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Newsroom

Wear a Damn Mask, PLEASE!


Read the latest blog post from Cureus Editor-in-Chief, John R. Adler, Jr., M.D. When Covid first appeared in the US, several Asian physician friends had simple advice for me, “Wear a mask.” Having dealt with various coronaviruses for over a decade, this was the fundamental lesson taken from dealing with and controlling these respiratory viruses. Now, I may only be a dumb neurosurgeon, (said with humility, irony and in jest), but I know a thing or two about masks, having spent 30 years of life wearing them, sometimes for 12 or more hours at a time. There is nothing pleasurable about wearing a mask, but I have experienced first-hand how masks can protect patients and physicians from illness. More broadly I have seen how masks can protect healthcare workers from the worst of infectious diseases, even giving them supernatural-like protection when they must enter the belly of the beast while caring for highly contagious and fatal illnesses like Ebola. Meanwhile, each and every day, healthcare workers all over the world, including my own family members are able to avoid infection while caring for hospitalized Covid patients who are often spewing the virus everywhere. It’s incontrovertible - masks truly work!; they prevent Covid infections. So why is it that some people contest the efficacy of masks and refuse to wear them? Perhaps they’ve heard claims that wearing a mask poses a health risk such as hypoxia (when the body is deprived of oxygen) or hypercapnia (excessive carbon dioxide in the bloodstream). A plastic bag might do such a thing but certainly never a cloth mask, the preferred personal protection equipment (PPE) for the public. More sophisticated surgical masks and N95 respirators tend to fit more tightly than a cloth mask but they never result in hypoxia or hypercapnia. Meanwhile these more sophisticated tight fitting masks are generally reserved for healthcare professionals who sometimes can be literally engulfed in a cloud of airborne Covid-19 particles when dealing with very sick patients. No matter, masks trap only a tiny bit of carbon dioxide which is why as a surgeon I could wear one all day while performing very demanding surgeries. Even most patients with asthma and chronic obstructive pulmonary disease, or COPD, can AND SHOULD wear masks unless they are in the middle of an extreme exacerbation of their disease. So damn it, why can’t y’all just wear masks when in public? Deep down I am a lifelong libertarian, and truly cherish freedom as much as any, but to equate wearing a mask with subjugation is just plain stupid. Neither is going maskless some expression of courage! I am asking you to wear a mask not to protect yourself, but so that you might protect other people, especially truly vulnerable individuals. OK, maybe you don’t give a sh*t about yourself or others; then wear a mask because you don’t want to be poor. Rampant Covid infections are interfering with US domestic economic activity but especially between the US and the rest of the world. If you haven’t heard, or experienced first-hand, Covid is really REALLY bad for the US economy. So what is it? What is your excuse for not wearing a mask when you are in public? Damn it, you are out of excuses. Covid-19 may be one badass virus, but it turns out it is no match for masks. So please, please, please wear a mask… and by the way, wash your hands too!

Jul 06, 2020

COVID-19 and the Titanic Dilemma: Which Patients Get Priority?


Read the latest blog post from Cureus Editor-in-Chief, John R. Adler, Jr., M.D. Passengers, frightened by the Titanic sinking beneath them and knowing that there were not enough lifeboats to go around, had mere minutes to prioritize who among them might be saved. Steerage passengers were largely left to fend for themselves. Among everyone else it was implicitly understood that children would be saved first. In fact, this necessity of sacrificing ourselves for younger generations is as old as humanity. This hierarchy of sacrifice for a “greater good” resonates deeply within all cultures and is part of why the movie Titanic is so beloved worldwide.   Fast-forward to Spring, 2020, where we find ourselves trapped on a metaphorical ship. This time we have tragically struck an invisible microbe precipitating the current Covid-19 pandemic. Starting first in Wuhan, then Northern Italy, Spain and France, and now bearing down with all its fury on the United States, Covid-19 is challenging the moral framework of our society, and even our identities as compassionate humans. At the heart of this calamity is a subset of very sick patients requiring prolonged respiratory support from a finite pool of ventilators. Anticipating a tragic necessity to ration these life-saving devices, a handful of US states, and most recently The University of Pittsburgh (UPMC), have developed a range of “guidelines.” Some states have chosen to consider age, advanced cancer and intellectual impairment as relevant considerations for rationing ventilators. However disability and elder rights groups, seeking to represent their constituencies, have recently and successfully pushed back hard. Specifically, these lobbying groups have raised objections to the US Office of Civil Rights, arguing that hospitals (via state guidelines) were being “ordered to not offer mechanical ventilator support for patients” with “severe or profound mental retardation,” “moderate to severe dementia,” and “severe traumatic brain injury.”  Memorializing these civil liberty objections, the ivory tower team of UPMC medical ethicists has developed their own set of “guidelines,” to which “100s of hospitals” are now poised to sign up. The group think, the politics, the idiocy of where we now find ourselves in this health rationing debate, leaves me dumbfounded. Mortified. Stupefied. What I am hearing is that society’s politically savvy actually subscribe to the notion that a 90-year-old Alzheimer’s patient, a vegetative head injury patient, or an end stage cancer patient should have the same access to a proverbial lifeboat as a healthy 18-year-old. How can our collective judgment now be so impaired? How is it that our ancestor’s self-evident notions have been washed away during the current panic? In no way do I wish to suggest a healthy Down’s Syndrome or vigorous cystic fibrosis adult not be given a fair shot at a life saving ventilator. However to not acknowledge that “fairness” can involve a hierarchy of intellectual, medical and “chronological” disability is beyond foolish. Hopefully such indifference to OUR collective future will not prove to be the final legacy of the “greatest generation”? Fortunately I am reassured by the many senior and disabled individuals with whom I have discussed the current intellectual brouhaha. Each of these many family members and friends are, like me, utterly dismayed that we are even having this debate.  So let me end by being thoroughly blunt. If at some juncture a medical team with only one ventilator needs to choose point blank between saving me, a healthy 65-year-old, and the life of a much younger and reasonably healthy patient, please do not hesitate - let me die. Does anyone want to live in a world that has forgotten the wisdom of the ages?

Apr 06, 2020