Thursday, March 26, 2020

End-of-Life Implications of the Coronavirus Pandemic

Sid Roberts, MD
Lufkin Radiation Oncologist

Member, Texas Medical Association

We are early in this coronavirus game of social distancing and hand washing. We haven’t quite become weary of it. We joke about it. And yet, I am starting to see – among my friends – some very real concern about our elder parents and grandparents. But we don’t allow ourselves to linger on those thoughts much. We should.

The United States has been accused of being late to respond to the coronavirus pandemic, late to test our US population compared to other countries (South Korea, for example), and “doomed”  in our response. Even so, we are just beginning the initial rise of the now well-known bell curve of the Coronavirus Disease 2019 (COVID-19) pandemic. Known cases are doubling every day, it seems. Deaths are increasing as well.

As a cancer physician with additional hospice and palliative medicine (end-of-life care) certification, I view the coronavirus pandemic with increasingly darkened lenses. Coronavirus is a new and immediate threat to life, and we are not ready for what that means. If we don’t succeed in slowing the spread of coronavirus and suppressing new cases – now widely known as flattening the curve – 2.2 million people in the US could die.  We are not talking openly – publicly –about how we are going to handle this massive number of deaths with COVID-19.

If the coronavirus epidemic is as bad as some predict it will be, discussions about end-of-life care with this disease will soon become front and center. There may not be enough ventilators for everyone who “needs” ventilator support. Italy has been forced to triage sick coronavirus patients based on age, given that the death rate among the elderly is so high. Italian doctors have admitted that there were simply too many patients for each one of them to receive adequate care. They describe a “tsunami” of patients and a more than 7% death rate (though researchers have lowered the calculated death rate in Wuhan, where the pandemic started, to 1.4% ). Preliminary outcomes of patients with COVID-19 in the US show death is highest in persons aged greater than or equal to 85, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years.

The Italian society of anesthesiologists issued fifteen recommendations of ethical and medical criteria to consider if ICU beds are exhausted, saying doctors may have to adopt more wartime triage criteria of gauging who has the best chance of survival versus “first come, first served.”   Those who are chronically ill with pre-existing lung disease, even if they survive a serious coronavirus infection, are likely to be left with even further reduced lung function and poorer quality of life.

Unlike a localized disaster – most memorably Hurricane Katrina, in New Orleans in 2005, where healthcare decision-making received intense scrutiny and prompted legal action  – we are experiencing a global, acute healthcare emergency that may require historic moral and ethical decisions that impact who lives and who dies. We will be rationing healthcare on the fly. Are we ready for that? As family members? As a community? As a nation? Are our hospices ready for the number of patients needing immediate, short-duration, and contagion-related end-of-life care?

Perhaps the most terrifying aspect of the coronavirus epidemic in countries where death has become frighteningly common is the loneliness of the death. Hospitals in the US are already limiting or even forbidding visitors. In Italy, seriously ill coronavirus patients are isolated from family and often die alone. Families are not allowed to have a proper burial, and not just due to restrictions on gathering – morgues have an enormous backlog to work through. That is certainly not what we would call a “good death” and not what those of us in the hospice care field want for any patient.

President Trump has labeled himself a wartime president, declaring we are at war with an invisible enemy. "Now it's our time. We must sacrifice together, because we are all in this together, and we will come through together," he said.  What is not stated – and what I am afraid will happen – is the wartime sacrifice analogy will extend to real lives lost. In an ironic twist of fate, it very well may be that the remnants of the Greatest Generation are once again on the front lines. Even down to the Baby Boomers, our nation’s elders will bear the brunt of the coronavirus disease, certainly, but likely the financial catastrophe surrounding the pandemic as well. (I wonder if the economic collapse will kill as many or more people than coronavirus does.)

The time is now to have discussions with our older/elderly parents and grandparents about the very real risk of serious illness and death from COVID-19. Wills need to be written and advance directives and durable powers of attorney completed now – before our loved ones hit the hospitals. This is not morbid; it is both pragmatic and necessary. If we emerge from this battle relatively unscathed, we are no worse off for having had the discussions and done the planning. Patients and families should be driving end-of-life care decisions. We owe it to our hospitals and healthcare workers not to overburden the system with trying to care for those who neither want nor would benefit from aggressive measures.

Dr. Sid Roberts is a radiation oncologist at the Temple Cancer Center in Lufkin and contributing columnist for The Lufkin Daily News. Previous columns can be found on Dr. Roberts' blog.

Wednesday, March 18, 2020

An ER physician's advice to the general public: How to flatten the curve

Mercy Hylton, MD
Indiana Pediatric Emergency Medicine Physician

Editor's note: This article originally appeared on

Some advice as an emergency physician, daughter, mother, and concerned citizen.

Help keep older relatives and neighbors self-quarantined at home. Same goes for those of any age who are immune-compromised (cancer-patients, on immune-suppressant meds for autoimmune diseases, etc.) Pick up and deliver their groceries and prescriptions to their front-door for them.

Health care workers (physicians, nurses, respiratory therapists, social workers, pharmacists, environmental services, EMS, etc.), law enforcement, and other public agency workers are essential personnel and need to go to work. College students home from school and older high school students can help by stepping up to provide childcare for these families. It is not a good idea to ask grandparents to provide childcare if at all possible. The young and healthy can do their part.

Postpone all non-essential doctor’s appointments (check-ups and annual physicals, routine follow-ups, elective procedures, etc.) This is to prevent you from being exposed to sick people as well as to free-up physicians’ time to care for the acutely ill.

Save the emergency room for true emergencies only. Call your primary care doctor’s office before you head to the ER (i.e., not just if you have a flu-like illness). Many things like rashes, constipation, and muscle sprains can wait to be seen in a few days in the office, or recommendations can be given over the phone. Do not “play up” symptoms in order to be given the authorization to go to the ER.

At this time, tests for COVID-19 are not readily available for people with mild illness. If you are not sick enough to be admitted to a hospital for respiratory distress and low oxygenation, you are unlikely to be tested. Do not go to the ER, urgent care or your doctor’s office for a test just so you can definitively know if you can go back to work. It’s not going to happen at this time. This may change in upcoming days as tests and the regulations on their use change.

Many children from low-income homes receive two free meals a day at school, and school cancellation for weeks may be a heavy burden to these families. Donate or volunteer at community food banks.

Your kids are going to go stir-crazy in the next weeks since many schools have been closed, and spring vacation plans have been canceled. However, this is not a good time to go to the Children’s Museum, movie theater, arcade, or other indoor group activities. Playing outside is a good idea, with the exception of people who have a history of asthma or environmental allergies (which may get worse outside). Put them to work with projects around the house: spring cleaning, cleaning out your closets, cleaning out the garage, etc.

Social distancing does not mean we should not continue to patronize businesses, but we should do it in responsible ways. Order take out instead of eating out. Order groceries online and pickup. Go to the grocery store at low-volume times (early morning).

Business owners, please send home employees with any sign of illness, and please be understanding of your employees’ struggles with lost income and finding alternative childcare. Please do not require a doctor’s note from your employees.

Get your information from responsible sources. Do not stir panic. Do not hoard supplies or food. Do not take advantage of others’ misfortune or ill-planning. Be extra patient and kind with everyone and in all venues.

This is a great time to teach our children the value of community-mindedness, not wasting food or other goods, prudent use of resources, healthy habits like hand-washing and avoiding public outings if you are ill, planning not panicking, etc. Our children are watching and learning from us.

#FlattenTheCurve #SocialDistancing #StayHome #DoYourPart

Mercy Hylton is a pediatric emergency physician.

Friday, March 13, 2020

Flu & COVID-19: The Six Main Differences Between the Viral Infections

As the novel coronavirus disease (COVID-19) continues to spread across many countries including the U.S., the outbreak is happening around the same time as another viral illness we all try to avoid this time of year: influenza.

The two viruses share some clear similarities:
  1. Both are spread by contact – If you don’t want to contract either virus, avoid touching or coming into close contact with people who are sick and/or surfaces last touched by those who are infected. Both the flu and COVID-19 are transmitted by droplets from sneezes and coughs from infected patients and high-contact surfaces like door handles and handrails. Wash your hands frequently, use your elbow or a disposable tissue to cover a cough or sneeze, and refrain from touching your face.
  2. Flu and COVID-19 symptoms can be similar – Both influenza and COVID-19 are respiratory illnesses that can range in severity. Patients with either illness may experience coughing, fever, and fatigue. If left untreated, mild cases can lead to pneumonia, which can be fatal. 
Knowing that the flu and COVID-19 are illnesses that spread easily, it may at first seem confusing to know which illness you may have if you feel ill. However, there are notable differences between the two viruses, according to a recent report from the World Health Organization (WHO).

  1. The flu spreads faster than COVID-19 – The flu has a shorter incubation period than COVID-19, which means a shorter time from when a person is infected to the time the first diagnosable symptoms start to show. It can take up to three days for the flu to spread from person to person, whereas COVID-19 takes five to six days to spread from person to person. Because of the flu’s fast spread, vulnerable groups like children, pregnant women, and people with chronic medical conditions or compromised immune systems are more likely to get the flu.
  2. COVID-19 is more contagious than the flu – According to WHO, a person infected with COVID-19 can be contagious 24 to 48 hours before showing signs of symptoms. A person carrying the flu could be contagious longer – three to five days – before symptoms appear.
  3. COVID-19 can lead to more secondary infections – While both illnesses are nothing to take lightly, COVID-19 can result in two or more secondary infections. WHO data highlights that 80% of COVID-19 infections are mild (like the common cold) or the person has no symptoms, but 15% are severe cases requiring oxygen, and 5% of cases require intensive care. Flu cases sometimes lead to a secondary infection like pneumonia, but patients hardly ever suffer from two or more infections after having the flu.
  4. Adults are more likely to contract COVID-19 – Elderly people, especially those with chronic conditions such as heart disease, lung disease, or diabetes, are the most susceptible to contracting COVID-19. WHO reports that children, from newborn to age 19, aren’t as affected by the virus as adults are. Children are more prone to getting the flu and spreading it to others.
  5. COVID-19 is deadlier than the flu – Make no mistake, both illnesses can be deadly. But the mortality rate for this coronavirus (the number of reported COVID-19 cases divided by the number of deaths attributed to COVID-19) is greater, ranging from a 3% to 4% death rate. (It may be lower due to many unreported cases.) In contrast, the flu’s death rate is 0.1%.
  6. There isn’t a cure or vaccine for the COVID-19 – While there isn’t a definitive cure for COVID-19, researchers are developing more than 20 COVID-19 vaccines. However, flu vaccines are widely available and strongly encouraged by physicians and other medical professionals, not only for individuals to protect the person getting the shot, but also to prevent or limit community-wide outbreaks.
Understanding the main similarities and differences between the flu and COVID-19 is essential to protect yourself from both viruses during the current health crisis.

Thursday, February 27, 2020

Coronavirus: What You Need to Know About the Latest Outbreak

Mark M. Shelton, MD
Pediatric Infectious Diseases and Pediatrics, Fort Worth
Member, Texas Medical Association Committee on Infectious Diseases

Editor's note: The following article is up to date as of March 3. Case statistics are subject to change.

Coronavirus (COVID-19, otherwise called the 2019 novel coronavirus) is making news headlines worldwide. But what is it to us in Texas? This virus outbreak started in December of 2019 in Wuhan, China, and has spread to nearly 50 different countries and territories – including the U.S. As of Feb. 27, there have been nearly 90,000 reported cases and more than 3,000 deaths, mostly in China. The news and understanding of this outbreak are changing daily, and there are many unknowns about the virus and the disease it causes. At this point, risk to people in the U.S. is thought to be low. However, the Centers for Disease Control and Prevention (CDC) is urging the public to prepare for COVID-19 if it does become widespread in the U.S.

What is a coronavirus?
Coronavirus is a virus, a microscopic living infectious germ that can make people sick. Other similar viruses have infected humans: severe acute respiratory syndrome (SARS), which originated  in civet cats (small nocturnal mammals native to Asia and Africa) in China in open air “wet” markets (outdoor food markets that sell fresh produce, meat, and sometimes live animals); and Middle East respiratory syndrome (MERS), which came from camels in the Middle East. These two epidemics, which occurred in 2003 and 2012 respectively, were largely controlled by quarantine.

There are several common human coronaviruses. Coronaviruses (CoV), in general, cause upper respiratory illnesses similar to colds, and flu-like illnesses that generally cannot be distinguished from other viral infections without specialized laboratory testing. Most of these don’t spread widely. They are pretty common and typically occur in the winter in Texas.

Where did this disease come from and what happens upon exposure?
Scientists believe the current outbreak, COVID-19, is an animal-specific coronavirus transmitted from bats to an armadillo-like creature called a pangolin – which apparently is the animal that can spread this virus to humans. Pangolins are a wild endangered species but used for food and folk medicine in China (they can be found in “wet” markets there).

COVID-19 is a new virus to humans, also sometimes referred to as SARS-CoV2. The disease starts like other coronavirus infections. After exposure, the incubation duration (the period before symptoms of a viral infection first appear) is about four to seven days. Then the patient suffers upper respiratory and flu-like illnesses. For some people, it progresses to a “viral” pneumonia. People who are elderly or have underlying diseases seem to be at greatest risk of getting severely sick from COVID-19. 

There is a great deal that physicians and scientists do not know about this virus and how it might spread among large populations. For example, are people with a mild case of the disease contagious, and if so, for how long? 

Regular coronavirus infections are seasonal. In North America, they seem to correspond with influenza season, which typically starts in October and can run through May. It remains to be seen whether this will be the case with COVID-19.  

What’s being done to fight against COVID-19?
There are currently no drugs approved for, or that seem to be helpful for, this infection. Drugs are available that appear to have some effectiveness in laboratory studies and might be useful in some people. Scientists continue to study this to see if any drugs are useful

Historically it’s taken decades to produce a vaccine for an individual disease.  However, there may be an available vaccine for coronavirus within a year, which would be an incredible feat.

What is the coronavirus situation in the U.S.?
Right now, as of Mar. 3, there are 33 confirmed cases of COVID-19 in the U.S.1; So far, six people in the U.S. have died from the virus, all in Washington state. American public health authorities led by CDC have strongly recommended quarantines and infection-control measures, including isolating hospitalized patients. Hospitals across the state have developed action plans and are training staff in case they must care for patients with COVID-19. On Feb. 29, CDC confirmed 11 cases of COVID-19 at the Lackland Air Force Base in San Antonio2, one of the U.S.’ many quarantine stations. 

CDC has already developed a laboratory test for identifying
individuals with COVID-19 and is sending that test to selected
laboratories in the U.S. and abroad.
The Texas Department of State Health and Human Services (DSHS) is  active in tracking and identifying individuals who may have been exposed or infected. Incredibly, CDC already developed a laboratory test for identifying infected people and is distributing that test to designated state and local public health laboratories – including DSHS – U.S. Department of Defense laboratories, and select international laboratories. Standard tests used by physicians to identify “ordinary” coronavirus, will NOT detect COVID-19.

So how should Texans respond?  
First, it would be advisable not to travel to areas of the world where we know there is infection. ChinaIranItaly, and South Korea are on that list.  Japan is on alert, meaning certain high-risk populations should take precautions. Hong Kong is currently on watch, but the CDC does not recommend canceling or postponing travel there. CDC posts daily travel warnings to avoid COVID-19. People who have been exposed by travel, or other means, need to contact their physician and local health department for evaluation.

For perspective, influenza is spreading in Texas right now and is a much greater risk to all Texans. To avoid getting the flu, first have a flu shot, and practice everyday hygiene measures – cover your mouth and nose when coughing and sneezing and wash your hands or use alcohol gel.

Fortunately, CDC and our state and local health departments are monitoring the COVID-19 situation, aggressively testing people exposed to the virus, planning for outbreak control, and making recommendations for hospitals, in case the outbreak becomes worse.

If this coronavirus acts like SARS and MERS outbreaks, it will most likely be controlled by public health measures including quarantine and isolation. By following CDC’s travel restrictions and taking precautions to avoid exposure like you would do with any other infection, you probably not only will keep yourself from getting sick but also will prevent the spread of such viruses.

I would add, this is not 1918 – the year of the deadly Spanish flu – which was the year of a worldwide epidemic that killed millions. Our public health authorities have rapidly identified the cause of the outbreak and distinguished it as a unique and novel (new) virus, and there are ongoing epidemiologic studies to understand how it is spread. In the U.S., travel restrictions and quarantine measures are in place. The state health department has a way to test individuals suspected of being infected. Physicians and hospitals, along with state, local, and federal health departments, are working together to contain the virus. Several potential therapies have been identified, and a vaccine is being studied. If we play our cards right, our society will successfully get through this outbreak.

1 According to the CDC, 22 of these cases are travel-related; 11 cases were from person-to-person spread. (Twenty-seven cases are under investigation, making the total number of cases detected and tested in the U.S. to 60.) There are an additional 48 people who tested positive in the U.S. among repatriated persons, including individuals under federal quarantine from Wuhan and the Diamond Princess cruise ship.  2 One of these cases is from the repatriated group from Wuhan; the other nine cases are from the Diamond Princess cruise ship. According to San Antonio Metro Health, another patient who tested positive for COVID-19 is from California to receive treatment. 

Wednesday, February 26, 2020

Understanding Teen Dieting and Weight Loss

By Anitta Philip, MD
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association

We’re creating a culture that idolizes an impractical and thin beauty standard through the rise of social and mainstream media, Photoshop and photo filters, and advertisements for fad diets and weight loss products pushed by social media “influencers.” According to the Pew Research Center, 71% of adolescents say they use more than one social media website and are exposed to these ideals repeatedly. Teens also consume health information that isn’t based on scientific evidence but rather on an influencer’s personal experience with a trending diet or product (posted for that person’s own social and financial benefit). These attempts to restrict food and to focus on weight loss can have lifelong consequences on teenagers’ physical and mental health.

How can dieting be harmful?
Although dieting can help teens achieve weight loss, rapid change in caloric intake and restriction can put a them at risk for nutritional deficiency, menstrual abnormalities, bone loss, arrhythmias (improper beating of the heart), irritability, fatigue, binge eating, poor self-esteem, and an eating disorder. Research suggests dieting can also have a reverse effect on teenagers: weight gain! In a 2003 study involving more than 15,000 children aged 9 to 14 years, those who restricted themselves from certain foods lost weight temporarily but ultimately gained more excess weight over time compared with the children who did not diet.

Is your teen at risk?
Girls are more likely to engage in unhealthy dieting to achieve
weight loss, according to a 2003 study from The American
Academy of Pediatrics.
Many of the tweens and teens in the study reported wanting to lose weight; it was a bigger concern for the females. While all are prone to being dissatisfied with their body in some way, girls are more likely to engage in unhealthy dieting. Other risk factors include being overweight, having a negative body image, having a mental health disorder such as anxiety and depression, parental dieting or parents urging the teen to diet, and weight teasing from family members or peers. Consider, too, that most patients with eating disorders were not previously overweight, though one study showed that one in three of those adolescents seeking treatment for an eating disorder had the highest body mass index (a body mass index greater than 85% of kids the same age and sex). Thus, parents of children who are overweight or obese must also be mindful of eating habits and harmful eating habits their children may exhibit.

What behaviors should be concerning?
Warning signs to look for that may suggest a more serious disorder – regardless of your child’s weight – include chronic and/or fad dieting, excessive exercising, fasting, skipping meals, inducing vomiting, or taking laxatives or diet pills.

How does communication about weight loss and dieting affect children?
A long-term study of adolescents who were encouraged to diet showed years later a higher risk of obesity, binge eating, disordered eating, and body dysmorphic disorder (a disorder in which a person constantly worries about a perceived defect in his or her physical appearance). Additionally, it found that these same participants encouraged their own children to diet, creating an unhealthy cycle.

How can you help your teen?
The American Academy of Pediatrics lists these interventions to address obesity and eating disorders:
  1. Discourage dieting, missing meals, or use of diet pills. Instead, promote healthy eating and physical activity that is sustainable over time. Try to incorporate these lifestyles into your family’s daily routine.
  2. Support positive body image and avoid using body dissatisfaction as the purpose for dieting.
  3. Implement frequent family meals. Research suggests families eating together eat more fruits and vegetables and other essential nutrients compared with families who didn’t eat together. Studies also show family meals also protect girls from acting upon eating disorders.
  4. Avoid talking about weight. According to several studies, parental discussions about weight, whether encouraging their children to diet or talking about their own dieting, is tied to overweight and eating disorders. Shift the focus of the conversation to healthy eating habits and being active. Studies found when parents followed this approach, their overweight or obese teen was less likely to diet and use unhealthy approaches to losing weight.
  5. If your teen is overweight, talk about whether he or she is bullied or treated poorly by peers.
  6. Monitor your child’s weight loss to ensure it is not too much too fast, which could signal a more serious problem such as an eating disorder.  
Teens in today’s society face mixed messages on what health and beauty should look like. Having them understand the dangers of those messages can prevent them from falling into unhealthy habits and instead be more aware of what makes a healthy lifestyle.  

Friday, February 14, 2020

How to Avoid and Fight Your Risk of Developing Kidney Stones

Marawan M. El Tayeb, MD
Clinical Assistant Professor, Texas A&M University College of Medicine 
Member, TMA Leadership College

Kidney stones hurt, which is a valid reason why people try – and should – avoid getting them if they can. Kidney stones are crystals made of various minerals that form and grow in your urine. Passing them can lead to severe pain, and obstruction can lead to damage to the urinary tract. Unfortunately, one in every 10 people in the United States will form a stone in their lifetime. Many people who have experienced kidney stones often describe it as worse than giving birth. People get kidney stones from ingesting too many crystal-forming substances, or not drinking enough fluids to dilute the urine and prevent crystals from forming.

If you think you have a stone, it is very important to visit a urologist as soon as possible. Stone symptoms can be very intense in the form of sudden severe back pain, vomiting, nausea, pain during urination, and abnormally-colored urine (pink, red, or brown). If you start developing a fever, you need to visit the emergency room as soon as possible. If kidney stones are treated right away, they are unlikely to cause permanent damage.

People who develop kidney stones can experience severe back
pain and pain during urination, among many other symptoms.
The gold standard of diagnosing a stone is with a computerized tomography (CT) scan, which is a series of x-ray images taken from different angles around your body.  A urine analysis may also be conducted to assess if there is an infection. If you have no infection, the CT scan should determine whether the stone will pass on its own or will require intervention. If the stone is small enough, your doctor may advise you to stay hydrated to help it move. However, if it’s larger, it could block your urinary tract – causing even more pain and requiring further treatment.

Men are more likely to develop kidney stones than women, with the first occurrence often happening after age 30. Someone who has had a stone – or has a family history of kidney stones – might be more susceptible to forming one again.

Fortunately, preventing kidney stones isn’t difficult. Here are the five most important things you can do to decrease your risk of forming a stone:
  1. Drink plenty of fluids - Water is the best, but any fluid will help. Try to avoid black iced tea in general as it has a considerable about of oxalate (a stone-forming chemical the body produces or gets from food) which can increase your risk of stone formation. Drink more than two liters (half-gallon) per day. This amounts to drinking about eight ounces of water every hour, consistently throughout the day. You can squeeze some lemon or lime into your water to make it more palatable.
  2. Eat a low-salt/sodium diet - Salt consists of sodium chloride, and too much of it can lead to kidney stone formation, so try to limit your sodium intake to less than two grams (2000 milligrams) per day. Processed food, in general, has a large amount of sodium, so make a habit of looking at the labels of the food that you are consuming and avoid using the saltshaker.
  3. Limit your animal protein intake to less than 12 ounces a day - Uric acid is a by-product of animal protein such as pork, beef, fish, and poultry. If you consume foods that produce high uric acid, this can make you susceptible to uric acid stones or calcium stones, as the uric acid may act as a place for a stone to form.
  4. Consume adequate calcium - People susceptible to kidney stones might assume that they should avoid calcium since it’s one of the chemicals that forms kidney stones, but calcium is essential for our bone health. Ironically, consuming enough calcium can help prevent kidney stones because it binds to oxalate in our digestive tract. The recommended daily allowance of calcium is 1200 mg per day, which is about two to three servings of dairy products, including milk, cheese, and yogurt.
  5. Limit foods high in oxalate - If you tend to get calcium oxalate stones, try to avoid high oxalate-containing food and drinks like iced tea, peanuts, peanut butter, chocolate, and spinach. Soy also contains a large amount of oxalate.
By maintaining a balanced diet and drinking enough fluids, you can keep your kidneys in good health, reduce your chance of developing kidney stones, and avoid a painful episode.

Monday, February 10, 2020

That Text Message Can Wait. A Trauma Surgeon's Plea to Houston Area Drivers

By Michelle McNutt, MD
Houston Trauma Surgeon

Note: This article was previously published in the Houston Chronicle.

Houston, we are in trouble. We are home to some of the nation’s most distracted drivers. How do I know this? Every day on my way to work in one of the country’s busiest Level I trauma centers, I can’t help but notice all of the other drivers looking down at their phones with their eyes off the road. It frightens me — as a trauma surgeon, as a commuter and as a mother. No text message, social media post or phone call is worth your life or the lives of those around you.

Texting and driving is a nationwide epidemic, but in Houston the problem is especially serious. Did you know we are the deadliest city for motorists as was reported by the Houston Chronicle? Distracted driving has become a leading cause of motor vehicle collisions in Harris County and surrounding areas. More than 3,000 people were killed across the country in 2016 due to distracted driving, according to the National Highway Traffic Safety Administration. In Houston, distraction was listed as a likely cause of more than 8,000 motor vehicle collisions.

As chief of trauma at Red Duke Trauma Institute at Memorial Hermann-Texas Medical Center, I see the damage and devastation caused by distracted driving. Our team does everything we can to save lives, yet for some survivors, their lives are forever altered because of their injuries.

I’ve witnessed firsthand the emotional impact that grips a family when they find out their loved one’s life has been altered or they have been killed because another driver was distracted. I have also been personally impacted. I am a survivor of a motor vehicle collision involving a distracted driver. Fortunately, I was able to walk away with minor injuries.

The reality is that trauma caused by distracted driving is preventable.

It’s time to put down our phones. To my fellow parents, I urge you to lead by example. Talk to your children, even before they are able to drive, about the dangers of using a phone behind the wheel. From a very young age, our kids are watching our behavior and looking to us to be their role models.

As a society, we have collectively advocated against drinking and driving. We are outraged when people get behind the wheel while intoxicated. I believe that distracted driving should merit that same level of outrage.

Not all driving conditions and scenarios are in a driver’s control, but there are things the driver can control, and the most important is reducing distractions and limiting risky behaviors. Through targeted prevention initiatives, Memorial Hermann is working to motivate the entire community to put down their phones and keep their eyes on the road. In 2014, we launched Live Your DREAMS, a program that teaches high school students about safe-driving behaviors. Recently, we began working with SAFE 2 SAVE, a free mobile app that rewards drivers for not using their cellphones when they are behind the wheel. Users receive points, that can be redeemed at select Houston area businesses, for every minute they refrain from using their mobile devices in the car. It is our hope that this app will help curtail distracted driving and help us all refocus on what’s important — creating a safe environment for everyone.

Join me in saving lives and making our community safer for my children and for your own. Take the pledge today to drive change in our great city so we all have an equal opportunity to get home safely.

McNutt is the chief of trauma at Red Duke Trauma Institute at Memorial Hermann-Texas Medical Center
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