Q: As a doctor and public health expert do you have ideas about how COVID should be managed in Minnesota that will help us get back to normal? Have you personally been affected by COVID?
- Yes! I have several ideas, including the appointment of epidemiologists statewide. Learn more on my Issues page.
- I got laid off from my job this summer because of COVID. I recently found a new job.
Q: Was the government unprepared for the pandemic?
- Not just the government. The world was unprepared. I think if a UFO had landed in St. Cloud or if Elvis had walked into the Mall of America back in February, we would have been more prepared.
- The world was unprepared because the last similar size pandemic was in 1918, at the end of World War I, which was before the advent of modern medicine. During the past 100+ years we have achieved dramatic advances in science and technology, while not a lot has happened in large-scale public health interventions. Our expectations have moved ahead a lot farther than our capabilities. Imagine if we had to fight a 21st century military battle using World War I equipment – it’s like that.
- The United States is especially challenged because although we have public health agencies like the CDC and the Minnesota Department of Health, these organizations don’t influence how care is provided to patients. It’s hard to scale up testing, diagnosis or treatment for a new condition in a system with as many different parts as ours.
Q: What caused the pandemic?
- In some ways, nothing. Pandemics have always been with us, and in some ways they are like earthquakes – we don’t know when they will happen, but we do know that a bad one is going to happen every so often. We’re always kind of waiting, but the wait can get so long that almost everyone forgets.
- In other ways, everything. Scientists know that nowadays, more and more contagious illnesses are being transmitted from animals to humans and vice versa. That’s because our habitats are increasingly coming into contact. Animals have been the source of almost all our recent new viruses, including Zika and Ebola, and including coronavirus which are a new virus family altogether for us.
Q: Why are masks being mandated now, when earlier in the pandemic we were told that masks wouldn’t help?
- Pandemics unfold over time. Last spring, when the Coronavirus (COVID-19) was new to the US and only a handful of people had been infected, the number of contagious individuals was small compared to our population size with its hundreds of millions of people. The big concern then was for health care workers who were treating COVID-19 patients in hospitals. Around that time there was also a national shortage of medical-grade (for example, “N95”) masks. So there was a push to conserve medical-grade masks for the health care workers who desperately needed them.
- We are in a different phase of the pandemic now than we were last spring. The virus has spread into the “community” now. The risk to most of is higher now, so it makes sense that we would take extra precautions.
- Medical-grade masks are worn by doctors and nurses to prevent them from acquiring or spreading infectious respiratory illnesses. The masks the public is being advised to wear do not have to be medical-grade. Evidence has shown that wearing a simple face covering decreases the likelihood that a contagious person will spread the virus to others by breathing, coughing, talking, etc. near them. So, simple masks are now recommended to the public in order to slow the community spread.
- There is lots of scientific research and data about masks and their effectiveness against various types of infections. But the reason the public heard one thing in the spring and are hearing a different thing now is for the reasons I just mentioned.
Q: What do I personally think about masks and the mask mandate?
- I hate wearing a mask. I can’t wait until I don’t have to. And like a lot of people, I can relate to not liking the idea that my freedom is being intruded upon. But I understand where the mandate is coming from and why, which makes it a lot easier to tolerate and comply with. That’s why I think we need better public communication on topics like this.
- Honestly, I don’t wear it to protect myself. First of all, it’s not medical grade, so if someone near me with the Coronavirus coughs on me, I could still catch it. Second, I’m just not a person who worries a lot about getting sick. I’m adventurous and I’ve traveled all over the world, catching my share of weird bugs, with no regrets!
- Still, I always wear my mask in indoor public places because, if I am infected with the Coronavirus and don’t know it, and if I breath on others, they are more likely to inhale the virus themselves than if I were wearing a mask. So, I wear the mask to protect others, especially my family members who are older.
- Anybody who says they know for sure that masks either work or don’t work is not being honest. Scientists make guesses about things, and then they test their guesses over and over using experiments. With coronavirus, we just started that process. We’re in the very early stages, in terms of our knowledge.
- The thing I like about masks is that they give us the all-clear to go ahead and do a lot of things that otherwise might be very risky in the middle of a pandemic, like going to the store, walking around in public, or visiting family. Masks won’t bring the risk of catching or spreading COVID down to zero. But they very well might decrease that risk for many people.
- Good public health policy needs to be based on an as accurate as possible an understanding of both the benefits and risk involved both with the policy and without it. To the best of our knowledge we believe masks decrease the risk of spreading COVID. And the risk of wearing a mask is negligible.
- I think it’s a lot like driving and road safety. A lot of us might drive faster on the highway if we were only thinking about ourselves and not the safety of others.
Q: Is it fear-mongering to promote masks? Why are masks mandated when the rate of COVID-19 in our area is so low?
- No! (It is not fear-mongering.) It is most likely that what we are seeing is the predicted result of mandated mask-wearing. Because so many people are wearing masks, it means that there is less community transmission, which means that fewer people are sick, our health care resources are taxed less, and the economy can stay open.
- Still, no single factor is responsible for what we are seeing with COVID rates in our county or region right now. There is not a simple explanation.
Q: What if science later shows that masks don’t help at all?
- I don’t think this will happen, but if it does, the worst we will have endured is an unhelpful inconvenience that doesn’t cost a ton. It won’t be the first time people have done this!
Q: If masks had been mandated earlier on in the pandemic, could the shutdown to the economy have been avoided?
- Possibly. But remember how little we knew about the Coronavirus at the time, and how unprepared our medical system was. The purpose of the shutdown was to slow community spread, so that hospitals would not be flooded with seriously ill patients infected with an unfamiliar virus.
Q: Are masks harmful medically?
- For the vast, vast majority of people – no. I advise all my patients to wear masks in public indoor spaces.
Q: They say that Coronavirus mutates. If that’s true, then what good is a vaccine? The flu mutates, doesn’t it? That’s why a new flu vaccine has to be created every year.
- All viruses mutate. The flu happens to mutate in a way that allows it to “trick” the human immune system, so that pretty much every year there is a new “strain” that gets through our immune defenses. Coronavirus belongs to a different family of viruses. Coronaviruses mutate in ways that can change the characteristics of the illness, such as its severity, length, and complications. But we have not seen that they mutate like the flu.
Q: I’ve heard that the only people who really get sick from Coronavirus are people who have serious underlying conditions.
- Actually, the comorbidities that seem to make people particularly vulnerable to the Coronavirus include chronic diseases that are extremely common in our society, such as diabetes and obesity. A large percentage of Americans are therefore in this category.
- When otherwise healthy people do get sick from the Coronavirus, it can still be very serious.
Q: I’ve heard that for most people coronavirus is no worse than a bad case of the flu
- For some people it is true that their coronavirus symptoms are no worse than the flu. And some people don’t experience any symptoms at all. But others get extremely sick. They may require a ventilator to breath. We are also seeing more and more reports of people with lasting symptoms, and with symptoms that affect organs outside the respiratory system. Medically, it’s uncharted territory and that is what concerns doctors so much.
- Coronaviruses are novel, meaning they are new to us, and there is much more we don’t know about them than we do know. With the flu, we are dealing with a known quantity.
- The flu causes a respiratory illness. Coronavirus also causes a respiratory illness – but what we are seeing is that it also causes other problems too.
Q: Isn’t this all being blown out of proportion? I hear that hospitals list COVID on death certificates when the person actually died from something else. The CDC says one thing one day and another thing the next. Now they are saying that 94% of people who died from COVID had other contributing conditions.
- This is the wrong way to be looking at the data. The public is being confused by reporting from journalists who don’t understand epidemiology or medicine. Pretty much all causes of death involve one condition impacting another condition. The COVID-19 death certificates that list multiple conditions but get counted as COVID?? There’s nothing deceptive there. That’s how many death certificates are.
- Most of the time, when someone dies, they die because a short term (or “acute”) problem comes along and adds to existing (or “chronic”) problems. Acute conditions almost always hit older folks worse than they hit younger people. Age itself is a “condition” since all people decline physically with age. That doesn’t mean we ignore those acute events on death certificates. Let’s say a person has seizures from time to time. And say that person is out hiking, and they have a seizure and it causes them to fall off a cliff. You could say that the seizure caused the fall. But the cause of death, on that day, was the fall, and it needs to be listed on the death certificate along with seizures. It’s the same with COVID. When a person dies from COVID and they also are elderly or have other problems, that doesn’t mean we can just leave COVID off the death certificate. Death certificates are legal documents and there are penalties for filling them out incorrectly or erroneously.
- It does not make sense to say, “COVID-19 is not a serious threat because 94% of deaths had contributing conditions.” Rather, we should look at a number called “Excess Deaths.” This number tells us how many people have died over a certain time period compared to the same time period in previously years. The CDC has reports on this, and indeed they show that more people are dying this year than last.
Q: I don’t trust what hospitals say – they are all just getting paid for each COVID death they have, so if someone has COVID and they get hit by a bus, the hospital will count it as a COVID death.
- No hospital would do this as a matter of practice, because any hospital that pads its death rates will get shut down! If hospital A has twice the COVID death rate as hospital B, you can bet that the various hospital licensing agencies will notice. If Doctor X’s patients die at twice the rate from COVID as Dr. Y’s patients do, Dr. X’s license could be revoked by the Medical Board. Hospitals, and the doctors that work in them, work extremely hard to avoid such situations, and to keep their outcomes within normal ranges. If they didn’t, no one would trust their medical skills!