Home Forums Hunting & Shooting Hunter's Campfire COVID-19: The Science is NOT Settled

Okay, I'm gonna be brutally honest here, which I can't be on my "public" posts elsewhere on the innanet. I'm curious to read what the misfits and degenerates here on the 24HCF write in response. By way of preface, I need to tell you that I have been reading (what internet ninjas call "research") as many credible articles as I can every day since early January. I have been frequently interacting with other doctors who are invested in understanding this pandemic; sometimes in person at my hospital, and sometimes on the phone to places as far away as Canada and the England, and by email all over the world. I can honestly say that the Big Picture on COVID-19 is just beginning to come clear, and our collective understanding of the pandemic is emerging slowly and constantly evolving.

I am on the front lines of the battle, so to speak, as an ER doc in a fairly busy urban hospital which also happens to the the County Hospital, so we get all the schitt that nobody else will take. Ground Zero for COVID when it hits. So I am invested very deeply in doing the Right Thing, and am advising people to stay home, shelter in place, wash hands, etc, etc, etc.

As of midnight GMT last night the USA had 69,047 confirmed COVID-19 cases. This is a gross underestimate (more on that later). Total deaths, 1037 (Case Fatality Rate [CFR] = 1.5%). Compared to other countries, we are doing really, really well: Italy's numbers stand at 74,386 and 7503 (CFR 10%) , Iran's at 29,406 and 2234 (CFR 7.8%), China's at 81,285 and 3287 (CFR 4%). So far, the USA is doing well.

And this makes sense. We have a very good healthcare system overall (despite the constant whining from "progressives" that we need to go full-on socialist with our healthcare) and our population of vulnerable people is well cared for, in the main. We have a relatively low smoking rate, compared to other countries. We have more ICU beds per capita than any other nation on earth. And so on. We SHOULD be doing better on those grounds, so let's not start patting ourselves on the back quite yet. We are still in the early stages of the epidemic, nationally speaking, so it may get a whole helluva lot worse.

And therein lies the problem: we don't know what to expect. We don't have good data to use for our analysis. COVID-19 testing is barely starting to catch up to demand, and that's just testing for active cases in sick people. Testing in people who are infected but asymptomatic, infected and only mildly ill, and infected but recovered, is beyond our reach yet, so we don't have any real idea how many people fit into those categories.

And we NEED to know those numbers to adquately predict what's going to happen so we can meet the challenge in the most effective way. More on this in a bit.

Right now, most of America is shutting itself up in homes and closing doors on business. This may be economically catastrophic, or it may be a speed bump in the roadway of life. I have no clue. I'm not a financial guy, I'm a medical guy. But we know it's going to hurt to some degree. The question we need to answer ASAP is how much is this helping, and how much will it hurt? Further to that, should we be doing something else that will produce a better cost/benefit ratio?

We have no choice but to stay the course, for now... the CDC, WHO and the COVID-19 Task Force (C19TF) are calling the shots and the President is going along. But I suspect we are going to see a change in our national strategy sooner rather than later, as the data give us a better picture of what's going on.

For now, let's look at how we got here. I believe the COVID-19 cluster f u c k is a "perfect storm" that was just waiting to happen. All the requisite components had to be in place for this to happen:

1) Public health has been grossly underfunded at the UN and in America for decades, which is squarely the fault of Congress for the past 50 years;

2) A small, but influential, segment of the public is aware of this underfunding, and has been squawking about it. This has not fallen on deaf ears in the mainstream media (MSM);

3) Apocalyptic fiction has been an increasingly popular theme in worldwide fiction (books, TV, movies) for the past 30 years, which has kept more or less insane TEOTWAWKI scenarios constantly before the public eye in that period;

4) The American Public is scientifically illiterate, thanks to our horrid public education system (hence the popularity of #3);

5) China, which has been every virologist's waking nightmare for at least 2 generations, and which has been ground zero for multiple pandemics and near-pandemics in the past, is reaching a tipping point for poisoning itself out of existence and was ripe for breeding the wild COVID-19 virus (but they've been producing pandemics for centuries, this isn't really anything new... not that the American Public would know that, as they are Historically Illiterate in addition to being Scientifically Illiterate);

6) The bulk of journalists in America have become so deranged by anti-Trump rhetoric that they have completely lost the ability to report any news story in a manner that could be even remotely described as rational discourse; so, finally,

7) The MSM has capitalized on #1-6 to create a firestorm of alarmism, emotion, and knee-jerk overreactions.

Despite the above, the medical community continues to search for REAL answers to our problem. The science is far from settled, shall we say. I have read a number of good articles from all over the world in the past five days that tell us that shutting down whole economies is probably not doing what we hope it will, so it isn't necessary. What they are saying is this:

1) Let's find out what the actual prevalence of this disease is (total number of people who are and have been infected), rather than focusing on incidence (number of new cases); estimates from many sources say prevalence is at least 10X the number of reported cases, as many infected persons are asymptomatic or mildly symptomatic, and thus are not tested;

2) This can only be done when we expand our testing to a larger segment of the population, and we don't have the capacity for that yet, so we need to maintain social isolation measures until we can catch that up;

3) Using prevalence data, we can calculate an actual relative risk (RR) and case fatality rate (CFR) for this pandemic, which will certainly be much lower than the CFR's being touted currently;

4) Once we have a handle on RR and CFR, we can concentrate our isolation/quarantine efforts on segments of the population who are at high risk, and lift restrictions at populations at low risk;

5) Use the new anti-viral treatment protocols (hydroxychloroquine, hydroxychloroquine + azithromycin, hydroxychloroquine + zinc sulfate) to treat high-risk and seriously ill patients to keep them out of the hospitals and ICU's. (The new anti-viral protocols are the most important development in the pandemic response to date. We can thank doctors in Israel and France for this development, by the way.)

President Trump told us a couple of days ago he expects we will be able to lift the restrictions "by Easter". I doubt he would have made that statement if he didn't have knowledge from the C19TF to inform his decision. And that knowledge isn't restricted to the C19TF... as I said in the beginning of this piece, there are a LOT of doctors and medical researchers out there who are reaching this same conclusion.

Again: the science isn't settled by any means. But we know more every day than we did the day before, and the epidemiologists and infectious disease specialists who are working on the medical solution to this mess are going to come up with a good response. So far it appears that the CDC, the C19TF, and President Trump are listening to that consensus. And that is a good thing.

Please be clear: we are NOT at the point of being able to lift social isolation/quarantine yet. People who disregard the measures in place are unquestionably hastening the spread of the epidemic, and putting our nation's hospitals at risk of being overwhelmed. So keep doing the positive things, my friends, and wait for the smart guys to figure this out. I am confident they will.