It is the 38^th week of our battle with the Wuhan modified “gain of function” Bat virus known as SARSCoV-2 and the cult of obedience it has spawned. Overall, in the United States, we are just coming out of our second peak of “cases” and hospitalizations. Deaths have also begun to fall. There are significant regional differences, however.

In Pennsylvania for instance, we are clearly past peak with daily “cases” roughly 2/3 of those seen in the third week of December. Hospitalizations have seen a similar decline. Deaths too are on the downslope but as always, are lagging the other indicators. This rise and fall of cases seems to be occurring independently of other factors. My sense is that there was little impact, for instance, from the tightening of restrictions over the holidays.  

Also notice that this outbreak is declining in the dead of winter. Last spring, when we assumed that the warming conditions were responsible for the reduction in cases but there’s no warming now. This further suggests that the virus is on its own schedule, not ours.

Still the current number of new “cases” is formidable, in most cases far higher than the spring. Thankfully there is generally far less hospital utilization.

I am disturbed by several developments. First is the sudden change of heart among governors and mayors who have had a miraculous epiphany and now realize that remaining in lockdown will destroy what’s left of their economies. Funny thing that with a new president inaugurated, that suddenly their positions have changed.

I am disturbed by this on multiple levels. With the possible exception of Illinois, where cases clearly have bottomed out, all of the involved states still have significant disease burdens. New York in particular has just probably rounded the curve. So, with numbers the same or worse than in late November and December but with the electors counted and accepted, now we can reopen our restaurants and businesses. Don’t get me wrong, I think this is the right decision. But it should absolutely destroy any remaining trust between our elected officials, and the citizens who have suffered under their capricious dictates.

Now let’s turn to the newest utterance from the venerable Anthony Fauci, who has essentially supported the wearing of two, yes count them, two masks. Asked by Savannah Guthrie on The Today Show as to the advisability of “doubling up” Dr. Fauci responded: “It likely does because this is a physical covering to prevent droplets and virus to get in. If you have a physical covering with one layer and you put another layer on it, it just makes common sense that it likely would be more effective”.

 Not so fast.

First off, “America’s doctor” is up to now been a devout adherent to empiric data, first noted when he rejected case reports suggesting hydroxychloroquine might be useful for the virus (it is). Now we’re going with common sense? I could find no empirical data to support that two masks are better than one.

Secondly, I think, the good Doctor is unfamiliar with the dynamics of respiratory devices. The more you increase the resistance of air penetration through the masking material, the more likely the air will seek an alternate route. Most of the masks currently in use fit poorly to the face and thus tend to leak. With 2 masks, during inhalation one is more likely to “entrain” air from around the mask and then reverse the process when exhaling. Thus, you will be inhaling and exhaling more unfiltered air. How is this helpful?

By coincidence I had a gentleman enter my clinic office today with 2 masks on, one paper, and one cloth. I could watch the sides of the masks flare as he breathed. It looked like a fish’s gills.

There is also the issue that we refer to in pulmonary medicine as “work of breathing”. For people who have reduced pulmonary reserve, increasing the airflow resistance with a second mask would likely result in significant increases in shortness of breath. I know this because I do have respiratory problems, and wearing a single mask makes it difficult for me during any exertion. Two masks for some could be extremely uncomfortable.

It’s also worth remembering that this is the same Dr. Fauci who suppressed the use of masks in the initial phases of the pandemic, so to preserve the limited supply of the PPE’s. I hope we have lots of supply now because his words could double facemask consumption.

My final point will be an “I told you so”. Very quietly on January 20, the World Health Organization released new guidelines for Covid testing. They finally addressed what we have known all along: that the PCR test has been incorrectly used, which has inflated the number of cases. They now recommend, a decrease in the amplification cycles (sound familiar?) and the use of other confirmatory evidence such as actual symptoms and a second, different diagnostic study, such as an antigen test,

Just how many “cases” have been diagnosed incorrectly is anyone’s guess; but let me try. I’m thinking…a lot (between 60 and 90% according to the August 29th New York Times article).

I received an email today from the Feds on the topic of COVID-19 immunization. the email explains that the vaccine does not confer immunity, but the antibodies and immunity derived, merely help those who are vaccinated to fight off the virus (We knew this, though). It states that “guidelines for masking, social distancing all remain in place and should be adhered to regardless of vaccination or antibody status”.

In other words, there is no end in sight for this truncated, stilted lifestyle that we have all been forced to adopt. Even if 100% of people are vaccinated, there will likely always be vulnerable people that need to be protected. You know, the same way it has been with influenza over the years.

The pandemic was real. But it was shamefully manipulated by people in power for their own benefit. Yes, people have died from this virus much as people have been dying from respiratory virus infections for centuries. But the illogical, emotion-based restrictions placed upon us, are also causing financial, educational, and emotional devastation which may have very long-term effects.

It’s time to leave the cult, and return to life.

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

Header image: St William’s at Raquette Lake (Fujifilm XE2, XF 18-55mm f2.8-4)

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)

I was going to post a “Viral Post” today. Given yesterday’s fiasco at the nation’s capital, I felt that such a post would seem obtuse. Given the postings in my Facebook stream, I have been provoked to weigh in.

As a conservative and at least for now, a Republican, I unequivocally condemn the invasion of the capital. It is a stain on the MAGA movement for whom peaceful protests were part of the brand. Just who incited the invasion remains obscure (Q Anon vs. Antifa). It was an act of insurrection, one that was tactically stupid.

This summer, during the BLM/Antifa multi-city riots, we were told by Democrats and the press, that these were essential political activities by citizens that feel frustrated, and have no other recourse. We watched attacks on federal courthouses, businesses burned to the ground and people assaulted and even murdered. This occurred with the tacit approval of Democratic mayors and district attorneys. these disturbances occurred over many months, not just one over one afternoon. Our upcoming vice president actually supported a program to bail these criminals out of jail, returning them to the street.

I also remember the invasion of the Senate Office building during the Kavanaugh hearings. The leftists involved were lauded by the press and allowed to come into contact with Republican senators who were harrassed. Democrat response…crickets.

Now after a 4-hour MAGA tantrum in the Capital, the left suddenly finds their outrage. To be blunt, when I see their indignation on Facebook, it makes me want to vomit. They have no shame.

Make no mistake, the people of the right have been exposed to real evidence of voter and election fraud, largely through the alternative media. They believe that the “no evidence ” mantra of the left is a lie. When they watch the leaders of both political parties cut off their options, they believe that they are without recourse.

75 million people voted for Donald Trump. The vast majority feel that they were disenfranchised by Democrat-run election fraud. More powerfully, they can see no way forward where this doesn’t happen again. Whether you agree with them or not, this is an untenable situation.

It is in everybody’s best interest, in the long run, to reassure all voters that are elections are valid. This could be accomplished by creating a truly non-partisan Election Commission( if it is still possible). It would have to proceed with the understanding that the 2020 election is over

We need to fix this quickly, or we will lose this country.

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

Header image: At the Capital (Panasonic G1, Zuiko 12-40mm f2.8)