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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