We have now reached week 10 of the Wolf/ Levine “2-week lockdown to flatten the curve”.

For my county, Luzerne, and other counties in eastern Pennsylvania, there is a tiny light at the end of the tunnel. On Friday, we are going to be allowed to exercise a slightly larger sliver of our former civil rights. We are moving into the “yellow” phase.

For many people, this will seem like thin gruel. Though the governor will allow us to open more of our businesses, which will undoubtedly help some to survive, he still refuses to allow restaurants, hair care professionals, athletic facilities, and shockingly, the almighty casinos to reopen. Schools also remained closed, even though children are minimally affected by this virus. Church services are still functionally forbidden.

He is finally allowing much of the Northwest of the state to move into the so-called “green” phase. Even this however is rather restricted with some businesses limited to 75% of capacity, and bars/restaurants limited to 50%. The governor likes to refer to this as “the new normal”.

He now apparently believes, that we cannot return to baseline until there is a vaccine (presumably one that is widely available). Perhaps conveniently for him, this is unlikely to occur before early November.

If I lived for instance in Tioga, Cameron, or Sullivan County each of which has low single-digit numbers of cases, and no deaths, I would be furious. These counties have likely had more influenza cases than COVID cases, yet they are only now being allowed into the “green” phase. Imagine owning a small business in say, Coudersport, and watching it fail, arguably for no good reason.

Germane to this, is new data out of the CDC suggesting that the death rate of this virus, based on the ever-growing number of documented asymptomatic cases, is down to about 0.25%. This is roughly what is seen during a bad influenza year.

,Another fascinating study has found that 40% of random blood samples collected from patients prior to the pandemic have immunologic cross-reactivity with COVID 19. In other words: some of us may have had full or partial immunity to this coronavirus all along. This helps to explain so many infected ended up asymptomatic or with very mild cases.

As I reflect on this, I think most everyone supported a short period of lockdown, especially given circumstances such as those in Italy, and of course in New York City. It was not unreasonable to think that such a dire situation could’ve happened here. It clearly did not, but despite this, the lockdown continues.

In fact, most of the severity of COVID 19 in Pennsylvania occurred because of the Wolf/ Levine decision to insist that infected patients be admitted to nursing care facilities. This of course occurred at the same time Dr. Levine insisted her elderly mother be moved from just such a facility, to a hotel. I don’t really want to fault a decision to protect an aging parent, but the sense of risk to the mother should have absolutely informed the decisions affecting other elders at risk.

If one looks at deaths per 100,000 of the population, Pennsylvania’s number is 40. Florida, early on did the opposite and prohibited COVID patients from admission to nursing facilities. Their death rate that is one quarter as large. As more than 2/3 of deaths in Pennsylvania involved nursing facilities or personal care homes, the numbers make sense. And remember, Florida locked down less severely, and opened earlier, than Pa.

Now to be fair, there was a concern at the beginning of the pandemic that hospital beds would quickly fill, and nursing homes would have to be utilized for convalescing patients. On the other hand, the first outbreaks in the country, occurred in Washington state where it swept in deadly fashion through nursing homes in the Seattle area. This might have been a clue as to what not to do.

At any rate, the disease statistics being used to justify our imprisonment were mostly the result of faulty decisions made at the beginning of this pandemic. And so far as I can tell the governor’s emergency powers have no time limit.

I was curious about what limitations different states place on their executive branch during times of emergency. It turns out that 35 states are like Pennsylvania, in that they allow the governor to change both statutes and regulations under emergency powers. Seven states allow Governors to only change regulations, and 8 states give the governor no explicit power under these circumstances.

While we need to our governors, to have flexibility during times of emergency, this should have limits.

We need to revamp the system. I imagine the law modified so that at some point, perhaps a month, any emergency authority should expire, which would relax all the restrictions that have been imposed. This would occur unless the state legislature voted to extend the time limits. Any extension by statute ought to itself be limited, requiring additional votes. This would force the governor to work with the legislative branch, rather than reject their input as Governor Wolf has done.

I have no wish to disparage fellow public servants who in the beginning, worked very hard to contain this pandemic. Happily they succeeded. As this drags on, it is not hard to believe that other factors are at play.

And they’re likely no longer about us.

We have now reached week 9 of a societal aberration that was supposed to last for 2. The lobster pot is starting to simmer, while we accept completely illogical, and capricious prohibitions, that would’ve been unthinkable 4 months ago.

Some retailers are allowed to be open, while other similar businesses are forced to remain closed because of an arbitrary process of waivers, granted by the state. The practice of religion is suppressed as ruthlessly as it might be in communist China. You can still obtain an abortion, but cannot schedule a procedure to alleviate the severe pain in your arthritic knee.  

Despite the improvement in your statistics, if you live in the wrong city or county, there is no end in sight.  Businesses both large and small are running out of money and calling it quits. And because of this, jobs are disappearing.

And in most cases where these restrictions are imposed, they are edicts of the executive, who dismiss any action, even at this late date, from the state representative bodies. In Pennsylvania this means that a lame-duck governor, and his ethically dubious health secretary, are acting without any voter accountability. They have rejected any input from the legislature (formerly called laws). They are overseeing the destruction of the state economy, perhaps with an eye towards the upcoming presidential election.

Let’s talk about masks. There is no consistent data on the use of masks. There are a lot of statistics bandied about, but little hard science, particularly in the face of the vast variety of face ware people are using.

Some justifications I have read include the idea that since countries like Taiwan and South Korea, have widespread usage, and they have done relatively well during this outbreak, then masks must be useful. Not really hard data from my point of view.

According to the CDC, on one hand, if a sick and a well person both have masks on, the transmission of virus will be very low. One study from the University of Hong Kong, studied this in hamsters.

Before you indulge yourself with the unbearably cute image of hamsters with teeny -tiny masks, it turns out that the study involved covering the hamster cages with mask-like fabrics. It did show that transmission of coronavirus was the lowest with both infected and uninfected hamster cages covered,

This is interesting I suppose, but it is not really directly comparable to our situation.

I wear a surgical-type mask in places where it is requested, mainly as a courtesy to others. The right mask can protect those that you encounter. Unless you’re wearing an N95 mask or better, it is unlikely to protect you. Many of the facial adornments I see in public are probably useless.

I can’t find any data to suggest wearing a mask in the out-of-doors protects anybody if people keep a reasonable separation.

I suspect we are all much too cavalier about these masks anyway for them to be useful. According to the WHO, we need to avoid touching them (yea right), and each time we do, we need to wash our hands once again. I’m sure we’re all doing that. They also worry that wearing a mask may cause some people to ignore social distancing. By observation, this seems to be true.

 I finally received the fancy masks I had ordered so many weeks ago through Amazon. This was a 5 pack of black masks said to be washable. It turns that these are made of a rubberlike plastic, with the mask itself composed of a foam-type material. Now the foam seems fairly dense, but I suspect not enough to filter micron-level droplets.

Unfortunately, the manufacturer included a button-like one-way exhalation valve on the right side of the mask. This conveniently allows me to share my potentially viral-laden droplets with others. I have relegated these masks for workshop duty, but I still see people wearing them.

I guess the message here, is that I hope we don’t get too hung up on facial coverings, as I suspect they are of limited value.

We continue to be told that this virus is likely to be persistent in the environment. In fact it is this theory that is being used to prolong our isolation.

It can be argued that the fact of viral persistence should lead to the opposite conclusion. If we are stuck with this coronavirus, we will not be able to avoid it forever by staying at home and keeping businesses and schools closed. The long-term cultural and psychological effects of this would be devastating.

Oh yea, and it will destroy the economy.

We are going to have to protect our most vulnerable, but the rest of us will need to swallow hard and understand that as the denominator increases with increased testing, that the mortality rate in most locales for relatively healthy people younger than 65, is quite low. The overall case fatality rate in Luzerne County for instance is about half a percent. At one point, two-thirds of those came out of nursing facilities.

I don’t want anyone else to die. But the state, national, and global economy has to survive if we’re to avoid a civilization level disaster.

I say this with the knowledge that in the event of a second wave, given my profession, I may be drawn into the middle of it.

We have endured a difficult spring, caused by both the pandemic and some persistently cold, crappy weather that made things even less pleasant. This weekend however is Memorial Day, our traditional beginning of summer. In the Northeastern US it is predicted to finally be warm and dry. I suspect people may find that the joys of the season may beguile them from their isolation.

I will likely be one of them.

Come see my new mask.

Well, here we are in week 8 of the coronavirus shutdown. For those of us in Luzerne County, there is essentially no end in sight. Clearly, we had been a hot spot in the state.   But our numbers have stabilized or decreased despite the vastly increased testing available.

This feels promising compared to the situation where testing was less scarce but our growth in cases was exponential. Something is happening. It’s likely not all because of mitigation.

It is worth noting however that here, in Luzerne County, 82 of 112 deaths have come out of nursing facilities. Sad, but these vulnerable souls are not representative of the working public.

In Pennsylvania, there are now 3 phases of existence. Until recently most of our state, no matter how few cases there were, was in the red phase. We are ordered by fiat to stay home. We can actually be questioned and cited for “nonessential travel”. So-called “essential” businesses are open. We have been permitted to visit our grocery stores, beer distributors, hardware stores, big-box stores, and gas stations. With masks and social distancing, we seem to have been able to control the spread of this virus.

If we are deemed to be worthy, we may someday get to the yellow phase where we can open other retailers, but still cannot gather in a group larger than 25, or visit bars or restaurants. It appears that this viral purgatory will be denied to us until at least June 1.

Does this mean that churches will still not be able to open? What happened to freedom of religion?

Green phase, where things return to basically normal almost seems like a dream.

The problem is, I remember what we were told at the beginning of this. Remember: “two weeks to flatten the curve”? Well, we damn well flattened the curve. So much so in fact, that hospitals who have been curtailing other services, threaten to lay off workers because of low volume. Only modest percentages of hospital beds have been needed for coronavirus patients. There are plenty of ventilators. Yet two months later we remain locked down.

Looking at the number of new cases in Pennsylvania, the curve is noisy but is clearly trending downward.

Even more disturbing to me is the attitude of the state government. It appears for the Wolfe administration, the new default position for our commonwealth is “closed for business”. We only get to open if we are properly respectful and deserving. He seems little inclined to relieve our misery.

This feels unconstitutional. Given the crisis, we gave our state government some leeway and submitted ourselves to rules (not laws) that go against the basic freedoms of society. This was done for one purpose, which was realized. Now as others have pointed out, Gov. Wolfe has moved the goalposts from the field to an undisclosed location. And he does this without explanation.

The administration might want to study data from states that have reopened. Georgia is a case in point. Their numbers prior to late April were not the most favorable, yet since opening their new cases are declining. Hopefully, this is because to an extent, this virus is running its course as the season progresses.

We are now living in a society where state agencies in the state police are being used to suppress our freedoms and our commerce in a way that will damage our economy for months if not years.

Warren County in northwestern Pennsylvania is an example. As of this date, they have had exactly one case of coronavirus with no deaths, yet they were under severe lockdown for 2 months. How lovely for them that they will now be permitted to move to a slightly less damaging state of existence? And much of the rest of the state, many counties with single- and double-digit case numbers are similarly oppressed. This is ridiculous.

I have been uncomfortable thinking about this idea, but I now have to wonder whether this is political. As a swing state, a damaged economy might be helpful in moving Pennsylvania towards a democratic challenger. And yes, politics is that ruthless.

I think at this point Gov. Wolfe has jumped the shark. What started as a reasonable response to a bad situation has morphed into tyranny. An increasing number of counties are declaring that they no longer will submit. This rebellion includes a lot of South-Central Pennsylvania including Dauphin County, where Harrisburg is located.

In answer to this development, the Governor has doubled down. He referred to counties and businesses threatening to open as “cowards” and “deserters”. He threatens to use weapons such as state licensure, access to federal funds, and business insurance as retaliation for this behavior. His words suggest he has no compassion for those who are struggling financially in these times.

To quote him: “in the end, the ultimate goal is to defeat this virus”. Except that we can’t defeat it by hiding. The goal should be to get through this pandemic with the least amount of medical and psychological morbidity, and economic damage.

At this point, we have all the tools for dealing with the pandemic. We wear our masks, wash our hands, and observe social distancing. We’ve been practicing for 2 months.

Governor Wolfe has a perverse concept of cowardice. He believes that a small business owner, who desperately needs to reopen to avoid insolvency is a coward. He considers that people who are in dire straits and are willing to face exposure to feed their families as cowards.

Meanwhile, Wolfe, and his vast state executive, are paid biweekly and doing fine, thank you.

Lockdown was sold to us as a temporary strategy for extraordinary circumstances. It has worked.

But now if we are to avoid economic devastation, it needs to end.

Despite the atmosphere’s reluctance, spring is insistent on emerging here in Northeastern Pennsylvania. As I write this, the trees in the valley are leafing out. Up higher the forest canopy has erupted in fluffy light green as the stubborn oak trees cautiously bloom.

We were teased with several warm days over the weekend. Unfortunately, predictions for the week are cool to cold, and unbelievably there is snow predicted for Friday. It seems somewhat cruel of nature to provide us with an unusually cold spring, in the same year it has gifted us with this wonderful Chinese coronavirus.

Time in lockdown rolls on. At the VA Hospital in Wilkes-Barre, we see sporadic cases, most of whom are modestly sick. Around our state, infections and deaths continue to rise, but far more slowly than before.  Overall from the standpoint of coronavirus, Pennsylvania appears to have stabilized.

Regarding drug treatments, Gilead’s antiviral drug remdesivir, underwent a phase 3 trial, that was featured rather prominently in the news as supporting the drug’s effectiveness. As I read the trial, it seemed to be more about establishing whether a 5 versus a 10-day course of the drug was appropriate for treatment. Efficacy did not seem to be an endpoint in this study. The drug was used to treat hospitalized, hypoxic but not ventilated COVID-19 patients. The mortality rate of these patients in both arms of the studies (5 versus 10 days) was 7%.

By comparison, a study in JAMA looking at hospitalized patients with COVID 19 in New York City had a mortality rate of 21%. These studies are completely unmatched however in terms of age or disease severity, and again the Gilead study did not include ventilated patients (at the start). The New York study had a mean age of 63 years old, with patients apparently as old as 107. This clearly might hint that remdesivir is helpful in these patients.

 Interestingly, 553 people died in the New York study, but only 373 were admitted to an ICU, and roughly 330 were placed on ventilators. This means that at least 223 of the dead, did not receive ICU care or mechanical ventilation in a premorbid state.

Given the age range reported, I suspect a percentage of these people were not aggressively treated due to age, or multiple comorbid conditions. This suggests that there were many patients, even without the pandemic, with the potential to die in the next several months. This would tend to lower the practical mortality rate of this illness.

Let’s talk about masks. First rule: No mask short of an N95-type will protect you for instance from an aerosol containing viral particles. However, there is some conflicting data to suggest that an infected person, projects less infectious material by using facemasks. The problem has been that supplies of medical type masks, which are more effective are inadequate, forcing people into homemade alternatives.

So, when I’m in the grocery store, I see all manner of masks from 3M particulate masks, to surgical type masks, to homemade cloth masks and even bandannas pulled up over the nose. If you’re an asymptomatic carrier, the homemade cloth masks and particularly the cowboy chic, probably does little to contain your little viral hitchhikers from visiting other folks. Surgical masks when available, test better in this regard.

Then there those people who wear them while solo running or driving in their cars alone. I fear it’s becoming another form of virtual signaling. According to CDC’s newest guidelines when you’re asymptomatic, masks should be worn only when conditions preclude social distancing. They are in no way a replacement for adequate separation and are probably unnecessary when that is achieved. All this, of course, changes if you’re coughing. In that case, wear a mask and stay the hell away from others. I would say however that wearing a non-occlusive bandanna is useless. Stores should probably not accept this as being compliant with the state guidelines.

At week 7, the economic consequences of this lockdown are becoming apparent. Corporations as diverse as Norwegian Cruise Lines, Lord and Taylor, and J Crew have filed for bankruptcy. More are likely to follow. Businesses are closing prematurely. I worry greatly that the ultimate morbidity (and even mortality) resulting from a severe economic downturn, will be every bit as significant as that from the virus itself.

 If we believe this disease is going to be persistent in the environment, then at some point were going to have either be immunized, or to “face it down “. As the most optimistic timeline for a vaccine is sometime in the late fall or early winter, we have little choice but to open things up in a judicious way, and deal maturely with the bump in diagnoses and deaths that may occur.

So let the snow come on Friday. I know its inevitable that true spring must come, likely soon. Have hope, it’s almost here.