AAPS News April 2020: Crisis and Opportunity

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Volume 76, no. 4  April 2020

Never-let-a-crisis-go-to-waste Alinskyites may have found the ideal opportunity. The COVID-19 pandemic/panic is destroying the free-enterprise economy, getting people to accept draconian restrictions on liberty, and making people increasingly dependent on government. Fear combined with guilt is a potent weapon. Some people are going to die suddenly or after a prolonged painful course of respiratory failure—old or young, chronically ill or healthy. And those willing to take the risk of going somewhere might be guilty of infecting someone. The SARS-CoV-2 virus is invisible and lurks for hours or days in aerosols or on surfaces. People cannot live without touching things or their face, and so  every human being is a potential threat to every other.

There are tests, including antibody tests necessary for determining disease prevalence, but since U.S. government agencies forbade their use early on, they are only now becoming widely available. There are potential treatments, but government, social media giants, and the gurus of evidence-based medicine are suppressing use or even discussion of cheap, safe, currently available modalities such as antimalarials or high-dose IV vitamin C.

Evidently we must wait for approval of inevitably scarce monoclonal antibodies costing $1,200 per dose, or a vaccine.

Bill Gates proposes that the federal government build vaccine manufacturing plants with unique equipment that might never be used, because private companies could not take that risk, meanwhile calling for a nationwide shutdown (tinyurl.com/rslkc5d).

Apocalyptic Models

“This model is designed to drive fast action, not predict the future,” say the creators of the online mapping tool COVID Act Now. Michigan Governor Gretchen Whitmer cited this model to tell the legislature to expect 460,000 deaths if the state did nothing. The model is derived from the Imperial College UK model that guaranteed 2 million dead Americans (tinyurl.com/vct2cmz).

Gov. Whitmer has withdrawn an order threatening administrative action against physicians who prescribed chloroquine or hydroxychloroquine (HCQ) to treat or prevent COVID-19, calling it a “miscommunication,” and is asking the federal government to send her state shipments of these drugs (tinyurl.com/sc7mjjj).

The cascade of alarming predictive models depends on assumptions without accurate, relevant data. Epidemiologist John Ioannidis states that COVID-19 could be a “once-in-a-century evidence fiasco.” We lack good prevalence data, like that collected  in Iceland, and definitive cause of death. Also we don’t know the long-term consequences of prolonged lockdowns, which could be billions of deaths (https://tinyurl.com/uj539o4). Statistics can be unduly weighted by hot spots such as New York, where more than one-third of U.S. cases and more than 40% of U.S. deaths have occurred so far (https://tinyurl.com/t9j9fdw).

There is evidence that lockdowns are working, writes Christopher Monckton, looking at reductions in the daily rate of increase in the number of deaths. Sweden, interestingly, has one of the lowest daily growth rates although it has not imposed a lockdown (https://tinyurl.com/yx7shmlu).

What Does the “Right to Medical Care” Mean?

JAMA editors in the Mar 17 issue write that the key issue in the 2020 election is how a candidate will “make health care a fundamental right at reasonable cost.” How does that work today?

For would-be controllers such as Ezekiel Emanuel et al., a pandemic is a perfect opportunity to design a system to “fairly allocate scarce resources.” Should it become necessary to take a ventilator away from a patient for the benefit of someone with a  better prognosis or “higher instrumental value,” institutions need an expert [death] panel to relieve front-line clinicians of that burden. Physicians thus disempowered would, they write, be spared psychological trauma (NEJM 3/23/20).

In Italy, ventilators were first denied to patients over age 70, then to those over age 60. In France, one physician wrote to a relative on Mar 30 as he was starting his shift on the COVID unit: “They are killing old people on purpose, putting them in induced coma and giving them medication to help them die.”

U.S. physicians are being threatened by state medical boards if they dare to offer “non-essential” medical care for conditions such as compound fractures or ruptured tendons, and hospitals could lose their operating certificates if they do so. Patients suspected of having COVID-19 are not receiving rapid invasive intervention for myocardial infarction, no matter their troponin level. While patients are denied care, facilities denied revenue may close permanently. Essential nurses may be fired if they “self-treat” with hydroxychloroquine, which their hospitals might prescribe if they get admitted, when it is far less likely to help.

Italian physicians are now giving HCQ for the earliest symptoms (tinyurl.com/us73op9). Brazilian patients have HCQ and azithromycin delivered to their home based on a telemedicine consult (tinyurl.com/qv966tj). But Twitter forced Fox News host Laura Ingraham to delete a tweet reporting successful use in New York City hospitals (tinyurl.com/t53cbv3). It also deleted two tweets by Brazilian President Jair Bolsonaro (tinyurl.com/rtefg3m).

This crisis could be a turning point in deciding whether Americans have the right to try, the right to know, the right to work or innovate without crushing government management—or any unalienable rights at all.


Resources

Non-invasive oxygen hood: A hood used in some hyperbaric oxygenation chambers can be readily modified to provide oxygen to patients with acute respiratory distress syndrome. It has reduced intubation rates and 90-day mortality (tinyurl.com/sorfy3s).

Low-dose radiation: A single dose of 100-250 mSv of X-irradiation for COVID-19 pneumonia might modulate excessive inflammatory response and control bacterial co-infections without   exerting selective pressure on the virus (tinyurl.com/r8crgjh). The dose received during dilation of a chronic coronary occlusion may be as high as 194 mSv (https://tinyurl.com/tldnzpt).

Oxygen: Hyperbaric oxygenation therapy was used with success in the 1918 influenza pandemic, and is being used in China for COVID-19. A report is pending (tinyurl.com/rthzoya). Some say COVID-19 is like high-altitude sickness, not ARDS, and ventilation protocols need to change (tinyurl.com/v34qonf).

AAPS collection of articles: bit.ly/coronavirusarticles.

Censored video: A video suggesting that breathing hot air as in a sauna or from a hairdryer might stave off colds or the more vicious coronavirus has not only been “debunked,” without evidence of harm, but removed by YouTube (even from sites that embedded it), and amazon has removed the 1984 book and audiobook Conquer the Common Cold by Dan Lee Dimke. As of now, the video with transcript and caveats is still at tinyurl.com/wrydz8r.

Mask shortage: Notes from Stanford Medicine, including DIY tips” (https://tinyurl.com/vpl9gox).


Perspective: Worldwide Deaths, Jan 1—Mar 25

  • COVID-19: 21,000
  • Seasonal influenza: 331,000
  • Malaria: 228,000
  • Suicide: 229,000
  • HIV/AIDS: 391,000
  • Starvation: 2,382,000
  • Abortion: 9,900,000

Nothing New under the Sun

From a letter by F. Scott Fitzgerald, quarantined in the south of France during the Spanish influenza outbreak:

“At this time, it seems very poignant to avoid all public spaces. Even the bars, as I told Hemingway, but to that he punched me in the stomach, to which I asked if he had washed his hands. He hadn’t. He is much the denier, that one…. The officials have alerted us to ensure we have a month’s worth of necessities. Zelda and I have stocked up on red wine, whiskey, rum, vermouth, absinthe, white wine, sherry, gin, and lord, if we need it, brandy….

“In the distance, from my brooding perch, the shoreline is cloaked in a dull haze where I can discern an unremitting penance that has been heading this way for a long, long while. And yet, amongst the cracked cloudline of an evening’s cast, I focus on a single strain of light, calling me forth to believe in a better morrow.”


“A tyrant is the worst disease, and the cause of all others.”

William Blake,  https://tinyurl.com/vn3nbap


Who’s in Charge?

Gov. Andrew Cuomo’s state of New York has a death rate 25 times higher per 100,000 population and a hospitalization rate 26 times higher than the other three big states, California, Florida, and Pennsylvania (David Stockman’s Contra Corner 4/1/20). By executive order, Cuomo prohibited pharmacists from dispensing hydroxychloroquine outside a hospital or inpatient setting to treat COVID-19 (tinyurl.com/sjbcxxo). In 2015, Cuomo was informed that the state would need 16,000 more ventilators in a severe pandemic. Instead of purchasing those, he spent $750 million on a “Buffalo Billion” solar panel boondoggle and updated a triage protocol (tinyurl.com/wtrf8rk). This year, he brushed off reports of the state’s stockpile of unused ventilators (“we don’t need them yet”), then later announced his intention to seize privately owned ventilators and personal protective gear and have the National Guard distribute them (tinyurl.com/tpse57z).

On Mar 2, New York City mayor Bill De Blasio encouraged people to “go out on the town” (ibid.); now he threatens to close churches permanently if they dare to hold services.

The World Health Organization (WHO) found out about the outbreak in Wuhan, China, on Dec 30 and delayed the declaration of a global pandemic for more than 2 months. WHO at first repeated China’s talking points about “no clear evidence of human-to-human transmission,” and extolled China’s transparency even after evidence emerged that China was silencing whistleblowers. China strongly backed Tedros Adhanom Ghebreyesus when he ran for WHO director-general in 2017 and defeated the UK candidate (https://tinyurl.com/s6qjm8h).

Dr. Tedros, as he prefers to be called although he is not a medical doctor, was formerly Minister of Health for Ethiopia. He was accused of covering up three cholera epidemics (tinyurl.com/uwggdsn) and of complicity in corruption and human rights abuses (tinyurl.com/yx57blyg). He was a top member of the Tigray People’s Liberation Front (TPLF), a violent communist revolutionary party listed as a terrorist organization by the U.S. government in the 90s (tinyurl.com/qr64r9r).

Dr. Anthony Fauci, an admirer of Tedros, has been in the forefront of epidemic response since the AIDS epidemic in the 1990s. In the 2009 H1N1 swine flu pandemic, which infected 60 million worldwide and caused 13,000 deaths in the U.S., Dr. Fauci was much more relaxed: no calls for home isolation or closing businesses and schools or cancelling surgery (tinyurl.com/s6zpvxz). But current lockdowns are a mere “inconvenience.”

FDA delayed testing for weeks, ordering scientists in Seattle to stop even after they found evidence of local spread (tinyurl.com/vyklcre). Need sanitized masks? FDA won’t allow production to ramp up (tinyurl.com/scq3ohg). And on and on….


AAPS Calendar

Sep 30-Oct 3. 77th Annual Meeting, San Antonio, TX

Sep 29-Oct 2. 78th Annual Meeting, Pittsburgh, PA


Flashback: Act Turns Governors into Dictators

In a Dec 3, 2001, analysis (tinyurl.com/r5xkzrt), AAPS wrote:

“HHS Secretary Tommy Thompson is urging State legislatures to adopt the Model State Emergency Health Powers Act, prepared by the Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities for the Centers for Disease Control and Prevention. This Act grants unprecedented and unchecked powers to the Governors of the 50 States….

“HHS is using the 9/11 emergency as a pretext to rush passage of an Act that has been in the works for more than a year. Its main author, Lawrence O. Gostin, was a member of Clinton’s Task Force on Health Care Reform, …[and] a member of the informal group promoting Single Payer.

“Under this Act, any Governor could appoint himself dictator by declaring a ‘public health emergency….’ [He could handle the emergency by] whatever means he chose. He is under no obligation to use scientifically valid methods, or to choose the least destructive method, or to perform any kind of risk-benefit analysis…. [He may] commandeer any private facilities or resources considered necessary…. This Act, in effect, empowers the Governor to create a police state by fiat, and for a sufficient length of time to destroy or muzzle his political opposition.”


Medical Board of California Threatens Doctors

California has joined several other states that have issued “emergency restrictions” on “wrongfully hoarding and prescribing for themselves and family members certain medications referenced in the media relating to the novel coronavirus (COVID-19).” It noted that “the FDA recently issued an Emergency Use Authorization to allow for the use of hydroxychloroquine sulfate and chloroquine phosphate products donated by the Strategic National Stockpile for certain hospitalized patients with COVID-19.” The medical board and  pharmacy board remind professionals that “inappropriate” prescribing or dispensing constitutes unprofessional conduct, and they are obliged to “follow the law, standard of care, and professional codes of ethics”—but the boards do not provide specifics.


ACTION OF THE MONTH

Watch for biweekly AAPS Webinars, and invite your colleagues. The first, on legal issues, discussed by Andrew Schlafly, J.D, is available at: https://tinyurl.com/wqokoxx.


Spy on Your Neighbor

A system is now in place for City of Tucson residents to report violations of Arizona Gov. Doug Ducey’s “Stay Home, Stay Healthy, Stay Connected” Executive Order. An online form asks whether anonymity is desired. Reporter is to supply name and address of business, reason for suspecting a violation, and opinion about what should be done, e.g. “non-essential, should be closed.”

Bellevue, Wash., has a MyBellevue mobile app that people can use to report large social gatherings. The  reports generate a heat map that police can use to enforce the Stay Home order.

In her action banning use of HCQ (later reversed), Michigan Gov. Gretchen Whitmer said physicians were “required to report” colleagues who prescribed this drug (tinyurl.com/umpsq7k).

Facebook, Google, and other tech companies are in discussions with government on how to use location data to fight coronavirus (https://tinyurl.com/sve6oz5). Singapore immediately created an app to keep tracks of every person under quarantine and all contacts (https://tinyurl.com/sme6dnk).


Resistance

According to the Austrian newspaper Wochenblick,  French executive orders for limited movement and business closings, under pain of fines up to 3,700 euros, do not apply in migrant neighborhoods. Enforcement there could lead to “violent social upheavals.” A police officer suffered a serious head injury from a stone throw, one officer  was bitten, and the fire brigade was shot at while attempting to rescue a coronavirus patient. “The great nation is on its knees, and police speak of the “lost territories of the republic” (https://tinyurl.com/wgfstrb).


Why Not Shut Down for Climate Change?

Could the coronavirus lockdown of America be a roadmap for authoritarian methods to destroy the industrial economy to fight the “existential threat” of climate change? Dennis Prager notes that “the dam has been broken.”

“We can only be certain that shutting down virtually every part of society will result in a large number of people economically ruined, life savings depleted, decades of work building a restaurant or some other small business destroyed. But the longer-term ripple effects are potentially far worse.” For example, could production be turned off when CO2 emissions exceeded some limit (tinyurl.com/rul82fn)?

Dr. Rupert Read, spokesman for the climate protest group Extinction Rebellion, writes:  In this pandemic, “there is a huge opportunity for XR… It is essential that we do not let this crisis go to waste.” When the crisis begins to wane, XR must “seek to continue the silver linings of the corona tragedy: the massively reduced carbon emissions.… The moment that siren voices call for a return to business as usual, that is the moment to say NO.” XR’s leaders have said many times that they want to abolish parliament and capitalism (tinyurl.com/yx65f66n). Targets include  modern living standards, “heteronormativity,” and private property ownership (https://tinyurl.com/uf64je6).

Groundwork is being laid for a global greenhouse monitoring system, which could ultimately monitor neighborhoods in order to enforce constraints on energy use (Science 12/18/15). 


Possible Outcomes

The pessimistic view is that with intermittent outbreaks Americans will volunteer to be on a biometric control grid in return for the freedom to participate in the economy and interact with other people. People may need to have a digital marker showing that they are “clean,” like the system being used in China now (https://tinyurl.com/svconkk).

An alternate view is that coronavirus could save America. Better hygiene habits, if they persist, could reduce influenza deaths by thousands. Business  practices, long accepted as they were invisibly implemented, will change, now that the vulnerability of America is displayed in front of the people—not the little cliques of “health professionals” and CEOs who fostered it.  Who knew that China made 95% of our antibiotics? America will be the huge beneficiary of increased domestic production, increased research on improved quality, and increased security (https://tinyurl.com/u78uy4e). And closing universities might end the Left’s stranglehold on our youth (tinyurl.com/wpsvdhc).


Correspondence

Government Contradictions. Now that government laws and policies and the “nationwide purge” by hospitals have driven independent physicians out of hospitals, Gov. Andrew Cuomo is asking them to come back “to supplement our hospital capacity on a temporary basis to treat seriously ill coronavirus patients.”

The CDC says that if someone in your household tests positive for SARS-CoV-2, you should stay home—except that medical professionals can “continue to work after options to improve staffing have been exhausted.” As to N95 masks, a nurse reported that “they said I needed that equipment to protect me yesterday but now they say I no longer need it to protect me” (Buffalo News 3/22/20, https://tinyurl.com/sxycgv6).

The government tells physicians to provide more telemedicine so as to reduce coronavirus spread, but our local Medicare carrier says not to file claims until CMS provides instructions on how to process them, to “avoid unnecessary claim denials.”

 Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY


Not Anecdotal? In a “case series” of only five critically ill patients with COVID-19 and acute respiratory distress syndrome (ARDS), administration of convalescent plasma containing neutralizing antibody was followed by an improvement in clinical status (tinyurl.com/w6eptvl). Our local blood center is accepting donations, and doctors can’t wait to try it. Apparently any doctor can fill out the expanded access FDA form 3926 for investigational use in individual patients (tinyurl.com/wddoktr). Yet academic and institutional physician leaders, including the Texas Medical Association, do not endorse early outpatient use of “anecdotal” hydroxychloroquine to try to prevent hospitalization in COVID-19 patients.  

Ray Page, D.O., Ph.D., Fort Worth, TX


“We’re All in This Together.” I have come to hate this phrase, which is less an expression of communal goodwill than a euphemism for “we get to take your stuff and tell you what to do.” Arizona’s two major health systems, Banner Health and Dignity Health, are putting this into practice with physicians and nurses. Due to sudden shortages, “administrators are yanking masks off workers’ faces,” according to private messages among  employees. Which of these systems kept extra stock for emergencies instead of wasting money on “core measures” and more administrators? The nation has lain itself wide open for major health crises by wasting probably hundreds of billions and untold man-hours on wasteful mandates and centralized control that contributes not a bit to actual patient care.  These days should be a call  to return to the individual physician and patient, and a screaming caution against relying on large, impersonal organizations.

Pat Conrad, M.D., https://tinyurl.com/wdelcek


Lessons from COVID-19. Globalism does not serve the interest of our country; it serves the interests of like-minded globalists invested heavily in cheap labor in China and profits at all costs. It is not a good idea to allow a potential enemy to produce items for key industries needed for survival. I hope Millennials learned, after the shock of having to stand in line for food and toilet paper, that the socialism they so desperately desire is a disaster that will never work no matter who is in charge. I hope all learned that socialized medicine in Italy and in communist China were quickly overwhelmed and that socialized medicine does have death panels, rationing care based on a person’s age and utility to society. I learned that schools closed and taught their students online, eliminating a lot of unnecessary personnel and administrators. Why  pay high college tuition when you can learn online much cheaper? 

Ileana Johnson, Ed.D., https://tinyurl.com/s59bnb7


COVID-19 Death Rates Probably Inflated. An ICD-10 code of “U07.1 COVID-19, virus identified” is assigned to a disease diagnosis of COVID-19 confirmed by laboratory testing. An ICD-10 code of “U07.2 COVID-19, virus not identified” is assigned to a clinical or epidemiological diagnosis of COVID-19 where laboratory confirmation is inconclusive or not available. Either may be used to code COVID-19 as the cause of death

Marilyn M. Singleton, M.D., J.D., Redondo Beach, CA


Numbers Just Wrong. The CDC website reports that only 40% of the “COVID deaths” had pneumonia.  Dr. Anthony Fauci acknowledges that the death from COVID is “cytokine storm that results in pneumonia and/or ARDS” So, what did the other 60% die of? Diabetes, coronary artery disease, cancer, sepsis (unrelated to COVID), etc. And of the 40% who did have pneumonia, many were “clinical diagnoses” (i.e. not confirmed).

Kelly Victory, M.D., Steamboat Springs, CO


COVID Needs Apolitical Truth-telling. The trust that we have placed in public health programs based on coercion may not survive. The constant alarm bells, in the absence of any offered treatment, suggest that many bureaucrats have more to gain by sustaining the problem than by solving it. Scaremongering is so 19th century. When did the treatment of the individual patient become isolation and containment “for the good of the remaining healthy,” without an effort to treat the disease? 

Jeffrey Hall Dobken, M.D., https://tinyurl.com/r62lbah