“Need To Know” – What they don’t want you to Know

In 1977-1978, I was the medical officer on the USS Virginia (CGN-38). She was an awesome ship that was powered by two Nuclear Reactors. The prototype is still at the INEEL and the two reactors from the ship are now “mothballed” at Hannaford on the Columbia River. We had 500 men on the ship and there was absolutely no need for a physician, except for one thing—the radiation health program needed the “Imprimatur” of having a physician as its director.

I spent the good part of one summer in Ballston Spa New York at another nuclear facility where I did my medical reactor training. The two years on Virginia were some of the best years of my life. I went through the qualification process to be Officer of The Day Underway, and I read radiation exposure badges of those crew members working in the engineering spaces. In addition to reading books my father sent me Anna Karenina, Tale of Two Cites, and Man of La Mancha to name a few—no internet or phone access in those days, in other words, I had lots of free time, so I devised little experiments for crew members in the area of public health. Powdered scrambled eggs vs real scrambled eggs—if properly prepared by shifting the egg through a sifter they couldn’t tell the difference. But I wanted to try another experiment about radiation exposure levels of the crew serving in different work areas.

Because every week we had to record the TLD (Thermo luminescent dosimeters) of all the crew members I soon realized that the boatswain mates, those working outside on the sun exposed deck of the ship, were receiving more radiation exposure than the engineers working next to the nuclear reactors below decks. Over the course of a quarter or a year the difference in radiation between those who were exposed to the sun above decks and those that worked below was significant, but never dangerous for the boatswain mates. This begged the question however when I included these findings in a report to Naval Reactors in Crystal City Washington and to BUMED at “Foggy Bottom” DC., if the Navy should monitor radiation levels of all crew members on all ships no matter what weapons or propulsion systems they were exposed too. The exact same data precipitated opposite responses from the two different Bureaus. Naval Reactors wanted to publicize the low levels of their men. BUMED was instructed by The Atlantic Fleet not to publish the numbers because it may heart recruiting and people wanting to work above decks. “What you don’t know won’t hurt you”. The exact same information with the same analysis, but different responses (actions) recommended to take by the authorities. Sound familiar?

I think we are seeing some of this today when information about Covid 19 mitigation and treatment strategies are discussed. I believe just like the crew members on the Virginia whose best interest would have been served by publishing that data—both those below decks who should have been reassured, and those above decks who may have been helped by wearing broader brimmed hats and long sleeved shirts, we should all have access to all the information and the experts should always give us context.

I do not dispute the numbers being given to us by the authorities, though many people rightfully are. But numbers just like risk need context and when numbers are used to assess risk and when measures are taken to mitigate that risk, then full transparency is required. Let me give some examples:

1. I accept the fact that 90% of people who have been recently infected have not been vaccinated and that 90% of those in the hospitals have not been vaccinated, and that 90% of those in the ICUs have not been vaccinated and that 90% of the deaths have not been vaccinated, but isn’t it also true that if you are less than 65 years old and have no comorbid conditions and are not immune compromised that your chance of surviving an infection are 99%? The information should be published with context and mitigation strategies for those at risk should be different than for those not at risk. We need to take care and isolate those at risk—again their choice, and the rest of us should go about living normal everyday lives.
2. When reporting on hospital bed availability shouldn’t total beds available be reported along with the total beds able to be serviced by nurses and technicians? Why prior to May was it published that Statewide we had 350 ICU beds and after that it was reported that we had half that number? Why aren’t ancillary ICU beds, step down units, cardiovascular ICUs and recovery room beds listed? Why aren’t Surgical Hospitals (SAs) and Ambulatory Surgical Centers (ASCs) used to offload elective surgical cases away from the hospitals seeing the Covid surge? There are over 20 communities nationwide where private hospitals have been designated for routine patient care including elective cases. Those routine cases would be “offloaded” making more Covid beds available. Why couldn’t either St. Luke’s or St. Al’s be the Covid facility? Affiliated Hospitals could also be part of the calculous, and the ASC’s and SA’s could take on the more urgent elective cases? Or could Covid funding be creating an incentive not to offload or could loosing elective cases be a consideration—no matter that total joint cases are being booked out over 6 weeks—sounds like Canadian Health Care.
3. Finally, and I have used the example far too many times—why aren’t nurses and front-line doctors and technicians, given more of a voice on the interhospital “strike” teams and on the various government agencies. There is context that needs to be given to the numbers. For example, when Speaker Bedke toured St. Luke’s earlier this week and he came away saying that there were no more beds or ICU beds, did he know about all the beds that weren’t able to be manned or other opportunities to open up more beds by consolidating services between institutions? He didn’t know to ask—but an ICU staff nurse could have informed him of those opportunities to increase beds.

And the “Superhero amongst snowflakes” Governor Jay Inslee of Washington complaining about having to take care of Idaho Covid patients in Spokane where Deaconess, Sacred Heart and Providence Hospitals have more than enough bed space, but they may have to cancel some elective cases for a few days (that is their real issue)—money . Hospitals a generation ago were still designed to take care of sick patients. Today, not so much. The profit margins for elective surgery patients are bigger than for a Covid patient in the ICU. The Holy Cross Sisters who came across the desert to serve the people of Idaho came to take care of the “sick, hungry and impoverished”. Ten years ago, I was told by a former CEO at St. Al’s—“No Margin-No Mission”. When you spend all your time and intellectual and strategic capital planning to maximize margins and you forget that someday you may be called upon to take care of sick patients under mass casualty triage conditions, then don’t be surprised if you have to scramble to fulfill your mission and promise to the community. And when you find yourself in this kind of a situation don’t be like Governor Inslee and blame citizens. Always look first to yourself. Don’t be like the Navy Admirals who didn’t want the “deck crew” to know about their radiation exposure. What WE THE PEOPLE don’t know can hurt us. We are fully capable of making our own decisions when we are given all the information.

In the end compliance by coercion never works. Choice and personal mitigation strategies will always be the best road to follow when WE are given all the information.

(MIGA) Make Idaho Great Again