Why Have Guidelines, Rules & Regulations If No One Adheres to Them & There are NO Consequences?

I live and practice internal medicine and geriatrics in South Florida. We have a substantial elderly population living both independently and in senior facilities. The Sars2 Coronavirus Pandemic has been devastating to this patient population. There are many who became ill and passed away under the loneliest circumstances of in-hospital isolation. There are those who became ill and recovered but have lingering long-term effects. There are those who have avoided infection but are just beaten down by the daily monotony of staying safe, avoiding crowded public places and subsequently forsaking the company of friends and family.

The vaccine rollout in Florida was Helter Skelter and disorganized. It was every man and woman for themselves trying to obtain an appointment to be vaccinated. For the most, part the senior community managed to get the shots.

We were all grateful and buoyed as the summer of 2021 began by the news that we could venture out without masks and start resuming our pre-pandemic lives. The Delta variant and the recent surge in infectious cases, hospitalizations and now mortality put a quick and moribund end to that for most. The disparity between the message coming out of Washington and the CDC and the message delivered by our Governor and State Legislature has made decision making for individuals far more difficult than it should be. The latest conundrum is about the need for booster COVID vaccines or not.

The State of Israel, which exclusively used the Pfizer Vaccine, announced a third shot for those over 50 beginning a few weeks ago. Germany announced it would start such a program in September.

The CDC hinted at a booster program but until a NY Times article appeared on the evening of August 16th there was no official news on the subject beyond the recommendation that immunosuppressed individuals, especially organ transplant patients and cancer patients, under therapy get a third shot. Days before this announcement my patients had begun calling me, texting me, emailing me to tell me that their friends had walked into a Walgreens Pharmacy or Publix Pharmacy, showed them their Medicare ID card and their vaccine card and had been administered a third COVID vaccine shot with no questions asked. This was substantiated by multiple other patients including one couple spending the summer in the mountains of North Carolina.

Is there one set of rules for large chain pharmacies and another set for the rest of the world? What is the point of data and evidence-based recommendations if anyone can just do what they want when they want to?

At this point I will wait to hear the CDC’s recommendations on when to take a third shot and the data they used to explain why. I am thrilled that Pfizer has shown that a third shot is safe with few adverse effects. I am also buoyed by a research paper that showed that those groups who spaced their second shot at longer than the three- or four-week recommendations had a more robust immunologic response.

When my friends call me and ask me to join them on a trip to Publix or Walgreens to get the third shot now, I will hear my late mother’s voice in my brain asking that irritating question, “If all your friends decided to jump off the Empire State Building would you jump too?”

When Can I See My Grandchild? Social Distancing – Today’s Norm

I have a neighbor down the block who is a talented internist, administrator and teacher. On his resume is a stint as the Chief Medical Officer at a large urban hospital and director of the medical doctor training program as well. We walk our dogs at a safe social distance daily and update each other on the latest news on the Coronavirus in Florida.

We are also both relatively new glowing grandparents of two-year-old boys living in Dade County. Both boys brought home a viral illness 10 days ago and, quite frankly, with no testing available, we do not know what they had. The only important item is that they both recovered, and their parents are not sick.

“Do you have any idea when I can safely see Hank,” he asked rhetorically? “The CDC told me he needs two negative Covid-19 tests at least five days apart to make sure it is safe for someone over 60 years to safely take that risk. It’s difficult enough to obtain testing for acutely Ill patients so why would I waste them in this situation”?

Initial papers out of Wuhan, China demonstrate that when a sick person recovers from this infection, they continue to shed live virus for days or even weeks. Researchers either are not sure, or do not yet know, if those viral pieces can cause illness in some other susceptible host. They are not sure how someone is still contagious after recovering?

Hopefully this information will be available soon. Until we know for sure I would advise high risk patients to stay away from recovered Covid-19 patients for a few weeks.

Tonight, my wife and I will drive down to South Miami for a family BBQ. My son-in-law, daughter and grandchild, plus their dog Mia, will be on one side of a fence in a covered area. We will be across from them separated by a fence using our own gas grill. We will stay separated by a minimum of 10 yards and prepare our own food.

We will talk in person, tell some stories, sing some songs and then make the long drive home.

 

Hugs, kisses and rides on my shoulders will have to wait for another time.

Life’s New Reality with Coronavirus aka COVID-19

We are bombarded daily with news about the spreading infections with CoronaVirus or Covid-19. With television, the Internet and other news mediums; the quantity, quality and accuracy of information can be overwhelming.

This single stranded RNA virus has managed to invade most of our populated continents and is now moving into communities. There is more we do not know about this pathogen than we do know.

Public health officials which include the Trump Administration, the CDC, the NIH and local health departments have been extremely tight-lipped on the clinical course of the hundreds of US citizens evacuated from infected areas and quarantined for 14 days.

We do not know if there are any telltale historical or clinical markers to tip us off as to whether the patient in front of us with a cough and low grade fever might have a run of the mill seasonal viral infection or Covid-19.

And, it is still unclear,

  • How long the virus stays alive on a surface and remains infective.
  • How long the incubation period is and how long in advance of demonstrating signs of infection asymptomatic patients can transmit the disease.
  • What role, if any, children, who seem to be less vulnerable to the disease, play in the transmission of the disease as asymptomatic carriers?
  • How a relatively healthy nonsmoking adult in their 30’s to 50’s will do if they catch the disease?

The recommendations on testing from the administration and CDC have been unrealistic based on the lack of availability of the testing labs and kits in affected states. This will improve with time, but will it improve to the level of the “quick, never get out of your car, drive-through testing” being done in South Korea? That story, covered by CNN, was both enlightening and disheartening. Enlightening by illustrating how government can institute a plan quickly and efficiently.   Disheartening realizing that with all our wealth and expertise in the United States we are not doing something similar.

The recommendations about prevention are commonsense. Do I really need to log onto the CDC website to learn that I need to wash my hands, avoid touching my face and stay home if ill?

The selfishness and entitlement of the American public make even asking these minimal changes in our pattern to be a major inconvenience and intrusion into our privacy. I see the Ultra Rock Festival in Miami and the Calle Ocho street festival have been cancelled smartly to prevent infection. At the same time restaurants are jammed, servers and food preparation individuals without sick leave and health insurance still show up at work ill, to serve and prepare food, and many chronological adults balk at giving up their restaurants, bars, clubs and shows to prevent the spread of disease.

Posters suggesting we stay six feet away from others are plastered on buses and train platforms of mass transit systems where if you can stay 6 microns away from another transit passenger it’s as if you are travelling in the First Class section.

If we are all fortunate, Covid-19 will ultimately be an annoyance in the low risk population. We will develop fast and effective ways to detect it and then, with knowledge of how it spreads, we will be able to provide advice on how to protect others.

I am just not sure today’s American public has the will, the determination or the sense of community, altruism and sacrifice of lifestyle needed to prevent a major health and economic crisis.

INFORMATIONAL RESOURCES: