Too Fast Too Soon

Mentally Leaving the Pandemic

Photo by USA Today

There have been five hundred and fifty thousand deaths from COVID-19 in the United States and 2.81 million worldwide, according to the (New York Times March 31, 2021). When we address the issues, let us remember that it is global disease and the measures taken by governments in many countries have largely been to prevent more deaths.

There is a mental fatigue from the pandemic, affecting overall health.  It is from staying indoors and not seeing friends or family no matter where you live or what country you are in.  There is also the loss of work and income, and the impact on long-term financial stability while trying to pay one’s current bills.

We should also remember that the younger generation facing social issues and the difficulty of hanging out with friends. Now we have family or at home schooling. To be at home with one’s parents and siblings must be frustrating at times, and our youth, like some adults, are not able to hold part-time jobs.

What do we do?

COVID-19 has not gone anywhere. If we compare this pandemic to the Spanish Flu from 1918 – 1920, we see that the number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States (from We understand the gravity of the pandemic, but can we afford mentally, physically, and financially to remain in the pandemic mindset?

If we look at the recent Spring Break in Miami, it’s been hard for young people. The parties, the drinking, and the having fun are things we all miss. Yes, there is also the destruction, fights, and recklessness that we cannot condone nor can we overlook the transmission of the virus it may have caused.  YouTube Video Should we have totally canceled Spring Break and closed our bars and restaurants?

Let’s go back to the debate on mental health and leaving the pandemic. There is a physical leaving and a mental staying in place.  Traveling, vacations, getting out with people and going to our usual places help maintain our mental health. It is also about the planning and the anticipation. If we take that away, then mentally we lock ourselves indoors.

As we ponder the situation in America, we are seeing a rise in COVID Cases. Some European countries are already looking at their fourth wave and we are seeing the lockdowns begin. Let’s not forget the direct impact of the disease – the rampant death – but also what has been done to us on global level both mentally and physically.

by Dane Flanigan ultraHealth Agency

How Politicizing the Fight Against COVID Makes Both Parties Losers

In the U.S., many aspects of the fight against COVID have been politicized. From mask-wearing to vaccine approval, actions have been labeled as liberal or conservative rather than scientifically proven or not. States’ early responses and current situations are judged according to party affiliation. Following this line of reasoning, all blue states should fare better than red states. However, comparing California, Texas, and Vermont, two liberal states and one conservative, the results do not support this assumption. A closer look at the actions of each reveals what has really led to successes and failures. 

California was the first state to issue stay-at-home orders back in mid-March. It also took steps to increase testing and tracing capacity and had strong public messaging. However, economic concerns, public restlessness, and seemingly plateauing cases put more pressure on state officials to re-open. As restrictions eased in May, county and city officials gained more regulating power. The decentralized structure made it difficult to enforce measures consistently throughout the state, especially when officials clashed with each other. Sheriffs in four counties said they would not enforce the governor’s order to wear masks in public places. Many people were anxious to get back to normal and not as likely to follow recommendations like mask-wearing and social distancing. 

Cases and deaths spiked in the summer following months of holidays and parties. Some attributed the increase to Black Lives Matter protests, but the data did not support this. The suggestion was dismissed as many participants wore masks and the protests were largely outdoors. Additionally, major outbreaks occurred in nursing homes, prisons, and among migrant workers. Experts say the state re-opened too quickly and focused too heavily on regulating outdoor spaces like beaches and parks as opposed to restaurants and bars. The spike among migrant workers, particularly the Latinx population, supports this. Latinx people are 2.9 times more likely to test positive than whites. They make up a large portion of California’s essential workforce in foodservice and hospitality. Those in these industries are less likely to be able to work from home or stay home if they are sick. Currently, California has one of the highest case counts in the nation, with cases doubling about every 56 days. However, when adjusted for population, California’s rank is lower. The state accounts for 9% of the nation’s cases and 7% of deaths. And increased testing does account for some of the rise.      

Despite some people’s belief that the state is turning purple, Texas is still decisively conservative. The last time a Democratic presidential candidate won was 1976. This past election, Trump won the state by 6 points, the Republican incumbent kept his spot in the senate, and 60% of the house seats went to Republicans. While opposites politically, Texas and California share many struggles. Disagreements at the local level, between judges and mayors, over shutting down businesses and enforcing social distancing and mask-wearing played a large role in why Texas’s case count is the highest in the country and the first to surpass one million. Like California, premature opening of businesses and fatigue from staying at home led many to take liberties when policies relaxed. Additionally, Texas also has a large Latinx population who face similar challenges as those in California. 

Although Vermont is often thought of as one of the most liberal states in the union, the high profile of its Democratic Socialist senator, Bernie Sanders, contributing to this, it actually has a mixed government. Republican, Phil Scott, has been the governor since 2016 and won the most recent election with 66% of the vote. This makes Vermont an interesting comparison to California and Texas when examining why the state has the lowest infection rate in the country. Some argue its small size and ruralness explain this but, officials in Vermont are quick to dismiss that, pointing to the state’s targeted use of resources for vulnerable populations as the foundation of its success. 

Dr. Mark Levine, the state health commissioner, says three things have helped. First, having a healthy population before the pandemic. People there place health high on their list of priorities, making them likely to follow orders like washing hands and wearing masks. The second contributor, shutting down the state quickly. But California did this also, so what made the difference? Vermont did not re-open until officials felt the virus was at a better level as opposed to bowing to public pressure about the economy or isolation fatigue. And when the state did ease restrictions, it did so gradually. 

The third and most unique point in Vermont’s plan focused efforts like testing and contact tracing on the most vulnerable populations, including those experiencing homelessness and those living in nursing homes. Vermont paid to move some people living in shelters into motels to avoid overcrowding. It also made meal deliveries, gave hazard pay for essential workers, offered free pop-up testing to vulnerable communities, and Governor Scott has even proposed a $1,000 stipend for those asked to self-isolate. Instead of focusing on curfews or stay-at-home orders, which apply to people that work, it looked at high-risk populations and created policies centered around them and their needs.  

While some, including President Trump, have tried to make mask-wearing and case counts political, the science does not support this. COVID does not distinguish between red and blue states. Instead, what made the difference between states’ successes and failures is how unified they are within themselves and how they met the needs of high-risk groups. Although California and Vermont initially had similar plans, the patchwork of policies California attempted to enforce after re-opening led to spikes it hasn’t fully recovered from. Texas also suffered because lawmakers and enforcers could not agree on a proper course of action. And both states failed to meet the needs of vulnerable groups like the elderly, those experiencing homelessness, and essential workers. To prevent higher case count and death toll, states must allocate resources to those that need it most and strongly enforce scientifically proven preventative measures. 

How Countries’ COVID Measures Stack Up

Whether out of fear of repeating the past, the virus, economic trouble, or public criticism, nations have responded differently to the pandemic. Although it’s not over, and it’s still too early to determine the long-term effects of each strategy, the data thus far does suggest which measures have worked best and why. 

Two methods for containing the spread of coronavirus are herd immunity and lockdowns. The Mayo Clinic states that herd immunity occurs when a large portion of the community becomes immune to a disease making the spread of it unlikely. Ideally, herd immunity is achieved through vaccinations. Vaccines have a low risk of complications and illness, they protect vulnerable populations that cannot receive vaccinations, and they have a strong history of controlling the spread of highly infectious diseases.  

At the beginning of the pandemic, vaccines were a hopeful but distant solution. Now, the first shipment of Pfizer’s vaccine will arrive in the U.S. on December 15. The U.K. became the first to approve it for use with their announcement on December 2. The shortened approval process, 10 months as compared to 10 years, as well as the U.K.’s reliance on Pfizer’s data instead of independent analysis, has made some hesitant to follow Britain’s lead. Dr. Anthony Fauci, the U.S.’s top infectious disease expert, took the opportunity to praise the Food and Drug Administration’s slower regulation process and offer support for the agency which has been under pressure by the White House to approve the vaccine. 

Achieving herd immunity can be difficult when people refuse to take the vaccine. Additionally, the effectiveness of vaccines can wane over time. If multiple vaccines are necessary to inoculate against a certain disease, it’s not guaranteed people will complete the series lessening the effectiveness. 

The World Health Organization (WHO) has criticized the other, widely used approach, lockdowns. Lockdowns, or large scale physical distancing measures, slow the spread by limiting contact. They harm social and economic life and disproportionately affect people living in poverty, internally displaced people, and refugees. 

In Europe, both Italy and Greece have utilized lockdowns with different results. Originally, Italy was the hotspot of Europe, while Greece initially had a low number of cases. Italy declared a state of emergency and placed a strict lockdown. Greece acted similarly but did not declare a state of emergency. With such similar methods, the two nations should have yielded similar results. However, one key factor that separates them is timing. Italy began suspending events and closing schools nine days after the third confirmed death from coronavirus. It closed non-essential shops and banned non-essential movement after two weeks. In comparison, Greece suspended events and closed schools before the third confirmed death, closed non-essential shops one day after, and banned all non-essential movement only eight days after the third death. 

Timing also played a key role as to why Taiwan and South Korea have both had continued success with their efforts. Taiwan went into a strict lockdown very early, like Greece. However, it did not last long. Instead, they moved to closing borders, banning the export of surgical masks, contact tracing, and mobile SIM tracking. They kept businesses open by requiring temperature checks and offering sanitizer before each person entered. These efforts have resulted in just seven deaths. South Korea responded similarly and has not only low death rates but also a low case count. Their early and aggressive response included and still includes extensive testing, isolation, contact tracing, and tracking COVID patients in real-time. They have also managed to keep businesses open, and a sizable government stimulus helped citizens financially.       

Both nations had experience with epidemics in recent history, Taiwan with SARS 20 years ago and South Korea with MERS in 2015. This may have made them better prepared and primed citizens to comply with strict and invasive measures early on. While some question the privacy violations associated with SIM contact tracing and patient tracking, the low case and death count, as well as the public’s willingness to follow such measures, highlight that people are willing to make the tradeoff between personal freedoms and restrictions to avoid disastrous outcomes.       

Rather than focusing on limiting the spread of COVID and protecting citizens, Turkey has focused on restricting the spread of information. Starting in March, officials have investigated doctors and healthcare workers commenting on the government’s actions and coronavirus in the media. In one instance, after a health expert talked about underreporting of cases with local media, a governor claimed they were “misinforming the public” and “causing panic.” The investigation brought against them was dropped only after multiple rights groups condemned it. 

But public support for Turkish doctors and nurses is waning. Increases in resignations led some to liken them to soldiers fleeing a battlefield. However, many that left public hospitals did not leave medicine altogether but moved to private care facilities that have better working conditions. Doctors were even prohibited from retiring between March 28 and June 8 and starting again on October 27. 

Turkey has continued to declare the situation is under control and lift partial lockdowns even when independent doctors and medical associations warn against it. In addition to keeping information from its people, Turkey has also not followed WHO’s recommendation of regularly releasing case and death numbers by city or include probable causes in their counts. 

While many countries took action at the beginning of outbreaks, the strength and continued enforcement of their policies have differentiated the success of their efforts. Time will tell if Italy and Greece’s regional measures and extended lockdowns save them from further spikes. Countries like Taiwan and South Korea have managed to not only protect most of their people but also protect their economies. This has improved their governments’ images both among their people and around the world. Turkey inverted its approach, starting with appearances and putting science second, leading to discontent among its people and healthcare force, arguably making their efforts a failure.

How the Pandemic Has Redesigned the Food Pyramid

At the beginning of 2020, food analysts and registered dietitians predicted innovations in food and people’s increasing concern about the practices that go into making what’s on their plate would lead to improvements both for individuals and the planet. The Kerry Health and Nutrition Institute predicted sustainability would be a megatrend. One big way to work towards a greener food industry was by eating greens. 2020 would see aisles filled with plant-based ice creams, vegetable pastas, and, of course, plenty of chik’n tenders and meatless burgers. Not only would this help the planet by reducing the carbon footprint of heavy emitters like beef and cheese, but it would also improve individuals’ health. Getting sufficient servings of vegetables and fruits has long been one of the biggest challenges to a balanced diet. Incorporating a wider variety in convenient and novel ways was going to help.

Going from the global scale to the individual, the next trend focused on tailoring diets to meet individuals’ needs. As certain intolerances and allergies became more widespread, new diets also sprung up. The keto, paleo, and low FODMAP diets are various approaches to help people lose weight or ease digestive issues by eliminating certain food groups. One of the big draws to the paleo diet is that it helps those with Celiac or gluten intolerances. But there are also some benefits to choosing gluten-free options for those that don’t need to. For example, swapping chickpea or lentil pasta for traditional wheat pasta adds bonus protein and vegetables to lunch or dinner. 

Similarly, the low FODMAP diet aids those with digestive conditions like Crohn’s disease or IBS. The diet eliminates many fruits, sources of fat like nuts, grains, and dairy products. Diets like this have contributed to the growing demand for dairy alternatives. Milk alternatives now include banana, hemp, and oat. While the FDA is currently trying to ban the label “milk” used with these products, the popularity of these diets and the growing number of allergies means these mylks are here to stay.             

Functional nutrition shares much of its philosophy with alternative medicine. Like some practices in alternative medicine, functional nutrition seeks to support and heal the body through natural remedies such as eating more whole foods and adding supplements. Probiotics and prebiotics found in foods like kombucha, kimchi, and sauerkraut promote the good bacteria necessary for a healthy gut microbiome. The microbiome is thought to play a role in the development of conditions like eczema, cancer, and depression. 

In addition to helping the body, functional nutrition can also help the mind. Some mood-boosting foods fall under the category of botanicals, specifically nootropics and adaptogens. Examples include turmeric, ginseng, B vitamins, and ginkgo. CBD is another additive that was expected to grow in popularity. It is the non-psychoactive component of marijuana and hemp. While hemp products like protein and oil are legal, CBD products are not. However, it made its way into ginger beers, ciders, and water despite lack of approval from the FDA by complying with all other FDA standards like labeling and avoiding unsubstantiated claims. Additionally, while the FDA has currently outlawed it, some states have legalized CBD and regulate it as a food ingredient.                                  

Now more than ever, people are looking for ways to take their health into their own hands. Dietitians and food experts predict functional nutrition for immunity support and mood-boosting will continue through 2021. More people will look to prevent illness by taking supplements like zinc, selenium, vitamin D, and vitamin C. There will also be increased use in alternative medicines like echinacea, elderberry, turmeric, and ginger, as well as antioxidant-rich whole foods. 

Although people have established new normals, it is still a stressful time. Companies will seek to support people with products aimed at reducing anxiety and improving sleep. With CBD still a gray area, Copaiba may be the next big thing. The completely legal essential oil made from tree resin supposedly has similar effects as CBD. Established brands are also joining the “food as medicine” trend. Pepsi created Driftwell, a drink that contains magnesium and L-theanine and is supposed to help consumers relax before bed. 

A more balanced approach to eating will also provide some emotional support. While still good options for those that need to avoid certain foods due to intolerances or allergies, the restrictive diets of 2020 will fall out of favor as people continue to use food for comfort. However, people will still want to lower the number on the scale. One survey found over 3 in 4 Americans say they’ve gained up to 16 pounds in isolation. This may be due to lower activity levels, returning to comfort foods, and an increase in snacking. 

The emphasis on sustainability and plant-based eating will also stick around. These “climitarians” may become “flexitarians,” meaning there is more variation in their diet as opposed to strict veganism or vegetarianism. These flexitarians will still take action to limit the environmental impact their food has but do so in more moderate ways. This may include swapping beef for chicken, having meat fewer times per week, or opting for blended options like mushroom and beef burgers. Plant-based options will still be key for this trend, but all veggies or all meat will no longer be the only choices. Consumers will also look for ways to reduce their carbon footprint by continuing to pay attention to the manufacturing practices and packaging of their food. While this trend is still predicted for 2021, the pandemic has forced companies to put some climate-friendly initiatives on hold. They are choosing to delay or cancel new product launches.    A final trend for 2021 borne out of the pandemic is ghost restaurants and kitchens. These are defined as “a professional food preparation and cooking facility set up for the preparation of delivery-only meals.” Restaurants now double as grocery stores and turn fan favorites into meal kits for people to assemble at home. These alternatives are useful as lockdown policies continue to change when outdoor dining is and is not allowed.  Finding new ways to keep restaurants alive and bring them into people’s homes will continue in 2021. 

Is Diversity a Disqualification to Practicing Medicine?

A breakdown of the first twenty-one Google image search results for “doctor” yields roughly equal images of men and women, nine pictures with people of color, and three show an animated or ambiguous partial image. Looking further, both pediatricians are female, the only surgeon is a white male, and all appear not to have a disability. While difficult and even impossible to gauge identifiers like race and ethnicity, disability, and sexuality from images, this rudimentary analysis reveals some key truths about these categories of diversity in medicine while also misrepresenting others. 

Starting with what Google got wrong, women do not make up half the physician population. They’re actually closer to 36%. Additionally, about 2% of physicians identify as having a disability. While not a large portion, it is completely excluded from the results even when scrolling far past the sample. Google did get some things right, although that is not entirely positive. The racial breakdown is surprisingly accurate. 43.8% of physicians identify as a racial or ethnic minority. The majority are Asian, while Hispanic, Black or African American, and Native Americans make up a combined 11%. Almost three-quarters of surgeons are white, and two-thirds are male. And the proportion of women in family medicine, as opposed to general surgery, is higher than males. 

The percentages of acceptees to and graduates from medical school for men and women are almost equal. But research shows almost 40% of women physicians go part-time or leave medicine completely within six years of completing their residencies. The majority of women reduce hours or leave to achieve a better work-family balance. Women in medicine “take on an average of 8.5 hours more work at home each week than men. Married men with children worked 7 hours longer and spent 12 hours less per week on parenting or domestic tasks than women.” Women lessen their hours at significantly higher rates than men, pointing to larger issues in gender dynamics. 

Another factor, lack of support for women with families that stay. Women have an average of 8.6 weeks paid family leave as opposed to the recommended 12. Having to decide between family and career is one of the main reasons why women are steered away from surgical specialties and encouraged to choose disciplines with less demanding residencies and professional schedules like family medicine. This also plays on the stereotype that women are more nurturing and emotional, thus more suited to working with children. 

For physicians with disabilities, stereotypes also affect perceptions of them and their abilities. One doctor that uses a wheelchair recalled how a fellow physician mistook her for a patient in the cafeteria even though she was wearing her uniform and had “doctor” written on her badge. She described how this moment underscored that she, and others with disabilities, are often seen as a person with a disability before anything else. While disability is often underreported, those that do identify themselves only make up 2.7% of physicians when including learning or psychological disabilities. Those that don’t report may fear they will be perceived as weak or not capable of fulfilling their duties.    

A lack of self-identifying, rather than actual absence from medical professions, also accounts for the underrepresentation of LGBTQ+ doctors. While not much research has been conducted on sexual minorities in medicine, one study from Stanford University found “about one-third…chose not to disclose that information while in medical school, with 40 percent admitting they feared discrimination.” However, one poll conducted from 2017 to 2019 found the rates of students identifying as bisexual, gay, lesbian, and transgender had increased. While not huge numbers, as more research is done and more workers feel comfortable identifying themselves, perhaps these numbers will improve even more.       

Diversity, or lack thereof, in healthcare professions also has roots in education, particularly for racial and ethnic minority groups and those with disabilities. Black men cited a lack of educational opportunities and economic barriers as key reasons for not pursuing medicine. Black women gave similar reasons adding that 40% recalled a “high school or college counselor trying to dissuade them” from a career in medicine. 

Barriers persist throughout education. The economic hurdles that hold some Black men from applying also contribute to why they and other minorities do not stay in medical school. The majority of medical students come from affluent backgrounds. Students coming from “low socioeconomic status families are underrepresented” and “more likely to leave medical school within the first two years.” Researchers theorize racial stereotypes leading to feelings of exclusion also explain why “Black and Latinx students in STEM programs are more likely to drop out or switch majors than their White peers.” Finding community significantly contributes to why these students stay or leave. Minority-serving institutions like Howard University and The University of Puerto Rico graduate the largest amount of Black and Latinx physicians. A study showed that while students at historically Black colleges saw their STEM programs as diverse and felt supported, students at predominantly white institutions felt excluded. 

Application barriers may also discourage students with disabilities. Schools’ websites vary in advertising their accommodation policies. Researchers found only a third clearly stated they would accommodate students with disabilities that are otherwise qualified, while “another half had vague information about who they would accept.” Even when the researchers posed as students and inquired, multiple schools did not respond. In many cases, the technical standards (TSs), what a school will or will not accommodate, are not clear or readily available. Each school determines its TSs. Rather than helping students receive necessary accommodations, they may help institutions unwilling to make them disqualify students with disabilities.              

From Google images to prestigious universities and world-class hospitals, the need for greater diversity exists at all levels. But diversity isn’t necessary just for diversity’s sake. Those that identify as members of underserved or underrepresented groups are not only more likely to serve those communities, understand their specific needs, and teach other students and physicians how to address them, making for better health care.