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The Pandemic of Fear

The Pandemic of Fear

The Pandemic of Fear

So here we are 10 months into a worldwide pandemic.  How are we doing?  How was public policy formulated?  How is it being implemented today?  We can be ruled by fear or we can be ruled by reason and example.  Fear is the coinage and watchword today.  Fear destroys our capacity for critical and rational thinking and decision-making.  You know the old expression, “I was so nervous I couldn’t think straight.”  That is where we are today. Pursuing The Middle Path.

My pick for one of the all-time great football coaches was Bill Walsh of the 1980’s 49ers.  He always scripted the first 15 plays.  Everything by the book for the first 15 plays.  Then he would reassess based the opposing team’s read and creative reaction.  Reassess, call new plays based on today’s game.  Here is where we are today.  However we got here, despite all missteps, what do we do now going forward?

When I hear politicians say, “let’s follow the science” I say ridiculous.  There is no such thing as “the science.”  Science is a messy affair.  Science is a method of inquiry and derivation of truth in the world.  Science is the alternative to myth, superstition and belief.  It is a matter of developing hypotheses testing all possibilities, including counterintuitive possibilities and deriving conclusions based on the results of rigorous testing.

Dissenting viewpoints

There is a definite air of medical arrogance from Dr. Fauci and the CDC.  This has not been a fair and open debate.  Dissenting views and approaches have been censored and arrogantly dismissed.   We shun the courageously crafted Swedish approach.

My glimmer of hope is the Great Barrington Declaration.  You should fully read this statement by three highly respected academic epidemiologists.

Dr. Martin Kulldorff, professor of medicine at Harvard University, a biostatistician, and epidemiologist with expertise in detecting and monitoring infectious disease outbreaks and vaccine safety evaluations.

Dr. Sunetra Gupta, professor at Oxford University, an epidemiologist with expertise in immunology, vaccine development, and mathematical modeling of infectious diseases.

Dr. Jay Bhattacharya, professor at Stanford University Medical School, a physician, epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations.

We will return to this in a minute.

The Total Picture

So it is time for reassessment.  What we are doing is not comprehensive.  We are not looking at the total picture.  It is a series of fitful and reactive decisions.  It started with unrealistic and wildly pessimistic assumptions from Prof Neil Ferguson of Imperial College.  We have not anticipated the unintended consequences — the collateral damage.   As I have said from the very beginning:

The fallout from our decisions and public policy will dwarf the virus.

Please watch my Covid 19 video.  From beginning to end.  You cannot scan it.

Bottom line.  Highly communicable. Low virulence.  Please understand this. It is not about “cases.”    That is the daily drone.

Contrary to what you hear, this is not the worst pandemic in our lifetime.  AIDS has claimed the lives of 35,000,000 people worldwide.  1,000,000 people die of tuberculosis, worldwide every year.  More people, and especially teenagers, have taken their lives in suicide since the beginning of this pandemic. Watch Childhood 2.0.  Most hospitals are actually underutilized not over utilized.  Cancer diagnoses, treatment and elective surgeries are being subordinated and delayed.   Homelessness is on the rise.  Airline travel down 90%.  And the entire restaurant business endangered.

There is a Middle Way

What do we know about this virus?  Quite a bit.  But it eludes public policy.  And it has degenerated into hopeless hyper-political hyperbolic rhetoric.  If you are on the Blue Team, you are all for masks and severe restrictions. Protect me at all costs.  If you are on the Red Team you don’t believe in masks or restrictions.  “Don’t tread on me.”

So here is the first problem.  So much of today’s discussion and debate is a series of binary choices.  It’s Pink Floyd’s Us or Them.

Us (us, us, us, us) and them (them, them, them, them)
And after all we’re only ordinary men
Me
And you (you, you, you)
God only knows
It’s not what we would choose (choose, choose) to do (to do, to do)

Carl Sagan, in his wonderful book the The Demon Haunted World:Science as a Candle in the Dark lays out a series of logical propositions.  In Chapter 12: Baloney Detection he talks about the excluded middle or false dichotomy – considering only 2 extremes in a continuum of intermediate possibilities.  We are looking for simple answers.  Science is more messy.  It takes time.  It takes testing.  Thesis, antithesis, synthesis.

The most salient warning Carl Sagan gave us:

Arguments from authorities carry little weight – “authorities” have made mistakes in the past.  They will do so again in the future.  Perhaps a better way to say it is that in science there are no authorities; at most, there are experts.

And, finally, watch this a stunning interview with WHO special envoy, Dr. David Nabarro.  He was former Special Adviser to the United Nations Secretary-General on the 2030 Agenda for Sustainable Development and Climate Change;   He is now advocating the Middle Way.  A more sustainable path that avoids all the economic strife and dislocation that we have been suffering.

We need to change course!  Lock-downs do not work.  It only amplifies human suffering.

Are Masks Protective?

If you will remember early during this pandemic there was a raging debate about the shortage of ventilators.  Do you hear this plea or argument any longer?  No.  Then you were hearing a cry for PPE – personal protective equipment.  Masks and other garments.  There was a unholy shortage.  Why?  And then there was no longer shortage.  In fact, probably a surplus.  So what is the actual science of masks?  This can become quite technical.  And we can talk about the finer points of aerosolization, micro-droplet size, and N95 masks etc.

In the end, there is no good definitive scientific evidence that masks are fully protective.  It is just another assertion.

If masks are fully protective, then why do we need to wear masks and socially distance at the same time?  Why are health workers still contracting Covid 19 if they are fully protected by masks and gowns and gloves?

Sidewalk cafe without masks
A mixed message

If masks are fully protective why do we walk down the street wearing a mask, but alongside is a row of restaurant tables with people not wearing masks?  Since you cannot wear a mask while eating.  In other words, worry about the virus in one lane, but not in the adjacent Lane.

 

Masks have become overly politicized.  Another example of the Blue Team promotes masks.  The Red Team shuns masks.

The best you can say, in the end, is masks have some utility.  That’s it.  That is a qualitative and not a quantitative statement.  It is better than nothing.  Let me repeat.  It’s better than nothing.

You see people wearing masks in the center of a field.  You see people wearing masks driving around in cars.

Most unfortunately, masks have become a scarlet letter.  Subject to vitriolic and self-righteous indignation.  Why is it that person not wearing a mask?  He is a super spreader.  There is a self-righteousness that supersedes rationality.

Back to the Future – The Middle Way

Just to round out this story line read How to Survive a Pandemic by Michael McGregor.  Among other voluminous sources he cites the former WHO Director of Communicable Disease Surveillance Response,

history has told is that no one can stop a pandemic.

Is this true or not?

Further, he quotes,

but experts feel that not only would quarantines be wholly impractical and ineffective, they would make matters worse.

To which I fully agree.

The World Health Organization recommends against such measures, in part, given the impracticality of enforcement.

Amplifying Dr. Nabarro’s recent WHO statement and interview.

And finally, he quotes

following the 1916 polio epidemic in New York City, the head of the health department wrote that given the “countless instances of inconvenience, hardship, yes real brutal inhumanity which resulted from the application of the general quarantine, it was no wonder that so many people developed a real and most perverse ingenuity in discovering automobile detours.”

The point of McGregor’s book is, this pandemic is a dress rehearsal for a future pandemics of much more serious proportions involving the H5N1 flu virus.  Really?  Whoa!

So What Can You Do Now?

All disease is a host response. It’s not the virus as much as how you respond.  It’s up to you to enhance your own internal health, well being and immune vigilance.  This simple suggestion and admonition is so sadly missing from current public debate and policy enforcement.  This is about personal responsibility and action.

The Warp speed Vaccine is not going to stop this pandemic.  It is not going to save you.  Remdesivir is not saving lives.  Flu vaccines do not save lives.

In fact, kind reader, if you have read this so far, your chances of contracting serious illness from this virus is vanishing small.

Isolating kids from the pandemic is unnecessary
This is insane

This is not a pandemic of childhood or younger adults.  Send all children back to school immediately.  Open up all restaurants and travel.

Reason (his pen name) suggests in this weeks FightAging.org Covid-19 as a disease of aging.

Stop all these country to country and state to state restrictions.  We are going to have to learn to co-exist with this virus.  It is like a wild land forest fire.  Fire fighters know a simple fact.  All they can do is contain a massive fire.  Only nature eventually stops and ends massive wild land fires.  So too with massive world wide pandemics.

Turn off the news.  It’s no longer news.  It’s groundhog day over and over.  7-8 hours sleep.  Get some fresh air.  Some exercise.  You can safely visit your friends, children and grand kids.

Daily immune enhancement:

  • Vitamin D 5000-10,000 units daily
  • Zinc 30 mg daily
  • Selenium 200 mcg daily
  • High quality protein

And finally don’t buy into the frenzy of widespread media sensationalized fear.  Strive for courageous and kind actions.

Philip Lee Miller, MD
Carmel, CA Oct 2020

CoronaVirus: The Unintended Consequences

CoronaVirus: The Unintended Consequences

The Set-up

CoronaVirus aka SARS-CoV-2 aka Covid-19.  It has become everything.  It has consumed our daily lives.  The constant daily, nay hourly, haranguing of “breaking news.”  The media talks about nothing else.  As if life had stopped.  I want to give you a different view and projection.   A medical / epidemiologic / economic view.  A more global and comprehensive take.  The view from 10,000 feet as it were. This is going to be a longer blog.

This Virus is Striking High Density Cities

Is there a Middle Path?  We know the stories about China, Italy, and now the United States.  When in reality, statistical analysis tells a more sophisticated story.  It is never black-and-white.  In China 80% of all cases were in the city of Wuhan – Hubei Province.  Virtually no cases in Beijing or in Shanghai.  In Italy the vast majority of cases were confined to Lombardi.  And now the United States, the vast majority of cases are confined to New York City.  What is common to all of these?  High density populations.  In fact,  there is a paucity of cases and fatalities in the entire Southern Hemisphere.

Background Resources and Historical Perspective

I want to give you more specifics about this CoronaVirus with a list of resources and technical details. This is a variant of the CoronaVirus group which has been well studied since the 1960’s.  It is not new. The current mutation is the Novel CoronaVirus, SARS-CoV-2. The disease caused by this virus is Covid-19.  Do you remember the SARS and MERS epidemics?   Sudden Acute Respiratory Syndrome.

Let’s revisit my previous blog by putting this in proper historical perspective.  This pandemic is here.  It is worldwide.  It is real. It has been predicted. But we must see it in perspective.  Because you are being overwhelmed and I want you to see some daylight and hope.

This is not to ignore or in any way diminish the current suffering or stresses on our health delivery systems.  But the world has suffered from far greater pandemics and plagues in the past.  Watch this brief YouTube video from South Front – a necessary overview.  You can barely see Covid-19 in this graphic.  It’s like comparing Mercury to the Sun.  You will have a difficult time even finding Covid-19 in this graphic.

Major Plagues throughout history

Now look at another fine series from The VisualCapitalist worth bookmarking.  It illustrates the same.  Just how massive previous pandemics and plagues have engulfed the world.

And here is an up-to-the-minute link for real-time stats from WorldOMeter.

Finally, another long video graphically detailing the apocalyptic Spanish flu of 1918, following the end of World War I.  It was a time of massive troop movements between America and Europe associated with widespread poverty and the devastation of war throughout Europe.

Why am I showing you all the videos links?  To give you a sense of how pervasive and absolutely devastating prior pandemics were.

So why are we so fearful?  How did we become so subordinated, freaked out and frantic over this current pandemic, as opposed to previous pandemics that were manifestly larger and more deadly?

Because we are overwhelmed with a sense of the unknown.  Heightened by a pervasive media and social amplification.  We are developing an entirely new lexicon.  Newspeak.  Social distancing.  Shelter-in-place.  We want zero risk in our daily lives.

The Bottom line: this is still a minor pandemic compared to the Black Death Plague of 1348, or the Spanish Flu Pandemic of 1918, and even more recent epidemics such as the cumulative deaths worldwide from HIV/AIDS.

What Exactly is this CoronaVirus – SARS-CoV-2?

SARS-CoV-2 originates from an animal vector – bats.  We suspect it travels to Pangolins whose scales are prized in Traditional Chinese Medicine.  Then humans are infected.  That seems to be characteristic of so many modern flu-like and viral pandemics.  Jumping from an animal reservoir to humans.  Like swine flu, bird flu, SARS (civet cats), MERS (camels) and now Covid-19.

We know that this virus spreads rapidly.  Scientifically and epidemiologically we look at R0 values, how many people are infected by a single person.  In other words, its multiplication factor.  The ideal is R0 = 1.  That flattens the curve. The current R0 is assumed to be about 2.5.   But these numbers are estimates, subject to complex differential mathematical models.  We do not know how accurate these models are.

80% of all cases are considered mild cases.  That is the source of herd immunity.  Let me return to this concept later.

This may be a sidebar but highly recommended.  If you really want to know the science beyond the headlines here is the best lecture series I have seen.  He explains and shows you all aspects of this viral origin and pandemic spread.  It is produced by Ninja Nerds, an unlikely face of academic knowledge.  But if you watch this Ninja Nerds series on Covid-19 you will learn everything you need to know about the epidemiology and the pathology of this virus. You will be well schooled after finishing this series.

Controversies in Containment Strategies

I always look at the outliers.  Why are there so few cases in India, Australia, Africa, South America, and Scandinavia?  And why the differences in approach?  We are told the approach in China and in Korea was draconian.  Cell phones were being monitored.  And yet look at this recent story showing Korea did not shut down their entire economy like we have.

Korean Containment

from NPR news:

How South Korea Reined In The Outbreak Without Shutting Everything Down

We’ve seen examples in places like Singapore and [South] Korea, where governments haven’t had to shut everything down,” said Mike Ryan, head of the World Health Organization’s Health Emergencies Programme. “They’ve been able to make tactical decisions regarding schools, tactical decisions regarding movements, and been able to move forward without some of the draconian measures.”

An article in Science:

Mathematics of life and death: How disease models shape national shutdowns and other pandemic policies

“Long lockdowns to slow a disease can also have catastrophic economic impacts that may themselves affect public health. “It’s a three-way tussle,” Leung says, “between protecting health, protecting the economy, and protecting people’s well-being and emotional health.”

I’m not really sure whether the theoretical models will play out in real life.” And it’s dangerous for politicians to trust models that claim to show how a little-studied virus can be kept in check, says Harvard University epidemiologist William Hanage. “It’s like, you’ve decided you’ve got to ride a tiger,” he says, “except you don’t know where the tiger is, how big it is, or how many tigers there actually are.”

And more from the New York Times.  Dr. Katz is president of True Health Initiative and the founding director of the Yale-Griffin Prevention Research Center.

Is Our Fight Against CoronaVirus Worse Than the Disease?

“So long as we were protecting the truly vulnerable, a sense of calm could be restored to society. Just as important, society as a whole could develop natural herd immunity to the virus. The vast majority of people would develop mild CoronaVirus infections, while medical resources could focus on those who fell critically ill…

A pivot right now from trying to protect all people to focusing on the most vulnerable remains entirely plausible. With each passing day, however, it becomes more difficult. The path we are on may well lead to un-contained viral contagion and monumental collateral damage to our society and economy. A more surgical approach is what we need.”

If you are still with me, you will find this YouTube with Dr. Jay Bhattacharya, professor of medicine at Stanford University most enlightening.  Subsequent to his editorial in the Wall Street Journal.  He is asking the right questions.  Is our draconian approach based on faulty assumptions? 

Sweden and Holland have taken a different approach.  What I call the middle path.  Isolate and quarantine known cases.  That is what is traditionally done.  That is how you treat infected patients in a hospital.  Isolate and contain.

Adverse Consequences of Flattening the Curve

What has been missing in the United States is the mobilization of a centralized strategic plan.  It was all in place.  Now we have a patchwork of federalized responses.  These are tactics, with states scrambling for limited resources. This is not a strategic plan, which flows from a designated and recognized incident commander.  What we used to call a Czar. One who directs and executes the strategic plan.

Dr. Anthony Fauci is a vaunted virologist and epidemiologist.  Epidemiologists are not policymakers.  He should not be the face of this pandemic.

There are some very sophisticated models of viral spread based on R0 values.  This is illustrated below, with an animated graphic. Here is the link the more interactive dynamic graphic model.  Please take the time to play with the interactive graph for a few minutes.

If you look at this model of increasing isolation (shelter in place) 3 critical questions arise.  What is the goal?

  1. Reduce all cases – incidence?
  2. Reduce and mitigate hospitalizations and stress on our entire EMS system?
  3. Reduce and mitigate fatalities — mortality rate?
Containment Time line
Containment Duration — Light color is incidence, medium color is hospitalizations, dark color is fatalities

The answer to each of these questions might lead to entirely different strategic plans.

The incidence decreases the most.  Then you see a decrease in hospitalizations.  But the mortality rate decreases the least.

Our Ultimate Goal in Increasing Herd Immunity

As counter-intuitive as this may appear, decreasing the case incident rate may have negative consequences.  Our goal with natural wild type immunity antibody production vs. acquired immunity through vaccination programs is to increase “herd immunity.”  That is, increase the greatest number of people who have been exposed to a virus and are now immune.  They can no longer spread the disease to other people.  It is a firebreak. The current policy of “dampening the curve” actually diminishes herd immunity.  In the long run, that is the real goal.  That is what prevents the spread – enhancing herd immunity.

Dampening the curve will lower the incidence of new cases, lower hospitalizations, and slightly lower fatalities.   But lengthening this curve is at the expense of prolonging  economic and financial distress.  That is the key concept.   That is why you are seeing Congress hurriedly passing historic and unimaginable emergency legislation.  Remember Andrew Yang’s promise to give us each $1000?  How ridiculous that sounded?  Here we are.

What is missing from these epidemiologic models is a balance between containing the viral spread and prolonging economic dislocation and total financial/economic collapse.

The Economic Fallout will Dwarf the Medical Tragedies

We will see a rise in unemployment to historic levels.  Look at this graphic representation of the most precipitous DJIA slide in the stock market in history.  Even if you have no interest in the stock market or have nothing invested, it is an indicator of financial distress and a prediction of economic calamity.

DJIA precipitous drop

The more important statistic is the VIX indicator.  The VIX is a measure of volatility — of panic.  And this level is equal to or greater than 2008.  It is a perfect storm with other indicators that I will leave to later.

VIX volatility index

What is the point?  It is a plea for a middle path.  What is the least amount of time of widespread quarantining vs. a disastrous total shutdown of local commerce, business and economic vitality?  This cannot go on much longer.  So many small businesses will fail as unemployment figures skyrocket.

This will exceed our experience of 2008. The economic consequences will eventually dwarf the medical consequences.

Prevention, Treatment, and Therapeutics

This is what all my patients are asking.  What can I do for prevention?  What can I do if I become sick?

The most important set of preventatives is concentrating on your optimal health and immune support.  7 to 8 hours of sleep daily.  Some degree of day exercise.  Healthy eating.  Decreasing carbohydrate intake.  Increase in your protein intake.  A good nutritional supplement program.  This includes adequate a quality multivitamin, Vitamin D, Vitamin K, extra selenium, extra zinc, and a good probiotic at the very least.  All my patients are taking much more. as part of a robust daily routine.

Good hormonal balance, which includes optimal thyroid balance.  Thyroid is the seat of your immunity.

I am not convinced that wearing masks are effective.  The most effective N95 masks are in short supply and should be saved for medical workers.  Washing hands and possibly wearing surgical gloves may be beneficial.   I have always been wary of ATM pin pads and handle bars on shopping carts.  These are simple precautions that are easy and beneficial.   Avoiding all possible contaminated surfaces.

I now recommend stop watching the news!  It is no longer healthy, educational or informative.  You will see your stress levels fall immediately.  Watch all your old favorite movies or all those new ones you have not seen yet.   Read more.   Take the time to do those things you have been putting off for years.

There is no definitive drug treatment for this virus except for pulmonary support, fluid resuscitation, and some possible advanced therapies directed to the loss of alveolar surfactant and accumulation of alveolar consolidation.

Many of you have asked me about the combination of Chloroquine and Azithromycin.  There have been very limited studies that show some promise.  But these are more anecdotal.  Although I personally favor empirical approaches to medical problem solving, I do not support the use of these drugs for casual and unsupervised use.  This combination should be limited for very sick hospitalized patients.

There are a number of problems with Chloroquine.  Hydroxychloroquine (Plaquenil) is less toxic than Chloroquine.  And in the mad rush to sequester and hoard Chloroquine or Hydroxychloroquine you are stealing vital medications from patients with advanced rheumatoid arthritis, lupus, scleroderma, or CREST syndrome who rely on these drugs for their significant disease modifying benefit.

And by the way, behind the scenes, there are conflicting policy decrees.  The CDC is trying to approve “off label” use of Chloroquine and Azithromycin for life-threatening disease.  On the other hand, the Medical Board of California has issued warnings that physicians using these drugs off label are being warned.  We do not know whether that includes sanctions or some other bureaucratic intervention.  It all muddies the waters further.

It is very interesting that in the medical profession, we have been chided for the last 20-30 years not to use antibiotics for viral syndromes.  The standard dogma is “antibiotics do not treat viruses.”  And yet the addition of Azithromycin is now being advocated as an adjunct.  There are some theoretical aspects of Azithromycin and Chloroquine enhancing zinc absorption which enhances antiviral activity.

There is also a theoretical discussion in medical journals regarding the potentially harmful effect of ACE inhibitors and ACE blockers.  This would include Lisinopril, Vasotec, Cozaar (Losartan), and Valsartan (Diovan) to name a few.  It is postulated that the CoronaVirus attaches to ACE2 receptors facilitating viral penetration and cellular infection.  This ultimate effect of this mechanism is an unknown at this time.  But you may hear various discussions regarding this mode of activity.  Do not stop these anti-hypertensives.

I fall back on my anti-viral routine which has been successful in the past.  At the very first sign of any viral infection.  I highly recommend:

  • Vitamin D 50,000 units for five days.
  • Astragalus 1000 mg daily for five days.
  • Thymic protein A (Pro boost) 2 packets 3 times daily for 5 days

Now having made that recommendation, I am seeing major backorders for virtually all nutritional supplements and most especially, zinc, Astragalus and Pro boost.  My recommendations still stands as soon as they are available.

In Summary:

It did not have to be this draconian.  So many missteps and failures of leadership.  But here we are.

One more quote from Max Brooks, son of the great Mel Brooks and Author of World War Z :

I think right now we have to be so careful about who we listen to, because panic can spread much faster than a virus. And I think in addition to social distancing, we have to practice good fact hygiene.

Take care of your own health. Don’t watch the news any longer.  Watch great movies.  Be with your family.  Read my past blogs on nutritional routines.  Support clear thinkers.  You will be OK.

Send me a list of your favorite movies or books.   Every one will have their own.  If enough people respond I will publish later.

For sure another CoronaVirus blog will follow soon.

Philip Lee Miller, MD
Carmel, CA
April 2020

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