Unfortunately, here we are again. People with major influence continue putting forth false information with or without intent to stir agendas. I have been hearing more and more about it and seeing reposts and shares on social media platforms and it is frustrating and frankly, upsetting. I would like to clarify some misinterpretations of some of these claims once again because as we have learned…Words are dangerous…

The first and biggest claims I would like to dispel are those from Joe Rogan and Elon Musk. Now don’t get me wrong, I like to listen occasionally to Joe Rogan’s podcast at times (not all of his conversations strike me as interesting or scientifically accurate). I am a fan of Elon Musk’s Tesla vehicles and push to stretch the limits of engineering and science. Having said this, their most recent podcast on 5/7/2020 did cause me to reel back in frustration. Joe has also made some statements in a few other recent podcasts which have been inaccurate as well. I’m going to talk about a few of their claims and put forth evidence to dispel this. The reason why this is frustrating, is because he reaches millions of people per day and has a large influence on a large part of the population which could potentially cause a resurgence of COVID-19 cases if they do not adhere to public health measures. He is not politicizing or pushing a personal agenda but his beliefs and incorrect facts could sway people to feel a false sense of security and go out in public in defiance of what is currently known about this virus. I don’t believe he is saying this out of malice but still…words are dangerous.

The first claim that struck me as frustrating is when both Joe and Elon claimed that COVID-19 deaths were being falsely reported and ultimately inflated. Currently there are over 90,000 deaths in the US and likely more due to home deaths and under reporting. A comment was made stating that if you had been eaten by a shark and they tested the arm and it was COVID-19 positive, that would count as a death. While this was intended to be a grossly exaggerated joke, the point he was making is inaccurate. Per the CDC for death reporting guidance related to COVID-19, as a medical provider, there is a process and guidance in how to report these deaths. As someone who has filled out and signed death certificates for patients, I can assure you that this is being done appropriately across the country. Sure, there may be a few (much less than 1%) which may be presumed COVID-19 and are not or they were thought to be COVID-19 related and in reality may not have been in the end, but that is a very minuscule percentage. Let me explain why this matters. If a patient walks into the hospital and has symptoms consistent with COVID-19, we presume it is such based on a number of clinical factors (symptoms, vital signs, physical exam findings, chest imaging results, inflammatory markers, blood markers, chemistry values, etc). If they pass away with this clinical syndrome which is consistent with COVID-19 prior to PCR testing and die from hypoxia (low oxygen) from respiratory arrest or multi organ failure, it is recorded as presumed COVID-19 related death and this can be done with a fairly strong degree of certainty. For all others, patients are confirmed with PCR testing to be COVID-19 positive. And yes, if a patient walks into the hospital and has a heart attack and dies with a positive test result, it will be counted as COVID-19 related death. The reason for this is because the virus puts strain on the person’s body, including the heart and causes a cascade of inflammation. Inflammation is typically what causes heart attacks and is ultimately the originating cause of death. Yes, the patient likely had plaque in their coronary arteries and may have had a heart attack at some point regardless of COVID-19, but with the inflammation seen in COVID-19, this is likely the straw that broke the camel’s back, triggering a premature heart attack. They say that patients who have “weakness or shortness of breath” are automatically being labelled as COVID-19 and they “don't know any person that doesn’t have weakness or shortness of breath when they’re dying.” This is not true. We do not label someone as having weakness or shortness of breath as a cause of death and as a medical provider, it is insulting to insinuate that this is being exaggerated to say we are labeling anyone with weakness and shortness of breath as a COVID-19 death. If a patient does have these symptoms however, it is likely that they do have COVID-19 but have shown other clinical signs to indicate this label. They also note that the flu is not labeled as a cause of death when someone tests positive and then has a heart attack. This is not true. There are patient’s whose deaths are reported as related to flu. So when Elon and Joe state that causes of death are exaggerated or falsified, it is incorrect and actually insulting to those providers who are doing their job well and appropriately (which is a large majority). Words are dangerous.

The next claim Joe and Elon made was that ventilators are causing a large number of deaths and we in the medical community are unnecessarily putting patients on ventilators because we’re trying to make our hospitals money due of the drop in other revenue sources (elective procedures, outpatient visits, etc.). This is flat out wrong and once again, insulting to any upstanding medical provider having to treat COVID-19 patients. Intubating and putting someone on a ventilator is something we absolutely DO NOT take lightly and it is a difficult decision we make when faced with a critical health scenario. We don’t want to ventilate someone because there are associated complications; the same reason we don’t always like prescribing medications because there are inherent risks (like hydroxychloroquine, but we’ll get to that later). First of all, if a patient needs ventilation, they will get ventilation. This is typically when the highest amount of oxygen that can be delivered non-invasively is still unable to achieve a normal/acceptable blood oxygen saturation. Other than a pressurized high-flow, non-invasive ventilation helmet, there really are no other options than ventilation. Failing non-invasive oxygenation and ventilation for any respiratory condition will result in intubation (unless a DNR/DNI order is in place). COVID-19 is causing a respiratory syndrome unlike what we have seen before requiring longer than normal ventilation times (weeks instead of days compared to other usual respiratory conditions). So the fact that they are insinuating providers are putting patients on ventilators at the order of their hospital to make money despite not being clinically indicated is truly an insult to our healthcare community’s integrity and moral code. Now is a time when we need to have faith in our medical system, not doubt and fear of ulterior motives. Yes there are financial incentives and likely some poor intentions in some health institutions but overall this is an unlikely occurrence at this time. Call me naive, but I don’t know any providers personally who would commit such fraud and explicit moral maleficence. Words are dangerous.

As for claims that ventilators are killing more people than helping, that is not true either. Patients with COVID-19 require higher than normal pressures (different settings) which can result in lung injury when compared to other respiratory disorders. Joe Rogan stated that ventilators have an 80% mortality rate. This is a false number which was once reported however a more accurate number is less than 30% which is comparable to other non-COVID lung conditions requiring ventilation. The reason the initial ventilator-related mortality rate for COVID-19 was around 80% in the beginning, was because people at the peak of surge were only counting those who died from COVID on ventilators compared to those who were discharged. Sadly, they did not count those who were, at the time, still alive while on ventilation but have since recovered and been discharged. Appropriately adjusting this data, caused a drop in that number dramatically to less than 30% and further ventilator mortality rate studies have been conducted globally, showing improvements in that number to 20-30%. This is in line with typical non-COVID ventilator mortality rates. Also, patients who require ventilation are typically the sickest of patients which has a lower survival rate to begin with. There are thousands of patients, if not, tens of thousands of patients who have been extubated off of ventilators. If patients hear this, they may once again fear the medical system and decline treatment if they need ventilation out of fear of what they heard from Joe Rogan. Words are dangerous.

They then go on to talk about civil liberties being violated related to the lockdown and how Tylenol/smoking have associated deaths and discuss what are “acceptable death rates.” Tylenol has about 500 deaths per year related to acute liver failure from overdose (also, not contagious). Smoking has about 500,000 deaths per year. They debate how no one pushes back against smoking for a political platform. This is not true as the surgeon general has released guidance and agendas to reduce smoking. This is the reason why in Massachusetts (and many other states) most public and even some private areas prohibit smoking where it once was because we learned that secondhand smoke causes about 250,000 of those 500,000 deaths. When public health is threatened from the actions of another person, there is a moral obligation to prevent that from happening. This is just my opinion and could be debated for eons but they discuss that civil liberties are being violated from having to be on lockdown. They note that those who are at risk should stay at home and those who are low risk should have the freedom to live their lives. The unfortunate truth is that the risk still remains high for those who are high risk (and some do not even know they are high risk). Many people are walking around unknowingly with immunodeficiencies, undiagnosed lung disorders/diabetes, or even just having obesity thinking because they have not been diagnosed with something, they are young, and have avoided the doctor’s office. Those who work for companies that are now reopening may not be able to return to work because they were born with a condition which places them at risk of complications related to COVID-19. What then? I am not saying there is a perfect plan to reopen because there isn’t. This is unprecedented, however we cannot assume that if you are perceived as healthy and between the ages of 19-60, then you’re low risk. That may not be the case if you are undiagnosed with a condition or have not seen a medical provider in a while. That would then violate their civil liberties to be safe when working at their job. There is no perfect solution however we DO know we have slowed the transmission of this virus and prevented a surge over capacity in our hospitals as a result of staying inside. We don’t want to incite any irresponsible individuals to go out and “live their lives” out in public and act as vectors for the virus causing increased rates which could then overwhelm our healthcare systems. Influential people like Joe and Elon could singlehandedly spark a surge if the wrong message is put out to the millions of their malleable followers. Words are dangerous.

Another video which has been bothering me and putting out false claims is a rant by Dave Portnoy of Barstool Sports, an individual far from a public health expert, epidemiologist, or economist. He expresses outrage over Dr. Fauci. He exclaims that Dr. Fauci made a testimony stating that if we reopen “everyone is dead.” The one thing Dr. Fauci has never done, is made a definitive statement about this pandemic in regards to predictions other than that it WILL return and not just “disappear.” As providers, we are trained to never give definitive answers for questions with the potential for changing answers. Dr. Fauci actually said that if we reopen too quickly and do not follow the federal guidelines put in place for reopening safely, it “could lead to avoidable suffering and death.” This is true. If a county or state opens too quickly without taking the appropriate precautions put in place by public health experts, transmission rates will be higher resulting in “avoidable suffering and death.” Dr. Fauci’s statements have not changed over the course of this pandemic. He has noted this is not going anywhere, anytime soon and things will depend on how the infection behaves in the country. Portnoy then goes on to complain about “changing the rules.” YES! Some places have to change their tune because they’re seeing an uptick in cases so they have to delay or slow down their reopening plans. He then further rants about some states opening and others not. It doesn’t take a medical degree or masters in epidemiology to know that if a state has a high rate of infection and deaths, it is not the best idea to let the public loose, while those states with very few cases and lower population density can reopen sooner. Dave then perseverates on the idea that we have to be on lockdown “until we have a cure.” This is not the basis for reopening. That would be great but it’s unrealistic and certainly not the plan for reopening. Reopening is based on various metrics such as the number of cases, hospital capacity, etc., not whether or not we have a cure. Yes, he has a point, people are losing their life dreams and decades of hard work to this virus and the lockdown. But to say “we are Americans,” we should be able to do what we want and take the risk if we choose, is a bad message to his followers who are of a certain demographic which includes some of those during the beginning of the pandemic partying on the beaches of Florida for spring break. This is dangerous. Portnoy says,” let me take that risk, it’s my right.” Yes, he may have been staying inside and following the guidelines but if everyone else shares his sense of distrust and goes outside, the infection could persist and worsen. How is that fair to those of us who work in healthcare or those who prefer to stay home that are then at higher risk because “stoolies” (Portnoy’s followers) feel they don’t have to. Yes people are out in public walking in parks, along rivers, and at essential locations; but if they’re wearing masks, that is ok because it’ll help drop transmission rates. It is ok to go outside and exercise. The policies aren’t perfect but the public health measures are based on current scientific evidence. By perpetuating these statements about how he claims Dr. Fauci is changing his mind and saying “we’re all gonna die” is grossly inaccurate and could spark further mistrust in our medical community and public health experts who are the only sources of scientific truth. It is bad enough, right-wing fanatics are holding signs saying fire Fauci or hang Fauci (horrible, but true). By pushing for people to “take a risk” is dangerous and could spark the wrong idea and push his followers to behave irresponsibility in defiance of the policies in place. I get it. This lockdown is frustrating, disheartening, and devastating for some. I am not saying those who support reopening are choosing money over lives, but I do think this way of thinking can be dangerous if pushed by the wrong influencer using the wrong tone or misinformation. Actions should be supported by evidence and scientific data, not impulse and the desire to “get back to normal.” I don’t want my friends to lose their gyms or restaurants they’ve worked years to open and achieve but at the same time, if we don’t do this the right way, it’ll make it even worse in the long run and cause further economic destruction. So, please before you listen to Dave Portnoy, think about his credentials before you act on any of his misguided, emotional rant. Words are dangerous.

Last and certainly not least, is Donald Trump’s recently announced treatment of hydroxychloroquine with zinc. Apparently today, he admitted to the press that for the past 10-14 days, he has been taking hydroxychloroquine daily with zinc after begging the White House doctor for a prescription. He also reports that he had a dose of azithromycin as well. Trump notes that he is symptom and exposure free but is taking it to prevent the virus. It is shocking (or not, depending on how you look at it) that the White House doctor actually provided this prescription to him despite multiple studies suggesting that this regimen is ineffective in preventing or treating the virus. While these studies were observational, hydroxychloroquine plus azithromycin is still a risky move in a disease in which it has not been studied. Millions of people have taken this medication with little effect for malaria or rheumatologic diseases however they are monitored under the care of a medical provider. Also, the drug has been extensively studied with rich data and long-standing use in the real world, however that is only for these indications, not COVID-19. We do not know how this drug works in those with the virus or healthy individuals for an extended period of time. All guidance is to avoid the use of hydroxychloroquine especially with azithromycin due to drug interactions and potential toxicities. Because Donald has declined to wear a mask in defiance of his own federal face-covering policy and he is now taking the unapproved drug combination of hydroxychloroquine and azithromycin that health experts including his own task force has recommended against. He is setting a dangerous example for the American people. Medication sharing is a common problem in the US, especially among the elderly or family members. I have seen this personally in my patients hundreds of times. If a family member is taking hydroxychloroquine for lupus, rheumatoid arthritis, or other inflammatory condition and their grandparent, aunt, uncle, mother, or father, borrow their hydroxychloroquine, it could have potentially fatal consequences and could have been prevented. I know I would be upset if a friend or family member tried this without regard for its potential harms because Donald said “what do you have to lose” and he “is doing ok” and something happened to him. This is a dangerous way of thinking and could influence others with potentially fatal complications. Remember…words are dangerous, but actions can be fatal.

Be safe, stay well!