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The COVID foxhole

The wrong way to start this piece would be stories about the horrors of COVID-19. I will start with what everybody should do.

  • Keep your social circle small

Stay away from as many people as possible. If you know someone is a social butterfly and always around a lot of different people it would be prudent to stay away from them. Stay away from large groups, especially indoors. The best way to not get or spread the virus is to decrease exposure. The only sure way to do that is increased isolation and distancing.

  • Vaccinate

The data is convincing that the vaccines are reducing the risk of death or hospitalization. Some of that data has been exaggerated but analysis of recent hospitalizations and deaths show significant benefits for people who are vaccinated. The FDA should have approved boosters for everyone in my opinion. The reason they did not is it appears the vulnerable populations, the elderly and sick, were the most likely to get breakthrough infections. Remember you still can get infected and spread the virus if vaccinated and it should not be a reason to loosen up other behaviors.

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DOC

Most convincingly, The New England Journal of Medicine published a randomized placebo-controlled trial (Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine | NEJM) on the Pfizer vaccine last week. It demonstrates the vaccine has an excellent safety profile. It clearly prevents infections, hospitalizations, and deaths. It confirms what has already been seen with collected retrospective data. It is reasonable to think data on the other vaccines will follow and be similar. This is how science works.

  • Wear masks

Mask data is not great in terms of effectiveness. The best data for protection is with higher level masks in highly ventilated environments. In the new world of the delta variant cloth masks appear to have lost significant effectiveness if it ever existed at all. Some areas of the world have started using medical quality masks in public places. I would recommend getting medical masks if you can. Masks can help if used properly but should not be viewed as any kind of absolute protection. One of the best reasons to wear one is to not irritate some of the people around you. Wearing a mask while indoors for brief periods of time is not worth creating an unnecessary ruckus.

  • Clean surfaces

Almost all respiratory viruses have some transmission by surface and it is a major transmission source for many of them. I disagree with the experts on whether COVID -19 can be spread by surfaces. In any case, clean surfaces will prevent other infections which is desirable when COVID-19 is ravaging the medical system.

None of the above is any guarantee. As many people have found out you can do all of it and still get infected. The good news is most people are not going to be hospitalized or die from the virus. The vaccinated are even more protected in that regard.

I am not frightened. I am not going to cry. I am not going to pretend I am some kind of oracle from on high. I will not be the mouthpiece for any political position here. I am a simple stomach doctor.

The country is being divided. Misinformation is flying in from all sides. The messages have constantly changed. It is comical to hear people say “science” when almost nothing in the media reflects true evaluation of the science. Physicians have been guilty of playing that game. Some have allowed themselves to become political tools. And worst of all, some have decided to determine who they will care for based on patient decisions about their health care.

I have a patient get irritated with me almost daily when I suggest they get the vaccine. You would think the hospitals are filled with people getting vaccine side effects if you believed the stories I hear. I make it clear to them it is ultimately their decision but that the risk/benefit ratio is in their favor getting vaccinated.

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Ermine Skate

There are patients who give my office grief over masks. I try to explain that even if they do not believe masks work it is a reasonable thing to do. I hate wearing a mask and I essentially have one on all day. It is always at least a surgical mask and occasionally an N95. I get funny looks at Costco now when I am wearing one. It provides some protection. More importantly it makes patients and others feel safer and that matters. In the same respect, people should not lose their mind over someone not being masked.

I get accused of being anti-vaccine because I do not think mandating is helpful. I get accused of being non-scientific because I dare point out mask data is not strong.

And there is the heart of the problem. People are so caught up in their position and need to be right they have lost empathy for the other side. It is no different than anything else in politics right now. If you veer away from the absolutes you are the enemy.

It is no different than what has happened over the past years. Unlike 9-11 which united us, COVID-19 has divided us. It has fed into all the other political divides.

There is no politics in the exam room.

I have evaluated medical studies for 30 years. I know what is a good study and what is a bad study. I also know when you have to move the lines and accept less strong data. COVID-19 is one of those times. It is important to be honest when you do that and realize better data is around the corner.

The government should not have to mandate behaviors. People should do it because it is the right thing to do. This should be up to the private sector. People should work from distance if they can right now. Businesses should encourage vaccinations and masking.

I know it is a lot to ask for people to not make bad decisions. The life of a physician is mostly telling people to make better decisions. Hospitals would have far less patients if people made better decisions. After 30 years I have learned some people are just not going to listen.

Make no mistake, bad decisions cost us all. Seven of the ten costliest diseases in the United States are obesity related. Tobacco, alcohol, narcotics, and more recently marijuana, make their mark on costs as well. Those costs hurt all of us. Substance abusers create all kinds of societal ills as well. The consequences of all of that will still be a problem when COVID is in the rear-view mirror. Calling the unvaccinated menaces lacks empathy we usually have. It does not move the ball down the field. It will just harden the resolve of the opposition.

They say there are no atheists in a foxhole. I suspect that same kind of realization happens in a patient dying in an ICU from COVID.

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Blueprint

Everybody should take a step back. Put down your political biases. Listen to the simple stomach doctor. You will not see me get paraded out by a Christopher Constant or Felix Rivera. You also will not see me endorse some of the unfortunate rhetoric coming out of the mayor’s office.

I avoid unnecessary contact. I have been vaccinated. I wear surgical masks or N95s in public indoor places. And I keep everything sanitized around me. This stomach doctor is not stupid. And you should not be either.

Dr. Sweeney has practiced gastroenterology in Anchorage for 21 years, with the first three at JBER. The views presented here are his own and are not made on behalf of any organization.

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Kiana Peacock
28 days ago

How pray tell is marijuana making a mark on cost? I mean this sincerely. As a doctor what does marijuana use do to damage someone’s health?

Brian Sweeney
28 days ago
Reply to  Kiana Peacock

Cannaboid hyperemesis is on tbe rise. I have seen quite a few ER visits and hospitalizations from it and a CO study showed a spike in visits for it since legalization. Anecdotedly I have seen a steady rise in AK the last 5-10 years. There is also growing data that cannaboid users are more likely to have myocardial infarctions (heart attacks). Jury is kind of out because of confounders in early studies but that has not been the case in recent ones. Higher potency marijuana products are being linked to more psychotic episodes as well although that stuff requires a… Read more »

AKforever
28 days ago
Reply to  Brian Sweeney

A follow up but mind providing some studies if you have any? Not nitpicking, just want to read it for myself out of curiosity and examine the data for myself.

Brian Sweeney
28 days ago
Reply to  AKforever

I could link studies all day long. I usually hate google but in this case I looked and most of what came up was NIH/NCBI studies including what we know about the pathophysiology. If you just search “cannaboid hyperemesis studies” and “cannabis myocardial infarction studies” you will get quite a bit of info and surprisingly reliable info. And that NIH stuff has references if you want to dig deeper. The psychosis data is mostly in flux because of a chicken/egg argument and some people believe underlying conditions predispose to cannabis use. Other than cannaboid hyperemesis the only thing catching my… Read more »

AKForever
28 days ago
Reply to  Brian Sweeney

Hey thanks for the search terms (it will make my life a lot easier), I’ll read through a few of these studies/papers when I have the chance. Appreciate your through response. On a side note. Snoop Dog is already beginning to look and sound like the weed version of the Marlborough man.

Rhodawrn
26 days ago
Reply to  Brian Sweeney

I agree

floridawoman
28 days ago

Is mandating seat belt use helpful?

floridawoman
28 days ago
Reply to  floridawoman

Should public schools and the military stop mandating the polio vaccine? Because vaccine mandates are not helpful?

LisaV
28 days ago
Reply to  floridawoman

Okay of all of the opinions expressed above, do you really need to latch on to the one that’s clearly the most “opinion,” and put into doubt the rest of this very rational advice? “If you veer away from the absolutes you are the enemy” – you are proving his point!

floridawoman
28 days ago
Reply to  LisaV

Logically it is his most dangerous and flawed statement in terms of societal health and ultimately individual health.

Vaccine mandates also work and there is ample evidence to prove they work to protect society and ultimately individuals.

There is no scientific evidence vaccine mandates are unhelpful. As a self-declared expert his words are not simply opinions and hold weight and can have ill affect when presented as such.

So yes.

Cali Scoob
27 days ago
Reply to  floridawoman

I agree with your premise but would point out that the author seems to support mandates but he/she wants those mandates coming from the private sector. I certainly could be wrong.

sam
28 days ago

A fairly large study on masking, in case you have not seen it:https://www.poverty-action.org/publication/impact-community-masking-covid-19-cluster-randomized-trial-bangladesh

As to surface contamination…It has been some time since I searched for data, but as I recall there hasn’t been a single proven case, outside of a clinical setting, that was shown to be the result of a contaminated surface. But, cleaning, like chicken soup, can’t hurt. Please correct me if I’m wrong.

A great piece, Doc. Thank you.

Brian Sweeney
28 days ago
Reply to  sam

That study randomizes promotion which means it is far away from anything high quality. Not much different than studies looking at mandates or no mandates and those results are all over the map. The Dutch study in the Annals had all kinds of issues but remains the best randomized study we have and it used medical masks and found no statistical difference. The data really is all over the place which is why people keep trying to do meta analysis which is a tool, albeit crappy, when all the data is mixed. When a virus gets in the air it… Read more »

Areal Bilk
28 days ago

“ Some of that data has been exaggerated” and “ Physicians have been guilty of playing that game. Some have allowed themselves to become political tools. ” Oh f that. There aren’t two sides to this debate. There’s the listen to your doctor and get vaxed side and there’s the whacko far right death cultist side. This gas doctor tries to play both sides. Tell it like it really is… the unvaxxed are plunging this state into a hellhole. Anyone who sympathizes with them and tries to tell us there are two sides is just making it worse. Also… wtf… Read more »

Brian Sweeney
28 days ago
Reply to  Areal Bilk

Going to give you the most recent data flub I can remember. Fauci and the CDC said vaccinated individuals could demask when together and be safe. The MA outbreak where 74% of the cases were in the vaccinated happened and they had to reverse. Breakthrough appears to be becoming a bigger problem with time (vs. Delta resistance) and Israel data suggests we probably should be boostering everyone. For the record, all gastroenterologists are internists. Internal Medicine (IM) also contains pulmonary/critical care and infectious disease. I maintained my board certification in IM for 20 years and scored in top 30% last… Read more »

floridawoman
28 days ago
Reply to  Brian Sweeney

That is not a data flub. Science is fluid, as should be decisions based on science.

“Flub” seems more political(?) than anything else because it is a value weighted statement.

I agree the science on masking in general (covid aside) is limited and evolving.

The science on vaccine mandates, drinking and driving mandates, smoking mandates, and seat belt mandates is very robust.

Brian Sweeney
28 days ago
Reply to  floridawoman

It is a data flub. There was no data to suggest people who were vaccinated were completely safe. Even this NEJM article shows breakthrough is far less but still out there. It is is simply false to say it is okay to make a statement not based in what is available because it is “fluid.” The data on most vaccines is very good. The COVID vaccine is not any more or less safe than other vaccines so safety concerns are not a legit argument. Effectiveness is not what it is for most vaccines. Boosters are going to be necessary. And… Read more »

floridawoman
27 days ago
Reply to  Brian Sweeney

There was lots of data at the time
out of Israel. Which is still gold standard of covid-vaccination data. Your implying the CDC just makes decision willy-nilly without applying the scientific process. Yet providing no data support a so called “flub.”

The response and the science like our federal and state constitutions are living.

Brian Sweeney
28 days ago
Reply to  floridawoman

Ever wonder why there is no flu shot mandate? Or no Shingrix mandate? Or pneumovax?

Areal Bilk
28 days ago
Reply to  Brian Sweeney

Dr Sweeney has spoken. His vast knowledge of Covid was bestowed upon him after an in-depth study of Facebook memes.
This is the kind of crap we put up with. Are you an infectious disease specialist? An ER doc? If not what gives you the credibility to post this?

Last edited 28 days ago by Areal Bilk
floridawoman
27 days ago
Reply to  Brian Sweeney

Ever wonder why there is no mandate for malaria vaccines in the USA? Come on dude, your clearly educated, can read, and can present a logical argument. This is not one. The US military mandates a broad spectrum of vaccines for a reason. However, they don’t mandate all vaccines for all members. That does not mean they should have vaccine mandates. You can do better. Chess much?

Brian Sweeney
26 days ago
Reply to  floridawoman

The only malaria vaccine available is a four shot regimen that is not effective. I have actually taken care of a couple of malaria cases early in my career.

Shingles, pneumococcal pneumonia, and the flu are all common in the US and affect the elderly disproportionately. Sound familiar? That is why I picked those specific vaccines and it went right over your head.

floridawoman
26 days ago
Reply to  Brian Sweeney

It did not go over my head. You claim masks are ineffective, then acknowledge wearing a mask increases the timeline for exposure without infection. You claim mandates don’t work except for all the documented examples of mandates working. Then you just hide behind random, not relevant statements. Ever wonder why exercise is not mandated? oy All I ask is you acknowledge vaccine mandates work and there are situations where a properly fitted N95 mask offers some protection from exposure to Covid-19. Otherwise your just blowing hot air. Once we agree on the basics we can dither on the details-wearing masks… Read more »

floridawoman
26 days ago
Reply to  floridawoman

Flub, over your head, all these value loaded and
ad hominem attacks-why? When facts are facts.
Vaccine mandates work (polio much?) and properly fitted N-95 masks offer increased time to likely infection during exposure.

Richie Romero
28 days ago
Reply to  Areal Bilk

Ok Areola
The nippleless tit has spoken again.
So glad to be responsible for this hellhole you live in. As Carnac the magnificant said “may the fleas from a thousand camels infest your armpits”

Areal Bilk
28 days ago
Reply to  Richie Romero

Enjoy your hermancainaward Richie.

Last edited 28 days ago by Areal Bilk
Richie Romero
27 days ago
Reply to  Areal Bilk

So you don’t like black doctors?

Maurice F Robinson
28 days ago

Well done, Brian. This stone is right on the button. We need more team players or we are going to be dealing with this over and over.

Brian Sweeney
28 days ago

Nice curling reference!

Lynn Willis
28 days ago

Thank your for your comments Dr. Sweeney. Without public health mandates this “death spiral” is now irreversible for the foreseeable future at the local level because the Governor and the Mayor of Anchorage purposefully chose to ignore the objective scientific evidence you and others lay before them to pursue a perceived political benefit to themselves regardless of the cost in lives and public funds. I want to hear now from our federal delegation who share the same political party as the Governor and the Mayor. Regarding COVID control do they support the Governor and the Mayor, YES, or NO?

Last edited 28 days ago by Lynn Willis
Andy Holleman
27 days ago

This is all well stated and a good read. In a lot of ways I can’t disagree, except we see where we are right now. Hospitals are flooded and for the most part, precautions in Anchorage are gone. I was longing for a good steak last night and stopped in to a place that specializes in them. Good meal. Good service. It was just what I wanted. But the place was packed. I almost turned around but decided to see it through. The restaurant was back to full capacity on tables and they were full. No masks on staff, and… Read more »

James R Wilke
27 days ago
Reply to  Andy Holleman

I went to the Seahawks game 10 days ago with 70,000 folks. Masks were required to enter but by the end of the 1st quarter, almost everyone had taken their masks off. Ushers and security said nothing. We all survived.

floridawoman
26 days ago
Reply to  James R Wilke

I see lots of people smoke, but never die, hence smoking is safe?

Brian Sweeney
26 days ago
Reply to  Andy Holleman

I would reference the ADN piece by Dr. Ben Westley. He thinks he got breakthrough COVID eating out with his kid. I have been out to eat twice since this started both for business meetings I had to go to. We all make choices and staying away from crowds is #1 in piece for a reason.

James R Wilke
27 days ago

You wear a mask despite being vaccinated. Do you wear a helmet and a seat belt when you drive your car?

floridawoman
27 days ago
Reply to  James R Wilke

Yes if you are in a convertible and getting hit with rocks.

Brian Sweeney
26 days ago
Reply to  James R Wilke

I honestly wear the mask to make people around me feel more comfortable. If I am worried about transmission to me I wear an N95. I am avoiding large groups but if I did go to an event I would wear an N95. I am wearing an N95 when I fly bit will switch out if the plane is not crowded. I see a tweet every day about a physician getting a breakthrough case. An LA weatherman who was vaccinated died of COVID about a month ago. Life is always about playing the odds and I rig them in my… Read more »

floridawoman
26 days ago
Reply to  Brian Sweeney

You wear a properly fitted N95 mask to make people feel comfortable or because you know it offers some protection from exposure as the science proves?

Brian Sweeney
26 days ago
Reply to  floridawoman

Read what I said. I wear the N95 when I think I am at risk of exposure.

S. Foley
26 days ago

Hi Dr. Sweeny, My first issue to address is when you were asked to provide references that you stated you had already ready you told that person to do a Google search. This is odd. Why? Because for proper research you say you did you would have saved those references and have them easily accessible to back up your claims. Through Google search it is very easy to come across bias information that supports what you already believe. A proper and better prepared response on your part would have been links to peer reviewed scientific research papers, regardless if someone… Read more »

Brian Sweeney
26 days ago
Reply to  S. Foley

You do realize most high quality peer reviewed studies are behind paywalls? And what is not would be pages of links as I explained. So I googled a very specific way and found almost all the first page was NIH abstracts which is peer reviewed data. You, of course, ignored that explanation. I am not going to sit here and list 50 references many of which behind paywall because you think an internet comment section is a medical meeting. Cannaboid hyperemesis and myocardial infarction in cannabis users is building evidence in the medical literature. Nice try but you are not… Read more »

Brian Sweeney
26 days ago
Reply to  S. Foley

Mask data remains poor. I wear one as I said mostly because of psych effects on others. I also always wear higher level masks. Your point about worse is easy. Delta variant. It is more contagious and more virulent. It appears that is because delta creates more viruses when it infects and o e gging missed here is infective dose. More viruses means more infections and more virulance as it overwhelms ommune systems. It is silly to think what is going on is masks because there is some data out there are particularly less effective with delta. If you want… Read more »

Robert
23 days ago

Masks have one other benefit… they serve as a reminder to do the other things… keep your distance being the first, washing hands and surfaces as well. I have first hand experience with the virus in 2020.

sam
22 days ago

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab797/6370149

Far more evidence that masks can make a difference than cleaning surfaces do.

Brian Sweeney
21 days ago
Reply to  sam

You are a prime example of how people do not understand science. This is a bench study not a real world study on transmission. It has zero clinical relevance. Studies like this are used to formulate studies that will actually answer the question. In addition this study is tiny. No clinician would ever use this to make any decision or formulate a guideline.