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John Livingston

Comorbidities and Unintended Consequences

As Chris Rock opined tonight “I’m still processing.” I just came back from teaching a military trauma course at Ft. Sam Houston. We had about 60 students from across the USA and several corners of the world. All surgeons or physicians who are currently serving in the military of their countries. The instructors were all military or former military with experience in military trauma surgery. I reported in a previous article about the comments of several of instructors from The National Institutes of Health and from the Centers for Disease Control (CDC). But I wanted to make the stories for this article more about individual patients and the impact that Covid mitigation had in other areas of medicine.

The wife of one of the instructors—a senior military physician, was diagnosed with Lynch Syndrome many years ago. This is an autosomal dominant disease so 50% of her family and siblings have a chance of having colon cancer. She was diagnosed several years ago and underwent a left hemicolectomy at the age of 45—she should have at least had a total colectomy. She was supposed to undergo yearly surveillance colonoscopies but because of Covid mitigation strategies at military, VA, and civilian hospitals her colonoscopies were canceled four times over two years. By the time she was rescoped she had recurrent metastatic disease and then underwent a completion colectomy followed by chemotherapy. She has had severe complications from the chemotherapy and today she can barely walk or carry on the activities of daily living.

A medical “opportunity cost” of Covid mitigation?

Another cost—less dramatic but I am sure common and ubiquitous is that many of the instructors that I haven’t seen over the past two and a half years have gained a lot of weight. One has gained over seventy five pounds. Most of the instructors failed to keep up with their Physical Training. They related to me how training schedules and deployments were set back by over six months. Air Force and Navy Flight surgeons related how air readiness was down to 33% because of limited flying hours, and maintenance training was almost a year behind schedule.

I was probably in better shape than most of the active-duty guys, because my gym and swimming pools stayed open at The Plantation and Crunch. Especially older people needed to stay in shape and that didn’t happen. It is estimated that every adult over 35 gained 15 pounds during the pandemic. Obesity is one of the five risk factors for Covid-19 morbidity and mortality. Not going to the gym or pool could be just as deadly as not getting high risk cancer screenings. Below I will show how comorbid conditions impact survivability in elder trauma patients. The graphs look almost the same for Covid elderly patients, except one should substitute kidney failure for liver failure.

My final story is this. One of the Sr. Enlisted personnel that helps us put on our course tested positive for Covid the day after the course! All students—who were still in the field, and instructors no matter their travel status were asked to take a Covid test and report via e-mail the results back to the command. I had already flown back to Boise. E-mails numbering almost 90 came back. I had already been back to Crunch twice before I got my first e-mail request to test. Remember many of these instructors are from (NIH) and (CDC) and are absolutely obsessed with “testing”. I wrote back saying that I had no symptoms and saw no reason to test.

My time in the pool and exercising was more important than any test I could get. If I become symptomatic, I will get a test. Heck hyper-chlorinated water in the pool is probably viral static anyway. Do any of the expert scientists know the answer to that question? Maybe those fat instructors would be better served by getting some PT time in the pool—everyday, instead of testing every time they sneeze. Opportunity costs are everywhere. I will take care of my own health and fitness. I am a civilian-citizen and not in a deployable status in the military. An e-mail requesting a test takes my eye off the ball.

REPORT PREVALENCE COMORBIDITIES.

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