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.

 

We biked into the church parking lot this Sunday morning.  I was so happy to be back at church that my eyes filled with tears.

I’ve been having flashbacks of Duane’s medical residency, forty years ago, during these last months of lockdown.  We had moved to Rochester, Minnesota, where we knew no one.  Duane was on call at the hospital every third night, leaving me alone at home.  That July, I realized the normal routines of life would be gone for three years.  The natural rhythm of workweek/weekend disappeared.  Friday night movie dates, over.  We used to go to church together on Sunday mornings.  Now I went alone.

I was pregnant, too, so technically not alone.  I found a job at the County Clerk’s office processing passports and marriage licenses.  A  kind couple at  the church I attended started a Bible study for new mothers soon after Mike was born.  Even though I was new to the church, the ladies held a baby shower for me.  I went home with a car full of presents, from other young mothers who hardly knew me.

For Duane and I, being part of a healthy church has been a top priority.  We’ve moved a lot in our forty three years of marriage.  Wherever we settled, we searched for a good church.  A place where people who follow Jesus gather.

I remember the couple who taught our Sunday School class when Duane was in residency, Herb and Fran Reigler.  They tried anonymously, to pay for our car repair bill when the motor froze.  Where ever we’ve moved, we’ve met more people like them:  the friends who visited the juvenile jail with us to share their lives with incarcerated kids.  Jeanne always remembered each child’s birthday with a card. Our Sunday morning team who planned and led a worship program for kids.  The high school kids who babysat the kids of young parents so they could get together.  The friends who have listened to our family emergencies and prayed for us, and asked us, “How’s it going?”  These are people who care about others.

Over the last weeks, unable to go to church on Sunday mornings, I miss my Christian friends.  We’re different ages, in different ‘life seasons’ with different callings and backgrounds.  But my Christian friends share two characteristics that attract me: gentleness and grace.  Over the years, we’ve shared the good, bad and ugly of life.

When something comes up on a Monday morning, or whenever life crashes into my plans, I  think, “I’ll be able to share this with my friends at church.”  It comforts me to know they’re praying for me. I’ve seen circumstances change in ways I couldn’t make happen myself.  These aren’t just nice people, they’re people who’ve made the choice to believe God exists and that he cares about us.  And so, we  care about each other.

On the old  British show “All Creatures Great and Small”, two veterinarians were discussing the hard lives of their patients, the farmers of northern England.

“They have sheer stubborn pride and refuse to quit, in spite of the frightening day to day realities they face.  They’re a breed apart.  They possess that exceptional quality of the unbreakable human spirit.”

In the next scene, James, one of the vets, is sitting at the kitchen table of the farm family whose cows needed his healing.  The farmer’s wife kindly asks James if he would like a cup of tea and a piece of pie.  Her son, hardly twelve, breezes through the room.

“I’m off to check on the cows for Dad,”  he announces as he goes out the door.

“Where’s your husband?”  James asks.

“He’s in hospital,”  the wife answers.

“Is it serious?”  James looks shocked, as he had just seen him a week ago, and farmers can’t afford to go to hospital.

“Well… it’s not looking hopeful,”  she says quietly.  Set in 1937, before present day medical treatments, death was not uncommon for illnesses we shrug off today.

I’ve been meditating on that ‘unbreakable human spirit,’ pictured so poignantly in that farm family.

When ‘the going gets tough, the tough get going,’ goes the old motto, and in these present days my ‘unbreakable human spirit,’ can feel fragile.  I used to turn on the news each morning, to catch the local weather.  Not anymore;  I’d have to endure hearing the newscasters spouting the latest Covid stats.  So I make other choices, which take time to consider.  The constant ‘considering how to spend the time’ and being forced out of life’s habits and routines, is, in itself, exhausting.

I try to surround myself with inspiration.  Winston Churchill’s speeches can do that. The epitome of moral courage, he determined to survive against Hitler.  In response to the idea of surrender to Hitler, Churchill stated, ““If this long island story of ours is to end at last, let it end only when each of us lies choking in his own blood upon the ground.”    

I try to copy his resolve.  Lately, I also  remember that Churchill spent much of the war taking hot baths and drinking heavily.

The greatest hardship of quarantine for me has been the loss of the Sunday morning church experience.  Zoom and internet services can’t fill the void.  My mainstay, beyond faith in God, is  being able to get together with people who love God.   I go to church on Sundays with expectancy.  A  serendipitous Energy pervades those gatherings, that begin out in the parking lot when we arrive, because we often meet there first.   Surprising encounters happen in hallways and the lobby.  The carefully planned services restore my spirit’s perspective.  Through music, prayers and spoken truth I’m changed and strengthened.  Something I didn’t expect but came looking for is found.

It’s the one morning out of seven where the focus is God’s community, not me.   I’m reminded of important things I knew but forgot.  Being with other Christians, God’s kingdom comes alive. The ideas I hear may propel me to a new choice or a new habit.  Or something to eliminate from my life.  This morning I learned about a summer Bible study to join.

If the human spirit is ‘unbreakable’ or we’re stronger than we feel at times, it’s only because God is the one who supplies the love and strength that we need to make it.  He designed us to live in relationship with him through our relationships with others.

I was thrilled and thankful to be with my church family this Sunday.  We met at 8 a.m. outside, in our shady parking lot.  Being the middle of June, no one  expected the cool Florida breeze that floated around us, scattering the Pastors music and sermon notes.   We sat on lawn chairs or blankets we brought, with our children at our feet.   We joined in Communion with each other.

In the last weeks, as our county has begun a careful Reopening,  some of the New Normals have been a disappointment.  Store shelves still have empty spaces..  Libraries and restaurants aren’t their usual selves.

But this Sunday morning’s gathering, thoughtfully planned with wisdom, began my week with the same life-giving joy as every other Sunday.  As always, God’s glory shines in his people.

 

“I will proclaim your name to my brothers and sisters. I will praise you among your assembled people.”       -Psalm 22:22.

“The world is a perfectly safe place to be as long as you are in the Kingdom of God.”  – Dallas Willard

Another in what has turned out to be a series of medical posts by Dr. Duane Rommel:

I read the headline in the National Review, “Why does the CDC think the Covid 19 fatality rate is so low and why won’t it tell anyone?”  (https://www.nationalreview.com/corner/why-does-the-cdc-think-the-covid-19-fatality-rate-is-so-low-and-why-wont-it-tell-anyone/)

I’ve been asking myself the same question.

In April, early data was beginning to show the Covid virus that locked us  in our homes was not as fearsome as first thought.  The health experts that supported that view were lambasted.  As the weeks pass, more data has arrived, supporting their claims.  The latest news comes from the CDC, our government’s scientists; yet some don’t want to believe it.  Or, worse, report it clearly to the public.

This report from the CDC, our nation’s health protection agency (https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html) was dated May 20.  Their best understanding of Covid 19 shows  that for those age 0-49 the Case Fatality Rate for people who have symptoms is .05%.  

Please take time to learn this important statistic.  This is one statistic that has meaning, in a never ending sea of confusing numbers broadcast in the media.  The case fatality rate means the number of deaths from Covid 19 divided by the number of people who had symptoms of Covid 19 and tested positive.

The case fatality rate for age 50-64 year olds with symptoms is .2%. The case fatality rate for age 65+ year olds  with symptoms is 1.3%. The CDC currently estimates that 35% of Covid 19 cases are without symptoms.  

Even more important than the Case Fatality Rate is the Infection Fatality Rate.  The Infection Fatality Rate is the number of deaths from Covid 19 divided by all the cases; symptomatic plus asymptomatic.  The Infection Fatality Rate, according to the CDC’s research at this time, is: 

Age 0 to 49:  .032%

Age 50 to 64:  .13%

Age 65 + :   .85%

Earlier rates were being used by the government to set policies leading to the shutdown of our country.   These numbers are a significant change from those used in March, which were estimated to be 3-5%.  The case fatality rates clearly have been a major factor in government officials’ decision making.  The higher the fatality rate, the more aggressive we needed to be to minimize the transfer of the virus from person to person.  The less the fatality rate, the more we can resume activities which allow contact between people.   

The current understanding of the Infection Fatality Rate by the CDC on May 20, is one tenth the original estimate.  A typical infection fatality rate for the ‘seasonal flu’ is .1%.  So Covid 19 is three times more deadly than the seasonal flu, not thirty times, as originally predicted.

This great news should be leading media headlines.  Instead, each night news anchors mindlessly read the number of cases and deaths.  Death counts have no meaning out of context.  If a patient deciding on surgery with anesthesia asks, “How many people died from anesthesia last year?”  The factual answer is “310.”  This is not helpful; what they need to know is the death rate, not the number.  The death rate is .001%, a reasonable risk to take.

Why did the CDC, a reliable group of physicians and scientists, change their estimates?

Scientist Brian Nosek, Ph.D., of the University of Virginia, comments: 

 “The pandemic has exposed the messiness of science.  That’s how science always is, but we don’t usually see that truth exposed so vividly.  We all want answers today, and science is not going to give them.  Science is uncertainty.  And the pace of uncertainty reduction in science is way slower that the pace of a pandemic.”

 From the beginning of the pandemic, scientists have been clamoring for reliable data.  New data and findings continue to pour in. The truth about Covid 19 is complex.  These fatality numbers are the CDC’s new best estimates.

It’s better to understand science  as a process.  As the new knowledge about Covid-19 emerges, the recommendations by experts need to reflect this change.  We cannot stay stuck in the March policies when we have a better understanding of reality.  This means we should not be fearing the numbers of cases in most people under age 65.  We should be treating this situation as we deal with our yearly flu epidemics. Open schools.  Open camps.  Open stores.  Stop wiping all surfaces.  Finally, figure out how to protect the elderly.  

The greatest challenge for our government and health leaders will be to communicate, after months of fear, that this is a virus we can manage and survive.  The CDC’s latest projections can’t be ignored.

The tornado that whisks Dorothy out of Kansas in the Wizard of Oz,  and drops her house on the Wicked Witch of the East, terrifies the folk of Munchkin Land.  The Munchkins are hiding in their homes. Glinda, the good witch, arrives and sings, “Come out, come out, wherever you are, and meet the young lady who fell from a star.” 

We can come out now.

 

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.

 

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.

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.

 

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

 

We’re the only country in the world with the motto, “In God We Trust” plastered on our money,  We are a uniquely spiritually based place.  So I’m shocked at the flood of virus fear rocking the U.S.A.  The panic has exposed, like the Emporer in the fairy tale strutting about in his birthday suit, that for many, our faith has rested not on God, but on two powerless gods: Science and Government.

I’m the wife of a scientist; my husband is a doctor, as are two of my children.  I’ve also run for political office, worked on local political campaigns, and investigate candidates before I vote for them.  I admire and respect our scientists and politicians for their work.  But in this crisis, they will not save us.

People can see that.  There’s no way out.  There’s no epidemiological chart that will protect anyone 100%. For all the explanations, there are some people dying that ‘don’t meet the criteria.’  Panic!

We  set ourselves up for this.  We built special schools for our kids called “STEM” schools, because Science (along with math and technology) is the Most Important subject.  We love facts.  Yet science cannot, for as much as it tries, tell us where we came from, what our life’s meaning is, or predict the future.  I’m a Floridian.  I’ve lived through hundreds of Spaghetti models of hurricanes’ track.  Meteorologists  can tell you a hurricane is coming, but not where it will land exactly or how catastrophic the devastation will be.  Ask thousands of cancer survivors about their supposed ‘life expectancy.’

As for the power of our country’s elected leaders to help us in this crisis:  in general, I grew up thinking Democrats thought they could do more, and Republicans expected to do less. But in this event, both Democrats and Republicans are falling over each other to Help.  Two weeks ago our Republican sheriff began posting  “closed signs” at every beach entrance and “non-essential” business.   This to ‘slow the spread.’  The President’s Virus Team, a group of dedicated doctors and politicians (‘politics makes strange bedfellows’!) informs and entertains each evening on the television regarding their Plans For Us.  Unfortunately, for all the testing, shut downs, masks, etc., they cannot control the virus.  If the truth is told, much of what is stated is pure conjecture.  A guess.

They’re not telling us the truth: only God is in control.

“You can’t handle the truth!”  the famous quote from the military film, “A Few Good Men” indicts most of us.  It’s a hard pill to swallow for many in the United States, because with our brilliant scientists and the American Way, God has been on the back burner or off the stove completely.

We now have time in our viral induced seclusion to look at ourselves in the mirror and ask the hard questions about what I believe my life is all about.

Put your trust in God.

Psychoanalyst Viktor Frankl, survivor of the Nazi concentration camps that killed over 3 million, wrote,

“Forces beyond your control can take away everything you possess except one thing, your freedom to choose how you will respond to the situation. You cannot control what happens to you in life, but you can always control what you will feel and do about what happens to you.”

We can choose faith in God.  I keep hoping to hear, during the televised Virus Team meetings in our capital, some acknowledgment by our leaders, several of whom are people of faith, that our country has a need for deliverance that can only be met by God.  I did hear the word ‘miracle’ used once or twice, but that is not near the credit God deserves.  Medical treatments, lower than expected mortality rates or the coveted vaccine will come, but will the team, or we as individuals, give credit to God,  the source of all healing and good?

In a favorite episode of the comedy “Dick Van Dyke Show”, Laura and neighbor Millie have spent an overnight petrified because they thought they heard robbers in the house.  To drown out their terror,  they blast the TV and radio, and turn on all the lights.   After hearing one more crash, they dash out to the garage.  Millie begins screaming hysterically.  Then, shockingly, Laura slaps Millie in the face.

“Pull yourself together!”  Laura cries.

Millie immediately stops.

During the show, we the viewers were shown some of the harmless events that got translated into high anxiety.   We know the night is not as scary as Laura and Millie’s experience. We’re laughing, because their fear was all nonsense.

This virus is no joke.  But it is something we can trust God with.  And must, if we want to be true to what we say we believe, and the very money we print.

That slap is what we all need right now.

Put our trust in God.  This is our opportunity to see him provide for us.

“This I declare about the LORD.  He alone is my refuge, my place of safety; he is my God and I trust him.  For he will rescue you from every trap and protect you from deadly disease.”  Psalm 91: 2-3

 

 

 

 

 

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I can still feel the chilly breeze on my cheeks that May morning we visited Hotel Dieu, in Beune, France.  The French word  ‘hotel’ has roots in the Latin ‘hospes,’ meaning ‘a place of caring for a stranger.’  Our word, ‘hospitality.’

In 1443, Nicolas Rolin, a wealthy ‘old man’ of 47, and his third wife, the 18 year old Guigone de Salins, built Hotel Dieu, or the House of God.  The people of the area were destitute and suffering from the plague, a contagious illness that had no cure.

 

On the tour we heard that Nicolas built Hotel Dieu as an act of Christian charity.   His wife, Guigone, was the heart of the work.   An educated noblewoman, she furnished the rooms of the hospital with art because she believed healing the body was inseparable from healing the spirit.   The motto  Nicolas had inscribed on floor tiles and walls, “Seulle,” as a tribute to his wife, means ‘only her.”

After Nicolas died,  Guigone joined the order she and her husband established at Hotel Dieu, “Les sœurs hospitalières de Beaune”, serving the destitute there until she died in 1470.  The mission continued until the 1970s.

The furnishings we saw in The Room of the Poor, above, date from the 19th century, when each bed held two patients!  The chapel sits in the same space, through the wooden gothic arch, so the bedridden could still attend Mass.

In 2020 with a new plague afflicting us,  I remember our visit to Hotel Dieu.  Through the centuries,  Jesus’ followers are the courageous caregivers serving the sick, poor and needy.

“Lord, when did we ever see you hungry and feed you?  Or thirsty and give you something to drink?  Or a stranger and show you hospitality?  Or naked and give you clothing?  When did we ever see you sick or in prison and visit you?”

And Jesus will say, “I tell you the truth, when you did it to the least of these my brothers and sisters, you were doing it to me!”   Matthew 25:38-40

 

 

 

 

 

“I hear America singing, the varied carols I hear,

Those of mechanics, each one singing his as it should be blithe and strong.

The carpenter singing his as he measures his plank or beam…

 

…The delicious singing of the mother,

or of the young wife at work,

or of the girl sewing or washing,

Each singing what belongs to him

or her and to none else….”

– Walt Whitman  (I didn’t quote the entire poem but its worthwhile)

I open the ‘Daily Gleanings’ calendar to “Tuesday March 24, 2020.”  I scan the verse for the day as I set my foot on the plank floor.

“I will look unto the LORD; I will wait for the God of my salvation; my God will hear me.   Micah 7:7

Dating all the way back to the days of Moses and the crossing of the Red Sea, Israel was taught to “Stand still, and see the salvation of the LORD…(Exodus 14:13).”

Written thousands of years ago, It’s as if a fortune teller predicted exactly what I needed to read in the present day.

For those of us who are introverts, the present ‘social distancing’ and the idea that we need to stay home is like a Christmas gift.  Except the reality is that with reduced work and nonexistent school hours, I’ve had more people around than usual.  People I love…   But… I need more than solitude to write.  Like Captain Hook, in the Broadway version of “Peter Pan,”  I need inspiration.

“Inspire me!  Play, you dogs, play!”  Captain Hook demands music of his rag tag pirate urchins.

After days of dismal discouragement, fresh air came blowing in the window from listening to Dr. Deborah Birx last evening during a White House press conference.  “Who is this intelligent woman, sharing clear and helpful statistics?” Duane and I wondered.  This morning, I dug around and found she is one of the doctors on the President’s crisis team and she graduated from Houghton, a Christian college, in New York.

And Walt Whitman’s poem inspires me, describing the vibrant  joy of work.  Specifically, the heroism of every American worker.  Some U.S. officials are deciding, these days, what to keep ‘open’ and what is ‘nonessential.’  All work is essential; our efforts to feed, cloth, shelter and protect each other,  all bring meaning and blessing.

Interesting that we have a phrase for our work: ‘what we do for a living.’  Our work isn’t only about a paycheck.  Our work, illustrated in Whitman’s poem, is one of the things that keeps us alive.

For ‘home managers,’ now we’re on the battle’s front lines.  Psalm 84 illuminates the beauty of ‘place.’  Verse 3 describes security,  “Even the sparrow finds a home, and the swallow builds her nest and raises her young at a place near your altar, O LORD of Heaven’s Armies.”

In Lance Morrow’s excellent article, “What to Do When You’re Sheltering in Place,” he shares practical ideas for creating a haven of peace for our families.

Saturday I planted flowers outside the kitchen window. I’m making simple but tasty dinners, using the recipes on the back of the Stove Top Stuffing box.  Yesterday we listened to Rimsky -Korsakov’s “Scheherazade” while we made S’mores.

The German bombs that killed 43,000 civilians in Britain during WWII created the slogan of resilience its people carried in their hearts, “Keep Calm and Carry On.”

We must do the same.

 

“The light shines in the darkness, and the darkness can never extinguish it.”  John 1:5

 

 

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