Poor Data and Politics Plague U.S. Response to Pandemic

By Roger Chriss, PNN Columnist

The United States’ response to Covid-19 is now more focused on partisan politics and reopening the economy than it is on public health. Before the end of this holiday weekend, the nation will likely surpass more than 100,000 coronavirus deaths – nearly three times more than any other country.

Back when Covid-19 was still the “novel” coronavirus, there was cause for optimism. In late January, Dr. Ashish Jha, Professor of Global Health at Harvard University,  wrote in Health Affairs that "our health care system has capacity and expertise to handle a meaningfully larger caseload if necessary.”

Unfortunately, this is not what happened. Instead, Dr. David Shlaes writes in the American Council on Science and Health that the federal Department of Health and Human Services was "completely dysfunctional” and that the CDC guidelines for dealing with COVID-19 “defy logic and science.”

The article aptly carried this headline: “The Keystone Cops Vs. Coronavirus.”

Screwy Data

The state response has also been inept in places. Georgia was among the first states to reopen, based on what appeared to be a strong downward trend in new cases. But the Atlanta Journal Constitution reported that Georgia public health officials were using a misleading chart that appeared to show infections declining when they had actually only plateaued. There were also serious lags in data collection and processing.

In Florida, state scientist Rebekah Jones was apparently fired for refusing to manipulate data, according to USA Today. Jones reportedly refused to "manually change data to drum up support for the plan to reopen."

Virginia is also suspected of manipulating its Covid-19 data. The Atlantic reports that Virginia combined the results from viral and antibody tests into a single statistic, making it appear the state had a “more robust infrastructure for tracking and containing the coronavirus than its actually does.”

Other states are also massaging their data. Texas and Vermont have been combining the viral test results that show an active infection with antibody tests that show a past infection. The results may look impressive, but experts say they do not give an accurate picture of how the virus is spreading.

The Atlantic reports the CDC is also combining the data, “distorting several important metrics and providing the country with an inaccurate picture of the state of the pandemic.”

“It is terrible. It messes up everything,” Dr. Jha told The Atlantic.   

‘Archaic’ Tracking System

Another reason the CDC’s coronavirus data is bad, according to Business Insider, is that it has to depend on states to collect and submit their findings. CDC Director Robert Redfield described his agency’s tracking system as “archaic” at a Senate hearing.

Some of the CDC’s coronavirus data is weeks old, according to CNN, “causing senior leaders at the agency to believe the current death count in the U.S. could be significantly higher."

Worse, the federal and state data do not match up. The Atlantic found that in 22 states, the CDC’s reported number of tests diverges from the number reported by the states by more than 10 percent. In 13 states, it diverges by more than 25 percent. In some cases, the CDC’s tallies “are much higher than what states are reporting; in others, much lower."

Poor data and the resulting policies may already be having consequences. Texas reopened quickly and has since seen a “massive jump” in new cases, particularly in the state’s panhandle. Similarly, cities in the Midwest are experiencing spikes.

The Hill reports that almost 80 percent of Americans live in counties where the virus is spreading widely, according to an analysis by the Brookings Institution.

The U.S. now risks losing the ground it gained in late March and April. May has seen little if any progress, and a second wave of the coronavirus is a virtual certainty in the fall.

We need timely, accurate data about the pandemic and a willingness to accept the data and respond quickly and effectively. Otherwise we’re just feeding the virus.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research. 

Why We Need Connections

By Dr. Lynn Webster, PNN Columnist

On a recent "Hidden Brain" podcast, Shankar Vedantam interviewed former U.S. Surgeon General Dr. Vivek Murthy about the need for human connection.

Dr. Murthy is promoting his book, “Together: The Healing Power of Human Connection in a Sometimes Lonely World,” which is especially timely given the fact that so many people are currently experiencing social isolation.

I encourage everyone to listen to the podcast and, perhaps, to buy the book. Murthy comes across as a sensitive, intelligent physician who offers an empathetic perspective.

To state the obvious, the COVID-19 pandemic has created distance between most of us and isolation for many of us. To some degree, it has traumatized nearly all of us.

It is important to recognize many people will be seeking ways to heal from the experience. A desire to feel connected is primordial. To have a sense of belonging is on our hierarchy of basic needs. It is also important to healing.

Rachel’s Story

I want to share a short, true story to illustrate the power that connection plays in wellness and healing. 

Debra Hobbins was a nurse practitioner who worked with me in our clinic. She had a unique capacity to connect with patients and make them feel they were important. It was genuine; she was a compassionate and empathetic clinician. 

Debra and I had a patient, whom I will call "Rachel," who had developed an opioid addiction. After several years of fighting the addiction, Rachel tried to get help, but the barriers and rules created by treatment centers and the government prevented Rachel from seeking the care she needed. One day, Rachel found her way to our clinic, where Debra became her primary provider.

Since we were treating Rachel with Suboxone for an opioid addiction, I was included in Rachel’s treatment team. (This happened at a time before nurse practitioners could prescribe Suboxone for addiction.) However, it was Debra who took the lead role in offering a powerful sense of caring and connection for Rachel.

Debra was uniquely qualified to understand Rachel's pain, because she had lost her son to a heroin overdose many years earlier. She knew what Rachel needed to begin healing. Debra gave her what no one had given her before: understanding, compassion and nonjudgmental, unconditional love.

The connection Debra offered Rachel was essential to Rachel’s healing. But there are all sorts of support, and people in pain need various types of help at different times.

Religion and Spirituality Can Help Us Heal

Sometimes, people need help that no human can provide, and they seek healing and comfort from the divine or through spiritual practices.

Researchers are especially interested in how effective religion and spirituality are in helping people deal with physical or emotional pain. Time and again, studies have shown a correlation between a religious or spiritual orientation and improvements in pain or health.

In a 2011 study of 60 depressed patients, researchers found that “hopelessness and suicidal intent correlated negatively with the level of religiosity." In other words, people in pain who are religious or spiritual tend to feel better than those without belief. They are more likely to have "better psychological well-being."

Seeking Connections During the Pandemic

For many of us, our sense of isolation has been heightened by the pandemic. Some people who typically feel connected to others may have temporarily lost the ability to participate in activities that provided them with a sense of belonging, such as going to church or the gym.

There are alternatives, such as using Zoom to visit with friends and family, but all forms of connection are not equal. Some options work better for some people than for others. Those who are lucky enough to be able to participate in video calls may find them inadequate. According to Psychology Today, the technology may leave some people feeling exhausted and depleted rather than satisfied.

Tapping into their faith or joining video conferences may help some people feel connected. But for others, that may barely scratch the surface of their loneliness.

As Murthy points out, a "dark thread of loneliness" can cause physical health problems, including drug abuse. Physical distancing may keep many of us safe from the coronavirus—but without human connections, the richness of life can be elusive.

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

Study Debunks Use of Hydroxychloroquine for COVID-19

By Pat Anson, PNN Editor

A large international study on the use of hydroxychloroquine and chloroquine for treating COVID-19 has found the antimalarial drugs offer no benefit for hospitalized coronavirus patients and appear to significantly raise the risk of death, particularly when taken with antibiotics.

The study, published in the peer-reviewed journal The Lancet, looked at data from nearly 15,000 patients with COVID-19 who received hydroxychloroquine or chloroquine, with or without the use of antibiotics. They were compared to a control group of over 81,000 patients who did not take the drugs. The study included patients being treated at 671 hospitals in North America, Europe, Asia, Africa, South America and Australia.

(Update: On June 4, The Lancet retracted this study after the authors said were unable to complete an independent audit of their research and concluded they “can no longer vouch for the veracity of the primary data sources.”)

“We found no evidence of benefit of hydroxychloroquine or chloroquine when used either alone or with a macrolide (antibiotic),” researchers said. “Our study included a large number of patients across multiple geographic regions and provides the most robust real-world evidence to date on the usefulness of these treatment regimens. Although observational studies cannot fully account for unmeasured confounding factors, our findings suggest not only an absence of therapeutic benefit but also potential harm.”

The study found that 9.3% of patients in the control group died in the hospital. Of those treated with chloroquine or hydroxychloroquine alone, 16.4% died. The outcomes were even worse for patients who used chloroquine with an antibiotic (22.2%) or hydroxychloroquine with an antibiotic (23.8%).

Researchers also found that serious cardiac arrhythmias, which cause the lower chamber of the heart to beat rapidly and irregularly, were more common in the groups that took hydroxychloroquine or chloroquine.

“This is the first large scale study to find statistically robust evidence that treatment with chloroquine or hydroxychloroquine does not benefit patients with COVID-19. Instead, our findings suggest it may be associated with an increased risk of serious heart problems and increased risk of death,” said lead author Mandeep Mehra, MD, Executive Director of the Brigham and Women’s Hospital Center for Advanced Heart Disease.

“Randomised clinical trials are essential to confirm any harms or benefits associated with these agents. In the meantime, we suggest these drugs should not be used as treatments for COVID-19 outside of clinical trials.”

President Trump disclosed this week that he has been taking hydroxychloroquine as a preventative treatment for COVID-19, even though there is only anecdotal evidence the drug may work against the virus. The president said he was prescribed the drug by his physician after two White House staff members were diagnosed with the virus. Trump said he would only take hydroxychloroquine for about two weeks.

The Food and Drug Administration has said hydroxychloroquine or chloroquine should not be used as frontline treatments for COVID-19 outside of hospitals and clinical trials.

The FDA has only approved chloroquine to treat malaria and hydroxychloquine as a treatment for lupus and rheumatoid arthritis. Both drugs have good safety profiles for those conditions.

Chloroquine and hydroxychloquine have been shown to have antiviral effects in laboratory tests, which has sparked interest in their use as potential treatments for COVID-19. Some countries have been stockpiling the drugs. In March, the FDA added hydroxychloquine and chloroquine to its list of drug shortages. Chloroquine was recently taken off the list.

“Several countries have advocated use of chloroquine and hydroxychloroquine, either alone or in combination, as potential treatments for COVID-19,” said co-author Frank Ruschitzka, MD, Director of the Heart Center at University Hospital Zurich.

“Justification for repurposing these medicines in this way is based on a small number of anecdotal experiences that suggest they may have beneficial effects for people infected with the SARS-CoV-2 virus. However, previous small-scale studies have failed to identify robust evidence of a benefit and larger, randomised controlled trials are not yet completed. However, we now know from our study that the chance that these medications improve outcomes in COVID-19 is quite low.”

In addition to their findings on chloroquine and hydroxychloroquine, researchers also noted that obesity, heart disease, diabetes and smoking raise the risk of death for hospitalized COVID-19 patients. Interestingly, patients being treated with statins or ACE inhibitors for high blood pressure had a lower risk of mortality, suggesting that medications that stabilize the cardiovascular system may be beneficial.

9 Best Practices for Telehealth

By Barby Ingle, PNN Columnist

Telehealth can make life easier for chronic pain patients. We spend so much of our time and energy traveling to and from provider appointments, paying for gas or public transportation, and then sitting in waiting rooms for our appointments to begin.

Being able to talk with providers over the phone or online without leaving home is not only more convenient, the “virtual” visits greatly reduce the risk of exposure to COVID-19 and other communicable diseases – an important point for patients with compromised immune systems.

If you’re new to telehealth or wondering how to make use of it, here are nine best practices I’ve learned.

1. Be strategic in your appointment time slot. It is best if you can schedule it earlier in the day because providers are often less rushed and can spend more time with you.

2. Before your appointment, you should take time to assess your needs. Should a loved one or caregiver participate in the call? They could have some significant information about your health or have a question you didn’t think of.

3. If your appointment is online, your provider will send you a login link or they will call you through their online platform. Some doctors work with telehealth companies that provide their patients with health monitoring tools, such as blood pressure checks. Practice using the technology before your appointment.

4. If you will be on camera with your provider, do a test with a family member or friend. Make sure that you are in a well-lit, quiet location, and there is nothing in the background that is distracting or inappropriate.

5. Telehealth may seem a little less formal, but remember to stay focused on what your needs are, just as you would when visiting a doctor in their office.

6. Patients may benefit if they have access to their online patient portal information. I utilize this feature often with my primary care provider and his staff. During my last appointment, he said that he prefers that I text him directly if the situation is more urgent.

7. I have a thick case file and keep my health records organized. You should too. Make sure to keep track of your telehealth appointments, billing and insurance payments, just as you do with in-person visits.

8. If you struggle with new technology or this type of communication, be sure to let the provider know. Maybe your internet is not fast enough, your wi-fi not strong enough, or you don’t have the right app on your phone. Ask for help or other options.

9. Just in case the technology fails, have a backup plan. One of my providers was a little late and called me two minutes after our scheduled time. He apologized and said his last appointment went longer than expected. In those two minutes I realized I didn’t know what to do. Was I supposed to call him? Was he going to call me? Did he give me a link? Having that information on hand will save you some stress in an already stressful moment.

Not all healthcare needs can be addressed via telehealth. Some prescriptions, such as opioids, may require a visit to the office. So will some medical exams. A combination of in-person, phone and online appointments may be best for you.

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website.  

Controversy Grows Over Trump's Use of Hydroxychloroquine

By Pat Anson, PNN Editor

President Trump on Tuesday defended his use of hydroxychloroquine (Plaquenil) as a preventative treatment for COVID-19, even though there is only anecdotal evidence the drug may work against the virus and it may be harmful to some patients. Hydroxychloroquine has been linked to at least 48 deaths in the U.S. so far this year, according to an FDA database.

The president first disclosed his use of hydroxychloquine on Monday, claiming that White House physician Sean Conley said it was okay for him to take the drug.

“I asked him, ‘What do you think?’ He said, ‘Well, if you’d like it.’ I said, ‘Yeah, I’d like it. I’d like to take it,’” Trump said.

Dr. Conley confirmed that account in a statement.

“After numerous discussions (Trump) and I had regarding the evidence for and against the use of hydroxychloroquine, we concluded the potential benefit from treatment outweighed the relative risk," Conley said.

The Food and Drug Administration has only approved hydroxychloquine for the treatment of malaria, lupus and rheumatoid arthritis. However, nothing prevents a doctor from prescribing a drug "off-label" to treat another condition.

In recent months, Trump has touted hydroxychloquine as a possible "game changer" in the treatment of COVID-19. He said he started taking the drug as a preventative measure a week and a half ago, at about the same time two White House staff members tested positive for coronavirus.

“I’m not going to get hurt by it. It’s been around for 40 years,” Trump said. “For malaria, for lupus, for other things. I take it. Front-line workers take it. A lot of doctors take it."

Last month, the FDA warned against using hydroxychloroquine as a treatment for COVID-19 outside of a hospital or clinical study because of “serious and potentially life-threatening heart rhythm problems.” Patients with heart and kidney disease are especially at risk, the agency said.

The FDA's Adverse Events Reporting System lists over 10,000 reported cases involving hydroxychloroquine in the past decade, most of them serious, life threatening or resulting in hospitalizations. Nearly 600 people have died since 2010, including 48 deaths so far this year.

The number of adverse events involving hydroxychloroquine has soared in recent years, from less than a hundred cases in 2010 to over 4,500 in 2019

SOURCE: FDA ADVERSE EVENTS REPORTING SYSTEM

'Reckless Action'

"President Trump’s use of hydroxychloroquine to prevent Covid-19 infection without any clinical evidence of its utility is dangerous and will cause untoward toxicities, likely including death, in some people following his lead," Dr. Michael Polis, a fellow at the Infectious Diseases Society of America, told The New York Times.

"He needs to be strongly criticized by the medical community for this reckless action."

A recent study funded by the National Institutes of Health looked at patients at VA hospitals who were given hydroxychloroquine to treat COVID-19. They concluded the drug was ineffective and raised the risk of patients dying.

“In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs,” researchers found.

Trump dismissed the research as a "phony study" by his political enemies.

“There was a false study done where they gave it to very sick people, extremely sick people, people that were ready to die,” he said Tuesday. “It was given by obviously not friends of the administration.” 

Several patients who are prescribed hydroxychloroquine for rheumatoid arthritis or lupus have told PNN they are worried about possible shortages due to Trump's touting of the drug.

“I have been on hydroxychloroquine for five years for my autoimmune disease and had never had an issue getting the medication until the virus. In March, I had to check 3 different pharmacies before I found one that had any in stock,” one patient said. “My usual pharmacy said that not a single one of their local chains had it in stock and that they were back-ordered. The pharmacy that did have it, was only able to do a partial refill.” 

“I am currently on Plaquenil for lupus and having Trump declare it is the cure for COVID-19 has limited my access to my medication. I am worried there won’t be enough,” another patient said.  

“I am in a horrible RA flare at this moment. I have no doubt that the stress of being concerned about getting my needed medication has helped to bring this flare on," said another. "I am really concerned about being able to get my much-needed hydroxychloroquine. There is no reasonable explanation for drug shortages in this country other than ignorance.” 

Former Vice-President Joe Biden said Trump was “absolutely irresponsible” for taking hydroxychloroquine, which could encourage others to take it to prevent COVID-19 infections.

"It's like saying maybe if you injected Clorox into your blood, maybe it'll cure you. What is he doing? What in God's name is he doing?" said the presumptive Democratic 2020 nominee. “Look, this is absolutely irresponsible. There's no serious medical personnel out there saying to use that drug. It's counterproductive. It's not going to help."

UK Study Finds Weather Can Worsen Chronic Pain

By Pat Anson, PNN Editor

Do you feel “under the weather” when its rainy and cold outside? About 75% of chronic pain sufferers believe certain weather conditions can aggravate their pain. Some even think they can predict a storm coming because they “can feel it in their bones.”

A new analysis of weather patterns in the United Kingdom suggests there may be some truth to those old clichés.

For 15 months, researchers at the University Manchester collected data from over 10,500 UK residents, who recorded their daily pain levels on a smartphone app. The GPS location of their phones was then compared to local weather conditions.

The study found a modest association between weather and pain, with people more likely to feel pain on days with low barometric pressure – and the wet and windy weather that usually comes with it.

The key appears to be the upper level jet stream – a narrow band of air currents that circle the globe several miles above the earth. On days when the jet stream was aimed right at the UK, with above normal wind, humidity and precipitation, about 23% of people reported more pain.

But when the jet stream blew north of the UK, and pressure was above normal with less humidity and precipitation, only 10% of people reported higher pain levels.

“Although the weather may not be the primary cause of people’s pain, our results through multiple independent methodologies demonstrate that weather does modulate pain in at least some individuals,” lead author David Schultz reported in the Bulletin of the American Meteorological Society.

“The results of this project should give comfort and support to those who have claimed that the weather affects their pain, but have been dismissed by their friends, their coworkers, and even their doctors.“

The new analysis builds on earlier research from the Cloudy With a Chance of Pain study, which is the largest in both duration and number of participants to examine the link between weather and pain.  Previous studies have found little or no association between the two.

A 2014 Australian study, for example, found that acute low back pain was not associated with variations in temperature, humidity and rain.  And a 2013 Dutch study concluded that weather had no impact on fibromyalgia symptoms in women.

“Part of the reason for this lack of consensus is that previous researchers have treated the different measures of the weather such as pressure, temperature, humidity separately, which assumes that one could vary the temperature while holding all of the other weather measures fixed. Of course, the real atmosphere does not behave like this, as all the variables are changing simultaneously,” says Schultz.

Schultz and his colleagues plan to further study the data to see how environmental conditions modulate pain, insight that could be used to develop better treatments and individualized pain forecasts.

The Importance of Slowing the Pandemic

By Roger Chriss, PNN Columnist

The U.S. economy is starting to reopen amid the coronavirus pandemic. It’s still early, but Health and Human Service Secretary Alex Azar told CNN’s “State of the Nation” on Sunday that there has not been an increase in new infections in states that have reopened.

“We are seeing that in places that are opening, we’re not seeing this spike in cases,” Azar said. “We still see spikes in some areas that are, in fact, closed.”

However, over the weekend Texas reported its highest single-day increase in new cases, and Wisconsin saw a record number of new infections.

The coronavirus has become entrenched. CDC Director Dr. Robert Redfield tweeted Friday that all 12 forecasting models used by the agency forecast over 100,000 deaths by month’s end.

The Institute for Health Metrics and Evaluation predicts over 147,000 American will die by early August. Infectious-disease researchers estimate over a quarter million fatalities by year’s end.

Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told USA Today that “this damn virus is going to keep going until it infects everybody it possibly can.”

Epidemiologist Dr. Johan Giesecke wrote in The Lancet  that "measures to flatten the curve might have an effect, but a lockdown only pushes the severe cases into the future — it will not prevent them."

CDC tracks 12 different forecasting models of possible #COVID19 deaths in the US. As of May 11, all forecast an increase in deaths in the coming weeks and a cumulative total exceeding 100,000 by June 1. See national & state forecasts: https://t.co/PI1AtLCCmt pic.twitter.com/iylBnom5U0

— Dr. Robert R. Redfield (@CDCDirector) May 15, 2020

But even if everyone will eventually be infected, there is little sense in rushing headlong into that future.

Covid-19 is deadly and damaging. The mortality rate of Covid-19 is still uncertain, but an estimate of 1% is common. So a rush toward infecting most people in the U.S. means at least 200 million sick people, the number associated with herd immunity. This means two million deaths, possibly more if the healthcare system is overwhelmed or the virus is more virulent than now believed.

Even if the mortality rate is much lower, there is still considerable disease burden. The Guardian reports that about 1 in 20 people with Covid-19 have a chronic course of illness that lasts for months.

And Covid-19 is more than a respiratory virus impacting only vulnerable adults. CNN reports that it is also causing blood clots and multiple organ failure in young adults, and multi-system inflammatory syndrome in children.  

All of this will cost a lot. The Kaiser Family Foundation estimates that the average cost of COVID-19 treatment for someone with employer insurance is $9,763. Someone whose treatment has complications may see bills about double that. Hospitals are spending between $6,000 and $8,000 a day on coronavirus patients, meaning an extended hospitalization could cost well over $100,000.  

Slowing the pandemic will buy time to better understand the virus and develop more effective responses to make the future less risky and costly. We already have tools and technologies to make that happen.

First and foremost, social distancing. A new study in Health Affairs reports on the success of strong social distancing measures. Based an analysis from April, government-imposed social distancing reduced the daily infection rate by 5.4% after 1-5 days, 6.8% after 6-10 days, 8.2% after 11-15 days, and 9.1% after 16-20 days. That translates to millions of fewer cases of Covid-19.

Second, hygiene. Yale University researchers looked at the impact of face masks in mitigating the spread of Covid-19. They conservatively estimate the value of each additional mask worn by the public at $3,000 to $6,000.

Third, systematic tracing and tracking of cases. This includes state and federal health measures to identify new cases, track chains of transmission, and alert people who have potentially been exposed. Washington state will require restaurants that reopen to keep customer logs, a simple measure that may help slow the spread of Covid-19.

Last, planning. Society needs to function but cannot just go back to pre-pandemic ways. Instead, staggered work schedules, flextime and telework can lower transmission. Some cities are closing streets to vehicles to make more space for people, who can then dine and shop. Schools are looking at part-time programs and adaptive scheduling to promote safer educational environments. And medical facilities are offering more telehealth and remote services.

There are many ways to slow the spread of Covid-19 and a myriad of benefits to doing so. Society does not need to be sacrificed in the process. Instead, we can adapt. The virus adapted to people, but people can be clever and cooperative enough to outcompete it.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research. 

Where Are You Most Likely to Contract COVID-19?

By Dr. Lynn Webster, PNN Columnist

As the country reopens, some people may be at greater risk of contracting COVID-19 due to a lack of understanding about how the virus is transmitted. Having too little information (or too much misinformation) about how the coronavirus spreads and how we can protect ourselves can cause people to feel a false sense of security and unnecessarily place themselves in harm's way.

It may also lead to poor outcomes for those who fail to seek medical care for heart attacks, strokes and other urgent conditions. They may believe that going to a hospital where COVID-19 patients are present is dangerous, but their exaggerated fear may cost them their lives.

While panic is counterproductive, we do need to be realistic. Recent projections suggest the United States will see more than 140,000 deaths before September. If there is a second wave of the virus this fall, the number of deaths by Christmas may be staggering.

How We Transmit the Coronavirus

Initially, COVID-19 was thought to target elderly people with co-morbid health conditions. But many younger, healthy people have also died. Children with Pediatric Multi-System Inflammatory Syndrome and women who have miscarried because of a SARS-CoV-2 infection are awakening scientists to new horrors and challenges.

Erin Bromage, PhD, an Associate Professor of Biology at the University of Massachusetts Dartmouth, recently posted one of the most informative articles that I have read on how the virus is transmitted. It is worth reading.

We know that transmission most commonly occurs in dense gatherings and at home. Bromage explains that inhaling 1,000 viral particles can infect you with COVID-19 -- and that a single sneeze spews as many as 200,000,000 virus particles, moving at a speed of 200 miles per hour.  

Engaging in a conversation with a carrier can expose you to hundreds of thousands of virus particles with each exhalation. A single breath can expel 100 or so virus particles. Assuming we each exhale 16 times per minute, it takes less than one minute of conversation to exceed the 1,000 particles necessary to cause an infection.

The droplets released via a conversation can be aerosolized into a fine spray that remains suspended in the air for several minutes. That means people standing more than 6 feet away who walk through the virus mist within 5 to 10 minutes after the carrier has left the scene are also at risk of becoming infected.

Bathrooms, according to Bromage, are cesspools of transmissible virus particles. Even flushing a toilet can aerosolize droplets. 

Restaurants are common sites of transmission. Airflow from heating and air conditioning systems circulates viral particles through closed environments. As an asymptomatic carrier enjoys dinner, viral particles from breathing travel through the ventilation system of the restaurant to reach far beyond 6 feet.

If there are ceiling or standing fans, it is even easier for an infected person who is only talking to seed the air with viral particles from a distance. If the carrier stays at the restaurant for an hour or more, there could be enough virus particles circulating through the dining area to infect people at tables throughout a small restaurant.

Workplaces, choirs, church services, weddings, funerals, birthdays, and indoor sports gather people in close proximity and are responsible for a large portion of transmissions. Bromage points out that these venues, along with public transportation, are responsible for 90 percent of all transmissions. 

Calculating the Risk of Infection

We can calculate the risk of acquiring the contagion. As Bromage states, dose and time determine the risk: the amount of virus a person is exposed to and the length of time they are exposed to that dose. 

Runners or bicyclists may spew large amounts of virus as they breathe heavily. But, because they are outdoors, the exhaled particles can be quickly diluted in the air if people are separated by several feet. Runners' and bicyclists' diluted virus particles are less likely to pose a threat because of the limited amount of time people are exposed to them.

People who are less mobile, like the elderly or many people with advanced illness, are generally indoors, either at home or in hospitals. These people are at the greatest risk when they are exposed due to the dose and time factors. Small doses over long intervals of exposure in a home, nursing home, or hospital greatly increase the chances of contracting the disease.

As our communities adapt to the changing needs of society, we need to understand how this deadly virus can penetrate our barriers. Knowledge about how the virus spreads can help minimize our risk of contracting and spreading COVID-19. This may require us to rethink the wisdom of many of our traditions for the next year or more.

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

The opinions expressed in this column are those of the author alone and do not inherently reflect the views, opinions and/or positions of Pain News Network.

The Unnerving Impact of COVID-19 on the Chronically Ill

By Pat Akerberg, Guest Columnist

Let’s face it. Living with a debilitating chronic health condition and a global pandemic at the same time are a “double whammy” with unthinkable impacts. Trigeminal Neuralgia (TN) happens to be my medical vulnerability. Yours may be a different one putting you at risk.

Known as the “suicide disease,” TN is an excruciating facial pain disorder that is considered the worst pain known to medicine. With a tenuous prognosis, TN significantly compromises life quality and puts its sufferers at risk both medically and psychologically.

Covid-19 needs no introduction as it continues to hold a worldwide population hostage -- isolating, living in fear and starved for hopeful news.  Add living with a serious co-morbidity like mine or yours, and the stress of getting hit with the double whammy increases.

Destabilizing factors shared by TN (or your condition) and Covid-19 are several. TN patients, already vulnerable with compromised neurological and immune systems, have to be hyper-vigilant now about staying safe to avoid the scary risks Covid-19 can bring. The effects of this fear, stress and worry loom large when considering the possibility of our chronic conditions being compounded by Covid-19. 

“In my field, we have conducted a lot of work to look at what predicts who gets colds and different forms of respiratory illnesses, and who is more susceptible to getting sick,” says Christopher Fagundes, PhD, a psychological scientist at Rice University.  

“We’ve found that stress, loneliness and lack of sleep are three factors that can seriously compromise aspects of the immune system that make people more susceptible to viruses if exposed. Also, stress, loneliness and disrupted sleep promote other aspects of the immune system responsible for the production of proinflammatory cytokines to over-respond. Elevated proinflammatory cytokine production can generate sustained upper respiratory infection symptoms.”

With intractable pain, sensitized nervous systems are already compromised. Add prolonged anxiety and exhaustion to the isolation, loneliness and a loss of physical connections necessitated by social distancing, and the ground is fertile for hopelessness and depression to take root.

A form of medical neglect is taking shape too, making it harder to cope as important medical, ER or clinic visits and medication refills have been pushed aside by Covid-19.  Yet they remain urgent needs for those afflicted with ongoing conditions.

Caring families and friends are rendered helpless as they witness previously healthy, vibrant loved ones reduced by the chronic conditions that take them over.  Like Covid-19, the life altering stories of TN sufferers are hard to take in. Listen to what some are dealing with:

“I’ve had two surgeries for TN after medications were unable to stop the pain… recently, after 15 years, the pain has come roaring back!  The stress in my life caused by my inability to work during the Covid-19 isolation has triggered the TN pain… it has made it enormously worse… and I can’t even reach my doctor… sometimes I feel like giving up.”

“Things are ridiculously difficult right now. Everyone in our family is feeling it.  My husband and I feel defeated and my Mom feels stressed and overwhelmed. The kids are struggling, flip-flopping between difficult emotions. For nearly 5 years we have been telling ourselves that things will get better as we do our best to live in ‘survival mode.’ But we feel extreme failure as we are starting to see the damage survival mode has done. We aren't sure how to fix it or keep this ship afloat. It feels like we’re the Titanic after it hit the iceberg.” 

“When newly diagnosed, TN patients and their loved ones are worried sick when they discover its’ reputation as the suicide disease.  In searching for answers, they come up against gut punches instead – the discouraging lack of research historically, the poor performance of medications, and/or the disappointing impermanence or complications of risky treatments. Yet, the drive for relief is so great, they’re forced to roll the dice and choose among shortfalls.  Familiar with horror stories of what can go wrong, like a recurring nightmare they are haunted by what might happen to them, fearing their capacity to endure.” 

While we may all share the threat of this pandemic together, the truth is those of us deemed “at risk” can also feel alone as we cope with our personal medical plights. To counter such destabilizing vulnerabilities, we must recognize that the potential for this double whammy fuels an urgent need for HOPE and concrete progress now that can change lives for the better.

Hope and progress – in the forms of more research funding, lasting treatments, promising prognoses and encouraging scientific breakthroughs – can’t come soon enough! 

Pat Akerberg is a member of the TNA Facial Pain Association and serves as a moderator for their online support forum. She is also a supporter of the Trigeminal Neuralgia Research Foundation.

Former CEO of U.S. Pain Foundation Released Early from Prison

By Pat Anson, PNN Editor

The founder and former CEO of the U.S. Pain Foundation will spend the next six months in home confinement after being given “compassionate release” from a federal prison due to COVID-19 concerns. Paul Gileno suffers from asthma and other health issues, which puts him at high risk from the coronavirus.

Gileno abruptly resigned from U.S. Pain in 2018 and was later charged with embezzling millions of dollars from the Connecticut-based charity, which at one time claimed to be the largest advocacy group for pain patients. Gileno cut a deal with prosecutors, pleaded guilty to fraud and tax evasion, and in January began serving a one-year sentence at a minimum-security prison in Minersville, Pennsylvania.  

In correspondence with this reporter from prison, Gileno complained about conditions at the facility and said he was worried about becoming infected with COVID-19.

“Basically 100 of us are locked in one building, all sharing the same bathrooms and common areas. I sleep on a top bunk in a room of 30 people which is all open,” said Gileno.

“The CO's (correctional officers) and staff do not wear masks and they come from the outside world. They say they test them, but that consists of taking their temperature. They won’t let us out to get fresh air, only to go eat and come back which is less than 10 minutes.”

PAUL GILENO

In March, Gileno’s attorney filed a motion asking that the remainder of his sentence be modified to home confinement.  A judge rejected that request, but on April 17 a second motion was submitted and Gileno’s release was approved.

“Mr. Gileno has demonstrated that he suffers from asthma and respiratory conditions that place him at greater risk from COVID-19, and that he is unable to properly guard against infection while incarcerated,” Judge Victor Bolden said in his order. “Undue delay in his release could result in catastrophic health consequences for him.”

Prisons and jails around the country have become hot spots for COVID-19. Over 3,000 federal inmates and prison staff have been infected with the virus, with 51 inmate deaths to date. Last month, Attorney General William Barr ordered the federal Bureau of Prisons to identify low-risk inmates who could be released to home confinement. Over 2,500 have been released so far.

Gileno’s sentence has been reduced to time served and he was released from prison April 20. He will remain in home confinement until November 12, and then begin a two-year period of supervised parole. Under another court order, Gileno is required to pay over $3.1 million in restitution to the U.S. Pain Foundation.

Permanent CEO Named

This month U.S. Pain announced the appointment of two new members to its board of directors: Edward Bilsky, PhD, an academic administrator and professor at Pacific Northwest University of Health Sciences, and Jessica Begley, a marriage and family therapist from Texas.

They join board members Ellen Lenox Smith, a retired teacher; Marv Turner, a producer and filmmaker; and Shawn Dickens, a government defense contractor. Dickens was elected Chairman and Treasurer.

The revamped board also voted to appoint Nicole Hemmenway as permanent CEO. Hemmenway had been acting CEO of U.S. Pain in the two years since Gileno’s departure. She had previously served as vice-president and board chair while working with Gileno.

Gileno’s misuse of donated funds allegedly went undetected for three years due to poor oversight by the board, which apparently held no annual meetings or elections as required by Connecticut state law.

“I still find it difficult to believe that nobody else who’d been in upper management of the foundation for several years, knew anything regarding the going out and coming in of money/funds,” former board member Suzanne Stewart wrote in her blog. Stewart resigned in frustration in 2018 because she felt the board was “left in the dark” about how money was being spent.

At one time, U.S. Pain claimed to have over 90,000 members and nearly a quarter of a million social media followers. The non-profit later admitted having only 15,000 people on an email subscriber list.  

According to an audit and U.S. Pain’s 2018 tax return, the charity spent over $1.2 million that year on salaries, employee benefits, lawyers, accountants, tax penalties and business losses – including a failed attempt to operate a bakery. The foundation’s 2019 tax return has not yet been filed.

Hospitals ‘Ready to Get Back to Work’ After First Wave of COVID-19

By Pat Anson, PNN Editor

One of the biggest ironies of the coronavirus pandemic is that – in the middle of a healthcare crisis -- many hospital emergency rooms, surgery centers and waiting rooms sat empty. Elective surgeries and non-essential medical tests were cancelled to clear the decks for the first wave of COVID-19 patients.

In PNN’s recent survey of over 2,200 patients with chronic pain or chronic illness, over 71 percent said they had a medical appointment cancelled or postponed.   

“My surgery for a tumor has been postponed because of the pandemic, yet there are more than enough hospital beds to provide for my needs. I am angry and disappointed,” one cancer patient told us.

“I am very upset to have had my shoulder surgery delayed again. I have already waited over 2 years and now this! My pain level is something terrible,” another patient said.

“I need to have surgery for my hernia but I'm not sure when I can get the surgery now. It's frustrating because it hurts every day,” said another.

It’s not just doctors cancelling appointments. Many patients in life-threatening situations, with chest pain or stroke symptoms, are staying home rather than go the ER and risk exposure to the virus.

“In the past, people went to the ER maybe a little bit too often for minor conditions. And now we’re seeing a complete swing of the pendulum to another dangerous level where people are not going when they should,” says Mary Dale Peterson, MD, a hospital administrator in Corpus Christi, Texas who is President of the American Society of Anesthesiologists (ASA).

In March, many hospitals were forced to cancel elective surgeries because of chronic shortages of surgical gowns, face masks and other personal protective equipment (PPE) that were needed for the care of COVID-19 patients.

The ASA recently joined in a campaign to reassure patients that it’s safe to reschedule those surgeries. Peterson say the supply chain is “still somewhat fragile,” but most hospitals are well-equipped to perform surgeries again.

“We’re ready to get back to work,” she told PNN. “I understand people’s concerns and we want people to shelter in place, but at the same time, they should be confident that the healthcare facilities have worked really hard to make the environment as safe as possible. A lot safer than going to your local grocery store.”

Pent-Up Patient Demand

The ASA recently joined with medical societies representing nurses and surgeons in adopting new guidelines for healthcare facilities to resume elective surgeries when the following conditions are met:

• Sustained reduction of at least 14 days in new COVID-19 cases in a geographic area

• Regular testing of patients and hospital staff for the virus

• Adequate supplies of anesthesia drugs and PPE, including an emergency supply for a potential second wave of cases

• Prioritize surgery scheduling based on medical need and availability of staff.

“When the first wave of this pandemic is behind us, the pent-up patient demand for surgical and procedural care may be immense, and health care organizations, physicians and nurses must be prepared to meet this demand,” the guideline warns.

Peterson says patients should expect to be tested for COVID-19 and to self-isolate before their surgeries. She’s also encouraging patients to ask questions.

“I think patients are free to ask, ‘What have you done to make your hospital safe?’ I think that’s a fair question,“ Peterson says. “We’ve worked really hard to do that. We’re testing patients before they come in for coronavirus and asking them to isolate themselves after the test to protect themselves and others.”

Florence Nightingale Was Born 200 Years Ago and Is More Important Than Ever

By Roger Chriss, PNN Columnist

This week marks the 200th anniversary of Florence Nightingale’s birth. She was born on May 12, 1820, and is considered the founder of modern nursing and an innovator in the use of medical statistics.

Named for the city of Florence, Italy, where she was born, Nightingale grew up in a wealthy British family and demonstrated a gift for mathematics. She traveled extensively throughout Europe during her youth and announced her decision to enter the nursing field when she was 24, despite the opposition of her family and the restrictive social mores of Victorian England.

Nightingale made fundamental contributions to nursing and biostatistics during the Crimean War, during which she managed and trained nurses, and organized care for British soldiers.

In 1854, she identified poor care for the wounded at Selimiye Barracks in what is now Istanbul due to overworked and under-equipped medical staff and official indifference. Medicine was limited, hygiene neglected and soldiers suffered as a result, she found.

Nightingale collected meticulous records of patient outcomes in the military field hospital she managed. Then she summarized this information in a form of pie chart now known as the polar area diagram, clearly showing the benefits of improved patient care.

FLORENCE NIGHTINGALE

This visual representation of statistics was much more readily understood than conventional columns of numbers and helped convince civil servants and even members of Parliament that her findings were significant.

Nightingale applied the same methodology to a study of sanitation in rural India, playing a key role in improving medical care and public health services in that country. She found that bad drainage, contaminated water, overcrowding and poor ventilation were important risk factors in the spread of disease. Her work ultimately helped reduce mortality among British soldiers stationed in India from 69 to 18 per 1,000.

But Nightingale is best known for her role in the foundation of modern nursing. She led by example, with a commitment to patient care and medical administration.

She developed the first official nurse training program, the Nightingale School for Nurses, which opened in 1860. It is now known as the Florence Nightingale Faculty of Nursing and Midwifery at King's College London.

Her work is also remembered in the Florence Nightingale Medal for outstanding service in nursing, among many other honors in her name.

Nightingale’s work in public health and record keeping dovetailed with the first epidemiological success in Britain. In the summer of 1854, English physician John Snow showed that a cholera outbreak could be traced to the contaminated Broad Street Pump, which he stopped by simply removing the handle of the pump so people couldn’t use it anymore.

Snow’s methods involved what we would now call outbreak maps and contact tracing. And his findings inspired improvements in water and waste systems in London and around the world.

NIghtingale’s 1859 book, “Notes on Nursing: What It Is, and What It Is Not,” is a seminal text about the nature and practice of nursing. In it she wrote: “The very first requirement in a hospital is that it should do the sick no harm.”

Today, amid the global coronavirus pandemic, the dedication of nurses and the importance of medical statistics cannot be understated. Nurses are falling sick and dying at alarming rates, in part because institutional leadership is failing them. One-third of Covid-19 deaths in the U.S. are occurring among nursing home residents and staff.

Nightingale’s example needs to be recognized and followed. Her bicentennial provides a timely opportunity to emulate her lifelong dedication to medical care and public health.  

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research. 

Arachnoiditis Nearly Destroyed My Life

By Robert Perry, Guest Columnist

I was a pipe welder when I first hurt my back in 1992. The doctor ordered a myelogram imaging test on my back with a chemical dye. It was one of the most painful tests I ever had. After the test the doctor told me I had to learn to live with my pain. At that time, I was only 27 years old. The doctor told me I might be able to work for another 15 years.

He was right about that. In 2008, I was a project manager at ATT and started losing the ability to use my legs. One day I couldn’t get out of bed for about 3 hours because I was having so much pain in my legs and lower back. I was screaming from the pain and the muscles spasms were so bad it made me cry.

I started falling at work and hurting so bad it was unreal, so they did an MRI on me and found I had Arachnoiditis. Since then my life has been a hard road. It’s unreal how many doctors don’t know anything about this disease. One doctor did 5 epidural steroid injections on me and made it worse.

Another doctor put a spinal cord stimulator temporarily in my back to see if it would help, but he accidentally punctured my spine and left an air bubble. I went home and late that night got a terrible headache that felt like it was killing me. My ex-wife and kids took me to the emergency room. I was about to die from the bubble in my body.

They finally found the bubble in my body by cat scan. The only way you can get a bubble out is to remain really calm, so they started giving me a strong painkiller in an IV drip.  But the nurse wasn’t paying attention and I overdosed. I knew I was dying and thank God that a person came in to clean my room and I got her to go get help.

ROBERT PERRY

I had her call my family on my cell phone. I was able to tell my family goodbye. Right after that, I lost consciousness. I finally woke up 8 hours later and the doctor was waiting on me to ask me things to see if I had any brain damage. The first thing I asked was for my dad, but I couldn’t remember that my dad was dead until they told me.

I have been through a lot because of Arachnoiditis. I lost my family and now I am married to a wonderful lady who knows I am a very sick person.  This disease is the one of the most painful. I have to take two shots a month and I am on a lot of meds. I have a good doctor now who put me on a fentanyl pain patch and my life has been a lot better.

I am a preacher and have a lot of faith. One night at church I was in so much pain the congregation was about to take me to the hospital. And I told God that night either heal me or take me. They prayed over me and I walked out of the church without any pain or my cane.

That’s was 5 years ago and I am still doing a lot better and able to live now. The doctors can’t help, but God can. I am very thankful for that night in prayer.

Arachnoiditis nearly destroyed my life. I hope they one day find a cure for this terrible disease. Before God touched me that night, I was about ready to take my life because of the pain.

Robert Perry lives in Kentucky.

PNN invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

FDA's Stem Cell Reformation Must Go Beyond COVID-19

By A. Rahman Ford, PNN Columnist

The COVID-19 crisis has been a catalyst for new regulatory flexibility at the U.S. Food and Drug Administration. The FDA is pushing aggressively to develop new vaccines and treatments for coronavirus, including dozens of clinical trials of stem cell therapies on critically ill patients.

Mesoblast recently dosed its first patients on ventilators in a 300-patient trial using its Remestemcel-L stem cell product to treat acute respiratory distress syndrome (ARDS). Pluristem Therapeutics is using placenta-derived stem cells in another trial, while The Cure Alliance is using umbilical-cord derived stem cells. GIOSTAR has a trial approved for its mesenchymal stem cells under the FDA’s “compassionate use” program. And Athersys has begun a large trial using stem cells derived from bone marrow on patients with moderate to severe ARDS.

A stem cell reformation of sorts is underway at the FDA due to the coronavirus pandemic. But what about the chronic pain crisis? About 50 million American lives with chronic pain, as opposed to 1.3 million confirmed cases of coronavirus in the U.S. to date.

The reformation is not only the result of COVID-19, but due to the simmering pressure of the American people, who have long demanded greater democracy and autonomy in medical treatment. The voice of the people and the virulence of the pandemic have merged into a veritable stem cell Martin Luther, the German monk who rejected the teachings of the Catholic Church during the Protestant Reformation.

Like those told to wait for the promise of stem cell therapy to materialize while being inundated with propaganda about “unproven” cellular treatments, Christians in the Midieval era were told to wait for a salvation controlled by an entrenched religious establishment -- when the salvation they sought was always right inside of them. 

One aspect of our current medical crisis is not new. Americans suffering with intractable chronic pain have endured perpetual crisis for a seeming eternity, waiting for the FDA to abandon its rigid, doctrinaire, one-size-fits-all approach to medical care in favor of more flexible, forward-thinking and tailored treatments.

The COVID-19 crisis — and Americans' consequent demand for solutions — has forced the FDA's hand. This demand compelled the FDA to reconsider its bureaucratic veneration of regulatory relics that denied the revolutionary novelty of stem cells.

The FDA deserves some credit for finally acknowledging the need for exploration and innovation in its clinical trial procedures. But now the agency must recognize that chronic pain - like COVID-19 - is a national medical crisis that necessitates a similar creative solution.

Stem cell regulatory innovation must not end with coronavirus. In fact, it must continue and accelerate. Yes, the current progress is heartening. However, more must be done. And needs to be done immediately. The chronic pain crisis demands it.

The FDA's current push for stem cell innovation must proceed beyond the therapeutic necessity of coronavirus. The agency needs to reform its restrictions on the use of our own stem cells for treating arthritis, neuropathy, degenerative disc disease and other chronic pain conditions.

This reform must no longer be the subject of directionless academic debate or an issue for consideration by medical "ethicists" and self-proclaimed protectors of the common good. The time for debate and delay has ended. The time for decisive action has arrived.  

At the core of the matter are the cries of millions of Americans in a critical crisis of pain that existed well before the face masks, latex gloves, hand-washing, social distancing and trillions of dollars in federal appropriations that COVID-19 has spawned.

To the FDA and Commissioner Stephen Hahn, your effort in pursuing stem cell therapy for COVID-19 treatment has not gone unnoticed. Now it is time to relax FDA regulations on the use of our own stem cells. Devolve regulatory authority to the states and their oversight, and let physicians and patients decide when stem cell therapies are appropriate.

This is the next logical step in the FDA's reformation. It is a necessary step. It is the right step.

A. Rahman Ford, PhD, is a lawyer and research professional. He is a graduate of Rutgers University and the Howard University School of Law, where he served as Editor-in-Chief of the Howard Law Journal. Rahman lives with chronic inflammation in his digestive tract and is unable to eat solid food. He has received stem cell treatment in China. 

The opinions expressed in this column are those of the author alone and do not inherently reflect the views, opinions and/or positions of Pain News Network.

Chronic Pain and COVID-19: Why Is Treating One Disease More Noble Than the Other?

By Dr. Lynn Webster, PNN Columnist

During the coronavirus pandemic, our frontline healthcare providers have put their lives on the line, and many have paid a price. Their sacrifice is quintessentially noble, and we feel boundless respect and gratitude for their work.

Similar compassion is felt for COVID-19 patients. We are moved by the tireless efforts made to provide them with proper care, medication and life-supporting equipment.

This outpouring has led me, as a pain and addiction medicine physician, to reflect: When is healthcare noble? And why is some healthcare noble and other healthcare suspect?

There is a stark, bittersweet disparity between the esteem and appreciation we rightly bestow on COVID-19 frontline providers and the suspicion we direct toward chronic pain physicians.

Our frontline heroes in the coronavirus crisis -- regardless of patient outcomes -- are viewed as inherently noble and courageous. Conversely, those who treat people with chronic pain -- especially in cases with an adverse outcomes -- are often threatened with harsh judgment, loss of medical licenses and even incarceration.

Recently passed federal legislation provides “broad immunity” from legal liability to providers treating COVID-19 patients. Pain physicians have no such immunity.

This disparity is also mirrored in patient treatment, sometimes involving the same drug. There is a shortage of injectable fentanyl and other painkillers ventilated coronavirus patients need. The Drug Enforcement Administration recently increased the production quota for those drugs so manufacturers could produce more of them. But DEA-ordered cutbacks in the production of other opioids remain in place.

People in pain -- whether they have the coronavirus or not -- deserve the same effective and humane treatment.

As a pain physician, I have watched people with chronic conditions who are forced to live with undertreated pain for years. I have seen them fight to get through each day as the medications they need are tapered due to governmental regulations and cultural biases, rather than their physicians' decisions. I have observed their struggles with desperate options, including suicide, in the face of daily, oppressive and almost unimaginable pain.

Even as I recognize the heroism of the frontline practitioners caring for people with COVID-19, I have to wonder: How did patients with chronic pain end up on the wrong side of the empathy divide?

Pain patients feel this empathy inequity. It's not uncommon for some healthcare providers to treat them like exiles from society, as drug-seekers, malingerers or even criminals. But these "criminals" are people who have a disease that saddles them with long-term pain. Does their suffering matter less than coronavirus patients’ pain?

How must they feel about society’s outpouring of love for COVID-19 fighters and victims compared to the suspicion, derision and slander they receive?

An Opportunity for Reflection

I submit that the heroic and selfless medical response to those afflicted with COVID-19 should prompt valuable reflection by all providers on empathy and equitable treatment for all patients.

What is it about certain medical conditions that results in unprecedented concern, a willingness to muster all resources, and an outpouring of selflessness from practitioners and the public alike? Why are healthcare professionals willing to risk their lives for coronavirus patients, but not their reputations to treat chronic pain?

Some may argue that it is the immediacy of the threat and risk of death that makes the difference. But that’s a false argument. All pain is immediate and, despite what is commonly thought, people with severe chronic pain have dramatically shortened life expectancy. 

Providers on the frontlines of the lengthier, more widespread and complex pain crisis are as noble as those fighting the current pandemic. They often take on patients that others don’t want to treat. They show open-mindedness, concern and great courage in risking the respect of their peers, running afoul of misinformed authorities, or being persecuted by misguided legislation. They put aside their professional well-being to serve a seriously oppressed and underserved population.

We need to find a way to professionally restore belief in the nobility of those providers who may not cure patients, but who do offer comfort and relief. These are professionals who are willing -- often for months and years -- to fight wearying and risky battles for their patients.

If such battles received the respect they deserved, there would be nothing bittersweet about watching all members of the same profession going above and beyond the call of duty for all.

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

The opinions expressed in this column are those of the author alone and do not inherently reflect the views, opinions and/or positions of Pain News Network.