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CORONAVIRUS UPDATES CONTINUED

 

 

COVID-19 Update No. 14: “Trump’s Pandemic Performance”/Politics

10/26/2020

Just weeks away from Election Day and, if the polls are to be believed (not a given), President Donald Trump is behind. Since he fares better than his opponent on the economy, now and into the future, it must be that personal dislike of him and the public’s inclination to blame him for the state of the COVID-19 Pandemic account for the poll deficit. Of course, all this occurred on his watch, but a review of the facts will clarify what is and is not reasonable about all this. In order to arrive at proper conclusions, we must revisit the beginning of COVID-19 in the U.S. Starting there, the questions to answer are,

1. How might all this have gone, at best?
2. What was done?
3. How has it gone?

Recall that the first U.S. COVID-19 case was Jan. 21, 2020. It had clearly come from China. Despite a widespread outbreak with many deaths in China at least the prior 2-3 months (very possibly longer), with the arrival of a novel virus on our shores, the first priority was to get information from the Chinese experience with haste. China would not cooperate. They would not allow our CDC experts access to their high security biological lab (much of which was funded by U.S. taxpayers) in Wuhan where SARS-CoV-2 (COVID-19 virus) had been under study, virtually the epicenter of the Chinese epidemic. So, from the outset we had no helpful information. We were starting at zero (and we now know the virus was spreading here exponentially, but silently). We were already behind. In addition, the Chinese misinformed us, suggesting human-to-human transmission was not a serious issue. By that time, SARS-CoV-2 was already showing up outside China, in other parts of Asia, India, and Western Europe.

Further, the nature of novel, pandemic viruses is to spread quickly and in rolling waves over 1-2 years after their first appearance. So, the cat was out of the bag with the first U.S. case and no one could have stopped it. No one. We now know that up to 20% of infections have no symptoms, and 60% are mildly ill. And, we had no test yet to detect the virus. So, we would spend a couple months just to collect actionable information allowing policies and protocols to contain spread. And we had no idea who was at most risk for serious disease and death. We were entirely in the dark for the first couple months on what we faced.

The President did what leaders do. While trying to develop information, he announced the problem to the country with a calm, optimistic tone. Should he have then been grim and worried, leading the country to panic- a rush on supermarkets, home supplies, banks? No. That is not leading. But, on Jan. 31, 2020 (10 days after our first identified case), he made a bold decision to stop travel from China, anticipating the worst. He was immediately criticized by Joe Biden as being “xenophobic” (racist) against the Chinese. Nancy Pelosi, Democratic Speaker of the House, smilingly told the country to go to Chinatown to eat Chinese food, as she did so on camera. This was the “anti-Trump” strategy. Whatever he does, do or say the opposite and find a way to label him. So, from the start, some Democrats worked this pandemic for political advantage. As Jane Fonda, a lifelong Democratic Party darling, recently said, “COVID-19 was God’s gift to the Left.” … but not to the over 215,000 COVID-19 U.S. dead.

He then shut down travel to and from Europe on March 12, 2020. Leadership.

1. How might this have gone? What was done?

With what we know about pandemic viruses’ behavior and the SARS-CoV-2 virus specifically, no one could have contained this. Infectious Diseases specialists and public health experts know this. President Trump’s COVID-19 Task Force, which he formed immediately, came out with the most reasonable approach. The goal was not to stop the virus. It was to “mitigate” it. The idea was to break an expected tsunami of cases into many smaller “surge” waves, so that the healthcare system had sufficient workers, facilities, and equipment to optimally treat the afflicted. Italy failed at this and so choices were made by its physicians of who would get the ventilator and who would be made comfortable to die… rationing care. This never happened once here, despite a horrific hotspot outbreak in New York City. Why? Because the President and his Task Force mobilized the military and private sector business to go into wartime mode to outfit two U.S. Navy hospital ships for expanded bed and intensive care unit capacity in a matter of weeks… record time. The ships were deployed to New York City and Los Angeles. Both the Democrat Governor of California, Gavin Newsome, and New York’s Democrat Governor, Andrew Cuomo, were effusively grateful and complimentary of the president’s time-critical effectiveness and speed in getting the job done for these governors and their constituents.

In parallel, the president had the biotechnology companies develop an accurate diagnostic test for SARS-CoV-2 within the first month, and then ramp up production and distribution of test kits as soon as possible over the next couple months. This was essential to success, to have a tool to detect the enemy and to track its behavior and extent. Only with this could we develop a containment strategy while working on the currently ill. Likewise, personal protection equipment (PPE) of facial visors, masks, gloves, gowns, and cleansers were urgently needed, especially for frontline medical workers, and the president pushed manufacturers to retool their factories for massive production of all this and ventilators that were sorely needed for survival. All of this activity was initiated and coordinated by the president’s Task Force. But, its work also included mobilization of the U.S. basic and medical science communities to study the virus in detail and to start clinical studies on patients and patient groups to start to define methods and standards of care for the clinicians charged with care for these patients—an ongoing process to continually re-evaluate new data and to optimize care, the goal being to minimize the death rate. So, the death rate and intensive care occupancy by COVID-19 patients has dropped radically.

Finally, the CDC also daily and weekly produced guidelines and protocols as new information was collected real-time for the medical profession, first-responders, and hospitals and the general public (schools, restaurants, bars, sports venues, etc). There was a necessity to address virus exposure across the society with the goal of mitigation to limit further spread. And so, to bend the building huge wave of new case numbers downward, all of this had to happen at virtually the same time. President Trump’s Task Force, under his leadership, got this done.

Sure, there were some shortfalls in production and distribution of supplies in the early months, but this was unavoidable with an unprecedented biological catastrophe (at least since the 1918 Spanish Flu Pandemic). And, President Obama and Vice-President Biden had exhausted the supplies of PPE with the 2009 H1N1 Influenza Pandemic from the national stockpiles and never replaced them. Nevertheless, everyone received the best care available in the moment.

To diminish the first, huge wave of cases, a “lockdown” of the country was done under the advice of public health experts, such as Dr. Fauci and Dr. Birx—to be managed by each state’s governor according to their state’s density of population, total population, rate of new cases, and many other factors. And, now that more was known about those most at-risk for serious COVID-19 disease and death, strict quarantine of the most vulnerable was effected. It was clear that any lockdown was a double-edged sword. The more severe and longstanding any lockdown, the more societal paralysis and collateral COVID-19 damage: ruined businesses, defaulted mortgages, exhausted savings, mental illness exacerbation, alcohol/substance abuse incidence rising, broken marriages, physical violence, diminishing tax bases threatening government and public services breakdowns, closed medical practices, and financially tenuous hospitals, and on and on. Knowing the peril to his white-hot economy and the potential political fall-out in an election year, President Trump called for sweeping lockdowns in outbreak hot-spot areas in the best medical interests of the American People, per the discretion of governors and local leaders.

One important point about lockdown that has not been discussed. The longer and more severe they are, the more people are not exposed to the virus and so not developing immunity. So, when strict, long lockdowns are terminated, it is a set-up for massive resurgence of infections—creating the tsunami that mitigation was designed to avoid. That is what is happening in Europe now. Lockdowns were over-done there. Lockdowns are supposed to be managed to slow down and, so to spread out, new cases. President Trump did that.

Finally, President Trump had the Food and Drug Administration (FDA) streamline its ponderous, inefficient approval process so that promising medications and other therapeutics could be fast-tracked in what was a public health cataclysm. This innovation also is relevant to what appears to be a record-breaking development of a COVID-19 vaccine, expected to be available by the end of 2020, an unheard of 8-9 month timeline, compared to the usual 3-5 years. This could only occur with the lightning fast mobilization of U.S. basic science companies and academic institutions by an expert leader and manager to develop the science on the nature of SARS-CoV-2 as well as its interplay with human immune systems (immunology). This had to start up back in March in order to meet a vaccine target arrival date in late 2020, or early 2021. Fantastically ambitious and unprecedented.

Finally, it appears likely we will have a vaccine that will enable us to return to our usual lives understanding that a new vaccine is never a given possibility. Do we have a vaccine for HIV/AIDS, Herpes simplex, Zika virus? No.

How has it gone?
Well, cases continue to appear and deaths continue to occur. But, again, that was always expected. It could not be otherwise. We had to open, or sacrifice the country’s economy, and so America. With that, more people would be moving about, and so, with increased testing as well, there would be mounting case numbers. Many of these are positive COVID-19 tests without illness, though the media does not explain this critical detail when announcing panic “alerts” on “surges” of new cases, which fits their aim to exaggerate and to sensationalize. But, the focus should not be on the media’s alarmist “alerts” on new case totals as people re-engage in their lives. The focus should be on several facts,

1. The public is, by far, more used to the need to “social distance” and to wear masks, where appropriate. It is not the “new norm”; rather, a new norm for a while…probably another year (depending upon the effectiveness of the anticipated vaccines).

2. The medical profession now has methods and tools to deal with the worst cases. So, COVID-19 hospital admissions, ICU cases, and deaths are all way down the past 3-4 months. Most of the deaths occurred when we were COVID-19 ignorant and inexpert. This will only continue to improve as more medications and other therapeutics (monoclonal antibody and convalescent plasma infusions) become available. Many are in the pipeline and will be available in just months because of the mobilization of private enterprise, the healthcare system business and scientific communities, and military and public health sectors—all done immediately and in parallel by President Trump’s Task Force from the outset. An apt analogy would be America’s all-out, full-societal response to entering World War II after December 7th, 1941, Pearl Harbor.

3. Children are increasingly back at school. That is necessary as they have been hit hard in their development in crucial years of their lives. Long-term life success is highly correlated with the elementary school years’ experience. There are next to no deaths in people under 19 yrs-old who are otherwise healthy. Recent studies show in 1 in 1,000 school children acquire SARS-CoV-2 at school; 1 in 2,000 teachers. And, children are now known to not likely spread SARS-CoV-2 to adults. Adults get COVID-19 from other adults.

4. With easing or cessation of lockdowns, we will see more cases. But, the great majority of those new cases are in people in their 20’s, not a risk for serious disease or death more than seasonal influenza. The more of this that happens, the more “herd immunity,” until finally, between those previously infected and immune and those who have been vaccinated, we will see this all in our rear-view mirror, much as any virus that is part of the human condition, such as influenza. The president is correct when he says we have “turned the corner.” Case counts will continue to register, but death rates and hospitalizations will go down and the virus will gradually mutate to a weaker form. Anything that suggests otherwise is misrepresentation to create panic. Walk away from that.

MASKS

One other topic should be discussed…masks. Politically, the failure to religiously wear a mask or to insist on it has been used as a “virtue signal” for social irresponsibility, and wanton disregard for others, in fact, gross negligence. This has been a drum loudly beat by President Trump’s adversaries. And, they have used mask wearing, virtually every time in front of a camera, to create political theater over the issue as a negative signal on President Trump’s alleged personally unethical behavior and incompetency, as well as an ever-present reminder that we have a pandemic and it is on Trump’s watch; so, he owns all its negatives (or so they assert).

No one can argue against wearing a mask. If it allays anxiety in an individual because they are “doing something,” then, so be it. But, it is clear that the data on efficacy of masks having a reliable impact on the risk of acquiring COVID-19 are conflicting. Likewise, the opinions of experts on the matter. The CDC just turned out data on patients who were so COVID-19 sick that they were admitted to the hospital. Of those, 71% had worn a mask all the time; 14%, most of the time. Seems like the mask did not provide much value. The U.S. Surgeon General, some months ago, doubted their value. On March 8th, Dr. Anthony Fauci (NIH) said masks were not needed. He since then has seemed to advocate them, but he has vacillated on his position, like on other pandemic issues, many times during this pandemic. But, before we take a political party’s condemnation carte blanche, we should examine an issue, the facts of which are still evolving, ourselves. The Democratic Party and Joe Biden’s opinions on this are just perhaps not entirely motivated by established science. The bottom-line on masks from the CDC is that masks may decrease the risk that someone ill with SARS-CoV-2 will spread it to others, but it is less clear whether masks protect the wearer.

Note, just last week, the World Health Organization pronounced COVID-19 quarantine lockdowns no longer advisable because any value with respect to COVID-19 prevention were negated or even outdistanced by the severe collateral damage of societal isolation, economic damage, and non-COVID-19 medical morbidities and deaths from the lockdown as people delayed or avoided medical attention for serious problems out of fear (from the media) of acquiring SARS-CoV-2 while seeing a physician or going to a hospital. And, until this, lockdowns were written in stone, COVID-19 dogma, as necessary, even to the point of many Democratic Party governors over-reaching their legitimate legal authority to bring to bear almost COVID-19 martial law on their constituents as they restricted their constitutional rights. Yet, the lockdown issue is still open to debate by qualified experts.

You want to end COVID-19? Put every person on a private raft at sea for 3 weeks. Done, virus gone. The only fool-proof anti-SARS-CoV-2 intervention is strict social distancing. And now, knowing it hangs in the air in minute, aerosol particles, everyone must be at least 20-feet apart. As for masks, jury’s out.

The Election/Trump/Biden/Pandemic: Conclusions

Lexicon: Propaganda, misinformation, disinformation, political theater, exploitation, manipulation, mistruths

All of the above.
Well, if you’ve gotten here, you have the picture of all that went into, over a very short time, orchestrating a comprehensive public health, medical, and societal response to this unprecedented crisis, without the benefit of any collaboration with those who originated the outbreak. Really astonishing by anyone’s measure. I won’t say unprecedented. FDR, likewise, mobilized all needed expertise and resources with our sudden entry to WWII.

Nevertheless, Joe Biden, Kamala Harris, and the Democratic Party leadership seem to have gotten away, in this age of sound bites and partisan social media edits, to misconstruing President Trump’s leadership and effectiveness in confronting the pandemic for the American People. They claim President Trump has been asleep at the switch, fiddling away while Rome burned.

Joe says he would have done (in fact, will do) it differently. He’ll let us know (just like with Supreme Court “packing”) what groundbreaking solutions of his would have turned all this around, after the election. Funny. What happened to the telephone? To email? I am sure the Administration would have welcomed a message from him with his prescient wisdom to impart on ending the COVID-19 Pandemic from a former vice-president. Certainly, no one committed to the welfare of the American People (and the country) would withhold information that would save lives until after an election. That would be a pre-requisite for a would-be president.

Had Biden been president in January, he would not have stopped travel from China. Remember, China had a wobbly economy and would not take well to such a lockdown of travel between the U.S. and China. Besides, they needed the SARS-CoV-2 to spread broadly across the world—a receding tide to lower all ships. They needed the U.S. hurt, badly, without firing a shot so that their timeline for becoming the Number One Super Power of the 21st Century was not derailed. And, the Bidens are tightly entangled with them through under-the-table business schemes when Joe was VP, more evident every day.

According to Joe Biden, President Trump is personally accountable for all the COVID deaths. Any competent president would have prevented all of them, according to Biden. Well, the pandemic modeling in February suggested about 2 ½ million U.S. deaths with what was known. That’s 6X more than so far. Had Biden been president and not stopped China travel, there would be tens of thousands more deaths. Parenthetically, tens of thousands of these deaths were mass-murder actions by several Democrat governors defying (New York, New Jersey, Pennsylvania, Michigan) CDC guidelines and sending recently infected elderly patients back to their nursing homes to pollinate thousands of doomed residents (about 11,000 estimated deaths by Gov. Andrew Cuomo, alone, who still does not take responsibility and still holds office; says a lot about their real concern for all those deaths about which they decry President Trump).

When Biden does offer up a sampling of what he would do, it is everything President Donald Trump already has done. But that’s just like Ole Joe. Once a plagiarizer, always a plagiarizer (the reason for his two prior failed runs for the presidency).

But, we don’t need to speculate. Joe Biden was charged by President Obama with managing the 2009 H1N1 Influenza Pandemic. In the U.S., 61 million were infected (compared with 5 million with SARS CoV-2). There were about 12,500 deaths with H1N1 compared to over 215,000 so far with COVID-19. However, the SARS-CoV-2 virus is 6X more lethal than seasonal flu and 30X more lethal than the 2009 H1N1 flu strain. If SARS-CoV-2 had been the virus in 2009 with 60 million infected, Biden would have presided over 360,000 deaths. Joe Biden is in no position to criticize President Trump. Yet he does. Politics. Trump has been a master, given the unprecedented circumstances. His virus is a killer, more like the 1918 Spanish Flu with a death rate of 2%.

His chief of staff, Ron Klain, said, “It is purely fortuity that this isn’t one of the great mass casualty events in American History,” in commenting on Biden’s management of that pandemic. The fortuity was that, though the virus spread prodigiously, it was much less lethal than SARS-CoV-2. Joe lucked out. However, not so for the 12,500 who died, who were mostly between 15-40 years old. SARS-CoV-2 deaths are about 50% in nursing home patients, well past their life expectancy. 80% are over 65 yrs-old. So, Joe Biden was tested on a pandemic and did not fare so well, relatively.

So, in closing, just to get this right, first, Trump did too much, too fast, because he’s a racist. Then, he did next to nothing (and he doesn’t wear a mask in the shower!) and so mass-murdered over 215,000 people, which would not have happened with a President Biden. Guess we can all relax because all this will be over and we can return to our lives when he’s sworn in. At least that’s the Trojan Horse they’re selling to the American People. Maybe the Democrats will be charitable and at least take 25,000 off the death totals due to Democrat governors’ gross negligence, so as to not hold them against the president. Nah!

It is also essential to understand that from the outset the president was clear that COVID-19 was a pandemic, which is defined as a number of individual, contemporaneous epidemics, each one with its own particular expression according to the geography of each state as well as other characteristics particular to each locale: number of large cities, total population and population density, use of public transportation, number of medically vulnerable individuals, etc. In other words, the pace and extent and severity of the pandemic would be highly variable, state-by-state. Some needing total lockdown, others gradual or partial shut-downs. For example, at the start of the pandemic, the states and cities on the coasts were hit hardest because of their extraordinary exposure to international travelers. With all this in mind, the president plainly stated that each state governor should determine what measures were needed and when, to match their healthcare system resources to the nature of their specific COVID-19 epidemic that they were experiencing. President Trump said the federal government stood ready to provide whatever was needed by each state, upon request. He did so. Most notably, Governor Newsome of California and Governor Cuomo of New York, both Democrats, praised him unequivocally for his immediate and exuberant response to all their needs. President Trump overwhelmed them and anywhere else requested with sufficient supplies, equipment, and hospital bed capacity. So, this always was a multi-centric management strategy to be overseen at the state level by governors with the full support of the federal government. Nothing else would make sense or would be effective. To now try to lay all blame entirely at the feet of the president is preposterous.

If you say President Trump failed, you need to say what he did not do that should have been done and when, with the information available at the time, it should have been done. And, if so, where were you with these ideas when all this was playing out? You don’t get to be Monday Morning Quarterback with no facts, only criticisms, to claim you would have done better.

The best benchmark of success is a decrease in death rate (deaths per total cases), decrease in hospitalizations, and opening up of the economy. All of that has been happened about 6 months after the inception of this nightmare. The media panic us with “surging” new case numbers which mostly reflect more and more availability of tests…the vast majority are minimally ill, or not at all. Beware of this messaging. It is cynically perverse politicking the pandemic in an election year.

As for President Trump, as a specialist in these matters, I cannot see how anyone could have done better. Thankfully, we have had an expert business manager/developer executive as the Chief Executive when COVID-19 arrived. Biden, who has never created a job or a service, never been an executive manager, and never started and run a business would have been a tragic failure, with unimaginable losses for our country. If elected, he’ll get the benefit of all Donald Trump has done and President Trump will get no credit from the partisan media.

Edward R. Rensimer, MD
Infectious Diseases

 

COVID-19 Update No.13: Being A Low-Risk Patient

6/29/2020

How long will this go on? Well, we had the worldwide 1918 Spanish Flu Pandemic, which cycled continuously, with about three major surges of disease and death more than two years. It is a fair guess that 1-2 years of COVID-19 will be prominently in our lives. However, we are physically interconnected across the globe in a matter of hours with air travel. And, this is a below-the-radar SARS-CoV-2 virus that is spreading most vehemently in the 48 hours prior to the onset of illness symptoms, when the unsuspecting host is shedding virus profligately and that person is going about their life with abandon, unaware of the danger they pose to family, friends, co-workers. So, the features of modern civilized society make predictive models of COVID-19 behavior and pandemic timelines tenuous at best.

The best thing has always been to avoid doctors and hospitals by maintaining your health and physical conditioning. More so now, with the extraordinary communicability of this virus as every place in the healthcare system is a trafficking funnel that concentrates the sick, medically infirm, and elderly… those at most risk for COVID-19 fatality. The healthcare system is the worst place to be, the frontlines.

What are you to do? You are not a habitual medical care seeker (there are those). But, you have blood in your urine, unexplained weight loss, fever, extreme new-onset fatigue, or cryptic chest pain. Problems that cannot wait-out COVID-19. And, the collateral damage of COVID-19 contagion is yet to be tabulated- people delaying seeing a physician or going to the Emergency Department because of COVID-19 fear- and die of a stroke, heart attack, septic shock, ruptured appendix, etc.

How do you balance the risk-benefit of being evaluated timely in the context of COVID-19 exposure risk? Below, I will give you practical ideas and actionable points that should provide a template for your medical care until all this is way in our rear-view mirror.

1. Telemedicine Appointments: Many medical offices are offering at-a-distance visits that may be effective for the problem (we do). Most certainly, the physician should lean strongly toward this type service for those over 65yrs and/or with underling medical conditions. Whether an in-person visit is in the patient’s best interests, and so necessary, is a medical decision by the physician. Ask your physician if they are set-up for this.

2. Minimize Time in Medical Facilities: This is intuitive on its surface. There are creative ways to do this aimed at infection control. It is all about pre-emptive communications, personal preparations for the appointment, and operational flexibility of your medical professionals. To limit your exposure time to other patients and the medical staff,

a. Complete all forms and provide all documents (updated insurance, prior medical records) prior to arrival.
b. Inform the office staff you will wait in your car until they call you to enter the facility so that you can be showed directly into an exam room, with no time among others in the waiting room.
c. Wear a mask (consider a double-mask, like I wear) and rubber gloves.
d. Have your story (onset, timeline, encounters with other physicians, medications and their impact on the problem or lack of it, prior diagnostic test reports- blood, urine, imaging) written out to present the physician. Optimal if this can be forwarded pre-visit (FAX, secure email).
e. Have your questions and concerns defined and written for the encounter.
f. Try to physically distance (other than the actual physical exam) during the visit (6 feet or more from others, including the physician and staff).
g. Do not be seen by medical professionals who are not wearing masks.
h. Clean your hands when exiting the medical facility, in a building restroom if needed.
i. Most of these measures are also relevant to an Emergency Dept, laboratory, imaging facility, physical therapy, pharmacy, and other medical service locations.
j. Wash your hands thoroughly as soon as you arrive home, touching nothing else (consider keeping hand cleanser in your car, as well).

3. Potential COVID-19 Illness Case: It is medically irresponsible to have a person who has an illness consistent with COVID-19 come into a medical office, potentially exposing staff and other patients to the virus.
a. Your physician’s staff should be asking each person trying to come in whether they have recently had symptoms consistent with COVID-19, exposure to a confirmed COVID-19 case, or themselves been found positive for COVID-19? These patients need to be turned away from an in-person office visit. The physician can arrange a phone or telemedicine (computer) visit. What if that person is really sick, with ominous symptoms, such as shortness of breath? They must be directed immediately to the hospital Emergency Department, with the doctor and the patient calling the ED staff to forewarn them of an arriving COVID-19 illness so they can sequester the patient into areas designated for such cases, protect themselves, and give directions. Such patients are not welcome at outpatient labs and imaging facilities- they do not want to be shut down because their staff have been compromised and/or infected. The rest of us do not want them closed down either, nor physicians’ offices. We need them up and running out of self-interest.

4. Conclusion: Stay away from medical professionals and medical facilities, but, with any problem that would normally bring you to contact your physician, do that and let them decide how to address the issue. Do not sit on something you normally wouldn’t. COVID-19 isn’t the only thing that can come to a very bad outcome.

Lastly, if your physician and staff cannot work with you in line with the aforementioned principles or they seem apathetic, dismissive, and/or ill-prepared, maybe it’s time to look for another physician.

Edward R. Rensimer, MD

COVID-19 Update No.12: “Surging” Case Numbers, Media Alerts, and Reality

So, COVID-19 “lockdowns” were eased and new COVID-19 case numbers “surged”? We should all panic. The pandemic is roaring back and we can do nothing but lockdown again. Texas’ governor, Greg Abbott, is giving that serious consideration. This, even though we know further, significant societal lockdown carries dire consequences for our economy and all Americans, while COVID-19 poses a death risk now approaching a small multiple of seasonal flu, and that for a small group of people, mostly the very elderly and medically infirm. The average age of COVID-19 death is 82 yrs, about the U.S. life expectancy for other causes. But, with the alarmist nature of the media and of breakneck, reflexive 24/7 “Media Alerts” and “Breaking News”, we don’t deliberate on the situation… we emotionally react with dread and borderline hysteria.

Lets’ try something new. Let’s calm down and think through the facts, like scientists, like physicians.

1. The Pandemic Goal: It never was to stop the virus. The cat was out of the bag in January and it was spreading with unprecedented speed and ease across the globe. Based on prior “novel” virus pandemics, we knew this would play out over 1-2 years until the virus slowly changed (mutated) to partner better with humans biologically, rather than kill them (which is against its own interests- a suicide virus). The virus would become the vaccine; eventually, once about 60% of the human herd had been infected and had immunity, the potential human hosts would be radically reduced, and so the pathway to those at most risk for death. The virus would become just another background occurrence in the human condition- like influence, West Nile virus, head colds.

So, we took measures to slow down the outbreak pace (“mitigation”) and to spread it out over many months, rather than over the initial 2-3 months, to allow us time to learn more about the virus and how to deal with it. More medications and management techniques. Maybe a vaccine (but don’t count on it). And, with the concern that the Fall season brings people to congregate more in close-ventilated spaces, as well as the certain annual rise of flu cases, the chief goal was to spread COVID-19 over months so the healthcare system could have staff, supplies, and equipment so no one received less than optimal care when both viruses hit.

Conclusion? Once we re-opened we knew there would be more COVID-19 spread, more hospitalizations, more deaths. It was acceptable, balanced against the sure devastation of lives and of the country with continued lockdown. So, what is happening was expected to happened, yet there is anxiety all about, fanned by the media.

Leadership needs to monitor COVID-19 hospital admissions and ICU occupancy, and adjust infection control measures to match the case numbers to resources. This is analogous to Harris County officials “bleeding off” water in phases threatening to burst the Addicks Dam during Hurricane Harvey to minimize flooding. Some property would be lost, but not all property.

Finally, despite increasing COVID-19 cases, the fatality rate has decreased, suggesting more of the cases may be in those under 65 yrs-old. If that continues, we could be moving toward the 45-60% “herd immunity” that will dramatically decrease the size of future outbreak “waves”.

2. Case Increases Across the South: It is unclear why this is so, but possibly the cases were at such a low number because of intelligent, effective lockdown measures initially such that we did not have the outbreak disasters seen in New York, New Orleans, etc, due to major errors in management (public transit, nursing home errors, Mardi Gras), and so less infections. As we eased lockdowns, COVID-19 is now getting to more people, but in the intended, measured way. Further, with increasing outside heat, people in Florida, Texas, and Arizona are naturally driven more indoors to air-conditioning, much like the effect of winter’s cold air arrival in the North. We know most COVID-19 infections are acquired among household members in close, prolonged contact, not people out and about.

3. COVID-19 Case Labelling: There is an incentive for hospitals and the medical profession to label a medical case as “COVID-19” diagnosis. Why? The government and insurers are processing payment for testing and care quickly and at good rates in order incentivize the system to prioritize care for COVID-19 cases as this has been termed “a national health emergency”- analogous to FEMA dollars for floods, hurricanes, tornadoes. The uninsured are even covered, where hospitals would normally eat the bill for them, other than a tax write-off.

So, I arrive at a hospital from a serious car wreck. Now, all patients arriving at the hospital are screened for COVID-19 to protect the staff. But, once that test is positive, I am labeled as a COVID-19 case. If I die from my injuries and was only carrying COVID-19, but not ill from it, I may be labeled as a COVID-19 death. There is a financial incentive to over-diagnose. There is also a political incentive. Make this a bigger, more ominous epidemic, governors, mayors, county judges are given more room to exert power. Be clear also that this is a presidential election year and many politicians have a big stake in not seeing the economy recover for fast and in making this natural disaster the result of mismanagement by current leadership to influence elections.

4. Social Distancing/ Politics: Somehow, over a thousand medical professionals disgracefully issued a letter stating that the specter of COVID-19 transmissibility during huge public protests across the nation took backseat to the cause of “systemic social justice”. I suppose the COVID-19 virus threat to individuals, which previously required draconian isolation measures by political fiat, now was not so much. I guess “Black lives DIDN’T Matter”, since many of the protestors were black and it is well-established that black death rates from COVID-19 are substantially higher than other groups. Even if mostly younger blacks were protesting, they could take virus to their families.

So, many medical professionals took a political position against their professional oaths to protect the health and medical interests of patients. This put people at risk for serious injury and death, in the name of a political protest movement which was based on a questionable, yet unproven, premise of “systemic social injustice”. Moreover, just weeks before, medical leaders advised and insisted on tight, protracted COVID-19 infection lockdowns with absolutely probable devastating effects on the lives and health across our entire population. It is unequivocal that “social distancing” is the most effective measure against COVID-19 propagation. You put yourself on a single-person raft in the middle of the Gulf of Mexico the next 2 years, you don’t get COVID-19.

Did anyone but me note that the incubation period for acquiring the COVID-19 virus to onset of illness is up to 14 days, and the uptick of cases in Houston occurred 1-2 weeks after the local mass protest gathering and funereal crowds for George Floyd in Harris Country? Yes, what was predicted and speculated is happening. But, the media has no interest in making this association, as apparently they are all-in with the “social justice” movement.

This must be stated. It will be remembered as a low-point for the medical profession and leadership who advocated against the public good, resulting in loss of “precious” lives (“Every life is precious” is, I think, what had been the mantra) out of political self-interest. A disgrace. Disgusting hypocrisy.

Edward R. Rensimer, MD

COVID-19 Update No.11-2nd Wave or Expected Blip

Recently, in some parts of the U.S., including here in Houston, TX, we have, just weeks after businesses have gradually re-opened, seen an uptrend in COVID-19 new cases. Think back to March. At that time there was a strategy of containment and mitigation of the pandemic curve’s upward tack. It was felt too late to stop COVID-19. Rather, the aim was to “flatten the curve”- to turn the new cases curve to horizontal and then gradually downward. That “mitigation” occurred by dramatic lockdown of human interactions and wearing masks, hand cleansing, and social distancing. The curve was bent and new cases as well as deaths declined.

As we saw the resulting economic devastation, a deliberate decision to re-open was made and it was presumed that with people out and about, COVID-19 activity would pick up. It had to. But, we had, for the country’s greater interests, to re-open and expect an increase in new cases.

That’s where we are. We are seeing an uptick in COVID-19 cases. Further, keep in mind that 100X more COVID-19 tests are being done than 2 months ago. This naturally will detect cases that before would have gone unseen. The result? An appearance of increased disease activity, which might actually be an increased detection of cases that were already there, all along.

In the month ahead, look to hear new information showing far more COVID-19 cases than before, many more subclinical or asymptomatic “infections”. Further, we should see the COVID-19 total case denominator grow substantially, which will decrease the mortality rate a good deal, perhaps just above seasonal influenza- say, 0.2-0.3%. If you have 10 deaths in 10 cases, the death rate= 100%. 10 deaths in 1000 cases is 1%. The denominator is everything.

Finally, if there really is some true increase in COVID-19 cases, the long-term benefit is “herd immunity”- much fewer people available to be infected for a large 2nd wave in the Fall.

So, don’t panic, even if the media have a political agenda in keeping this thing going. Wear your mask, wash your hands, and socially distance. Enjoy the gradual re-opening, but continue to be smart in playing your role in continuing to “bend the curve”, until we are told we can go back to “normal”, which I believe is 1-2 years away.

Ed Rensimer, MD

Director, International Medicine Center

Copyright, 2020, E. Rensimer, MD, All Rights Reserved