Doctors are human and make mistakes

This article on WOWT Channel 6 about a letter sent by a doctor’s office caught my attention, but not in a good way.

https://www.wowt.com/2020/07/25/omaha-doctors-office-issues-controversial-letter-about-children-and-covid-19/

After reading this letter, I would probably look to another family medicine practice to work with.

I have written a lot of documents for work and personal, and persuasive documents are some of the most critical if you want to get your message across, convince people to take up your cause, or even simply help them understand your point of view. In my opinion, this letter does none of that and is probably going to cause problems for them in the long run. (And in case it’s not obvious, I’m not a medical practitioner so please talk with a medical professional you trust if you have questions.)

Right off the bat, they mentioned “SARS-CaronaVirus-2” and “COVID-19” – both are referring to the same viral infection, the “SARS” name is the formal name but they use both within the letter. They don’t mention this (the letter is aimed at a non-medical audience), and it’s not evident why they felt the need to alternate the names. In this document, I’ll stick with the common COVID-19 name.

In the first section, they discuss treating patients with Hydroxychloroquine, ZPak, and other medications. The Hydroxychloroquine treatment made the news earlier this summer as the “super cure” by some people. There were reports of its effectiveness in some trials, but none of those trials could be reproduced and many more trials showed no significant benefit to treat COVID-19, and its known side effects are bad enough to make taking it risky when it is used properly (https://www.webmd.com/lung/news/20200407/side-effects-halt-use-of-chloroquine-vs-covid-19). And their use of ZPak is also concerning – ZPak is commonly used to treat bacterial infections, not viral infections such as COVID-19. Again the side effects of using ZPak in this manner are concerning because their over (mis-)use will ultimately breed antibiotic-resistant bacteria. Their off-label use of ZPak and Hydroxychloroquine seems to be pandering more to the “Karens” of the world instead of relying on sound medical practice.

The next section down-plays the role of masks in reducing the spread of the disease. A quick search of the Internet using your preferred search engine for “evidence masks work” will yield a lot of links to many well respected medical research sites discussing their benefits. While I do agree with them when they suggest that an ill person should seek treatment and stay home until they are healthy instead of relying on a mask, they are missing the obvious point. With COVID-19, many people can be symptom-free for many days – during that time they are able to infect anyone around them through the water droplets in their breath hanging in the air and landing on another person’s eyes or getting into their lungs. And as they point out in their next paragraph, it does seem that younger people tend to not get as sick as older adults. So the wearing of masks is important here too as the masks on the young will decrease the chance of spreading, and the masks on the older will further reduce their chances of inhaling an errant cough particle. Until an effective vaccination or other treatment is available for COVID-19, wearing a mask one of the few actions we can take to protect ourselves.

Finally, we get to what appears to be their main point: children in schools.

They begin by stating several “facts” about the rarity of certain events: how often young people contract COVID-19, how often they get sick, and finally how often the virus is transmitted to adults around them. There are many well-documented cases of people who spread viruses but never show the symptoms – does Typhoid Mary ring a bell?. If you use an Internet search engine for “covid-19 transmission vectors” you’ll find numerous medical research articles where they found the exact opposite – the ability to spread COVID-19 is not clearly related to age.

In that section, they have a number of sentences that bring up “facts” about fatalities attributed to other sicknesses such as Influenza. They specifically mention pediatric fatalities attributed to COVID-19 are “somewhere between 3 and 30, in the USA”. A quick search of “pediatric coronavirus deaths in US” brings up this information from the CDC which seems to corroborate their information:

As of April 2, 2020, the coronavirus disease 2019 (COVID-19) pandemic has resulted in >890,000 cases and >45,000 deaths worldwide, including 239,279 cases and 5,443 deaths in the United States (1,2). […] Three deaths were reported among the pediatric cases included in this analysis.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm

That is good, but the following sentence raises an alarm:

These data support previous findings that children with COVID-19 might not have reported fever or cough as often as do adults (4). Whereas most COVID-19 cases in children are not severe, serious COVID-19 illness resulting in hospitalization still occurs in this age group. Social distancing and everyday preventive behaviors remain important for all age groups as patients with less serious illness and those without symptoms likely play an important role in disease transmission (6,7).

https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm

The same source for their fact on the “low risk” that COVID-19 plays to our children go on to explain that this is probably due in large part to the infection being overlooked in children (i.e. infecting others), combined with the current social distancing and other preventative measures we have had in place. These actions ended the 2019/2020 school year early; as a parent, I’m worried that this fall we will have a dramatic increase in infections of our children that will cause the pediatric fatality number to go well beyond “3 and 30”.

You may have noticed that I put the word “facts” in quotation marks above. I’m not doing this for dramatic effect, rather I’m trying to point out that many of their figures and comments are stated as “facts” but there are no links to where that data came from. For most of my facts and comments I’ve noted here, I’ve tried to put links to multiple sources where possible. Their document does not provide any of this – you’re expected to take all of this at face value and not question anything.

And that’s what probably has me the most concerned. Our society has been built on learning from each other and having active discussions around topics so a wider audience can be informed and hopefully at the end of the day all sides come away with new and better information. Too many of us are taking the easy way and either failing to engage to improve our understanding of the topics, while others resort to grade-school level name-calling and shouting down instead of discussions.

Taken as a whole, the letter provided by “Family Medicine at Legacy” feels like it was written only to appease a certain mindset individual who wants to ignore reality and hope this all “goes away” overnight without needing to be further inconvenienced. It’s this mindset that makes me think that our society has reached a tipping point and we’re collectively the “fragile snowflake” more than the strong and resilient humans we claimed we were a few decades before.

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