President Donald J. Trump The White House 1600 Pennsylvania Avenue, NW Washington, D.C. 20500 May 19, 2020 Dear Mr. President: Thousands of physicians in all specialties and from all States would like to express our gratitude for your leadership. We write to you today to express our alarm over the exponentially growing negative health consequences of the national shutdown. In medical terms, the shutdown was a mass casualty incident. During a mass casualty incident, victims are immediately triaged to black, red, yellow, or green. The first group, triage level black, includes those who require too many resources to save during a mass crisis. The red group has severe injuries that are survivable with treatment, the yellow group has serious injuries that are not immediately life threatening, and the green group has minor injuries. The red group receives highest priority. The next priority is to ensure that the other two groups do not deteriorate a level. Decades of research have shown that by strictly following this algorithm, we save the maximum number of lives. Millions of Americans are already at triage level red. These include 150,000 Americans per month who would have had a new cancer detected through routine screening that hasn’t happened, millions who have missed routine dental care to fix problems strongly linked to heart disease/death, and preventable cases of stroke, heart attack, and child abuse. Suicide hotline phone calls have increased 600%. Tens of millions are at triage level yellow. Liquor sales have increased 300-600%, cigarettes sales have increased, rent has gone unpaid, family relationships have become frayed, and millions of well-child check-ups have been missed. Hundreds of millions are at triage level green. These are people who currently are solvent, but at risk should economic conditions worsen. Poverty and financial uncertainty is closely linked to poor health. A continued shutdown means hundreds of millions of Americans will downgrade a level. The following are real examples from our practices. Patient E.S. is a mother with two children whose office job was reduced to parttime and whose husband was furloughed. The father is drinking more, the mother is depressed and not managing her diabetes well, and the children are barely doing any schoolwork. Patient A.F. has chronic but previously stable health conditions. Her elective hip replacement was delayed, which caused her to become nearly sedentary, resulting in a pulmonary embolism in April. Patient R.T. is an elderly nursing home patient, who had a small stroke in early March but was expected to make a nearly complete recovery. Since the shutdown, he has had no physical or speech therapy, and no visitors. He has lost weight, and is deteriorating rather than making progress. Patient S.O. is a college freshman who cannot return to normal life, school, and friendships. He risks depression, alcohol abuse, drug abuse, trauma, and future financial uncertainty. We are alarmed at what appears to be the lack of consideration for the future health of our patients. The downstream health effects of deteriorating a level are being massively under-estimated and under-reported. This is an order of magnitude error. It is impossible to overstate the short, medium, and long-term harm to people’s health with a continued shutdown. Losing a job is one of life’s most stressful events, and the effect on a person’s health is not lessened because it also has happened to 30 million other people. Keeping schools and universities closed is incalculably detrimental for children, teenagers, and young adults for decades to come. The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse. Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise. Please let us know if we may be of assistance. Respectfully, Simone Gold, M.D., J.D. Simone Gold, M.D., J.D. & >500 physicians (attached) Steven Abelowitz, M.D. David Bloom, M.D., N.B.P.A.S Marc E. Adams, M.D. Kenneth J. Bochenek, M.D., D.A.B.A. Jon Ahrendsen, M.D. William F. Bodenheimer III, M.D. Camille A. Alden, Ph.D. Valerie Bonnett, M.D. Rory Allen, D.O. Robert C. Bransfield, M.D., DLFAPA David W. Allison, M.D. Keith Brookenthal, M.D. Richard Amerling, M.D. Stewart Brooks, M.D. Neel Anand, M.D. Dale R. Broome, M.D. Catherine Anderson, D.O., M.B.A. James Broomfield, M.D. Maria-Lucia Anghel, M.D., M.B.A. Emile Broussard, M.D. Elena Antonelli, M.D. Annie Bukacek, M.D. Shahzaib Anwar, M.D. Juliet D. Burry, M.D. Mario R. Anzaldua, M.D. Andrew Lennon Buscemi, D.O. Robert A. Appel, M.D. Kerrey B. Buser, M.D., F.A.C.S. Deanna Armstrong, M.D. Paul A. Byrne, M.D. Patrick James Baggot, M.D. Kelly A. C. Busby, D.O., B.C.O.F.P. Martin H Bailey, M.D. Steven A. Campau, M.D. Scott Barbour, M.D. Garlon L. Campbell, Jr., M.D. Ronald M. Barke, M.D., F.A.B.O. Douglas J. Campbell, M.D. Morton W. Barke, M.D., F.O.C.O.G. Sean T. Canale, M.D. Jeffrey I. Barke, M.D., N.B.P.A.S. Paul Canale, M.D. Jeffrey Barke, M.D., N.B.P.A.S. Enrique J. Canton, M.D., F.A.A.P. Kurt Barrett, D.O. David Caponigro, D.D.S. Bart Barrett, M.D., F.A.B.F.M. Renee Caputo, M.D. James P. Bartels, M.D. Gabriel Carabulea, M.D. Barry L Beaty, D.O. Joyce Carnes, M.D. David Behar, M.D. Wesley Allen Carr Jr., M.D., M.S. David Bennett, D.O. John T. Casto, M.D. Linda L. Berkley, M.D. Roland Chalifoux, Jr. D.O. Lawrence W. Biel, M.D., F.A.B.I.M., A.B.I.H.M. Kenneth S. Cheng, D.O., N.B.P.A.S Antonio E. Bifero, D.C., M.B.A., D.A.A.I.M. Brian Chesnie, M.D., F.A.C.B.M. Robyn Bilinski, M.D., M.P.H. Janis Chester, M.D. Marsha Y. Blakeslee, D.O. James N. Childs, M.D. Andrew Blankenau, M.D. R. Lee Chilton III M.D., F.A.C.E.P., F.A.A.E.M. Paul Church, M.D. Laurel DeStefano, M.D. Robert Cihak, M.D. Vishva Dev, M.D., D.M., F.A.C.C. David Bruce Clark, M.D. Joseph N. DiBello Jr., M.D., F.A.C.S. Teryn Clarke, M.D. Robert DiDonato, M.D. C. Drew Claudel, M.D., F.A.A.D., F.A.C.M.S. William A. Diedrich, M.D., F.C.A.P. Lynwood Paul Cleaveland, M.D. Jihn R. Diggs, Jr., M.D. Mary P. Coday, M.D. Jeffrey Hall Dobken, M.D., M.P.H. Ronald S. Cohen, D.P.M. Jane Doe, M.D. William R. Cohen, M.D. William Domb, D.M.D. Stefanie Colavito, M.D. Larry L. Doss, M.D. Edward J. Coleman, M.D. Tom Douglas, M.D. Kevin Considine, D.O. Edward Frank Drass, M.D. Paul Corona, M.D. Glenn W. Drumheller, D.O. Sydney Crackower, M.D. Thomas Dumler, M.D. Michelle Cretella, M.D. Edward Dupay Jr., D.O. Steven M. Croft, M.D., F.A.A.N. Robert W. DuPriest, Jr., M.D., F.A.C.S. Scott K. Cunningham, M.D. Eric Eck, D.O. Lawrence Czer, M.D., F.A.C.C., F.A.C.C.P. Alieta Eck, M.D. Scott Glickman, D.O., F.A.C.O.S. Ryan Eggers, M.D., M.A. Anthony M. D’Agostino, M.D., F.A.C.P. Michael Eilbert, M.D. Andrew Dale, M.D. E. John Eldridge, M.D. Dusan Damjanovic, M.D. Robert Ellsworth, N.M.D. James Dancho, D.P.M., F.A.C.F.A.S, F.A.C.P.M. Edward Elmer, M.D. Dennis Daniels, M.D. George B. Elvove, M.D. Boris Darovsky, M.D. Kim Erdmann, M.D. Stephen M Davidson, D.O. Brian Erdmann, M.D. Matt Davis, M.D. Diego Fallon, M.D. Marianne Dawn, M.D. John Fan, M.D. Richard B. Dawson, M.D. Daniel Farb, M.D. Michael De Luca, M.D. Harold G. Fdelter, Jr M.D. Robert Dean, M.D., Ph.D. Ronald E. Feldman, M.D. James K. DelloRusso, M.D. Robert Feldtman, M.D. Anthony F. Dempsey, M.D. Jeffrey E. Fernley, D.O., M.S. Thomas Denley, M.D., F.A.B.I.M. Fraces Dee Filgas, M.D., D.A.A.P.M. John R. Fish, M.D. William Grant, M.D. Albert Fisher, M.D. Karladine Evelyn Graves,M.D. Kenneth Alan Fisher, M.D. Cesar Guanzon, M.D. Richard G. Fisher, M.D. Joseph Guarino, M.D., M.P.H., FACOEM Michael Fitzgibbons, M.D. Rajan Gulati, M.D. Bernadette Flynn, D.O. Vincent J. Gulfo, M.D. Edward F. Fogarty, M.D. Amit Gupta, D.O, D.A.B.A., D.A.B.P.M. John Forney, M.D. Hugh Hall, M.D. Patricia L. Foster, M.D. Jason Hall, M.D., F.A.C.S. Stuart W. Fraley, M.D. Bob Hamilton, M.D., F.A.A.P. David A. Frank, M.D. Laura T. Hammons, M.D. William Franklin, M.D. Ralph Harder, M.D. Leonard Friedman, M.D., J.D. Rich Harover, M.D. Paul Fronapfel, M.D. Michael J. Harris, M.D. Gus G.Stratton, M.D. Lyle M. Harrison, M.D. Martin Gallagher, M.D., D.C., FABOIM Angelique Hart, M.D. Gary L. Gallo, M.D., J.D. Elizabeth Hawruk, M.D. John E. Gambee, M.D. Adrian J. Heap, M.D., F.A.C.S., F.R.C.S.(C) Silvia Garcia, M.D. Steven Hearne, M.D. Hiram L. Garcia, M.D. Richard C. Heckmann, M.D., DABPN John M. Garrett, M.D. F.A.C.S. Sebastian Heersink, M.D. Michele Gasiorowski, M.D. Kristin S. Held, M.D. James Gentile Carol L. Henricks, M.D. Elaina George, M.D. Hector N. Hernandez, M.D., F.A.C.S. Sullivan Gerald, M.D. Robert E. Herold, M.D. Sophos Geroulis, M.D. Michael A. Herron, M.D Steven Giannotta, M.D. Vernon J. Hershberger, M.D. Dan Giurgiu, M.D. Meir Hershcovitch, M.D. Jeffrey Glaser, M.D. David Hesse, D.P.M. James Godchaux, M.D. WIlliam Highberger, M.D. Vernon L. Goltry, Jr., M.D. Elias Hohlastos, M.D. Steven R. Goodman, M.D. Sara Gayle Hornberger, D.O. William S. Graham, Jr., M.D. Sylvia Horsely, M.D. F.A.C.O.G. Robbie Grant, D.O. George Hughes, M.D. Robert J. Hughes, M.D. Mark F. Kowalski, M.D. Keith A. Hughes, M.D. Paul Kozak, M.D., F.A.B.E.M. Corey Hunt, M.D. Barry Krakow, M.D. Mark A. Hurt, M.D. Igor Kravchenko, M.D. Robert Hutchins, M.D. Richard Kravis, M.D., F.A.C.P. Dinora Ingberman, M.D. George Krol, M.D. Robert J.Willard, M.D., F.A.A.D., F.A.C.M.S. Gil Kryger, M.D., F.A.C.P.S. Stanley K. Jack, D.O. Richard A. Kube II, M.D., F.A.C.S.S., F.A.A.O.S. Rick Jackson, M.D. Mark Kummer, M.D. David H. Janda, M.D. Brian Kung, M.D. Russell Jayne, M.D. Diane M. Kushnar, D.O. Harold L. Jesser, M.D. Thomas L. Hesselink, M.D. Christopher L. John, M.D. Nikolai Lagoduke, M.D. Montgomery N. Johns, M.D., F.A.C.O.G. Thomas W. LaGrelius, M.D., F.A.A.F.P. Peter C. Johnson, M.D., M.A. Terry Lakin, D.O. W. Daniel Jordan, M.D. Falin Larsen, M.D. Karen Josephson, M.D. Edwin Leap, M.D., F.A.A.E.M. Cambria Judd, M.D. Erika L. LeBaron, D.O., M.S.N. Brian M Jurbala, M.D., F.A.A.O.S. Lionel Lee, D.O., FACOEP Brian M. Jurbala, M.D., FAAOS, C.A.Q.S.H. Charles Lehnardt, D.O. Frederick Kapetansky, M.D. Stephen D. Leonard, M.D., F.A.C.S. Keys S. Keel, M.D. Gregory S. Lepkowski, M.D. Jeffrey A. Keenan, M.D., H.C.L.D. Peter LePort, M.D. James Kelly, D.O. H. Michael Lewis, M.D., F.A.C.S. Paul Kempen, M.D., Ph.D. James G. Lindley, M.D. Brian Kent, M.D. Dylan Lippert, M.D. John M. Kerr, M.D. Rosina Lis, M.D. Roman Kesler, D.O. Charles Lively, M.D. William R. Kilpatrick, M.D. Curtis Lockhart, M.D. Robert L. Kimber, M.D. Barbara Lockwood, D.P.M. Susan C. King, M.D. Richard Loffreda, M.D. Punyamurtula Kishore, M.D., M.P.H. Jennifer Lorine, D.O. Renee Kohanski, M.D. Willard B. Lyons, OD, Ph.D. Joseph Kou, M.D. George Isajiw, M.D., K.M. Brian Adams, M.D., M.P.H., M.S. Hector O. Molina, M.D., M.S. Douglas Mackenzie, M.D. James L. Mona, D.O. Richard Mackool, M.D. Manuel Moran, M.D. Tony Maglione, M.D. Kenneth Moresco, M.D. Sarita Maradani, M.D., F.A.C.O.G. Glen Morgan, MD Susan Marcel, D.O. Hubertus Mulders, M.D. Claudia Marcelo, D.O. Baron Mullis, M.D. Ruth Martens, M.D. Michael Murphy M.D. Linda Martin, M.D. John Murphy, M.D. David Marzewski, M.D. Daniel J. Nagle, M.D., F.A.A.O.S., F.A.C.S. Randolph Matthews, M.D., F.C.P. Ron Neer, D.D.S. Stephen F. McCartney, M.D. F.A.C.S. J. Tucker Neilson, M.D., F.A.C.P. James R. McCarty, M.D. B.M. Nowak, M.D Leah S McCormack, M.D. Regan O’Brien, M.D. Mark McDonald, M.D. Michael O’Mara, D.O. Ella M. McElwee, Ph.D., Hm.D. Ron Oberfoell, D.O. David McKee, M.D. Raymond J. Oenbrink, D.O. M. Polly McKinstry, M.D. H. W. Oliver, M.D. James McMillan, M.D. Jane M. Orient, M.D. Robert McQueeney, M.D. Daniel L. Orr II, D.D.S., Ph.D., J.D., M.D. Daniel McQuillan, M.D. Oduah D. Osaro, M.D., F.A.A.F.P., C.I.M.E Thomas E. Meads, M.D. Shaun Ostrofe, D.O. Marelyn Medina, M.D. Richard Pacini, M.D. Richard B. Meister Sheila Page, D.O. Kathy Mercer, D.O. Ray Page, D.O., Ph.D. Darren Meyer, M.D. Carey P. Page, M.D. Blaise Milburn, M.D. Christopher Patitsas, M.D., M Div. Cynthia Miley, M.D. Tom Peponis Jr., D.O. Asher M Milgrom, Ph.D. Rene Perez, D.O. Donald W. Miller, Jr., M.D., Professor Emeritus Jonathan Perley, M.D., F.A.C.U. Shira Miller, M.D. Christina Peterson, M.D. John R. Minarcik, M.D. Douglas Peterson, M.D., Ph.D. Vincent P. Miraglia, M.D. Tracy M. Pfeifer, M.D., M.S. Mitchell G. Moffat, M.D. Charlotte Pham, D.O. Alice Pien, M.D. Molly Rutherford, M.D., M.P.H. Stephen L. Piercy, M.D., F.A.C.S., D.A.B.U. Andrew Ruzich, M.D. Gregory Polito, M.D., K.M. Naina Sachdev, M.D. Tracy Powell, M.D. Jay Salwen, M.D. Ronald Powell, M.D. Frank B Saucier, M.D. John Prunskis, M.D. Matthew Schaeffer, M.D. Mihael Puc, M.D. Vann Schaffner, M.D. John H. Pulliam, M.D. James L. Schaller, M.D. William E. Purnell Jr., M.D. Joseph M. Scherzer, M.D. E. Michael Purvis, M.D. Daria Schooler, R.Ph., M.D. Robert L. Pyles, M.D. Linda Schultz, M.D. Tracy L. Ragland, M.D. David Schultz, M.D., Ph. D. Rich Rawson, M.D., F.A.B.E.M. Marlan Schwartz, M.D. F.A.C.O.G. Gary Reasor, M.D., F.I.P.P. J. W. Scott Wallace, M.D., L.F.A.P.A. John Redwine, D.O., F.A.A.F.P. Neil A. Shah, M.D., F.A.A.D. Gina Reghetti, D.O. Mirand Sharma, M.D., F.A.A.E.M. Paul Rein, D.O. Ervin B. Shaw, M. D. Stephen Replogle, D.O Ed Sherling, M.D. Micheal Todd Rice, M.D., M.B.A. Aneek Shoenaker, M.D. Alan D. Richardson, M.D. Martha W. Shuping, M.D., M.A. Robert Richter M.D. Yelena Shvarts, M.D. J. Michael Ritze, D.O. Diane S. Silver, M.D. Michael Robichaux, Jr., M.D. Albert Simpkins, Jr., M.D., F.A.O.S. Al Rodriguez, M.D., F.A.A.B.A. Dr. Singleton, M.D. Scott Roethle, M.D., F.A.S.A. Marilyn M. Singleton, M.D. Joel Singer, M.D., F.A.C.S. Vladimir A. Sinkov, M.D. Jorge Romero, M.D. Clay R. Skinner, M.D. Catherine A. Ronaghan, M.D., F.A.C.S. Ralph D. Skowron, M.D. Harry J. Rose, M.D. Scott L. Sledge, MD Bernard A. Rosenberg, M.D. George L. Smith III, M.D. Tamzin A. Rosenwasser, M.D., F.A.A.D. Russell R. Smith, M.D., F.A.A.F.P. Troy Ross, M.D., M.P.H. Daniel Sneed, D.O. Robert Rowen, M.D. Santanu Som, D.O. Ken Runner, M.D., F.A.A.D. Stuart Spitzer, M.D. F.A.C.S. Calvin Sprik, M.D. Miles Trumble, M.D. David T. Springer, M.D. William Y. Tucker, M.D. David G. Stanley, M.D., F.I.C.S. William Y Tucker, M.D. Anthony A. Starpoli, M.D. Shereeen Underwood, D.O. Robert L. Steele, M.D., F.A.C.C. Constance Uribe, M.D., F.A.C.S. Patricia Stewart, D.O. Elmer H. Van Dyke, M.D. Joan V. Stratton, M.D. Schuyler H. Van Gorden, D.D.S. Joel Strom, M.D. John VanHoose, M.D. Maria Stubbs, M.D. Kenneth George Varley ,M.D., F.A.B.A. Billy D. Sturrock, D.D.S. T. Keith Vaughan, M.D. James Sudimack, M.D. Kathleen Veglia, M.D., F.A.A.D. William K. Summers, M.D. James H. Vernier, M.D. MaryKelly Sutton M.D. Lawrence A. Vierra, D.O. Todd Swathwood, M.D., F.A.A.O.S. Bradley Vilims, M.D., D.A.B.P.M. Joseph W. Szczesniak, M.D. Richard Vinson, M.D. Jossette Taglieri, D.O. A.B.F.M Elizabeth Lee Vliet, M.D. Vipin Tandon, M.D. Gabe Vorobiof, M.D. Wallace E. Taylor Jr., M.D. Raymond Votypka, M.D. Edward Teitel, M.D., F.A.C.S., J.D., M.B.A. Khanh Vu, D.O. Jerry Tennant, M.D., M.D.(H), PSc.D. Mark D. Vuolo, M.D. Holdredge Terry, M.D. Dr. Roger W. Evans, M.D., F.A.C.P., F.A.C.C. Sherif Tewfik, M.D. Brian Boxer Wachler, M.D., F.A.C.O. Glenn Thomas, M.D. Patrick J. Wade, M.D., F.A.C.S. Charles Thomason, M.D. Bill Wagner, M.D. Michael Alan Thorpe, M.D. Patrick Wagner, M.D. Thomas Tieu, M.D. Daniel Wallace, M.D. Stephen Tines, M.D. Bruce W. Walters, M.D. Ellis A. Tinsley, Jr., M.D., F.A.C.S., F.S.V.S. Peter Q. Warinner, M.D. Glenn Toth, M.D., N.A.B.P.S. Scott Washburn, M.D. George C. Trachtenberg, D.P.M., M.S., A.B.P.S. John Waters, M.D. Sebastian Troia, M.D. Craig M. Wax, D.O. Francois D. Trotta, M.D. Wayne Webber, M.D., F.A.C.O.G. Aldo Trovato, M.D. Charles Weber, D.O. Robert True, M.D. Daniel Weiss, M.D., F.A.P.C.R., P.N.S. Miriam F. Weiss, M.D., M.A. Lee O. Welter, M.D. Nancy Henning Weres, M.D. John J. Wey, M.D. Daniel R. Whipple, M.D. Kathryn E. White, M.D. R. Matison White, M.D. Robert Williams, M.D. James A. Williams, M.D., M.S. John L. Wilson, Jr., M.D., F.A.A.F.P., F.A.A.E.M. Michael Winnicki, M.D. Michael Wolff, M.D. Linda Wrede-Seaman, M.D. Ken Wright, M.D., F.A.C.O. Ted Yaeger, M.D., F.A.C.R., F.A.C.R.O. Denis A. Yalkut, M.D. Suzanne M. Yang, M.D. Therese H. Yang, M.D. Joel E. Yeager, M.D. LuAnne D. Yeager, M.D. George Yiachos, M.D., F.A.C.C., F.A.S.N.C. Jeffrey Yormak, M.D. Robert B. Young, M.D. Clayton Young, M.D., F.A.C.O.G. Sohrab Zahedi, M.D. John J. Zelis, M.D. Kevin Zhang, M.D. Christopher Zieker, M.D.