Reply to Dr Michael Blackburn’s letter on FB

A reply to this letter on FB from Dr Michael Blackburn

Dear Mike (aka the Anaesthesiologist replying to the physiotherapist whose open letter is doing the rounds on social media)

I was surprised that you didn’t address your letter directly to me (Nicola Aylward) as we know each other, but I’m pleased that you wrote it and challenged me on it, as that’s what I am encouraging – critical thinking and robust debate. So, thank you for your comments and I address them below.

  1. I am pleased you are in agreement about sanitisation tunnels – so were the panelists of the South African Paediatric Association webinar on their Covid-19 “Children returning to school – what advice for parents and caregivers” webinar on 27 May 2020. As Dr Moherndran Archary, Paediatric infectious diseases specialist, says, there is a lot of evidence to support the harmful effects of these.
  2. I agree that this deep cleaning prior to opening is unnecessary. And the sanitisation of schools is important and should continue as it has always been done – most schools are cleaned every night (prior to this Covid-19 outbreak) in their bathrooms, toilets, and high traffic areas, and then cleaned regularly through the week. I am concerned about the high levels of chlorine-based cleaners that are being suggested and used. As we know chlorine is a chemical used in many industry cleaning products, but it is still a toxin and used in chemical warfare – it’s most harmful route of exposure is through breathing it in and from skin and eye contact. Chlorine gas is heavier than air and therefore sits on surfaces such as desks and chairs where our children will then be sitting for the next 6 hours. When inhaled it reacts with water to produce acids which are corrosive and damage cells in the body on contact. I do not want this for our children. Please read more about this in this article by the New York Department of Health.
  3. Face masks – the American Medical Association just released a position paper on masks “Face masks should be used only by individuals who have symptoms of respiratory infection such as coughing, sneezing, or, in some cases, fever. Face masks should also be worn by healthcare workers, by individuals who are taking care of or are in close contact with people who have respiratory infections, or otherwise as directed by a doctor. Face masks should not be worn by healthy individuals to protect themselves from acquiring respiratory infection because there is no evidence to suggest that face masks worn by healthy individuals are effective in preventing people from becoming ill. Face masks should be reserved for those who need them because masks can be in short supply during periods of widespread respiratory infection. Because N95 respirators require special fit testing, they are not recommended for use by the general public.” (Journal of the American Medical Association (JAMA); April 21, 2020 Volume 323, Number 15 https://jamanetwork.com/journals/jama/fullarticle/2762694)

I have many other research articles to support my concerns but let’s leave it here for the moment for the sake of the brevity of this letter. But if you or your readers would like to do further research on this, this article has many helpful links. It addresses the very real and validated concern of decreased oxygen levels and re-breathing CO², as well as an increased susceptibility to infection after wearing a mask for prolonged periods due to the hypoxia.

When I mention “medical masks allow for more airflow than fabric masks” I am referring to the disposable surgical masks. I’m sorry that you misunderstood and thought that I was referring to N95 masks (also referred to as N95 Respirators). Those are not for general public use and are critical supplies for health care workers and first responders, so they were not even on my radar. This  FDA.gov article explains their use more. I was certainly not suggesting N95 masks for children to use on their return to school. And since children will be screened when arriving at school every day, and are not allowed to attend school if they have any symptoms of illness at all (again discussed in the webinar here), surely masks are then redundant in accordance with the AMA position of 21 April 2020 stated above?

  1. Thank you for acknowledging that supplements may be helpful. The only area of debate on this seems to be within the medical community. There are in fact many, many research articles demonstrating their efficacy. Our Family Physician, Dr Sheri Fanaroff, quoted 3 studies on vitamin D in one of her recent updates to her community. “A recent study led by Northwestern University conducted a statistical analysis of data from hospitals and clinics across China, France, Germany, Italy, Iran, South Korea, Spain, Switzerland, the U.K. and the US. This included patients up to 20th April 2020. The researchers noted that patients from countries with high COVID 19 mortality rates, such as Italy, Spain and the U.K., had lower levels of Vitamin D compared to patients in countries that were not as severely affected. They discovered a strong correlation between low Vitamin D levels and cytokine storm (the hyperinflammatory condition that we are seeing in COVID 19 patients caused by an overactive immune system). Cytokine storm is what leads to acute respiratory distress syndrome and sometimes death. Vitamin D enhances our innate immune systems and also prevents them from becoming dangerously overactive. They concluded that while vitamin D will not prevent a person from contracting the virus, it may reduce complications and mortality in those who are infected (they hypothesised that this may be as much as 50%).” She went on to mention 2 more studies and various sources of vitamin D such a sunshine which will be helpful once we are able to go outside more, and various dietary sources. As she mentioned, many people have sufficient levels here in South Africa (it’s not the case in the northern hemisphere countries) but it is worth testing and supplementing if levels are low, especially in our high risk and vulnerable communities. She went on to discuss and share similar information on vitamin C and zinc- “A review article published in April in the International Journal of Molecular Medicine states that despite the lack of clinical data, Zinc is known to modulate antiviral immunity and regulate inflammatory response, and modulating Zinc status may be beneficial in COVID 19.” I would be happy to share the full statement with you (or any interested readers) along with many more research articles, but will keep this letter short.

I appreciate that your primary concern remains the mask issue. You state that “There is absolutely no need to be concerned about mask wearing if it is done properly. The danger with sending kids to school is not that they get sick but that they may transmit the virus to vulnerable people at home.” Again according to the SAPA webinar and Prof Madhi, Professor of Vaccinology at WITS University, “children are less likely to get symptoms. And children are less likely to transmit infection (he had data and stats to support this). It’s more likely for parents to bring it home from work than for a child to bring it home from school”. It was a very helpful webinar and one worth listening to – here is the YouTube recording. And I will continue to disagree with you on the mask issue based on my extensive research.

But thank you for being willing to sacrifice the health of your children for the sake of my family’s safety. It is very generous and kind of you, and I recognise deep desire to stop the spread of this virus, and the hope for a healthier South Africa, when you say this. I share the same very deep seated desires and hopes.

However I hope to achieve this not through masks and over sanitisation, but through uplifting health. As I have mentioned a couple of times, the South African Paediatric Association webinar was very helpful and empowering for many reasons. But what sadly lacked for me was any focus on what we can do to create health instead of just manage disease. I asked numerous questions on this in the chat but not one was answered. Questions like “What about advising high dose vitamin C, and appropriate vitamin D and zinc? There is research to support the benefit of these – more than masks”, “Should we as medical professionals not be advocating measures to improve health? Diet, exercise, healthy food, healthy cooking, limiting sugar – again research on all of these, looking to uplift a family’s health – including Gogo at home”, “This can be an opportunity for medical professionals to help empower out country to become MORE healthy over the next year by working with government to educate on how to work with diabetes, obesity etc”, “Is it not time for South Africa to lead the way by bringing in HEALTH measures not just spending money on over sanitisation which as has been discussed can be detrimental long term.”, “Can we not suggest that food parcels contain vitamin C, D and zinc supplements. We have a responsibility to petition government for this”, “Like when we learn to walk we have to fall. Our immune system builds by getting sick. Surely we look at supporting ourselves and our children so that we can handle illness better and develop resilience in our health?” I asked all these questions and more and not one was answered even though the specialist panel were checking the chat constantly for questions. In the entire webinar there was no mention on how to improve health – which to me as a health professional is devastating – is this not our job? For in our Hippocratic Oath we find the lines “I will prevent disease whenever I can, for prevention is preferable to cure”. So why is the emphasis of how we are handling this virus, and how we approach disease in general, all focused on “cure”, vaccines, medication? Surely we are not living up to our Hippocratic Oath if we are not educating and empowering people to live healthier lives? For it was the great Hippocrates who is quoted to have said “Let food be thy medicine and medicine be thy food”.

And so I appreciate your letter to me and the opportunity to respond. I thank you for all you and your wife Karen (particularly in her role of a Family Physician) do to support so many people, and communities, in their health and wellness. It is very important that medical professionals come to the fore in a time like this, and speak our truths, and help to educate people. Now is the time, and there is a better way.

Kind regards

Nicola Aylward (nee Durrant)

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