We are now in week 29 of what is apparently an endless state of behavior control by our omnipotent masters: the executive branch of Pennsylvania government. Once again, another legislative effort to loosen up the restrictions, in this case on the restaurant industry, has been vetoed by the governor. This is despite the fact that while we are seeing modest numbers of positive PCR tests, there is very little actual illness resulting.

I remind myself that when I posted my first “viral” article back in mid-March, I assume naïvely that this topic would die out by midsummer. That my cover image for this edition now features autumn foliage, is quite discouraging.

Meanwhile, our governor, in a conversation with Rep. Wendy Ullman of Bucks County, is caught on an open mike discussing the concept that for our elected elites, wearing masks in public is “political theatre”. Good to know.

In Pennsylvania, the small peak of cases we had over the summer is waning. The number of hospitalizations, ventilated patients are all decreasing from already modest levels and the percentage of emergency room visits devoted to COVID-like symptoms is well below 1%.

I think we know this anecdotally. Other than a few patients whom I have attended, I know perhaps 3 people who tested positive for this illness. One of them had a fairly severe flu-like illness from which she recovered. Another had a short period of mild respiratory symptoms. The third was absolutely asymptomatic and was retested in 4-5 days and found to be negative. Most people I talk to have similar impressions. I understand that I didn’t live or work in NYC or similar hotspots. I’m referring to Pa. and I think, most of the rest of the country.

One of the things I have been pondering about is the disparity I have noted between my liberal and conservative friends, and their attitude towards the pandemic. In general, my liberal friends tend to be much more concerned about the possibility of contracting the illness and are much more careful about human contact. My more conservative friends seem more willing to interact, and in general, are more casual about their behavior. In my mind, this crosses all intelligence levels in both political persuasions. While this disparity is not absolute, to me it seems pretty consistent.

Let me say that I am excluding from this discussion the more militant “anti-maskers” from this as #1 I don’t know anyone who is a complete nonconformist to the rules, and #2 given their lack of courtesy, I would tend to discount their opinions.

I don’t see anything innate in one’s political leanings that should lead to this effect. I refuse to believe for instance, that all my liberal friends, want to keep us shut down to affect the upcoming elections.

 I am left to believe that it is the media that we consume that forms our attitudes. It is clear to me that conservative media is more willing to entertain a certain skeptical approach to the pandemic through their pundits. The liberal media tends to emphasize the case numbers and the strains on the healthcare system where they occur. If there is a political motivation for this, I think it exists within the media and their allies in the political parties. This is a potentially dangerous game as it inhibits a purely rational approach to this outbreak.

So I shall once again restate my current thinking.  Yes, there is/was a pandemic. Each of the states has had different peaks depending on travel patterns and other factors. There has been an “excess of deaths” throughout the country, though the numbers don’t precisely match the COVID death numbers. There is a reasonable case to be made that some of the additional deaths may be consequences of the lockdown, particularly suicides, addiction, and the fear of hospitals by people who required medical attention.

Currently, I believe that per a number of sources including the New York Times article, that PCR testing is oversensitive and maybe creating a lot of false positive “cases”. I believe that rather than worry about the numbers of additional positive tests, we should scale our precautions based on actual disease burden which for now is modest at best.

I look at the pandemic the way I would look at a critically ill patient during my years as an intensivist. Let’s say a patient is admitted to the intensive care unit, with sepsis and low blood pressure. We would intervene in this, often by giving a large amount of IV fluid, plus drugs that can compress the blood vessels, raising the pressure. These modalities though, have long-term side effects that can be life-threatening, so in these situations, we are constantly testing. If the patient’s blood pressure appears to stabilize, we begin to withdraw the interventions. If the patient deteriorates then we may need to re-increase the therapy, but ultimately the goal is to discontinue these measures before they do the patient more harm.

This experience informs my attitude towards the current status of COVID in most of the country. The measures we took back in March, were certainly appropriate then, but they have been continued in situations where the “patient” seems to have stabilized. The problem is that prolonged intervention has done a lot of damage to large and small businesses that are now either crippled or deceased.

The goal of therapy needs to be the return of the “patient” to normal life as soon as possible. I suspect we would be doing this more aggressively if governor Wolf was not a “lame duck”, and if a presidential election were not imminent.

It’s now Autumn. Time to end the political theatre.

As always, we would be honored if you would share.

Header Image : Scene Along Glenside Road (Fujifilm X100V)