We’re killing the people we’re trying to save

Extreme social distancing is causing harm to the same people that it’s trying to save.

“What President Trump tried to say at his press conference, though not effectively, is that there are medical consequences to the lock downs, as well as the severe economic consequences. The extreme measures of social distancing may be causing more harm to the vulnerable population than COVID-19.”

By Israel Zwick, March 24, 2020

About the author: Israel Zwick holds advanced degrees in biology, science education, and school psychology. He recently retired from working as a school psychologist for the NYC Department of Education. Before that he taught biology and chemistry for 15 years. Prior to that, he worked in the microbiology laboratories of the NYC Department of Health.

Yesterday I was watching President Trump’s press conference on the government response to the COVID-19 pandemic. I must admit that when it comes to public speaking, Donald Trump is definitely not in the same category as Tony Blair or Barack Obama. What the President was trying to say, though he didn’t do so very effectively, was that the extreme lock downs might be causing more harm to the vulnerable population than the disease itself. There is some merit to this argument that needs to be examined.

First, I would like to illustrate with three personal anecdotes.  Several months ago, my wife came home at night and found me lying in bed behaving very erratically. An ambulance was able to get me to the hospital quickly because there was little traffic at night. The young resident on duty in the ER recognized the symptoms of hyponatremia and immediately put me on IV sodium. The next day I felt much better and was eager to be discharged, but they kept me another day for observation. That young doctor saved me from cardiac arrest, and possibly death. Today, the ER rooms are unfortunately filled with patients presenting with respiratory symptoms, some mild, and some severe. Had I been brought in today; I might be dead or severely disabled.

Another example. Just after the mysterious virus from Wuhan was revealed, my wife underwent ambulatory surgery for a common urological problem.  Last week, she went to her physician for a follow-up examination.  The physician emphasized how fortunate she was to have the procedure because now all elective surgical procedures in the hospital have been cancelled. That’s just one surgeon in one hospital.  Now multiply that by all the urologists, orthopedists, gastroenterologists, ophthalmologists, and dermatologists who have had their elective procedures cancelled. How much unnecessary suffering will continue unattended? How many small tumors will be undiagnosed because they are undetected? How many biopsies will not be taken because patients are hesitant to go to their physician and have the procedure, assuming that their physician is even available?

Third example. I know someone who is currently in the early stages of chemotherapy. He called his oncologist to ask if he should come in. The oncologist urged him to come in because he noted that if the number of COVID+ patients increases, the chemotherapy units may be converted to respiratory units.

These are examples of people who are vulnerable for COVID-19 but have other medical conditions that may go unattended because of the lock down, panic, and hysteria, that we are experiencing.  But there may also be medical consequences caused by the panic, stress, anxiety, and social isolation. I have another example. Some years ago, a middle-aged man that I knew was sitting on his porch enjoying his cigarette and cup of coffee. Suddenly an emergency ambulance had to be called.  Apparently, what happened was that the nicotine in the cigarette constricted his blood vessels while the caffeine in the coffee increased his blood pressure.  He may have had an undiagnosed aneurysm that suddenly burst. Unfortunately, in this case, he was DOA when he arrived at the hospital. But others in a similar situation might be saved if they can get to the ICU in time.  Today that would be much more difficult, and such a situation can also be brought on by increased stress and anxiety.  Much has been written about the consequences of social isolation and depression on the health of the elderly.  Even fecal impaction, a common condition among the elderly, can have dire medical consequences. Is anyone in the emergency room going to attend to an elderly person who complains of constipation?  Probably not.

So what President Trump was trying to emphasize is that the medical consequences of the extreme social distancing and lock downs might even be more damaging than the disease itself. Whether he is correct or not, it is definitely something that needs to be considered.

I have great respect for the eminent infectious disease experts, epidemiologists, and public health officials who are guiding us through this crisis. They are highly educated and trained professionals. I became familiar with their activities when I worked in the research laboratories of the NYC Department of Health many years ago.  At that time, we served as a sort of mini-CDC for the NYC area.  I would like to ask these experienced professionals to examine the data carefully as it comes in on a daily basis. Their decisions should be based on rigorous statistical examination of the data coupled with consideration of several appropriate interventions and their possible consequences.  With their expertise and guidance, we can actually get through this crisis sooner than later.



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