Better in their words…

It is my pleasure to host this guest essay by an anonymous second year medical student at a prestigious east coast university. His classes tried to teach him evidence based medicine, but he was the victim of irrationality, fear and bad policy. The policy choices affected him, as you will see.

When people ask me why I speak up when I see smart people making stupid decisions— this is why.  

-Vinay Prasad, MD MPH

Medical School During COVID-19: A Student’s Thoughts

By Anonymous, East Coast Medical Student, MS2

I just finished my first year of medical school! Many wonderful things happened, and I hope to share these some day, but today I want to describe my thoughts on COVID-19, and how my university’s policies affected my education.

I was a premed student when the virus hit, and I didn’t know how scared to be

Like many, I followed the pandemic from the beginning. I watched as President Trump described the dangers of the novel virus. I’ll admit, I feared what was to come. In the beginning, we didn’t know what the virus was capable of and weren’t getting reassurance from mainstream media. If anything, they made things worse.

Many medical doctors and PhD scientists began speaking on TV claiming to be ‘experts’ regarding SARS-CoV-2. Many of their messages weren’t data driven, and unfortunately, were fear driven. No wonder the world went crazy. I remember thinking then, and still to this day, how can these individuals be experts? This is a novel virus, and the world has little to no experience dealing with a pandemic of this magnitude, so how can someone be an expert in something that has never existed?

During the first few weeks of the pandemic (March 2020), we were talking about interventions that had never been attempted in all of human history – shutting down school, borders, and society itself – even if these ‘experts’ knew everything possible about coronavirus transmission, how could they know which of these interventions, if any, were justified? Which would have unintended consequences?

The real experts were those who were silent, spending their time critically evaluating all the data to derive objective conclusions decoupled from their political ideology – only speaking when having something relevant and important to say.

When watching an April 3rd, 2020 YouTube video by Prof. John Ioannidis, I felt for the first time that I was being spoken to honestly. He simply described that there was uncertainty about the severity of COVID-19 and that we currently were lacking reliable data. He then explained that fatality rates from a Carnival Cruise outbreak were much lower and likely more accurate than estimates by the WHO (3.4% CFR). His message was objective, calming, and in stark contrast with messages from the mainstream media. I often wonder how the public’s perception of the pandemic would have differed if the CDC and mainstream media would have adopted a similar message to Dr. Ioannidis.

Unfortunately, one of Professor Ioannidis’ videos was removed in the early days of the pandemic because of the claim – that COVID-19 might have an IFR in the same ballpark as the worst seasonal influenza. But how could this claim be wrong? Who decides how big a ballpark is? I found the censorship surreal.

As time passed, it seemed our response to the virus moved further and further away from the data, and, at least from my perspective, further from common sense.

I get accepted to medical school, conditional on vaccination

Fast forward to Spring 2021. I was fortunate and got my medical school acceptance letter early, so thankfully I wasn’t one of those students who struggled with the anxiety of potentially not being admitted.

Nonetheless, my worries found me as I learned that my university would be mandating the COVID-19 vaccine for students. I wasn’t ready to take the COVID-19 vaccine. Plain and simple, I wanted to know more about the efficacy in my age group, and I hoped to see robust safety data before making this decision.

In my mind, mandatory vaccines are only justified if we know that the adverse event risk to the recipient is trivial, that vaccination protects the health of others, and that natural infection is insufficient to do so. Other vaccines are mandatory for medical school, but students can opt-out by showing evidence of pre-existing antibodies. However, for COVID-19 there was no alternative to vaccination even if an individual had detectable antibody levels.

I thought there must be a reason for this – But, I am still waiting! Vaccinated and naturally infected individuals both produce antibodies against the spike protein – those infected naturally actually have additional antibodies specific to other motifs on the virus. Moreover, the risk of bad outcomes from reinfection appears lower in those with natural immunity than those merely vaccinated. Finally, escape variants have rendered both natural immunity and vaccination defenseless against reinfection. My question remains: why is natural immunity not considered a vaccine equivalent? It surely is.

Not only my university, but all mainstream public health agencies have consistently discredited any immunity gained from natural infection. Of all the blunders public health has committed over the pandemic, this one may only be rivaled by school closures and will lead to years of distrust.

Countless studies have now been published supporting what many of us already knew – immunity post infection is robust, long lasting, and durable. Yet, to this day, the U.S. government and CDC are hesitant to acknowledge immunity gained from infection.

We are cloth masking, after vaccination, outside, in the heat and humidity 

In August of 2021, I arrived on the east coast to start class. Coming from the Midwest, I experienced a type of culture shock when moving. I had never before seen so many people wearing cloth masks outside, especially in 95-degree weather with unbearable humidity. I didn’t quite pick up on this trend, but it is still alive to this day.

On campus, masks were required at all times whenever indoors – a cloth mask, of course. Needless to say, it was anything but joyful sitting all day in a mask while also trying to listen to professors teach complex medical topics. Although the rules allowed for professors to take their mask off while lecturing, few followed.

Furthermore, the policy permitted students to lower their mask for a sip of water or bite of food in the lecture hall. I know what you are thinking – what is the point of an intermittent cloth mask mandate – that was what I wondered as well.

Adding to this, consider that everyone inside the building was COVID tested once every two weeks and 98% of people were vaccinated. Why were we still required to mask if virtually everyone had immunity to the virus and people weren’t allowed into the building if they happened to test positive?

If I am honest with myself, I must admit that whenever I see another human smile, I feel happy.  It is strange that a natural human reaction, and a desire to see data to support recommendations (i.e. cloth mask mandates) would be labeled “anti-mask” rather than common sense.

Testing rules led faculty and students to be thrown out 

As the semester rolled along, there were additional times where I was confused about the university’s policies. For example, on multiple occurrences professors and students struggled to bypass security at the entrance of the building because they were not up to date with their COVID-19 testing. They didn’t have symptoms. They simply did not take a test on time despite being perfectly well in health.

This was a foolish policy that prioritizes fear over education. The university has no data that prohibiting an asymptomatic, healthy person from the building improves anyone’s health or reduces transmission of the virus. Furthermore, a few days before winter break, with zero warning, the university decided to move all classes online. This persisted for a couple additional weeks after winter vacation. Some students applauded this decision as now they could remain at home longer or extend their vacation at breathtaking venues. I, on the other hand, actually enjoy learning from the lecture hall. I find it beneficial to sit among other students and listen to professors speak in real time. Virtual school was a challenge, and I feel short-changed having had to miss out on seeing friends and instructors during that period.

The mask mandate falls, but then is resurrected

In spring of 2022, the university dropped the mask mandate. Words can’t describe how wonderful it was to see my classmates’ whole faces rather than their eyes peering over a piece of cloth. I feel like everyone can agree on this, but for some reason, it is not valued. The American Academy of Pediatrics even stated that babies seeing faces doesn’t matter – I cannot believe they were so wedded to a political ideology that they lost sight of common sense.

Just as quickly as the mask mandate was lifted, it was re-implemented a few days later. I shouldn’t have been surprised, but I was. I would concede this was the correct decision if they had provided any sort of data indicating that the period of no masking (which many did not take advantage of) caused massive infections, hospitalizations, and deaths among students and staff. This aligns well with many of the pandemic decisions – implementing a policy without data. By the way, the mask mandate remained in place through the end of the year and is still active today. They have never had data supporting mandates, and now that breakthrough infection is inevitable – what is the goal?  Furthermore, the mask mandates end when we go off campus to the bars – there are no masks in sight.

What is the point of all these anecdotes?

My university prides itself on practicing and teaching evidence based medicine, yet the COVID-19 policies they have implemented are vastly discordant with the evidence base. I’m afraid my university values its image over pursuing sensible, data driven guidelines. Despite having intelligent physicians and public health leaders making decisions, it seems they would rather fit in with the crowd (follow suit with other universities) than use their judgment to make and adapt policy. I don’t blame them for ‘following the leader’ as it is quite challenging to be the one pushing against the grain. However, I am disappointed to be at an institution that (through the lens of COVID-19 policy) appears to discredit the truth and lack urgency in finding it.

How has COVID affected my medical education?

In all honesty, I don’t believe COVID has impacted the quality of my medical education. Despite vaccine/booster/mask mandates, routine asymptomatic testing, random breaks from in-person learning, and a constant reminder that COVID is real and dangerous, I don’t feel cheated out of critical learning experiences. At the same time, I will admit, I don’t know what things could have been like had we had sensible policies.

Although the policies/restrictions were burdensome, I learned to live with them. Preparing to be a competent doctor who provides the best possible care to patients is far more important than letting ill-advised policies affect my education. I suppose the policies gave me a chance to show my resiliency.

Finally, the pandemic will likely remain a guiding principle throughout my life – even if my university still has not heeded the lessons. This experience has convinced me that “in God we trust, but everyone else must bring [honest] data”. I am now much more critical of what I read and arrive at conclusions that are derived from my thoughts rather than parroting what others say.

I wish there were easier ways to have been taught this lesson, but I am grateful to have learned it and know it will serve me and my patients well. Thank you for reading my experience.