Without a measure that is proportional to infection and disease, resistant to ever-change testing criteria and comparable across places and times, the public will not understand how the pandemic is progressing and government leaders will make the wrong decisions.

First published at TheHill.com on September 1, 2020

For eight months, the U.S. government leaders have operated the machinery of the COVID-19 pandemic following case counts of positive laboratory tests. But, in the middle of a pandemic, case counts are not a representative indicator of infectious disease in a population.

So far, according to the CDC, the United States has seen two waves of the COVID-19 pandemic, a larger one in April and a smaller one in July. Hospitalizations, which are roughly proportional to infections, peaked at 10 per week per 100,000 people during the week beginning April 11th fell…

Every life is sacred, but COVID-19 isn’t the only disease that kills Americans.

There will be more deaths. On one side America, the statement is an indictment of the hastily made ambitions of the heartless. On the other, it’s a plot for the country’s take-down. In a divided country, no one can offer a middle path.

At Dr. Anthony Fauci’s recent Senate hearing, we only heard the party line of the expert consensus. Open only when infections are falling and hospitals are ready. Make decisions place by place. Don’t expect a vaccine. Be prepared for more cases and deaths. The hearing didn’t provide much political ammunition, but it could have offered more perspective.

Making decisions to respond to COVID-19 more openly and with more deliberation will not only make them less vulnerable to error but also will better ensure their acceptance and success.

Originally published @ The Hill

Politicians are not scientists, yet they have promised that their decisions to contain COVID-19 will be based on science, not politics. Is that even possible?

The science of COVID-19 still has more questions than facts. The first models forecasting calamity alarmed us, but their predictions have been way off. Each week brings a new revelation. The first cases arrived earlier than the ones we caught. The number of us infected are orders of magnitude higher than we can count. Ventilators, we are learning, may be harmful. And, though tragically fatal for some, COVID-19 appears to…

Our actions to respond to Covid-19 will have public health winners and losers today and in the future. We each have a responsibility to examine all the risks and have a difficult but necessary public conversation to get the balance right.

By Rajiv Bhatia MD, MPH

If I told one of my patients that quitting her job would save lives, I suspect she’d have some questions. She’d want a lot more facts.

Covid-19 didn’t given us time for much of a public conversation. The restrictions on travel, gathering, and business came swiftly. What was once unimaginable quickly became quickly acceptable.

The curve is now flat; we can safely move towards less restrictive policies.

By Rajiv Bhatia, MD, MPH

Uncertainty and fear are normal, and being precautionary wise, at the beginning of an epidemic. Many are anxious both about exiting “stay-at-home.” But, now that we have some actual experience. There are many reasons to feel more secure.

Every epidemic is local

Most places in the US do not share the characteristics, including, for example, intergenerational households, high population density, and daily public transit use, of the cities where the virus has spread the fastest. What happens in Wuhan, Milan, and New York doesn’t necessarily happen in San Diego, Houston, and Oklahoma City.

People began…

How to manage Covid-19 as we emerge from sheltering in place, by two California doctors

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Photo: Josh Edelson/Getty Images

By Rajiv Bhatia, MD, MPH and Jeffrey Klausner MD, MPH

On March 19, facing uncertainty as to whether the state’s hospital capacity would meet the needs of the Covid-19 epidemic, the California Department of Public Health ordered everyone in the state to stay home, effectively ending normal economic and social routines. Weeks after that indefinite order, the pace of the epidemic has thankfully slowed, and many hospitals — now retooled to manage increased Covid-19 demand — are well under capacity.

Without either proven pharmacological treatments or an effective vaccine, we’ll be living with Covid-19 for the foreseeable future. California needs…

Techniques to control epidemics are neither novel nor revolutionary. The US has simply not prepared to implement them at the scale required.

Rajiv Bhatia, MD MPH

The U.S. failed to test at the scale required for understanding, predicting, and controlling the coronavirus epidemic, and we are living with the consequences. Overwhelmed with the immediacy of hospital demands and struggling with shortages of testing supplies, our doctors and public health officials are still telling us: “We can’t test everyone … just stay home unless you are really ill.” This message is profoundly disconnected from the one coming from most national and international public health experts: “Test every suspected case.”

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Trajectory of COVID19 Mortality in Different Countries

Once community transmission of coronavirus occurred, authorities told us that it was too late…

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Chowpatty Beach, Mumbai, India. Photo by Shreyans Bhansali.

Doctors train to find the diseases behind the symptoms and signs. But, social diseases, like poverty, are usually hidden behind the ones that afflict our bodies. It’s something that medicine doesn’t often talk about it. And, our politics is what keeps these social diseases alive.

We already know that Americans on average are not the healthiest lot. Endless statistics tell us that our life expectancy and our rates of chronic disease lag behind our peer countries. As for those with less — less education, less income, less power, in lower-class jobs, and in the least desirable neighborhoods — health is even worse.

Basically, you die earlier and spend more time disabled if you’re an American rather than a member of most other advanced countries. — Dr. Christopher Murray, Director of WHO’s Global Program on Evidence for Health Policy

This is old news. Yet, Princeton researchers…

When someone can’t afford stable housing or nutritious food, his health suffers and healthcare costs rise — for all of us. If our country is serious about improving health, meeting human needs will need to be the foundation of healthcare.

After finishing my medical training, I worked at the Tom Waddell Clinic in San Francisco’s Tenderloin. The clinic was free for everyone with no questions asked. In the winter, homeless patients would drop in, telling the nurse they had pneumonia. What most wanted was a note for a week in a residential hotel.

At Tom Waddell, I learned that poverty was physical. I saw how poverty hurt and how it got under the skin. I remember a man who couldn’t get his asthma under control. He had a regular job, understood his disease and took his…

Rajiv Bhatia, MD

Rajiv is a physician and health scientist working to make basic human needs the foundation for population health improvement.

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