But it is not pure arithmetic. You have to think about asymmetries --like a stroke is usually worse than a bleed (anticoagulation). You also have to consider different patients have different experiences and goals. (Eg. NY COVID not same Montana) 2/
Always bad is to avoid facing harsh realities. If you dance around frank discussions of say a cancer or heart failure diagnosis you do patients a disservice. I wish everyone had an easy problem--like SVT. 3/
Enter #COVID19 -- you have the virus, a terrible disease b/c of its novelty, contagion, and unpredictable course. But then there is the intervention: shutting clinics, reducing hospital volume, lockdowns of the economy, Also terrible. 4/
What I tried to write about is the harm caused by intervention. I know people care about it, but it seems the public discourse heavily weights towards all things safety, with less consideration to non-covid ills. Much of my job is helping people avoid iatrogenesis 5/
Take cancer care. I've seen patients who have been hurt worse from the therapy than the disease. Consider how badly COVID hits the elderly, disadvantaged. That sucks. But the social distancing/lockdowns can also disproportionally harm these same groups. 6/
Part of the reason people could be harmed by interventions is because candid discussion isn't allowed. Can we say 1) the virus will not be contained and 2) Flattening of the curve protects hospitals from being overrun, but will have little to no effect on cumulative deaths? 7/
What I tried to do as apolitically as possible is write from the assumptions that our struggle against #COVID19 is 1,2 or 3 year endeavor, a marathon not a 5K. This virus will always be dangerous to elders, but so is isolation. 8/
I recoil against the idea that moderation of distancing measures in places in the US and Sweden is akin to human sacrifice. That sort of hyperbole and fear-mongering in medicine always leads to bad decisions. Also, no US hospital is now unprepared. It's May, not March 9/
Here's my attempt at considering the hard questions. I take it as assumed, having seen Remdesivir data and read on the challenges of vaccine use in a disease w 99% survival that there will be no magic bullets any time soon wb.md/2SryRYW
