This is a slow take on some serious questions. First of all what is the NEJM doing writing a political editorial accusing the president of mismanaging the COVID pandemic? The assertions, largely untrue, beg both academic and scientific credibility. NEJM publishes Journal Watch and other CME articles and enjoys an authoritative role at the heart and sole of academic medicine.
The second thing that seemed strange was NEJM’s guidelines for treating COVID19. The guidelines have come to be a treatment imperative for a number of reasons mainly medical-legal. These published guidelines restrict treatment with antiviral drugs to when the patient requires high oxygen flow rates. By then it’s too late. One might assume that some if not most hospitalists will follow those guidelines. So doing, goes against all intuitive medical judgment and appears to be in contradiction to all experience in treating influenza and Vanderbilt’s rather spectacular success in containing Ebola, 11 cases, 4 deaths, 2 nurses and a doctor recovered.
Directing criticism of President Trump’s management of the Chinese virus seems misplaced. Trump cut off travel from China well before WHO condoned it and shortly after CDC trace managed and guaranteed the first known US case in Illinois. The president furthermore held daily public briefings with CDC physicians and evoked the emergency measures act to manufacture personal protection supplies, drugs, test kits and respirators all of which were cut off from the Chinese manufacturing and supply chain. US manufacturers came through in heroic fashion.
Guidance for masks, testing, distancing, isolation and quarantine were driven home from the podium. The economy shut down and the rest is history. The responsibility for balancing deaths from the pandemic with deaths and displacements from the shutdown is awesome and there may never be an acceptable solution, but not for lack of leadership.
Public health is a state run institution, a fact largely misunderstood by the media. Furthermore, masks and isolation authority runs contrary to the legality of individual freedom of choice. What ever mandate that’s legal, comes at the state level. Also, public health is not a clinical specialty. There was always a disconnect between clinical medicine and public health. Most physicians choosing public health do so not to see patients.
It’s a matter of opinion, but at this point in the pandemic, management might better be directed by clinicians, medical schools especially. Public health has exhausted its role in preventing the spread of the virus, maybe it was a lost cause from the time the CCP deliberately encouraged its worldwide spread. Clinical medicine can do much to reduce the death rate with early treatment. The case for early treatment was dramatic with Trump’s rapid recovery at Walter Reed.
Googling publication of NEJM, revels mass distribution if not publication of the NEJM in China, in Chinese. I wonder just how much investment, domination and ownership the Chinese Communist Party (CCP) now enjoys with what amounts to the backbone of continuing medical education (CME) in the US.
Not a conspiracy theory but serious questions about the integrity and possible subversion of the NEJM.
