Physician Outlook

COVID’s Fourth Trimester

While slowly entering the fourth trimester of this “Pandemic Pregnancy,” the entire world is anxiously awaiting the production and distribution of a COVID19 vaccine. All along this journey that the whole world has been sharing, what else could and should we do?

Almost ten months have elapsed since COVID19 appeared on this planet, and Coronavirus cases in the U.S. continue to soar.

We have officially entered “the fourth trimester1 of COVID19.”

In the last issue of Physician Outlook I wrote a piece titled “Pandemic Pregnancy” in which I waxed philosophically about the similarities between an unexpected, complicated pregnancy and the long almost 9 months we had collectively endured as humans after we became unwittingly impregnated with the nasty novel coronavirus.

I, for one, was naively looking forward to a quick, easy uncomplicated election-induced delivery come November 4th.

Unfortunately, it IS 2020, and nothing can or will go as planned.

The long-anticipated controversial US election did not yield an unequivocal landslide winner. Joe Biden and Kamala Harris are the President and Vice President-Elect based on electoral college numbers and the popular vote, but the election has yet to be officially certified amidst allegations of voter fraud.  With roughly 51% of the votes in favor of Democrats and 47% for Republicans, there is still, unfortunately, continued controversy and division amongst the people of this nation.

We are a deeply divided country, with roughly half the country feeling “cheated” and the other half experiencing elation that a new administration will take office on January 20, 2021.

Globally we have embraced contagion control, which involves wearing masks and socially distancing. Some of us wear masks everywhere, even inside of our own homes and vehicles. Some of us wear masks begrudgingly, barely covering our noses.  Some of us refuse to wear them at all.

Some have continued to work from home, while others (mostly ‘essential workers’) have never stopped going to the workplace, while many of us remain un- or under-employed. Many of us are learning to parent in a post-COVID world, which for some means daily in-school attendance (with many stops and starts when a suspected COVID case is identified). Some are home-schooling, and some have children who are learning via a hybrid of in-person and online attendance.

We are ALL anxiously awaiting production and distribution of a COVID19 vaccine, which promises to “open up the world” with >90% efficacy.  But a great majority of us are secretly hoping that “someone else” will be first in line to get the shot(s) that will help us all earn our eventual freedom.   

This virus, like a newborn baby, is not going anywhere soon.

It is no secret that we are currently experiencing a surge in symptomatic COVID19 cases. I live in rural Pennsylvania and work in a very rural county in upstate Western NY. Every day I hear about another infected patient, and every few days about another death.  Rural areas continue to experience new cases and deaths at a higher rate than metro counties. At our local hospitals we do not have the expertise and capacity to take care of very ill patients. It is difficult to transfer sick patients to higher levels of care.

The common ground we all have is that NONE of us, whether Republican or Democrat, wish to have COVID19 seriously affect the health of someone we love. The current ‘sicken in place until ill enough to be hospitalized’ approach that has become the norm over the past 10 months of this pandemic is NOT NORMAL. We do not treat ANY other illness in this way, and I am hoping that the dawn of a new administration will be tolerant of and open to outpatient and early treatment of COVID19 instead of mocking any attempted treatment because of political persuasion or leaning. Politics has played an unprecedented role in this pandemic, partially because of Trump’s frequent rhetoric and style of pitting “the people” against “the establishment,” as well as his early endorsement of hydroxychloroquine as “game-changing.”  The vast majority of the 51% of the US citizens who voted for Biden are afflicted by a new tongue-in-cheek diagnosis, aptly termed “Trump Derangement Syndrome.” Most would rather die than consider taking a medication endorsed by “the orange man.”

This is an attitude and approach that needs to change. We do not tell patients with mild angina to wait a few weeks to see if their pain resolves, or instruct them to have crushing chest pain before they seek medical attention.  We do not tell patients with cancer to wait two weeks prior to going to an oncologist. Yet, we tell even at-risk COVID19 patients to not present for care until approximately 2 weeks after the onset of symptoms IF they don’t recover. By that time the cytokine storm may have already started brewing in the patient, leading to higher morbidity and mortality.

Dr. Peter McCullough and other physicians recently testified before the Senate about the importance of developing and adopting an early treatment initiative. McCullough is a Baylor cardiologist and internal medicine specialist who has treated COVID19 patients and has written extensively about the importance of EARLY outpatient treatment for the SARS-CoV2  virus. In his article titled “Physician Secrets Revealed: Outpatient Treatment for Covid-19”  in this month’s Physician Outlook issue he describes the importance of early ambulatory treatment to reduce hospitalization in those patients who are high risk.

The three other pillars of pandemic management as proposed by McCullough are contagion control, hospitalization as a safety net for late-stage treatment and prevention through vaccination.

I listened to Dr. McCullough and his colleagues’ testimony at a recent Senate Committee hearing with renewed hope that there MAY be light at the end of the tunnel while we await vaccines to be available and distributed to those most at need. Meanwhile I am wearing my mask, but also stocking up on the medications and supplements that could potentially help me and the high-risk members of my family manage COVID19 should we contract it. 


1 The term “fourth trimester” was first coined by Dr. Harvey Karp to describe the three months following the delivery of a baby.  I am using the term allegorically to describe the state of the coronavirus epidemic, which is entering its 10th month in existence.

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