THE GENERAL definition of a mass casualty situation is one in which an incident or incidents overwhelm the medical resources, personnel, equipment, and supplies available to respond to these events. In many parts of the United States and around the world, this is exactly what is happening with COVID-19 cases that result in hospitalization and deaths.

For anyone who has ever been in the military, especially medics, this is a familiar situation in which they have been trained to respond in a rapid fashion. Incident commanders are taught to assess the overall situation, respond to limit further casualties, triage patients, and treat and transport victims as rapidly and effectively as possible with the resources they have on hand. In the old days, for combatant commanders, this was called the “come-as-you-are war.” From the medical perspective, this means that you use the treatments you have on hand, not those that need a randomized, prospective, double-blind study that may or may not give you the result you’re looking for in 2 to 4 years.

For much of the last several months, the U.S. health system has been responding to the surge of COVID infections and hospitalizations in much the same way, with one exception. There has been very limited, and in many cases non-existent, attempts to successfully prevent further cases. We have relied almost entirely, if not exclusively, on vaccinations as the only means of accomplishing this task.

Treatment options to prevent the progression of early cases into more severe illness have been severely limited to the occasional use of monoclonal antibodies. All attempts to use FDA-approved drugs that appear to have some effects in treating COVID, have been severely constrained by the federal government on down to the local level, simply because they are not FDA approved for this infection.

Even a local physician who heads the emergency department of one of the area hospitals had recommended that New Hampshire sanction practitioners who wish to try these drugs for COVID-19 treatment. If we were dealing with a new outbreak of some version of the old Spanish influenza, I can almost guarantee we would be handing out Tamiflu or similar drugs like candy.

Although anecdotal evidence should generally be avoided in making treatment decisions, there comes a point when so much worldwide use information on the effectiveness of certain drugs against a particular disease becomes available that practitioners should be allowed to use their own clinical judgement and do what they believe is right for their patients. This already happens with many drugs in the United States. Between 12% to 56% of all FDA drugs, depending on the particular drug category, are used “off label” to treat conditions for which they were not explicitly FDA approved. Even if these drugs are not 100% effective (no drug ever is), if they could reduce the number of cases progressing to severe illness by 50-60%, that would have an immediate and substantial impact on the current crush of hospital admissions and beds until more specific drugs are available.

This approach to treating COVID was advocated by a paper from the Yale School of Public Health, Department of Epidemiology, well over 18 months ago.

Therefore, I would respectfully urge all federal and state health departments to stop the efforts to prevent individual health practitioners from using all available pharmaceutical means to treat early cases of COVID-19, and help relieve the pressure on the hospitals throughout this state and the nation.

Andrew J. Breuder, MD, MPH, FACPM, FAsMA, CPE, is a retired USAF chief flight surgeon who lives in Bedford.

Thursday, January 13, 2022

CHRISTOPHER THOMPSON’S January 9 column, “People are quitting their jobs in record numbers”, points to management failures and an employee awakening as factors in the significant number of people changing jobs. I’d like to address a few things employers can do to retain and motivate workers.

Wednesday, January 12, 2022

STOP THE PRESSES, because Kamala Harris got something right. That’s not something even her strongest allies have been able to say often — if at all — so when it happens, we should all take heed.

Tuesday, January 11, 2022

A FEW YEARS AGO at a gathering in my town, a fiery speaker said that our government is reaching into our pockets through taxation in order to steal our hard-earned money to pay for programs that are simply giveaways to growing numbers of the “undeserving.” This is not true.

Monday, January 10, 2022

IN THE YEARS immediately following the Civil War it looked like the enfranchisement of former slaves and their descendants might actually happen. The 13th and 14th Amendments to the U.S. Constitution were ratified in 1868 and 1869 extending the full rights of citizenship — including the righ…

Sunday, January 09, 2022
Thursday, January 06, 2022

THE GENERAL definition of a mass casualty situation is one in which an incident or incidents overwhelm the medical resources, personnel, equipment, and supplies available to respond to these events. In many parts of the United States and around the world, this is exactly what is happening wi…

Wednesday, January 05, 2022
Tuesday, January 04, 2022

WHEN THE New Hampshire Public Utilities Commission (PUC) rejected a plan to double the cost of a program known as NHSaves, it reignited a debate about the value of ratepayer-funded energy efficiency. The questions at the heart of the debate concern the cost versus the benefits of these progr…