Dual enemies: Doctors fight COVID and disinformationCommentary by Dr. Jason Wilson of TGH and USF

We are in a precarious place with COVID in which some patients, some members of the public have grown angry with doctors and healthcare workers. They are sure that if we would just give them a magical medicine, this pandemic would be over and they and/or their loved ones would be cured. 

I remind myself and others that we must focus on the dual enemy of this virus and the disinformation that surrounds it, and remember that our patients are victims of these shared foes. 

This disinformation campaign has been a part of COVID since the beginning but seems to have ramped up again this summer -- our second COVID summer.

Sometimes, when talking about where we have been with COVID, I catch myself saying “March” or “June” and then realize that the month now needs the modifier, the extra detail of the year. March 2020 or March 2021? June 2020 or June 2021? Eerily similar months in the continuing onslaught that this pandemic has wreaked on our lives. Infectious diseases, plagues, and pandemics have always had eerie relationships with human groups.

In 2015, I took a trip with my wife and good friend to the UK. We visited York, the Cotswolds, London, all the familiar sites. The buildings and cities of England were and are, to my Florida eyes, so old and have stories that trail back a thousand years. So many of those stories revolve around the Plague. I wondered often during our trip what life would have been like during such a devastating infectious disease that lasted so long that the disease itself became a fixture of the rhythms of life.

I have had hints throughout my medical career of just how much damage infections can reap on our society. There have been the daily impacts of HIV/AIDS, the H1N1 swine flu epidemic of 2009 (with pregnant women on oxygen support acting as harbinger to our current state), planning for the possible arrival of Ebola patients as another seemingly far off outbreak disease became a reality in the United States. Even now, as a physician, I am battling an opioid epidemic that has fueled a resurgence of Hepatitis C in young people. 

But nothing has prepared me and the healthcare system on the scale of what we are seeing with COVID in 2020-2021.

Lethal disruptions caused by disinformation

Nothing before, in real time with clinical reality and ongoing feedback, has tested public health policies, structural determinants, and individual choices about how humans make decisions when faced with rapidly evolving information. 

I had imagined these depths of misery in worlds with less scientific knowledge, but I hoped that a better human condition had arisen in the 21st century with the illusions of modernity and the shared work of maintaining freedom in a democracy.
 
 
''Nothing has prepared me and the healthcare system on the scale of what we are seeing with COVID in 2020-2021.''
There have always been anti-vaxxers, but their lethal disruptions multiplied in the late 20th century by the now discredited publications of Andrew Wakefield that (intentionally) falsely linked vaccinations to neurological delays and cognitive changes (e.g autism). But most accepted that vaccination, along with sanitation systems, represent the most powerful tool that public health and medicine have ever created to ward off misery and human suffering. 

According to the CDC, in 2021 only 9.1% of people opt out of measles, mumps, and rubella vaccination. But something else is going on with COVID. 

People have difficulty calculating and understanding risk in their own lives. Some will drive on I-4 without concern when it is the deadliest road in United States with a rate of 1.34 deaths per mile but fear flying on commercial airplane flights, which have a rate of just .08 deaths per billion miles traveled. 

Similarly, the COVID vaccine results in very few significant side effects in very few people yet some people fear getting a jab more than getting the disease. 

CDC data suggests approximately 1 in 10,000 doses of the vaccine may lead to a possible event, and 95% of those resolve (do not cause permanent damage). The flagship New England Journal of Medicine has published data showing the risks of adverse events (blood clots, heart inflammation, neurological problems) ranges between 5-100Xs higher in patients who get COVID than in those who get the vaccine against. Yet, again, some people fear the vaccine more than the disease.

Capitalizing on the difficulty in communicating and understanding this data, the disinformation war has ramped up. 

However, disinformation cannot challenge clinical reality. Clinical reality also has an eerie way of showing itself. 

Reality is that I am not seeing patients sick because of the vaccine. I am seeing patients sick with COVID. Most (90%) of those sick patients are unvaccinated.

 The message that will save lives: Get vaccinated

Stories of people getting COVID after vaccination are now hampering vaccination efforts as confusion arises around breakthrough cases and vaccine efficiency. The vaccinated patients, though, are very rarely hospitalized and often recover quickly (finally equating COVID to “just the flu”). 

Vaccines prevent most people from acquiring COVID, prevent spread of COVID when infected, and prevent serious illness when someone does get COVID. Going back to the numbers for a minute, even if there is waning efficacy of antibody, we know vaccinated people are 5Xs less likely to become infected and 25Xs less likely to be hospitalized. Put another way, if I only had breakthrough cases to take care of, there would be no pandemic.

You may find a doctor out there who does not support vaccination or is prescribing non-studied, off-label drugs for COVID. A few of those doctors simply aren’t up to date, a step removed from the acuity of the ER or a hospital COVID unit. Some are just snake-oil shucksters. 

The message of qualified physicians and public health experts, especially among those of us who see COVID patients every day, has remained persistent and consistent about the seriousness of this virus since March 2020. 

We are vaccinated and have gotten our families vaccinated. We tell others to get vaccinated. We utilize approved clinical research studies when attempting to use new medications for therapy and ensure they are safe and that the data can be collected to examine for efficacy. We are not inflating death counts or hospital numbers. We are not making money off of COVID admissions. 

Instead, we are challenged with surging case volumes, trying to find new spaces and ways to care for COVID and non-COVID patients with limited staff and resources.

Finding a path forward
 
The COVID disinformation campaign is a very different public health threat than any we have seen previously. Together, with the virus, this is an enemy that threatens our way of life and our freedom to live our lives as much as any violent domestic terrorist, religious extremist, or antagonistic nation-state. 

Many of those perpetuating disinformation -- including some politicians, news agencies, media outlets, and medical personnel -- are themselves vaccinated and wear a mask indoors with other people.

Too many people are listening and believing the disinformation and as a consequence are suffering in a milieu of risk calculations that aren’t real.

The disinformation they hear (hydroxychloroquine saves all, masks don’t work, physical distancing doesn’t work, vaccines are dangerous, ivermectin saves all) doesn’t add up with the reality of COVID injury and death that must be getting more and more difficult to deny and more unsettling to align with worldviews they want to protect. 

This disinformation campaign is bigger than COVID and hints at a path forward between those of us who see a world together and those of us who have given up on the possibilities of a democracy with the responsibilities of that social contract. 

Freedom for me is a live music, pick up basketball, travel, and my kid going to school safely. 

I recognize that message may be getting boring -- get vaccinated, avoid indoor crowded places, wear a mask in those scenarios, wash your hands -- but boredom doesn’t make the message wrong. 

Imagine the luxury of that boring message living in Europe during those long years of the Plague. A lot less walking Ghost tours now, I guess. But at the rate we are going, the tourists of the future will have plenty of haunted sites to visit. 

Jason W. Wilson, MD, MA, CPHQ, FACEP, Director, ED Clinical Decision Unit, Tampa General Hospital at TeamHealth, is an emergency medicine physician, medical director, and medical anthropologist with an interest in developing patient-centered pathways that are medically efficacious but also consider structural and cultural forces in determining health inequities while reconsidering the role and position of the emergency department. He is also an Associate Professor at the Morsani College of Medicine, University of South Florida, with a core faculty role in resident education, and completing a PhD in anthropology at the University of South Florida, where he is an affiliate faculty member in the Department of Anthropology.

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