Friday, August 28, 2020

More Than Just a Form: Why Completing the Census Matters For Your Health

Lauren Gambill, MD
Pediatrician, Austin
Member, Texas Medical Association (TMA) Committee on Child and Adolescent Health
Executive Board Member, Texas Pediatric Society


Doctors are community leaders. This role has become even more important during the COVID-19 pandemic. As patients navigate our new reality, they are looking to us to determine what is safe, how to protect their families, and the future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net. The U.S. Census helps determine funding for those resources, and that is why it is of the upmost importance that each and every Texan, no matter address, immigration status, or age, respond to the 2020 U.S. Census. The deadline has been cut short one month and now closes Sept. 30.

COVID-19 has only increased the importance of completing the census to help our local communities and economies recover. The novel coronavirus has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more. Schools also have been stretched thin, with teachers scrambling to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago. Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the pandemic’s fallout. Therefore, it is vital that all Texans be counted.

The federal dollars Texas receives generally depends on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.

Take Medicaid, for example. Federal funds pay for 60% of the state’s program, which provides health coverage for two out of five Texas children, one in three individuals with disabilities, and 53% of all births. The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, any of which are potentially detrimental.

The census data also is key to funding other aspects of a community’s social safety net:

Health care

  • The Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.
  • Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census. Texas also uses this federal funding to study and respond to maternal mortality and perinatal depression.

Food and housing 

  • As unemployment rises and families struggle financially, many live with uncertainty as to where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the pandemic continues. The Central Texas Food Bank saw a 206% rise in clients in March. Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census. 
  • Funding for local housing programs also is calculated via the census. An accurate count will help ensure that people who lose their homes during this economic crisis have better hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.

Childcare and education

  • As we navigate the new reality brought on by coronavirus, more parents are taking on roles as breadwinner, parent, teacher, and caretaker. This stress highlights the desperate need for affordable childcare. 
  • The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families. 

The good news is you still have time to complete the census. Visit 2020census.gov to take it. It takes less than five minutes to complete. Then talk to your family, neighbors, and colleagues about doing the same. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.

Completing the census is one of the best things that you can do for the health of your community, especially during the pandemic. Thank you for helping Texas heal and for supporting these essential safety net programs.

Wednesday, August 26, 2020

Flu Clinic Counters Vaccine Myths, Hesitancy

(L to R): UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan Wealther, Sidney Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan Wealther



Ryan Wealther
Medical Student, UT Health San Antonio Long School of Medicine
Student Member, Texas Medical Association

Editor’s Note: August is National Immunization Awareness Month. This article is part of a Me&My Doctor series highlighting and promoting the use of vaccinations.

“Can the flu shot give you the flu?”
“Is it dangerous for pregnant women to get a flu shot?”
“Can vaccines cause autism?”

These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu vaccine discussion. It is easy to see why these questions were asked, as vaccine misinformation is common today.

UTHSA medical student Frank
 Jing (left) gets a vaccine from
Kaparaboyna Kumar, MD, (right).
Photo courtesy of Ryan Wealther
“No” is the answer to all the questions. These were exactly the types of myths we set out to dispel at our vaccination drive.

UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the vaccine drive at Alpha Home with the support of TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and vaccine awareness through shot clinics and education. Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general vaccine myths. The Alpha Home residents could ask us questions during the program.

We were interested to see if our educational program could answer Alpha Home residents’ questions about vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.

(Before I discuss the results of the survey, I should define vaccine hesitancy. Vaccine hesitancy is a concept defined by the World Health Organization; it relates to when patients do not vaccinate despite having access to vaccines. Vaccine hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from vaccine-preventable diseases.)

We surveyed the residents’ opinions about vaccinations before and after our educational program. While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive a flu shot today?” We had informed the residents and improved their understanding and acceptance of immunizations.

Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about vaccines,
 after learning more about their effectiveness by trusted members of the medical community. Graph by Ryan Wealther
Why is this important? First, our findings confirm what we already knew: Education by a trusted member of the medical community can effect change. In fact, it is widely known that physician recommendation of vaccination is one of the most critical factors affecting whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by the end of the evening.

Second, our findings add to our understanding of adult vaccine hesitancy. This is significant because most of what we know about vaccine hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as well, like the yearly influenza vaccine. 

After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu vaccine. Graph by Ryan Wealther
Another reason improving attitudes is important is that receiving a flu shot is even more timely during the COVID-19 pandemic because it decreases illnesses and conserves health care resources. Thousands of people each year are hospitalized from the flu, and with hospitals filling up with coronavirus patients, we could avoid adding dangerously ill flu patients to the mix. Lastly, these findings are important because once a COVID-19 vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. 

Though the COVID-19 vaccine is still in development, it is not immune to vaccine hesitancy. Recent polls have indicated up to one-third of Americans would not receive a COVID-19 vaccine even if it were accessible and affordable; work is already being done to try to raise awareness and acceptance. In addition, misinformation about the COVID vaccine is circulating widely. (Someone recently asked me if the COVID vaccine will implant a microchip in people, and I have seen the same myth circulating on social media. It will not.) This myth, however, illustrates the need for health care professionals to answer patients’ questions and to assuage their concerns.

Vaccines work best when many people in a community receive them, and vaccine hesitancy can diminish vaccination rates, leaving people who can't get certain vaccines susceptible to these vaccine-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots. As the COVID-19 pandemic progresses, we need to ensure children and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention

I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions. 

Tuesday, August 25, 2020

PODCAST: COVID 19: Know and Lower Your Risks



Editor's Note: The following episode was recorded on July 24. Certain stats have changed and Texas is no longer in the "exponential" phase of disease transmission at this time.

As we learn more about COVID-19 and the ongoing pandemic, there are still many questions left to be answered. It's helpful to have credible guidance: What should we do?

In the latest episode of Texas Medical Association’s Practice Well podcast, TMA’s Director of Public Health, Christina Ly, PhD, sits down with Trish Perl, MD,  to discuss the latest concerns around COVID-19, and provide solid guidance. Dr. Perl is a member of  TMA’s COVID-19 Task Force and Committee on Infectious Diseases and chief of the infectious disease division at UT Southwestern Medical Center in Dallas.

Dr. Perl provides an update on the state of coronavirus cases in Texas and review’s TMA’s COVID-19 Activity Risk Chart, explaining why going to the gym or a bar is riskier than having an outdoor picnic or camping. The two talk about face masks: the different kinds of coverings, their effectiveness, when to wear them, and how to properly wear them.

The episode also goes into detail on the measures people should take after being exposed to the virus, the difference between quarantine and isolation, the scenarios people can face if their test comes back positive or negative, and how to safely return to work upon exposure.

View TMA’s COVID-19 Activity Risk Chart in English and Spanish. For more episodes of TMA’s Practice Well podcast, visit us on our website, Apple PodcastsSpotify, iHeartRadio and Podbean.

Wednesday, August 12, 2020

AMA president: Baseball's Covid-19 outbreak is a sign we still have hard work to do

Resuming our pre-pandemic lifestyle without concern for COVID-19 transmission will continue to yield more infections, hospitalizations and deaths.

Susan R. Bailey, MD
Fort Worth Allergist/Immunologist
President, American Medical Association
Member, Texas Medical Association


Editor's Note: This article originally appeared on USA Today.

In a world knocked off its axis by COVID-19, in a year when so many of our familiar routines and pastimes now put us at risk, the long-awaited return of Major League Baseball was thought to mark our first steps down the basepath to new normalcy.

Unfortunately, the experiences of the Miami Marlins and St. Louis Cardinals baseball teams are evidence that conducting even an abbreviated season offers only an illusion of normalcy amid a pandemic, a mirage like the digital and cardboard crowds dotting empty grandstands for TV viewers, or the phantom crowd noise we’ve heard piped into radio broadcasts.

Seventeen of the 33 Marlins players who traveled to Philadelphia for three games against the Phillies during baseball’s opening weekend tested positive for COVID-19, which placed their season on hold for eight days after only three games. Thirteen members of the Cardinals organization, including seven players, have tested positive and their season was tentatively scheduled to resume Aug. 7. Meanwhile, MLB’s owners and league officials are pondering the next inevitable surge.

Baseball is often called a metaphor for life. And in this, our summer of COVID-19, lessons abound from Major League Baseball’s handling of the virus.

While we can’t say for certain what led to such a sudden outbreak on either team, it seems plausible that the virus spread quickly through the close quarters of the locker room, clubhouse, team bus or chartered flight.

What’s true about COVID-19 in baseball is what’s true about COVID-19 in the world outside — it does not respect borders or boundaries or differences of team uniforms or political affiliation.

And we know one more thing: Physical distancing works. Wearing a mask works. And limiting exposure to people outside your bubble helps slow the spread of the virus.

Baseball is often called a metaphor for life. And in this summer
of COVID-19, we can take a lot of lessons from MLB's
handling of the virus.
But MLB’s outbreak revealed another concern we need to pay attention to — the lag in testing. Multibillion-dollar sports leagues have access to some of the best testing capabilities in this country. But, because COVID is spread even when people are asymptomatic and because test results can take days, in the case of the Marlins, players and personnel remained in contact with the rest of the team, unknowingly spreading the virus while they awaited testing results.

Baseball’s cautionary tale should drive home the point that it is folly to resume our pre-pandemic lifestyles in the face of a viral outbreak that is anything but under control. We don’t know how half of the Marlins’ players contracted the virus so early in the new season — but we do know that failing to take the steps shown to slow the spread of the virus puts more people at risk of infection.

As researchers race to produce a safe and effective vaccine that prevents COVID-19 infection, for our own safety and for the well-being of our loved ones and our communities, we must all wear cloth masks, practice physical distancing, wash our hands, avoid large gatherings and limit the time we spend indoors with others. There is so much to be done, and we must find the collective will to do it, together.

During a press conference held over the July 4 weekend, Washington Nationals pitcher Sean Doolittle spoke to reporters through a facemask about the pending return of baseball and other pro sports in the summer of 2020.

“Sports are like the reward of a functioning society,” Doolittle said. “And we are trying to just bring it back, even though we’ve taken none of the steps to flatten the curve. We need help from the general public. If they want to watch baseball, please wear a mask, social distance, keep washing your hands.”

The speed with which the coronavirus spread among the Marlins demonstrates how easily it is transmitted. We ignore this contagion at our own peril, and resuming our pre-pandemic lifestyle without concern for COVID-19 transmission will continue to yield more infections, more hospitalizations and more deaths.

The return of baseball was supposed to be part of a return to normalcy — the benefit of hard work to flatten the curve. Instead, as cases continue to spike across the country and problems from March and the earliest days of the virus remain unaddressed, no one — not even baseball — is immune from the big challenges.

Sadly, in 2020, baseball is not so much a metaphor for life, but a reminder of our failure to take the tough steps necessary to defeat COVID-19.

Dr. Susan R. Bailey is president of the American Medical Association.

Monday, August 10, 2020

Vaccines: Still Protecting Your Health in An Ever-Changing World

Sue Bornstein, MD
Internal Medicine Specialist, Dallas

Member, Texas Medical Association (TMA) Board of Trustees

Editor’s Note: August is National Immunization Awareness Month. This article is part of a Me&My Doctor series highlighting and promoting the use of vaccinations.


I can say without hesitation where I was on Sunday, July 29, 1962. As an 8-year-old Dallasite, I stood in line with my family to receive a sugar cube soaked with the newly released Sabin polio vaccine. On two consecutive Sundays, more than 900,000 Dallas residents were immunized against the polio virus.
Percy Luecke Jr., MD, a Dallas pediatrician, was chosen by the Dallas County Medical Society to help organize this mass immunization. Dr. Luecke worked with local health authorities, civic, and religious leaders to make these vaccination events possible. In a 2017 Dallas Morning News article about the mass immunizations, James Luby, MD, then chief of infectious diseases at UT Southwestern Medical Center in Dallas, said, “I think the public was convinced that the problem was significant and that they could play a role in defeating the disease by being immunized.” Thanks to similar vaccination programs across the country, no year-round transmission of polio has occurred in the U.S. since 1979. However, international travelers can – and have – brought the virus into this country. 

Vaccines are among the safest and most effective tools against
preventable infectious diseases like influenza, measles, and
tetanus. Photo by Heather Hazzan, SELF Magazine 
Many things have changed since 1962. We’ve seen the exponential rise of the internet and social media and its influence in our culture. We live in a 24-hour news cycle. Mistrust of the pharmaceutical industry is rampant. Celebrities are now increasingly looked to as experts in health and medical treatment. In his book The Death of Expertise, scholar Tom Nichols says about the U.S.: “We do not have a healthy skepticism about experts: instead, we actively resent them, with many people assuming that experts are wrong simply by virtue of being experts.” I agree with Nichols’ premise. This is a dangerous trend.

Texas is one of 16 states that allows parents to bypass vaccine requirements to enroll their children in school by claiming a conscientious exemption. The exemption rate for kindergarten students has risen from 0.3% for the 2005-6 school year to 2.15% for the 2018-19 school year, to 2.24% for the 2019-20 school year. However, some private schools have reported exemption rates greater than 50%. This, combined with the recent data showing 44% fewer Texas children received their immunizations during the early days of the COVID-19 pandemic, raises concerns. At this shrinking vaccination rate, will “herd immunity” – protecting a community from disease by vaccinating enough people in it – remain effective?

Another major change that has occurred since 1962 has been the worldwide shift in causes of death from infectious diseases to non-communicable diseases. In 2015, the chronic diseases of diabetes, heart disease, stroke, and cancer were the top four causes of death in Texas and the U.S. Vaccines are the biggest reason fewer people die from infectious diseases. We must stay committed to getting our shots to continue that success.

Vaccine-preventable infectious diseases like influenza are bad enough, and many of them can lead to other life-threatening conditions. For example, pneumonia – which occurs in some patients with the most severe flu cases – has led to cardiac complications within a week of the pneumonia diagnosis. People with diabetes, asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung diseases also are at higher risk of more severe illness from influenza and invasive pneumococcal diseases. The COVID-19 pandemic has shone a bright light on the connection between infectious diseases and chronic illness, since people who die from COVID-19 often also have an underlying chronic illness.  

One thing that hasn’t changed since 1962: Vaccines are among the safest and most effective tools available to and used by physicians. Yet vaccine hesitancy and even refusal are increasing. How can physicians increase their success in getting their patients vaccinated? One way is by recommending vaccinations as a routine part of a patient’s care. Vaccination should be a routine procedure. Getting your shots should be the norm; not the exception. 

Your doctor might counsel you about vaccines. He or she might try to convince you why immunizing is the best choice. Please listen and discuss with an open mind. Some physicians use tools from accredited medical associations like the American Academy of Pediatrics and American Academy of Family Physicians to help them discuss vaccines with their patients. Medical Economics magazine also provides patients with a better understanding about how their physician might approach vaccines

Paul Offit, MD, a pediatrician and expert on vaccines at The Children's Hospital of Philadelphia, noted, “Vaccines are a victim of their own success. We have largely eliminated the memory of many diseases.” TMA’s “Talk To Your Patients About” series goes into detail about the many infectious diseases prevented by vaccination, including influenza, measles, polio, tetanus, and others. 

Vaccine development and distribution continues to evolve. We no longer must wait in lines to get vaccinated, as I did as a child. Scientists are working harder than ever to produce a COVID-19 vaccine. Vaccines protect us from illness and death, which is why it’s so important we continue to take advantage of them.

Wednesday, August 5, 2020

Finding Your Best Self During Uncertain Times: A Guide to Wellness During (and After) the COVID-19 Pandemic


Marawan M. El Tayeb, MD
Endourologist (Urology Subspecialist)
Baylor Scott and White Health
   
Clinical Assistant Professor, Texas A&M University College of Medicine 
Member, TMA Leadership College

Over the past five months, COVID-19 has put an enormous amount of pressure on almost everybody. Although we do not know when, the pandemic will end. Many people will go back to work soon as more states like Texas reopen, but everything will feel different. You may find yourself obligated to work more. Regardless, it is easy to feel overwhelmed with work responsibilities, family obligations, or financial burdens. Here are some tips to help you navigate this challenging time.

Well-Being of Self: Putting Yourself First

Your well-being is vital. It sets the tone for your outlook on your goals, your career, and your relationships. If you are not taking care of yourself, you will not be able to take care of others.  
  • Eat healthy and cook your own food. If you must eat out, try to pick healthy food options.
  • Go to sleep early and get enough quality sleep. 
  • Stay hydrated. Drinking water is one of the best things you can do for your body, as it regulates body temperature, protects your organs and tissues, and helps rid your body of waste, among many benefits.
  • Visit your primary care physicians to make sure that your health is good; control your blood pressure and blood sugar if there is a problem. Don’t be hesitant about going to the doctor for a wellness visit or to treat a preexisting condition. Physicians are still here to help you, and many practices have set safety protocols to keep patients and staff safe. 
  • Adding onto that, reach out to mental health resources for conditions like anxiety and depression. Mental health is just as essential as physical health. There are a number of mental health services available at low to no cost
  • Limit watching TV. (That will save you plenty of time for the next tip.)
  • Make a routine of exercising every day. You can save time by exercising at home. I have a small gym in my garage; I wake up every day at 5:15 am and spend 45 minutes on strength training and 15 minutes on cardio. If you don’t have the equipment, you can do bodyweight workouts. Many gyms, studios, and fitness trainers are offering free online workout options as well
  • Spend at least 30 minutes outdoors every day; walk, run, or bike. 
  • Plan your workday ahead of time. Despite popular belief, multitasking is counterproductive. Instead, prioritize your tasks each day (preferably the day before) so you know exactly what needs to be done. A notable example of this is setting aside time, perhaps half an hour each day, to reply to all your emails at one time, rather than all day long. 
  • Stick firmly to a work-life balance. Go home as soon as you finish your work. If you’ve been working from home because of the pandemic, remember to “sign off” at the end of your workday and turn your attention to life outside work.

Well-Being of Others 
When you take better care of yourself physically and mentally, you can care for others in a more effective way too. 

New Perspectives 

The pandemic has changed how we go about day-to-day life. There’s a good chance it will change how we go about life in the long-term, too. 
  • Allow this time to love what you do, try to find meaning in it, and seek the bright side. Austrian neurologist and psychiatrist Dr. Viktor Frankl applied this concept while imprisoned in a Nazi concentration camp during World War II and wrote about it in his memoir, Man’s Search For Meaning.  
  • The pandemic creates an opportunity to do a long-term assessment of your finances, whether that means revising your budget, starting an emergency fund, or building upon your retirement plan. Everyone’s current financial situation is different, but we can all take productive steps to plan for the future.
Again, we don’t know when the COVID-19 pandemic will be over, or at least be less of a threat to society. Medical experts believe COVID-19 is here to stay for at least the next two years – or at least until researchers develop a vaccine and/or treatment for the virus. We can’t control the pandemic, but we can control how we respond to it. If we utilize this time to take care of ourselves physically, mentally, and emotionally, we will be better equipped to endure this period. 

Wednesday, July 29, 2020

To wear a mask is to be brave. To trust your doctors is to be brave.

























Abubakr Chaudhry, MD 
Pulmonary and Critical Care Physician
Atlanta, Georgia


Editor's note: This article originally appeared on KevinMD.com.

The pandemic is a lie. I will not wear someone else’s fear. This is all fake news. It is remarkable to see these statements littered across the news and social media. Individuals with a fairly decent level of understanding and intelligence pandering to these ideas just go to show how strong anti-science culture has become. We forget so quickly how it started, forget those who comforted us in times of uncertainty, and those who heeded the call when so many didn’t.

On January 19, 2020, a 35-year-old would test positive for the novel coronavirus in Snohomish County, Washington. Shortly thereafter, Seattle would become the first U.S. epicenter, Wuhan, China would go into lockdown, and the WHO would declare a global health emergency. By early February, the hysteria would start to set in, while local spread would be confirmed in California, Oregon, and New York. Social media would start increasing speculative reporting, and this invisible enemy would be given a new name, COVID-19. On February 5, the death toll would pass that of the SARS pandemic of 2003. Even still, it wasn’t until mid-February when it became real for me. My colleagues from California to New York began reporting their experiences, and I knew it would only be a matter of time before the virus landed on our doorstep. I did what I always do in times of uncertainty: immerse myself in the science and search for an answer. Much to my dismay, the reports being published were anecdotal at best, and most were not yet peer-reviewed.

By late February, the stress and arguments about who should take responsibility began to boil over. Then there was the increase in fear among health care exposure rates, conflicting case fatality reports, the impending disaster in Italy. Frustrations began with the CDC on the flip-flopping in guidelines; was it airborne or droplet, how long did it survive on surfaces, what should we use to treat it, and mostly why couldn’t we test more or everyone? That was probably the worst part, the unknown. Today we forget that the CDC only lifted restrictions on testing on March 3, 2020.

We became tired of the complaining, the fear, and misinformation, so we decided to pen a guideline for our hospital. The first draft was sent for review on March 14, 2020. At this time, there were 153,523 cases worldwide, 5,789 confirmed deaths, and the president had declared a national emergency.

Within two weeks, we had a patient transport plan, admission criteria, treatment algorithms, surge plans, ventilator back-up plans, COVID-19 specific cardiac resuscitation plan, cohorted units, orders placed on protective equipment, and EMR power plans up and ready to go. For the next month, we would meet two to three times daily. By March 17, COVID 19 had spread to all 50 states, and by the 20th, New York had become the outbreak epicenter in the US.

Georgia went on lockdown April 3. Throughout March and April, the world seemed to trust us as the scientific community to lead them through this crisis.

By April, we saw our algorithms were working, and we had some of the best outcomes in the state. Our teams were acting fast and stabilizing our patients even faster. We had specialized teams that functioned like a symphony. There were no vacations. Every intensivist was always available if needed. We developed a camaraderie that will translate to life-long friendships. People were adhering to the guidelines by staying home. Businesses had shut down, the spread was contained, and we could see the light at the end of the proverbial tunnel.

Then on April 24, 2020, with 892 deaths and 22,147 infected in GA, the lockdown restrictions were eased in our state. We were one of the last to close but the first to reopen. We knew the world needed to open; we just didn’t know our world would open like this.

I remember wondering why we couldn’t mandate masks, contact tracing, and social distancing when we reopened. Suddenly, the virus became political.

While the world argued with experts, we were working hard to make a finite resource seem infinite. We created units out of hallways, shifted resources, brought in, and trained health care workers. When we ran out of one medication, we made do with alternatives. When we got busy, we choose to increase our risk of exposure over delaying care to our patients. Administrators are quite literally trying to make a dollar out of fifteen cents, wondering how the system will survive. We don’t know how to help the millions that are uninsured, or the millions more that have insurance which covers only a fraction of their medical bills.

When I started writing this, I was upset at a social media comment I read from a friend that read, “This pandemic is a joke, I will not wear a mask because I will not wear their fear.” Now I see that he was afraid and uninformed. People, in general, are still afraid, if not of the virus, then of loneliness, poverty, or even subjugation. When people exhibit these fears, and if their voices are loud, the politicians must bend to their will. If our politicians are afraid and their voices alleviate our fears, then we bend to their will. My point is, it is OK to be afraid. I am a pulmonary and critical care doctor, my wife is a pediatric intensivist, we have a small child, and we are afraid. But to wear a mask is to be brave. To social distance is to be brave. To trust your doctors is to be brave. To those with doubts, know that you are correct in your feeling that the system is broken. I don’t know how to fix it, but I know that it has to be done soon. Help us get through this so we can build a better world: a world built from understanding and not from fear.

Abubakr Chaudhry is a pulmonary and critical care physician.

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