It is now 6 months into the dictatorial restriction of our liberties sold to us as “2 weeks to flatten the curve”. There do not appear to be any goalposts being offered to give us hope.

We can surmise, that the availability of an effective vaccine for SARS Cov-2 will liberate us, but this was squelched by the eminent Dr. Fauci, who claims that even with a vaccine, restrictions will need to be maintained until at least the middle of next year. I read that as until June/July 2021.

Meanwhile here in Pennsylvania, the number of new cases per day, after a small late July peak, has once again begun to decline, along with the number of hospitalizations. The average percentage of emergency room visits for COVID-19 type symptoms is 0.6%. The highest percentage comes out of Sullivan County with 3.8% though they still have no documented cases of COVID 19. The average PCR positivity rate is 4.2% throughout the Commonwealth. I’m sorry but this no longer feels like a pandemic.

Meanwhile, we continue, with what is becoming ritualistic behavior vis-à-vis masking. I have made it clear in the past, that I have been compliant up to now, out of courtesy, and out of the desire not to cause problems for businesses I frequent. But as this disease fades, so should we see our precautions fade. Instead, it’s becoming ingrained.

So now I walk into a restaurant. Shortly before entering, I slip my mask on my face. Throughout the summer this is largely been out of doors, and I walk at a distance from other patrons over to a table (no bar seating allowed), either with my wife or to join a group of friends. At the table, we are permitted to unmask. This is despite the fact that we are now sitting much closer to each other (often no further away than we would be at a bar). None of this makes any bloody sense, not only given the minimal incidence of the virus now but by the mechanics of respiratory droplet spread.

Another issue has to do with the persistence of the virus. The experts seem to be preparing us to understand that this particular virus is going to be persistent in the environment. This is really shouldn’t be any great surprise, as it is true of the adenoviruses, rhinoviruses, and other coronaviruses that circulate year-to-year. It’s only by repeated exposure that most of us have at least partial immunity to these common viruses. This means unless you’re very debilitated, you are unlikely to get very sick. Sound familiar?

I hope we have not squandered the opportunity over the summer, through more unfettered social interaction in outdoor spaces, for healthy people to get small exposures to the virus. This would be important in the pursuit of some level of “herd immunity”. I am concerned that as the cold and flu season begins, that we will overreact as respiratory illnesses become more common.

As many of you know, I have been using the Atlantic magazine’s COVID Project among other resources, for some of the data in these articles. As a left of center publication, one would hardly think they would shave the data in a conservative way.

I looked at South Dakota, now 4 weeks from the Sturgis motorcycle rally. South Dakota, it is one of the few states that does not have a mask mandate. The event was accused of being inappropriate, and later of being a “super spreader”. On the website, there are multiple graphs documenting a number of parameters including new cases, number of tests, number of hospitalizations, and number of deaths.

At first glance, the numbers are concerning. South Dakota had had very few cases of COVID, with small peaks in April and May. The curve was then flat until roughly August 16 (right around the end of the rally) when an upward spike began, peaking in early September. Hospitalizations, also peaked, interesting to roughly the same level seen in May with a much smaller number of total cases. The graph of deaths also had a small peak.

All of this looks discouraging except for something I initially overlooked. The graphs used by the Atlantic, have a different scale for each state. This makes it easier to track smaller numbers but also makes small changes look much more dramatic. For instance, the second large peak of hospitalizations post-Sturgis looks impressive, but the number was only 83 admissions for the state. The death peak was 2. Sturgis hardly appears to have been a “super spreader”.

There is more encouraging news. We talked about the CDC reports of “excess deaths ” several weeks ago. This is a comparison of the agency keeps between the actual number of deaths throughout the US for a particular time of year, versus the expected number of deaths. For the first time since April, in the third week of August, there were no excess deaths, and in the fourth week of August, we’re actually 14% below the expected death rate for the week. This certainly seems consistent with our impression that although there are significant numbers of positive PCR tests, the morbidity and mortality associated with this are very low. This may be due in part to the over sensitivity of the PCR test, and possibly a better understanding of how to treat the smaller numbers of those who become critically ill. If we remain below the expected death rate, it might rightfully be said that this outbreak is over.

At any rate, in Pennsylvania, there appears to be no end in sight. A federal judge ruled that a portion of the Wolf/ Levine unilateral restrictions are unconstitutional. I’m not well versed in law but I understand this suit was brought by plaintiffs in a variety of businesses, whose complaints have been largely dealt with as the state partially reopened. Members of the hospitality industry were not a party to this, thus their issues were not addressed in the ruling. The main effect of this may be to relax the restrictions on public gatherings. The Wolf administration is expected to ask for a stay, while they appeal.

I’m uncomfortable with the idea of becoming a militant “antimasker”. The extreme viewpoints on either side of an issue tend to be wrong. Then again, I think we need to find a way to cut through the unwarranted fear, both for our health and for legal liability, the politics, and the religion-like virtue signaling that has become a part of the public reaction to the pandemic. If the virus is here to stay, we’re gonna have to learn to live with it. To me that means moving back towards a normal state of existence.

People keep saying “follow the science”. I completely agree.

As always, I would be honored if you would share this.

Header image: Old Trail near Ray Brook (Fujifilm XE3, XF 18-55 f2.8-4)

We are now in week 25 of the two-week effort to flatten what has become the flattest curve that can still be a curve. Pennsylvania seems to be over a slight bump in cases we had in July and August. The number of new deaths remains flat.

Nationwide statistics are interesting. I’m looking at the curves on the Atlantic’s COVID Project. Overall, in the US were clearly two peaks of new cases: 1 in early April and a second peak this summer. The latter produced roughly double the number of new cases per day as the peak in April. Of course, the number of tests performed during the summer surge was significantly higher than those performed in April.

 Interestingly the number of hospitalizations for both of the peaks was roughly the same, but the number of deaths was significantly lower in the summer (April peak daily deaths were around 1800, in early August around 1200. This tends to confirm the impression on multiple fronts that the virus has become less virulent, or we have figured out better therapies. Or… maybe our testing is a problem. More on this below.

Despite the favorable Pennsylvania numbers, our governor has thoughtfully extended his emergency powers for another 90 days, thus, of course, past election day. He can get away with this and continue this virtual dictatorship because his fellow Democrats control the Pennsylvania Supreme Court. I’m not sure I can see an end to this. Though he touts the various benefits the state receives from this emergency declaration, the fact remains that we probably wouldn’t need the benefits if he didn’t insist on the restrictions on businesses and churches.

There has been some news from the CDC on the characteristics of patients who have died carrying COVID as a diagnosis. Turns out that only 6% of the patient’s died of the virus without the contribution of comorbid conditions. Yes, this coronavirus is dangerous and potentially lethal. However with the overall death rate of COVID per Dr. Fauci currently at 0.6%, the death rate for healthy people who contract the virus is thus 0.0036%.

Now I have written before about death certificates. If the patient denies of respiratory failure secondary to congestive heart failure but has COVID as a contributing factor on the death certificate, is that counted as a COVID death? Remember a diagnosis of CoV-2 infection was financially advantageous for hospitals that were struggling because of the cancellation of all of their elective procedures. In light of this, here is another interesting guideline from the CDC website regarding the coding of COVID deaths:

COVID-19 deaths are identified using a new ICD–10 code. When COVID-19 is reported as a cause of death – or when it is listed as a “probable” or “presumed” cause — the death is coded as U07.1. This can include cases with or without laboratory confirmation (italics mine).

So in other words, if the patient presented let’s say in early spring with a respiratory syndrome, perhaps with a fever and URI symptoms, and ultimately died, the patient can be coded as a COVID death even in the absence of a positive test. And the coding in that way would benefit the hospital with an increase in reimbursement.

When you look at the CDC’s COVID mortality numbers, they are in a category known as “deaths involving COVID”. Not deaths “from COVID” or “caused by COVID”. This is the roughly 160,000+ US deaths being reported secondary to the virus. This apparently includes deaths from other causes when COVID 19 is listed on the death certificate. Even George Floyd may have qualified in this way.

As we have discussed before, death certificates typically have two or three lines where the causes of death would be entered. An in-hospital death would likely be filled out by an intensivist, or a hospitalist often employed by the facility. The first line is for the “disease state that caused the death”. The second and third lines are for “significant conditions contributing to death that did not contribute to the underlying cause of death”( per Pa’s Death Certificate Manual). Once filled out, it ultimately goes to the county coroner where it is reported to the state Health Department. Depending on the motivations of the state government, these numbers could certainly be subject to some “sleight of hand” if one wished to increase the numbers of Deaths related to COVID.

Before I get accused of being a COVID denier, let me say that on the same CDC website there is a graph showing monthly US death rates as far back as 2017, with a line just above the graft showing the point of so-called “excess deaths”. In every month since March, we have been above that line, so clearly there has been illness and death beyond the norm. It’s just that for many of us, the wave has passed.

The PCR test (deep nasal swab) for the coronavirus has recently come under scrutiny. A recent article in the New York Times does a nice job of explaining the methodology of the PCR test, and the likelihood of false-positive results.

PCR testing, also known as gene amplification testing, becomes more or less sensitive depending on the number of amplification cycles the lab specifies. It is thought that most labs have made the test so sensitive that it detects tiny amounts of virus or viral fragments that would not lead to clinical illness or disease spread. In the article, it is suggested that 85-90% of positive tests would be negative if testing were conducted more appropriately.

 The risk of false positives in PCR testing has been recognized before. In previous viral epidemics such as SARS-CoV-1, Zika, Ebola, or MERS-CoV, the CDC and WHO recommended that tests should only be performed on patients who either were symptomatic or were known exposures. It was also recommended that a positive test be followed with a second confirmatory test before assigning a diagnosis.

For some reason with the current virus (SARS-CoV-2), testing until recently was not limited to symptomatic patients, and still, no confirmatory tests are necessary. One positive PCR is enough.

There have been a variety of testing errors that have come to light. Most notably the 77 NFL players tested positive for the virus in late August in preparation for training camp. The players were all then retested and came out negative. Apparently, there was contamination at the testing lab. I think of other labs in Florida the reported having 80-100% positive results. Then there are the anecdotes of patients who registered to be tested, but never actually had a sample taken, but still received positive results. I continue to be concerned that our current testing regimen is deeply flawed.

All of the above is why I continue to believe and have stated multiple times, that the best marker for disease activity in the community is hospitalizations and deaths actually caused by SARS-CoV-2. It is these parameters that should be used to determine the government and public response.

So we in the “early states” where the actual COVID illness has come and gone, remain stuck with business and worship suppressed, following illogical regulations with no end in sight. Oh, maybe there will be a rushed vaccine of questionable efficacy and safety that many will refuse.

The curve is officially flattened.

Now we’d like our lives back.

I would be honored if you’d share this.

Image: Summer evening at Fountain Lake (Samsung Galaxy S8)