The Science (and Art) behind the Closures

The Mantra for the past ten months in many quarters has been the demand to show the science behind the establishment of infection rates that trigger closures of businesses, churches, schools, beaches, parks, etc. It’s actually a very good question, and since lives and livelihoods are on the line, it deserves to be answered respectfully (and perhaps with a little humor to leaven the subject).

One of the Nadal children asked the very same question. My response was that the book for managing the SARS-CoV-2 pandemic may be found in the Self-help section of the bookstore right next to the scientific book on raising perfect children. Here in Casa Nadal that sort of Brooklyn wit is seen as instructive and not sarcastic. It invites us to go deeper.

Parenting and medicine have much in common. They rely quite a bit on science to inform their judgements, but many of those judgements are more art than science.

{The gentle reader may infer a paternalistic attitude forming up here in the pandemic management, but nothing is further from the truth. No analogy is perfect, but given that public health officials are making decisions that will affect people against their wills, and have those decisions backed by force of law, the analogy isn’t that far off}

So, let’s get back to looking at the benevolent dictatorships we all call home. Every member of a family is different. Each one of the Nadal young adults is different–VERY different. Each one presents with a different risk profile with regard to circles of friends and the influence each circle has. Blessedly there are no bad circles, but there are certainly differences in how casual certain friends are with regard to following the rules.

When the decisions need to be made about who goes where with whom, and how late they stay out with a given circle, there is not a uniform standard.

That’s when the sparks fly.

In our COVID reality, different professions/occupations present with different risk factors for disease acquisition and propagation. There is no book that tells us how to proceed, at least not yet.

It’s being written and edited as we go through this experience in real time.

But just as there is no manual for parents (The “What to Expect” series and Dr. Spock only get you so far) that allows us to paint-by-number our way through life, and there is no manual for managing a pandemic such as this one, that does not mean that we are bereft of rock solid information, foundational principles, wisdom passed through the ages by mentors, and prior experiences. How we apply all that we have received to our emerging knowledge of the pandemic is ultimately an art that begets the science aspect of ongoing and future management.

Why do some states draw a line at 10% infection, and others at 15%? Well, why do some families permit kids to go to rock concerts and others do not? It comes down to risk tolerance based upon the unique set of prevailing factors in each home. Each mayor and governor must look at a blizzard of variables:

What is the overall population in my city/state?
What is the population density?
What is my current rate of infection?
What is the ratio of general hospital beds to population?
What is the ratio of ICU beds to population?
What is the predominant mode of transportation?
What is the socioeconomic status of my population?
What is the overall health of my population?
What are the percentages of multigenerational homes in my population?
How many of my homes have more people dwelling in the house/apartment than there are rooms in the dwelling?
What is my city/state’s ability to purchase and stockpile PPE?
How has my state’s case fatality rate compared to others?
How many illegal aliens do I estimate my city/state to have, and how cramped are their living conditions?
Do I have adequate public health outreach to the illegal aliens, homeless, mentally ill–who form shadow populations that live beyond the margins of society?
How robust is my public health infrastructure?
What are the eating habits of my population relative to frequency of dining out compared to eating at home?
What is the current capacity of my hospital system relative to supplies, ability to create makeshift COVID wards and ICU’s, etc.?
What strains of the virus are we isolating?
Are we seeing more infectious or more virulent strains emerging?
How much of a transportation hub is my state for interstate and international travel?
Could contact tracing work in my state/city?
What is my testing capacity?
What is my capacity to identify hotspots through testing?
What capacity do my hospitals have for treating early symptomatic COVID cases with Antibodies, Remdesevir, Ivermectin, etc… to prevent progression to full-blown critical status?

…and these are just a few that inform how we are to proceed. Now come the war games.

1.) What if I just do nothing and let the virus run its course?

Here it’s worth pointing out that the Washington Post published an excellent article with animated simulators last year. Check it out here.

2.) What if I shut down some services while keeping others open?

3.) What happens if I shut down all businesses?

For each of the war game scenarios, the answers to all of the above questions come into play in determining the best course of action for that given city or state. There is no, “one size fits all,” approach to pandemic management.

“Yes, but we’ve had shutdowns and lockdowns and they have not worked!”

The answer to that is yes, and no.

The shutdowns definitely slowed the rate of disease spread, and that saved lives. Many who might have been sickened in the first months of the pandemic did not get sick until much later, when monoclonal antibodies, convalescent plasma, Remdesevir, hydroxychloroquine, Ivermectin, high dose Vitamins C & D, azithromycin, doxycycline, budesonide, and anticoagulant therapeutic protocols were put in place. Also, we learned that severe hypoxemia in COVID does not necessarily warrant being put on a ventilator, and that ventilators killed quite a few patients…so much so that their use has been cut back substantially.

You don’t want to be in the initial wave of patients during a novel pandemic!

The initial shutdowns kept our hospitals from being completely overwhelmed and bought the medical community time to learn, and time to develop vaccines. Many people are going to be immunized, who might otherwise have perished, thanks to the shutdowns.

Laws and shutdowns work to the extent that people don’t cheat. But we have seen open defiance on a massive scale, and the results have been catastrophic.

Returning to the demands for the science behind the closures…

As mentioned, we don’t have a book. We’re writing it as we go. That’s unacceptable to many, and that’s understandable. But seriously, we’ve only gotten as far as we have in science and medicine because we stand atop the twin mountains of those who perished in previous epidemics and pandemics, and those whose efforts to learn and manage the unique parameters presented by each novel pathogen have given us the tools to manage outbreaks of those pathogens in the future.

Now it’s our turn.

Future generations will have a much more precise means of managing COVID outbreaks, if there are future outbreaks, because of our trial and error approach to learning disease management for this virus.

There’s no other way.

When our youngest gets to do things that our older children weren’t permitted to do at the same age, we hear about it. Our parental response is the universal parental response:

“I’m smarter now.”

Those earlier restrictive rules didn’t hurt them, and definitely kept them safe.

Be patient, folks. We’re getting smarter every day.

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I’m Now on MeWe

It seems that I’m not long for FB. The purge is underway. All of my penalties have been for posting lifesaving information on the COVID pandemic. So, I have opened an account on MeWe. It looks pretty good over there, and since the FB criteria for offenses are utterly arbitrary and capricious, I expect to be permanently banned by the summer. So this is my new home. Head over, open an account, and stop in for coffee!

See you there, and here! 🙂

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I’m Back in FB Jail–30 Days

Hi, friends. FB has put me back in jail. This time it’s a 30-day stretch. Evidently their bots don’t like my posts on COVID. FB has put the “Artificial” in Artificial Intelligence.

I’d be obliged if folks could share this post. I’m still available through messenger, or here, or at my email: gerardnadal60@gmail.com

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No More COVID SWAG!

For one long year the COVID-19 pandemic has been afflicted by no shortage of people with MD and Ph.D. after their names spouting all manner of idiocy and nonsense that flies in the face of over a century of highly developed and refined principles of infectious disease biology and immunology, as well as epidemiology.

If you want to be a hero for a week or two, just assure people that the pandemic is mostly over and we’ll all be back to normal any day now. Then militate against the mitigation protocols for good measure.

Last summer we were assured that NYC had reached herd immunity based upon the massive number of cases in the spring, followed by very low numbers throughout the summer months. It was all over, we were told. New York had reached herd immunity at below a 20% infection rate for the population. It would have been laughable had it not had such deadly implications for a population who were savaged by this pathogen as no other state had been, with over twenty-thousand dead in the city in just two months. People were willing and needed to believe any ray of hope. Herd immunity at 20% for an airborne pathogen that could remain airborne for hours as an aerosol, and that was highly infectious with a case fatality rate at the time above 7% was damned near criminal to assert. A look at the Johns Hopkins data on New York State, above, shows that we were FAR from herd immunity in the Spring, with the current rate of infection and absolute numbers dwarfing the Spring data.

The data below show the NYC numbers as of today.

Does that look like herd immunity having been reached in the summer?

No. What we have been afflicted by has been clueless individuals offering up their own SWAG (Scientific Wild Ass Guess). We’ve had a year of that, and quite frankly, we’ve had enough. So, here is a little unpleasant truth.

Politicians and citizens on the left AND the right have politicized this, either with draconian shut-downs (as opposed to targeted), or complete rejection of masking and the other mitigation strategies. Physicians and scientists have SWAGed the biomedical community into a perceived group of Keystone Cops. The truth of the matter is that all of this has contributed to a climate of hopelessness and distrust that has cost us 375,000 lives when the data get updated tomorrow. We’ll top 400,000 dead by January 21, the official one-year anniversary of CDC reporting data on this pandemic.

Given the amount of distrust in the vaccines generated by anti-Trump leftist politicians, medical personnel who don’t know what they’re talking about, and the anti-vaxxer community, we’ll fall short of the number of vaccinated individuals necessary for herd immunity. Given the hardened positions against targeted closures and mitigation protocols, we may well see an ADDITIONAL 400,000-500,000 dead by the end of next summer.

That doesn’t have to be the case.

We can cut that down by at least 300,000 if people get serious about masking, distancing, minimizing contact, sanitary practices, targeted closures, and vaccinations. In order to achieve that, we need to stop listening to the sweetly seductive voices of the SWAGers and other deniers of scientific reality.

The truth is that we are in the midst of a once-a-century pandemic, and we won’t get our old lives back until we defeat this pathogen. It stinks, but that’s the reality. As with all other adult realities there are no quick and easy shortcuts. The work before us will be long and hard, and if we don’t rise to the challenge the death toll will approach 1,000,000 before this virus is brought to its knees.

Tomorrow we’ll look at the mRNA vaccines and see that they have not been nearly as rushed as people think.

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The Scandal of the Vaccine Rollout

Image:cenblog.org

As of today, January 8, a mere 6.8 million out of 20 million doses of COVID vaccine released for distribution in December have been administered. This is scandalous. Excuses abound, chief among them that healthcare workers are refusing vaccination in astounding numbers.

So?

The point is?

Go to the next group on the priority list. The is a priority list, no?

Taking a trip down memory lane to 19.5 years ago when the 9/11 attacks were immediately followed by anthrax attacks. 2001 was the year when not only our security vulnerabilities were exposed, but when we realized that we had no plans on the shelf for the mass vaccination of the population. We were now in the age of bioterrorism, and we were naked and exposed.

Fast-forward to 2021.

We STILL have no plans on the shelf for rapid, efficient, mass vaccination of the public. Public health officers and military personnel who began their government service in 2001 will be retiring on 20-year pensions this year, and we still have no plans in place for vaccinating the public in an emergency.A full generation and we’re still groping for the light switch in the dark. This has been the greatest bi-partisan governmental failure in living memory. This entire operation has the look and feel of an ad hoc endeavor.

If not seeing to a distribution operation while the vaccines were in development is a failure of the Trump Team, incoming President Biden is about to dump a truckload of gasoline onto the fire. He is proposing to just flood the country will all the vaccine we have in stock. That’s not the answer at all. It will only make matters worse by adding a free-for-all carnival atmosphere where black marketeers will obtain stocks of vaccine illegally, where stocks of the temperature-sensitive and fragile vaccine will not all be stored properly (leading to spoilage), and where countless Americans will be injected with inert material, providing no protective benefit at all. Add to that the reality that the mad dash and haphazard distribution will mean people missing the optimal window for the critical second dose, which boosts the level of antibody made.

The issue isn’t availability. The issue is a lack of distribution logistics.

But this is the same government that spent trillions of dollars on Obamacare and couldn’t create a functional website for years to get people enrolled.

The solution begins with the mayors and governors. Every mayor should get his/her police chief, fire chief, and director of public health into the mayor’s office and let them know that they have 14 days to draft a plan to get the entire city/town vaccinated in a week, or they’re fired. Mayor Koch in New York was famous for that kind of management of civic planning. How hard is it, really, to find appropriate space, especially with so many businesses that went belly-up in the pandemic, and whose spaces go unoccupied?

The mayors then need to report their needs to the state, and the governors need to tap the state police and national guard for the safe and efficient delivery of vaccine stocks.

All of this should have been put in place during the anthrax attacks of 20 years ago and updated annually.

It’s time for some leadership in America.

It’s long overdue.

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COVID-19. No longer a Nation in Denial

{The Statue of Liberty is visible behind refrigeration trucks that function as temporary morgues at New York City’s South Brooklyn Marine Terminal. “If you’re driving by … you might just assume that this was some sort of distribution hub,” Time reporter W.J. Hennigan says. “But they are each filled with up to 90 bodies apiece.” (NPR)}

When it all began in March and April, NYC became the epicenter of COVID death in the United States. The reality was so harsh, so brutal, so traumatic, so beyond the experience of anyone alive under the age of 107, that those of us reporting on all major hospitals being ringed with six or more refrigerated trailer trucks (as pictured above) were denounced as liars, or worse. It was hard to get angry at them. It was as traumatic and terrifying here as it was unbelievable everywhere else. Then came the explanations/rationalizations.

We were told that the virus had already gone through the nation since October of 2019. Everyone had an Uncle Louie or Aunt Matilda who was really sick with some strange flu-like affliction that defied Nyquill. It was New York’s turn. That’s all. (No word on why WE had scores of refrigerated morgue trucks packed to the gills and 30-day wait lists for cremations)

We were told that New Yorkers were more susceptible to the virus than the rest of the nation. (An assessment I’d agree with if the viral manifestations were F-bombing and straightforward talk with the bark on.)

We were told that obviously the rest of the nation had hit herd immunity ahead of New York with strains of the virus that were milder than ours. (The first quasi serious-sounding assessment.)

We were told that Floridians and Texans had so much sun (in the winter) that their bodies were just little factories of Vitamin D production that we pale northern-types could only envy and That’s why they had practically no cases in the Sunshine State. (These sunny epidemiologists were nowhere to be found when cases spiked in late Spring and Summer, when Floridians shed their sweaters as the frigid 60-degree temperatures climbed into the 90’s and sunshine exposures increased ten-fold.)

We were told that doctors were categorizing every death as COVID to take advantage of the partial compensation the Federal Government was giving for patients on respirators. So follow the logic here. Docs put everyone within arm’s reach on a ventilator, including the passing janitors, in order to score $38,000 bounties from the Feds (a compensation, as the government asked hospitals to shut down all elective surgery in order to use those ventilators). Then after putting people with slight coughs on ventilators and killing 80% of them, they said it was COVID, in order to cash in.

No, seriously. That’s essentially what was being said: People not needing ventilation were being hooked up so hospitals could cash in, then their deaths were being called COVID when they really died from comorbidities hitherto stably managed.

And all to get a bounty for the hospital. Who knew that free money could make more liars out of physicians than the IRS and golf combined?!?!

Who knew that free money could make the best docs anywhere a pack of Josef Mengeles?

But that was the New York experience as told by an army of Google epidemiologists and microbiologists. Meanwhile, this new peer-review committee of Google scientists was telling this scientist (at it since the 1980’s), that he didn’t know what he was talking about as he refuted their echo chamber expertise.

I have no way of breaking it gently to the denizens of the Google Faculty Lounge, but, really, I’m not their peer. As Jefferson said in the Declaration of Independence,

…accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed.

What began as an understandable level of denial morphed into denial masquerading as political statement, and with that silliness (deadly, to be certain), it really is time to clear the faculty lounge and have the voices of those who actually are trained to deal in truth, who follow the science wherever it leads, being heeded for the first time in almost a year.

I and many others have predicted pretty much every turn of events throughout this pandemic. It’s not that we are the Amazing Kreskins of microbiology and epidemiology, but because there are laws of physics and biology that do not genuflect to politics. Those laws, when coupled with human behavior tell us which direction the pandemic will take two months distant. So, when not wearing a mask became the mark of a true Conservative, a true Catholic, the real scientists knew the squall would become the perfect storm.

If facts couldn’t shake people from their panic-induced denial, it was all but certain that they could never risk membership in their tribes by engaging in heresies such as mask-wearing. But here is where the well-rehearsed tropes of the late Winter and Spring would become so very deadly:

People began to believe their own press releases. As cases rose across the country on the heels of a maskless rebellion, it seemed that the doctors in the rest of the nation were as greedy and deadly as the New York doctors.

So profoundly entrenched in popular culture was the accusation that there were no increased deaths in the US, that the CDC in October published a report showing that indeed there was an increase in deaths, year-to-date, that slightly exceeded the COVID count. Read it here.

Indeed, Johns Hopkins reports that on October 23, the date that the CDC issued that report, there were 224,500 COVID deaths, so that tracks perfectly with the CDC estimate in the graphic taken from the article. (Of course, every time I mention this on FaceBook, at least 20 people from different states all tell me of the motorcyclist run over and flattened by a UPS truck that they scraped of the pavement and brought to the ER, where the docs promptly declared the cause of death to be… you guessed it…. COVID-19! And another $38,000 into the till!)

But now the nation is in serious trouble. Another of the great tropes fell today. The one where we were told that the flu is deadlier than COVID. According to CDC, an average flu season sees 35.6 K deaths. Today the US reached a milestone of 357,300 deaths. For serious adults, that’s ten times the number of deaths as an average flu season. (The Google epidemiologists will immediately discount the 321,700 motorcyclists run over by delivery trucks and grudgingly admit that they were wrong, that COVID kills just as many people as the flu.) We still have two more months to complete a full year of COVID, so it’s not impossible to imagine this thing being 13 times deadlier than the flu.

And then there was our being told by the deniers that a 99% survival rate argued against closures. That meant that if everyone in the country was infected, 3.28 million would die. Oops. So much for the flu being deadlier.(You can forgive the Google epidemiologists. Evidently Google doesn’t require inconvenient subjects like statistics for their degrees.)

This week the cracks in the dam have given way and the flood waters of misery are bursting forth all over the nation, no longer able to be denied. Los Angeles County has instructed their ambulances to leave the critically ill who can’t be saved and declare them dead in the field. This tracks with what happened here in NYC in the Spring, when paramedics were told that there were to be just two rounds of defibrillation and CPR for heart attacks and the show had to be wrapped up in 20 minutes instead of the customary 45, among other dire changes in protocol. (That, too, was denied by those west of the Hudson River) 

Los Angeles has such an overflow of patients that they are running low on deliverable oxygen, as the lines freeze up if too much oxygen is drawn from the storage tanks too quickly.

All across the South and West we are seeing shortages of beds and the silent appearance of the refrigerated morgue trucks.

{Acela Truck Co.’s refrigerated units range from 9 to 53 feet and have racks that each hold four body trays. “We’re very busy and have orders in all of the lower 48 states,” says CEO David Ronsen. (Amelia Anne Photography) CNN}

And STILL there is a hearty band of deniers who swear that California, having the strictest mitigation protocols and restrictions in the country, MUST have an undiscovered source of COVID infections. (They would just love to say it’s in the water, but California has little of that at the moment.) Having laws is one thing. Heeding them is another, especially when you move the illegal gatherings indoors and justify your 60-person Thanksgiving dinner as a funeral for the family’s turkey, in order to get around the 10-person limit for parties, etc.

But most Americans have awakened to some brutal reality: We are in the midst of a pandemic with an aerosolized virus that isn’t attached to a six-foot leash. Six feet gets you safely away from most of the droplets in a typical sneeze, but aerosols that linger in the air for three hours don’t travel six feet, then hang out and have a beer. We are in deep trouble because we have had unserious political leaders on one end of the spectrum, and opportunistic population controllers on the other. In between we have had public health officials repeatedly lie to the American people, squandering their credibility.

It’s a new year, and the deadliest wave of fatalities hasn’t hit us yet.

What we need desperately is adult leadership, and a population more willing to bite the bullet than take one.

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Vitamins, Ivermectin, and Keeping COVID at Bay

Dr. Paul Marik, Professor of Medicine; Chief, Division of Pulmonary and Critical Care Medicine; Eastern Virginia Medical School, has spearheaded the use of Ivermectin in the prophylaxis and early intervention in treating COVID. This is a little over an hour in length and will be the best hour of information you’re likely to to encounter regarding the pandemic. My only issue with this conversation is that they condemn hydroxychloroquine based upon some of the most flawed studies ever conducted in modern medicine. But that’s a conversation for another day.

At this writing I am in FaceBook Jail (7 Days) for writing about this stuff. Questions and answers will be conducted here.

Here is the link to Marik’s website with research, protocols, etc… on Ivermectin:

https://covid19criticalcare.com

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