It has a been year and 7 weeks since our lives were truncated by the ruling elites, on account of a virus from China. Here in the US, vaccinations are being made available to a greater portion of the population, and more and more states, including my own, are easing their grip on our lifestyle.

This is our second spring under regulation, and it seems that this year, warming temperature have definitely brought out a lush growth of Covid 19 fatigue. Given our circumstances, I think it is justified.

I for one have absolutely had it with the policy people at the CDC. The new masking guidelines, giving us permission to gather outside without masks, only if it with household members or people known to be vaccinated, is ludicrous on its face. It will obviously be universally ignored. Don’t get me started about Dr. Fauci and his wildly meandering utterances. Someone needs to put a stop to his media appearances.

Especially since he bears some responsibility for our situation.

I have been perusing the internet for more Covid news. I recently encountered Sharyl Attkisson’s report on the origins of Covid on one of the compilation sites. I posted it earlier this week on Facebook. Based on multiple sources and documents both conclude that the virus was likely engineered in a Wuhan virology lab and then escaped out into the population. This was a lab had been noted by multiple organizations to have poor containment policies. This “gain of function” research was being done in cooperation with virologists at the University of North Carolina. And… it was funded by the NIH. Yes, our NIH.

Just to clarify: “gain of function” in this care means modifying an animal virus …to infect humans.

Regarding coronavirus, “big tech” continues to lie and distort. Earlier in the week when I posted Attkinsson’s report, it was quickly followed by a disclaimer from Facebook.

 Her report reminded me of a video from April of 2020 written by Joshua Phillips of the Epoch Times, a right of center publication. Reflexively I searched the video to review it. The list of citations Google provided me only included articles ridiculing the theory of the lab origins of the virus and the Phillips documentary. Reading over the list of titles would tend to make one convinced that this was a “crackpot” theory, and move on.

I then searched for the article on the unbiased search engine DuckDuckGo and immediately found the Phillips video as one of the first citations. Watching it again reminded me of how incredibly well researched and persuasive it is. Invest the time, it’s definitely worth it.

https://www.ntd.com/coronavirusfilm.html

What makes this dismissive Google search so infuriating, is that this is no longer a “crackpot” theory. It has been proposed and investigated and promoted by Josh Rogin of the Washington Post,  Robert Redfield, the former CDC director. Add in the Lawrence Livermore Laboratory, the institution most responsible for our nation’s bioterrorism defense. They apparently did a secret investigation in the spring of last year and raised the same concerns. Make no mistake: Google is lying, probably on China’s behalf.

So here is another wrinkle to this story. When asked about Dr. Redfield’s opinion, Dr. Fauci attempted to shoot down, continuing to claim that the virus passed from a bat species (found nowhere near Wuhan Province) to humans directly. Well here’s the thing: The gain of function coronavirus research going on at Wuhan was being done in cooperation with the University of North Carolina, through several NIH grants including one ultimately sourced to the National Institute of Allergy and Infectious Disease.

Apparently the leader of that organization, who has been called “the godfather of gain of function research” was forced to move this portion of the research to the Wuhan lab at China, when in 2014 the Obama administration declared a moratorium on these practices. The work went on even though multiple scientists in virology circles warned against continuing. It was performed in a lab that were the subjective multiple memos by the US State Department questioning the lack of safety protocols.

Who is the “godfather”? That would be Anthony Fauci.

This may explain a lot. For instance, imagine you’re the beloved Dr Fauci, in early January 2020, and you hear about a viral outbreak, specifically respiratory, in Wuhan China, in the same city you’re sponsoring gain of function research on respiratory viruses.

I’m pretty sure that was a holy sh*t moment for the good doctor.

Fortunately, there happens to be a “wet” market a few blocks from the lab. That made a good cover story for all involved including our NIH/NIAID people as well as the Chinese Communist Party. Neither party would confess that particular sin.

In the early going it made sense for Dr. Fauci to downplay the seriousness of the outbreak. He probably hoped that it would remain confined to East Asia and fade quickly (like SARS1). On January 21, 2020, at the onset of the outbreak in an interview, he stated: “This is not a major threat to the people of the United States and this is not something that the citizens of the United States should be worried about right now,”. At the same time, he reassured us that they were “taking it seriously”.

As late as March 8, 2020, Dr. Fauci stated “there’s no reason to be walking around with a mask.”

Unfortunately, this was not SARS1 and by late March had begun to spread throughout the globe including the United States. And the overzealous, inconsistent, mask-loving Covid-scold Fauci was born.

Maybe he is just cautious by nature.

Or maybe it’s guilt.

And then there’s this, published yesterday.

https://thebulletin.org/2021/05/the-origin-of-covid-did-people-or-nature-open-pandoras-box-at-wuhan/

I am very uncomfortable feeling this way, but it’s becoming clearer by the day.

They’re lying to us. They have been all along.

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

Header Image : The Barrrens Awaken (Sony RX100 Mark III)

Smartphone fine art photography? After two months with my Samsung Galaxy S 20, I have to admit it appears to be a real option. Though I am not sure, that all of my work qualifies as “fine art” I would say that in 2021, a state-of-the-art phone camera module is no longer severely limiting.

I’m writing this follow-up article to demonstrate what I’ve been able to capture with my new phone.

First, let me say that these images are not all intended to be jaw-droppers. Some of them were shot rather specifically to reveal the sensor’s abilities/limitations. Others were shot with somewhat higher aspirations Hopefully, they are somewhat pleasing.

In 2015, Samsung introduced a brand-new line of cameras called the NX series. It was Samsung’s first foray into a mirror list interchangeable lens camera, and it hit the market with a splash. It was beautifully constructed, extremely well-featured, and came with very fine newly designed lenses.

Most interestingly, it also featured a Samsung-manufactured, very high-quality 28-megapixel sensor. This was shockingly competitive with sensors made by the dominant manufacturer’s Sony and Canon. It was for a time, highly promoted. Samsung hired a number of very well-known photographers for this purpose. I shot with a loaner camera at a photo expo in Seattle and was very impressed.

Then suddenly, the Samsung NX series was no more. Apparently, Samsung decided that cameras “weren’t their bag” and they dropped the product line rather abruptly. It’s actually a shame because there was clear potential for this product.

Apparently, they didn’t forget how to make sensors. As you saw perhaps in the last article I wrote about the S20 weeks ago, despite the diminutive size and tiny pixels, it can produce very high-quality files. Given this, I decided to keep it in service.

For the most part, I shot it entirely in raw which is available in “pro” mode. Shot this way the camera produces a .dng file in a 4/3 format and a wide format JPEG. The latter is processed by the phone’s software. Very typically the results of the processing are fairly pleasing and pleasant to look at on the small screen. Details in the JPEG files are definitely smoothed out by the processing and don’t appear useful for anything beyond digital display.

In early March my wife and I spent a week in the Adirondacks. I brought my typical travel kit including my Fujifilm X100V and my XE3 with a variety of lenses. I never got them out of their bags. When skiing or snowshoeing, I would merely take my small Manfrotto tripod and the smartphone mount, and shot with the Samsung exclusively. I have been doing that ever since, in part with this article in mind.

I have to say that I didn’t really miss my Fujis. Part of this, however, is that I’ve been photographing the high peaks region in early March for so many years, it’s hard to find novel scenery. This was thus an interesting new challenge.

Once home, I continued with the exercise playing with the bleak, early spring scenery as our snow finally melted away.

This is a really good sensor. Many of these images you will note, were shot into the sun with prominent shadows. Better digital sensors have several qualities. One of them is dynamic range, which in part feeds into their true resolution.

Dynamic range describes the ability of the sensor to capture very bright scenes, and deep shadows, but still retain detail when the images are edited. Small pixel phone sensors have traditionally been terrible at this. This sensor handles it brilliantly, certainly as good as for instance my 2009 vintage Panasonic GH1, a much larger sensor interchangeable lens camera (also 12 megapixels).

Another attribute of a good sensor is tonality. This describes the subtle gradations shades of gray, and of color. Earlier technology recorded shades in discrete steps makes the image look more like a painting than a photograph, especially when viewed in detail. More sophisticated sensors have much more subtle gradations. I would say this Samsung sensor does surprisingly well in this regard.

I’ll offer one more thought. No one really talks about the lenses in these tiny camera modules, but in the case of this Samsung S20, there is little to criticize. There is some lens flare, and given the lack of any lens shading, but it is pretty well controlled. And if there other lens distortions that can be measured, they are well hidden in normal usage

At any rate, I think I’m done with this experiment. I’m going back to my more serious gear as the Spring season presents more photographic opportunities.

But it’s nice to know I’ll have the Samsung just in case.

As always, I’d Be honored if you’de share.

Header image: Wind and Snow( Samsung Galaxy S20 EW 5G)

It’s hard to believe, but it’s been 1 full year since rising COVID-19 infections inspired the policy of “3 weeks to flatten the curve”. In that period of time, we have been living our lives subject to the whims of our public servants. They have wielded, what many would consider unconstitutional power. They have imposed draconian, and often capricious rules and regulations, ostensibly to protect us from an increasingly manageable viral infection.

One year ago, I remember feeling a fair amount of anxiety. We assumed that no one was immune to this novel virus. We did understand that mortality increased with increasing age. I remember the nervous joking in the room as I taught a course for my non-pulmonary colleagues on how to run ventilators. This was set up out of concern that I and my fellow pulmonologists, all of us in our 60s, might fall ill, or worse, and be unavailable.

Yikes.

Caution was certainly warranted at that stage. We were hearing reports out of Italy of legions of sick people and overwhelmed hospital facilities. New York City was starting to have problems. Here in Pennsylvania, we had our first reported case. This was the point where Governor Wolfe shut down schools, and most businesses, other than those deemed “essential”.

 Nonessential businesses, including haircare salons, bars, restaurants car dealers, and other retailers were either fully or partially shuttered. Because of unemployment benefits that were offered, many people out of fear of the virus chose not to work. This affected many of the businesses allowed to open. It was a circumstance unprecedented in our lifetime. I think most people accepted the restrictions as necessary. Many of us, however, assumed that the disease and the lockdown would disappear by late spring.

As I have written before, we are in an entirely different place in March 2021. First off we know much more about this virus. We know that something like 40% of the population (based on blood bank studies from blood drawn before the pandemic) have pre-existing T-cell immunity. This is probably due to previous exposures to other Coronaviruses.

We have much better therapeutics including two inexpensive generic regimens that appear to have activity against the virus (ivermectin, and HCQ/azithromycin. Mortality rates are falling, and hospitals are non-stressed. Importantly, caregivers and most of the elderly population have been immunized.

I think my biggest fear now, is that even though it is only been a year, I see signs that people remain devoted to the illogical dogma that has been cultivated by media hype and governmental overreaction. If they cling to this. we may struggle to return to an open, welcoming society.

I’m concerned about the psychology of this. People tell me that their memories of our pre-Covid lifestyle are fading into the mists, as we grow ever more habituated to the lockdown life. We have been steeped in the belief that both family, friends and strangers, are potential vectors for Covid and must be kept at a distance. Greeting kisses and embraces for many are unthinkable. When people do gather, there is a wariness in personal interactions that I do not remember prior years. I see this, even in those who have recovered or have been immunized.

We need to get over this mentality. If you have recovered from the illness, or have been vaccinated, you are at best immune from further infection, and at worst, unlikely to become very sick if reinfected. You certainly do not need a mask. The fact that public health organizations will not admit this, suggests to me an inappropriate zeal for control.

I for one, welcome the relaxation of regulations scheduled for April 4 here in Pennsylvania. I am watching the data from states such as Texas where restrictions are almost completely eliminated. So far, after nine days there has been little change in their infection/mortality rates which continue to decline.

It should be clear I think to all of us, that going forward, that lockdowns are not a long-term strategy for dealing with this pandemic. If cases increase again sometime over the summer or in the fall, we need to recognize the virus may be endemic. We need to react to the disease burden, and not just positive PCR tests. Remember, people have been contracting coronaviruses for millennia, and a few become critically ill. A small number die. This is nothing new.

We should focus now on immunization and therapeutics, rather than curtailing our lives and liberty.

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

Header Image: Dying Spruces at Brady’s Lake ( Fujifilm XE3, XF 18-55mm f2.8-4).

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)

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)

It is week 30 of the Chinese-sourced scourge that is the COVID pandemic. Throughout the country, cases are soaring. Everything is increasing including the percentage of positive PCR tests, the number of hospitalizations, and to a lesser extent deaths.  Happily, the ratio of hospitalizations to new cases remains significantly better than in spring.

This matters to me, as I too have become a statistic.

I was feeling fine until Saturday. I have had a very nice prime beef brisket in my freezer probably since the winter. With no possibility to socialize, it remained frozen. This week I decided to cook it, either to share with friends or freeze it for further use. Cooking a brisket at 225° can be an 18-hour event. I started it late at night and then tended to it periodically until morning. When I woke up Saturday morning feeling tired, it was no surprise.

I went to bed early that night and awakened on Sunday, nine hours later having apparently slept well. If anything I was more fatigued and began to notice muscle aches and pains, and a cough. I figured I had developed a more mundane viral infection, but realized as a practical matter I would have to be tested before going to work at the hospital on Monday. I ultimately had a rapid COVID test in our hospital emergency room Sunday morning which turned out to be positive.

I was uncomfortable most of Sunday, with fatigue caused undoubtedly by the interleukin levels provoked by the virus. In the late evening as I prepared for bed I had a sensation of flushing and brief nausea which cleared after about 10 minutes. 15 minutes later, I was no longer fatigued and felt better. Other than some minimal sporadic headaches, I have basically felt fine since.

Therapeutically, I have been taking zinc and vitamin D on a fairly regular basis. Back in March, I had obtained a course of hydroxychloroquine, and azithromycin; despite the conflicting data, I elected to take them in the morning right after I was diagnosed. I’m not sure whether they were helpful or not but I’ve experienced no unpleasant side effects.

I think the worst part of this has been the isolation. I’m lucky to live in a big old rambling Victorian, and it’s easy enough for my wife and me to isolate from each other. I have been basically existing in my office at the back of the home which has my computer, and a pullout couch (not particularly comfortable). There is an outside entrance so that I can go up to my shed/workshop in the back. I distance myself from my wife and wear a mask in her presence.

I don’t know why, but she seems pretty happy with the arrangement.

This is not meant in any way to trivialize the pandemic. I know that my friends working in other healthcare facilities are once again under stress. People are really sick.  I suspect, if my good fortune continues, it is because of the fact that for 37 years as a physician I have been quite intimate with the coronavirus family of viruses, and thus probably have some immunity. Obviously, others have not been so lucky.

With my newfound perspective, it is interesting to watch the states respond to this surge. I’m actually sympathetic to Governor Wolf in this situation, as his options are very, very limited. Hopefully, he understands that another shutdown like the one in March would truly devastate the economy, wiping out the businesses that barely survived the restrictions in the spring. The new Pennsylvania restrictions tighten up on interstate travelers except those that have to travel every day (which kind of makes this moot) and increased mask-wearing to include certain outdoor circumstances, and indoors when your family has a visitor.

Governments, after all, have to be seen to do something about crises. But as I’ve said before, it’s becoming more and more clear that this virus is on its own schedule. It’s likely to run its course, at least until there’s a viable vaccine. This will hopefully be soon. Happily, the current surge means that a lot of people’s immune systems are becoming familiar with this coronavirus, and will hopefully have relative immunity to it. I suspect over the years it will join the rest of the coronavirus family, as merely a periodic irritant.

Meanwhile, I’ll continue my exile, and maybe even wallow in self-pity.

At least there’s brisket.

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

Header image: View from Elba (Sony RX100 Mark 3)

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)

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)

We have reached week 11 of the suspension, by decree, of religion and commerce in the Commonwealth of Pennsylvania. Here in Luzerne County, we are scheduled on 5 June (Friday) to move into the “yellow phase” which means that the Wolf and Levine team will allow a tepid amount of additional business activity.

Whoopee.

This is occurring in the middle of a new crisis, namely the protests/riots in our cities caused by the universal outrage over the apparent murder of George Floyd, a black man, by a Minneapolis policeman who has been subsequently fired, charged, and imprisoned.

Scenes of large crowds of masked and unmasked protesters, provocateurs, and criminals, freely associating in our urban centers, to say the least, has been destructive to the culture of social distancing we have come to know over the past weeks.

Suddenly, coronavirus feels like yesterday’s news. With this new crisis, I suspect the caution and fear people felt about the pandemic will begin to dissipate.

There may be other reasons for this. Certainly, in most areas of the US, the number of new infections and deaths is clearly decreasing. No longer do we wait breathlessly for the state and federal coronavirus broadcasts for the most recent bad news. Drs Birx and Fauci seemed to have faded from the public view.

There was a report this week out of Italy (which appears to be the proximate source of our eastern viral strains) to suggest that the coronavirus there has become significantly less virulent in recent weeks. Based on basic virology, this would make sense.

First, it’s important to remember that this virus comes from a specific species of bat, where it infected large colonies with minimal deleterious effects. This is likely because the bats had a degree of “herd immunity” and the virus had evolved to maximize its spread by minimizing virulence. A virus receives no advantage by killing its host.

Then it spread to humans, whether from freshly slaughtered animals in a Wuhan market or more likely released by accident from the neighborhood virology lab. Humans had little or no immune defenses to this novel agent, and the virus had not yet evolved to avoid excessively sickening the new hosts.

Add in a little globalization and voila… a worldwide pandemic.

Now, if over time, there are multiple mutations of this virus (which there are), it makes sense that some of them will be more aggressive and some less. The strains that make people obviously sick, and/or dead, will tend to be more quickly diagnosed, and the patient isolated, impeding further spread.

Less symptomatic strains will be less likely to attract the attention of the public health system and thus have more opportunity to spread to and replicate in a new host.

At some level, the most successful viruses will be among the mildest ones. The virus has to be aggressive enough to infect the right tissues (respiratory ) to facilitate transmission by coughing and sneezing, but mild enough that the illness will provoke little concern from others and can spread freely.

Now consider a virus such as Ebola, with a horrifying presentation. In modern times an infected patient is quickly recognized and carefully isolated, reducing or hopefully eliminating spread.

In one of Dr. Fauci’s last publicized statements, he feels there is now hope that there will be no recurrence of the virus in the fall. I don’t entirely understand the data that this is based on, but it is undoubtedly good news.

With the good weather, and now obviously with the mayhem, the enthusiasm for social distancing is fading, and I think will eventually become extinct, rules or not. If there is no meaningful bump in cases around the country after all of the mass gatherings that have been occurring, then I suspect the sense of the coronavirus as a threat will reasonably ebb. The practice of masking, and spacing ourselves out, will likely then feel dated and unnecessary.

We are obviously living through extraordinary times. More than anytime in my life, I find myself praying for the welfare of our country and its citizens. I do believe that in God’s good time, there will be recovery and a return to a slightly different, but acceptable baseline.

I just hope this happens before there is more damage to our economy, our infrastructure, and our psyche.

I’m writing this article on 21 March 2020. I am ensconced in my mountain enclave, in a state of semi-isolation because of the coronavirus situation. I say “semi-isolation” because although I mainly write about photography issues on this little website, my living is made as a pulmonary physician for the Veteran’s Administration and I have to go to work. I think it is likely that I am going to have an “interesting” next several weeks.

Things are already somewhat tense in our facility. We have made great efforts to reschedule nonessential physician visits, handling things over the phone. We have shut down routine testing. I undergo a brief medical history and have my temperature taken on arriving for work in the morning. All of this seems very prudent to me. The hospital is actually very quiet right now, with a very much reduced risk for exposure. This, however, may change.

More ominously I have been conducting seminars to update my colleagues on the management of mechanical ventilators for the types of problems seen in a SARS-type infection. We have begun to convert our short procedure unit into an adjunct ICU/negative pressure room. All of this is a little scary for a hospital not typically engaged in the care for very high acuity patients. Hopefully, this will all be overkill, but it’s clearly necessary to plan for the worst.

It’s very likely that my pleasant part-time pulmonary/sleep medicine career is about to revert to my former life as a critical care physician.

In terms of the disease, I am somewhat hopeful about several recent developments. Number one would be the possibility that several medications (hydroxychloroquine, azithromycin, and remdesivir) already available or nearly available, may have activity against the virus. Number two: hopefully the infectivity and/or virulence of this bug will fade over time much as do many of the seasonal viruses. It would be hoped that if there is a summertime pause, a vaccine can be developed to be available for the next season.

Like many people, I watched yesterday’s press conference where Dr. Fauci seemed to downplay the president’s enthusiasm for the proposed medications. This is inevitable for a man deeply involved in research, a culture where a treatment is only endorsed after multiple double-blind studies prove its efficacy. Unfortunately, we don’t have time for such perfection. He is right when he says that if we are to try these medications, then we need to keep the data so we can draw appropriate conclusions regarding their efficacy.

Meanwhile, I have two children in Seattle Washington. Both are healthy, and working from home, and report to me that all is well. Hopefully, that will continue.

On the other hand, I have a 93-year-old physician father sequestered at his home. I do visit but stay at least 6 feet away from him. From his point of view, as he doesn’t drive, things aren’t that much different than normal. These visits may have to stop at some point, which is sad.

I pray for my friends whose jobs and thus their income has been interrupted by this mess. Hopefully, we can find ways to help.

My advice to all would be to lay low, wash your hands frequently. Perhaps a shower after a trip to the grocery store, or other public spaces would be prudent. Disinfect work surfaces obsessively. By all means, get outdoors for exercise if you can.

I would ask your physician about hydroxychloroquine/azithromycin. The doses are readily available on the web and at least around here, they are still available in the pharmacies.

It would be really smart to stop smoking at this point.

And for God’s sake, don’t be a martyr. If you’re sick don’t go to public places, and don’t go to work. Even if you are a healthcare worker, stay home. You’ll do more harm than good.

I fervently hope, and cautiously believe that in a month or so, if all of the efforts in place are effective, the curves will flatten, and things will begin to normalize.

Then I can go back to writing about cameras.