It is week 39 of the increasingly irrational response to the Sars-Cov-2 viral pandemic in Pennsylvania and elsewhere. It is a response, increasingly the province of emotions and politics rather than science and logic. In our Commonwealth, it involved an abrupt change in regulations that deliberately suppressed the festive winter holidays that help to keep us sane over the dark days of the solstice.

In this article I wish to pose some questions. I am neither a virologist nor an epidemiologist. I am merely an internist and pulmonary physician engaged in the menial tasks involved in actual patient care. But, I can read.

As many of you know, I contracted the virus shortly before Thanksgiving. Against the judgment of the experts in this country (but not elsewhere) I took a course of hydroxychloroquine and azithromycin that I had on hand from when such medications were deemed promising. Six hours later I had the most abrupt cessation of viral symptoms I had ever experienced. Anecdotal?… Sure.

 I decided to do a search to review the current data. I first searched on Google. This produced a list of articles emphasizing the negative aspects of the drug. Most of these references described its use in the hospital setting.

Out of curiosity, I then performed the same search in the increasingly popular DuckDuckGo search engine. Amazingly, it brought up a much more varied group of studies. For instance, It cited a review article from the Journal of New Microbes and Infections. Written in November 2020, the authors reviewed 43 articles written on hydroxychloroquine and COVID. Twenty-five of them showed clear clinical efficacy, 11 showed no efficacy, and 3 reported worsened outcomes. Most notably all of the articles examining hydroxychloroquine used early in the course of Covid 19 (outpatients) supported the use of the medication.

This should not be read as advocacy for use of the drug. My question involves why there is a discrepancy between the studies in the literature and the stance taken by the government and organized medicine. For instance, why did the AMA seemingly soften its recommendations against the use of the drug in late October on the eve of the election? And why is there such a difference between a search on Google and on this upstart search engine? I feel very manipulated.

Here in Pennsylvania, like much of the rest of the country, our positive tests skyrocketed in December. In the last several weeks it appears that the numbers may have peaked and are now in decline. Testing is also declining, hopefully, due to decreased demand. There was a small post-holiday bump (or perhaps an intra-holiday dip) Hospitalizations also seem to be on the downslope. Happily, even though the peak in positive tests/day was 7.5 times the peak in April, hospitalizations ended up being little more than twice those in the spring. Again the system has not been overwhelmed. According to the state, between 1 and 2% of emergency room visits are for “Covid-like illness”. Elective surgeries are still performed.

I have certainly advocated using the disease impact rather than just new cases, as the trigger for government action. Over December, there was a lot of talk about hospital occupancy being in the 90-100% range, with full ICUs. Clearly, some of that patient population is being treated for coronavirus, but given the low percentage of ER visits that are due to “Covid like illness,” it’s hardly the predominant admitting diagnosis.

What I don’t think people understand is how hospitals work. In Luzerne County Pennsylvania where I currently reside, there are 4 acute care hospitals, only 2 of which offer tertiary care level critical care. Twenty-Five years ago, there were 8. In the intervening years, the smaller hospitals either closed or were absorbed into the bigger systems. Their buildings tend to be used for outpatient and/or subacute care. Thus there has been a big decrease in acute care hospital beds.

Because of this, it is now commonplace, especially in winter for admitted patients, to be “stuck” in the emergency room for lack of any beds upstairs. (it happened to my father last February). This is financially beneficial to the hospital systems who obviously do not get paid to staff empty rooms. So the hospital bed situation we face now is not particularly unusual.

Another problem is that Covid patients tend to be admitted to ICU settings regardless of severity. This is because, in many hospitals, it is the critical care units where the “negative pressure” rooms are located. These rooms have airflow that is exhausted to the outside, not back into the unit itself, preventing viral spread. Another factor is nurse staffing, as ICUs often provide one to one nurse-patient ratios, which helps to deal with the arduous personal protection efforts inherent in their care.

I continue to hear people tell me that they have undergone testing for multiple reasons, most often not for symptoms. My own illness apparently provoked a flurry of testing among my asymptomatic friends. It is interesting that on our state’s “Covid dashboard” they report not “positive tests” but “positive PCR tests”.

I have written before about the PCR test before, quoting articles including a highly publicized report from the New York Times documenting the tests on reliability. PCR tests are designed to look for fragments of DNA/RNA. The test relies on amplification cycles to progressively increase its sensitivity. Up to 40 such cycles are utilized in routine testing for Covid RNA strands. Experts on the technique suggest that no more than 20 would be a better limit to prevent false positives. Why haven’t we fixed this?.

We could report the number of amplification cycles needed with the results, This would tend to put things in a better perspective. For instance, if a person tested positive after only 15 amplification cycles the likelihood that they are truly infected is much higher than if detection of the RNA required 30 or 35 cycles. It’s not clear why this information is withheld. Reporting is required in some states (Florida).

Speaking as a recovered patient I see many inconsistencies about the rules going forward. One question would be with masks. Apparently, the powers that be suggest I should continue to wear a mask even though: #1 I can no longer infect anyone, #2 I’m presumably relatively immune and not at risk of recurrent infection (at least until the next seasonal cycle), and #3 if I do get reinfected, I’m likely to weather it well. So why the mask? I suspect it has to do with emotional support for the more Covid frightened population and to encourage conformity. Neither of these reasons is particularly compelling, especially as I do have respiratory issues and the mask makes me short of breath.

Another related question would involve the vaccine. This has not had the cleanest release with reports of allergic reactions, and immune-related side effects, particularly after the second dose. Dr. Fauci says that even if you’re vaccinated, you should continue to socially distance and wear a mask because “you could still infect someone”. If that is so…

THEN WHY IN HELL SHOULD ANYONE SUBMIT TO VACCINATION?

Dr. Fauci also says that those who have been infected and recovered should also be immunized. So I ask myself: My immune system has been exposed to the entire virus with all of the related proteins. Why would my immunity be improved by being injected with a vaccine that ultimately replicates only the spike protein of the virus? And, as my B and T cells are already familiar with the spike protein, wouldn’t the side effects be worse?

I want to make myself clear here. I actually do think people should be vaccinated, both for their own protection, and to reduce the spread. Depending on how things evolve, I may choose to be vaccinated, perhaps next year once more data is available. But whether you are a survivor or have been immunized, I do think it’s time for you to drop the masks and the other rituals, that are ruining our quality of life.

I have one last concern. This virus isn’t going to go away. Once we reach herd immunity either through infection or vaccination are both, it will recede to the background. There’ll be occasional infections, but in an immunized population, they will be less consequential. Remember, any of the respiratory viruses have the potential to kill a vulnerable host.

What is going to happen perhaps next fall when respiratory viruses surge again? Will we continue to test for Covid, and begin to panic once again when positive PCRs start increasing? Hopefully, a reduced rate of hospitalizations in the newly immune will temper this effect. But I doubt it.

2020 was obviously a very difficult year particularly for those who lost loved ones to Covid. I have been lucky in that regard. The fact that that government, and healthcare profession appear to be manipulating data to achieve political aims as well as profit, is for me, a source of profound despair.

I used to believe.

I am now officially a skeptic.

As always, I would be honored if he would share this post.

Header image: Birch in December (Sony RX 100 III)