The Covid-19 crisis highlights how the interests of individual patients and those of public health officials can sometimes be at odds.
In other words, the general advice that government officials give from a public health perspective – looking at the proverbial bigger picture, the statistical aggregate – might not actually be the best advice for you personally or for the members of your family.
One example: From the earliest days of this coronavirus crisis, public health experts all over the world have insisted that patients should stay at home unless their symptoms become severe. “Not only can you self-manage from the comfort of your couch, but health officials want you to do so,” the Washington Post explained on March 4.
Only when symptoms become severe, the experts said, should patients seek treatment in a hospital or clinic setting. This is also the reason why you can’t get a Covoid-19 test in many locations unless you’re very ill.
From a public health perspective, this advice had a certain logic.
Experts like US White House Coronavirus Task Force lead Dr. Anthony Fauci were worried about overwhelming hospital emergency rooms.
They advised hospitals and clinics all over the US to eliminate most non-Covid-related treatments and elective procedures – so much so that some American hospitals are now laying off nurses and staff because the flood of expected Covid patients never appeared and their normal work has been eliminated.
In addition, public health experts like Fauci assumed that marginally ill patients may not have Covid at all and could actually end up catching the virus by going to hospitals or clinics.
Yet the government’s general advice may sometimes be incorrect in individual cases – and may be killing people unnecessarily.
A recent article in the New York Times, written by Richard Levitan, MD, an emergency room physician who is working on the frontlines of the Covid crisis in New York City, argues that early treatment is sometimes essential if you actually do have Covid-19 pneumonia.
In fact, the last thing you should do, this doctor writes, is wait until your symptoms are severe before at least seeking medical advice. By then, it could be too late. You could end up on a ventilator – and die.
Dr. Levitan explains that Covid is NOT like ordinary flu or pneumonia. These diseases are, he says, like conventional armies. They attack openly, cause damage and provoke an immediate counter-attack by the body’s immune system and doctors.
Covid is different.
Covid is like a special ops commando unit that sneaks into your body and silently attacks your lung’s air sacs without you knowing it or raising any alarms.
You gradually have less and less oxygen until, quite suddenly, you can barely breathe.
“A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life,” Dr. Levitan writes. “But they were using their cellphones as we put them on monitors.”
In other words, the Covid virus slowly chokes off your oxygen supply without triggering your normal warning system – feeling short of breath – as occurs with regular pneumonia. Dr. Levitan calls this “silent hypoxia.”
By the time you realize you’re having trouble breathing the disease can be far, far advanced – and you’re in serious trouble.
And here’s the tragedy in this: A US$30 device available from Amazon, a pulse oximeter, could help some patients detect when their oxygen absorption levels are falling precipitously.
Rather than waiting for treatment until their symptoms are serious and their only hope is a ventilator, patients with symptoms of Covid may be better served seeking breathing treatments and/or oxygen therapy right away – in other words, the exact opposite of what the public health experts have been telling us for over a month now.
Toughing it out in your basement, the way Covid-afflicted CNN anchor Chris Cuomo demonstrated for the nation on television, could be precisely the worst strategy for patients developing Covid pneumonia.
At the very least, government officials should re-think their advice in the light of what front-line physicians are learning on the battlefields of New York City hospitals.
Dr. Levitan recommends patients with symptoms monitor their own oxygen levels and, yes, consult with their doctors first before going to a hospital or clinic. As is true with blood pressure cuffs, pulse oximeters are finicky and can lead to false readings, easily misinterpreted by the lay public.
Yet at the same time, early intervention in more severe cases could potentially save lives, he says.
“Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment,” Dr. Levitan concludes. “When they noticed their oxygen levels declining, both went to the hospital and recovered…”
In the end, what’s good from the point of view of public health bureaucrats may not necessarily be what’s good for you and your elderly parents on an individual basis.
New York City recently decided that it would order ambulance EMTs not to attempt CPR at all on cardiac patients – not because such efforts would not potentially save the lives of individual patients (they would), but because of the larger public health ramifications (that is, the danger of infection to EMTs).
Public health experts like Dr. Fauci look at the big picture, and that’s their job.
But ordinary folks, charged with protecting the lives of their elderly parents and other vulnerable family members, need to know what’s best for them, too.