Another guest editorial by Dr. Duane Rommel, FAAP, member of Alpha Omega Alpha medical honor society, and Board Certified Pediatrican, practicing at Children’s Medical Center in Palm Harbor, Florida.
I was surprised at the overwhelming response to my previous post. The first article surveyed the current situation and treatments regarding Covid 19 in the U.S. I received a number of questions from people who are at higher risk, according to the current knowledge, of Covid 19. Time to talk about risk.
We now know some people have a higher mortality risk. We also know that some populations seem to be almost immune from the virus. Clearly, age is the biggest risk factor. The older you are, the more risk of dying from the virus. Children’s deaths are so rare, the numbers can be counted on one hand.
My response to the question of risk is that each individual must make decisions about their life choices with input from your own physician.
Everyone makes risk judgments every day. Often we don’t even know the exact amount of risk, but we know there is some risk involved. Older people commonly climb on ladders to paint or clean gutters. We know that if an older person falls, he has a much higher risk of permanent disability or death. I see this same risk assessment played out in my office every day. We recommend the flu vaccine for everyone. About one half of the patients choose not to get the vaccine which is proven safe. Some patients are more concerned about their perceived possibility of getting sick from the vaccine, than dying from the flu. Even when I try to convince them that the vaccine is safe and that you cannot become ill from the vaccine, they choose the riskier path of not getting vaccinated. They have the responsibility and right to make this personal decision.
The same risk responsibility should apply regarding Covid 19. Physicians should be informing patients about how to manage the new reality with Covid 19. We need to inform our patients about the level of risk they face according to the best medical knowledge so that the patient can decide what course of action to take. Our knowledge of Covid 19 is continually expanding so these risk assessments may change over time.
As I stated previously, the latest scientific data has been very encouraging regarding the risk of mortality. Even today, according to the Oxford Centre for Evidence-Based Medicine, Covid 19 will be fatal in a flu-like 0.1% to 0.36% of cases. The large majority of the deaths from Covid 19 would be in the over 65 years population. The mortality rate for people under 65 is .001%.
We have accepted these mortality rates as a society many times in the past with other serious flu epidemics without panic and shutting down the country. Unfortunately, instead of helpful data, for the last weeks we’ve only been inundated with daily death counts. These numbers, out of context, have no meaning other than to create hysteria. That number tells me nothing about my individual risk or the risk that we face as a country. Our government leaders, standing on the best medical knowledge, need to educate citizens about risks they are facing. Then each person may determine what risk they will take and make decisions on their own activities . This is, basically, what Sweden is doing.
For the last few weeks, I gave government the benefit of the doubt about their leadership. They were just being cautious in their heavy response to Covid 19. Now the time has come to stop needlessly frightening us.
I live in Pinellas County, Florida. After watching yesterday’s County Commission meeting, I must speak out again. The Commissioners were meeting to decide whether to reopen the beaches and swimming pools. Citizens were allowed to comment on their decision. Fear dominated much of their discussion and some public input. A majority of citizens pled for freedom from the government restricting activities that under all other circumstances would be obvious rights we have as Americans.
The commissioners finally voted to open up the beaches and pools next week. However, it was obvious that they are very reluctant to give away the powers that they have assumed during this crisis. Even though Sheriff Gaultieri told them that some current guidelines are unenforceable for a number of reasons, they still wanted to keep some restrictions on people at the beach. The idea of restricting beach activities has no valid medical basis. There are miles of beach in Pinellas county and people can easily social distance at the beaches. The commissioners don’t trust that people know how to do that. Or there might be a few people who don’t social distance enough. This is ridiculous. Government must give up these emergency powers which they are currently abusing. They need to allow people to determine their own activities, such as beach-going, since they want to accept the miniscule level of risk.
Yesterday’s meeting illustrates the bigger issue: who will decide our health choices? The government, or patients under a physician’s care? Our current crisis has become a major health mess. The government has scared the community so much that the risk of Covid 19 has disproportionately eclipsed every other health risk. Medical professionals who are able to understand and apply medical decision making must be involved in their patient’s health. Many patients are now too afraid to even go and see their doctors.
The most important thing for our government leaders to do now is get out. People must go back to their physicians to get the medical information they need to determine personal life choices based on their own risk tolerance. To continue down the current path of trying to control the virus by restricting activities and controlling our behavior until a treatment or vaccine is developed, is unwise. From the feedback that I received, the longer our leaders dawdle in that direction the more people will suffer and die.
Disclaimer: My views may not reflect views of Children’s Medical Center where I work. Please seek medical advice for you own situation with your doctor.