A Good War

Dr. Amesh Adalja explains the science behind the story on Hydroxychloroquine. Most importantly, he describes the difference between double-blind, randomized, placebo-controlled trials (science) and the anecdotes you may have heard reported by physicians and various non-medically trained talking heads on several cable news channels and internet videos..

There are many things we do not know about the COVID-19 disease, but the role of Hydroxychloroquine is not one of them. The evidence is in. Hydroxychloroquine is not a safe and effective treatment for COVID-19.

Dr. Adalja is a board-certified physician in internal medicine, emergency medicine, infectious diseases, and critical care medicine. He has been treating COVID-19 patients for more than 6 months . Early on, he treated patients with Hydroxychloroquine, but based on the overwhelming evidence from double-blind, randomized, placebo-controlled trials, Dr Adalja no longer prescribes Hydroxychloroquine, a position endorsed by professional medical organizations such as the American College of Physicians and the Infectious Diseases Society of America. 

Several people have contacted me about the stories of physicians who have treated COVID-19 patients with Hydroxychloroquine and claimed it to be a “”miracle drug”, including Dr. Stella Immanuel . Prior to the COVID-19 pandemic, Dr. Immanuel was best known for her theories regarding the use of rituals to cleanse people of evil spirits or demons. She has said she also believes in alien DNA, and in 2013 she shared a video saying that certain women’s diseases are caused by sex with demons in dreams.

Bottom-line: If any of my family members contracted COVID-19, I will want them treated by Dr. Adalja, not Dr. Immanuel, Laura Ingram or Donald Trump.

Read the article by Dr. Adalja.

There is no question in my mind the pandemic will be with us for at least another year. Therefore, we all must learn to function in this new reality. It will mean dealing with risks that are acceptable to us and our families. 

To do that, we must first understand the risks. That is not always easy for most of us who read the sensational headlines and watch hyperventilating TV talking heads and TV anchors (aka political pundits poorly disguised as journalists—on both ends of the political spectrum).

When making decisions on risks for your family, keep these two important data points in mind:

• 74% of all COVID-19 death in the US have been in people over 65 years of age

• Only 19 children under age 15 have died from COVID-19

These figure are from CDC (2-1-20 to 7-25-20)

https://www.cdc.gov/nchs/covid19/index.htm

Dr Adalja is a longtime colleague and the person I call when I have questions about COVID-19. In addition to being a Senior Scholar at the Johns Hopkins Center for Health Security, he is also a board-certified physician in internal medicine, emergency medicine, infectious diseases, and critical care medicine.

In this short interview, Dr. Adalja talks about the treatment he uses on COVID-19 patients, plus things you need to know about virus tests, getting your children back to school and your vacation plans.

CBS Saturday Morning

It is easy for me to understand why the general public gets  confused about all the different statistics on the pandemic. I spend a lot of time, often 6-8 hours a day, reading reports, studies, articles, and listening to “experts” on radio and TV.

First of all, there are so many things being measured—total cases, total deaths, case fatality rates, mortality rate, rate of disease, and on and on. All of these data points are important to public health professionals, but what about us ordinary folk who are just trying to determine what is going on in our community and what we should do to protect our families?

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The Czech Republic has done it, and it didn’t take rocket science to figure out how to do it–just basic public health practices and common sense.

Within two weeks of the nation-wide order for all to wear masks in public, including the Prime Minster, the rate of COVID-19 infections significantly dropped, and now they have had a nation-wide celebration of their victory.

Wearing a mask in public is not a political statement, it is just a statement that you care about those around you and you want to get America back to work and school (and have an NFL season).

Read this article about how the Czechs defeated COVID-19.

In many areas of the country we are seeing significant increases in the number of people being tested for COVID-19, but also seeing major delays in getting the results. Delays of two weeks are not uncommon. (I waited 15 days.) These lengthy delays make the testing virtually useless as a means to slow the spread of the disease.

A public health official in Alleghany County PA has suggested one method that would rapidly reduce the delay–reduce the number of tests.

Only those with “COVID-19 symptoms; those who have had close contact with a known, positive covid-19 case; and health care workers and first responders who have been exposed to covid-19” should be tested. Clearly not a perfect solution, since between 20-40% of cases are asymptomatic, but we must reduce the delay between testing and results.  

Without question, a 12-18 day wait for results is useless.

Obviously, this will not fix all the problems with testing, but we applaud a local official for taking action on the problems she can fix.

See the article: Allegheny County explains covid-19 backlog, advises priority testing

Dr. Tom Inglesby is the Director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health. He has served on committees of the Defense Science Board, the National Academies of Sciences, and the Institute of Medicine, and in an advisory capacity to NIH, BARDA, DHS, and DARPA. In addition to his work in public health policy, he sees patients in a weekly infectious disease clinic.

During the past 20 years, Dr. Inglesby has been my mentor and most trusted advisor on public health preparedness, pandemics and emerging infectious diseases.  Whenever you see him on TV, rest assured, his analysis and advice will be nonpartisan, clear, honest, thoughtful and educational.  

Dr. Inglesby talked with Chris Wallace about the challenges of reopening schools, the recent spikes in COVID-19 cases, and what you can do to protect your family, friends and community.

Continue reading “Dr. Tom Inglesby Interview with Chris Wallace”

I understand. During the past weekend I read many articles and watched numerous video clips that provided contradictory information on how to protect our families from the COVID-19 pandemic. Additionally, the debate rages on about protecting our American values and freedoms from authoritarian dictates of public health officials and political leaders.

Key Issues

Should we wear masks when in public places?

Most public health experts and many political leaders are saying “yes”.  However, there is a growing group of citizens who argue against it on constitutional, religious and some rather bizarre logic including a woman who spoke at a Palm Beach city council hearing in Florida. 

“I don’t wear a mask for the same reason I don’t wear underwear, things gotta breathe.”

How about hand washing?  

A couple months ago we were told to wipe down groceries and mail when we brought it into the house. Later we were told this was not necessary—the virus may be detected on these objects for up to three days, but it was not viable. (At least we can now all agree that drinking bleach is a really, really bad idea.)

How about large public events (more than 100 people)?

We have seen public events (peaceful protests, religious services and political rallies) attended by thousands of people without social distancing and masks. Good idea or bad idea? The answer seems to depend upon which cable news channel one happens to be watching.

Droplet or aerosol? 

A major controversy emerged this weekend within the scientific community.  Is COVID-19 being transmitted via droplets or aerosol particles?  For the past several months, we have been told it was the larger droplets expelled from coughs, sneezes and even breathing, but that it required extended exposure (10-20 minutes from someone who was infected). Now we are told the virus may be an aerosol (3-5 micron size) that could remain suspended in the air for an extended period. This would mean the virus could be transmitted more like measles. If a person infected with measles left a room and a person without immunity walked in 30 minutes later, they could become infected. 

So, what to do, whom do you believe?

I am neither a scientist nor physician, and have no degrees in public health, but I have worked in the field of pandemic preparedness policy for 25 years. I also have one other qualification—I have been playing poker, very successfully, for 60 years. I do everything I can at the table to get the odds in my favor. Getting the odds in your favor is the best advice I can provide to best protect your family from this pandemic.

The following is the advice I give my family and friends. It is based on a great American tradition—common sense. This is the same strategy I recommended in my 2007 book, OUR OWN WORST ENEMY.  Bob Schieffer of CBS News commented, “Larsen advocates a seldom-used tool to fight terrorism—common sense.”

Masks

Whenever outside your home and in an indoor public facility, wear a mask.  A scarf, bandana or surgical-style cloth mask is sufficient. You wear it to protect those around you. This is critically important since 20-40 percent of those infected with COVID-19 have no symptoms, and for those of us not personally involved in the droplet/aerosol debate, it makes no difference who is right. Wear a mask. Many of my friends and family members served in the military. It was a public service. I don’t think it is asking too much for all Americans to perform a small amount of public service by wearing a mask. I fully support personal freedoms, even the young woman in Palm Beach who prefers to go commando, underwear may be optional…masks are not.

Hand Washing

The debate over hand washing in the scientific community rages on. That is the nature of scientific inquiry. However, the advice you likely received from your grandmother makes sense—wash your hands. There is virtually no down side, other than dry skin and that is easily managed with hand cream.  This is a habit that should remain part of our culture after the pandemic is gone. It will help during flu season and will reduce the cases of food poisoning—what many people refer to as “intestinal flu”. Nearly 50 million Americans get food poisoning each year, 120,000 are hospitalized and 3,000 die. That is more deaths each year than we experienced on 9/11. Wash your hands!

Large Public Events

I do not recommend attending such events unless social distancing and masks are required, and I would limit the number of events one attends.  Once again, consider the odds and return on investment. Going to church—with social distancing and masks—or an outdoor get-together with family or friends–with social distancing—may be a risk you decide to take. Going to a concert, bar, indoor sporting event, political rally or demonstration where social distancing and masks are not mandatory will guarantee the spread of the virus and increase the risk for the elderly and those with serious medical conditions.

On July 7, Randy Larsen discussed these issues on the Jim Bohannon Show

On May 23, I posted an article, Who Should Be in Charge of the COVID-19 Response?  It concluded with, “The president, governors, county executives, and mayors clearly need to listen to the experts, both inside and outside of government but ultimately, the decisions will be made by elected officials.” 

As a follow-up, I will periodically provide my assessments of the pandemic responses of various political leaders. These assessments are mine and mine alone, based on 25 years of work in the field of pandemic preparedness and response, and have nothing to do with partisan politics, the upcoming election, or issues not associated with the pandemic response.

On June 28, Vice President Pence implored Americans to wear face masks. 

Assessment:  It’s about damn time!  Political leaders at all levels, and for that fact, media celebrities (yes, Laura Ingram I am talking about you) should be encouraging the use of masks, social distancing and hand washing. Every person in this country can play an important role in controlling this pandemic and getting America back to work. 

On June 26, Texas Governor Greg Abbott stated, “If I could go back and redo anything, it probably would have been to slow down the opening of bars.” In addition to re-closing bars, he also scaled back restaurant capacity to 50%, shut down rafting and tubing businesses, and banned outdoor gatherings of over 100 people unless approved by local officials.

Assessment:  Kudos to Governor Abbott. I fully supported his bold decision on May 1 for beginning the process of re-opening Texas (guidance included a recommendation for wearing masks in public). The data clearly demonstrated the state-wide lockdown and ban on elective medical procedures were causing a greater public health threat to Texans than COVID-19. Governor Abbott demonstrated political courage in beginning the re-opening process for Texas in early May, and great judgement last Friday in making adjustments to policies–when the facts clearly called for such actions.

On March 7, Travis County Judge Sarah Eckhardt and Austin Mayor Steve Adler demonstrated great political courage when they cancelled South by Southwest (SXSW), an international music, technology and film festival that annually brings 400,000 visitors and a third of a billion dollars to the local economy.

Assessment:  The bold action of Judge Eckhardt and Mayor Adler, at a time when there were fewer than a dozen COVID-19 cases in Texas, likely prevented Travis County and Austin from becoming a major pandemic hotspot. Their actions saved untold numbers of lives.

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Written by Leigh Henderson

On the 40^th anniversary of the global eradication of smallpox, there are calls for attacking the COVID-19 pandemic as smallpox was attacked. One hallmark of smallpox eradication has been undertaken with enthusiasm—research. Scientists around the world are investigating COVID-19. Scientific journals are waiving their usual access fees to ensuring rapid and widespread communication of results.

Can smallpox eradication be a model for tackling the COVID-19 epidemic? Yes and no. Smallpox eradication could not have succeeded without its basic management, organization, and epidemiologic principles. These ‘lessons’ apply broadly and can influence the success or failure of global public health programs. 

However, the two diseases are very different. Smallpox had many characteristics that made it a viable candidate for eradication, and the strategies used took advantage of these. Confronting COVID-19 will require different strategies.

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