COVID America at 6 months

worldometer.com

The novel coronavirus 2019 pandemic was declared a national emergency in the U.S. by the President on March 13, 2020. Far along the timeline, we’re now just a few weeks away from the 6-month mark here. So much was unknown at that time. Fear and anxiety were the rule… and seem to be, yet. Models were estimating over 2 million US deaths without lockdowns, quarantines, and social distancing. (These numbers were later shown to be based on Neil Ferguson’s “unreliable” computer code, although that’s been a hotly debated and politicized topic, as well.)

Flatten the Curve!” became the crying call across media and politics. The argument was that via heavy interventions, the spread of the virus could potentially be slowed. A massive peak might be avoided. Otherwise, the nation’s health care capacity would be overwhelmed and perhaps hundreds of thousands of Americans would be left without care. Also, by slowing the spread and flattening the peak of cases, more time would be allowed in order to bring down the death toll from over 2 million to maybe 250,000. That would also allow time for herd immunity and vaccine development.

As the situation was looking better, perhaps by June, by July there was a “second wave” feared as virus numbers and deaths began to increase again. In retrospect, it doesn’t appear that this was another wave of a returning viral infection, but the movement of the virus from the coasts (especially New York) towards more central states. My home state of Texas, especially Houston, faced fears of overwhelmed hospital and ICU capacity. As Texas had done very little mandatory social distancing or masking, this was seen by the media and lockdown advocates as justified punishment for lax behaviors. I heard as much in talk from staff and doctors in my own hospital environments in Pittsburgh, PA. Fortunately, Texas had a quick peak at the end of July that lasted a week or two, and has slowly trended downward. Houston’s ICUs reached baseline capacity at that time, but never experienced stress on their Phase 2 overflows nor did Texas cities require use of any makeshift facilities for patients.

worldometer.com

At the six month mark, the original calls and mandates for a few weeks of curve-flattening lockdowns have extended in many ways until today, with no foreseeable return to normalcy. The expectations of case flattening and hospital capacity preservation have morphed into a demand for zero positive tests. Masking mandates are the norm. Some schools are opening with hybrid online and in-person classes. Many classes are entirely online and/or remain in various stages of uncertainty. Parents are caught between figuring out child-care, education, their role in supervision or homeschooling, their own work options, and navigating new financial situations caused by the economic turmoil of lockdown.

Many will argue for the appropriateness of these measures, and potentially even call for stricter enforcement. There have been, after all, 180,000 deaths attributed to this virus in the US, to date. That’s a big number, and it isn’t over, yet. Bad flu seasons here may hit 60,000 to 70,000 deaths. People die from this – primarily the elderly and otherwise ill – but many young and healthy people are afraid of contracting or spreading the virus. The numbers, testing and risks can and have been debated everywhere, with little consensus anywhere. I’m still a proponent of Sweden’s low intervention model that isolated the sick and ill, leaving much of society to function with caution,… but that opinion is sure to ignite a heated debate!

worldometer.com

What has been reinforced to me throughout this period is less about the behavior of viruses and more about the nature of humans. We all have different risk tolerances, reading affinities, personality traits, isolation tolerance, employment needs, life experiences, political and world views, sets of biases, vulnerabilities, baseline health status, levels of regard for experts and authority figures, tendencies towards logical fallacies, and different intelligence levels – although this last may be among the least influential. All of these factors, and certainly more, contribute to our personal attitudes and responses. I work with a lot of presumably intelligent physicians and professionals, and their opinions regarding the risks of the virus and the costs of the societal interventions are as polarized as those of the general public. Does that mean that we’re all seeing different data? Or that many are misinterpreting it? Or are too stupid to understand it? Or just that our personalized calculations and subjective value sets lead to us all to divergent opinions and choices?

In our increasingly polarized (or at least electronically amplified) society, some may believe that my comparatively reduced concern for viral risk is callous, cavalier, poorly reasoned, even perhaps “murderous.” Simultaneously, I may look at some of the die-hard lockdowners as simple-minded, automatons, catastrophists, incapable of broader perspective and cost analysis. Where is the consensus to be found? I think the answer is: there is none. Our views are often irreconcilable. And the more that enforcement, shaming and threats are utilized to coerce others to comply with our views, the greater the animosity, disregard and division. Of course, this dynamic is clearly extrapolated across political, cultural and religious spectra. So, what is to be done to find some peace and unity?

For one, self-aware adults can realize that we are often wrong in our assumptions and “certainties.” Our impressions and convictions can be (and often are) incorrect. We all have information biases and knowledge deficits. We misunderstand probabilities and likelihoods. We cannot humanly contemplate or predict the breadth of consequences for ourselves and others. We all have many individual factors that influence our opinions. Recognizing these imperfections and variations can provide room for understanding, or at least tolerating, others.

Of course, the entire role of politics and media is to exacerbate then exploit myriad differences towards emotionalized polar extremes, rather than to foster calm, discourse and understanding, which would do little to drive the machinery of ratings, money flows, votes and power distributions. So, secondly, maybe a healthy move that could save and value more lives than lockdowns (especially in the realm of foreign interventionism) would be to turn off the media and the political circus.



P.S. Of note, (pre-dating our most recent iteration of discord,… which really is nothing particularly new over the centuries) here are some interesting works that I’ve audiobooked this past month. These touch on the biases and the flaws in our thinking, which should make us all less certain of our “convictions.”

The Undoing Project: A Friendship That Changed Our Minds, by Michael Lewis. “Forty years ago Israeli psychologists Daniel Kahneman and Amos Tversky wrote a series of breathtakingly original studies undoing our assumptions about the decision-making process. Their papers showed the ways in which the human mind erred systematically when forced to make judgments about uncertain situations. Their work created the field of behavioral economics, revolutionized Big Data studies, advanced evidence-based medicine, led to a new approach to government regulation, and made much of Michael Lewis’ own work possible. Kahneman and Tversky are more responsible than anybody for the powerful trend to mistrust human intuition and defer to algorithms.”

Thinking, Fast and Slow, by Daniel Kahneman. “Nobel laureate Daniel Kahneman’s seminal studies in behavioral psychology, behavioral economics, and happiness studies have influenced numerous other authors, including Steven Pinker and Malcolm Gladwell…. Two systems drive the way we think and make choices, Kahneman explains: System One is fast, intuitive, and emotional; System Two is slower, more deliberative, and more logical. Examining how both systems function within the mind, Kahneman exposes the extraordinary capabilities as well as the biases of fast thinking and the pervasive influence of intuitive impressions on our thoughts and our choices.”

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Memorial Day: The best way to honor fallen soldiers is to stop creating them.

Memorial Day wikipedia image

Memorial Day to honor those who served and lost their lives in that service.

As always, I support the troops. My divergence from most Americans is that I wouldn’t have sent them to die in bullsh*t wars in the first place. I don’t validate or provide cover to government sponsored and/or forced tragedy with a chest-thumping, misplaced, nationalist pride that mirrors the emotional and unquestioning obedience of religion.

While many would find this view offensive, it is not merely an inflammatory statement to invoke a moment of shocked contemplation. It has the deepest of implications. Those who believe and validate the manufactured premises, the white-washed histories, the overly simplified and distracting rationales, the promoted nationalist sentiment, the subservience of mind and body to the State,… they are a danger to humanity.

Many will point to the necessity of war in some circumstances. I don’t deny that here. What I will argue is that since the founding of the United States, it is unlikely that any of its wars have been necessary. Lincoln could have purchased slaves’ freedom, as every other developing nation did in their paths out of slavery. Was it morally superior for 600,000 soldiers to die in that war and to burn and pillage much of the South, as Sherman did in his March to the Sea?

WWI was hardly a US necessity. As a result, WWII likely would have never seen the German aggressions had not WWI’s Treaty of Versailles left that nation in a state of starvation and in search of a fanatical savior. Were the US not involved in China and blockading Japan’s imports of oil and commodities, the latter would have had little interest in Pearl Harbor or in debilitating the US in the Pacific.

All of the Cold War and its splinter wars (as well as the bloody, clandestine interventions) of anti-communist fervor, especially in Korea and Vietnam, would have been unfounded had FDR, and then Truman, not been the friend to Stalin, providing him a WWII win, increased power, and control over large swathes of Eastern Europe. (Realize, too, that Stalin killed tens of millions through starvation, political murders, genocide, and labor camps. Numerically, his level of mass murder could only have been dreamed of by the German with the little mustache.)

As what may be considered by many to be the most offensive thought in this post, please also realize that since WWII, had the US not been interfering, controlling resources, occupying nations, and overthrowing governments around the globe – typically without US citizen, and often even Congressional, knowledge – the invaders that came to attack in 2001, would have had no vengeful reasoning to do so. They attacked because their lands were occupied, they were being controlled, and there was no diplomatic avenue to address that resentment. None of that is to absolve the guilt of their offense, but for Americans to believe that persons from across the globe made the trip, efforts and ultimate personal sacrifices merely because they hated another nation’s prosperity, freedom and differing religions is a collective failure of reason. That failure is the result of purposeful ignorance and nationalist emotion. Certainly, that is the prevailing background of all wars throughout history.

While we must all be saddened by the loss of military lives, rather than validate governments’ and leaders’ misuse of its citizens, diverting attention and emotion from cause to effect, a more useful expenditure of energy would be to spend Memorial Day reading about these wars, their inceptions, the benefits elicited by these Authors of Destruction, the alternatives that were rejected, contemplating the costs, the disruptions, the societal upheavals, the unintended and little recognized downstream consequences, considering perhaps that our embedded worldviews might not entirely align with actual events and circumstances, and determining how to avoid these mistakes and misconceptions in the future.

I invite you to peruse the list of books on these pages for a relevant title. With a broadened perspective and a healthy dose of skepticism, perhaps we can make it more difficult for the Authors of Destruction to create the casualties that might be mourned on future Memorial Days. The best way to honor fallen soldiers is to stop creating them.




Addendum, the day after.

For a little levity, I’ll add the absolute silliness of our dogs at their Dogtopia home-away-from-home, where the spirit of the holiday was apparently in full force. This is embarrassingly adorable.

Taggart, humiliated but patriotic.
Ayva, ready for the parade.
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“Disease Mitigation Measures in the Control of Pandemic Influenza” – D.A. Henderson, et al

The COVID lockdowns continue, although many states are phasing back into permitting many businesses to open under conditions of masking, distancing, reduced patrons, etc. Some states are still heavy in their controls. For example, there was a protest in Michigan this week where barbers and stylists (still forbidden to work) cut hair on the capitol lawn in an act of civil disobedience. They were ticketed by state police, referred to the DA, and could face fines up to $500 and up to 90 days in jail, and lose their professional licenses for their “illegal operation of a business.”

In another example of abject silliness, San Francisco has allowed some parks to open, but in one park, placed social distancing circles on the ground. It is unknown what law enforcement measures will be taken against the non-compliant.

Meanwhile, criticisms of lockdowns, of government measures, and of the media’s general unquestioning approach and promotion of the same, have attracted censorship, shaming, conspiracist labels, de-platforming, verbal threats and even job loss. One source of criticism that I read today (from the American Institute for Economic Research) led me to a 2006 paper, which is the title of this blog.

Although government and media would have the public believe that concerns and responses to pandemics are novel, uncharted territory, and must be heavily managed by government interventions lest society be ravaged and overwhelmed by disease and death, these situations have been considered by experts and opined upon for years. D. A. Henderson, a Johns Hopkins epidemiologist (who died in 2016), is considered the “eradicator of smallpox.” He and his co-authors wrote about disease mitigation in a pandemic 14 years ago. They reject the measures that have been forced upon us all. They find those measures without proven efficacy and to have significant social and economic consequences. Although they specifically considered an influenza, COVID behavior is the same: a viral pathogen that follows biologic and epidemiologic principles.

Some of their recommendations: Wash hands, isolate the sick, support the vulnerable at home as needed with food and financial assistance, offset potential high hospital demand with alternative care sites (e.g. converted gyms), vaccinate once an immunization is available. The other social distancing, economic shut down, long-term school closures, mass “quarantine” (modified house arrest), even general masking measures, are not supported by evidence, and are not advisable.

So, if these measures have been previously discussed and modeled, and much of the official and media response disproven, rejected, OR AT LEAST NOTED TO BE DEBATABLE(!), what is the source of the current approach and controls? How did these measures become accepted, and even bullet-proof to debate? How did science and evidence become usurped by political pressures and unified media programming? How did one set of “experts” become untouchable, immune to criticism, given constant media promulgation… while others are vilified, silenced, intimidated, shamed, slandered? Who benefits? Who controls the levers of power, communication, public relations, the marketing of allowable opinion? Which poorly-evidenced and damaging precedents are now set for the next public health threat? What are the boundaries for minimum death tolerance? Will society be shut down if the promoted modeling shows that a thousand people will die? How can a cost-benefit analysis be considered by those that bear no costs, that have perpetual power and/or uninterrupted income?

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COVID Contrarians

graphic lifted entirely without permission from an article by an unsuspecting gentleman, Mr Sharma.

Although treated as social pariahs for speaking out, despite the threats to their careers and reputations, there are a number of physicians, epidemiologists, scientists, economists and politicians that provide reasoned opposition to the extreme social and economic lockdowns of governments’ CV-19 responses. In an attempt to turn up the thought and turn down the emotion, I’ll list some that I come across, in no particular order.

Video upload 29 April 2020. This Austrian politico is great! Reminds me of some of British Nigel Farage’s parliamentary rants against his governments’ idiocy over the years. “On April 22, 2020, before the Austrian government, former Minister of the Interior Herbert Kickl openly denounces the fear-based manipulation built on catastrophic forecasts, helped by the media, to establish a strict confinement, presented as the only possibility for avoiding a coronavirus mass death. However Sweden, judged irresponsible for not having applied lockdown, had neither mass death, nor destruction of its economy, nor freedom restriction of its citizens.”

Freddie Sayers’ UnHerd article and video interview on 02 May 2020, with Michael Levitt, “professor of Structural Biology at the Stanford School of Medicine, and winner of the 2013 Nobel Prize for Chemistry for ‘the development of multiscale models for complex chemical systems.’ With a purely statistical perspective, he has been paying close attention to the Covid-19 pandemic since January…. [H]e thinks indiscriminate lockdown measures [are] ‘a huge mistake,’ and advocates a ‘smart lockdown’ policy, focused on more effective measures, focused on protecting elderly people.” Some of the numbers that Levitt uses in the interview seem way off because I think he is using a “per 100,000 population” metric rather than total numbers. Regardless, his points are well made.

Opinion piece in the NYPost, 27 April 2020, by Daniel G. Murphy, MD, – chairman of the Department of Emergency Medicine at St. Barnabas Hospital in The Bronx. He says that his ED and hospital experienced 2 weeks of the worst medical situation that he has seen in his career. That peaked on April 1, 2020, and quickly declined. He calls to open the economy and the hospitals, to get on with suspended medical care. He reports that the virus is much more prevalent in the community (and subsequently has a much lower fatality rate) than is appreciated. He cites that 43% of people in his area test positive. The public’s fear is excessive. Natural herd immunity is developing. Get back to work!

The Bakersfield, California, doctors. May 4, 2020. “Perspectives on the Pandemic – Episode 6: When Dr. Dan Erickson and Dr. Artin Massihi held a press conference on April 22nd about the results of testing they conducted at their urgent care facilities around Bakersfield, California, the video, uploaded by a local ABC news affiliate, went viral. After reaching five million views, YouTube took it down on the grounds that it ‘violated community standards.’ We followed up with the doctors to determine what was so dangerous about their message. What we discovered were reasonable and well-meaning professionals whose voices should be heard.”

Zubin Damania, MD (ZDoggMD) interview from 17 March 2020. “Is Our Cure Worse Than The Disease?… Legendary vaccine scientist and rationalist Dr. Paul Offit and I discuss the current response to the COVID-19 epidemic, relationships to influenza and RSV, absolute vs. relative risk, which populations we should target most for social distancing, the fecal-oral spread of this novel coronavirus, comparisons to norovirus and rotavirus, and a deep dive into vaccine development and its challenges.” Dr. Damania has some other related interviews at his site.

One of several interviews by Journeyman Pictures with Stanford epidemiologist, Prof. John Ioannidis, who “discusses the results of his preliminary studies, including his latest, which shows a drastically reduced infection fatality rate of SARS-CoV-2. (Several study links are listed.) He also gives an insight into the Swedish approach to the crisis and gives a possible explanation for the escalated situation in New York City. Furthermore, he highlights the importance of remaining rational, analytical and aware of the potentially fatal consequences of the measures. Prof. Ioannidis advises we calmly and rationally consider which measures work and which don’t.” He says that no one should be blamed for being scared and reacting strongly to the unknowns of the virus, initially. However, science has given us the information to make adjustments to our approach. Deaths are on the order of a severe flu. Lockdowns do not have any evidence of superiority over the non-draconian approaches used elsewhere (like Sweden, Taiwan, S. Korea). Significant bad consequences are on the horizon for continued lockdowns.

Another great Journeyman Pictures interview, “Perspectives on the Pandemic Episode 5” with, Knut Wittkowski, a professor of epidemiology for 15 years in in Germany, who then worked for 20 years in NYC at the Rockefeller Institute as the head of the Dept of Biostatistics, Epidemiology and Research Design at the Center for Clinical and Translational Science. There was apparently a big media push to discredit this previous Professor of Epidemiology, that he was not so titled at the Rockefeller Institute. In this follow up video interview, he clarifies that he never represented himself as such. His true credentials are above. Sad that media and public ad hominem attacks have to be employed to attempt to discount and discredit him because his information cannot be refuted. He “says his initial claim has been vindicated: The lockdowns – always a dubious proposition for a respiratory virus – came too late in the U.S. and elsewhere, and were therefore even worse than useless. By turns emotional and darkly comic, Wittkowski ranges across all the essential topics of the crisis, and gives answers you are unlikely to see in the major media. Not to be missed.” Journeyman Pictures YouTube channel link. And their website with a host of documentaries and interviews. And here is Dr. Wittkowski’s pre-print study: “The first three months of the COVID-19 epidemic: Epidemiological evidence for two separate strains of SARS-CoV-2 viruses spreading and implications for prevention strategies.”

A study out of Univ of Rochester Med Center, April 2020. “The Potential for Antibody-Dependent Enhancement of SARS-CoV-2 Infection: Translational Implications for Vaccine Development.” The lethality of COVID is associated not so much with the direct effects of the virus, but rather the body’s massive immune response. Antibodies from previous infections or those produced by previous vaccinations may play a role in harmfully ramping up an immunopathology. This Antibody-Dependent Enhancement (ADE) may cause greater disease severity due to an excessive immune reaction that causes host harm and/or death. ADE is “linked to the development of cytokine storm syndrome, which occurs in the most severe cases of MERS, SARS and COVID-19 infection.” “… we may produce vaccines that enhance, rather than protect against, severe SARS-CoV-2 infection.” Study by Jiong Wang MD, and Martin S. Zand MD PhD. Department of Medicine, Division of Nephrology, and Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY USA. Here’s the downloaded .pdf if the link is not available.

2012 UTMB-Galveston immunology dept study with SARS vaccines. They led to infiltrative eosinophilic pulmonary disease. “Immunization With SARS Coronavirus Vaccines Leads to Pulmonary Immunopathology on Challenge With the SARS Virus.” Additional studies are referenced at the site. There is a big rush to develop a COVID vaccine. If previous vaccine attempts for corona viruses have had significant side effects, precluding their advancement to safe use in humans, I, for one, want to see some long term safety studies. Let’s make sure there is evidence that benefit outweighs risk. (Authors: Chien-Te Tseng, Elena Sbrana, Naoko Iwata-Yoshikawa, Patrick C Newman, Tania Garron, Robert L Atmar, Clarence J Peters, Robert B Couch. Department of Microbiology and Immunology, The University of Texas Medical Branch, Galveston, Texas.)

Professor Peter Collignon from the Australian National University medical school, interviewed by his local newspaper, 02 April 2020. The extreme government reactions and lockdowns are based on panic, not data. “You are safer outside than inside.” He also “took aim at modeling that suggests hundreds of thousands of deaths, saying the same models were used for the SARS, ebola and swine flu epidemics and had been wrong.”

16 April 2020. YouTube video. “Unlike its European neighbors and much of the rest of the world, Sweden has chosen to avoid a lockdown in the face of the coronavirus pandemic. Cato Senior Fellow (and a Swede) Johan Norberg explains why Sweden is keeping its country open and allowing so much economic activity, and why its approach may prove to be superior from a public health perspective.” He says, “Sweden isn’t the experiment. The rest of you are. No one has ever taken such drastic measures.”

17 April 2020, UnHerd interview with Swedish epidemiologist and consultant to EU and WHO, Johan Giesecke: “Why lockdowns are the wrong policy.” Professor Giesecke explains Sweden’s more reasoned approach: socially isolate the elderly and ill, encourage adults to work and study from home without police enforcement, *hygiene*, kids still go to school, people can shop, people practice distancing, groups under 50 in number are permitted. He says the models have been unreliable and based on highly variable guesses, that the draconian lockdowns have no scientific basis, that governments have no viable criteria from which to back down from the lockdowns because there is no achievable goal (when deaths are zero for a month?), that this will likely be on the order of a severe flu season, that many millions of people have already had the virus and mostly been low to asymptomatic, that although typically the virus will take months of life from the elderly and ill it is the living that will deal with the aftermath of societal disruption and government excesses (especially the dictatorial trends of Eastern Europe), that even if lockdowns have an effect at slowing spread that ultimately the final death count will be relatively unchanged, no matter what you do this virus is a tsunami that will roll across the globe, fear and political gain drive the response rather than science, a major epidemiologic difference in COVID transmission and influenza is that the latter is driven by children whereas the the former is uncommon to affect the younger population,….

17 April 2020, Spiked Interview with British pathologist Dr. John A. Lee. “There’s no direct evidence that the lockdowns are working” Some of Dr. Lee’s quotes: “Unfortunately, the media have tended to reinforce the initial ideas about what this disease was like which have not necessarily been borne out by the numbers since then. …other places which are doing different things seem to have similarly shaped graphs. It is only an assumption that the lockdown is having a big effect on the virus spread, but this is not a known scientific fact…. It seems incredible to me that we are not equally as interested in the effects of the lockdown on lives and livelihoods as we are in the actual virus itself. I think we are guilty at the moment of being a bit monomaniacal and focusing only on one thing, and really not focusing enough on the consequences that are coming out of what we have done to face this one thing.”

researchgate.net link or click here for .pdf

Full lockdown policies in Western Europe countries have no evident impacts on the COVID-19 epidemic. Thomas Meunier. Woods Hole Oceanographic Institution, Falmouth, Massachusetts. Ensenada Center for Scientific Research and Higher Education, Ensenada, BC. April 23, 2020. Abstract: This phenomenological study assesses the impacts of full lockdown strategies applied in Italy, France, Spain and United Kingdom, on the slowdown of the 2020 COVID-19 outbreak. Comparing the trajectory of the epidemic before and after the lockdown, we find no evidence of any discontinuity in the growth rate, doubling time, and reproduction number trends. Extrapolating pre-lockdown growth rate trends, we provide estimates of the death toll in the absence of any lockdown policies, and show that these strategies might not have saved any life in western Europe. We also show that neighboring countries applying less restrictive social distancing measures (as opposed to police-enforced home containment) experience a very similar time evolution of the epidemic.

Addendum 09 May 2020: On May 6, 2020, US Senate video round table led by Pat Toomey – PA (R) with expert witnesses for epidemiology, health policy, economics and physician leadership. Some of my interpretations: it is safe to allow phased and gradual opening of schools and workplaces while continuing to increase targeted testing and screening surveillance; nursing home and hospital patients and staff need high levels of testing as potential hot spots for resurgence; much of the rest of the country’s population can receive “representative testing” samples with more focused testing and isolation in response, which can be accomplished with fewer than 1 million tests per day; the country is in a much better position than a few months ago and has proven a high health care capacity, especially considering that the very high original estimates for morbidity and mortality were inflated; the “new normal” may include retaining changes in our social patterns of interaction (e.g. no more hand shaking, comfort with greater distancing,…) and delivery of health care (like telemedicine); the health care, economic and social costs of lock downs have been and may still be severe and must be balanced against realistic health benefits; the vulnerable will still need to be isolated and protected; as phased opening occurs, any identified areas or venues of increased will need modification;….

Addendum 12 May 2020: This past week it came to light that the computer modeling code used by Neil Ferguson is basically garbage, or sh*tcode. In Mark Jeftovic’s article: “It was an Imperial College computer model that forecasted 500K deaths in the UK (and 2.5 million in the US) should policymakers pursue a ‘herd immunity’ approach (a la Sweden), that influenced them to reverse course and go full lockdown instead. The model was produced by a team headed by Neil Ferguson, (who recently resigned his post advising the UK government when it surfaced that he was himself violating lockdown directives by breaking self-isolation for dalliances with a married woman). The source code behind the model was to be made available to the public, and after numerous delays and excuses in doing so, has finally been posted to GitHub.” A former senior Google software engineer reviewed the code here and calls for an immediate retraction of any publications based on it. A reddit thread entitled Code Review of Ferguson’s Model calls for review and commentary by professionals in the field, and is scathing.

Washington Post, May 9, 2020: The recurring mantra is to trust the “experts.” “… in this COVID-19 atmosphere, where scientists and researchers and medical professionals and scholars have taken over much of the control of U.S. politics and government and how American citizens are supposed to now behave and function — it’s more important than ever to remember this: Scientists can be wrong, very wrong. Moreover, scientists can lie. And very often, as history shows, they do.” (Article and links duplicated at RPI, if placed behind pay wall.)

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Sweden as a Voice of Reason Amidst COVID Hysteria

Graph from worldometers.info, 06 May 2020

Lockdowns continue in most of the world. While some states in the US are moving towards phased opening of businesses, others have extended lockdowns to as late as July 5, 2020. The economic fallout continues with record unemployment and underemployment (including in the health care sector), $trillions in new federal debt this quarter, disruptions and massive spoilage in food supplies, people are being fined and even arrested for violating local laws against commerce and associations,….

There continues to be much emotional and political argument about correct approaches. There is fear that phasing out the extreme distancing laws and guidelines will lead to increased viral transmission and death – second and third waves which could yet overwhelm. Lockdowns and social distancing are treated by many as religious tenets, not to be breached or challenged, regardless of logic, reason and/or scientific data. It is socially unacceptable to introduce information and opinion contrary to government and media guidance. Social media and Youtube have censored, deleted and de-platformed opposing opinions, articles, interviews and videos, labeling them as fake or false information, placing themselves as arbiters of truth.

Not all countries have followed such extreme distancing and lockdown measures. Sweden has been one that has mostly allowed life to proceed without forced economic and social shutdowns. There are distancing measures, like reduced capacity in restaurants, encouraging distance between persons, limiting gatherings to fewer than 50 people, encouraging hygiene, isolating the elderly and ill, etc. But, their kids go to school and people are permitted to work. They don’t fine and arrest for violations of commerce or association.

Sweden’s fatality rate from the virus has been higher than some countries that have enforced draconian lockdowns, but lower than some other countries. No country or person is protected 100%. There is risk. Sweden, however, has also seemed to better analyze the costs of their approach, avoiding the economic devastation that the US, in particular, has imposed upon itself. Perhaps needlessly. Or criminally.

Following Sweden’s case fatality rate shows that their curve seemed to have peaked two weeks ago, around April 23, per worldometers.info’s Sweden CV-19 page today. The entire “flatten the curve” social distancing/lockdown paradigm that most of the world has pursued was based on an avoidance of overwhelming the capacity of health care resources, hospitals, ventilators, ICU beds, personal protective equipment. Well, there ya go. Sweden accomplished that without devastating the 99.8% of the population who didn’t die of COVID. Sure, this is just one country for comparison, but it is information, evidence, data.

Maybe the COVID hysteria was and is misplaced. Maybe it was correct to take extreme measures against an unknown, initially. Maybe as reasoning human beings there is a duty to consider new information, to have a high degree of skepticism for those actions (like lockdowns) that cause significant harm to persons and society, to look outside of stringent paradigms for other answers and approaches. Maybe the high emotion is interfering with discourse, processing, adaptation. Maybe we have become too dependent on politicians, media and systems of perceived authority for our information, opinions and direction. Maybe it’s okay to question, to push back, to ridicule the ridiculous.

worldometers.info for S. Korea, 06 May 2020

Addendum: South Korea, Taiwan, Singapore and Japan have also been less restrictive in their approach. Per Business Insider and multiple other sources, “South Korea successfully flattened the curve on COVID-19 in 20 days without enforcing extreme draconian measures that restrict freedom and movement of people,” although they did track the infected with cell phone location to assure quarantine cooperation. That would surely bother many civil libertarians. Regardless, aside from public school and some high density business location closures (like gyms), people have been able to work and move about. Korea focused on broad testing, communication with the public about areas of exposure, and isolation of the at-risk and ill. Worldometers’ data shows Korean deaths peaked around March 28.

*Of note, I have not followed “number of cases” diagnosed. Testing rates have been too unstable to rely upon for disease spread. Deaths are a bit more definitive, and can be trended more accurately. Of course, at least in the US, a positive COVID test is not even required for the disease to be listed as a cause on the death certificate.

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Lockdowns as Violation of Medical Ethics

If we look at the lockdowns as treatment of the virus, or at least as medical prevention, then part of that prescriptive responsibility is to know the side effects and costs of that treatment. The four principles of medical ethics must be considered: individual autonomy, justice, beneficence, and non-maleficence.

What autonomy is left to the individual via lockdown?

Are the lockdowns just?

Is there scientific evidence that the lockdowns are beneficial to patient (and society)?

Do the lockdowns cause harm to individual (or society)?

There are many doctors (most, I imagine) that unquestioningly conform to “lockdown as prevention” as prescribed by state and federal governments. I do not believe that the prescription meets ethical or scientific criteria. I’ve shared some of the scientific failings and costs through my previous posts and links to others’ articles and interviews, including those of other physicians and epidemiologists.

So, how then SHOULD we proceed in an effort to mitigate the viral threat? Certainly, steps can be taken which can have an effect without causing harm.

Ethically consistent: encourage social distancing while continuing much of life, work or study from home as able, allow anyone to isolate at home who so desires, protect the elderly and ill from outside contact as possible, encourage hygiene and general healthy living, offer broad testing to track spread and immunity trends, collect and share confirmed data (not guesses, and assumptions).

Unethical: mandates by coercion and threat of force that prohibit work, travel or association. Fines and arrests for violations. Shaming and intimidation tactics to discourage any challenge to mandates. Certainly, any private organization that desires to place a condition on its employees and patrons (wash hands, take temperatures, wear a mask, etc.) is free to do so, as those persons are free to associate or not with that entity.

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Impacting the 99.95% Who Survive – what COVID doesn’t kill, government might

COVID-19 lockdowns continue. Much of the country has been prohibited by federal and/or state governments from working, moving about, purchasing “non-essential” items, or associating freely (even with masks and distancing). Churchgoers and clergy for Easter services were fined or arrested in some areas. This is recognized as excessive precaution and government overreach by many, leading to protests in state capitols this past week.

CDC dashboard today

Initially, back in early March and some weeks before, the fear was that hospitals would be overwhelmed and that there would not be enough ventilators and ICU beds to handle the critically ill and dying. That crisis scenario was how all of the economic and societal lockdown was promoted. That was the marketing for “flatten the curve.” With some exceptions in high density populations, especially New York City, hospitals are generally well under capacity, in economic crisis, furloughing staff (140 hospitals identified as of today, per Beckers Hospital Review). There ARE enough ventilators. Initial projections of deaths were up to TWO MILLION, then revised down to 250,000 with social distancing and quarantine models. We’re at 33,000 deaths in the U.S., as of 17 April 2020 (potentially inflated as no testing is required to add COVID as a “suspected or likely” cause to the death certificate per CDC guidelines). We are 2 orders of magnitude lower in deaths than the original estimates. That seems meaningful.

While there are hospitals in select areas (primarily the densely populated New York City metro area) that have been at capacity, the U. S. medical system has not been overwhelmed. While news reports provide shocking pictures of a few hospitals requiring corpse overflow for their morgues, military and national guard makeshift hospitals and ships have not supplied direct COVID care or patient overflow assistance in significant numbers. They have essentially gone under- or un-utilized.

Economically, the government-imposed lockdowns have led to record unemployment. We now see food bank lines reminiscent of the Great Depression’s bread lines. The response is costing trillions through stimulus, contentious bailouts and new federal debt. The economic distortions, the picking of winners and losers, the market manipulation, all will have unpredictable, and certainly undesirable outcomes in the cost column… with an uncertain benefit in regards to reduced viral transmission and death. These unintended consequences cannot be predicted. As 19th century economist Frederic Bastiat wrote about in The Law, there is “the seen and the unseen.” We see lockdowns, stimulus checks and government attempts to intervene into the economy. However, we cannot see what those downstream and long-term effects will be, or what might have been if one entity or set of persons were not artificially preferred over another. Which jobs and businesses would have survived? Which benefited corporation or bank perhaps should have been allowed to fail? Which individual choices and avenues will never become available to us as a result?

Continuing the point of view from my previous blogs here and here, I argue that the attempted cure for this strain of virus appears excessive for its level of risk and is likely to have greater cumulative negative effects on economy and society than the virus itself. The attempts to “flatten the curve” of the viral peak which could strain the medical system will cause a much larger, longer and higher peaked curve of societal damage. Admittedly, in the early days of CV-19, there was far too much unknown. Extreme caution can be excused, maybe even applauded, despite the decades of funding of government entities which should have been generally watchful and prepared for such events with appropriate plans and equipment, even if the pathogen was yet unknown. (CDC, FEMA, WHO, perhaps even the CIA for failed global threat analysis,… are they good for anything other than drone bombs, black site renditions and torture? Anyway…. ) The American taxpayer has certainly paid dearly for these entities and should expect appropriate pandemic plans and logistics to have been in place for early and brisk response. That’s an article for another time.

However, we now can see data and inputs which provide improved perspective… or those can who are not paralyzed by the fear, emotion and reflex defense of their initial responses, ideas and policies which they are resistant to dial back. As always, there are considerable political investments and exploitative gains at stake for just such useful crises, which create conflicting incentives for interventionism. Regardless, as reasoning, analytical human beings, we should use new information and conditions to adapt our response and planning.

It is time for low-risk Americans to cautiously get back to life. There is a middle ground between careless frolicking about during high virus season versus the lockdown of all living things. In Taiwan, for example, children were kept out of school for a few weeks then returned with daily screening and increased sanitation measures. Citizens showing signs of illness were quarantined and their progress tracked. Social distancing was especially encouraged with the elderly and those with co-morbidities. People generally have been able to work, function and live while maintaining precautions. They have arguably done better at disease mitigation than any other country which has locked itself down.

For every life that it is argued could be saved through extreme lockdown conditions and government responses, what are the costs in quality of life, living, well-being, lost wealth, unfathomable national (and perhaps personal) debt and ongoing societal disruption? What will be the consequences of the interventions into lives and the economy over the coming months and years? How will the political powers and controls have expanded? How will the landscape for employment have shifted? Which businesses and jobs will not have survived? Who will have lost their employment-provided insurance? What will that effect be on the provision of medical care in the near and long-term? (And if this is the point where you say, “yeah, that’s why we need national health care”… I’m inclined to temper that thought with, “you do see what national health entities have failed to do in this one instance alone, right?” I’m not enthused to give them ALL of the health power. Again, an article for a different time.)

Yes, people are still dying from the COVID-19 virus. It is serious. Of the roughly 2.8 Million Americans that die from all causes in an average year, per CDC data, the number of deaths so far this year from the virus is at 33,000 and climbing. It deserves significant attention. However, referencing my opening paragraph, 33,000 is not 2 million. It is orders of magnitude in difference. Perspective must protect us from societal paralysis and economic destruction. Our approach must be adapted with new data to allow us a reasoned and prompt way back to living – for the 99.95% of those among us who will survive. I hope to be among them. If I am not, at least I will not have promoted a legacy of destruction to plague the generations that follow.

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The Silk Roads: A New History of the World – by Peter Frankopan

Pandemics, climate change, natural disasters, destruction of civilizations, government excesses and collapses, famine, oppression, war, slavery, greed and exploitation, the rise and fall of many empires,… and the human perseverance, development, markets and successes over the thousands of years that trend toward improved quality of life, better standards of living, recognition of individual rights, decreased human misery and poverty. There is nothing new over the millenia. Some of it is just done differently, and online.

Perspective. The lessons of history. Immutable human nature. Cause and effect. Choices and consequences.

Just completed the audiobook. Thank you, Mr. Frankopan.

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COVID-19 Craze Continues

Italy, who.int dashboard, as of 20 Mar 2020

I wrote last week about the novel coronavirus strain that has the world paralyzed. Of particular note is the experience in Italy with their ICU beds filled to capacity. The state of that nation has driven increasingly drastic isolation responses in the US. As I’ve tried to get some perspective on Italy’s situation, I would point to a few tempering facts. 1) The rate of infection, the surge, or the “curve,” of cases is admittedly of concern for sudden capacity stress within the US hospital system. I just listened to a JAMA podcast (Journal of the American Medical Association) with a physician director of critical care in the hard hit Lombardy region of Italy. Around minute 9:00 he reports that their area has roughly 8 ICU beds per 100,000 population. In comparison, I found that the US may have 20-30+ ICU beds per 100,000. US capacity for care appears much better, by multiples. 2) Italy has an older population, with elderly and those with co-morbid states (cardiopulmonary disease and diabetes, for example) being primarily those who die from COVID. Per wikipedia search, Italy’s elderly are about 20% of their population, compared with 15% in the US. Of note, also, per prior wikipedia search, their smoking rate is 20% – higher than the US, although a smoking link with COVID mortality is assumed by me but not proven. So, there are some definite population differences. 3) To compare illness numbers, Italy in recent years has had influenza deaths averaging 17,000 per flu season. COVID deaths are numbered at 3,400. In addition, the World Health Organization COVID dashboard shows Italy’s new cases to be leveling off.

As China and South Korea seem to be mostly through their epidemic, deaths to date from COVID are 3,250 and 94, respectively (see WHO.int dashboard for those countries). In a bad year, influenza deaths worldwide can range between 250,000 and 650,000 (noted in previous blog). Again, admittedly, the surge of COVID may vastly outpace the rate of rise of influenza cases, as well as have a higher mortality rate. But as the data is collected the numbers do not look catastrophic. As testing of the population becomes more common, the mortality numbers are declining. Of course, much is still unknown, data is still being gathered, broader testing of the public is just being rolled out significantly this past week in the United States. However, we do have some data from the aforementioned and other countries, as well as cruise ship isolations/quarantines, that COVID is not the Spanish Flu of 1918 or the Bubonic Plague. From the public health, media and government responses, one might think it was and that disability and death were knocking on our doors.

Regardless of tempering data, this week has seen some (in my opinion) extremely authoritarian government mandates. US state governments have varied in their responses, but multiple states are in a condition of self-quarantine or in-home isolation for all citizens, work stoppage, forced closure of businesses. In my state of current residence, the Pennsylvania governor mandated closure of all non-life sustaining businesses. Some states have forbidden the gathering of more than 50 or 25 or even 10 persons… with calls to the public to report violators to the government. Restaurants that attempt to seat and serve diners have been shut down by law enforcement, with arrests made. Aside from any gross violations of Constitutional Law or the Bill of Rights which would guarantee citizens’ rights of speech, association, labor and movement, there has not been any appreciable civil libertarian resistance.

WHO.int COVID dashboard, as of 20 Mar 2020

Again, while COVID may carry higher infectious and mortality rates than influenza, examining numbers adds perspective. In the US, the current flu season has seen 36M confirmed cases, 370K hospitalizations and 22,000 deaths. In comparison, COVID here has caused about 15,000 confirmed cases and 200 deaths to date. This is no guarantee that the health care system could not become overwhelmed, but again, we’re seeing disease patterns and numbers here and elsewhere that permit insights and reasons for optimism, rather than panic and complete lock down.

Hospitals are preparing for potential surges of COVID related pneumonia cases. In order to make rooms and ICU beds available, as well as to minimize potential infectious spread, surgical cases are being minimized. My affiliate hospital in Pennsylvania stopped performing elective surgical and procedural cases (from OR to GI lab to interventional radiology). As an anesthesiologist who covers these sites and cases, I’ve observed our case load decrease by up to 75%. Another factor constraining our service is the national shortage of Personal Protective Equipment (PPE, like gloves, masks, goggles and disposable suits). Health care workers are uncertain of our exposure risk, especially from asymptomatic patients who may shed virus for up to 14 days. Universal precautions with typical surgical masks may not be enough as viral particles are aerosolized. A tighter fitting and more filtering mask, the N95 (used to protect against TB exposure), is in high demand and short supply, although companies are ramping up production.

Meanwhile, economic, social and governmental controls and fallout are increasing daily. I’ll post in the comment section some articles of interest as we proceed. While I do hope to persuade any readers to take a more tempered and thoughtful approach to this situation than what is being pushed by media and government, equally I write in order to create a log of an event that afterwards will likely quickly fade from memory, having been a precipitant to societal change which will certainly just be an accepted norm at some point in the near future, with historical perspective and roots retained by few.

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