Did We Defend and Protect The Lives of The Most Vulnerable Among Us?

Barriers to healthcare Clinical Trials Coronavirus Covid-19 Disease Control Emerging Infectious Diseases Global Pandemic Health Equity Hope for change National Public Health Emergency Public health Policy SARS-CoV-2

In the past one year we have lost more than half a million Americans to Covid-19. My worst estimate in March 2020 was a quarter of a million in a year. At that time I was very confident we would not even get close to it. So maybe I was wrong on the virus!! I did not really understand how effective the virus was at spreading. On deeper introspection, I realize that my miscalculation was not with the virus but our behavior, policies, and public health infrastructure. Sanjay Gupta interviewed the members of initial pandemic task force on what went wrong from their point of view. This is my analysis from my own vantage point as a citizen who saw it all happen. I am going to answer this question “Did we really protect the lives of the most vulnerable among us?”

The Manslaughter Charge Over The Half a Million Covid-19 Victims!!

Many believe that the safety of the most vulnerable is a good marker of a civilized developed society! This is America on trial for the live’s of those who died from this Covid-19 in the past 12 months. As Derek Chauvin is on trial for the life of George Floyd we are also on trial for the deaths from the pandemic. If on reading this post you feel yourself accused of any wrong doing it is so you are guilty. I say so because even as I write I know some of the blame falls squarely at my feet. So could we have done better. The most important questions I am trying to tackle is where in this processes did our system fail us? I am doing this because I love our systems. These same systems were tested in 2020 systems and we failed.

If you are American and have not acknowledged this fact you have really missed the point. The solution for the sequence of mishaps in our prevention and Covid-19 response all point towards a systems failure. Calling it what it is ensures we get a solution that respects lives lost as a result. I do realize there are many who will disagree with me on this. If you disagree, before you point any fingers compare the epidemic curves of the US the Canada. I don’t want to use South Korea or New Zealand. I chose our closest and culturally similar neighbor.

Covid-19 deaths US and Our Northern Neighbor Canada

The proportional death rate from Covid-19 is America is many orders of magnitude more that similar nations

We can point fingers at multiple reasons why we had on average our overall death rate is twice that of Canada. The truth is many of those who died will be here today if we had all been more decisive. One may ask, how does a nation act in a decisive manner? That is a great question. We lived through 2020 seeing one mistake after another at very high levels of our leadership but felt powerless. That is what I mean about a state of national apathy. I always considered America a great nation and never once agreed with MAGA. It was really disconcerting that during the course of the leadership of the Great MAGA we were failing so miserably. I started asking myself if we were really great to begin with. Did we lose something or were we never great as a nation?

The Early Response; Could it Have Been Better?

In the early stages of the pandemic we took a while to warm up to the precautions and mask mandate. What at all were we doing challenging these simple rules. Once it became clear this was a respiratory virus with a potential to aerosolize masks made sense, especially indoor settings. We however dragged our feet on that. In certain parts of our country many of us including our state governors totally ignored these rules. Many belonging to a political party that I would not name started behaving as if masks were an admission of allegiance for a party they have sworn never to support!!

Then-US president Donald Trump and members of the White House Coronavirus Task Force -March 16 2020

So we ignored or opposed basic rules supposed to keep us and the most vulnerable among us safe. Here, I identified one problem. A very hyper polarized political environment!! So what is the solution? This problem I believe stems from having a two party system. Remember I am not pointing fingers at individuals and bad leaders. There would always be bad leaders but how do we protect ourselves from them? By having viable alternatives we can rally around irrespective of our belief whether right or absolutely wrong and despicable. Don’t ever forget, even the ludicrous and despicable need good leadership. Actually, those of us with despicable views and beliefs need the best leaders to guide us all to safety.

Looking for Hope in The Absence of Good Data

I still cannot shake the Hydroxychloroquine debacle. When I saw the paper and read it on the preprint server even I the eternal skeptic was convinced for a while. This tells me how desperate we all were in looking for a solution. As a nation we found ourselves with a virus that was killing our friends, family members, co-workers. For us healthcare workers our patients and we did not have a solution. Usually, we know exactly how to handle such diseases. In this case we did not know what to do. Thus jumping on the hydroxychloroquine bandwagon was very easy to understand. Staying on the wagon after good evidence suggested is was totally useless and potentially dangerous is another problem all together.

Then came the Frontline Doctors for Hydroxychloroquine. To that I would say this. “You know things are bad when urologists and plastic surgeons have to form a coalition to campaign for internal medicine patients!” What is the solution to this confusion and acrimony over ineffective treatments? There has always been a system but many believe money and big business has eroded the trust in that system. There are even at this point many who still believe the system of drug discovery and development has been rigged. The belief that the system only works for big business is widespread. So what is the solution?

Building Trust in Drug Development and Discovery

We need to take a closer look at the drug development process and ensure that there is improved transparency in decision making. We cannot assume only scientists who work within this system need to understand the processes involved. For myself a physician trained in clinical epidemiology getting a grasp of this system was not a challenge. Public agencies in the drug development space will need to work better at engaging doctors and hospitals into trials that are not a clear priority for big pharma. One problem though is that for many including some in the medical field the drug development process is a black box. We need to do a better job at teaching our healthcare workers at various levels how that system works. It would also be helpful to make sure we have easy to understand information on what makes one drug worthy of use in a specific patient group.

Once more we need to understand that a drug that does not have any clinical benefit is not harmless but potentially harmful. As a people we need to understand that all drugs have side effects so if a drug has no benefit, all you are getting is the side effect. Many will talk about a placebo effect, if that is all you want you must choose your drug carefully. Do no harm still holds even during a pandemic.

The Lure of The Ludicrous And the Power of Misinformation

Over the course of the pandemic myself and many colleagues have written well researched articles to educate and guide our readership. Some of our posts were read far and wide but many barely made it to more than a 100 views. It is heartbreaking to see conspiracy theories bordering on the insane to totally ludicrous get read and shared so many times they go viral. Sometimes the servers supporting them fortunately crash!! In the meantime our well researched posts are barely read. Yes, most of us attention seeking bloggers write because we get a high when our content is read. We are the new digital junkies seeking the clicks that would send us into an endorphins fueled state of bliss!! So when you read our content get our point share, don’t only share the crazy conspiracy theories including the ones you know are utterly false just for laughs!!

So, I would end here because I believe that if you have stayed with me to this point you would have realized your contribution to this disaster that we all want to end.

Dr. Leonard Sowah is an internal medicine physician in Baltimore, Maryland

Feature photo: Homeless man courtesy of pixabay

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A physician providing primary medical care to patients across the lifespan