Leadership in the Time of COVID19:   The Importance of Learning to Walk and Chew Gum at the Same Time

Artist: Douna Montazer, MD, Psychiatrist

Leadership in the Time of COVID19: The Importance of Learning to Walk and Chew Gum at the Same Time

Dr. Stella Immanuel is a physician who is desperately trying to save the lives of COVID-19 infected patients at her outpatient clinic in Houston, Texas. Many of her patients are undocumented immigrants who fear deportation if they step foot in a hospital. Not only is Dr. Imanuel keeping her patients out of the hospital, she is making them better with off-label use of anti-malarial drugs, often within 24 hours of presentation to her.

As a nation we do have leadership but no one listens to our leadership.


If our current President encourages something, anything, the left and the media will rebel against it just “because.” Some say that they suffer from “TDS” (Trump Derangement Syndrome).  I believe it.


If the President says something “off” many on the right will support it blindly, just “because he said so,” or because they saw it on Facebook, even if it is dangerous. We are seeing this now with people gathering to protest their inability to go back to work. People are rebelling and not listening to the importance of social distancing to protect our most vulnerable. The media will only show the public parts of an entire speech, and solely blame our President.


For leadership to work there have to be people willing to follow who understand the reasons behind statements the leader is making. 


So to blame leadership when we specialize as a nation in rebelling does not make sense. 


When the President said he had the authority to open the nation, the media went berserk. 


When he delegated to the governors, the states complained that the federal government is not leading.  The media went bananas.


When the President promoted hydroxychloroquine (a medication which many of us physicians have used for many years) the left and the media went crazy and even reputable doctors who have used it for years went on tv saying “it can kill you.”


India has 1.4 billion people and the death toll is less than 1000 because they are using hydroxychloroquine extensively. 


But no one wants to talk about that.


Many rapid tests that were intended to be used in an in-office setting (with physician-led counseling about the significance of the test result) were denied FDA approval so that the Abbott test can be the sole source provider.  Follow the money.


The masses are asked to wear masks and protesters are screaming “do not make us wear masks like China.”


How can you lead a population that is constantly in rebellion without much knowledge of why they are rebelling?


When the leaders in South Korea speak, their people listen.


Why don’t we ask why in India people are not dying, where their people are often packed like sardines in their cities? They cannot even socially distance in the slums of Calcutta. In France some doctors are using anti-malaria drugs to keep people out of the hospital


There is an agenda, it’s not left or right. 


It’s not lack of leadership. 


It is evil. And America the great will be the first to fall for it.


We as physicians took an oath to do no harm.


We as physicians need to be the advocate for the people.


Why are we intubating patients when 80% of them die (as per NY Governor Cuomo)?


Why do we bypass less invasive methods of oxygenation such as using a non-rebreather, CPAP and BIPAP and go straight to intubation?


Why are many hospitals nationwide empty, doctors and nurses jobless, people in pain from postponed surgeries, patients dying at home because they are afraid to go to the hospitals?


Why did the FDA approve hydroxychloroquine to use in hospital patients when by the mechanism of action it’s better used early?


Why did they approve its off-label use (where a discussion must be had between the doctor and the patient) but you cannot find the medication at the pharmacy? 


Who is hoarding it?


As I research I find that many companies including Teva, Mylan and others have donated millions of doses to the government. Why are all these doses not being distributed to outpatient pharmacies by the government? 


Every day another study is released saying that hydroxychloroquine isn’t working when it is given in the hospital. Of course it doesn’t! These people are already very sick. Their lungs are already fibrosing. Only the sickest of the sick are showing up in emergency rooms. The Secretary of Veterans Affairs Robert Wilkie has reported that the drug appears to be working in middle-aged and younger veterans in observational studies.


The time to try hydroxychloroquine is when the patient is first diagnosed.  A full course is 20 pills. If we were able to give it to everyone that is positive there will still be a lot left over. Why are they sending positive patients home to come back only when they are very ill instead of giving the HCQ and Zithromax early?


Patients with lupus and Rheumatoid Arthritis who take hydroxychloroquine daily (at much higher doses than would be used for COVID19) for 5 years or more are not dying.  They are being monitored and not being found to have significant side effects.  


Yet, for political reasons, licensed physicians will take to the media to scare the public from taking something that could potentially help them. 


Every drug we take has to be evaluated for inherent risks versus benefits. 


How come we equate the risk of having a possible irregular heartbeat with death from Covid19? Why have we not allowed the patients to make an informed choice? Why are doctors who have used this medicine themselves not speaking up? 


Why are we doctors taking it when we get ill and even as prophylaxis if we thought it was so dangerous? Why are we giving patients for years if it was so dangerous? Why have they not made hydroxychloroquine readily available like other nations and let the decision to use it off-label be between the patient and their doctor?


Why do we think shutting the economy and killing jobs is less fatal?


Have we assessed the morbidity and mortality associated with increased rates of child abuse and domestic violence, the increase in suicide, obesity, increased alcohol and tobacco abuse while we focus on inpatient care of Covid19?


I ask these questions because I believe we should transcend this division and do what is best for the people.


We are physicians and should be advocates for our patients. 


We are the generals in this war, why are we allowing civilians to direct a war they know nothing about? Are we being the best advocate for our patients or we are allowing politicians to make decisions?


I recommend that we continue to protect our most vulnerable by maintaining reasonable social distancing. Everyone should wear a mask in public out of common courtesy, should wash their hands and we need to get people back to work.


We need to reopen our hospitals for elective procedures but enforce strict visiting policies on nursing homes. 


Instead of ticketing people for going to the park, ticket them for not wearing a mask. If you hate masks, stay home. 


This is what they did in Czech Republic. It worked.


We can walk and chew gum at the same time.


We can’t just sit on the couch and chew gum.


We have to get back to work and still continue mitigation.


Many more will die from poverty-related issues if we do nothing. 


Let’s get up and chew that gum.

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