Social Distancing, Public Health, and the Bible

Social distancing is an important public health measure to slow or stop the spread of many diseases. God’s instructions to the Hebrews in the Bible were primarily for holiness, but also had important health benefits.

I was at the auto parts store last week buying brake pads to replace the old ones in my daughter’s Prius. An elderly woman walked in, donning a mask and gloves, and carefully staying at least six feet away from others. When a clerk approached her and when other customers walked by, she retreated. I walked the long way down a separate aisle to get around her, trying to provide the space that she needed. Given her increased level of risk, and the fact that she didn’t seem grumpy, I appreciated her caution.

Social distancing, putting space between people who may infect each other with a disease, is the major way that individuals and governments throughout the world are trying to deal with the COVID-19 pandemic. It has worked many times in history, such as in the Spanish Flu pandemic of 1918, a far deadlier disaster than the current plague. The nation, and indeed much of the world, has been staying at home, or at least away from others, for over six weeks. Public health experts have used many other interventions for infection control as well. This article will discuss social distancing and other public health actions against infectious disease.

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How to Do No Harm

How leaders can minimize harm in health care, in other industries, and in all areas of life.

“How can we change this process to prevent this error from happening again?” the senior ward nurse asked the group. It is a common question, one that I have heard thousands of times from experienced and dedicated health care professionals of all stripes.

I have worked in health care for many years, serving in positions from volunteer to emergency medical technician to senior attending physician to chief of staff at a hospital to chief medical officer of a large network. In every position, “do no harm” is a fundamental theme. This famous statement from the writings of Hippocrates encapsulates quality improvement, patient safety, access to care, and many other goals in modern medicine.

“Do no harm” can be thought of as eliminating risks that could lead to a bad outcome, such as injury or death. Occupational and Environmental Medicine physicians learn that there are four ways to decrease risk in the workplace and in the environment:

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Public Health

A compendium of articles in outside sources written by Dr. Harris and looking at Public Health. 

In 2009 I wrote an article detailing the three most important factors in ensuring the health and security of a people: societal stability, public health, and primary care. The article studied the Black Death, the Great Influenza, and other key events in history to determine how these three factors, or lack thereof, impacted people’s lives.

In 2016 this has not changed. Large outbreaks like Ebola and Zika, and smaller ones like Influenza and Salmonella, impact the world every day. Non-communicable diseases such as diabetes, and injuries of all sorts, remain major threats to health. New hazards arise, whether from pollution or exposure to untested industrial chemicals. And as always, unhealthy lifestyle choices cause more early disease and death than anything else.

Meanwhile, as nations and individuals sink further into debt, public health funding declines. Greater need and fewer resources in public health mean that professionals in that field need to work smarter. Articles below are intended to help these public health and other medical professionals meet their mission.

American Family Physician

High Altitude Medicine

Bioterrorism

Military Medicine

Hearing threshold comparisons between 2001-02 NHANES and 2003-05 Fort Bliss U.S. Army Service components

Modeling hospital response to mild and severe influenza pandemic scenarios under normal and expanded capacities

Comparison of nondeployable hearing profiles by Army component (Active Duty, National Guard, and Reserve) and by gender

Preventive medicine in Task Force 1st Armored Division during Operation Iraqi Freedom

Medical reference databases used by Army primary care physicians in field environments

Other

Infectious Disease in Athletes 

Laser eye injuries in military occupations

Societal stability, public health and primary care as three pillars of defence in biosecurity

Vaccinating health care workers against smallpox in an isolated primary care facility

 

Attachments

Outbreak Investigation

Checklist for Evaluating Articles in the Medical Literature

Clinicians face mountains of medical literature, and no one can keep up. Much of it is trash. Doctors and other health care professionals must know how to evaluate medical literature to provide the best possible care to their patients; but few know how. Here is some help:

Title and General

1.    Is the title appropriate?

2.    Are the authors appropriately identified?

3.    Does information on conflict of interest or other disclaimers appear in the article?

Abstract

1.    Does the abstract entice the reader to read the article?

2.    Does the abstract correctly summarize the study and its findings?

Objective

1.    Objective(s)

2.    Study type – observational (cross sectional, case control, cohort) or experimental (randomized controlled trial, vaccine trial)

3.    Are the objectives reasonable and worthwhile?

4.    Strengths and limitations of the objective and study type

5.    How could these affect the results or conclusions (biased, generalizable)?

Methods

Study design

1.    Study design –

2.    How conducted?

3.    Who conducted?

4.    Methods appropriate for objective?

5.    Strengths and limitations

6.    How could these affect the results or conclusions (internal and external validity)?

Study population

1.    Who are the study subjects?

2.    How selected?

3.    Who selected?

4.    Strengths and limitations –

5.    How could these affect the results or conclusions (biased, generalizable)?

Study maneuver

1.    What treatments/interventions planned?

2.    How administered?

3.    Who will provide the maneuvers (where and when)?

4.    Are these appropriate for the study objectives?

5.    Strengths and limitations of planned maneuver –

6.    How could these affect the results or conclusions (biased, generalizable)?

Study observations/measures and data to be collected

1.    What observations/data collection is planned (On whom, where and when; are they consistent)?

2.    How will they be made or collected (by what method, are they standardized, are observers blinded)?

3.    Who will make the observations and collect the data, where and when?

4.    Are these appropriate for the study objectives?

5.    What are the strengths and limitations of the planned observations (exclusion, masked or unmasked, sources of bias, likely to be reliable, valid)?

6.    How could these affect the results or conclusions (biased, generalizable)?

Analysis

1.    What is the planned data analysis (what methods will be used, how will the data be grouped, what tests will be used for each analysis planned, what will be considered statistically significant)?  Are assumptions based on prior studies?

2.    How will the data be analyzed?

3.    Who will conduct the analysis?

4.    Is the planned analysis appropriate for the study objective and the type and level of data collected (parametric or non-parametric tests, one-sided vs. two-sided tests of significance, stratification when appropriate)?

5.    What are the strengths and limitations of the planned analysis (what is the power of the planned data collection/analysis)?

6.    How could these affect the results or conclusions (failure to detect a true difference)?

Results

1.    What results/observations are presented/not presented (are all the findings presented for all subjects)?

2.    How were the results obtained (what analysis was used, was the planned analysis completed)?

3.    How were the results which are presented/excluded determined and why (data insufficient, poor response, not significant)?

4.    Are the results appropriate for study objectives, planned observations and analysis?  Are they correctly performed and interpreted, internally consistent and valid (arithmetic errors, what is considered statistically significant, appropriate comparisons)?

5.    What are the strengths and limitations of the analysis results (statistical vs. biologic/clinical significance, statistical power)?

6.    How could these affect the results or conclusions?

Discussion and Conclusions

1.    What are the conclusions?

2.    How or on what basis were they made (are they justified by the results and analysis, is that analysis sufficient to determine whether significant differences may be due to incomparability of groups or methodological considerations)?

3.    Are the above limitations under all other sections adequately addressed in this section?

4.    How do they affect the conclusions?  Is this adequately assessed?

5.    What are the strengths and limitations of the conclusions?

6.    What recommendations do the authors have for future study?