“To a Healthy Future” is the current tagline of the Executive Director of Jefferson County Public Health (JCPH) Dawn Comstock. Comstock is a PhD, otherwise known as an academic, who rules with an iron fist over one of the largest counties in the Denver area. Unfortunately for Comstock, her lack of clinical practice experience causes her to think that the definition of health means the absence of COVID-19.
Yet health is much much more, and is better measured at the individual rather than population level and by a primary care provider (PCP) instead of by an academic with zero understanding of how health is managed within the context of an intimate doctor-patient relationship.
I started to understand this myself only after I became a community pediatrician. Prior to this I too was in the land of academia. During my residency at Children’s Hospital Colorado nearly 2 decades ago I attended our daily Morning Report where we reviewed hospitalized cases from the community where children might have been seen on numerous occasions by their pediatrician before presenting to the hospital where the diagnosis was made. To me it was the unspoken desire not to be that village idiot pediatrician who seemed to have missed what now appeared so obvious.
And then I became just that in Denver and realized that the academic specialists at that Morning Report did not know about the 90 children that presented with similar symptoms yet did just fine. They only saw the 10 that progressed into something more severe.
These academics also seemed to view healthcare through the lens of clinical practice guidelines and clinical prediction scores which assumes that the disease process at the individual patient-level also abides by these guidelines and scores.
I have seen this play out over and over again in clinical practice, such as my patient with a history of recurrent strep seen at a pediatric ER for fever and sore throat and discharged without a strep test because he did not meet Centor criteria, only to present back to me the following day to diagnose his strep and start him on curative treatment.
To me these examples help me reconcile the disconnect between these academic pediatric specialists who have been advocating both at the national and state level of the American Academy of Pediatrics (AAP), which in turn has advocated to the Colorado Department of Public Health and Environment (CDPHE) and local public health for the very COVID policies that have devastated the health of my pediatric patients throughout this pandemic.
Is it me as the PCP who has failed to mitigate this iatrogenesis in my patients? What about Children’s Hospital Colorado which lacked staff and beds to accommodate the epidemic of children attempting to kill themselves because of the very COVID policies advocated for by their very own infectious disease specialists? What about the pediatric infectious disease specialist at a reputable Midwest Children’s Hospital who asked the parent of my 5-year old patient, admitted due to fevers from her acute COVID-19 infection, if the child could receive her first COVID vaccine prior to discharge?
When constructing clinical practice guidelines, the AAP states: “For each key action statement, the quality of evidence and benefit-harm relationship were assessed and graded to determine strength of recommendations. When appropriate, parents’ values and preferences should be incorporated as part of shared decision-making.”
Yet neither the CDC, AAP, state or local public health have done any of this with respect to COVID policies imposed on our children. Where is this quality of evidence that mandating masks in school or rushing to vaccinate children prevents either infection or transmission while also satisfying the benefit-harm relationship?
How exactly are parents being incorporated into this shared-decision making? Throughout this entire pandemic I have found myself at odds with the AAP, CDC and others in academia because of their failure to consider health as nothing more than not having COVID-19.
In August I moved my family out of Jeffco to a small Midwest town hoping to return some normalcy to their lives. Meanwhile my family and friends in Jefferson County continue to suffer under non-evidence based draconian COVID restrictions of Executive Director Comstock even after Governor Polis declared the emergency was over.
Returning to visit for Christmas has been a tale of two cities with stays both in Douglas and Jefferson Counties where one could say the former is experiencing the better of times while the latter the worst of times. As Paul Klee wrote, this will only end when we say it will end and that is what Douglas County did in response to their own county’s local public health department, Tri-County Health, headed by Executive Director Dr. John Douglas, who like Comstock, continues to burden its residents and students with never-ending oppressive mask mandates and out of school exposure quarantines.
Instead of mindlessly following non-evidenced based Tri-County Health Department (TCHD) mandates, Douglas County commissioners split from TCHD to form their own board of health and residents elected a new school board majority which immediately eliminated mask mandates in its schools and businesses.
Meanwhile, JCPH Executive Director Dawn Comstock has declared war on Jefferson County residents, stating that unvaccinated individuals should not be allowed to enter the community and that anyone unvaccinated or refusing to wear a mask is fighting on the side of the virus. In her war to ensure our healthy future, Comstock continues to force children aged 3 years and above to wear masks in schools while continuing out of school quarantines despite no remote access to learning.
When schools object she uses taxpayer dollars to sue them into compliance. Outside of schools, Comstock wages war on local businesses by encouraging residents to shop outside of the county in places that have higher mask compliance. Yet perhaps the most egregious medical overreach is her violation of the doctor-patient relationship by collecting names of pediatric providers who have signed medically indicated mask exemptions for the purpose of reporting them to the State Medical Board for violation of their licensure.
The result of Comstock’s policies are that like-minded people are voting with their feet by pulling their kids out of Jefferson County Public Schools (JCPS) and driving to businesses in places like Douglas County where masks are not required. This will only end when JCPS Superintendent Tracy Dorland, elected county commissioners Kerr, Dahlkemper, Kraft-Tharp and the residents and businesses of Jefferson County say it will end.
Until then, we will continue to be lemmings following unelected Executive Director Dawn Comstock off the proverbial cliff, further risking our economic, physical and mental health, all in the name of not getting COVID. How is that for a healthy future?
Author: Dr. Todd Porter is a community pediatrician who has worked in a large safety-net hospital system caring for mostly low income children of color. He has been an eyewitness to the disproportionate harms the Covid-19 public health response has had on children. MD, MSPH.