It is week 24 of “two weeks to flatten the curve”. Pennsylvania’s recent bump in cases, mainly in Western Pennsylvania has subsided with a minimal increase in hospitalizations and no real increase in the rate of death which was already quite low.

There are a few counties said to be “problematic” because their PCR positivity rate is greater than 5% (the overall rate in the state is 3.4%). Most counties report that the percentage of their emergency room visits for COVID-like symptoms are less than 1%.

In the southern states, almost without exception, their rates of infection have peaked and are now decreasing. As I have said before, there was definite morbidity and mortality as a consequence of these surges. Those numbers too are either flat or improving. You can see this most easily on the Atlantic’s COVID project page where each state’s data is numerically and graphically displayed.

 Almost without exception, all of the recent trouble spots were in essence experiencing their first onslaught, much like the Northeast experienced in April. One gets the impression that the virus is moving through the country like a wave that started in the Northeast and moved south and west. Interestingly the Dakotas seem like the next hot spot, but although their numbers are rising, they are rather low compared to other states.

To me, it seems that the virus’s behavior in the Northeast over the summer months has been similar to the seasonal behavior of other respiratory viruses. We remain aware of its presence because uniquely among respiratory viruses, we are continuing to test for it in the population. Given the burden of disease suggested by the emergency room and admissions data, it would otherwise likely go unnoticed.

Some would say that it is through our masking and social distancing, that we have controlled the pandemic. I would argue that this virus is observing its own timeline, with a minimal impact from our suppressive efforts. Like most viral infections once it enters the population it spreads, peaks, and declines. That is happening all over the country, we’re just several months ahead.

I still wear a mask and respect people’s space. But after the onslaught, this spring and the many months since only 1% of Pennsylvania’s population has been documented to have an infection. Maybe we need to relax a bit.

There is certainly reasonable concern about opening schools and colleges. This has already happened in much of Europe and Asia with generally good success. Middle school and younger children have a low amount of the ACE2 viral receptor and generally are thought not to be contagious. Older children are “spreaders” but usually with fewer, milder symptoms. Teachers of course are older and a concern, but are exposed much the same as anyone who deals with the public. The good news is we can watch other countries as they move forward.

I do want to speak to another virus that infects us and is far worse than coronavirus. I speak of the rampant disrespect and intolerance online and in the community, at large. As a baby boomer, I would be tempted to ascribe it mainly to younger people, but I know that isn’t true. Somehow, we got to a point where people have no regard for others, especially if they hold views that they find disagreeable.

The incubator and breeding ground for this is social media. Facebook and Twitter have provided an arena for arguments in the “ether” where people feel unbridled from the courtesies we generally employ when arguing in person. This is extremely pernicious in our increasingly selfish, areligious, and amoral society.

As many of you are aware I’ve seen this first hand. I spend a lot of time researching these articles before they’re published and I genuinely hope to convey what I believe is truthful information, even if it flies against what is being said in the media. I have been guilty of some snark when it comes to the governor and the secretary of health. I only began to be critical of them in mid-May, after we passed our infection peak, and there was no sign that they had any interest in listening to voices in the legislature, or those of small business owners being driven out of business. I have tried to keep my criticisms based on their actions, and not their political party.

For several weeks now, I have had rather persistent, and militant, commenters on my Facebook page. These aren’t people that are pointing out specific errors they feel I’ve made. They prefer to condemn my viewpoint without evidence, and quickly go “Ad hominem” when rebutted. They accuse me of lying and are arrogant enough to report a post to Facebook for removal. They’re vicious and very persistent. The last person was posting under an account that appeared brand-new and had very little personal information. When pressed, the person admitted that the account was anonymous to avoid facing responsibility for their comments.

If I read something on Facebook for instance that I disagree with, I may post a retort. Usually, I reserve this attention for friends. I try to use irony rather than sarcasm as the latter tends to come off as mean. And I don’t persist. Friendships are worth more than winning an argument.

This angry self-righteousness in our citizens is far more dangerous than COVID. Because, as we see in places like Portland, Kenosha, Seattle, and Minneapolis, this pandemic has the potential to literally tear apart our society if it is not stopped. If anyone should be “quarantined”, it is the vicious purveyors of hatred and mayhem who infect and highjack peaceful protests.

I remain extremely grateful to those of you who share these posts and offer support and encouragement. I feel the same for those of you who disagree politely, either with a critique, or your silence.

It’s only with kindness and respect that we will cure this virus.

Image: Ligularia in August (Samsung Galaxy S8)

It is now week 22 of the reign of the King Tom and Queen Rachel. Here in Pennsylvania, we appear to have weathered a mild bump in coronavirus cases, and the numbers now are declining once again.

Centered mainly in Western Pennsylvania, it was of little clinical consequence, as the numbers of hospitalizations were unimpressive, and the rate of fatalities did not increase. It was to be expected, as we reopened. Nonetheless, our governor re-imposed restrictions and behavior control statewide, in ways that much of the general public regards as anti-business, illogical and annoying.

In our VA Hospital here in Wilkes Barre, screening and preoperative COVID testing continues. We have no acute cases and have not had any for some time. I do see there are a few admitted at other hospitals in the county.

Over the rest of the country, most of the recent trouble spots, like Florida, Georgia, Arizona, and New Mexico have peaked in numbers of new cases and are on the downswing. In those states, there was a more impressive burden of disease, but over the weeks I have been watching the data, healthcare systems do not appear to have been overwhelmed. In all of those states, modest peaks in hospitalizations and deaths are also on the decline.

I’ve been thinking about the apparent persistence of this virus throughout the summer. In the normal winter/spring cold and flu season, there tends to be a surge in respiratory problems including bronchitis and pneumonia (similar to COVID). If hospitalized, we treat patients stereotypically, and generally with antibiotics based on their presentation, We usually do not identify a pathogen. This probably leads to us treating a lot of viral illnesses with unnecessary medications. We test for influenza, but rarely for other viral pathogens.

Now we have encountered a coronavirus that has caused a pandemic and significant mortality. For good reason, we have created widespread testing for it. Unfortunately, not all of this testing has been accurate (ie: testing centers in Florida with 100% positive rates). Add to this the fact that we test people not only for illness, but for other clinical circumstances, often when they’re asymptomatic, and the numbers can get misleading.

Currently in Luzerne County, like much of the state, only about 5% of the tests performed come back positive.  Less than 1% of our emergency room visits are COVID related, and few if any are admitted. It is only because of this unusual testing, that we know the virus is still out there. But the respiratory impact is minimal… just like a normal summer. We may just be getting a lesson in the seasonal dynamics of viral infection.

I’m concerned that at least in the Northeast, our obsession with this virus is now creating a “paper pandemic”. The healthcare system normally sees modest numbers of respiratory illnesses, including pneumonia, all summer, but never before have we surveilled the patients for a particular strain of virus ( again beyond influenza). Now we do. And the press reports those numbers every day.

I don’t want to be cavalier about this. These patients can be quite sick, and the isolation measures required put a significant strain on the ICU staffs. Now, however, after nearly 6 months of intense study of the virus, we are far better prepared in terms of therapeutics. And, as near as I can tell from the statistics being reported, there is plenty of capacity to care for these patients.

Despite all of this, our governor’s in the northeast US maintain their restrictions, and are still inventing new ones. They brag about the conditions in their states, while on the other hand continuing to issue unconstitutional edicts to regulate their citizen’s most basic behaviors.

Now they’re instituting contact tracing. This means that if someone tests positive, they are interviewed to establish the identities of those with whom they have had close contact. Those people are contacted and advised to quarantine for 14 days. They are then monitored by the state. If they are uncooperative, then the state can force compulsion, even to the point of using law enforcement.

Now as a pulmonary doctor who treats tuberculosis, I have long understood the necessity of these measures. But given the fascistic nature of our governor and health secretary, and the apparent decrease in virulence of the virus, as well as the inaccuracy of testing, there is a lot of potential for overreaction. Remember, this is 14 days after an exposure defined as being within 6 feet of a positive patient for more than 15 minutes, even if you initially test negative and have no symptoms.

So for instance, you’re sitting at an outdoor deck of a restaurant eating dinner. An acquaintance at the next table for whatever reason ends up being tested and is positive. Congratulations! If he gives the state health worker your name, you’re confined to home for the next 2 weeks.

What makes this situation all the more grating is the sheer hypocrisy of our Imperial “ruling class”. As I write this, I see a report that Mayor Lightfoot of Chicago has weighed in on the extreme health risks of a beach party held on the shore of Lake Michigan. Oddly, she has not yet commented on the previous night’s 10 hour organized pillaging of the “Miracle Mile” Chicago’s main shopping area. I guess it was because most of the looters had masks (for a different reason though).

Another example: John Lewis’s funeral. As good a man as he was, there was no apparent concern for distancing going on in that church. It appeared filled to capacity. Three former presidents were in attendance. There were multiple unmasked speakers and unmasked singers. It was beautiful. You know… the kind of service you and I are not now permitted to organize or attend. The law, after all, is for thee, not for me.

Need I remind you of Gov. Wolfe’s march with protesters in Harrisburg? Or secretary Shapiro’s rescue of her mother from a nursing facility just in time to avoid the state mandated coronavirus admissions.

I want to talk about mask usage again. As I stated multiple times before I wear my mask as mandated as a matter of courtesy to others, without knowing whether it is in any way useful. I do suspect may lower the viral load of a respiratory exposure, leading to either no infection or at least a milder set of symptoms.

I see a lot of “virtue signaling” on social media pleading for the use of masks. What I don’t see are the actual “antimaskers”, those rogues who allegedly put us all in danger. Much is made of this but most everyone I see in my travels has dutifully donned some form of face gear. When I do occasionally see someone who is bareface while indoors in a public space, I basically keep my distance. Whether in life or on Facebook- don’t be a Karen.

So, we await a vaccine. What concerns me is that RNA viruses like coronavirus tend to mutate, which makes preparing a vaccine problematic. I’m also concerned that it fair number of people are already skeptical of vaccines, and will not choose this option.

I’m really concerned that despite what we’re being told (because vaccines can be very lucrative for pharmaceutical companies) the end of our travails will ultimately lie in some form of “herd immunity”. Thus, I am not particularly worried about the numbers of asymptomatic cases we are seeing now. They should transiently develop antibodies, but more importantly, develop T-cell immunity to this pathogen. This is what needs to happen.

At a time when the virus does not appear to be causing much illness, we should be relaxing restrictions on businesses and churches, much like we have for instance, on casinos. Cold weather is coming, and respiratory illness, including from those this coronavirus, will emerge once again. Our businesses need time to regroup before this occurs.

Common sense, not fear and certainly not politics, should guide our responses as we go forward.

Title image : Vernal Pool in August (Fujifilm X100V, TCL X100II)

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 [SHF1]