Letter From A Christian Country Doctor
See that image? It’s a screenshot from a BBC news clip I received from James C., in Scotland. I can’t find a link to it, but I’ll post one if I do. In it, the elderly Spanish woman is gasping for breath outside a hospital. Her husband died yesterday there of coronavirus. She has it too, but they are so overwhelmed that they sent her away. The beds are full of people sicker even than she is. James sent it to me, urging me to share the clip with anybody I know whose older relatives or friends are downplaying the virus. If any of you have seen the report, please post a link in your comment so I can get it embedded here, or at least linked to.
I received this letter tonight from a Christian country doctor I met in my travels last year.
The doctor gave me permission to post this as long as I kept his identity out of it:
It is not just New York, Seattle or other major metros that are headed for trouble. When the virus first showed up outside of China, I and several of my colleagues realized that it would likely make its way to the US.
As soon as I dealt with and discarded normalcy bias, the logical implications of this were terrifying to me. Basically, I independently arrived at the same conclusions as you. And I watched with horror as all those predictions came true — no plane cancellations, no quarantines, ineptness at every level of government, dismal testing rates, false reassurances, no serious containment measures, and the politicization of an existential threat. I felt biblically obligated to share my concerns with others and some, realizing that I am not an alarmist, looked at the data and came to the same conclusion. Others used rationalizing and wishful thinking to mock me.
My colleagues and I raised concerns that we were seeing high levels of flu like illness with neg flu swab (70% sensitive- only misses 3/10 people who really have the flu). We wanted to do a drive through swab clinic for anyone with flu-like symptoms and COVID swab everyone who had neg rapid swabs for flu/strep. We were blocked by our state health department and our local healthcare system who employs us. They both insisted on following the state protocol of only COVID swabbing those who came from endemic areas. This despite the South Korean data that showed that over 80% of their positives were community spread. We were able to swab a few anyways by breaking protocol and using a private lab and are still waiting on the results (4 day turn around).
When we kept pushing for a more serious effort to locate COVID and influence the city/area to lock down, we were met with talks of protocols, workflows, and other standard MBA corporate pre-COVID thinking. We need to go post-COVID NOW. We really needed to do that weeks ago. Now the cases in my state are piling up despite the low testing rate (the state health department lists less than 200 tests in a state with 5 million people). The official numbers are not even up to date (19 at the moment with 6 of those yesterday, but I heard of at least one more near my area before I was done with this email). Not to mention all the suspected cases they refuse to test.
I am now sitting in self-quarantine with a temp hovering in the 99s-low 100s, headache, and generally not feeling well. In 15 years of practicing medicine, I have had a fever over 100 only 2 other times.
If we have Wuhan’s mortality rate (5.8%) and have 55% percent of the population infected (180 million), that is over 10 million dead. I see us doing nothing right now to think that we will have the lower mortalities of S Korea, Hong Kong, Singapore, etc. That does not even factor in all those who cannot get care for heart attacks, strokes, surgical emergencies (appendicitis, bowel obstruction, etc). Then you have all the people that will not be able to get their cancer care or other ongoing treatments for chronic diseases. What about all the chemo kids when the system collapses? I saw a patient last week with a cough who turned out to have lung cancer, and I felt like a fraud talking about his next steps.
In a world of arrogant adults who love money and kill children, the Almighty has seen fit to bare his arm and send a virus that will expose the deceitfulness of wealth and kills adults and spares children. The world is coming to its knees, and we need to make sure we articulate and display the Gospel no matter the cost. We were always just a few base pairs away from disaster and had grown too arrogant to realize it.
We need to pray, minister, and start thinking about what kind of rebuilding we can do. The Republican party is likely finished. Perhaps a new party that supports a better healthcare system more local and regional industry so we aren’t so fragile. More supportive of family structure (like the Christian Democrats). Let proven physicians run healthcare systems (like the Mayo brothers), encourage ownership of businesses and not rewarding corporate managers, incentivize real wealth and not leverage. You know, like the “ancient paths” of Jeremiah that follows the “peace peace” when there is no peace.
Please, readers, pray for the health of this doctor, and for all those health care workers who really are on the front lines.
UPDATE: Here’s the clip:
UPDATE.2: A reader sends in this link to a letter from an emergency room doctor in the Bay Area, published at Talking Points Memo. The doctor says that the national media is not reporting on what he/she is seeing. Wyoming Doc has been telling me the same thing. I asked him to write about it. He said on Friday that he would, but wrote on Sunday to say he’s sorry, but he’s simply too exhausted from work. Excerpts from the TPM doctor:
Everyone I work with seems resigned to a sense of impending doom, and an expectation that we will all be infected in the weeks ahead, and that we have no alternative course of action without abandoning our patients.
Many coworkers live with their parents, immunocompromised family members, etc, and are terrified about what they will do when they get sick. Live in a call room? stay in a hotel? not go home for 2 months? We’re slowly changing our operations, adding staffing, infectious screeners, etc – but there is organizational resistance to make the big changes that are already necessary. Despite near-daily reports from Italy of WWII-era triage decisions, shortages of key equipment, PPE, etc – we are still operating as if we can add a couple shifts to the schedule and otherwise operate normally. We’re not isolating URI patients from other patients in the waiting room, nor keeping them out of the “clean” areas of the hospital. We still have zero ability to test anyone who isn’t critically ill. We’re still using PPE for individual patients, discarding it, then using a new set for every patient. This would obviously be appropriate under any other circumstances, however we have recently been told that we will run out of PPE, most likely masks, within several days. Colleagues in the NYC area report that in the last few days there has been a surge of ill ARDS/covid patients, including one facility which intubated 5 of these patients in a single 12 hour stretch. In addition they have been told only to wear masks if intubating because of shortages … Reports from China suggest Covid patients typically require ventilators for 2+ weeks before improving.
There are reports coming out of South Bay that hospitals there are inundated in covid patients – but everything is being kept hush-hush for no discernible reason. All the staff I work with (MD, RN, tech, etc) are quite certain that we are headed for a catastrophe of somewhat epic proportions. Some people in the news have been saying we can do it better than Italy – I think the opposite is likely true. We have less beds per capita than any other industrialized society, and a completely inadequate number of ventilators, prone beds, ECMO circuits, perfusionists, etc for the wave that seems to be coming. We have a population that is half-heartedly pursuing social distancing measures, and no capacity to truly isolate the infected (home quarantine is a joke. the majority of the cases in China were transmitted via family clusters). We have national leadership that is both arrogant, incompetent, and seemingly determined to pursue political advantage regardless of the price to the nation. There will be some extremely difficult decisions ahead for our leaders, and I have less than zero faith they will be able to nimbly guide us out of a crisis.
I’ve cared for loads of patients in situations that were plenty scary. I don’t think I’ve ever been as scared for myself, my colleagues, my neighbors, and our country as a whole.
Sorry if this is a bit scattershot, lots of long shifts this past week with not enough sleep – and the wave hasn’t even hit yet.
Read it all. Prepare for what’s coming. And by all means, if you can stay home, then STAY HOME!
UPDATE.2: Country Doc writes this morning:
Rod- I briefly saw some of the other doctors’ comments. Here is my wartime advice, at least as far as I have gotten with my other front line like minded colleagues. I would put all the N-95 masks into the same biohazards and save them. When you are about to run out, cook them at at least 150 degrees (I don’t know how long) in an oven/cooker/dryer or in UV-C light to denature the virus and reuse. Faceshields may be able to be sterilized as well. Cattle call all the moonshiners to crank out their 95% moonshine. You can cut it to 70% with water and use it for sanitizer. You can also Jimmyrig (keeping the WWII analogy going) an N-95 make by cutting a 3M viral air filter up and putting in between 2 dust masks and gluing or stapling them together. That idea is from a prepper on Youtube, but it is better than wearing a surgical mask or no mask. Sent out an SOS for other respirators that might filter virus from the community. Push testing the mild patients not the ARDS or really sick patients. The mild ones will be the super spreaders and we need to limit this thing on the frontside, not the backside. If you have ARDS, you will be isolated and cared for by folks in PPE. Load up on liquid Morphine/oxycodone and even have the pharmacists compound it from pills for those that have ARDS and won’t get a vent. If you can’t save them, at least ease the shortness of breath and palliate them. Do not use fentanyl for sedation, save it for the dying. The injectable fentanyl has been used off-label for years by hospice docs orally. I believe you dose it like the oral formulations. Any hospice docs that do this, please comment. The normal ways of doing things are not going to work, we need outside the box thinking.