Hi, I’m back as Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-about-Covid.

(And it’s okay with me if you want to share.)

Today I’m talking about protests and paycuts and guessing and bad science and open states.

Massachusetts’ numbers continue to look good.  We continue to have decreases in cases and deaths; and the number of Covid-positive people in the hospital went under a thousand for the first time! (Remember that horrible peak of almost 4000 in late April?). Yay, us!

At all of our hospitals, they have turned the ORs-that-were-turned-into-ICUs back into ORs and they are operating away.  People are streaming back in for their delayed hip replacements and cataract operations and thyroid tests and physical therapies.  Slowly but surely doctors and nurses are returning to the clinic so we will have less telemedicine (which I ended up really liking:  it’s nice to just have doc and patient, two human beings talking to each other, with no flutter and paperwork and no paper gowns! It was nice).  Not *no* telemedicine, but probably less.

Unfortunately while everybody was all-hands-on-deck taking care of all-Covid-all-the-time, the hospitals were hemorrhaging money – super expensive care for Covid patients and no payment for all the cancelled hip surgeries and cataract operations and etc — so this week the Partners hospitals announced wage cuts for senior leadership (10-25%), a one year wage freeze, and a suspension of retirement contributions for up to 12 months.  One nice thing is that they kept wage increases intact for the lower-income employees (which is defined as under $26.50/hour).  These kinds of wage impacts had already happened at the Beth Israel and many hospitals around the country, and we figured it was coming, and of course it’s worse in other industries….but still it stings. But at least so far no job cuts at Partners (that I know of). Yay to that!

A lot of people are wondering if the protests are going to cause an uptick in cases. Well, like with all things Covid, “a guess is just a guess”: we don’t yet have the data to be absolutely sure. It takes a few weeks to know if the case numbers rise, and probably six solid weeks til we would really see an increase in deaths.  Since the first big protest in Boston was on June 7, we’re not going to begin to know its impact until the end of June for cases and the middle of July for deaths.

But I continue to be cautiously optimistic protests won’t lead to a giant surge.  They’re outside, most people were masked (not all, but most), lots of people were young (not all, but most) and our infection numbers are low-ish. Plus there’s the denominator factor: even the biggest protest is still a fraction of the whole population of Massachusetts. 

On the other hand, people at protests are close together with shouting and singing and other higher-risk activities.  Still, my guess is we will end up okay — definitely some extra cases but I doubt it will tip us into another surge.

But my guess-is-just-a-guess really doesn’t matter a whit — what matters is what the data shows us.  Fortunately, some smart people in Massachusetts said, “Let’s find out what happens with protestors” so they set up fifty free testing places all over the state this past week. They apparently did TONS AND TONS of viral testing on people who went to demonstrations so very soon we’ll have a lot more data. 

It’s so smart, using the protests and ensuing testing as kind of a “case study” that we can learn from.  Once again our amazing (imperfect but still amazing) medical megalopolis is doing good science-based stuff. I wish they did the same in Tulsa, but I haven’t heard that’s going to happen. More’s the pity.

Because this is how the guessing stops and the science happens; this is how we “build the plane” — one study with formal data followed by another.  It’s the only way we translate “Robin’s guess-is-just-a-guess” to “science has shown conclusively that…”

We have to do a careful study, and then we have to compile the data, and then have it reviewed by people who know how to run studies and understand statistics, and have editors make sure the content is consistent and there’s no potential conflicts.  And then we need good science writers to translate it appropriately.

If you mess any of that up, you end up with bad science and quite possibly bad advice and totally ridiculous headlines. 

Like the study a week ago saying baldness was seen in a higher than expected number of Covid patients in Spain followed by headlines saying baldness led to worse Covid outcomes.  It scared the bejesus out of guys wearing baseball caps all over America.

But the conclusion was balderdash (sorry, couldn’t resist):  the older you are, the more likely you are to be balding AND/OR to be dying from Covid but that doesn’t mean they’re connected.  Young bald guys of the world: not to worry!   

Because we’re all so anxious to find solutions to this Covid catastrophe, we’re moving at warp speed (I swear there’s now 8 gazillion papers a month) plus in every epidemic there’s always some bad moments of bad science.

It’s certainly happened in this one: screwed up hydroxychloroquine studies, bad databases, this week’s press release on steroids without a review OR a publication, a bunch of weak anecdotal reports.  We need to walk through and out of bad science by waiting for the a) peer-reviewed and b) repeated scientific publications looking at the data.

This leads to the other big question: is Massachusetts’ current reopening going to cause an uptick in cases?  Probably the only way we can make more than educated guesses about this is to watch what happens in the wide-open and under-masked states. 

Already we can see some of these states are showing higher than expected case numbers. More worryingly, they are also seeing increases in hospitalizations and ICU bed needs.  And some states (eg Arizona, Florida, Texas) have some hospitals that look like they are heading towards the Italy kind of nightmare of not enough beds. 

All of us Massachusetts doctors and nurses and respiratory therapists and janitors and ward clerks are just feeling sick imagining what it’s like now in those states:  the dread of what you’ll encounter at work, the anguish of separating families, the rising numbers every night, the rivers of endlessly super-sick patients, the constant juggling and rejuggling of beds and staff and ventilators.  Our Massachusetts health care heroes just went through this — it’s still so fresh — it’s agonizing thinking of other people going through this all again.  All because of guesses. 

There’s some scary stuff out there and all we can do is learn from the other states, to not settle for suppositions, to insist on getting data so we can make decisions based on science. Not politics, not headlines, not guesses: science. We need to keep our eyes wide open while we watch those states carefully so we know exactly what to do in ours.