Category: Health Care

American Democracy On Life Support

Whether you are a Democrat or a Republican, whether you voted for Trump or Harris (I think most people realize that Joe Biden is simply a placeholder), there is no doubt that our American democracy is on life support or close to it. There is a widespread infection that is now ravishing this country, and I’m not talking about the coronavirus as bad as that may be. The major evidence of this other infection is the rampant cheating and lying that has infiltrated into our election process throughout all levels of our democracy endangering the very life of our country as we know it.

Our Country in Jeopardy

Like any infection we have to look at the symptoms, and then we have to locate the source or sources of the infection in order to render a cure. Once we find the source of the infection and where it is located, we then have to take the steps necessary to treat and eradicate the infection.

In the case of our democracy and the “infection” that has afflicted it with corruption, the symptoms are the rampant incidents of illegal voter activity seemingly condoned in so many states with predominantly Democrat leadership. We see evidence of dead people voting in these states. We see people voting from out of state. We see voting machines switching votes. We see the cover up of illegal ballots. We see appointed pole watchers unable to validate votes as being legitimate, even though they have a legal right to do so, because local Democrat leaders won’t permit it which itself is a violation of the law. By the way, being 6 feet away from a ballot is the same as not seeing the ballot at all unless you have superhuman vision. The list of violations can go on and on just like a list of ever widening symptoms of corruption in an overwhelming infection of deceit that has infiltrated into our election process throughout all levels of our democracy.

Like any infection you have to look at the symptoms in order to locate the source or sources of the infection, in this case the corruption of our electoral process. Then you have to take the steps necessary to treat the infection in order to root out the corruption. In the case of our democracy and the electoral system by which we govern, the symptoms are all the rampant incidents if illegal voter activity or fraud.

These violations are often overlooked by the liberal media just like an inadequate physician might overlook the important signs and symptoms of a corrupting infection.

Another sign of systemic infection, not to be confused with systemic racism, is the overthrow of our democratic principals by a biased media which has absolutely no right to declare a winner in any statewide election. That is solely the right and responsibility of the state. So once again it’s like an infection taking over the organ it is infecting. The corrupt media is infecting the organ of the voting public and corrupting it. The examples of this progressive, rotting “infection” are numerous as I said before. Whether this “infection” is so severe that it will overcome our democracy is not clear because we have not yet determined it’s extent. In simple terms using the analogy of a good physician treating a very sick patient, we have to first find out the extent of the infection which the Republican party is attempting to do now. Then we have to take steps to treat the infection and prevent it from happening again. That means we have to find the source of the infection. How did things like the illegal ballots get into the system? Who was responsible for the illegal activity? We have to be proactive and take measures to prevent these things from happening again even if these measures mean taking these cases to the Supreme Court of the United States where these problems can be cured.

So whether Harris or Trump wins the presidential election, let’s let an old medial adage take sway; namely, “daylight is the best disinfectant.” Let’s shine a bright light on all the illegal or at least suspicious activity surrounding this election in order to disinfect this contaminated voting system while we still can so that we can save this democracy because if we don’t the patient will not survive.

Knowledge Is Power, But Who Determines What Knowledge Is?

No one has a monopoly on knowledge, or better stated no on should have a monopoly on knowledge. A real education should teach us how to think for ourselves. It should teach us how to evaluate information and come to our own conclusions and not those that are fed to us by others as irrefutable truths. That is the hallmark of a true education. Yet today’s media, by and large, wants to determine for us what is “true” and what is not. It tells us what we have to believe and what we should disbelieve instead of allowing us to evaluate information on our own. Whether it is Facebook, Twitter, the so called “mainstream media,” or most newspapers and magazines, we the public are treated like children who must be spoon fed what others believe to be the truth because we are not capable of independent thought. There are some notable exceptions in the media to this dogmatic approach to knowledge, but they are few and far between. Instead, we are told what we are to believe, and God help us if we challenge the “authorities.” Our careers could be ruined. We could be ridiculed, ostracized or worse. We should be thankful for the independent thinkers in the history of mankind who had the fortitude to stand up against the rule of authority to speak their version of the truth. If not for such heros, we would still think that the earth was flat or that sun rotated around the earth.

Marble sculpture of Galileo Galilei contemplating the nature of the universe

Medical science, like any other science, can only advance when there is independent thought and when that independent thought challenges the conventional wisdom. Thought controllers like Twitter, Facebook, Google and other media giants exert enormous power on our thinking by limiting information, distorting information and literally persecuting any thoughts that they perceive as being erroneous or dangerous to the “group think” they espouse. They believe that we ordinary people are not capable of the independent evaluation of information. They determine who the “experts” are that we should listen to and obey. After all, they think we are not smart enough to make that determination. Instead of being platforms or formats for open discussion and thought, these media giants dare to presume that we cannot think for ourselves. They are convinced that we will be befuddled if we try to think independently or don’t follow their directives. Perhaps their reason for squashing our independent thought is more nefarious than that. Maybe it’s a method to be used to control us by taking away our power to think independently. As I said before knowledge is power, but even false knowledge can be powerful when it is presented as truth and efforts to refute it are thoroughly thwarted by the media. Furthermore, when that power is held by only a few people in the media, that power gets magnified. You are told what is right and what is wrong by the people in power, and who are you to question that? They are the only experts and their word is law. Sounds a little bit like fascism, doesn’t it?

I’ve Got My Own Mind

Let’s take a recent medical issue as a case in point that led me to this discussion. That is the recent censorship of Dr. Scott Atlas by Twitter because he dared to disagree with the conventional thought concerning masks espoused by the Dr. Fauci and others who are part of the medical/government complex. When I use the term “medical/government complex,” I am referring to medical and research personnel who have made working for the government their life long careers as well as the institutions that support them. Out of necessity these people and their institutions have learned more than a little about government politics and how to survive in that arena. That is not to say that these are bad people or unqualified for their positions. That is hardly the case. For example, Dr. Fauci is an eminent medical researcher with impeccable credentials who has worked for the government for many years and has had numerous scientists working under him. However, does that mean that Dr. Fauci has a complete monopoly on medical research and information? Is his the only truth that counts? Once again, I emphasize that is not how science works. Real science welcomes a diversity of opinion and discussion. Real science welcomes, or at least should welcome, an open and unbiased discussion of not only the facts but also the interpretation of those facts. So for a social commentary platform such as Twitter to ban the comments of someone like Dr. Atlas concerning the proper place for masks in this pandemic reeks of despotism. Dr. Atlas may disagree with Dr. Fauci and others concerning some aspects of mask use, but that doesn’t necessarily mean that Dr. Atlas is wrong, or that others who agree with him are also wrong. Dr. Atlas’ credentials are impeccable also, and his thoughts should be respected even if you may disagree with them.

It is important to realize that while we are embroiled on a day to day basis with all the aspects dealing with this pandemic such as modes of transmission, treatment of the disease itself, the social implications, the international implications and so forth, it will be years before we really have a good understanding of this illness, how it got here and how to best treat it. So in time to come it may well be that our “experts” were wrong on a number of points.

In the meantime, it’s also important to keep in mind the problem that I alluded to before which may actually turn out to be an even greater problem in the long run than the SARS-CoV- 2 virus itself at least as far as our national political health as a democracy is concerned. That is the overwhelming power of thought control that the media and the technocrats wield. We experience it every day now when Twitter or Facebook block a feed that in their infinite wisdom they deem incorrect, or when Google buries a source that it thinks is wrong or simply doesn’t like. This is real power because knowledge is power and when you control the “knowledge,” whether it is accurate or not, you control the real power.

It’s high time for our democratic republic to take a stand to do the right thing concerning the dissemination of information. Platforms like Twitter, Facebook and Goggle should be just that….platforms for dissemination of information without prejudice. One of the first steps should be to reform section 230 of the Communications Decency Act which in essence allows these tech media giants to act as censors picking and choosing to post only those things that they deem accurate while blocking all others. Another recent example of this is Twitter’s blocking of the New York Post article about Hunter and Joe Biden without adequate explanation. Too much power resides in the hands of big tech media giants like Twitter and Facebook. So much of the news we hear and see today comes through portals such as these, and he who controls the portals controls the “knowledge” whether that knowledge is accurate or not. With that control comes almost unlimited power. The danger of this situation is self evident and needs to be corrected as soon as possible.

Do Lockdowns Work for Covid-19?

Maybe the World Health Organization (WHO) is finally getting something right.

This week Dr. Nabarro of the World Health Organization stated that world leaders should “stop using lockdowns as your primary health control measure.” He went on to say that “the only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources, protect your health care workers who are exhausted, but by and large, we’d rather not do it.” This is a sobering approach that comes into line with what many experts in this country and elsewhere have been espousing for months now. Yes, indeed, this coronavirus is one bad virus that got exported to us and the rest of the world from China, but sometimes the cure is worse than the disease. Again, this is not to say that Covid-19 cannot cause very serious illness and death particularly in the elderly and those with so called co-morbidities like pulmonary disease, heart disease, diabetes, obesity, immunocompromised states and other ailments. For these patients and their families the illness can be devastating. However, for the vast majority of people who get infected with this disease and get ill their symptoms are fortunately relatively mild.

Dr. Nabarro went on to point some of the negative consequences that lockdowns have caused across the world, including devastated tourism industries and increased hunger and poverty in parts of the world already suffering from these problems. In addition, in this country as well as in many others we are seeing increased rates of alcoholism, drug abuse, violence, depression, anxiety. Also, many people are delaying visits to see their doctors resulting in lost opportunities to practice preventive medicine. Our educational system is likewise being badly affected and along with that the health and welling being of our children. All this and the Stress related to the lockdowns may very well cause much more death in the long run than the lockdowns will save.

Photo by Nandhu Kumar on Pexels.com

So maybe it is time for some common sense to arrive on the scene to help make us whole again while our vaccines and therapeutics are being developed. Remember, these things are already here or on the way. We will eventually get through this. To quote Franklin Delano Roosevelt, “we have nothing to fear but fear itself.” That was in 1933 when the U.S. was going through an even more difficult period.

So what are some of the common sense things to do?

  • Use masks rationally. Take a look at my previous blog about mask use, To Mask or Not to Mask…That Is The Question. If you are out in the open air, at the beach, walking in the park or on a country road, riding a bike or doing anything else where you are not in close proximity to people, i.e., not likely to be within 6 feet or so of anyone, there is really no need to wear a mask. Doing so only instills a sense of fear or dread which is totally unnecessary. Unless you are using mask wearing as a political statement. If you are in a crowded elevator or conference room, then by all means use a mask. But remember that simple cloth masks do not really provide protection against airborne aerosolized virus. They may give you some protection against droplets but not airborne virus particles. Only N-95 masks or better stand a chance of capturing the virus particles if you are on the receiving end. If you are on the giving end, in other words, the person with the virus and you cough or sneeze into your face mask, droplets and tiny aerosolized virus particles will still be dispersed. Even the CDC, which has flip flopped back and forth about the use of masks, recently reported a study showing that 70% of the patients who came down with Covid-19 wore masks regularly. So this study really puts into question the utility of wearing face masks. Nonetheless, the practice of wearing a mask (really an N-95 mask or better) may provide some degree of prevention and perhaps emotional security as well if needed, but to wear a mask (cloth, surgical or N-95) in the great outdoors where you are not in close proximity to anyone, or in environments where social distancing and good ventilation can be easily maintained seems fruitless and perhaps a bit paranoid.
  • It goes without saying that frequent hand washing and use of hand sanitizers should continue, but this is true even if the virus that causes Covid-19 were to disappear.
  • Society has to open again. That means restaurants, gyms, businesses, social gatherings, schools and so forth all using social distancing as much as reasonably possible and masks when appropriate.
  • Protect the elderly and most vulnerable. That means people with underlying medical conditions that may tend to weaken the immune system. In such instances, these folks should be kept away from situations such as large gatherings where they may be more likely exposed unless precautions can be taken to limit their exposure.
  • Continue to exercise, take Zinc and Vitamin D which seem to have some antiviral activity.
  • In short time more diagnostic tests with greater reliability and shorter turnaround times will become more widely available. While this may not completely solve the problem of identifying people who are potential spreaders, it will go a long way in alerting us to who has the virus and may be communicable. So screening before attending large gatherings may become more common and alert us to potentially dangerous situations.
  • In short time we will also have vaccines and better medications. The calvary is on the way to save the day.
  • We have to open up the country again soon. If we don’t, we won’t have a country to open up, or we will have one that is desperate and on the verge of collapse. People have lost their jobs. Educating our children has become a major difficulty. Alcoholism, suicide, drug abuse are all on the rise. People are not following up with their routine doctor visits and diagnostic tests. Some businesses are at risk of failing or have already failed. As many have already said, if we use lockdown as a cure for this virus, then the cure may indeed be worse than the disease.

Some further comments about “lockdowns” and herd immunity.

Maybe Sweden did have the right idea. After months of being criticized by the “experts” for not locking down as vigorously as its other European neighbors and seeing an early spike in cases, it now seems to be doing a lot better than many other nations in Europe and elsewhere. This may be due to the fact that the Swedes as a nation are developing a greater degree of herd immunity more quickly than other countries simply because they did not lockdown to the same degree as other countries which does seem to make some sense. Herd immunity, immunity related to widespread vaccination, better therapeutics and perhaps weakening of the virus itself will hopefully bring an end to this pandemic. However, we should also keep in mind that for a variety of reasons we may be seeing more of these viruses as time goes on. Therefor, from a scientific point of view we need to do more research on therapeutics and rapid vaccine development so as to be better prepared for the next battle.

To Mask, or Not to Mask, That Is Indeed the Question….Time to Look at This Again

To paraphrase Hamlet’s soliloquy, that is indeed the question we now face during this phase of the coronavirus pandemic. There are those amongst us that would have us all believe that the universal wearing of a face mask will save thousands of lives. However, instead of looking at this as the political statement it seems to have become, let’s take a look at the reasoning beyond this to see if a universal mask mandate really makes sense. Let’s look at some of the facts and not the political fodder that mask wearing has become for some in the media and politics.

First, let’s take a look at viral particle size and mask filtration characteristics. The SARS-CoV-2 viral particle known as a “virion” is about 120 microns in diameter although it probably varies from 60 to 140 microns. Cloth facial masks which most people are wearing are too porous to either catch the virus on exhalation if you have the virus or prevent you from inhaling it if you don’t.

Second, only a mask that has filtration characteristics of an N-95 mask or better has a chance of stopping such small particles. The “N” in N-95 stands for “Not Oil Resistant” and the “95” means that it will filter out 95% of particles 0.3 microns or greater in size. Without getting into the murky details of particle filtration science, suffice it to say that the SARS-CoV-2 virus itself may be smaller than the actual N-95 particle filter size, but the virus usually travels attached to larger particles or conglomerates of viral particles that are consistently snared by the filter. In addition, though the actual individual viral particle size may be smaller than the filtration or pore size of the N-95 material, there are other mechanisms that promote capture of the viral particle by an N-95 mask. For example, electrostatic attraction may promote attachment of the virus to the fibers of the mask and the erratic movement of the viral particles may also help to ensnare these viral particles in the filter material. In any event, the N-95 mask is pretty good in filtering out the virus if the filtration material is intact and if worn properly.

Third, a cloth mask may retain droplets of expiratory secretions, but these droplets are not going to be airborne for prolonged periods like an aerosol would be likely to do. So if a person is infected, a cloth mask may be of some benefit in limiting spread of the virus due to droplet transmission in a close environment. For example, if a carrier of the virus happens to sneeze or cough up droplets, then these infected droplets may be retained in the cloth fibers of the mask thereby limiting the spread of the virus to others. However, a cloth mask will not stop the transmission of aerosolized viral particles that may also be launched by a cough or a sneeze. Likewise, on the receiving end, a non-infected person wearing a cloth mask might be somewhat protected from the large droplets launched by a infected person with a cough or a sneeze, but a cloth mask will not protect him from aerosolized viral particles which will pass through a cloth mask. Bear in mind that when an infected person coughs or sneezes there is both droplet and aerosolized transmission of the virus.

Fourth, many people now seem to feel it is necessary to wear a mask, cloth or otherwise, when they are in the wide open spaces walking, running, or riding a bike with no one within yards or miles of themselves. This may make them feel more comfortable and protected, or it may make them feel that they are better neighbors because they are protecting others even if they themselves are asymptomatic. However, the reality of such protection is very questionable because the need for a mask of any kind under these circumstances is questionable. My personal feeling is that using a mask of any kind in this setting, and I emphasize “in this setting” is unnecessary and tends to foster paranoia, or at least unnecessary worry, at a time when we should be trying to bring things back to normal.

So my suggestions regarding mask wearing are:

  • Wear an N-95 type mask if you are in an enclosed area where you cannot maintain a good degree of social distancing. This affords the best degree of protection both for yourself and others.
  • If you don’t have an N-95 mask and can’t maintain social distancing, than by all means use a cloth mask at the very least. It will provide some limited degree of protection.
  • If you are in the wide open spaces for a walk, jog or a bike ride, then wearing a mask of any kind seems unnecessary. It’s time to start bringing things back to normal.

Can Socialized Medicine Work?

In the upcoming election this November the question of socialized medicine is likely to play a big role. This issue has been visited and revisited innumerable times in the past, but with the rise of the socialist agenda in this country this concept needs to be reassessed once more. While there is clearly a need for some form of universal health care, that does not mean that universal Medicare or socialized medicine controlled by the government is the right way to go for all of us. In fact, it is probably the worst way to go. Dealing with a huge monolithic organization such as Medicare and expanding it in order to be able to cover all persons in the country would add a gigantic financial burden to our economy. There is no “free lunch” here or anywhere else. Someone has to pay, and that would be the taxpayer one way or the other. By the way Medicare, Medicaid and even the VA for that matter can all be considered forms of socialized medicine. Medicaid is a state run health care program for people with low income. It is funded by the state and subsidized by the federal government as well. The VA Health System is for our veterans and paid for in large part by the federal government though depending on income criteria, whether the illness or injury was service related and other factors, the veteran may be responsible for some costs and co-pays. So as a nation we have already had experience with some forms of “socialized medicine,” and that experience has not always been good.

We all contribute to Medicare during our working lives. Upon reaching age 65 we begin to receive the benefits of the contributions we have made to the Medicare program during our working years. This is the medical insurance program designed to provide health care coverage as most of us start to reach retirement age and will no longer be the beneficiaries of our employment health insurance program. Medicare for all of its faults is an essential program for our elderly population. Without it the great majority of our retired elderly population would have no health coverage at all.

However, the bureaucracy of Medicare is enormous, and a Medicare for All program would complicate this bureaucracy even further. It would also lead to even greater financial deficits and more wasted dollars for a program that is already financially strapped yet crucial to the care of our elderly. More importantly the quality of medical care would likely suffer. In Canada and Great Britain each of which has its own form of socialized medicine, it may be relatively easy to see a family practitioner or nurse practitioner for a simple problem. This may account for some of the popularity of these programs, but for serious problems it could take weeks to get to see a specialist, have the proper testing or procedure done. So it may be a matter of the healthy getting good care or perhaps unnecessary care expeditiously, but the not so healthy getting not so good care. In a study done by the congressional budget office a few years ago comparing U.S. health care to Canadian, a number of interesting things were found. For example, the proportion of middle aged Canadian women who had never had a mammogram was twice that of the U.S. rate. Three times as many Canadian women had never had a Pap test. Less than 20% of Canadian men had ever been tested for prostate cancer compared to 50% in the U.S., and only 10% of Canadian adults had a screening colonoscopy compared to 30% of U.S. adults. This might account for the higher mortality rates in Canada for breast, prostate and colon cancer. From my own personal experience practicing at a major New York City medical center for many years, I saw many patients coming from Canada, Europe and elsewhere for treatment that they could not get in their own countries in a timely fashion.

In a study done by the Fraser Institute in 2016, 63,000 Canadians left their country in 2016 to have surgery done elsewhere. A study published in the New England Journal of Medicine showed that in Canada, despite it’s universal health care system, socioeconomic status had pronounced effects on access to specialized cardiac services. Another study showed that high-profile patients enjoyed quicker access to specialized care.  Moreover, among the nonelderly white population, low-income Canadians were found to be 22% more likely to be in poor health compared to their U.S. counterparts.

I have singled out Great Britain and Canada as examples of socialized medicine with less than desirable results, but most other forms of socialized medicine are similar.

Apart from the statistics what are the real issues as to why socialized medicine is may be bad medicine? Let’s take a closer at some basic points from a patient’s point of view.

  • First, although it is great to not have to pay for health care, at least not directly, we as patients always pay a price one way or the other. As I said before “free health care” is not free. Some one has to pay the piper, and we as patients will pay through increased taxes.
  • Second, socialized medicine will likely lead to rationing of health care. The bond between you, the patient, and your doctor will be weakened. Your doctor may act as your advocate against the behemoth of socialized medicine, but his effectiveness will be weak. There will only be one game in town, the socialized game. It’s hard to fight the government.
  • Third, the government will try to placate you by giving you free eye glasses and gym memberships with the mantra that preventive health care is great, and it is. However, you will be short changed on big ticket items which are more important such as your permitted length of stay in the hospital; your allowed rehabilitation days; what diagnostic tests you can get; which procedures you are allowed to get; which medications and so forth.
  • Fourth, your choice of doctors and hospitals will be limited.
  • Fifth, and perhaps most importantly, your ability to contest anything about how you are medically treated will be essentially eliminated. The bureaucracy will overwhelm you. What other choices will you have? The answer is none. It will be a one provider system. There will be no competition for your health care dollars. It all goes to the government.

Now let’s take a look how socialized medicine will affect practitioners.

  • First, practitioners will essentially become government employees. While socialized medicine may try to instill a sense that the practitioner will still be independent, this will most definitely not be the case. The practitioner may be working for the government as an “independent contractor,” but once again there will be no other game in town. So if you as a practitioner do not like the way care is being rendered to your patients, you have no options.
  • Second, medical care will become more impersonal. It will become an issue of quantity over quality. Arbitrary “guidelines” will be established dictating how many patients should be seen an hour. Fail to met the quota and your salary will be affected.
  • Third, more errors will be made because time constraints will prevent more thorough evaluations and follow up, but don’t worry malpractice insurance will be covered by the government. The problem with that is that it may be cheaper for the government to pay off a case than defend you against a wrongful accusation.
  • Fourth, professional satisfaction will diminish. Being a medical practitioner will no longer be a profession but rather a job and will be treated as such by the practitioner.
  • Fifth, like most government run programs practitioners will be overwhelmed by tons of unnecessary paperwork which will only serve to distract the practitioner from the real work at hand which should be to take care of patients’ needs.

So having said all of this, how do we get around the problem of providing good quality care without skyrocketing costs for those of us who have so called “private insurance” and perhaps also for those of us on Medicare, Medicaid or in the VA system? How do we take good care of patients in a way that is fair, sensible, effective, and less expensive than what we are paying for now? How do we do this in a way that is also good for practitioners most of whom at this point are frustrated and demoralized by the complexities, inconsistencies and hardships of practicing in the current systems of healthcare delivery?

More thoughts about how we can set up a health care system or systems that will do just that in following blogs.

Finally A Plan To Help With The Cost Of Drugs In The US

For decades the citizens of this country have been ripped off by the big pharmaceutical companies and their intermediary distributors. I’ve written about this previously (What’s Wrong With The U.S Health Care System?), but now with the stroke of a pen and by executive order President Trump has finally been able to do what preceding presidents and congresses have never been able to achieve. There will now be a system whereby the cost of drugs for citizens of the U.S. will be on a parity with other countries. This a great day for all of us whether Republican or Democrat.  Let’s see how his works. Here are a few of the key points. 

  • Health and Human Services (HHS) will end the “kick back” system that allowed  middle men distributors to jack up the price of drugs that are sold at the pharmacy. Medicare patients will see these “kick backs” as discounts in their Medicare Part D plan instead of the money going to the middlemen. 
  • There will be particular savings on insulin products dispensed through federally qualified health centers (FQHCs). This will be especially helpful to many uninsured or underinsured patients.
  • Through the Medicare program seniors in the U.S.  will pay no more for Medicare Part B drugs than patients in other economically comparable countries.
  • A pathway will be created for safe, imported lower cost drugs.

This plan may not solve all of the problems regard the high cost of pharmaceuticals in the U.S., but it is certainly a step in the right direction.  This is a step which previous presidents and congresses should have taken decades ago.  No longer will U.S. citizens be the only ones paying for the innovative research which the pharmaceutical companies often use as an excuse for the exorbitant costs of their products.

 

Drug Costs

“This Too Shall Pass”

This phrase has a long history dating back to biblical times in one form or the other.  Though the origin of this saying cannot be pinned down, it seems particularly pertinent to what we are experiencing as a nation today.  It is a reminder that regardless of our troubles today with coronavirus and the overwhelming impact it often has on our daily lives,  it will indeed ultimately pass.  We have been damaged physically, emotionally, socially and economically.  Thousands of lives have been lost,  but we and the rest of the world will get over this sooner or later.  Hopefully, we will all be smarter and stronger having gone through this so that we are better prepared for the next pandemic which is sure to come at some point.

So now one wonders what is next with outbreaks of the virus occurring in different parts of the country when it just began to look like we might have had things under control.  Keep in mind that this should not have been unexpected.  The virus is here to stay until one of two things happens.  First, the virus may mutate itself out of existence meaning that it changes in such a way that it becomes less capable of attaching to and invading human cells.  However, there is a caveat to this first scenario since the virus could also mutate in such a fashion as to make itself more likely to attach to a human cell and replicate.  The second thing that could happens, which we should hope for, is that so-called “herd immunity” develops.  This occurs when a large portion of the population either asquires the illness, survives and produces antibodies to the virus; or, a vaccine is given which also creates immunity.  When immunity develops in either fashion, the virus is less likely to enter a host to replicate, cause illness and spread to other susceptible people.  Those who were either sick and have recovered and those who have had the vaccine can no longer harbor the virus and thereby prevent it from replicating and invading the remaining susceptible individuals.  In those who have been vaccinated and developed antibodies, the virus is not longer able to attach to the host cell and enter it to cause damage to the cell and replicate itself.  In those who have acquired the immunity by having had the illness, antibodies likewise develop which prevent attachment of the virus to the susceptible cell so the virus once again cannot replicate and spread.  Either way, the chain of transmission is thereby blocked and the incidence of viral infection decreases in a population.  However, there is a caveat here also in terms of those who have naturally acquired immunity through infection; namely, that some individuals who have had the illness and recovered may theoretically become carriers of the virus.  Not enough is yet known about this virus to make any comments about a carrier state.  Remember that our objective here is “flatten the curve.”  That does not mean that we have eliminated the virus.  What is means is that we have reached a point where the rate of new cases occurring has slowed and reached a plateau making it much easier to control the pandemic.  Hopefully at some point the virus will have disappeared, but that may never completely occur.  Instead, what we may see is a situation similar to the influenza virus where we have to deal with a new strain or strains every year.  In the meantime while we await the development of vaccines and antiviral medications, we try to identify and isolate infected people as quickly as we can, maintain social distancing in a reasonable way in order to minimize exposure, and we try to resume our lives as close to normal as possible.

How And When Will The Pandemic End?clear-glass-with-red-sand-grainer-39396

We do not know yet how and when the pandemic will end, but it will will end.  This does not mean that the virus itself  will completely disappear though it may.  Instead, we may see this coronavirus  or other similar coronaviruses popping up periodically in different places for years to come. 

 

Lessons To Be Learned

This Sars CoV -2 coronavirus is “novel.” Its combination of easy transmissibility and its wide range of symptoms makes it somewhat unique, but there are lessons that can be learned from previous pandemics like the Spanish Flu of 1918. This pandemic lasted over two years and came in three waves that killed 50 million and 100 million people.  Exactly why the virus became extinguished remains unclear. There were no vaccines for it and no effective treatments.  It has been estimated that over a period of two years 500 million people worldwide were infected and somewhere between 50 and 100 million people may have died.  Several theories for its disappearance have been postulated, but it seems likely that this was due to a combination of factors.  One of these might have been that the virus mutated to a less pathogenic form which often happens with viruses.  Social distancing once it was used more aggressively likely decreased the rate of transmission.  Also, as time went on more and more people got exposed to the virus and became immune leading to so called “herd immunity.”  When enough people in a population are immune either through naturally occurring infection or immunization, the likelihood of transmitting the virus to the remaining others in the population who are not immune decreases dramatically.  This is where we are hopefully heading now.  

What happens next and how soon this pandemic ends depends on a combination of factors in addition to the development of herd immunity.  This includes the natural history of the virus itself, in other words, will the virus mutate to a less aggressive form; how effective the vaccines are; how good we get at discovering new antiviral medications; and how good we get at treating the inflammatory effects of the viral infection such as the so called “cytokine storm.”

Through all of this turmoil just remember that “this too shall pass.”

white and black moon with black skies and body of water photography during night time
Photo by GEORGE DESIPRIS on Pexels.com

A Tale of Two Illnesses

We in the U.S. are currently battling two major illnesses that may change the social fabric, customs and morality of our country for years to come if not forever.  Both are very different but certainly intertwined.  Together they will test our strength as a nation.

The first of these is Covid-19. While as a whole the country seems to be doing better handling this pandemic, we are by no means out of danger.  More illness and death is yet to come.  However, keep in mind that as time goes on and more and more people are exposed to the virus more herd immunity will occur, and that is really what we need in order to overcome the threat of pandemic. We achieve that “herd immunity” in two ways (see The Dilemma of Immunity).  One way is by immunization.  The second way is through naturally occuring infection.  This means that as more and more people are exposed to the virus naturally in the environment and recover, then fewer and fewer people are left susceptible to the virus.  The corollary to this concept is that people who have had the disease and recovered would be unlikely to spread the disease to the remaining others who might still be susceptible.  Hence there will be less communicability as time goes on.  This may seem obvious, but it is an important concept and probably as important as immunization if not more so.  However, there are some caveats to be considered here.  For example, we are assuming with good reason that having had the infection confirms immunity. While this is likely it has not yet been completely validated at this point. Neither has it been validated that the immunity will be lifelong..  Another issue which remains open yet is whether the virus will mutate to such a degree that prior immunity will no longer be effective as often happens with the influenza virus for which new vaccines are required on a yearly basis.  Of course the alternative is also possible; namely,  that the virus will mutate and become in and of itself less infectious as time goes on.  We will likely have a vaccine (or vaccines) for Covid-19 early next year and newer antiviral medications will likely be developed in the months ahead as well.  Also, very importantly,  other medications to treat the lethal inflammatory sequelae of the virus will soon be developed thanks to our robust pharmaceutical industry.  All of this should save lives. However, other new viruses and infectious agents will also likely come to our shores in time to come, and we will need to be better prepared for this future possibility.  Please see my previous blog about what we have learned from this pandemic (seeWhat Have We Learned From Covid-19).  In the meantime our experience with Covid-19 has had dramatic effects on how we live our lives and conduct our business.  There is no more hand shaking. Social gatherings are limited.  People walk around in fear of getting a dreaded illness, which by the way, has a mortality rate far lower that initially projected.  People are wearing face masks in situations where there is no rational reason to do so (see Pandemic). Uncertainty about our economic future and security is causing fear and panic in the population leading to unreasonable doubts about our survival as a nation.  We will survive the Covid-19 pandemic and other infectious disease threats that may follow. Not only will we survive these threats, but will will do well once we learn how to cope with them.

The greater threat to our health, both individually and as a nation, is the emergence of various anarchist groups threatening to overthrow our government and the rule of law without which no society can survive.  The widespread violence and destruction that we are now seeing and the inability of local governments, particularly those in left wing democratic cities, to control this is a greater risk to the health and wellbeing of the nation as a whole compared to any viral pandemic. We can face pandemics together as one nation and do what is necessary to overcome them if we put petty politics aside and use good judgement.  Instead, what we see happening is our politicians using this pandemic as a political tool to destroy the opposition putting power before country.  Beyond this we see some of our elected leaders, principally socialist democrats, on a state and local basis permitting, condoning and even encouraging rioting and destruction.  There is absolutely no doubt that we have social problems that need to be urgently addressed, but destroying the country is not the healthy way to do so.  The wanton destruction of private property, the desecration of  monuments, the attacks on law abiding citizens does nothing but create more fear and hostility at a time when what we need is unity.  The health of the nation and its citizens depends on it.  To destroy our government and our institutions, as the leftists and particularly the anarchists want to do, is like seeing a sick patient in the hospital who has an excellent chance of recovery and saying he has to be euthanized because he is not worth saving.

What Have We Learned From Covid-19

Hopefully we are drawing to a close of the Covid-19 pandemic or at least getting it under better control although the recent rioting the country has experienced may be leading to a new wave of infections far worse than the resurgence that was previously predicted. Nonetheless, the pandemic seems to have slowed down a bit for now so now may be the time to reflect on the state of the pandemic and some lessons that we may have learned.

First, it is clear that we were by no means well enough prepared for an event such as this. We had had warnings that something like this might happen, but we failed to recognize the warning signs. SARS, MERS and the H1N1 viruses were the warning signs that a worse virus was likely to occur at some point in the future, and it did so in the form of SARS-CoV-2.

The orginal  SARS (severe acute respiratory syndrome) broke out in 2002. SARS first affected people in southern China, but it eventually spread to 29 countries. It apparently started in animals, but then spread to humans. There were at least 8,000 cases world wide, and it killed about 800 people giving it a death rate of about 10%. The SARS virus is very similar to the current  SARS-CoV-2 virus which causes the illness that we now call Covid-19, but by 2003 there were only 8 laboratory confirmed SARS cases in the US. H1N1, otherwise known as the swine flu, is a different type of virus more closely related to the influenza virus. Between 2009 and 2010 it caused 60.8 million infections in the US and 12,469 deaths. Another coronavirus (MERS-Cov virus) first reported in Saudi Arabia in 2012 also caused a severe respiratory illness known as the Middle Eastern Respiratory Syndrome with (MERS). Only two people in the US have been know to come down with this virus and both survived. 

The U.S. should take Covid-19 as a warning and start preparing for the next pandemic as soon as possible. There are many reasons why this is likely to occur. Spontaneous mutations of the Sars-CoV-2 virus and introduction of new viruses from the wild into human populations are just a couple of reasons why this might happen. Given the interconnectivity of people traveling throughout the world, the spread of a new contagious virus in a pandemic fashion is very likely to occur. Shi Zhengli, a Chinese virologist, has warned that we are now dealing with the “tip of the iceberg” when it comes to impending viral epidemics.

This should tell us that we need to expand work on antiviral agents that will have as broad a spectrum as possible in terms of antiviral coverage especially since vaccines take a long time to develop and are not effective once the virus has taken hold in a patient. Think of vaccines  as preventive treatments, but treatments that may need to be changed frequently since the vaccines are often very type specific. We also need to develop better pharmacologic agents that will block entry of the virus into the cell so that it does not have a chance to propagate within the cell,  and treatments that interfere with the replication of the virus if it indeed manages to enter the cell.  Furthermore, we need to work on developing treatments for effects that the virus has on the body if it manages to enter the cells and replicate. This is what triggers intense inflammatory reactions such as the “cytokine storm” and “the multisystem inflammatory syndrome.”  So from a patient management point of view we need to work on three things: better antiviral agents with a broad spectrum of coverage; the ability to adapt manufacturing processes for vaccines quickly because the virus will change and new ones will appear; better regimens for treatment of the effects of the virus once it enters the body. Of course all of the above has to be achieved in such a way that we are never dependent on a foreign country, much less a potential adversary, to supply us with the medicines, vaccines or anything else needed for us to treat another pandemic. 

We learned that social distancing, as controversial as it may be,  likely had great impact on the mitigating the spread of Covid-19, and it is a practice that in all likelihood should be implemented again quickly as soon as the next pandemic arises.  The current pandemic showed us that certain areas of the country were more impacted than others for a variety of reasons that we are still being investigated. 

Very importantly this pandemic was also a lesson in logistics that should not be forgotten, and it goes hand in hand with the evidence that not all parts of the country were similarly affected by this virus. There has to be mobility in terms of the delivery of healthcare in any crisis situation we may face in the future so that we can deliver medical personnel, equipment and medications where they are needed. This includes the ability to to get mobile hospitals up and running anywhere in the country they may be needed. We demonstrated some of that capability when the Javits Center in New York was converted into a hospital, the hospital ship Comfort arrived in New York and Samaritan’s Purse set up camp in Central Park to help out with the hospital bed shortage. However, for reasons that are as yet puzzling and distressful, none of these facilities was used effectively in terms of terms of relieving the overwhelming burden of the those city hospitals that were inundated with Covid-19 patients.  For future medical catastrophes, which are sure to come, we need to be able get mobile hospitals up and running quickly wherever they may be needed. 

 

 

 

Welcome to Thunderdome

These posts usually have to do with health issues that may affect all of us and are not really politically oriented, and to preface the following comments neither is this post politically oriented per se.  However, the concept of defunding or disbanding the police departments of American cities will inevitably have effects on the physical and mental health of our country and its citizens.

Let’s take a look at what this really means and more importantly let’s take a look at what may be the real motive behind this. “Defund the Police” is the new war cry of the liberal left or more specifically the anarchist groups like ANTIFA and others, but take a moment and think about this “social change” from their perspective.  These groups are not just stupid rabble rousers. Far from that they are compulsively driven, calculating and manipulative.  These leftist groups know that their communities will need policing.  It is inevitable.  After all, who is going to protect them when one of their own begins to steal, rape or murder? What these groups really want is to police their own neighbors with their own enforcers and their own court systems all controlled by their own oligarchy of  “leaders” who will likely drive their power through intimidation and fear. They do not want any interference from a centralized government whatsoever unless they ultimately become the centralized government. What they want is a tribalized society with the loudest and strongest amongst them becoming the leaders who will meet out justice as they see fit. Welcome to the World of Mad Max and Thunderdome where might makes right and the weak are left unprotected. Europe’s “no go zones,” in which militant Muslims have total control of some areas where even the police fear to venture, may have been the models for this concept.  As much as this type of a take over may appear to be unlikely it has already happened in some of the large cities of Europe.  Even Angela Merkel, Chancellor of  Germany has acknowledged these changes.

In essence these anarchists in our own country want their own countries within the U.S. Once they’ve grown sufficiently strong enough through intimidation and fear they will want to establish their own form of government which will not be a democracy but rather an oligarchy controlled by people with absolute power.  In the meantime they want the financial support of the federal government of the U.S. without any responsibility to the federal government. It’s a little like paying for the bullet that kills you.

As I said before, these posts usually have to do with medical issues, but in the broader context, this idea of “defunding” or eliminating the police departments around the country will have obviously have effects on our physical  and mental health. Imagine a world where you have no choice and no control as an individual…where your every thought and decision about mandated by a mob. How could this possibly be healthy?