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6/24/2020 COVID-19 and Public Health: A Broader Perspective is Required

Considering the pandemic restrictions and tracking protocols going forward, I want to share an interview with Dr. Eileen De Villa, the Medical Officer of health for the City of Toronto and Dr. Richard Schabas, the former Medical Officer of Health for Ontario, Canada. I appreciate the way these two physicians can disagree but communicate in a respectful manner about COVID lockdown policy. They discuss and debate some of the lessons learned. Dr. Schabas opines that lockdown measures have not ultimately reduced the number of deaths from COVID-19 to the degree that many politicians or public health officials claim. As we have highlighted earlier, these restrictive measures have had significant adverse impacts on social determinants of health. I agree with Dr Schabas’s perspective. Ultimately, our public health policy will need to broaden the focus beyond this virus to include other population health metrics. Such an effort would help reduce harm to Oregon citizens by overly restrictive pandemic policies.

I have included some data directly from the Oregon Health Authority website. This data is meaningful and encouraging but does not seem to be making it into media headlines or emphasized by public health authorities. The media seems overly preoccupied by the number of new COVID cases which in large part is due to our aggressive testing and tracking processes. As of 6/21/2020, the weekly testing for COVID increased 25% as compared to the prior week, but the percentage of positive tests increased only slightly from 3.1% to 3.7%. This is not surprising given that we are now testing asymptomatic people. It is important to remember that the Oregon state lab was struggling to process 50-100 tests per day in mid-March (the time frame for peak activity for Oregon Emergency Department visits for COVID-like symptoms) and during this time, testing was limited to those who met a travel history or other CDC criteria. The Oregon Health Authority now estimates that public and private labs can test 34,000 people per week for this virus.

Despite these confounding factors, the total new positive case count metric leads in the media and there is more discussion about the state’s inability to remove restrictions. But what about the number of COVID related deaths, emergency department visits and hospitalizations? Despite relaxing pandemic restrictions and mass protests, as of 6/21/2020, the Oregon death rates, hospitalization rates, and emergency department utilization due to COVID have fallen for 4 consecutive weeks along with the global infection lethality rate. I do not understand why this encouraging data is not shared widely by the media or public health authorities since doing so would provide a more balanced perspective. Sars-Cov-2 virus will join our other endemic coronaviruses that we test for every year in hospitalized patients. The public never receives a daily accounting for these viruses or for influenza. The psychological impact on many citizens is not improved by emphasizing the daily case counts. Let’s try a different strategy and provide some perspective with the data.

Number of daily new patient hospital admissions in Oregon due to COVID-19

19 new patient admissions to Oregon hospitals- peaking on 3/28/20

6 new patients admitted to Oregon hospitals on 6/16/20

Emergency Department (ED) visits with COVID like symptoms in Oregon

6.3% of ED visits due to COVID-like symptoms peaked on 3/13/20

0.6% of the ED visits due to COVID- like symptoms on 6/15/20.

The interview between Drs. De Villa and Schabas took place on 6/12/2020. Enjoy the discussion by clicking on the link below.

Live well,

John Powell M.D.


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