Mythomania, pseudologia fantastica, pathologic lying are all psychological terms loosely defined as a condition wherein a person lies compulsively to the point that he believes his own lies. We in the U.S. are now witnessing a form of this disorder which is affecting millions of people around the world who are witnessing the political warfare that is threatening to divide this country to a degree that has not been seen since the civil war. It is a pandemic in and of itself. People afflicted with this condition can no longer accept the truth even when it is in plain site for all to see or hear who have the capacity to do. Instead, these individuals pick and choose words and settings to create a narrative they can believe in and defend even in the face of reality. It is indeed pathological even though there may not be a well defined DSM-5 code for it as yet. Let me give you some examples of this disorder.
Here are just a few:
Recall the images of “children in cages” that were all the rage heading into summer 2018, passed off as demonstrable proof that the Trump administration was taking a needlessly callous hard line in locking up illegal immigrants. Those photos ended up being from 2014 when Obama was president.
After George Floyd’s tragic death, the “main stream media” suggested that President Trump refused to address the situation. In fact Trump ordered FBI and Justice Department officials to conduct an expedited investigation into the matter. This got no attention at all. Then the looting and violence that occured in Minneapolis, Washington D.C., and elsewhere was all blamed on Trump whereas in reality this mayhem was just an excuse for ANTFA and the radical elements of BLM to run amuck.
Liberal political commentators claimed that President Trump, calling himself the “president of law and order,” was a race baiting tactic that would incite more violence. Yet honest, hard working people in crime ridden areas actually want “law and order” and not anarchy.
The president of the United States, Donald Trump, never said there were “fine” Nazis or Ku Klux Klansmen. The democrats have attempted to label Trump (and supporters of Trump) as racists. Where is the evidence for Trump being a racist? There is none. In fact, Trump has innumerable supports from all racial backgrounds. With the last election Trump’s supporters were all labeled as “deplorables” according to Hillary Clinton. Now I guess they are all labeled as “racists,” and nothing could be further from the truth.
And what about the claim by the left that he is anti-semitic? That also seems pretty outrageous given the fact that he moved the U.S. embassy in Israel to Jerusalem. Furthermore, his son in law and grandchildren are Jewish, and his daughter converted to Judaism so it seems highly unlikely that he would be anti semitic toward his own family.
What about the Russia-Trump collusion and the Mueller investigation? That whole debacle was based on a lie that Hillary Clinton and her cohorts perpetuated on the American people. I guess that is to be forgotten about along with the millions of dollars wasted on the Mueller Investigation.
The list of lies could go on and on ……
When almost all of the the nation’s media lies and supports the lies of one of the two major political parties in this country, it’s really hard for the average citizen to learn the truth unless he or she makes a real effort to do so. It’s really so easy to be bamboozled by the left wing media working in concert with the current democratic party. Sorry to sound so political here, but this grotesque lying emanating from the left and its news outlets really is pathological to the point where the liars are believing their own lies hence the terms referred to above “mythomania”, or “pseudologia fantastica.” The truth can make you free, but only when the truth is freed.
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.
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.
Covid-19: Florida v. New York
The Nursing Home Issue
According to the New York Times as of 7/23/2020 there were 414,405 cases of Covid-19 reported in New York State and 32,270 deaths.* According to the Florida Board of Health there have been a total of 389,868 coronavirus cases and 5,632 deaths. Though the populations of New York and Florida are similar (Florida has about 2 million more residents) and the number of overall cases reported by each state thus far are similar, there is close to a 6 fold difference in mortality. Hopefully Florida will not catch up to New York in regard to the death toll, but why we have this difference is not yet completely clear. It may never be completely understood, but there are some logical reasons as to why Florida has had so many fewer deaths than New York so far in spite of the fact that Florida has the larger population and a greater percentage of elderly patients. One likely reason for this is that Governor Desantis took a more aggressive approach in protecting this vulnerable, elderly population. For example, unlike in New York elderly Covid-19 patients were not sent into nursing homes where they could easily infect other residents and staff. In early March, Governor DeSantis put out a strong preventive message to his elder population, advising them to stay at home in order to avoid potential exposure. He made sure that nursing home personnel had the protective personal equipment (PPE) that they needed to help prevent acquisition and spread of the virus. He deployed the National Guard to help institute testing in the state’s nursing homes where older COVID-19 patients were not sent. These actions and others helped to give Florida a much better survival rate for patients in long term care facilities compared to New York. On the other hand in New York, Governor Cuomo had patients with Covid -19 go back to nursing homes that were not prepared to care for them. In spite of the fact that there were other alternatives such as the hospital set up at the Javits Center, the Hospital Ship Comfort that was sent to New York Harbor by President Trump and the Samaritan’s Purse field hospital that was set up in Central Park. There was inadequate protective personal equipment (PPE) for the staff in these nursing home facilities in New York and inadequate isolation procedures which led to promulgation of the virus and increased death tolls among staff and patients. In late April, the New York State Health department finally clarified that nursing homes should not take any new residents if they are unable to meet their needs. In May Governor Cuomo finally reversed his directive, and tried to shift the blame for the nursing home fiasco on to President Trump though President Trump had no role in determining Governor Cuomo’s response to the pandemic on a statewide basis. Governor Cuomo also said that nursing homes could have refused to comply, but he did not specify how they could do so without incurring any penalties.
Some Other Reasons Why New York Infections Skyrocketed
Another probable reason as to why New York became an epicenter of this virus is that early on in the pandemic, New York’s Governor Cuomo and the New York City’s Mayor de Blasio, tended to downplay the significance of the virus telling people to continue their normal activities including socializing. This lead New York City with its great population density to become an epicentre of the pandemic in the U.S. in such a rapid fashion that New York’s hospital system was overwhelmed. Their response as political leaders was marked by missed warning signs and health care policies that many health-care workers say put residents at greater risk and led to unnecessary deaths. For example, in the first few days of March, Governor Andrew Cuomo and Mayor Bill de Blasio assured New Yorkers things were under control. On March 2, Mayor de Blasio tweeted that people should “go see a movie”. Only after the disease was running rampant in the New York City’s low-income neighborhoods later in March did Governor Cuomo and Mayor de Blasio mobilize public and private hospitals to create more beds and intensive-care units.
Some Good News
The good news is that the death rate from the virus seems to be decreasing nationwide even though the incidence of infection may be surging in some areas like Florida and Texas right now. The reasons for this decrease in death rate are again not completely clear, but some of this may be due to the fact that we have learned how to better manage this infection. We know more about the sequelae of the infection and how to treat them. We have better contact tracing and management. We have some therapeutic modalities that seem to be helpful. Whatever the means, driving down Covid-19 deaths is becoming a major breakthrough. If treatments for Covid 19 eventually result in a mortality rate of only 0.1% similar to influenza than the Covid-19 would no longer be a major health problem even though it might persist in the population for long time to come.
More Testing Means More Numbers But Accuracy and Interpretation of Data Are Key
It should also be remembered that it may also be possible that the virus itself is changing and mutating to a less virulent and less infectious form. As far as the incidence of new cases is concerned some of these numbers have to be interpreted in light of the fact that more and more people are being tested. Moreover, as we get further and further away from this pandemic as time goes on, we may find that there have been irregularities in the data reporting and problems with the various screening tests that have been brought to market in terms of their reliability and accuracy. For example, the number of false positives and false negatives will need to be better scrutinized especially since there are a number of companies marketing tests that may not have been fully validated. So the total numbers of patients who have been exposed to coronavirus may be greater or lesser than what we now appreciate. Mortality issues will also need to be reevaluated. Many patients who have been cited as having died from coronavirus may actually have died from other illnesses, but they were listed as Covid-19 deaths because they were found to be positive for the virus when they were tested in the hospital. It’s well know that many patients who have the virus are asymptomatic or relatively asymptomatic so having a positive test in someone who ultimately died of something unrelated to Covid-19, but reported as a Covid-19 death, would obviously skew the data regarding total Covid-19 deaths.
Importance of “Herd Immunity” Cannot Be Overemphasized
Given the increased numbers of individuals who have been exposed to and presumably have antibodies against the virus should lead to greater “herd immunity” as time goes on. Overall, even though we are seeing some peaks of infection nationwide, the pandemic seems to be decreasing. “Flattening the curve” does not necessarily mean eliminating the virus all at once. What is really means is that the incidence of infection is flattening so that we are not overwhelmed by large number of cases. Things should only get better as time goes on and we get vaccines along with better therapeutics in the months to come. Also, as time goes on “herd immunity” will become greater and greater. Ultimately the virus that causes Covid-19 virus should, if not disappear completely, become much more manageable much like our conventional influenza virus. We may need annual vaccines like we do for influenza, and we may need to rely on different antiviral agents to treat sick patients. However, Covid-19 will likely become much much more manageable as time goes on similar to influenza. There is also the possibility that this coronavirus (Sars-Cov-2) will mutate to a less infectious and aggressive form as these viruses sometimes do although the alternative is also possible.
*This was data collated by the New York Times from several sources.
The Devil is in the Details
WHO and the Covid-19 Pandemic
What did the leader of the World Health Organization know and when did he know it?
First, let’s look at some background information about the World Health Organization and it current director general Tedros Adhanom Ghebreyesus.
What is the mission of the World Health Organization (WHO)? According to its charter it is supposed to “aim for the attainment by all peoples of the highest standard of health.” It’s object is “to improve peoples’ lives and reduce the burden of disease,” and it is supposed to be the “coordinating authority on international health.” However, regarding the coronavirus pandemic it has failed miserably in its stated objectives. Much of the responsibility for this failure can be laid at the feet of its current Director General, Tedros Adhanom Ghebreyesus. He is not a physician though he has a master’s degree in immunology and PhD in community health from colleges in Great Britain. He is Ethiopian and served as minister of health in Ethiopia from 2005-2012 and then minister of foreign affairs for Ethiopia from 2012-2016 following which he became Director General of the World Health Organization in 2017. It should be noted that Tedros Adhanom Ghebreyesus, who apparently according to Ethiopian tradition prefers to be addressed as “Tedros,” won the election for Director General of the World Health Organization largely because of the support of China which may explain why the WHO has seemingly become a tool of China in regard to the current coronavirus pandemic. It should be noted that the U.S., Canada and the UK supported British physician, Dr. David Nabarro for this position. The U.S. has been by far the largest financial supporter of the WHO for decades.
Tedros’ tenure as Director General of the WHO and before that as health minister for Ethiopia has not been without controversy. The most recent of which has been his handling of the coronavirus pandemic (see below). While minister of health in Ethiopia he was accused by some of his country men of covering up Cholera epidemics. The organization “Human Rights Watch” also criticized Tedros during his campaign for the Who Director General position accusing him of being a proponent of an authoritarian regime in Ethiopia that persecuted its political opponents (Tedros). At one time he appointed Zimbabwe dictator Roger Mugabe as a goodwill ambassador for WHO. His appointment of a Russian to head WHO’s tuberculosis program was also regarded as controversial because of Russia’s poor history of tuberculosis management. Putting aside some of the controversial issues regarding his tenures as health minister and foreign affairs minister for Ethiopia, let’s focus in on how his actions concerning the coronavirus led to a worldwide pandemic.
How WHO’s Actions Promulgated the Coronavirus Pandemic.
To do so Let’s look at the timeline beginning when the virus first arose in China.
- Various reports suggest that the first case arose in Wuhan, China in early December or perhaps as early as November
- December 30, 2019 an ophthalmologist at Wuhan Central Hospital alerted other physicians about the emergence of a SARS like illness. He was subsequently detained by police. Reports indicate that China also took measures to prevent information about the human to human transmission of the disease from being disseminated by people in its medical and scientific communities.
- In late December 2019 the Wuhan Health Commission reported 27 cases of viral pneumonia.
- On December 31 the Taiwan government contacted WHO and expressed its concern that that there was human to human transmission of this virus. WHO ignored this report in deference to China because Taiwan is not an official member of the WHO and China does not acknowledge Taiwan’s independence.
- January 1, 2020 Wuhan official close the Hunan wet market in an apparent attempt to blame the wet market as the source of the infection as opposed to the virology lab in Wuhan. We now know that it is much more likely that the virus somehow escaped from the Wuhan Institute of Virology either accidentally (or intentionally if you suspect that China has some ulterior motives).
- Beginning in January 2020 China begins a campaign to acquired more medical supplies in anticipation of the pandemic occurring.
- By January 14 the WHO is still reporting that investigations by the Chinese found no clear evidence of human to human transmission. This is the official position that the Chinese maintained until January 21 in spite of protests to the contrary by some of its own physicians and scientists. However, internal documents obtained by Associated Press indicate that Chinese officials knew a pandemic was occurring much earlier (AP) .
- The Chinese New Year was on January 25th. Many Chinese returned to Wuhan in January to celebrate the holiday after which they returned back to various parts of the world where they were living and working carrying the virus back with them to be disseminated throughout the world.
- Jan 23 China puts Wuhan in lockdown. Chinese nationals can apparently leave Wuhan for other parts of the world, but are prohibited from flying to other parts of China in an obvious attempt to prevent the spread of the virus within China.
- Jan 21 First Case Confirmed in the US.
At no point through all of this did the World Health organization under Tedros leadership raise any warning signs about the coming pandemic. Instead, it took the World Health Organization until March 11, 202 to declare the pandemic (WHO).
How Close Are We to Really Understanding What is Going On?
If you feel really confused about what is going on with this pandemic, you are not alone. Many the real experts are perplexed, and the confusion is sometimes made worse by some of the “TV experts” who are called upon to enlighten us while they bask in their 15 minutes of fame. As a physician who has had basic science training and decades of experience in the past practicing internal medicine, pulmonary disease and critical care medicine, I too feel that that our collective experience is much like that of the “blind leading the blind” while our elected leaders try to persuade us that we are on the right path. If truth be told, we re still wandering in the wilderness right now. Here are but a few examples of the confusion that we are dealing with and a smattering of logic along with them that might shed some light on the hidden realities surrounding this pandemic.
First, let’s take at look at the whole question of masks and social distancing. The central issue here at the beginning was whether or not facial masks were needed when we were out and about. Initially we were told that masks were not necessary except for care givers, first-responders and others in very close proximity to people infected with the virus. We were told that it was more important for infected people to wear them than non-infected people. Discussions were had in the media by the many “experts” first telling us that masks were not needed because the droplets from a sneeze or a cough cough do not travel very far and that there was very little risk of aerosolization or airborne transmission of the virus. A greater risk seemed to be the dormancy of the virus on various surfaces so that surface contact posed a greater risk than inhalation of a droplet that was coughed or sneezed out by a sick person. Here logic would dictate that if you were in danger of being in close proximity to someone coughing or sneezing, say in an elevator or crowed subway car, an ordinary surgical mask and eye protection would provide some degree of protection and if not a surgical mask than any type of face covering. However, we were not initially told that, or at least it wasn’t emphasized. Nor were we told that airborne transmission or aerosolization could possibly occur even in situations unrelated to ventilator management as in a hospital setting. For situations like this really an N-95 type mask, or better, would be needed. I don’t believe these were deceptions on the part of our medical commentators, but rather failing to think logically or perhaps a failing to question recommendations by the prevailing authorities of the moment. Yes, it is very important for sick people to wear the mask to protect others, but it seems very likely that wearing a mask even if you are not infected yourself gives you some degree of protection when you are in an environment where airborne exposure to the virus may occur.
Second, let’s take a look at the testing issue. From an epidemiologic point of view it’s most important to understand how many of us have or have had the virus, how may of us are symptomatic and how many of us are asymptomatic. This can only be done by testing for the virus itself to see if there is active disease or colonization and by testing for antibodies to the virus to see if there has been exposure in the past. There are a number of different manufacturers for the these tests. Unfortunately the tests are in limited supply for a variety of reasons, and it is not yet clear that all the various types of testing kits have been independently validated by the FDA. So we are left in a situation where it is hard for us to get the testing done (in spite of what we are being told by many of our leaders), and there are questions about the validity of the testing. Are the tests comparable? Yet it is vital for us to have this information because without it we really do not know the actual prevalence or mortality rate of this disease.
Third, let’s take a look at the issue of medications and vaccines. If the Sars-CoV-19 which causes the disease known as Covid-19 is like the simple cold virus, to which it seems to be related, or similiar to the common influenza virus, the likelihood is that it can mutate on a regular basis. If so, it makes it likely that any vaccine we eventually make will be only partially effective, which is much like the case now with influenza virus. That is unless we can develop a vaccine directed against an immutable part of the virus (a part of the virus that does not mutate). This may be difficult or impossible to do as evidenced by the fact that we need to get a different flu vaccine every year. Hand in hand with the development of a vaccine we need to make anti-viral medications just as we do for bacteria infections. So far we have no definitive treatment modalities in that regard. Off label use of hydroxychloroquine and azithromycin have received a lot of anecdotal support, but have not yet been fully vetted. Both are old, easy to obtain drugs with relatively few side effects which makes them attractive for use. Although the anecdotal reports and some early studies are interesting, there have been some recent studies that claim to show some detrimental effects in Covid-19 patients. There are also a handful of other antiviral agents that are now being looked at for effectiveness. Anticytokine type drugs have also been tried in some cases of Covid-19 with some success. For example, drugs like Actemra interfere with the progression of the “cytokine storm” which can be triggered by infection with the Sars-CoV-19 virus. The so-called “cytokine storm” is almost like an autoimmune reaction that is triggered by the virus resulting in a severe inflammatory response which can be very damaging to the lungs and other organs of the body. The downside of some of these drugs may be that they weaken the immune response to such a degree that the body becomes even more susceptible to infection.
Fourth, let’s take a look at the concepts of herd immunity and social distancing. Here’s the paradox. Herd immunity would be the ideal, but how do we get there without sacrificing more lives and illness? Herd immunity occurs when so many people in a community become immune to the illness that it not longer spreads. This usually occurs when anywhere between 40% to 90% or more of the population has immunity. The more infectious the illness , then the greater the percentage required to achieve herd immunity. The concept of “herd immunity” is sort of like restating the obvious because it is obvious that the more people who are immune , the less likely we see new infections. So we can get herd immunity either by vaccination or by naturally acquired immunity. The latter requires that people be exposed to and acquire the illness either symptomatically or asymptomatically. This is obviously not without risk because it could result in an overwhelming portion of a population becoming sick in a short period of time resulting in catastrophic effect on the health care system. Yet countries like Sweden decided to take this approach relying on naturally occurring immunity with a marked degree of success. They did not close cafes, schools, gyms and other social gathering places. The asked their citizens to act responsibly and maintain social distancing, but they did not close things down. How they were able to do so without a devastating effect on their health care system is unclear at this point, but perhaps it had to do with Sweden’s population density and the rate of infection. If the rate of infection is slowed by virtue of such things as population density and social distancing, then the virus spreads into the population more slowly and does not overwhelm the health care delivery system. Population density issues in cities like New York City make such an approach impossible as we have already seen.
More thoughts about this pandemic to come in subsequent posts……..