‘Flatten the fear’—but beware of compliance fatigue


By Rafael Castillo M.D.


Are we getting restless and careless with our stance against the new coronavirus disease (COVID-19)?

After more than six months of struggling to coexist with the virus, there’s a big tendency to develop compliance fatigue, and it may be expected that some people will throw caution to the wind.

This was exactly the same precarious attitude, however, during the Spanish pandemic of 1918 that led to the deadly second wave, and it was during this period of nonchalance and carelessness that most of the 50 million people died.

We certainly cannot afford this kind of tragedy, especially when we seem to be on the right track now in controlling, and, we hope, subsequently eliminating COVID-19.

Constant reminders to the public on established effective precautions have to be given. This is where the medical community can also help, not only in reminding the people, but by setting good examples themselves.

It is quite unsettling what we read in the papers recently of a medical event, where the participants—many of whom were doctors—brazenly wore no face masks during most of the proceedings. The organizers should have thought of the impact of their display of recklessness on the public, who still look up to doctors as their authoritative source of advice on matters concerning their health.

Hydroxychloroquine

To be fair, though, I share the objectives of the group to “flatten the fear,” which we have already discussed at length in this space several times.

Definitely, the consequences of the excessive fear of COVID-19 will likely result in more serious long-term complications, not only on our mental health, but on our overall welfare.

I share the group’s enthusiasm that we can still go on with our lives though the risk of COVID-19 remains. But that’s where I stop sharing what they’re advocating for.

I don’t share their recommendation to use hydroxychloroquine (HCQ) as a prophylaxis against COVID-19 on a massive scale. Obviously, they have been influenced by similar initiatives in the United States.

HCQ may have potentially serious side effects, including sudden cardiac arrest in people who may have cardiac issues. I also recommend HCQ for selected patients who are hospitalized, and where we could monitor the heart electrocardiogram (ECG) complexes. We measure some intervals in the ECG complexes, and when they’re unduly increased, we immediately discontinue HCQ.

If the general public will take HCQ like they’re taking vitamin C or zinc, this may lead to serious complications. This is likely the reason most studies to date have not really shown a net benefit for HCQ, prompting the World Health Organization to remove it from their global clinical trials.

It’s possible that it may be life-saving for some patients, but harmful for those with heart problems. Cardiac evaluation and monitoring in some high-risk patients are still necessary.

Tan’s statement

Former Health Secretary Dr. Jaime Galvez-Tan was invited to be a resource person in that event, but he denied having organized it, recommending HCQ as prophylaxis, or suggesting that wearing a face mask was no longer necessary.

He gave the following statement:

“Recently, several news outlets have reported that I organized an event called ‘Flatten the Fear’ last week, and/or that I was the leader of a group called ‘Concerned Doctors and Citizens of the Philippines.’ Some of these reports also stated that I advocate the use of hydroxychloroquine as prophylaxis and treatment for COVID-19.

“These reports are false.

“As I have previously clarified through my social media page and interviews, I am not the person leading the ‘Concerned Doctors and Citizens of the Philippines’ group. I also did not organize the ‘Flatten the Fear’ event.

“I only participated in the event at the invitation of colleagues from civil society, and it is only one of the many events where I spoke about addressing COVID-19 through a whole-of-society, whole-of-government and whole-of-systems approach.

“I also do not endorse hydroxychloroquine as prophylaxis to prevent, or as treatment to cure, COVID-19 infection. The endorsement was wrongly attributed to me, and it was entirely the opinion of the persons who made these statements during the ‘Flatten the Fear’ event.

“My recommendations to prevent COVID-19 are publicly available in the booklet, ‘Labanan ang COVID-19,’ published by Health Futures Foundation Inc. I encourage everyone to share this resource material, which can be downloaded from the following link: www.healthfuturesfoundation.com/COVID-19

“Finally, during the event, I wore my face mask, except when I had to eat my snack and talk on stage. I was not among those participants who deliberately did not wear face masks because they were allegedly on prophylaxis, as some news reports stated.

“I reiterate that wearing face masks—as the Department of Health, World Health Organization, and public health experts worldwide prescribe—should be done to fight against COVID-19.

“I urge my fellow Filipinos to do their share in helping protect each other and taking part in our nationwide bayanihan against the COVID-19 pandemic.”

Source: https://lifestyle.inquirer.net/371781/flatten-the-fear-but-beware-of-compliance-fatigue/#ixzz6ZS4VFwvf

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