It is a glorious spring day out here on Canada’s West Coast. I’ll be off to the dog park this afternoon. Good exercise, lots of sunshine, good mental health break. When I am doing the circuit of the park I will have the company of my 20 year old son, Sam, who is very smart but not quite as skeptical as I would like him to be. We’ll be discussing this video: https://rumble.com/vfa2gh-peter-mccullough-md-testifies-how-successful-early-treatment-for-covid-make.html?mref=6zof&mc=dgip3&utm_source=newsletter&utm_medium=email&utm_campaign=HealthImpactNews&ep=2

Dr. McCullough is a very smart, very eminent, doctor and he raises the question of why COVID patients are not offered treatment when they first test positive for the virus. He outlines some of the early treatment options but the real take away is that patients are routinely not offered any treatment or even information about treatment at all.

This has puzzled me from the outset of the pandemic. I realize that this time last year there were few clues as to what might make a difference. HCQ was touted but dismissed on the basis of some rather badly constructed single drug, later intervention, studies. Ivermectin was still over the horizon and some the steroids were being looked at but were not really options. But, a year later, you would think that early treatment would have advanced. But it hasn’t. Nor has there been much official conversation about the benefits of having strong Vitamin D levels and trying to bolster your immune system.

The entire arc of the COVID story has been social distance, masks, closures and lockdowns until vaccines can be delivered in bulk. The idea of a parallel track where doctors and researchers come up with a set of best practices to treat patients once they have tested positive seems to have simply never gained traction. At least not in the West.

Dr. McCullough points out that while all eyes were on the vaccine there was no comparable effort to develop treatment protocols. Why not? The good doctor points out that none of Trump’s COVID advisors had ever actually treated a COVID patient which might explain a bit. But Trump’s people were not the only people advising political leaders. Every country had its advisers.

My own ten cents worth is to look at it from a public policy perspective. From the go COVID has been seen as a public health emergency. Public health, by definition, looks at population scale solutions. Hospital capacity, rates of transmission, reduction of transmission by restriction on movement and activities. To public health officials, with the best will in the world, COVID is a mass phenomena which requires mass solutions. There are, however, other lenses to bring to COVID.

COVID could have been viewed as public emergency like an earthquake or an economic collapse. Through this lens, public health is one element of a government wide response. Through this lens, the public health interest in containing the spread of COVID would be matched by a medical response on a case by case basis. There is no reason we could not have done both. (Obviously, in the hospitals and the ICUs, case by case medicine is being practiced with somewhat encouraging clinical results.)

In a purely public health response, the idea of treating individual cases and developing protocols for early intervention can easily be lost in the drive to preserve the population until vaccines can be developed to save us all. And the logic of public health can justify all manner of non-pharmaceutical interventions to avoid overwhelming the hospitals and keep people from getting the virus. However, the public health response tends to see the virus as a binary: either you avoid it long enough to get vaccinated or you don’t and your risk of death rises. For a nastier virus than COVID has turned out to be, that might have been the correct reaction. But COVID is not ebola or even the Spanish flu, its nasty but most people will survive it.

The medical question, rather than the public health question, is what Dr. McCullough wants to talk about. It is a conversation which should have been had in the Spring and Summer of 2020 when the first wave had broken and the second wave had not yet arrived. Doctors now had clinical experience with severe COVID and were developing strategies to deal with it in hospital settings. But, apparently, there was very little work being done to figure out what to do in the critical week or two between a person testing positive and developing symptoms severe enough to require hospitalization.

Frankly, that amazes me. It shocks and amazes Dr. McCullough.

Right now I am going to organize the daily dog park tour and drink in the Spring sun. Like most upper respiratory infections, COVID should fade quickly as the weather warms. But, as it does, it would be a very good idea, even with the vaccines, to come up with standard of care treatment plans for people who come down with COVID as we wait for the vaccine.

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