A modest proposal for COVID-19 response (Or, I’m not King, but)

(This isn’t medical advice, since it would be unethical to treat people I can’t examine and follow. But this may be a good list of recommendations for discussion.)

If I were in charge of the public health response to COVID-19, I would implement the following:

1. Let physicians practice medicine!

Pharmacy Boards should never get between a doctor and patient except in matters of life and death or illegal practice. Politicians, State Medical Boards and our House of Medicine professional organizations should defend our legal practice of medicine rather than threatening physicians and changing the rules during a pandemic.

2. Encourage shared information & fact-checking among physicians as part of our missions of education & transparency.

3. Suggest voluntary use of masks in public places or self-isolation for those worried about their vulnerability. Traditionally, we quarantine the sick and at-risk and new-comers, not the healthy or people in place with a low risk of exposure.

JAMA review of masks, August 2020

4. Where a high percentage of the local population tests positive, local authorities should consider – and have the ethical responsibility to – impose higher isolation measures like masks and public distancing. The threshold for mandates must be locally determined with public input, and explained – clearly, frequently.

This means you, anti-maskers!

5. Stress that surgical procedure masks are nearly as effective as N95 masks, blocking nearly as much aerosols and viral particles for both wearer and those around us. Medical providers and those with a high risk of prolonged close contact need fitted N95 masks, the rest of us don’t.

Single layer cut-up T-shirts and homemade masks, balaclavas or bandannas, aren’t very effective protection at all, either for the wearer or the people around us. N95 Masks with single valves are a money-maker, but not nearly as effective as surgical masks, even with an added filter layer.

5. Educate the elderly & vulnerable about extra infection-avoiding and -control precautions, advising self-imposed near-quarantine for the most vulnerable of them.

6. Recommend Vitamin D & zinc over the counter supplements, possibly Vitamin C – which are harmless to virtually everyone, if not beneficial, to everyone.

7. Make Rapid tests for in-home testing available at nominal, sliding scale cost, on demand and at first symptoms or exposure. (This may be a place for donations by crowd funding.) Back up positives with the PCR tests, quarantine all rapid positives until cleared by PCR.

8. Begin early prophylaxis with hydroxychloroquine/zinc and/or inhaled steroids for the willing & likely exposed.

10. Open the schools, let the kids be kids on the playground. Utilize younger teachers and aides in the classroom. Supervision & protection for vulnerable teachers & students can be achieved as necessary with distance learning measures.

11. Make sure we have lots of Hydroxychloroquine/ azythromycin/ zinc/ vitamin D to begin at the first symptoms (I know the literature is mixed, but every article or study that I’ve seen it’s all flawed, see below**).

10. I’d sanction the Chinese government-connected businesses and confiscate their assets to pay for it.

** I follow the literature as best as I can: every single peer-reviewed study is flawed. However the anecdotal evidence for some protocols is very strong. If necessary to avoid politics, let the controlled trials continue but let willing physicians continue our ethical off-label prescription. We could just pretend we’re giving malaria prophylaxis, if it makes you feel better.

Hydroxychloroquine: 400 mg. twice on day one 200 mg twice on day two, then 200 mg. Twice a day every 4 days