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The Present

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To Vax or Not To Vax, That Is The Question

Guest Editorial by Dr. Duane Rommel, Board Certified in Pediatrics

 

The Wall Street Journal called upon Governor Ron De Santis to speak out on the benefits of the Covid Vaccine. (“A Covid Vaccine Crossroads, July 15, 2021). As a Primary Care Physician, I lend my experience with life-saving vaccines to this call.

As a grandfather of teenage grandchildren, this is personal. I support them getting the vaccine.

For years I’ve championed the benefits of vaccines, against a minority, the ‘anti-vaxxer’ voices who cling to internet science. After forty years, I’m not wasting my time arguing with them.

“You cannot reason someone out of something he or she was not reasoned into.”
– Jonathan Swift

My words are for those who support the vaccine. Unbelievably, I’m having to encourage those who do believe in science and are vaccinated.

John McEnroe, the famous tennis player, used to exclaim, “You cannot be serious!”

His outcry is mine. I’m shocked how some, in even the medical community and media, have complicated and confused the scientific facts regarding Covid. They insist mask wearing and social distancing are still necessary for the vaccinated. They don’t seem to believe in the lives saved and great success of the vaccines.

I do not believe, and neither does Ron De Santis, that our government needs to be in control of our health decisions. But, like Ron:

1.  I believe the Coronavirus is real.
2.  I don’t want to get a contagious illness that might cause mild to serious health problems, or death.
3.  I have gotten the vaccine.
4.  It is the vaccines, unlike any other measures, that have broken the back of the Covid pandemic.

For the vaccinated, the Covid Pandemic is over.

I’m writing to encourage those who are already vaccinated. You can live freely now, in spite of what we continue to read on the front page. Even fear mongering talk about ‘variants,’ can be disregarded, because they’re not life threatening to the vaccinated.

If you’re not vaccinated, join those of us living free from fear, and get the Covid vaccine. Currently 90% of people over age 65 have been vaccinated in the USA. However, if you look at people between 12 – 18 years old, only 13% of this age have been vaccinated.

My patients ask me, “Is it necessary, and safe to vaccinate my teenager?”

Although Covid 19 in children is usually milder than in adults, some kids can get very sick and have complications or long-lasting symptoms that affect their health and well-being.

A thousand cases of myocarditis (inflammation of the heart muscle), out of millions and millions of vaccinations, have been reported. But it’s a rare and mild condition which resolves quickly.
The benefits of being vaccinated for COVID-19 far outweigh the risks.

Get your teens vaccinated. The science shows that for the vaccinated, no more quarantines. Vaccinated school children need not miss school.

Get yourself and your kids vaccinated.

The American Academy of Pediatrics fully supports vaccinating children 12 to 18.

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Safe In The Arms Of Jesus

Every Christmas my Mother gave each of her daughters a “Choice Gleanings” devotional calendar. I still buy myself one every year, now that she’s in heaven with Jesus.

From January 27: “And I will give you the treasures of darkness, and hidden riches of secret places.” Isaiah 45:3 and “For you will light my candle: the LORD my God will enlighten my darkness.” Psalm 18:28 the note added, “… so do not fear dark places child of God, His presence will lighten your darkness and give you strength to go on.” another verse I have meditated on over the years , “When I sit in darkness, the LORD will be a light to me.” Micah 7:8.

Those words resonate with me after knee replacement surgery twelve weeks ago.

My knee is healing quite nicely. Duane and i have been biking with our red recumbent tandem since week four post surgery. I’m walking well although can’t do more than a mile. I’m back at yoga classes.

But after the surgery, what I thought was a mild anxiety disorder ballooned, with help from worry about pain, about not doing enough to heal properly and having some drug reactions that caused me to lose my appetite and ten pounds.

I’d wake up at 5 in the morning, sweating, jittery and crying to Duane for help.

Thankfully, I had a supportive doctor who I was able to get in to see. She did tests and said my health looked fine. I also called my therapist who I had seen in the past for direction and help with travel anxiety. She’s a Christian, and knows I’m a Christian, so when I told her, in tears, that I was worried I was going to hell, she could see I needed medical help.

“Jill, I’ve never seen you like this before,” she said. “I want you to see a psychiatrist to get your medications sorted out.”

The psychiatrist told me that one of the medications I had been taking for years for restless legs, and anxiety, had outlived its’ usefulness, and was the source of much of my problem, when it had combined with other knee medicines. It was time to wean off it.

Easier said than done.

One question my therapist asked, amid all the anxiety, was: “Do I feel safe?”

It’s a good question. I believe what I don’t feel safe about right now is my body. My knee is healing nicely, very well, and yet I still am limited in how much I walk and what I can do. I still remember the pressure the physical therapists put on me to “do everything right or you will not have a good outcome…”

Cutting back on the restless leg medicine solved the morning hysterics. Then as I cut back more, I began having hot flashes and jitteriness during the day or night, every day. It felt like my body was working against me with those general uncomfortable symptoms that some days had me laid out on the sofa. The psychiatrist gave me medicine to take the edge off, but the awareness of being on the cusp of an episode day after day is exhausting.

I was used to having a healthy body, but since December 10, when I had the surgery, I was fighting different body battles each week.

I grew up in a family where physical weakness was “poo poo-ed.”

“You’re healthy stock,” my father would say. He played tennis every day until he was 82. My mother walked daily with a friend. Neither was rarely sick. My mother developed Parkinson’s disease mildly at 65 which didn’t affect her daily life until her late 70’s.

Only in the last 2 years of his life did my father suffer with congestive heart failure, which caused him to lose so much weight he looked like a survivor of a concentration camp. That was when he and my mother had moved here to Clearwater, where my two sisters lived.

Some days we’d walk into their apartment at Regency Oaks and Dad would be sitting up at their small kitchen table eating his cereal, feeling fine. One day I walked in and he was sitting in his recliner, not feeling well at all. He often asked, “When do you think I’m going to go to the doctor and start feeling better?” He was a Dale Carnegie positive thinker. My unspoken response was, sadly, “Dad, you’re not going to be getting better.”

The day that hurt me the most was the day he said, “Just take me out and shoot me.” So unlike my Dad; he rarely complained but I knew the CHF was miserable.

Then the next time I visited, he was sitting in his recliner watching tennis on TV and he turned and said, “We’ll remember these days as the good times.” In my heart my response was, “Oh Dad, you have to be kidding, this is awful seeing you declining and suffering.” Now I laugh to myself that actually he was right: we enjoyed many good times with them in those last years, in spite of his health.

I’m thinking about my dad’s health because I think I’m too thin right now, like him. My appetite is coming back, but with drug withdrawal symptoms I’m not always hungry to eat, but know I should. Then I worry that the stress of being too thin and anxiety is hard on my heart. Duane checked that and it’s fine.

In my frustration and impatience with healing from surgery and overcoming medicine issues, my therapist suggested that maybe God has this time for me to slow down, wait, and work on relaxing.

“You need to adjust your expectations,” she said. “Give yourself six months to heal.” She suggested the “Calm” app when I was feeling anxious. Also, I began setting the iPad beside my bed so I could listen to hymns when I woke in the morning. Duane and I continue to take a walk after supper to listen to a Psalm and pray.

“Get a massage,” was another idea of the therapist, which was a new activity for me.

And Duane has been gently keeping me doing/going while also saying, “I understand.” I love him so much.

My morning devotional thought from March 5 was, “…He gives more of Himself to one person than to all the governments, politics, programs and opinions of this world. So dear believer, take courage and trust your loving Savior to get you through whatever you are facing today. You are a much loved child. Believe it.”

The blind hymn writer Fanny Crosby penned the lyric that followed, “…. Safe in the arms of Jesus, safe on His gentle breast. There by His love o’ershaded, sweetly my soul doth rest.”

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“Courage, Dear Heart”

I close my eyes or don’t watch movies with scenes of torture, or when a child dies or a pet is hurt.

So it’s been tough watching my grandkids, 4th and 7th grade, sitting, sitting, staring in front of a computer monitor for electronic ‘supposed’ learning, off and on the last months. 

I ventured out to Palm Harbor Nursery yesterday to buy red geraniums.  

“Don’t go out!” I hear the CDC voice, but I go out anyway.  The sun is shining in the great state of Florida.

During the purchase, the owner shared her horror about the kids in New York City who have been banished to E Learning.  I agreed with her.  The Academy of Pediatrics has stated that the safest place for children during The Virus is in brick and mortar schools.

Last Sunday, friends shared their experience visiting their elderly mother in a senior living facility.  

“They wouldn’t let us hug her goodbye, after the fifteen minutes, and she was crying.”

After nine months, these are not isolated cruelties, but repeated over and over and over, 

“Be safe,” everybody says to everybody now.

We’re sick of hearing it because it has created, not a safer world, but an unhealthy way of existing in our homes, churches, schools and businesses that used to bring life and joy.

The news media continues to peddle fear and misunderstanding so that we continue to tune in tomorrow. They’re desperate for ratings.  They have become expert in making us feel.  They should be helping us to understand.

The biggest turning point of 2020 is upon us.  Covid vaccines are ready for approval and distribution. We’ll be able to put this season of misery and death behind us.  However, in the misguided ideal of reporting both sides of the issue, the news continues to give air time to vaccine naysayers.

Many politicians, and the medical politicians at our CDC only make the problem worse.

We’re advised to not:  not go out, not get together with family for the holiday or any time, not travel, not touch.  That is cruel.  I can’t remember one week for the last nine months when the word ‘Surge’ wasn’t a headline in the newspaper, but the present week is always, according to The Experts, the beginning of The Worst.  That’s emotional torture.

In actor Alec Guinness’ autobiography “Blessings in Disguise” he describes his search for God during World War II.  He describes how he, along with many soldiers, turned to God, reading the New Testament on their Navy ship, in the days before battle and possible death.  

God is still our help, and we acknowledge Him as the source of providing treatments and vaccines for Covid.  He is our healer.

In Agatha Christie’s “An Autobiography,” she describes what life was like in London during the years of World War II:

“So time went on, now not so much like a nightmare as something that had been always going on, had always been there.  It had become, in fact, natural to expect that you yourself might be killed soon, that the people you loved best might be killed, that you would hear of the death of friends…”

Later, she reflects on the virtue that made those cruel days livable:

“…we can hope… we do not appreciate that second virtue in the trilogy ‘faith, hope, love.’ … how often do we forget that there is hope as well, and that we seldom think about hope?  We are ready to despair too soon…”  – Agatha Christie

The simplest shopping trip, over the last few months, could be a cause for despair.  I’d overhear a customer snap at another customer, “Stand back six feet from me!” Or encounter empty shelves.  But yesterday, I had a different, delightful experience. I stopped in at “The Painted Pear,” one of the few specialty shops of handmade and unique gifts that has not gone out of business because of the pandemic.  After picking out Christmas tree ornaments, I spotted, on the top shelf of one of the display cases, a wooden, handmade sign:

“Courage,   Dear Heart”

               -C.S. Lewis

I’m a Wheaton grad and devoted fan of Lewis.  He has a way of getting to the important point in a most clear and beautiful way.

I wanted to buy the sign, because it was the message I wanted to keep in front of me now.

I asked, but it wasn’t for sale. 

I’ll have to make one.

Encouraging truths which hide like secrets in the newspaper, regarding The Virus:

  1.  Safe and highly effective vaccines are almost ready to distribute.
  2. The Infection Mortality Rate, in spite of the constant drone of ‘case counts,’ remains extremely low, especially for the young and increasingly, because of advances in treatments, those of advancing age.

-picture taken at the College of Anesthesiologists in London, England.

 

 

 

 

 

 

 

 

 

 

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A Compassionate Covid Plan

an overdue guest editorial by pediatrician Dr. Duane Rommel:

“In a lecture at Cornell University in 1964, physicist Richard Feynman defined the scientific method:  First, you GUESS.  Then you determine the consequences of your guess.  Then you compare those consequences with outcome of experiments.  If your guess disagrees with the experiment, it is WRONG.   This is science.” 

    from the book, “How Innovation Works: And Why It Flourishes in Freedom”

For the past 9 months, we’ve been making a lot of guesses about Covid 19.  Some of the guesses have been wrong.  Some have been right.  Some vilified, some verified.  Some, we await the verdict.

I hear leaders claim that they are following “science.”  What that really means is that they are listening to certain scientists who happen to agree with their political bias.  The science of Covid 19 is incomplete and complex.  Therefore,  public health policy leaders need to be open to reassess their guesses and policies.

Anthony Fauci was christened by the press to be our ultimate “scientist.” Policy makers had to heed his guesses or be labeled “anti-scientific,” “uneducated,” or a “conspiracy theorist.”   However, our present reality illustrates that scientific policymakers need to re-examine their theory and be open to new ones.  That is how science works.  

Today’s newspaper trumpets “New Virus Cases Surge Across U.S. and America.”  The scientific policies followed by most Western countries are failing.   Many states and European countries hit by the pandemic imposed strict lockdowns this spring.  They launched testing and contact tracing programs to stop the spread of the virus throughout the summer and fall. These policies have failed as these countries and states have tried to ease their lockdowns.   They prove that the virus can’t be controlled that way. Their scientific theories aren’t working.

In October, another group of highly respected scientists gathered to propose a new plan for dealing with the pandemic.  

I strongly recommend everyone read “The Barrington Declaration,” and watch their video titled, “Dissenting Scientists Issue Herd Immunity Declaration” on their website: gbdeclaration.org.  Their Declaration challenges the current guesses about how to defeat the pandemic.

They explain why our current policies are 1.) Poor public health policy 2) Unscientific in their conclusions, and 3) Immoral as general policy.

They present the concept of herd immunity as a scientific fact which applies to the covid pandemic.  We reach herd immunity with every highly contagious illness that exists.   Herd immunity is the resistance to the spread of a contagious disease within a population that results when a sufficiently high proportion of individuals are immune to the disease. Herd immunity is not policy or opinion, but the way infectious diseases are controlled.  It will happen. The only question is how we will get to herd immunity with the least harm to the public.

Their proposal rests on the unchanging scientific fact of Covid: the Infection Mortality Rate.  This undeniable scientific data should be driving public health policy.  The Infection Mortality Rate for Covid 19 is ‘age specific;’ or radically different for different ages.  These scientists insist that leaders in public health must, in their words, ‘exploit this weakness’ of the virus to defeat it and reach herd immunity.  

I’m seeing patients frightened by Covid in my pediatric office.  These young people and their parents equate getting Covid 19 with a death sentence.  In fact, according to the CDC, the chance of dying from Covid, for a person under age 19, is 3 per 100,000.  www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html.   According to the CDC the chance of dying from the influenza last year for that same age person is 1.6 per 100,000.    For those 20 to 49 years old,  the chance of dying from Covid is 2 per 10,000.   The chance of dying from the flu is 2 per 100,000.   It’s not until age 70+ that the mortality rate of Covid 19 increases dramatically to 5 per 100.

This fact, the extremely low mortality rate in young people, which is accepted by all scientists, needs to be driving our policies. Scientific reality states that we will reach herd immunity at some point with Covid.  To clarify: the infection will largely come under control when enough people are immune to it.   Immunity will either be achieved through getting the illness or through a vaccine for the illness.  There is no other way.

The public health question that policy makers, assisted by the scientific data, need to discuss is: “How to achieve herd immunity with the least harm to the public’s health?”   

The Barrington Group recommends: “The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”

I strongly agree with their recommendations.  The second video illustrates their reasoning as to why this is better health policy, better moral policy and more compassionate than our current policy.  

We must stop being overly focused on Covid 19 alone.  That distorts our overall health policies to the point of harming the people we want to protect. 

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“Greyhound”: of Heroes, School and Covid

A combined movie review (by Jill) and Covid 19 update (by Dr. Duane Rommel)!

Jill:  Once again, Tom Hanks, the famous actor with the average face of Everyman, occupies center stage in heroic glory, as the Captain of an Allied ship in WW II.  Their mission: to defend desperately needed supplies as they travel through the Atlantic.  They face a formidable enemy,  German u-boats.

The most surprising moments in the film are brief scenes where Hanks prays over his breakfast, or fixes his tie as he gazes into a mirror edged with the verse, “Jesus, the same yesterday, today and forever, Hebrews 13:8.”  Or worries about the souls of the Germans he just killed.

Captain Krause is a man of faith.  The story unfolds as the intense 36 hour fight to protect the convoy.   Tom Hanks exudes believability Krause,  directing the ship through icy winter seas and torpedo attacks.   When the Germans send threatening messages in the dark night that play over the ship’s radio to the crew, “We are Grey Wolf and we are going to destroy you,” I felt the fear.  But Krause skillfully leads his team to work together to destroy a few of the German U boats who are trying to kill them.  Some of their own men die (war is hell) but Krause ultimately triumphs, bringing his ship into safe harbor.

In stark contrast, yesterday The Tampa Bay Times featured a front page picture of a teacher holding up a sign, “I can’t teach from a coffin.”  I was shocked.  In a time of war on Covid, our country and world need heroes.   The  teaching profession is usually made up of our leaders who instruct and inspire our next generation.   The message of magic marker on the sign was worse than a lie, it was a half-truth, something more powerfully destructive than a complete falsehood.  Yes, the truth is, a small percentage of those who get Covid will die.  But someone dedicated to teaching truth should know that the data supports the fact that most people will not.

Dr. Duane:  The fear and hysteria surrounding Covid 19 continues in a significant percentage of the population in the U.S.  Because of these overblown fears, many are now advocating a delay in the opening of school.  In my office, my patients ask me:

“Should kids return to school next month?”

My answer is an unqualified “YES”.

I am in agreement with the American Academy of Pediatrics, who wrote in their guidance statement: ” Schools are fundamental to child and adolescent development and well-being.  They provide our children with academic instruction, social and emotional skills,  safety, reliable nutrition, physical/speech and mental health therapy, and opportunities for physical activity, among other benefits.”  Statistics continue to show that the risks for kids under the age of 19 are minimal for dying from Covid.  Of the total number of deaths from the virus in the U.S., .0004 are in people under the age of 19.  And that does not even account for the underlying conditions in those children who died.  That is the total number.

So, school leaders need to ask themselves:  When is the treatment worse that the illness?  It’s obvious that the risks associated with the virus for our children are much less than the problems we will create in not opening the schools.  This does not address the personal concerns of  individual teachers.  If a teacher has an identified health risk from Covid 19 according to their physician, they should not teach this year.  But that does not mean we should close the schools because a small minority of teachers cannot be in the classroom.  To clarify: teachers, along with the general public, need to be reassured that statistical data shows the risk of dying from Covid, for teachers under the age of 65  is very low.  (see  http://jillrommel.com/2020/06/01/covid-19-statistics-for-dummies/).  The fear of some should not control a school districts’ decision about what is the right thing to do for our kids.

 

Winston Churchill said, “When you’re going through hell, keep going.”  We must move forward with life.  Schools must open.  As a physician, concerned with the whole well being of my patient families, I see how unwise policies produce more fear, which are pushing too many into unemployment, isolation and depression.

Jill and Dr. Duane:  The media is not helping.  Putting an image of a frightened teacher on the front page tears down the truth.  Rather than instructing the public, they pander to their fears to sell papers.  They play the part of “Greywolf” in the movie, the enemy, taunting the sailors with lies.  “We are coming after you and will destroy you.”  Instead, the media should be highlighting the lawn signs we’ve seen as we’ve biked our neighborhoods, “Thank you to our heroes: our health care workers and grocery store workers.”  Our heroes show up to work.  They are.  Teachers need to be heroes, too, and show up for school.

Seeing a hero, like the one Tom Hanks portrayed in “Greyhound,” reminds us that right actions are based in our faith in the truth.  And the truth is, getting Covid is not an automatic death sentence.  Scientific data continues to support this.    One would hope that schools, some with specific ‘STEM’ labels, would be places where their leaders would grasp these ideas.  I know quite a few teachers who do, and are ready to start back to school.

Some British made WW II movies are based on the idea of ‘the enemy within.’  This theme used to surprise me, as I assumed that all the Allies were on the same team:  ‘We’re all in this together.’  The facts reveal stories like that of Charles Lindbergh, American aviation hero, who was supporting the Nazis.  Royal Edward and his wife Wallis Simpson sympathized with the Nazis … or the traitor can be turn out to be the neighbor next door.  Unfortunately, there may be those among us that are trying to tear us down; who are on the Fear Team.

Facing the realities of life, like this Covid illness, forces each of us to choose what kind of person we’re going to be.  Interesting that in “Greyhound,” Captain Krause found his strength in God.  Duane and I have found ourselves to be in need of help these days.  Not that we’re afraid of the virus, but it’s sobering and saddens to see how the fear of the virus has destroyed so much.

‘Greyhound’ ends with a prayer.  Before falling into bed, exhausted after 36 hours straight of fighting the enemy, Captain Krause kneels beside his bed and says,  “I thank you, my heavenly Father, that you have graciously kept me this day.  Into your hands I commit my body and soul.”

 

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Fevers and Forecasts For Covid 19

 

Another guest posting by Pediatrician Dr. Duane Rommel.

I often get a call in the middle of the night from an anxious parent because their child has a fever of 104.  

“What other symptoms does he have?”  I ask.  “How is he acting?”

The mere fact that a two-year-old has an elevated fever is not a cause for alarm if the child is acting fairly normal, or if other family members have had the same illness.  Fever is only a symptom.  The important information for me is what is causing the fever. 

Similar reasoning applies to the most recent increase in Covid 19 cases in Florida.  The number of reported Covid 19 cases has increased significantly in Florida in the last week.  Forecasters are predicting their usual doom and gloom. 

“There will be catastrophic consequences,” according to the ‘model’ of Dr. Marrazzo of U of Alabama Birmingham Infectious Diseases. 

The big issue I have with the word “models” is that it suggests some kind of legitimate scientific basis for predicting the future.  However, every model which has been quoted in the news since the pandemic started has been drastically wrong. 

Governor Andrew Cuomo recently stated the same thing when asked about reopening New York, “All the national experts … were all wrong.”  There is not much difference between ‘models’ predicting the future for Covid 19 and tea leaves predicting the future.  These are guesses. There is a little bit of science and a lot of guessing.  So let’s start ignoring these guesses and concentrate on what is important.  

From the beginning, I have stated that many people will get infected with Covid 19.  The state of Florida has dramatically increased its testing availability and more cases are being diagnosed  which were missed several weeks ago.  

Also,  the state has relaxed the lockdown guidelines for most of Florida. Many more people are returning to normal activities with social distancing.  It is to be expected that more people will get the virus.   This also is not a cause for concern.

The infection mortality rate is the most important statistic, which the media continues to ignore.  The infection mortality rate is the risk of dying from Covid 19 if a person gets infected with it. The infection mortality rate in people under age 65 is about .1% in the latest U.S. studies.  This is a more encouraging and lower mortality rate than previously feared.  It is not necessary or wise,  in light of this data, to make any changes to present health guidelines regarding the virus in Florida.  

As Democratic Governor Gavin Newsom stated this week,”We have to recognize that you can’t be in a permanent state where people are locked away to see lives and livelihoods completely destroyed, without considering the health impact of those decisions as well.”

Efforts and resources need to be focused in protecting those who are most at risk of dying from this infection:  people in nursing homes and those with well defined risk factors. 

The most important statistics are not the daily case counts.   Other statistics to monitor are the ages of the individuals who are becoming infected, the daily hospitalization rates and  daily death counts.  These statistics will be better guides for our policy making decisions than the number of cases per day. 

A child with a fever can cause anxiety for a loving parent.  Reassurance and education  about how the fever is the body’s normal way of fighting an infection are often the only treatment needed.  The prospect of an uncontrolled virus at large has caused the same anxiety; however, the most important facts, like the infection mortality rate, should be trumpeted by the media to calm our country.

As a medical professional, I implore the media to cease broadcasting the so-called ‘scientific models’.  It’s harming my patients, and the general public as much as the screaming of ‘Fire!’ in a crowded theatre.

Disclaimer: My views may not reflect the views of Children’s Medical Center.  Please consult your own doctor for specific advice in your situation.

 

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A Prescription for Fear

Guest editorial by Pediatrician Duane Rommel, M.D.

In my first year of Pediatric Residency at the Mayo Clinic, I learned a major lesson.  We had to research a topic and present it at Grand Rounds.  The topic I chose was ‘The Placebo Effect in Medicine.’  Placebos are a harmless pill or procedure given for a psychological benefit to the patient.  The Placebo Effect, well documented in medicine, also explains why, when we do medical studies, we always take it into account.

I learned to use the power of placebo.  For example, studies have shown that patients begin to feel better when walking in the door to a doctor’s office.  My words and involvement in the patient’s life within the healing context of my office can influence both the actual illness and the perception of the illness in the patient.  This has a major impact on the outcome of the patient’s problem.

This applies to Covid 19. With Covid 19, as with many medical decisions  we face as doctors, there are unknowns.  We don’t really know the true fatality rate of this virus because the statistics are incomplete at this time.  We don’t know why it impacts the older population far more that the younger population.  We don’t know the likelihood of spreading the infection from surfaces which have been contaminated by someone with the infection.  We don’t know how the mental and physical health of people will be affected after months of ‘stay at home’ isolation.   

But as physicians, we are forced to make medical decisions within current knowledge, even though sometimes key facts aren’t clear.  We make educated choices on the science we have, along with past experience. 

Epidemiologists, another type of medical professional, make predictions about our health future. The scientific name for these guesses is “modeling.”   Modeling tries to put numbers on some of the theories which will predict our medical future. 

I’ve lived in Florida for 25 years. Floridians know modeling.  About ten times a year, scientists make models for hurricanes. They attempt to predict how strong they will be and where they will go.  Floridians spend hours, days, even weeks, glued to our televisions, watching the ‘spaghetti’ hurricane models.  Almost every one one of them is wrong in specific outcomes, especially when the storm is farther out in the Atlantic. 

The same thing is happening for Covid 19 modeling.  Two months ago, the models were predicting that there would be 460,000 cases of Covid 19 in Florida and that the ICU beds would be totally full by April 15.  As of today, May 4, there are 36,000 cases of the virus and about a 40% vacancy rate in the ICU’s.  

Our nation’s epidemiologists and newspapers have used models and statistics over the last months to scare us into behaving how they believe we need to live.  We’ve been told that if you get Covid 19 either you will die or, even worse:   “I’m not worried for myself, but I have a family member  who’s high risk, and I don’t want to cause their death.”

There’s a bit of truth there, but also, like an iceberg that is only partially visible, lots of hidden fiction.  The truth is that my life does impact others.  Because it does, I will take reasonable precautions, like six foot distancing and washing my hands and coughing into my elbow or possibly even wearing a mask.  But the insidious lie is:  ” I am the one responsible for a family member getting sick because I choose not to “stay at home” anymore.”

If we believe this lie, we wouldn’t drive our car with a loved one in it.  I would force my brother to get a flu vaccine even though he doesn’t want one.  I wouldn’t allow my children to go to school because they might get meningitis.   The truth is, every person is responsible for their own health. We can never fully protect our loved ones no matter how hard we try. I cannot take on the impossible burden of protecting everyone else’s health to the detriment of my own well being.

To be fair, medical epidemiologists will never give a message of comfort; their livelihood is statistics and graphs.  Scientists make the hurricane models. It’s the task of local weatherpeople, like our favorite Denis Phillips on abc TV,  to use their experience to interpret them, to advise and calm, during the storm.  Likewise, medical practitioners, the ones dealing with direct patient care, need to use their expertise to reassure the public.

“This is a serious infection, but very likely you will get over the illness, so take proper precautions and you will get through this.”  

Instead of hearing that reasonable and calming message, while the infection rate drops, the public’s fear rate now runs rampant.  

Today, in Florida, we’re allowed to go to the beach and pool. However, the Florida Department of Health has a two page list of disinfecting rules, so technical and at the same time vague, that citizens are afraid of liability or continuing to spread the virus.  There are warning signs at the beach.  FDOH is still spreading fear of the sickness that prevents people from enjoying these activities, even though the chances of transferring illness through them is likely extremely small.

Stores and restaurants began opening this week.  Jill went to three stores yesterday that were open but empty of customers.  Pandemic panic is still incapacitating us from getting back to life enhancing activities.  Many stores have chosen to remain closed.  The Placebo Effect is working in a negative way at this time.  We are being told the country is sick.  We aren’t being told we’re getting better. 

No one knows the final outcome of the Covid 19 story.  But as a physician, I choose to look for the positive outcome.  My goal is to remove fear from my patients.  In medicine the outcome is always better when patients have hope, rather than when they are anxious. 

 The biggest problem we’re facing now is fear.  Fear for myself.  Fear of me getting someone else sick. Fear is our enemy.  

In the film “The Farewell,”  a beloved grandmother in China is diagnosed with lung cancer.  She’s coughing up blood.  However, the medical community in China doesn’t believe in predicting the patient’s life expectancy.  The films’ true story plays out through the eyes of her granddaughter, a college student in America.  She’s horrified her grandmother is not being told the prognosis: death in six months.  Along with her parents and extended family, they travel to see the grandmother, ‘for the last farewell.’  The gathering of a family wedding conceals the real motive for the trip to China.  At the end of the movie we see a clip of the grandmother practicing Tai Chi, six years later. 

“It’s the fear of death that actually kills you,”  the grandmother’s Chinese sister explains to the granddaughter.

Modeling and statistics can be interpreted either to bring life, or cause suffering and death. 

As a physician, I choose hope and life.

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Risky Business

 

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.

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Duane Rommel, M.D.’s Pandemic Prescription

The following is a guest editorial by Dr. Duane Rommel, M.D.  Duane graduated Alpha Omega Alpha, with highest medical honors, from Stritch School of Medicine in Chicago; trained in Pediatrics at the Mayo Clinic in Rochester, Minnesota, and now practices Pediatrics with Children’s Medical Center in Palm Harbor, Florida.

 

Fantastic News!  The coronavirus pandemic is not as scary as we thought.

In the last 2 weeks, surveillance data has shown that the Covid 19 virus is much more widespread than testing had been able to show, because of the limited testing previously available.  As a medical doctor, I’ve been anxiously waiting for these results of antibody testing.  The surveillance statistics from this shows the real numbers of people who have been infected with Covid 19.  Two of the most recent surveys were reported in the Wall Street Journal’s  interview (April 25, 2020) with Dr. John Ioannidis, professor at Stanford’s school of Medicine.  He’s a well regarded expert in statistics, biomedical data, prevention research and health research and policy.  The surveillance testing showed that in a random population in the Stanford area,  the infection rate was between 50 to 85 times the number of previously confirmed cases.  This data has  been confirmed by  surveillance studies in high incidence areas in New York recently.

This is great because it demonstrates that the Covid 19  fatality rate is between .12 to .2%.  This is far less than the initial reports of a fatality rate of 2 to 4 %.  Also, of the fatalities, only 1% of the deaths involve people under the age of 65.  Therefore the fatality rate for Covid 19 is .0012 to .002% for people under the age of 65.  This rate is the same of most seasonal flu illnesses every year.  This is the key statistic that all public health decisions are being based on.

I’m excited about this new data because I’m a primary care physician.  My son and daughter-in-law are also primary care physicians.  We are uniquely qualified to analyze this data, as practitioners in the medical community.  We  routinely digest research and statistics from the the ‘experts’ in university and government programs, such as the CDC and FDA.  We continually have to make judgments for our patients based on real life applications of  medical .research and statistics.  We practice evidenced-based medicine, which means we make decisions based on scientific data.  However, statistics can be interpreted in different ways, depending on the biases of the physician looking at the numbers.  Medicine is not an exact science.

The first rule of medicine is “Do no harm.”  The next rule is that when a patient comes to us, we weigh the risks versus the benefits of the treatment which we are prescribing.  As this applies to our current situation, the nation’s physicians, Dr. Anthony Fauci and Dr. Deborah Birx have prescribed a “stay at home” treatment program for our country.  Based on their knowledge at the time when they made this prescription, this was the best treatment course of action.  Now, with the new information about the surveillance data,  we need to adjust our treatment program.

In light of the latest scientific data, we are doing more harm than good with our treatment program.  .  First, in the field of medicine, I am referring to the delaying of medical treatments and prevention.  The statistics are clearly showing that childhood, life-saving immunizations are being delayed.  Screening tests for breast cancer and colon cancer are not being done.  Patients are afraid to go to the doctor to get their diabetes or chest pain evaluated.   Medical problems are being caused by our current treatment program which are leading to an increase in mortality greater than the pandemic.

Other ancillary problems of our national shut downs are more difficult to quantitate.  Job loss leads to lack of meaning in life which leads to depression.  How will we tabulate the suicides related to our isolating treatment program? Fear and anxiety contribute to physical illness.  This is where primary care physicians are in a unique position.  We see the whole patient, not just the Covid related concerns.  We see the stress to our patients which is being caused by our treatment.   I have not even touched on the economic pain and disruption since I am not an economist, but that is interwoven with our current treatment.

The major objection to changing our current treatment plan is that people will die.   As physicians, we know that people die every day.  We also know that there are many illnesses for which we have no good treatments.  When a child comes to see me with a stomach virus, I routinely tell parents that the infection has to run its course.  I have no treatment for the infection.  I can make sure the child does not get dehydrated but I cannot cure the virus.

This is the case with most viruses today.  We have no treatment for Covid 19.  We cannot stop this infection from infecting 60 – 70% of people eventually, despite the public’s most vigorous practices. When the virus entered our country, medical advice pushed for us to ‘flatten the curve.’  This means that we were trying to spread out the infection over a longer period of time.  There was never a cure. The same number of people are going to get the virus: either now or later.   Covid 19 is a highly contagious virus.  This is the truth that I am not hearing from the leaders of our government, being advised by our medical community.  ‘Mitigation’ does not mean ‘cure.’   Your infection with Covid 19 may not happen in the next month but it will certainly happen in the next 12 – 18 months.  A vaccine is too far off for any help.  No responsible medical expert has promised any cure with our current stay at home guidelines.  Unfortunately, most people think they’re not going to get the virus if they work hard enough.  That is not truth.

We cannot make present medical decisions on “what if” possible treatments.  With the new statistics showing a far lower mortality rate, we must reevaluate our strategy.   We’re creating problems now and for the future with our treatment plan.  As a doctor, I make decisions based in the scientific facts of the here and now.   Consider the fatality rate.  That is the good news.  It is not Ebola virus.  It is proving to be similar to a flu virus, despite what the news has trumpeted with its 24/7 hospital videos and incoherent number counts.

In light of this latest scientific information, government and medicine must lead our country with a new treatment plan.  We need to let the public know that we do not have a cure for coronavirus and it will have to run its course.  We will monitor the course, to make sure it does not overwhelm society, but there are not any cures for viruses.  In mercy, we need to remove the gigantic layers of guilt we’ve laid on the general population; that by our own unhygienic practices, we are causing our loved one’s deaths.

We need to reeducate a panicked populace.  First, we need to remove excessive “stay at home” directives.  Encourage all people to resume all doctor visits.  Start meeting with family and friends.  Open up all retail and restaurants with reasonable social distancing.  Allow all outdoor activities: playgrounds, beaches, kids sports and fitness centers.  Reassess in 2-3 weeks the Covid 19 surveillance data.  If the infection rate is reasonable, make more changes such as opening churches and other larger gatherings.   Allow all domestic travel.  As much as possible get everyone back to work.    Responsible medical scientists will continue to monitor the numbers and statistics as we go forward to adjust for what we need to do.

The bad news, the hard truth that I am not hearing from our government and medical leaders, is that we have no cure for Covid 19 and you likely will get infected with it.  The good news is that Covid 19 is nowhere near as fatal as the original estimates. The really good news is that when you get your infection you probably will not know you had it. Let us start behaving with that reality.  We need to change our treatment plan and not harm the patient (our society) any further.   As more scientific knowledge becomes available, we will continue to adjust our treatment program based on that science and the wisdom which God provides to us.

 

Disclaimer: My views may not reflect the views of Children’s Medical Center.  Please consult your own doctor for specific advice in your situation.

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His Eye Is On The Sparrow

 

I have a little friend that visits me when I sit at my desk.  His mother built her nest in the hurricane shutter outside my window.  I have a ‘thing’ about birds.  It started with J.M. Barrie’s book, “The Little White Bird,” published in 1901.  I found a copy in a bookstore in England when I was there for the Wheaton in England program.  The middle chapters of the book introduce the wonderful Peter Pan.

Birds fly in many chapters of the Bible.  The dove descends on Jesus at his baptism.  A picture of the Holy Spirit.  Whenever I see a bird in flight, or standing near me on my porch railing, I think, “God is here.”  Good news these days.

What have Duane and I been doing these days?  On March 2, we bought a 2 bedroom villa in Countryside, to be nearer to work and church.  We’re keeping the beach condo.  Here’s a picture of our new bedroom.  Duane just got the mirror I found at a consignment store hung.  Outside the window you can see our deck that overlooks a  small retention pond.

Days after we bought the villa, our world began shutting down.  The lady we bought it from left most of her furnishings, so we had beds and chairs.   I’ve painted almost every room in my favorite color, Benjamin Moore’s OC-19, which sounds eerily like the virus.  It’s name is ‘Seapearl,’ a warm white.

With a new place, we’ve been making frequent trips to Home Depot, staying, as we say in Florida, “an alligator’s distance” from each other.

The owner also left four filing cabinets, and etc., in the garage.  Her move was overwhelming her; she was moving into a senior living facility.  We told her to leave whatever.  Over the last year of 3 or 4 moves we have become adept at Salvation Army, Facebook marketplace, etc.   This picture is after we cleared out, with our friend Dustin McCanse’s help, most of the stuff.

A clean garage, Duane’s pride and joy, because now he has a spot for our bikes.  He has hung my bike on a unique pulley system in the left corner.  Our recumbent tandem is not shown, or Duane’s other bike for riding to work.

We’ve been blessed with 2 of our 4 grandkids being in town.  Last week, Elizabeth and Mike were still in their offices working, so we tried valiantly to oversee Ethan and Sophie’s schoolwork, with schools closed.  Some mornings we had three computers juggling different Zoom meetings.

Then you have to make sure everyone gets lunch.  Sophie counts out the number of Pringles to go with the sandwiches.

After lunch Elizabeth picked up the kids.   We resume the continual small projects of moving, like cleaning dust out of the chandelier from when the popcorn ceilings were removed.    Going to the food store, doing the wash, getting ready for Zoom Bible study, Zoom men’s group, Zoom Adult Bible Fellowship, and church online.

Duane is still working, more part time than ever.  He’s busy with frequent physician telephone meetings to figure out how to best serve their patients.  Things change; another phone meeting.

And we make exercise a priority every day.  At the condo we bike or walk the beach or the neighborhood.  Officially the beach is closed however supposedly if you are in the water you can walk along the shoreline.  It’s pretty deserted but still beautiful.

And we bike.  It’s been easy putting our recumbent tandem, that we’ve had for over 20 years, in the van to transport it between the condo and the villa.  We are thankful we can get outdoors and see God’s beautiful world.  I took this picture because ahead of us is a guy on a bike with a giant front wheel, in the style of the original bikes.

I love this blue flower, a delphinium, in front of the pink geranium.  It won’t last in the Florida heat.  But I’m enjoying it for now.    One of Mother’s favorite questions was, “What are you looking forward to this week?”

If I read the newspaper or watch the news (I’m definitely stopping all news/press conferences as of today) it feels like there’s not much to look forward to.  The government’s idea of ‘soon’ things are opening up, and my definition of ‘soon’ are different!  Not accidentally, I hugged a friend I ran into on an essential trip to Target yesterday.

Each day, the good things prevail .

 

“Be strong and courageous, do not be terrified, for the LORD your God is with you wherever you go.”  Joshua 1:9

 

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