We should expand the differential diagnosis and find more inclusive solutions

Our previous Oregon governor and retired Douglas County Emergency Department physician (1974-92) recently wrote a guest column for our local newspaper. He provided an opinion as to what is causing the divisiveness and push back by county residents against the existing Oregon executive orders and mandatory public health measures.

I have admired Dr. Kitzhaber since I was a first-year medical student at Oregon Health Sciences University in 1989. At the time, he was championing an innovative Oregon Health plan proposal. I was impressed with his candid discussion about the previous dysfunctional Oregon Medicaid program and the need to honestly apply policy to use limited resources in the most effective and rational manner. This effort to change the status quo took courage and leadership. I am still grateful for his legacy in this regard.

However, I disagreed with Dr. Kitzhaber’s assessment that the anger, division, and discontent within my community may have less to do with COVID and mask mandates than our community’s previous years of economic challenges and perceived maltreatment by our state government. He implied that the adverse impacts of this rural community’s past socioeconomic challenges were driving the current sense of political disenfranchisement, distrust, and dissatisfaction.

Dr. Kitzhaber recalled instances of domestic abuse in women who visited his emergency department, indirectly related to our county’s economic decline in the 1980’s. During this pandemic, we also have seen an uptick in domestic abuse cases in our clinics and hospitals. Unfortunately, we have also seen suicidal and homicidal children, deterioration of existing mental health conditions, skyrocketing addiction issues, lost opportunities for our children to live and learn, delayed health care for non-Covid issues, social isolation in the elderly and children, personal and professional financial ruin, and a devastated local small business economy.

Many of these outcomes were self-inflicted wounds from top-down policies - not because of the virus. Our children have been sacrificed to accommodate the fear of adults. Small businesses did not just shut down. They were lost. The social fabric of our community has been torn and needs mending.

In March of 2020, our community was united and prepared to sacrifice equally when this pandemic began. However, we have evolved into our present situation precisely because of centralized executive orders, mandates and divisive public health policies that did not culminate in shared sacrifice.

We have seen state regulatory abuse and enforcement only add insult to injury. Our local population is blue collar. Many did not have the luxury of working from home. Health care, wood products and service industries drive the economy in Douglas County. Many people who worked through the pandemic acquired Covid on the front lines while doing their job.

Some of these front-line workers wonder why their recovered immunity relegates them to second class citizen status if they question the added value to vaccinate. Many citizens do not want to delegate their personal health choices to the state as it relates to the current novel mRNA vaccinations. Pregnant women, health care personnel and others who have recovered from Covid have lost jobs as authorities inexplicably deny the existence of natural immunity and characterize this type of immunity as inferior to vaccination.

Will the current breakthrough of omicron cases in fully vaccinated and boosted people stop this train of more mandates and passports coming down the tracks? It is a political question. The data should provide a clear answer if the public health quest is truly for unity.

There has been a lack of humility from officials as it relates to their missteps. Instead, state authorities double down with more mandates, administrative rules, and regulations. There is limited acknowledgment or respect for informed feedback. Authorities have not self-corrected or communicated in a transparent fashion as to why their previous directives did not work.

As a hospitalist, our inpatient capacity has been limited for many years. Transferring a patient to tertiary care facilities has been a challenge for well over 5 years now. We needed to improve capacity and local disposition options for covid positive patients during the pandemic.

I do agree with the former Governor that Douglas County people are a hardworking, proud, and dignified people. We are already mending ourselves, and we have appreciated state resources to help during this pandemic. Our citizens may have had peaceful protests about current policies, but Douglas County residents support our law enforcement and have not rioted or damaged public property. I do not believe that our citizens have lost our sense of pride, independence, or purpose. I do believe that fewer mandates, more collaboration, and a little more humility from policymakers would be welcomed.

I am not in favor of the current pandemic mandates. It is wrong to allow someone else to decide that their potential benefit outweighs someone else’s risk; and then, impose their own incomplete knowledge to mandate another person’s behavior. Many of the mandates violate medicine’s uncertainty principle. Do some people underestimate their personal risk due to definitive claims about the efficacy of masks and social distancing? Some people may not want their elderly parents to go shopping if they knew the efficacy of everyone else’s cloth masks and the current transmissibility of this aerosolized virus. Perhaps, they might have their grandchildren pick up their groceries, or use an N95 mask until there is a lower viral transmission rate or we have achieved the elusive herd immunity status.

Since the current vaccines do not prevent infection or transmission, this important tool will not achieve herd immunity. We should make personal health choices based upon our own known immune status and health conditions. We should not impose any more divisive medical segregation policies for this virus.

The focused protection approach has been endorsed by over 15,000 public health personnel and over 45,000 physicians worldwide. Choosing this traditional public health policy would have resulted in greater unity, better outcomes, and less collateral damage. It is past time for policymakers to acknowledge that there should be a new way forward. Perhaps then, trust can begin to be restored in our critical public institutions. I think that most county citizens would welcome back a sense of common identity and purpose as Oregonians.

John Powell M.D.

December 27, 2021