additional YLLs across these cancers is estimated to be 59 204–63 229 years.” (3)

But this does not touch upon the curtailment or delay of support services and the related personnel assigned to assure as close as possible a complete recovery. What if 3 weeks after radical radiation and chemo, you are deathly sick and getting worse. There is nobody to help you due to COVAD reassignment and restrictions. You can’t just go to the ER, the doctor won’t reply, so like my wife and I we sat tight and I did everything I could to help, wrote the doctors through the portal, called and then called the ambulance as she died in my arms; totally cancer free (big friggin deal now). Then the “Hero” EMTs arrived quickly but spent a casual 5 or more minutes talking, on th phone and putting on PPE. Nobody arrived dressed and ready to enter a call for a full cardiac arrest arrest. They pulled up 5 minutes after I started CPR, entered 5 minutes later (10 min without oxygen), called code blue 6 techs rushed in moved her to the dining room floor. At 15 minutes (no more time left) they put in an airway but never for the 20 minutes they were there did they try to get air into her lungs or did I ever see them apply oxygen. I was a combat medic (we all had to be), I know CPR and between my work and their continuing CPR she was revived. Thank God right? Wrong! Without administering oxygen or at least manually ventilating her along with chest comprehensions this is the gift they gave my wife and the decision they forced upon me: Alive, able to breathe off the respirator, neurological activity, but my wife was gone. When I arrived I expected she had died and struggled to accept it. Then a nurse told me she was alive and took me back to see her body still breathing and moving, but her pupils were fixed. My gift was to then after dealing with her death already I was pressured to “let her go”. I never saw the EEGs though I asked so if this mishandling of critical patients due to pandemic regulations, you all should have been there with me top say good bye and pull the plug. It took her three days and I will never shake the feeling I killed her. Thanks a lot all of you that I worked so hard for.

What else can I add? Did you hear any of this on the media? You figure out why not...

References

1) The Untold Toll — The Pandemic’s Effects on Patients without Covid-19, Lisa Rosenbaum, M.D., https://www.nejm.org/doi/full/10.1056/NEJMms2009984

2) The Pandemic’s Hidden Victims: Sick or Dying, but Not From the Virus, The New York Times, By By Denise Grady, Published April 20, 2020Updated May 14, 2020

3) Excess Deaths Associated with COVID-19, CDC and NIH, Sept 9, 2020, https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

4) The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, The Lancet-Oncology, 7/20/2020,. https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm