Good Advice and Quality Care Is Not A Negotiation!

In this era of the “Art of the Deal” many in my patient population seem to believe that dealing with science, math and physical laws of nature is a negotiation.  They seem to believe as it’s the same as if you hired a contractor to work on your home and he wants a 20% down payment when you sign the contract and you only want to pay 5%.

I’ referring particularly to the laws of transmission of respiratory viruses, droplet particles and aerosolized viral particles. We are supposed to be wearing masks or facial coverings when indoors or when we are within a few feet of each other (six feet or less). We are supposed to stay six feet or more apart.

If exposed to the coronavirus or COVID-19 you are supposed to go home, stay home and self-quarantine for 14 days. You can contact your physician and discuss the circumstances and ask for advice.

What you are not supposed to do is go home, get anxious and agitated and spend hours on the phone trying to get tested immediately. The tests are only about 70% accurate (nasopharyngeal swabs via PCR). The quick tests, with turnaround times of hours, are wrong 48% of the time.

I explain this to concerned individuals and try to soothe their fears but the negotiations begin. I am flattered by the degree of confidence and power they believe I have but just because you want me to say something contrary to what the scientific facts show, doesn’t mean it is correct or good advice.

Sometimes my patients try and make me feel like I am a priest in a Catholic Church during confession, but I have neither the training nor the connections with the good Lord. Sometimes they try and make me feel like the supreme leader who can grant them a special dispensation. I am not that powerful or good and this is Mother Nature we are dealing with and laws of science.

As an example of what I mean, let me use a personal situation as an illustration. My daughter, son-in-law and 2.5-year-old grandson live south of Miami in Dade County in an affluent community of young well-educated individuals called Palmetto Bay. They both work full-time and have been working from home due to the COVID-19 pandemic. My grandson is cared for, watched, taught, loved and instructed during the day by his loving grandmothers so the kids are free to work without incurring childcare expenses.

Both grandmas’ have master’s level early childhood teaching degrees and one is a psychologist who recently retired from the Dade County School system. Seeing my grandson grow up with his grandmothers doing what they love to do most is a joy. When COVID-19 raged in March, they closed the pre-school my grandson attended. Unexpected exposure to others resulted in both grandmothers having to avoid my children because they are both older with chronic illnesses and considered high risk for COVID-19.

The pre-school sessions resumed a few weeks ago bringing joy to my wife and grandson. My daughter’s neighbors show little or no respect for the coronavirus. When I last visited three weeks ago there was a party going on next door and four adult men in their thirties or early forties were out on the lawn without masks or social distancing puffing away on cigars while a band of young children intermingled on the lawn. We all waved hello but kept our distance.

Two days later my son-in-law left his home through a side door to take a stroller out of his SUV parked 30 yards deep in his driveway without a mask. The neighbors five-year-old, playing freely on her lawn saw him and ran over to say hello while his back was to the child. He turned around and this well-meaning child was right there in his face. He jumped back, thought nothing of it because they were outside, and he is three feet taller but realized that the close encounter was worrisome. Two hours later they received a phone call from the neighbor saying that unfortunately they had just been informed that all their friends who visited over the weekend were now ill and tested positive for COVID-19. The neighbor was concerned about the encounter between my son-in-law and her child because my daughter happens to be pregnant.

My daughter called her obstetrician who told her what I tell my patients. Your husband needs to self-distance and self-quarantine for 14 days. When my daughter said they had been in contact several times since the incident, the obstetrician repeated the original advice. They all went into self-quarantine for 14 days. The grandma nanny visits stopped. I received a frantic phone call that night after my daughter spoke to her OB and supported the advice she had been given.

Living in Dade County they tried to get tested beginning five days after exposure, but the lines were horrible, and supplies ran out while waiting several times. With no symptoms, they did not need the test. The strain of working full-time from home and caring for a toddler was an issue once the grandma’s stopped helping because they were afraid of catching the disease if the kids were exposed. They tried multiple times to negotiate another route or plan with the OB, with me and with their mothers. I finally said, “This is not a negotiation. These are the facts. These are the suggestions of the World Health Organization, the Center for Disease Control and your own doctors.“

On Day 15, the grandmas agreed to return. The neighbor’s child never tested COVID-19 positive nor did the child’s parents.

Missing your loved ones is a terrible price to pay for the unchecked virus. I feel horrible for those in quarantine who miss their loved ones dearly.

However, I cannot give you a “Get Out of Jail Free” card like they have in Monopoly. I cannot tell you that if you are recovering from a lymphoproliferative cancer it is safe to pass through an airport, take a commercial airliner and visit your kids or folks if it really isn’t. I cannot safely tell you after arriving it is fine to not self-quarantine for 14 days before seeing high risk relatives. I cannot tell you the same-day quick COVID-19 test they are performing at the local private walk-in center or your community board is providing is fully accurate when in fact science shows it is not.

I will discuss with you the facts and if asked for an opinion give you an honest opinion based on science and data. I will not negotiate however so please don’t ask me to anymore! As a famous detective said on a famous black and white TV show , “Just the facts.“ is what I will tell you because it is best for you even if it is not what you want to hear.

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.

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