Restricting doctors during this pandemic is the wrong prescription
Our nation remains besieged by a pandemic. Now more than ever we need the medical expertise and proficient care of our nation’s physicians.
Some in the media would have you believe that physicians are being empowered to tackle this unprecedented national health care crisis, with all the red tape cut and protective equipment provided, but tragically this is only occurring in microscopic proportions.
Strangely, as federal officials are encouraging the loosening of physician restrictions, the same caregivers are subsequently being restricted by state governments from providing potentially life-saving medical and surgical care to their patients. In many instances, state governments have threatened physicians and surgeons with loss of licensure, fines and even jail time.
The national focus has been on promoting social distancing, transforming tents, hotels and Navy ships into hospitals, while building and distributing ventilators to densely populated urban areas ravaged by end-stage consequences of the unchecked spread of this highly contagious disease among at-risk patients.
But the authority for caring for individual patients does not fall on the federal government; rather, it is governed by smaller bodies given the vast diversity throughout our country. Yet, those smaller government authorities are failing us.
We are capable of doing better than this.
As physicians and patients alike, we envision our health care leaders being on the cutting edge of solving the COVID-19 crisis. However, the ability to lead is dependent on the information our local authorities and health care administrators receive from those who advise them on the federal level. The reality is, the information put out by the Centers for Disease Control and Prevention (CDC) and other national and global organizations are being transformed into overreaching executive orders with the potential for unintended consequences at the state level.
Across the country, currently 35 states and Washington, D.C., have released official statements addressing the issue of elective procedures during the ongoing COVID-19 outbreak. The concept surrounding delaying elective surgeries is to ensure proper hospital bed, ventilator and personnel capacity with a rise in COVID-19 patients. However, the long-term consequences of delaying certain aspects of health care, such as cancer treatment and unruptured brain aneurysm management, potentially hold a significantly higher individual mortality than COVID-19 does.
However, because executive orders are being decided by nonclinical healthcare workers — the far majority who are not medical doctors — physicians are being held hostage and prevented from providing crucial care to their patients.
Not only is surgical decision-making being interrupted, but governors and state pharmacy boards across the nation are putting forth their own executive orders and emergency rulings restricting physicians’ prescribing freedom.
While there have been reports of inappropriate prescribing resulting in medication shortages, these instances should be looked at individually without a universal removal of prescribing freedom, further harming patients from receiving potentially life-saving treatments.
The trifecta of limitations being felt by physicians across the country concludes with COVID-19 testing. In New Jersey, testing is only advised for a narrow group of people, while those who can be prescribed medication are even fewer. The remaining people are told to watch and see if severe symptoms develop and hospitalization becomes necessary before testing and prescribing of HCQ are offered.
Hydroxychloroquine (HCQ) is being restricted to patients who are in the hospital yet it is showing effectiveness at decreasing severity of infections. If the goal is to decrease the amount of people with severe symptoms requiring hospitalization, then it would behoove legislators to lift the restrictions and let outpatient doctors decide if the medication is right for their patient.
We need actual physicians proposing solutions and making decisions to promulgate a dialogue with our leaders to solve this increasingly devastating crisis. Here are four basic steps that should be taken immediately:
Release physicians from onerous state emergency rules. These rules restrict all but urgent or emergency procedures, under threat of investigation and punishment. Free physicians from these limitations that prevent them from providing timely care to their patients lest inevitable disease progression and harm occur, creating a new public health crisis. COVID-19 is not the end-all-be-all of our country; we should not continue to allow others to suffer while restricting physicians in their operating and prescribing rights. Instead, we should take doctors off the bench and put them back in the game.
Timely treatment of active infection. Physicians outside of the hospital setting must be permitted to implement low-risk, low-cost measures to curb the transmission of COVID-19, through shortening viral shedding and potentially decreasing the need for hospitalization.
Mounting worldwide evidence supports the use of a combination of hydroxychloroquine, azithromycin and zinc, drugs that are inexpensive and easily produced having been deemed safe for use for decades. Waiting for robust clinical trials to prove efficacy may be futile while people are dying. Although the CDC continues to push the message that there is no proven treatment for COVID-19, which is true, the Food and Drug Administration (FDA) has issued an emergency use order for this medication combination given the increasing reports of its efficacy.
This inept trickle-down effect from continuously evolving global and national recommendations has to come to an end so we can shift from universally restrictive measures to a more patient-centric focus. It’s time to shift to more aggressive — yet cautious — outpatient use of this combination in early cases to potentially delay disease progression, diminish viral shedding and avert hospitalizations, all for which help mitigating community spread and saving limited resources. The only way to do this is by urging the states to remove their authoritarian executive orders and facilitate access to these agents by removing restrictions that impede outpatient use and use in presumptive positive patients.
Prophylaxis use of HCQ for high-risk individuals. In addition to proper personal protective equipment (PPE) such as N95 masks, we should consider utilizing HCQ as a preventive measure, given that it is a time-tested drug with minimal side effects and limited risk.
Areas in India are currently taking this proactive approach to keep their health care workers healthy, despite the effectiveness of such measures remain to be seen. However, perhaps it should be considered here too, especially for frontline workers to remain healthy and in circulation while we battle the disease. Of course, taking HCQ is not without risk and should only be taken judicially, and under the supervision of a medical physician it may prove to be an effective prophylactic measure.
Antibody testing is of utmost priority. Such testing would help to determine the true prevalence of infection and identify who might already be immune. Although the FDA is fast-tracking many applications and has passed Emergency Use Authorization for some, it must also not allow the testing to be restricted to inpatient hospital settings and must become available for outpatient point-of-care use.
The use of immunological data, testing for antibodies to identify active infection, to affirm a convalescent state has been achieved and potentially immune individuals who can return to work safely — because this population is quite possibly a wall of protection against the spread of the virus. Antibody titers — measuring just how much antibody an organism has produced — will give us a true denominator of how many have been infected, so we are able to then determine the true hospitalization, ICU admission and fatality rates of this global pandemic.
Current government actions focus on planning for the worst, hunkering down and fearfully waiting for a new vaccine and a new miracle drug to be approved next year, as our economy and our lives collapse around us.
We must instead shoot for the best, use what we have now, decrease the need for hospitals and ventilators, save lives and get back to work. Maybe it’s time to listen to physicians rather than politicians and their deep-pocketed pals
Nicole Saphier, MD, is a full-time practicing physician in New York and New Jersey and a Fox News contributor. Follow her on Twitter @NBSaphierMD.
Kris Held, MD, is a full-time practicing physician in San Antonio, Texas and president of the Association of American Physicians and Surgeons. Follow her on Twitter @kksheld.