Response to Dr. Dorsett

MEEKER | We are writing in response to Dr. Bob Dorsett’s previous letter on Jan. 7, 2021. His response is greatly appreciated, as it does point out some needed clarification. We understand how he reached his interpretation, so we are taking an opportunity to clarify.

First, for transparency, here is our process in writing this column. I, Dr. Justin Grant, have had the privilege to draft the articles representing PMC providers. Each article has been reviewed by my peers (the PMC providers) and has undergone multiple revisions based upon their critiques and suggestions, until each provider is comfortable with the article’s contents.

Subsequently, these articles represent Pioneers Medical Center’s providers (including this article, which has undergone the same process), and are not the sole opinion of any single provider. Additionally, it is important to note that as a group, we range the political spectrum from left to right.

Regarding the letters’ purpose, we have all seen and heard a plethora of misinformation, including emotionally driven opinions about COVID and what actions everyone should be taking.

We have also all heard differing “headline evidence” from varying news organizations ranging the political spectrum from CNN to Fox News. Furthermore, we have seen legitimately peer-reviewed evidence evolve as we continue to learn through this pandemic. Consequently, a surfeit of confusion has led to antagonistic extremes. Addressing these extremes and endeavoring to unify our community has been the primary purpose of our column. We believe that evaluating the actual evidence is the best way to do this, as it will help each person better understand their own situations and that of their neighbor’s. It is our hope that this understanding will help us reach across to our neighbor instead of throwing stones at him or her for individual decisions he or she makes.

Concerning Dr. Dorsett’s inference that we are implying you should not listen to medical or health experts — that is not at all our intent nor expectation. Our point is simply that COVID has not been around long enough for “COVID experts” to exist, and too often these touted experts are aired with a political agenda. We (the worldwide medical community) simply do not yet have enough information regarding COVID to be experts about it. For example, the full extent of asymptomatic transmission is still debated in the most respected corners of the medical community. It will likely be years before we have answers to questions with any relative certainty. As such, our comments are to caution against emotional attachment to surface-level information provided by “COVID experts” aired on politically opposing mainstream sources (ie Fox News vs CNN). New studies often have confusing, misleading, and contradicting headlines regarding the study’s implications amongst organizations across the political spectrum. So, instead of listening to those “experts,” we are encouraging our community to be as educated on this topic as possible, continually reviewing emerging evidence, and becoming immune to the political divide we see happening across the country — which has arguably reeked as much havoc as the virus itself.

Regarding vaccination, we do have an article addressing this coming over the next couple weeks. In short, as a preview, we are not telling anyone to not vaccinate, we fully support those who personally choose to do so, and we encourage vaccinating high risk individuals. We are simply presenting evidence for everyone to make informed decisions for themselves, as no medical treatment/medicine is without risks. The vaccine is brand new, and there are still a multitude of unknown risks. The currently known risks include anaphylaxis (which is treatable), and, at the time of this writing, there is one documented death following the COVID vaccine; though it has not been determined if the vaccine caused the death, and it may still be determined to not be the cause. The point is, there is no risk-free decision, and we do believe it is both unwise and irresponsible to blankly tell everyone, regardless of personal risk or health status, to take a new medicine that still has significant unknowns and is being presented with heavily biased information (studies provided by the medicine’s manufacturers who are immune to any legal repercussions). In time, unbiased third party evidence may very well fully support currently presented evidence. However, the medical community has witnessed the opposite occurrence more than once. Until then, this is our current state of affairs, and only time will reveal stronger evidence to guide our decisions as individuals and as a community. To be crystal clear, we will say again, we are not discouraging anyone from getting vaccinated, and we fully support everyone who decides to do so. There are definitely those whose benefits outweigh the risks. We are only attempting to provide an unfiltered, ethically responsible, review of the evidence to help people decide for themselves. This is still the United States of America, and we all have a choice. Stay tuned for our next column as we attempt to use what evidence we have to answer common questions and address risk.

A note addressing Dr. Dorsett’s critique of the accuracy of our presented information.

First, we greatly appreciate it. Ongoing constructive discourse about the evidence is exactly what we need. Right is the figure from the referenced article where I (Dr. Grant) obtained the information regarding the IFR ranges by age. I used a ruler on my laptop screen to make straight lines across for an approximation of the values. I did combine age groups for the sake of taking up fewer lines in the paper (ie 5 to 19 years old instead of listing 5 to 9, 10 to 14, and 15 to 19 separately); and doing so does not leave out any of the data. This method is not exact, but feel free to do this yourself and compare to the values in our previous article (copied below).

I believe you will find the values will be close enough for the stated point and for this conversation. However, repeating the exercise again myself for the purpose of this article, I do have a few corrections to make (see asterisk).

• n 0-4 years old = 0.0009% to 0.001%*
• 5-19 years old = 0.0003% to 0.008%
• 20-29 years old = 0.0011% to 0.015%
• 30-39 years old = 0.008% to 0.1%
• 40-49 years old = 0.1% to 0.12%**
• 50-59 years old = 0.08% to 0.17%*
• 60-69 years old = 0.09% to 1.2% n 70-79 years old = 0.15% to 9%**
• Greater than 80 years old = 2% to 10%

*0.009% to 0.01%
**0.01% to 0.4%
***0.08% to 1.0%
****0.6% to 9%

As you can see, we did not lop off “75% of the published IFR.” We did not discuss the parts of the article that did not pertain to our conversation (such as the death rate comparison of different countries).

We agree with Dr. Dorsett that a healthy lifestyle alone will not stop the virus. It is interesting to wonder, though, how much lower would the death rate be if we did not have such rampant metabolic and cardiovascular disease? If we did not have a metabolic and cardiovascular “pandemic,” would COVID be so devastating?

It is also now clear that social distancing, hand washing, and mask wearing will not stop the pandemic either. It will only slow the spread. Only herd immunity will defeat the virus, and there is hope that combined potential natural and vaccinated immunities will hasten COVID’s end. In the meantime, emphasizing your health will decrease your personal risk, and following public health measures (such as hand washing, social distancing, etc.) will help minimize the risk of overburdening our local healthcare resources.

Let us keep investigating emerging evidence, striving to understand its implications, striving to understand each other, and reviewing it together in constructive discourse — constructive towards both, protecting our vulnerable and safely returning to normalcy.

References:
“Age-specific mortality and immunity patterns of SARS-CoV-2.” Megan O’Driscoll, et al.
Nature. November 2020.

Special to the Herald Times