Just a Big Little (Massive) Rant

When are we reopening? Are we winning against coronavirus? These questions, as well as “coronavirus optimism”, “Newsom”, “coronavirus vaccine”, and “CDC guidelines” flood my Google search history. Let’s be real: there are no reliable answers. As we increasingly lack dependable direction, people seem to be taking it upon themselves to generate answers through fear and anger. Restless communities and governments are champing at the bit to reopen businesses and society through protest and conflict. That’s not necessary. As I mentioned in last week’s update, I too have been eyeing May Day as my target for a thoughtful reopening, but with humility and ever-so-cautious optimism.

“Reopening” does not mean unlocking the door, flipping on the lights, and resuming business as usual. Instead, it means enacting stricter guidelines and ensuring that patients who seek our services for nonessential services are not put at unnecessary risk. There is more pressure on us, the nonessential providers, than ever to “first do no harm”, and to ensure that we are doing everything we can from an esthetic and ethical perspective to protect our patients. Board-certified physicians that belong to multiple professional societies must adhere to the strictest guidelines, so it is our responsibility to lead the pack in reopening businesses, smartly.

Antibody tests, remdesivir, chloroquine. These hot topics are trending for sure. We have been hearing a great deal about rapid antibody tests and their involvement in concerted national and local plans to reopen America. In theory, this sounds great. It would seem that we now have a method to identify an otherwise invisible enemy and to protect antibody-naive, non-infected individuals from those who have the capacity to spread the disease. In practice, the tests are imperfect, incompletely understood, and unregulated. It is no surprise that dozens if not hundreds of testing centers have popped up and over 250 unique testing kits are now available. But what does it all mean?

For those of you who saw a recent video that my wife and I made (view here if you dare), you might understand why the vast availability and rapid nature of these tests is unsettling. For one thing, we may not accurately identify those who have the disease from those who do not. Researchers have suggested that up to 1 in 3 patients infected with COVID -19 will have a negative test. In addition, there are many iterations and mutations of coronaviruses that already exist in the community. How certain can we be that we are not picking up footprints of a preexisting virus? And is anyone reporting these new data to local and federal databases? How are we patrolling the positives? Under what guidelines? It’s a rat race and commercial and political interests may be playing a dangerous role the popularity of these tests.

Many of us have been conditioned to believe that antibody tests are a key ingredient of a solution to reopen the economy. I totally understand why this sounds so right. But keep in mind that the majority of Americans still not have access to the tests, the validity and reliability of these tests remains questionable, and people can still be infected without circulating IgM for up to a week. Even if the tests were 100% sensitive and specific, this is a huge problem when you’re dealing with a virus whose course is indolent in most. Therefore, I personally do not believe that these tests are, at the time of writing, a reliable contributor to the cure.

Practicing common sense is, though. Social distancing measures, handwashing techniques, minimizing nonessential trips, and taking special efforts to conserve personal protective equipment will continue to protect society as a whole. I just got an email that a local “ped spa” (pedi-spa?) reopened last week. Nice! This is the first such memo I’ve seen. This “ped spa” promises that they sterilize their equipment and are now open for business. Sterilizing the equipment is a plus (they should do that anyway) but will quickly be negated by a lobby full of overdue patrons, one of whom is an asymptomatic carrier. Folks, common sense and thoughtfulness is mission critical. The ped spa may not impose undue risk on society unless it is ignoring or not enforcing social distancing measures.

Protests are occurring nationwide. Conservatives are portrayed as downplaying the seemingly few lives lost in their communities compared to the millions affected by economic despair. Communities are rising up against governments. Conspiracy theories abound (do you ever read NextDoor?). The public is becoming more and more wary that government restrictions, although designed to protect societies, are perceived as unconstitutional, communist, unethical, and impede a set of freedoms to which most Americans have become accustomed. This is one indication of the restlessness that I feared for the past 2 months. I was pleasantly surprised, and continue to be pleasantly surprised, by the changes most people have made and are making in their lives for the sake of protecting others. It is nothing short of heartwarming.

A patient emailed me this morning and described this phenomenon as the “CA valve”. Love it. As this restlessness waxes, the so-called “valve” releases, so does the likelihood that those of us who minimize nonessential services, travel, interactions, and those of us who have sacrificed our well-being, livelihoods, and even our young medical practices, will pay the same price as the rebellious few. That’s how pandemics work. We can’t ignore that a second wave of disease will shut us down for longer, if our trial at reopening fails. Unfortunately, the repercussions of our behaviors today will not manifest for weeks. That’s a big reason why this is such a tough battle. As we relish optimistic trends associated with this pandemic, it will be hard to convince those who are fighting back that they are behaving inappropriately. Because they may not be. The protesters may be right. We just don’t know.

I do know this (and am super thankful for it): our community is still doing great, for now. I am very happy that local hospitals have not come close to reaching capacity, and the surge that we were so grimly warned about has not occurred, not yet. Although many colleagues, friends, and even family have been affected by coronavirus directly and indirectly elsewhere, we seem to be winning this war against coronavirus. At least locally, and for now. We should celebrate and nurture this fact, this blessing, not shirk it as “overblown politics”. I do think it is wise and absolutely necessary to reopen the economy before we reach a tipping point of irreparable economic harm. But we have to be SMART about it. This is my message.

When we reopen, we will continue to practice, enforce, and promote hygienic behaviors as though the epidemic were still in full force. Because it is, face it! We will screen patients accordingly. We will disinfect the exam rooms between patient interactions. And we will treat every patient as though they have coronavirus until proven otherwise. Because we cannot count on antibody tests or favorable local epidemiological patterns. Because no cure currently exists. And because turning a blind eye to this pandemic is a selfish, reckless, and stubborn behavior. If everyone plays by the rules, we should have no problem resuming most operations safely. As we wait for a cure for this invisible, indolent, and horrifying disease we must all tread lightly. In fact, when we reopen our doors, we must tread even more lightly than ever before. Reopening the doors is not a victory. Dare I say, it is not even our right. It is means to a necessary end that we are so very privileged to enjoy.

Can we take a moment to thank God (or spiritual equivalent) for sparing our community? I love Orange County. Still, we must be sensitive to the 1,600 confirmed individuals afflicted in the OC, and the families of the 32 neighbors we lost. For those of you who were affected- including our very own interior designer, you have my prayers.

I cannot wait to see you all again very soon. You have my vow- my friends, my patients, my audience, that I will do everything I can to open my business as soon and as responsibly as possible. I promise to protect your best interests, your family’s best interests, and society’s best interests. I am indeed aiming to reopen soon, and when I do, I will do it right.

Warmly,

Dr. Zelken