Hey good humans! Before we get into this episode of Middle Ground, here's a quick teaser of 'The Leap' that's coming soon. Very shaky I'm about to call my dad. My ex-boyfriend. Did you love me? You're the one who told me face-to-face that I am no longer your daughter Wish me luck. So stay on the lookout for that video of 'The Leap' that's coming out soon ...and if you want to challenge yourself and reach out to someone to reconnect and take the leap, then click on the link in the description below. And now enjoy this episode of Middle Ground. There are people making the argument that we should end self isolation because a few hundred thousand deaths is worth sacrificing for the economy, some people would agree with that until it's their mother who dies, or their uncle, or their grandfather. Nearly a dozen other states will start to ease their restrictions as they slowly start the reopening process... ...May not come back at all. There will be coronavirus in the fall. I can see the emotional agony it causes in patients and their family members. Restrictions should have been put on the people that are sick! I don't think it's a good thing for our economy or our country. So I had to layoff my employees. We have no work I believe that it violates our most basic of civil rights. I wouldn't say that I'm necessarily anti-self isolation, but more so anti-government imposed self isolation. Our new normal does not mean that we will sacrifice our freedoms for our safety. The key thing is is that working with good data is going to allow the US government to continue to make better decisions. I'm not able to work in my given profession, despite this, I am pro-quarantine. I own my own practice, but because of the quarantine, I've only seen patients two times a week. It might be hard to understand why people would gather like this while a deadly virus ravages America. What if it was your mother? What if your infant son or daughter gets sick? My name is Cedric Jamie Rutland, I'm a pulmonary critical care physician ...in Southern California, Newport Beach and Riverside, California, And I am pro self-isolation. Hi, I'm Dagny. I'm an ophthalmologist, I live here with my husband I'm an expecting mom to be here in Orange County, California, and I am pro self-isolation. Hi, I'm Alex. I live with my boyfriend and another roommate in a very small apartment and, I'm pro self-isolation. My name is Austin. I'm a chiropractor. I live here in Newport Beach, California. I would consider myself anti self-isolation. Hi, I'm Ali-Marie. I am a massage and craniosacral therapist by trade, but I'm currently a stay-at-home mom And I'm about 20 weeks pregnant, and I am anti self-isolation. Hi, I am Julia. I live with my family here in Texas. I am anti self-isolation. I know somebody who has been infected with COVID 19. Can the disagrees, please, turn off their cameras? Dr. Dagny: I know a physician colleague in New York who was infected and actually is an expecting mom, but thankfully she's doing okay and on the road to recovery. I also know someone from my neighborhood, who unfortunately passed away, and he's actually relatively young. Dr. Credric: One old partner of mine who's little younger than me, ...probably 34 or 35 who was infected with COVID-19. His case was mild. I had another physician friend of mine, who was older, probably about 55 or so. He was infected with COVID and I had to take care of him. Dr. Austin: I'll talk to a little bit different point maybe. One of my co-workers here, her father had a heart attack, ...but he was diagnosed with COVID at the hospital. And ultimately, they were told that COVID-19 killed the patient. When really it seems that the heart attack and complications from cardiovascular disease were ultimately the issue. The other health care professionals in the group here, I would love to hear your opinion on that as far as what you maybe heard about how they're counting. Who qualifies as a COVID case and what the cause of death was necessarily? Dr. Cedric: Here's what we've discovered: When you look at these patients that have COVID-19 is as a result of the presence of the virus ...within your blood vessels and your blood stream, it leads to the activation of the coagulation system, so their blood can clot easier. So we've seen heart attacks. We've seen strokes. We've seen pulmonary embolisms And so your point is well-taken. He died of a heart attack. Yes, but COVID-19 is a significant risk factor of coagulation. The disagreeres can join the conversation now. Ali-Marie: I do want to talk about the antibody test that they've started, ...and the extreme percentages that they have seen. There was the one that they did randomized in California recently, where they were getting as high as 55%. For all I know I've had it. My daughter and I were sick for four weeks, six weeks this winter. Right now in Michigan, Governor Whitmer is calling for all essential workers to be tested, ...but there's no antibody tests to go right alongside it. So my husband, who is an essential worker, could go get tested comes back negative. What? Does he have to get a weekly test now? When he could have already had it this winter with us and just had very mild symptoms? Alex: I'd like to make a point because I want the doctors in the group chat to respond to this. I have heard that getting COVID does not mean you won't get it again. Dr. Dagny: There have definitely been cases in the US and outside showing that those who recovered actually went on and tested positive again for the virus, so that is a little bit concerning because we were all kind of betting that once you get infected, you'd be immune. That previous assumption was based on what we know from some older viruses from before. It just goes to show that we still don't know a lot about this virus. Question: "The scare of the virus is over-hyped." Julia: I think that the scare has been largely driven by the media. I know that initially, there were models that came out of the Imperial College of London that claimed that millions of people would die. That was really used as the justification for these massive lock downs, and we have not seen those numbers pan out at all. Dr. Austin: I totally agree with you that a lot of what we're seeing is media created hysteria. There's a lot of new information that's coming out, we really think people were trying to do their best with the data that they were provided at the time. I especially have an issue with how the data is actually being collected and then ultimately how the deaths are being counted. Dr. Cedric: Since we initiated social distancing, especially when you look at, California, you can see that the amount of infections has slowed, and I actually saw this in the hospital. I saw the uptake and then all of a sudden as the governor got more restriced, and as the state got more restricted in terms of isolation, You can see that California was beginning to flatten the curve and actually lead the nation in that. I agree with the self-isolation principle because it did what it was supposed to do: which was prevent the amount of infections to bombard the hospital because that's not what you want. I mean, we still have physicians getting infected, and the more infections you have in the hospital, the more likely it is for one of us to get infected and then you have a reduction of healthcare workers to be able to manage these patients. Dr. Dagny: Someone called it even well ahead of time. If we find that weeks or months from now, the cases are not as bad as projected, people will say that we overreacted, when the truth is, that's just evidence that the things that we're doing right now, including self-isolation has worked. For those people who continue to compare, you know, COVID-19 to a really bad flu season, well, let's look at the data. They're saying that okay - a bad flu season we have 60,000 deaths in the U.S. Right now with COVID-19, We have about 50,000. So it's comparable. Well, we have to look at the rate at which that's happening. That's in one year. Right now we're in April and we're already matching the worst flu season. I do agree the media is always biased, but when we have epidemiological and infectious disease experts calling this a pandemic, calling this as something unprecedented, I think that's real and that is not hype. Julia: In terms of the hospitals being filled to capacity, that's obviously a situation that nobody would want. It appears to me that the US healthcare system Didn't become as swamped as they originally predicted, and I think that going back in history quarantines tend to be for the sick, as opposed to the healthy, and I wonder if maybe we would take more of an approach where the sick are being quarantined, which I think is is very justifiable as opposed to everybody who's healthy being quarantined, that might be more appropriate. Dr. Cedric: The issue with that is that we don't know who's sick with SARS-Cov-2. There are many different estimations of how many people are asymptomatic. I myself, have seen people be asymptomatic that are positive for the virus, so that becomes an issue. At least with the Spanish flu, you knew who was sick. And so until testing is rampant throughout the country, and we're able to know who is asymptomatic, I agree with you - quarantining the people who have SARS-Cov-2. If we tested everyone, is the most appropriate and probably the single best treatment that we can provide across the nation. Ali-Marie: With the United States, our judicial system is founded and rooted within innocent until proven guilty. Now, I'm not saying there's anything wrong with us acting like we're a carrier, washing our hands using antibacterial sanitizer. But ultimately, I don't think it's right or fair for the government to say you're not showing symptoms, but you could be sick, so you're gonna stay home It's like sending somebody on trial to prison because they could have been guilty. Alex: This isn't like putting people in prison because they're sick. I think this is actually more of a political difference than like I guess a medical argument. There are people making the argument that we should end self isolation because a few hundred thousand deaths is worth sacrificing for the economy. I disagree with that. Some people would agree with that until it's their mother who dies, or their uncle, or their grandfather. Question: "Slowing the curve is more important than human rights during the quarantine." Alex: Alright, guess I'll be the devil's advocate and just I'm going to take, I'm gonna take issue with the framing. Probably a better phrase would be civil rights perhaps. Limiting people's ability to gather is certainly an infringement on civil rights, but I would agree that the actions that have been taken are worth slowing the curve. Everyone can attack me now. Dr. Austin: There's no attacking, man. It's a hard one. Dr. Cedric: There's no attacking, I just wasn't gonna make a ridiculous like extreme statement. That's crazy. Ali-Marie: So I'm in Michigan where some of the most extreme lock downs have taken place. Governor Whitmer just today extended our stay at home order 15 days, but Relaxed some of the restrictions that everyone was so mad about. As far as you know, there was a huge Lansing protest recently Operation Gridlock that was organized by the Michigan Conservative Coalition. That was all about the fact that she was Not allowing all of these businesses to work that were able to practice social distancing some governors are willing to go to whatever extent it takes because it definitely has been an infringement on like all of our civil rights to be able to go out and in Harris County, I believe it's in Texas, right? That just said that you'll be fined $1,000 If you don't wear a mask in public.
Julia: The local police Union in Harris County actually came out and said they will not be enforcing that because they view it as unconstitutional. There's definitely a balance there between federal overreach versus states rights. So California even, where you are, it's a very different scenario in terms of the level of outbreak, the number of patients. Taking kind of an individual approach I think is important. If you're in a state that has seen very few cases, I don't know that the response needs to be the same. The federal government stepping in would make it a One-size-fits-all, and I don't know that any of us ...would feel that was appropriate. Alex: I think that charging people a $1000 fine for not having face mask is classist and is regressive. Who's less likely to have access to masks? It's poor people, and they don't have a thousand dollars to pay a fine. I agree that you know, you have to find a fine line between an authoritarian response and something that's responsible to all people. I think that the federal government and I'm talking about both parties here. I have a lot of issues with both sides. I think they need to be taking a leading role. When you have disparate responses from states, what you risk is states with a less extreme reaction or protocol. You risk those people going across state borders, and actually spreading the virus more. And we don't want to get to a point where we have to shut down state borders. Question: The US government is handling the crisis well. Ali-Marie: I am very torn on how I actually feel about this. My dad owns a small business, I've read a lot of the different arguments on the Payroll Protection Plan and a bunch of the different deals with Shake Shack, and everything else which... there are a lot of details that go into that. 75% of any loan that's given to the business owners has to be paid in to employee benefits. He has a company has 220 employees. So you're talking $65 million in revenue every year, and so some would say his business is too big, he shouldn't have gotten it, but that's 220 employees that he's taken care of. There can be an emotional response, saying "They're not protecting the mom-and-pop shops. They're not protecting this...", but ultimately 220 employees are getting their salaries, and 4 aren't. And while it's emotionally sad to see those smaller businesses forced to close, we're gonna be in a little bit of a depression, we're gonna hit a recession. And so we're all in this together. And I think the bipartisan support has been really lacking especially in the beginning, but I think that they're somehow finding a way. Dr. Cedric: So all I'm saying, and I think it's really simple is you have all this money that we're giving to businesses, and I think it's appropriate and I think that they should. The issue is just testing. Take some of that money, and give the country some tests. Antibody testing and the PCR testing. So until that's done and distributed across the country, no, I don't think it's a job well done. Julia: Can you tell me why that's such a priority? I know we need to know how many people have it. But can you explain to me why that's so critical? I just don't know. Dr. Cedric: If we give everyone an antibody test, We're gonna know who the sick are. IGM is what gets produced acutely It's a type of antibody in your bloodstream - SARS COV 2, so you'll know who's infected. IgG means that you've had a sustained response to the system and your body has had enough time to develop a neutralizing antibody. So you'll be able to quarantine the "sick" without being symptomatic. Alex: I haven't gotten my stimulus check yet. I don't know about anybody else. My rent has already been due, where the hell is the check? I already need another check. The government to be focusing on helping individuals who are stuck at home and who have no way of surviving. I think the fact that the federal government, the White House specifically, for months, was saying that this was a hoax and that this was completely blown out of proportion, was hugely detrimental to our response. Dr. Dagny: South Korea did a great job, Taiwan did a great job, but unfortunately, that is not what I can say for the United States. Things are turning around and all these stimulus packages that they're doing, the fact that they're vowing to expand testing is definitely on a better track, and my husband he was one of the first in line when that CARES package came out to sign up for the forgivable business loan and the PPP. He didn't get it, and it was heartbreaking to hear that these large corporations were getting access to that money. So even though the government was doing something of good intent, the way that it was executed unfortunately wasn't the best. Dr. Austin: Dagny you mentioned that South Korea, that you admired South Korea, how their response was. Well to my knowledge, they had trackers on everybody's cellular device that was monitoring where they were going. That just in itself to me is a completely asinine principle from the First Amendment, like the fact that government is tracking your every move seems a lot like house arrest. Dr. Dagny: The tracker system that South Korea used has generally been praised by most countries, and one of the main reasons that they were avoid to - able to avoid a peak and have to implement quarantine. And we the U.S, are actually taking lessons from them, but it's not as authoritarian as you think. We all have the option to opt out, but the only way this is going to work is if you opt in. And that's for people who decide that the public good is of higher benefit right now, than our own individual, I guess, concerns for privacy. Ali-Marie: So Dagny you're talking about different countries and what they're seeing. Sweden never did a lock down. They said if you're vulnerable and at-risk stay home, don't go to work. And their chief Epidemiologist right now, is saying that they are very close to reaching herd immunity. So, within this whole idea of staying home to avoid a second wave, a second wave is inevitable. Right now, the federal government recommendation on when you can reopen your economy is if you see a daily decline in positive cases over two weeks and regardless of how when those two weeks are it's gonna start to rise again when everyone starts being around each other. There is no negating it we can't stay locked up in our houses for three, four, five, six months, there's some doctors saying that we're gonna still be seeing COVID cases for 18 months. Dr. Dagny: When we compared the U.S to other countries, I think we were more similar to the tracks of Italy and China. I don't think herd immunity works for every country. It's really gonna be specific to you know, the region itself. Ali-Marie: I'm comparing Michigan to Sweden because they both have approximately 10 million people and their population, population density is about the same and Sweden has a far less death rate -- and infection rate than Michigan does
Dr. Dagny: --But again, Michigan is very heterogeneous compared to Sweden. Alex: Dagney, I feel like we have like the same mind or something because I was just I brought up this article about Sweden, and the situation there is very different. They have far more single person households than the United States does. They have a much more robust social safety net, so people who want to opt out of exposing themselves don't have to worry about not paying their bills. And the Swedish government is actually reconsidering their herd immunity approach, and considering taking stricter measures because they're seeing the cases in Stockholm rise. There are people in the Swedish government who are saying they might regret the herd immunity approach, and it is a much more homogeneous society. You know, I hate to say it, but there are societies that take more responsibility to the health of like everyone around them. America is a very individualist country. Question: "The lock down is harming my mental health." Dr. Austin: I have patients that are still coming in so we get asked about this every day like, "Dr. Quan, what do you think about the lockdown?" "What do you think's going on?" I've not only been doing and working my normal scheduled hours here at the office. But then we go home and I'll spend hours and hours and hours until the wee hours of the morning, researching trying to stay up on the new stuff that's that's coming out on the corona virus. So it has been very fatiguing and toiling on me just being able to take care of patients and do my normal daily routine. Obviously no deaths are discounted or lost or you know, we care about everybody who's dying in all this But you got to look at like child molestation rates that are going up, you're looking at spousal abuse rates going up, suicidal issues, depression, anxiety. Overall lifestyle choices people are making and especially mental health concerns through this isolation is definitely another factor that we're looking at. We might be stealing from Peter to pay Paul, this kind of idea when it comes to you know, we're we're looking at the deaths actually occurring. Julia: Has my mental health been negatively affected? I feel like that would maybe be stating it a little bit too strongly some of you have mentioned We we appear to be going the route of a depression. That's a scary thing. It's really sad. It's gonna have a profound impact on people's lives, and this might be too personal, but I feel like ultimately God's in control, and I have to just you know, that's something that I have to accept and and it gives me a little bit of peace, too. Dr. Dagny: I feel like not having a lock down would probably affect me more. Because it's the infection that scares me more. If I had to continue my normal patient caseload and surgery caseload at my practice, and be paranoid about every patient thinking, "Are they infected?" "Are they going to infect me?" And the fact that our supplies our PPE is running down, as well in my own private practice, that would be more mentally straining to me personally. Dr. Cedric: It's not that the presence of all of these restrictions is not harming my mental health. It's just that I feel that the restrictions are appropriate. My job as a pulmonary and critical care physician has changed forever. I have to now worry about COVID-19 in almost every patient that I see because I'm a pulmonologist, and they present with respiratory failure. And I have to be super protective and super cautious when I'm dealing with an outpatient, when I'm dealing with an inpatient, on-call in the ICU as I was last night from here on out. Until the vaccine comes or whatever, and this is something I have to deal with because I have two small little kids, I have a five-year-old and a seven-year-old little girl, and I got my wife and I just feel that I have to protect them. Question: I have felt judged by the other side Julia: If you oppose continued quarantine mass quarantine, I should say, people judge you and make the assumption that you don't care about somebody's life. That's categorically not true. I care very much for people that are suffering and people that are dying, and I don't want for that to happen to anybody. Ali-Marie: My sister-in-law, specifically, she was not happy because I had said that Whitmer was thinking about extending the order 70 days, and how I wasn't sure I felt about it, and I mean We're not even actually on speaking terms right now because she was so angry at me that I would even potentially think That we shouldn't all be quarantined by the government right now. Dr. Austin: As a doctor, like I truly believe I took an oath to protect my community and to always have my patients' best interest in mind and to really always be doing new innovative research to look for new ways to help take care of people. This is just something where now that I've seen what I've seen I've looked at the data. I've done my own analysis and research on it. I've talked to some of the leading experts in the field at this point. And there's enough evidence for me to go out and protest for people who may not know the data and may not really understand some of that kind of stuff that's going on. Dr. Cedric: This is a very interesting question, I'm sure you guys are surprised that I'm here, so most of my friends are in the financial industry, and so their respective fields are suffering. From them, what they say to me most often is well, you're a physician And your business hasn't been affected, and not only that but for the first time in my career Instead of my presence being one of relief, it's now one of fear. The first thing a non-COVID patient asked me is were you in a COVID room earlier today. Every time I make a right or left I'm being judged. Dr. Dagny: Pretty lucky to say that I haven't really been judged based on my position because I think I'm actually in the majority group in advocating for self isolation. I mean I've been judged on plenty of other things being on social media, one of the things I recently spoke up for was you know to end violence and hate against Asian American people of descent because of this pandemic. And I think ultimately we're all on the same page, we all want what's better for the greater good, and you know to you guys you think that is getting the economy back up again. If we hit it hard, like we are right now with the quarantine and we continue to stay on track, I think we all ultimately get to go back to a normal life faster. I don't think Pro-self isolation means that we're anti-economy. I'm with you guys. I want the economy to open back. But I only want it to happen when it's safe to do so and that's just based on, you know, objective data. Question: "I Have learned something from the other side." Ali-Marie: Can I ask a question? Do you mean in this conversation or like in general? Host: In this conversation. Ali-Marie: Oh in this conversation, okay. I'll stay. *laughter* Dr. Dagny: Thanks Ali. I was gonna be offended Dr. Cedric: Yeah. I was like dang, dude! Alex: I'm also an open-minded person and I understand the frustration from both sides is a nuance. It's not a one or the other issue technically I think that there obviously is compromise that should and can be made. Julia: Dagny, you said something that I thought was pretty profound, - being pro isolation doesn't mean anti economy, you know, I'm guilty of looking at the other side and thinking You people just don't even care. You've said yourself you're having you know, your personal situation that has been impacted. And so, so I really appreciated that point that you made and then getting a better understanding of where you're coming from. Dr. Cedric: This is one of the most pleasant conversations I have ever had in terms of being able to discuss politics, science, current events, in a way that was productive, and so with that you learn a lot from everyone who is included. What it shows to me is it shows the model behavior that I feel like our country should have in regards to how to be productive about setting appropriate restrictions, setting appropriate business opportunities for everyone and I think it can be done. I've learned so much from you guys like I wrote it all down actually and I'm gonna take it with me, put it here and use it next week. Julia: I feel like we're friends. I enjoyed it. Dr. Cedric: Austin, Dags, once they lift these restrictions, we're all getting together. Austin: Let's do it. Alex: I live in Orange County too actually. Dr. Cedric: Alex, Ally, and Julia.
