We continue addressing (basically, I'm playing catch-up) of several misunderstandings that have arisen or persisted or resurfaced over the last few weeks.
COVID-19 MISUNDERSTANDING #6
I'M TIRED OF MANDATES, WHY CAN'T WE BE MORE LIKE FLORIDA?
Governor Ron DeSantis, long upheld by those who feel COVID is overblown or who feel that mask/vaccine mandates are tyranny, or even just people who are tired of New York state's regulations (even though for COVID they have been helpful), has announced that Florida is doing much better. Of course, he also tried to say that during the summer time when Florida had among the top death rates (by state) in the USA. We have learned that COVID sort of does have a seasonal component - it spreads most indoors. So in the south, when it gets really warm and people congregate indoors with the air conditioning, COVID has a field day. Later, in the winter time when people across the northern US start gathering around heat, COVID surges there. DeSantis tried to say everything was fine and, in the name of “freedom,” forbade businesses from implementing masking. Make it make sense.
In addition, he appointed Dr. Joseph Ladapo as his yes-man surgeon general. Ladapo has proceeded to undermine masks and vaccines with zero evidence behind his own claims. Recently he was asked point-blank, "Are the COVID-19 vaccines safe and effective?" He took a FULL TWO MINUTES of hemming and hawing before he finally admitted that yes, they are. It was appalling to watch because he has the same education I do (and he was classmates with people who I like and respect in medicine) and yet he just ignores all of that to please his governor and uphold an anti-vaccine/anti-public health narrative.
They both recently held a press conference where they advocated for stopping COVID testing as a pre-emptive measure (a measure which I advise for whenever you go out to hang with friends when cases and hospitalizations are mid-surge). They stood behind a podium that said "Early Treatment Saves Lives" and DeSantis said, "Think about it. Before COVID, did anyone go out and seek testing to determine if they were sick?" Apparently DeSantis has never heard of cancer screening, blood pressure checks, or STD testing. Go figure.
He also tried to blame President Biden recently for revoking the EUA for "lifesaving monoclonal antibody treatments"...except that the EUA was only revoked for the two mAbs that have been shown not to work against Omicron, which is now the dominant strain in the world. The companies that make them even acknowledged that!
People like to talk about “the narrative” around COVID-19 vaccination, but this is some pretty terrible spin on DeSantis’s part, blatantly rejecting evidence, public health, and reason in favor of playing to the frustration of his supporters.
Because make no mistake, this is frustrating. No one likes vaccine mandates or testing requirements, least of all me. But if we are going to try to end this pandemic safely (or at least get to a level where we don’t see 2,500 people dying every day and that’s considered “a downtrend”), we must be willing, as a nation, to implement these measures when necessary. Not constantly or permanently, but more consistently than we are now. We are approaching what is hopefully the end of the Omicron surge. As Dr. Ashish Jha and epidemiologist Dr. Eleanor Murray have stated, the upcoming lull should not be a time of complete abandonment of mitigation measures (though a relaxation of some things may be possible), but a time of preparation so that the next variant or surge is less deadly, less taxing on our systems, which will get us that much closer to an actual end.
WELL, DID THESE PEOPLE WHO DIED HAVE COMORBIDITIES?
You're asking the wrong question. That answer may be important for statistics and understanding who suffers from the virus, but it is not justification for declining the vaccine or refusing other mitigation measures.
"Well, if I don't have those comorbidities, I don't need to worry, then!" Someone once asked me if, as a doctor, I could explain why the vaccine would benefit them (they had previously had COVID infection). From the very beginning, many of us have stated that vaccines have never been solely about the individual.
This also implies that if they have comorbidities they somehow deserved their sickness/death. "Well, if they'd taken better care of themselves..." without acknowledging the role of genetics, social determinants of health, and how incredibly contagious and potentially deadly this virus is.
If you don't live under a rock, there is a high likelihood that you know someone with "a comorbidity" (maybe it's just high blood pressure that is normally very controlled) or who has a level of immunocompromise. They may be more likely to get sicker if infected (though that's not a guarantee for those without comorbidities, as I said), so why wouldn't you protect them from that risk?
ARE ALL THESE PATIENTS HOSPITALIZED "WITH" OR "BECAUSE OF" COVID?
Again, this is the wrong question. The only people asking this are those who do not work in hospitals. Yes, there are patients who test positive incidentally when they come to the hospital for something else. So why do we bother testing? Because we know that asymptomatic and presymptomatic transmission happens with COVID-19, and in a building with vulnerable patients, we should take every step we can to prevent spread to those patients (this is also the reason for vaccine mandates among healthcare workers and hospital staff).
Of course, the reason people ask this is because they think that there is a distinction when we report hospital cases "from" vs. "with" COVID - it's not about people getting sick or dying, it's because they want to downplay the seriousness of the pandemic so that not as many restrictions need to be placed. What is not acknowledged is that every case, even when incidental, as the potential to lengthen the hospital stay (maybe they need to finish their isolation before they can go back to their facility or to their surgery/procedure without which they cannot leave the hospital) or, worse, make the patient sicker and/or kill them. It still leads to overwhelming the hospitals/healthcare system. The hospitals at which I work have been at/near max capacity before, but it's never been this sustained - that's a testament to how bad Omicron still is.
And if you're asking me to clarify whether people died "with" or "from" COVID, you haven't read my posts about how death certificates work and you need to go do that.
The only way to decrease need for mitigation measures is to decrease spread. The only way to do that is to USE mitigation measures and get as many people vaccinated as possible.
WHY ARE PEOPLE STILL MAD AT JOE ROGAN? WHY "CENSOR" SOMEONE WHO'S JUST BRINGING ON MULTIPLE VIEWS?
Rogan has proceeded to double down on the anti-vaccination rhetoric. Yes, at first he tried to play it down, but then he proceeded to have both Robert Malone (the self-proclaimed "inventor of mRNA vaccines", which is false) and Peter McCullough (a cardiologist beloved by Fox News) both of whom repeat multiple claims that are completely without evidence, in order to scare people off vaccines. I could be okay with this if Rogan fact-checked them (it's not hard) or even gave an equal voice to evidence-based science for a rebuttal (multiple evidence-based scientists have tried to reach out, including folks he’s had on before, but they’ve been ignored).
However, when Josh Zepps (an Australian media personality) pointed out the evidence that myocarditis is more frequent and worse from COVID-19 than from vaccination, THAT is when Rogan decided to fact check. Then when his intern looked it up and proved Zepps correct (vaccine-induced myocarditis is far less frequent and less severe than COVID-induced myocarditis, especially in kids), Rogan refused to believe that, casting about for alternative facts, even referring to misused VAERS data.
So Rogan is buying into disinformation for more listens/clicks. Why should I care? Why should I sign an open letter asking Spotify to identify his episodes as disinformation?
People are immediately decrying “the left” and “cancel culture.”
In a time where a portion of the country is trying to ban books and restrict voting rights, what Rogan is (barely) facing is a far cry from actual “cancel culture.”
This is merely consequences for his actions. Rogan and his guests aren’t just “stating opinions” - the guests claim they have facts that no one else knows, but with zero actual evidence or peer review. People then cite his podcast and his guests as to why they refuse life-saving vaccines and treatments and instead try other medications that have been proven not to work, and some of those people (or their families/friends) get sicker and/or die.
On top of that, he made a faux apology and soon after proceeded to share a (already-debunked) story about ivermectin. His disinformation is dangerous and he should not get to enjoy the same platform.
Many people, myself included, have paid Spotify for their services, and Spotify pays Joe Rogan a handsome amount for his program. I don’t want my money contributing to a person and his program that is literally putting people in danger. I will take my money from Spotify, for what little good that will do, but I will also advocate that Spotify, a private company, should not reward or platform this disinformation.
A colleague of mine, Dr. Leah Gilliam, put it this way: "You don't "both sides" this issue when one side is wildly and dangerously wrong. It's like saying we need to hear from the people who advocate for putting pennies in electrical sockets." Yes, that's an adequate comparison. Disinformation kills, and I will not stand for that. But it was good fodder for a TikTok I made.
HOW ABOUT THESE TRUCKS CONVOYING ACROSS CANADA TO PROTEST VACCINES? I HEARD THERE ARE MILLIONS!
Yeah, the "Freedom Convoy." Somebody tried to paint it as 250 million truck drivers protesting vaccines.
It's MAYBE a couple hundred truckers and some private vehicles who claim to be protesting for "freedom." Except once again, it's a protest of vaccines and reasonable mitigation measures designed to prevent the spread and prolongation of the deadliest pandemic in 100 years (quarantine for unvaccinated truckers who have to cross into the US and then return). They have raised a lot of money (it's a pretty unofficial GoFundMe, so hopefully it actually goes somewhere besides someone's pocket) and have a great deal of support from far-right extremist groups - much of the violence-inciting sentiment and even the flags on the trucks are very reminiscent of the white supremacist terrorists that attacked the US Capitol on January 6, 2021. There is also a great deal of Islamophobia and anti-semitism seen among the truckers and organizers, according to Canadian physicians and other activists. On top of all of that, the convoy apparently stole food from a homeless shelter on their route (Shepherds of Good Hope in Ottawa) and defaced a statue of inspiring Canadian Terry Fox.
Canada's vaccine rollout has been frustrating. Some provinces' pandemic response has been worse than that of the US. But this protest is 1) A minority opinion vs 85% vaccinated Canadians, 2) Not protesting for the right reasons, and 3) Has lost the plot anyway, a disinformation- and white supremacy-backed temper tantrum.
IS IT TRUE THAT THEY DENIED A PATIENT A HEART TRANSPLANT BECAUSE HE REFUSED TO GET VACCINATED?
This is another example of people suddenly noticing things that have been routine for decades. (Of note, when Jordan Peterson expresses outrage over something, you can be certain it doesn't deserve the outrage in the way he thinks.) Up-to-date vaccines have always been required for transplants, because once you receive a transplant, you have to take immune suppression medications that render vaccinations less effective. Transplant organs are an unfortunately rare commodity - there are many factors affecting eligibility, including susceptibility to preventable illnesses. So no, that guy was not taken off a transplant list - he was never able to be placed on the list.
Anyone who predicts that the pandemic will end after Omicron is selling you something, because there’s no way to predict that. Similarly, anyone who tells you the pandemic will never end is either tired of hearing about it and throwing in the towel (regardless of what it will do to the vulnerable folks around them) or despairing over the COVID apathy running rampant. Neither are correct. This paragraph is wrapping up nicely, but the end of the pandemic is not yet that neat. However, it is still within reach.
Last week, 15,000 people died of COVID-19 in the United States. There are still a high number of hospitalizations and deaths every day here. We are still very much in the middle of the pandemic. We are hopefully on the downward trend with the current Omicron surge, but if we're going to keep that trend going down, and prevent another one from happening, we MUST get as many people as possible vaccinated, and we need to keep up the mitigation measures for now. Recently someone expressed frustration about mask mandates being struck down by a judge while boosters and masks were required for healthcare workers. The unfairness is not that that boosters and masks are required for HCWs - it's that they are not required for everyone else. Teachers, police officers, and anyone who works in a place where they are up in people’s space should be vaccinated and, for now, masked. It's not about government control or some other conspiracy - it's about controlling COVID, which is still within reach, but is not going to happen overnight.