I certainly hope that this newsletter finds all our CANS members and their families safe and healthy. Covid-19 vaccines are here, but the distribution has gone more slowly and less efficiently than expected. More vaccines are supposed to be available by April and optimistic projections are looking at “herd immunity being reached possibly as early as July or August. However the targets for herd immunity keep moving from 70%, to 75%, to 80%, and some even saying now 90% of the population either having to have had Covid-19 and recovered, or have been vaccinated. We have certainly been disappointed by overly optimistic predictions before.
Clearly these projected dates are growing perilously close to the likely Sept 1, 2021 deadline, when CANS will have to either deposit money for a January 14-16, 2022 in-person meeting or cancel another in-person annual meeting. The future is mirky and uncertain. The American Association of Neurological Surgeons first moved their April 2022 meeting date until August 2021, and then changed the venue location from Vancouver Canada to Orlando, FL. The Society of Neurological Surgeons have now moved their May 22-25, 2021 meeting to October 14-16, 2021 In Austin, TX immediately prior to the October 2021 Congress of Neurological Surgeons meeting in Austin. The first upcoming scheduled in person UC Symposium will be the UCSF 2021 Spine Symposium June 4-5. Whether or not this one comes off as an in-person meeting will be a big bellwether for holding in person meetings in California as well as testing the current UC ban on meeting travel for UC employees. Given that a large portion of our CANS members are UC neurosurgeons, this will be an important, revealing and timely test. Needless to say your CANS 2020 Annual Meeting Committee is working hard to structure our venue commitments to minimize CANS’ financial risk, and to insure safe social distancing parameters will be possible for any site where we might hold our next in person Annual Session.
I would like to once again remind all CANS members of their Annual Dues commitment. Many of us use the CANS Annual Session registration opportunity as the time where we pay our outstanding and/or 2021 CANS dues to allow us to register. This year we will not be having a formal CANS Annual Session, and will also miss the opportunity this year to for significant income for our operational budget from our Annual Session. Thus, this year it is extremely critical that every member take the time to follow this hyperlink to our CANS website and pay our CANS annual dues https://cans1.org/membership-renew/ . I would ask every CANS member to please do this right now as you are reading this in order to help our organization remain fiscally healthy going forward. This is extremely important, and your participation and support of our organization is greatly appreciated!
I continue to hope that all of our members continue to remain healthy and safe during this trying time with Covid-19. CANS has yet to hear of any member who has been sick with Covid-19, but we very much want to know and keep track of any such event(s) to measure and document the direct personal impact of the pandemic among individual California Neurosurgeons. Anyone who knows of a CANS member, or any California neurosurgeon, for that matter, who has been sick with Covid-19, please contact our executive secretary Emily Schile with the particulars at email@example.com .
Please stay safe everyone. Please support CANS and the CMA, they are fighting for you. All the best!
There hasn’t been much we’ve agreed on these past few years as a nation, but there is one place where Californians may be on the same page: the early vaccination roll-out here has been abysmal. The trickle-down effect of each county fending for itself hasn’t worked. Elderly individuals standing in long lines as the rain pours down on them. People driving hours to mass-vaccination sites only to find them blocked by anti-vaxxers or closed for inadequate supply. Reserving vaccinations for special groups or for second vaccinations instead of administering them. Shutting down clinics for vaccinating outside the correct tier when the vaccine would otherwise go to waste. People without internet access or savvy who cannot make an appointment. I could go on and on.
The problem started almost a year ago with the lack of foresight. Nearly every week before FDA approval of a single vaccine, a news station ran a feature on the logistics of vaccinating three hundred million people. Real planning should have started then. What were the options? One of the best came from my brother, an Amazon employee, who said the going joke at work was to place a nurse on every Amazon truck and just go house-to-house giving injections. Not a bad idea in my book. Amazon, with its one-million employees, knows how to deliver. I am still amazed at how I can order something online and it’s on my doorstep the next day.
We could have gone the direction of the British. Realizing that it would be impossible to quickly vaccinate everyone with two shots, they opted for the protection of one. Having some immunity beats having none. Those who have flu-like symptoms after the first injection likely had COVID and hence already some degree of immunity. Indeed, from the Lancet on results in Israel and from the Washington Post on the British experience, one shot may be doing the trick. The data is showing that there is a 91% effectiveness after the first injection, though it took three weeks to achieve this efficacy. As of the third week in February, the British have given one injection to 23% of its population whereas it is 13-16% in the US. Israel leads all countries with 75%. In the US, 5.9% have received both. California sits squarely in the middle of the country with 13.9% receiving a single injection and 5.2% receiving two (npr.org).
We could have taken the Chinese approach. I volunteer with the Newport Beach Library Literacy Foundation and tutor a woman originally from China. She returned to her country this fall after sending her son off to an East Coast college. We still work on her English through the benefit of FaceTime. In China, the current philosophy is to vaccinate the workforce. If you think about this, this could be a better option. The elderly are perhaps the best at staying home and staying away from large groups. According to Monod in Science, it is the 20 to 49-year-old who is causing 72% of the virus spread. In other words, most cases originate from this age group. Vaccinating this mobile group of people might curb the spread and promote economic growth better than our current approach. Could just doing this help keep the elderly just as safe as prioritizing their getting the vaccine?
Hindsight is 20/20. It will take years to analyze all the data from a world-wide set of experiments with different hypotheses. I just am waiting for COVID to be in my hind sight too.
America's Amazing Accomplishments
I remember vividly a BBC news broadcast reporting an ambitious plan that President John F. Kennedy announced before a joint session of Congress on May 25, 1961. The U.S. would land a man on the moon before the decade is over. I was a 14-year-old boy, in Damascus, Syria. I had already decided to become a surgeon, and that I would do my training in the US.
I had no doubt that America would succeed in landing a man on the moon, a seemingly impossible achievement. But in my mind America and Americans could accomplish anything and everything they decided to do.
On July 20, 1969, shortly after my 22nd birthday, my family and I were glued to our small transistor radio. We gathered on a balcony at our home where we thought the reception would be best. We were listening to another BBC broadcast, a broadcast that was punctuated by periods of static noise and interruptions. the Lunar Lander, also known as the Eagle, was about to land on the moon. Michael Collins, one of the three astronauts who were manning the Apollo 11 mission was orbiting the moon in the Command Module, Columbia. My two other American heroes were about to make History; they pinpointed their landing spot on the moon, the Sea of Tranquility. Suddenly, the static disappeared, and the voice of Neil Armstrong came crisp and clear: “Houston, Tranquility Base here. The Eagle has landed.”
The applause on our little balcony was deafening. Similar applause was rising from other balconies in our neighborhood. Shortly after, the British announcer reported that Armstrong was about to become the first human to set foot on the surface of the moon. We held our breath. Was it really happening? Armstrong’s voice came over the waves again: “That’s one small step for a man, one giant leap for mankind.” I remember jumping for Joy and crying! Yes, America, my future home, and Americans are indeed capable of everything!
Americans were not the first in space but were the first to land a man on the moon. And America went on to develop the most robust and best space program, the envy of the world.
Can we still accomplish great things?
Handling the pandemic left some doubt in our minds, about our abilities: can we still accomplish the amazing stuff that the world expects us to accomplish? The stuff that we expect our Country to accomplish. Do “we” still have the “Right Stuff?”
Last week, we observed a solemn milestone in the pandemic, the loss of over half a million of our family members, friends, neighbors, and fellow citizens. There were many missteps in the handling of the deadly COVID-19 pandemic, including how the vaccine rollout was and is being executed.
But there is no doubt that “Operation Warp Speed” that resulted in the development of several vaccines in record time, was a resounding success. Our scientists still have the “right stuff.”
On February 18, 2021, the NASA Mars Rover Perseverance successfully landed on Mars. Specifically, in Jezero Crater, an ancient Martian lake roughly the size of Lake Tahoe. This site was selected because it is believed that ancient life may have excited there. Imagine that. We were able to land on the Red Planet, exactly on the spot we preselected, a great American accomplishment.
The trip to Mars is 309 million miles. The Mars Rover did not orbit the Red Planet, rather it entered its atmosphere and went directly to its landing spot, a novel and hazardous approach. Entering Mars atmosphere required a precise orchestration of deceleration using a “supersonic parachute” that fired retrorockets. It also required a “sky crane” to lower it onto the surface of Mars. Perseverance carried a small helicopter called “Ingenuity,” which would survey Mars by air and help with the scientific experiments that are planned. I still can’t wrap my head around such an amazing accomplishment. I watched the landing after the fact on You Tube with Joy and Pride. I recommend spending seven minutes to watch it for yourself.
Watch ‘7 Minutes Of Terror’ As NASA Perseverance Rover Descends To Mars | NBC News.
We are not the only country with a space program exploring Mars. In fact, Mars is getting crowded. Presently there are six orbiters, three Americans, one that belongs to the European Union and Russia, one Indian, One Emirati and one Chinese. The Chinese is scheduled to send a lander to the surface of Mars in May. But for now, the only “rovers” on the surface of Mars are Americans: Curiosity, Insight and Perseverance.
I think it is healthy that our space program has competitors; sharing our knowledge, exchanging ideas, and even learning from them is a good way to go. For now, however, we continue to be the leaders in space exploration.
Do we still have the “Right Stuff?”
Of course, we do!
Guest Editorial – Aiming for a Respectful Society
Growing up, I always heard teachers, parents, and community leaders speaking about the aim for a “tolerant” society. In fact, some were so proud of such a society, they felt that we had achieved it already, and wasn’t it sad that so many other parts of the world were struggling with accepting differences, and in being “tolerant” like us. In the last few years, we have seen our “tolerant” society turn ugly, with many of our highest elected officials openly saying intolerant things, abandoning the historically understood dog whistles for megaphones, and turning what my parents taught me about the uniqueness of all human beings on its head; perhaps most shocking was the deafening silence from pundits and elected officials who knew better. Like so many other Americans, I was shocked to see the assault of the Capitol on the 6th of January, and shudder to think what would have happened to democracy in our country, and in the rest of the world, if the outcome had been different that day. Could we be misguided in aiming only for a tolerant society, if those principles can be so easily overturned?
There have been some positive outcomes from the intolerance and indignity we witnessed in recent years: we learnt that some Americans were living in that reality for longer than we allowed ourselves to believe; our kids’ schools are now more committed than ever to diversity, equity, and inclusion (“DEI”); communities of faith joined hands to defend each other in ways that traditional sectarian stereotypes never anticipated; we can be proud that our youth are more naturally open-minded than prior generations; we have come to understand that “black lives matter” is not meant to exclude or diminish anyone else’s life, but actually is a call for acknowledgement of a truth that should always have been self-evident, that black lives ALSO matter. We have also learnt, sadly but critically, that our own country has vulnerabilities similar to places our ancestors left behind; that our own veneer of civilization is fairly thin; that a high level of literacy does not guarantee a low level of ignorance. All these are important discoveries, especially as the complacency that came with our unique status as the beacon of hope and progress in an unstable world has been shaken to the core. As a brooding, thinking, person who considers himself a patriot, I can honestly say that it may take me years to process what we went through as a country in the last few surreal months. Uncomfortable thoughts and questions have emerged from my subconscious to trouble my peace: I’m really struggling with how those who claim to love America, can hate Americans. If democracy is America’s greatest gift to the planet, how can it be so fragile at home? What will my children expect to see when they look in the American mirror?
I have always taught my children to avoid self-pity; to save their tears for the anguish of others; to pray for others as much as for themselves. We have discussed “tolerance” as a goal, and I am pleased to report that my 4th and 8th graders agree that this is a low bar to set as individuals, and as a society. When we tolerate each other, we often choose to look away from each other, to disengage. Wouldn’t it be a more worthy goal for us to reclaim our status as the leader of the world by being the standard-bearers for a respectful society, not just a tolerant one? When we respect each other, we will have reason to engage, to listen, to understand, and to empathize. As the most educated people on this planet, Neurosurgeons have a unique status of respect that positions us well to help our country move towards a more respectful society.
– Javed Siddiqi, MD
CSNS Resolutions Deadline
The Council of State Neurosurgical Societies will conduct a virtual meeting on April 16-17 at which submitted resolutions will be considered. The deadline for submitting a resolution will be March 14th. Any CANS member who would like to submit a resolution can contact CANS Secretary Joseph Chen for assistance is drawing up a resolution firstname.lastname@example.org
You as an Employer in the COVID-19 Era
The Cooperative of American Physicians announces a free Webcast on employment laws, particularly how they mesh with COVID-19.
Many new employment laws have emerged this year that impact physicians in their roles as employers, especially in relation to the COVID-19 pandemic. In this one-hour webcast, Complying with 2021 Employment Laws: The Good, The Bad, and The Ugly, Alexis James and Renee Noy, Managing Partners at WorkWise Law, PC, discuss new regulations and policies to help physicians avoid costly employment-related lawsuits.
This webcast will address:
- Recommended COVID-19 Vaccine Policies
- COVID-19-Related Employment Issues
- Sick Leave and Leaves of Absence
- Workers’ Compensation Updates
- Safety in the Workplace
Minimum Wage Increases
Observation for the Month
At the store, there was a big X by the register for me to stand on. I’ve seen too many Road Runner cartoons to fall for that one!
Looking for a new partner or position?
Any CANS member who is looking for a new associate/partner/PA/NP or who is looking for a position (all California neurosurgery residents are CANS members and get this newsletter) is free to submit a 150 word summary of a position available or of one’s qualifications for a two month posting in this newsletter. Submit your text to the CANS office by E-mail (email@example.com).
To place a newsletter ad, contact the executive office for complete price list and details.
Newsletter March 2022 Issue Volume 50, Number 3 Inside This Issue President’s Message | CANS Annual Meeting 2023: An Invitation to the Inland Empire! It is my pleasure to announce that the 2023 CANS Annual Meeting venue has been chosen as the Mission Inn Hotel & Spa in Riverside, California. This is a historic choice
Newsletter February 2022 Issue Volume 50, Number 2 Inside This Issue President’s Message | Changing Needs of an Evolving Profession In the 9 years prior to my appointment as Chief of Neurosurgery at Arrowhead Regional Medical Center, the institution had 13 neurosurgeons who came and left. When I was leaving London, Ontario for the USA
Newsletter November 2021 Issue Volume 49, Number 11 Inside This Issue President’s Message This will be my penultimate newsletter message as President of CANS. The January 15, 2022 limit for the terms for President, President Elect, and Vice Presdient is fast approaching. I am really excited to hear from Dr Javed Siddiqi as he outlines