Sex, Drugs, and Public Health

         The phone jangles me up from some pleasant dream. The nurse in the Emergency Room has a man with chest pain and an abnormal EKG. At that time, we community physicians covered the E R for the hospital, so I get up, tip-toe from the bedroom, get dressed, and drive down.

         The guy is very uncomfortable, sweating and scared. His wife, a thin, angry-looking person, scowls from a corner. I explain to them that it could well be a heart attack and he’ll need to stay in the hospital.

         She interrupts me with words like razor blades. The guy has just started a small one-person business and they can’t afford for him to stay in the hospital. She refuses to believe it’s a heart attack and insists that her husband get back to work. I’ll spare you the prolonged efforts to educate them, to warn them of bad outcomes, interrupted frequently by the wife. She marches out, her husband behind, wincing in pain, sucking air thru his teeth.

         Acute Heart Attack and signing out Against Medical Advice are a lethal pairing. Such displays of individuals in Denial making bad decisions are common in this business. But when a sizable chunk of an entire country does it, the impact is massive. Recall that in February, our national leader called criticism of his handling of the Covid epidemic a “new hoax.” A significant minority of the country has followed suit (like the man following his wife from the E R) including politicians at all levels and an angry, mis-informed portion of the populace. So, let’s see how this “hoax” is going.

         Everybody grab a crowbar and we’ll pry the top off the old Denial box.

         Wow. Look at all these countries. 195 of them. Let’s see now, where is the U.S.? Ah, right here. On the bottom. No other country has as many cases. Or as many deaths.  Pretty powerful hoax.

         What are these? Cobwebs? Drifting clouds? Oh, they’re dreams.  From Harper’s magazine:

         “Every time I picked up an item to place it in my cart, it coughed or sneezed.”

         “I began dating a wonderful woman. She was going to break up with me unless I got a decent haircut. It was impossible!”

         “A friend and I were sitting on the veranda, overlooking a big field with trees and flowers. The flowers whispered to me that we had died from the virus and would return in the spring as red flowers.”

         Awake, we may choose Denial.  But asleep, our brains know what’s really going on. Apparently, they exude Anxiety. Where did that come from?

THE PICTURE’S GETTING CLEARER:

         As we learn more each day, it currently appears that Covid comes in at least seven different flavors. (1) Asymptomatic – infected but not (yet) ill. But more than half these folks have abnormal lungs on CT scans.  (2) Long Haulers – folks who are not sick enuf for the hospital, but have headaches, “brain fog,” dizziness, fever, heart palpitations, anxiety and exhaustion for up to four months. So far. We’re still studying them. Many are young – 18 to 34 years. (3) Hypoxemia – people who don’t feel short of breath but whose oxygen levels are dangerously low.  (4) Respiratory Failure – people on ventilators  (5) Blood Coagulation Disease – strokes, heart damage, kidney damage, amputations.  (6) Pediatric Inflammatory Syndrome – resulting in critically ill children with many organs involved.  (7) Cytokine Storm – persistent fever and over-active immune system function which can be fatal.

         No wonder our Health Care Workers are burning out. Are anxious as they see their PPE supplies running low. And lots of them are getting the disease. In a study of 545 Irish nurses who became infected with Covid and “recovered,” 91% of them were still experiencing some Long Hauler symptoms for months. If you don’t die of Covid, it is nevertheless causing a lot of damage.

Certainly not “the Flu.” Not “sniffles.” Not a Hoax.

THE BIG EXPERIMENT

         Wow. Look at all those kids in our box. Your kids. Your grandkids. They’re all participating in the experiment some of our politicians want to run with schools. Thing about a Pandemic is, the disease is worldwide. Let’s see what we can learn from other countries. The most respected Medical journal in the U.S. reports that many European countries (Netherlands, Denmark, Finland, Austria) have had opened schools since April without worsening the epidemic. But with reduced class sizes and social distancing. And they didn’t open until they had already achieved low levels of transmission (fewer than two new cases per day for every 100,000 people), and they continued those control efforts. The U.S. currently is cranking out 22 new cases a day per 100,000.

         On the other side of the Great School Experiment is Israel. After opening schools in May with crowded classrooms and minimal precautions, there was a resurgence of cases.

         How could the U.S. open schools SAFELY? According to Medical and Public Health experts, it’s pretty much the same approach we need to save our exhausted and stressed Health Care Workers: close non-essential indoor workplaces, 100% compliance with personal distancing and face covering in public, widespread testing. Experts believe that, if we started this NOW, we could open schools by October, as long as we apply these same precautions in the schools.

FACE COVERING DENIERS

         Look at all those people with uncovered noses and mouths swarming over everyone else in our box. Without their Denial-driven behavior, the epidemic in the U.S. would be more controlled. Whether they realize it or not, these naked-faced folks are projecting their disdain for everyone around them: hard-working store clerks, public servants in the Post Office, their neighbors, their families, the most vulnerable among us. If 100% of humans were reasonable and considerate of others (you know, like Jesus taught), then everyone would do the right thing. Like not exceeding the speed limit (to decrease injury and death on the highways). But there are always jerks going 85, shooting for 100. That’s why society needs Highway police.

         In my Public Health experience, I’ve had patients with TB who refused to remain isolated, and carriers of typhoid who refused to stop cooking. As with the speeders, Enforcement of the laws protecting the public is sometimes needed. Many people have told me that they believe we are at that point with face-covering- refuseniks. They jeopardize others in the setting of a worsening Pandemic. The society’s health requires an agency with the appropriate training and staffing to enforce the Public Health laws.

O M G !

         What’s that coming from the bottom of our box? Looks like smoke. We dig deeper. It’s Fire! And no water to put it out.

         There are still some Deniers of the impending Climate Catastrophe, but let’s see who doesn’t deny it. “Climate Change is an urgent and growing threat to our national security, contributing to increased natural disasters, refugee flows, and conflicts over basic resources,” reported the Pentagon to Congress. In 2015. Who else? Insurance companies that analyze the increasing frequency of fires as enuf of a risk to cancel home owners’ policies. What’s your major asset (house) worth on the market without insurance? Who else? While I served as chairperson of the California Health Officers’ committee on Environmental Health, we fought the State’s grab to take control of health-related water issues. I saw State officials (who were listening to corporate farmers demanding access to more water) discuss the process of accessing data on water production of private wells in the Sierra. Connect the dots. Who else? Public Health folks who are aware of the medical impact of increasing heat, worsening storms, catastrophic fires, disease-carrying mosquitoes moving to higher altitudes, and food crop impacts of the changing climate. We are also seeing the ominously accelerating process of wild animals interacting with humans. This sets up a route for viruses to jump from animals to humans. Like, you know, Covid.

         If Covid is the Green Mamba bite to Public Health, Climate Change is the metastatic cancer attacking Public Health.

         Close that Denial box !!!