A PLEA FROM AN ANONYMOUS CANADIAN DOCTOR!

I think people need to calm the hell down about COVID. Here's why.

Remember that bad flu year we had in 2018... yeah - I know you didn't, because unless you work in an ER or ICU you didn't give a crap). 140K excess deaths in EU that year. This year? ~187K excess deaths. Here in Canada, we had about 230 deaths/million from the 2018 flu season, and from COVID so far we're at 240. And with COVID, deaths are much more confined to nursing homes than the flu of 2018, which was much harder on infants and pre-school kids. Some died. But nobody freaked out - because it was the flu.

COVID is so contagious it peaks and wanes in about 6 weeks instead of 6 months. That sudden rush of cases creates a scary problem for us in the hospitals and public health to worry about. But it doesn't mean you should freak out - leave that to us, we're freaking out enough for everyone!

Did anyone notice that subtle mission creep from "We have to work together to flatten the curve so the healthcare system doesn't get overwhelmed" (thank you all by the way!!!!) to "Even one death is too many"?? These are completely different goals, that require completely different responses. Most of us signed on for #1, but got railroaded into #2. We never signed on for that. If zero deaths is the goal, is this a new normal for Flu and other respiratory bugs? Are we going to shut down our lives for flu as well? COVID is here, likely forever. We're not getting rid of it. We can't save everyone. We need to figure out a balance between locking down to prevent transmission and opening up so we stop killing people through poverty, despair and depression, and lack of medical care.

If you're a "we'll just lock down until a vaccine" person, remember a few things:

1) flu vaccines are ~30% effective. They are not guarantees, they change the odds. Most likely a COVID vaccine will be similar.

2) the people that most need protection from COVID (elderly and sick) are the ones for whom vaccines work the least. The ones at almost no risk from COVID (young and healthy) have robust immune systems that respond well to vaccines.

3) it looks like summer of 2021 is the earliest we can expect a vaccine to be widely distributable. Even then it will be less rigorously tested than previous vaccines, so it's not a sure thing that it will work, or be completely safe.

Take a deep breath and consider some stats:

-far more people in BC died this year of OD's than COVID. Are you freaking out over OD deaths?

-many times more people are dropping dead of heart attacks and strokes than from COVID. Even in Italy, they are on track so that by the end of the year only ~6% of deaths will have been from COVID in 2020.

-)Even currently in the US where things are "bad", less than 15% of deaths each day are from COVID. So 17 in 20 people who die each day are dying from a non-COVID cause.

- people dying of COVID are 80% in nursing homes and an average of 79 years old (so more than half over 79 if you do the median/mean calculations, for you statistical geeks). It's always sad when someone dies, but patients with long healthy lives ahead of them aren't living in nursing homes. NH patients have a very high yearly mortality, COVID or not.

-when you hear someone "died of COVID" remember that many of these patients had end stage cancer, or dementia, or something else that had them on the edge of death. COVID was the final gust of wind that blew them over. Did someone with stage 4 bowel cancer on the palliative care ward "die of COVID", or was it the cancer? Officially we count it as COVID, rightly or wrongly.

-The percentage of COVID deaths where the deceased was actually young and healthy is TINY. Almost all patients dying of COVID have at least one comorbidity, and the majority 2 or more (all the more reason to take care of your health!!)

-This is not the Spanish Flu. The Spanish Flu killed 1/33 people worldwide, at an average age of 32. COVID has killed 1/10,000 people worldwide, and in the worst-hit areas 1/1500 people or less (mostly people who would have died very soon with or without COVID, who were at the end of their life)

-7 million people die of air pollution (combined indoor and outdoor) per year. Less than 1 million have died of COVID. Do you advocate shuttering the economy and closing borders to reduce air pollution deaths? Why not?

-1.4 million people die each year from motor vehicle collisions. We have lost less than one million from COVID, and numbers have already peaked. Do you advocate banning cars? If not why not?

-COVID is much LESS dangerous for kids than is the flu. So stop stressing over your kids and let them be kids!

-You know all this stuff about "long-term effects of COVID!!". That's crap. It's the media, not science. COVID only started in earnest 6 months ago, so other than with a crystal ball, we have no idea yet about "long-term" side effects. Stay tuned for the next year or 3 for a final answer on that. As of now what I can say is that as a doctor I have seen TONS of patients who were seriously ill and hospitalized with flu or pneumonia who have long term effects, from brain damage (especially for ICU patients) to kidney failure, to permanent lung damage and scarring, to heart damage. Anything that makes you really sick and stresses your organs will do this. There is no reason to suspect COVID is better or worse in that regard, other than if you want to make a clickbait headline on your media site.

Have a look at France's COVID data on Worldometer to understand why you shouldn't freak out about case count when there are almost no seriously ill or sick people. They have had a massive bloom of CASES over 8 weeks but essentially no DEATHS or seriously ill people. Believe it or not Trump is (partially) right - when we test a lot, we have a lot of cases. Well over 99% of people with COVID will not be gravely ill, and in fact over half have no symptoms. When we test, we find all these cases that only matter in terms of preventing spread - they are not at risk for death and disability. We don't test everyone who has the sniffles for mild flu, but we do test for mild COVID, so we see there are thousands of cases. Probably true for flu too, but nobody cares.

Understand that Canada's current seriously ill/death rate is negligible.

In most of Canada even during the first wave hospitals were as empty as they have ever been, many physicians were sitting home on their hands, and ICU's weren't full. There were a few exceptions in the big cities, but even that was fairly temporary. So even if wave 2 is multiple times as big, in my opinion our healthcare system will manage if you look at our resources that we can mobilize if needed.

I hope we have zero more sick people, but we are now well-prepared to deal with the next wave if it comes. (or at least as well-prepared as Canada's healthcare system can be given it's overall limitations)

Please try to understand that infectious disease is a fact of life EVERY YEAR. It's not new this year. You should have always been careful about visiting your granny when you have the sniffles. Just because a bug is mild for you doesn't mean it will be for her. COVID has been a reminder to take care. But unless you are the Howie Mandel type who freaks out about bugs in general, or you routinely freak out during the flu season, please stop freaking out about COVID. Frankly it's annoying.

MY PLEA IS THIS:

-Don't be holier-than-thou about masks or social distancing. If you do, it's likely that you have paranoid personality disorder or a saviour complex. Look seriously at your own reaction before lashing out. If masks help, the difference is small. (an analogy - trucks and SUV's are 6 times as likely to kill a pedestrian than a small car in an accident at the same speed. Do you report your neighbours to the police, or berate them, for putting others at risk when they drive their SUV? Do you drive one yourself? Stop feeling morally superior.)

-Understand your COVID risk relative to other risks. I saw a hilarious post where someone was seriously mad because "the guy behind me in line at KFC wasn't wearing a mask". Guess what chub-chub - your odds of dying prematurely of heart disease from eating KFC are way way higher than your odds of dying of COVID! Stay at home and cook some vegetables - zero COVID exposure risk and the bonus of not clogging your arteries and causing diabetes.

-DO wash your hands reasonably (leave some skin on).

-Don't kiss random strangers. For various reasons this is a bad idea, COVID or none. The police frown on it.

-DO get fit and active today. Stop eating crap and start eating fruit and veg and grains. (An aside - diabetics with poor control of sugar - ie: overweight, inactive, poor diet - are at 10X the risk of COVID death, and within 2 weeks they can seriously improve their sugar control through lifestyle.)

-Please stop being too paranoid about washing surfaces. You are probably creating more dangerous superbugs by overusing sanitizers than you are preventing COVID. Cleanliness is next to godliness. Over-cleanliness is next to OCD and is not healthy mentally or physically. Remember all this craziness about how COVID clings to surfaces forever like some evil villain lying in wait!? It turns out that was overblown.

-Remember that there is a balance between "staying safe" and "staying well". They are not the same. You can stay 100% safe by locking yourself in your basement for the next year. You will NOT be well - I guarantee it.

The safety-risk balance is different for all of us. I respect anyone's right to lock themselves in solitary confinement should they feel that's best for them. But remember that for others, their best life and best balance of safety vs. wellness may be seeing people smile, hugging their mom, or chatting with friends. Even if that means accepting a small risk of COVID. Leave them be.

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I'd love to be able to put my real name on this, but I fear for my job. High-profile doctors have been censored for similar opinions, and I'm just a nobody grunt in the primary care trenches so I could be burned at the stake. I hope other people can pick up the torch and talk about these issues. The right amount of lockdown is somewhere between none at all and full stay-in-your-house. We need to realize that lockdown has harms. We need to recognize that people have rights to choose their own level of risk. We need to tell our elected representatives that beyond the need to prevent the hospitals from being swamped, the government's legal and moral mandate to dictate to you or me as to how much risk is right for us, is highly questionable at best.

Dr. T.A. Tinalts

Primary care physician, Canada

September 2020