Leading doctor on COVID responses: From the sensible to the absurd

By Jane M. Orient, M.D.

Note: Dr. Orient is executive director of the Association of American Physicians and Surgeons, AAPS.

Draconian directives by some state and municipal authorities are so absurd that one wonders: Do the officials have a clue, or is something else going on?

The craziest things I have heard: Closing an entire shopping mall because a presumptively infected person walked through it, and forbidding people to go outside – the least likely place to catch an airborne infection.

Lockdowns: Well-intentioned actions can have unintended consequences. Kicking college students out of their dorms and sending them home – after they have already been infected – sends the virus from a group of young people who tolerate it well to the homes of older people with pre-existing conditions. An extensive lockdown that creates unemployment will force people into more crowded conditions. Restricting movement keeps people from seeking safety or items that fill their needs. Treating everybody like a Typhoid Mary keeps people from helping each other. Does it stop the virus? It may have already spread to half the population, who never got visibly sick or who recovered. Since we aren’t testing for antibodies, we don’t know. Only 3 to 4 percent of symptomatic persons presenting themselves for testing in South Korea were shown to be positive for virus in nasal secretions.

If we might die because we carried a COVID-19 virus particle into our home on our shoes, or picked one up on the handle of a gasoline pump (along with a gazillion other viruses and bacteria), we are all surely doomed. The most extreme obsessive-compulsive hand-washing or bathroom-scrubbing rituals could not save us. If we could sterilize the environment, never mind the gazillion microorganisms that peacefully coexist in our bodies, our immune system would atrophy, and we’d die like the Martian invaders in “The War of the Worlds” by H.G. Wells.

We need to sensibly protect the vulnerable (and the state of vulnerability is not triggered by our 60th birthday), keep our germs to ourselves when sick and practice universal good hygiene. But destroying the economy will also destroy our health.

Easing regulations: The federal government has decided that if you have a choice between a federally certified and approved medical device or death, because such a device is unobtainable, you may improvise – without fear of crippling fines or incarceration in a crowded, unsanitary jail. Auto manufacturers can make ventilators; individuals with a 3D printer can make missing parts; people can modify a ventilator to serve more than one patient; an underwear or pillow factory can make masks; and medical staff can disinfect and re-use protective gear they would otherwise throw out.

Also, some jurisdictions are forbidding instead of requiring those filthy reusable shopping bags, and coffee establishments are using only disposable cups.

Might greater freedom and common sense and cleanliness emerge from the crisis?

Preventing and treating the illness: There are NO FDA-approved preventive or therapeutic COVID-19 treatments. So, along with social-media giants, mainstream media and some political authorities, FDA is trying to squelch reports of “fraudulent” cures. But “unproved” or “unapproved” does not mean “ineffective” or “falsified.” If FDA standards had been in effect in 1747, British seamen would have continued to die of scurvy. Instead, the navy used a study that consisted of two “anecdotes” of patients getting well when given lemon juice, while all 12 who got something else died.

Now we have “anecdotes” of COVID-19 patients getting well after being given an old antimalarial drug, chloroquine or hydroxychloroquine. We also have reports of failures in seriously sick patients. This would not be surprising – the drug may inhibit penetration of the virus but not help once it is proliferating inside cells, and an over-exuberant immune reaction is damaging the lungs. President Trump has called on drug companies to ramp up production to meet the shortage. Nevada Gov. Steve Sisolak, who built a communications business, has ordered a ban on out-patient prescriptions for COVID-19. Some pharmacy boards and other authorities are restricting doctors’ prescribing, although it is perfectly legal to prescribe these long-approved drugs. Some criticize doctors for taking this prophylactically themselves, or prescribing it to protect family or staff. Do they think doctors should stay away from patients, or fail to protect themselves?

Stores are sold out of vitamin C, and this FDA-nonapproved treatment is being used in “massive” doses of 1,500 mg (1.5 g) intravenously in New York, reportedly with good results. (Many people routinely take much more than that daily.) In China, the use of 20 g a day has been reported.

Many drug trials are in progress. Adult stem cells, a modality the FDA is trying to suppress, are said to be a breakthrough that restores damaged lung tissue, according to a Chinese physician. Antibodies from the plasma of recovered patients – an idea used in the 1940s to treat pneumonia – are being tried. Back then, they were less effective than X-ray treatment; both fell out of favor when antibiotics were discovered.

The best treatment methods might be new and completely untested, or on one of those forbidden websites. How will we find out what works and what doesn’t if we gag people like the Chinese do?

The FDA’s effectiveness testing requirements have likely kept a huge number of effective drugs off the market since instituted in 1962, and enormously increased costs. The COVID-19 crisis might lead to a better approach.


COVID-19 can be a horrible, rapidly fatal illness in certain patients, and we cannot reliably predict which ones.

There is no evidence that a national, indiscriminate lockdown will decrease the toll of the disease, but it will do tremendous harm.

We need freedom to innovate in testing, protective equipment and treatment.

For further information, see this compendium of coronavirus articles.

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