- CDC report 215,000 more deaths this year than last
- Immunity might be better than expected
- Antivaxers will be unhappy in Massachusetts
- Credible Hydroxychloroquine (HCQ) study showed a benefit
- Hydroxychloroquine (HCQ) and Munchausen
- It’s tough to tell someone that his father, mother, or child just died
CDC report 215,000 more deaths this year than last
Many Covid patients never get diagnosed because they do not seek medical attention. Medical experts believe that the infection rate is 5 to 10 times what has been proven. That means there have been 25 to 50 million Americans already infected.
While a lot of testing can discover a lot of infected people, you do not need a test to discover a dead person. Testing has nothing to do with America’s disastrous death results in this pandemic. Experts have widely reported that our death rate is far greater than that of other developed nations. Our decisions have led to over 100,000 needless deaths.
The official current total is 175,000 dead Americans. However, the CDC report says that there were 215,000 more deaths through July this year compared to past years.
Many of these deaths are from people with heart attacks who were afraid of catching Covid if they went to the hospital. They decided that it was safer to to take a chance that their chest pain would soon go away. These people are still Covid deaths, even if though did not have the infection. If they had their heart attack in any other year, they would have survived. They died because of the pandemic.
Those 40,000 unaccounted for deaths are more than the number of soldiers that we lost in the Korean War. I have been saying since February that I think our approach will lead to a half million dead Americans before this is over. There is currently no reason to think otherwise.
Immunity might be better than expected
I recently wrote that one study found that the half-life of Covid antibodies was 76 days. That means that every 76 days, the number of antibodies is half what it was 76 days before. After a series of halvings, at some point, the level could become so low that it will not protect you from getting infected again.
But do the antibodies ever fall to that level? We don’t know. They may instead fall to some low level that is still enough to prevent or reduce the severity of a new infection.
Furthermore, the B cells that make the antibodies have memory. They now know how to make them. If you are again exposed to the virus, your B cells will be quicker to respond. That means that a protective level of antibodies will come sooner. That will shorten the duration of the illness and it will likely make it less severe.
I have also talked about T cells, which do not produce antibodies, but do protect against the disease. There are 4 types of T cells and each has a different means of fighting the virus. They, too, have memory and will be quicker to respond if you get re-exposed to the virus.
Antivaxers will be unhappy in Massachusetts
Massachusetts is going to require all kids to get a flu shot before returning to K – 12 school. How does a flu shot protect you against Covid? It does not, but it prevents you from messing up the school’s plans to protect its students.
Dr. Larry Madoff from the Massachusetts Department of Health explained the need this way:
“Every year, thousands of people of all ages are affected by influenza, leading to many hospitalizations and deaths… It is more important now than ever to get a flu vaccine because flu symptoms are very similar to those of COVID-19 and preventing the flu will save lives and preserve healthcare resources.”
They are giving medical and religious exemptions, but I do not see any exceptions for people who just dislike vaccines in general.
I assume the state is concerned about distinguishing between a flu and a Covid patient. If a person has the flu, there is no need to quarantine his contacts. If he has Covid, then there is a need.
If you have a bunch of flu kids running around, you have to worry that they might instead be Covid kids. You therefore will feel obligated to quarantine them and their contacts for at least long enough to get a flu and a Covid test to know the diagnosis. The result would be that you would quickly be quarantining the entire school, shutting it down.
Credible Hydroxychloroquine (HCQ) study showed a benefit
There was an interesting study from the Henry Ford Hospital systems in Detroit that was published by the International Journal of Infectious Diseases. It is a reputable medical center and the journal is peer reviewed, which is good. Both factors will attract attention in the science community.
They looked back at 2,541 patients treated with hydroxychloroquine (HCQ) with or without azithromycin and compared the death rates to those of patients who received neither drug. The death rate was 13.5% in the HCQ group compared to 26% in the untreated group. It is interesting that the combined treatment with azithromycin resulted in 20.1% death rate, worse than with HCQ alone.
I wrote that HCQ fell out of favor in the medical community after 6 peer reviewed articles found no benefit. The article in the New England Journal of Medicine was particularly persuasive. I said that most researchers at that point would conclude that if there is a benefit, it was going to be minimal. They therefore would move on in search of other treatments that might prove to be clearly helpful.
I wrote that the HCQ proponents would need at least a couple credible studies before medical scientists would spend any more time researching it. Their time is precious, and they are desperate to find an effective treatment. After 6 credible studies found none, researchers would need at least a couple credible studies showing a benefit before going back to studying it again.
Retrospective studies have distorted results
This is one credible study and the data are hopeful. But, it is retrospective, which weakens the conclusion. For example, the doctors were not following a protocol. Each could do what he wanted.
There were likely some doctors who chose to use HCQ on many patients with less severe disease. Other doctors might not have treated these patients with HCQ, believing they would do well without HCQ. This would result in the HCQ treated group including many patients who would appear to be responding to HCQ treatment, but in fact were going to do well regardless. HCQ would then appear more effective than it actually was.
But if the researchers can confirm their results with a prospective study where all of the doctors make treatment decisions based on standards, that will renew interest among other researchers.
Hydroxychloroquine (HCQ) and Munchausen
Baron von Munchausen was an 18th century German soldier known for exaggerating his life’s experiences. Well, his name lives on in the medical world. There are patients who claim to have all kinds of medical problems when in fact they have none. For some, it is serious enough to be a mental disorder. The name is Munchausen syndrome.
He’s just a turkey
When I was in medical school and a resident at the University of Chicago back in the 1970’s, we sometimes came across patients who kept returning with all kinds of symptoms. They were afraid that they had every latest disease that was reported on the news, and they insisted they had all of the symptoms of each disease.
As doctors, we had to make sure that nothing was wrong. We do tests and our results are signs. What the patient tells us are the symptoms. You need both for a diagnosis.
Most of these patients were not mentally ill and did not have true Munchausen syndrome. However, many of the residents were annoyed by this kind of patient and applied a label to these patients that everyone immediately understood. Residents would call them “turkeys.” Because we had to evaluate the patient fully, it would add an hour to our day. We would get home at 11 pm that night instead of 9 or 10 pm. The doctors were resentful.
But there was another saying that motivated the doctors to do their job. They would always follow-up by saying that they had to investigate because “turkeys sometimes actually get sick.” The point is that sometimes something looks fraudulent but actually is real.
Experts can also be turkeys
One of the problems HCQ faces is that its most vocal proponents are not mainstream medical experts. Instead, they are faux-scientific doctors (“Beverly Hills” types), conspiracy theorists, or people saying things based on politics and not science, like President Trump and Peter Navarro. Navarro is a PhD and he says that he can understand medical research as well as a medical scientist. He is a social scientist and a fool, not a medical scientist, and his claim is arrogant and nonsensical.
I am licensed to do brain and heart surgery, but I am not trained to do either. I would be a fool to contradict neurosurgeons or heart surgeons about what they are doing.
I was a medical scientist and I learned that medical data involves very complicated math. Only a fool would claim to be qualified to read it without a lot of experience in the field.
I have much more experience than Navarro in this area. I have written many peer reviewed medical papers and I was a peer reviewer for a premier ophthalmology journal. Also, I was a math major in college. Medical research math is not easy. Even the researchers do not do it themselves. They have statisticians who specialize in medical research do the analysis because there are always subtle points that have to be considered.
For example, the half-life of HCQ is long and it can sometimes still be in your body 2 – 3 months later. A person who took it a month before joining a study could be in the placebo group. That could make the results of the placebo group similar to those in the HCQ treatment group. Someone might conclude that HCQ was no better the placebo when in fact many placebo patients had HCQ in their systems.
A good statistician has to account for that, but someone reading the study might not realize it. So in fact, properly prepared data might actually correctly show that HCQ was not helpful.
Another problem is pseudoscientists in Beverly Hills
I worked in Beverly Hills for my 1st year as a practicing ophthalmologist. I was in a group with 4 other ophthalmologists and it was a celebrity practice. We had many famous movie and TV stars as patients, and lots of other patients with a Hollywood mindset.
If you want to make a living as a doctor, you have to value how your patients feel. For me, there was too much pseudoscience in Beverly Hills. Lots of people came in because they read about some new disease or some new treatment, and they expected me to be excited with them. I was uncomfortable in this environment. It was a pretend world. I saw myself as a medical scientist. After a year, I went off on my own, away from the Hollywood crowd.
I recently mentioned that I ate lunch everyday while in Beverly Hills at the hospital cafeteria with doctors who loved this type of medicine. Many of them actually looked like movie stars.
As fun as it was to be with them, I felt uncomfortable with their treatment choices. They were quick to use the latest fad because their patients expected it. I only wanted to use things that science showed had a clear benefit. I thought many of the Hollywood docs were pseudoscientists and I would never want them to treat a family member.
I did not meet any who were clearly con men. For me, a con man is someone who is making decisions entirely for fame and money. I have read about many in Los Angeles and I have seen them on TV.
The best con men are very likable and convincing, and their patients love them. Also, many have a lot of supporters in the medical community and a lot of respect in the political world and at their country clubs. But I consider them to be frauds. I resent how they are harming patients by using unproven or disproved treatments instead of ones that have been shown to be effective.
It’s tough to tell someone that his father, mother, or child just died
This is a very important, sacred part of being a doctor. I always saw it as the single greatest responsibility I ever had. It was an honor, but it was also very sad.
As a medical student, I was with residents many times when they had to tell the family that mom or dad died.
I had to do it a couple times as an ophthalmologist. One of my receptionists brought her father in for blurred vision. She thought he just needed glasses. When I looked in his eye, I saw a big, dark lump in his retina. I immediately assumed he had cancer somewhere in his body and it spread to his eye. That made it likely it spread everywhere. I had a very tearful conversation with him and his daughter, but I was the right person to do it. He passed away just a few days later after he and his daughter thought he just needed glasses.
Gina had cloudy vision
I had another patient, I will call her Gina. She was an IV drug addict, but if you met her, you would think she was a perfectly normal woman. Both she and her mother were kind and lovable. I liked them both a lot.
Gina came to me because she had cloudy vision in one eye for a few days. When I looked at her retina, there were white flecks in many of the capillaries. I asked her if she was an IV drug user. She was embarrassed and said that she was. I told her that she probably had talc particles blocking the capillaries.
Furthermore, I said this this was likely all over her body, including in her brain, heart, and kidneys. Also, the person cutting her heroine with talc was not doing it in a sterile lab. The talc probably contained bacteria.
One of her eyes had a haze in the vitreous, which is the gel that fills her eye. Under my slit lamp microscope, I could see that the cloud was composed of white blood cells. She had endophthalmitis, a bacterial infection inside her eye. Without treatment, she would lose her eye. I had the infectious disease doctors at the University of Chicago take over her treatment because she probably was starting to get infections all over her body.
Her mom still looked at me as her primary doctor. A week later, Gina died of massive sepsis. Since her mom saw me as her doctor, I was the one who had to tell her.
These kinds of conversations are devastating for the doctor and the patient. The reason I am telling these stories is because it shows why I am very careful to do what is best for the patient. The patient is trusting me with his eyesight and sometimes with his life. I only want to use treatments that have been tested by many different institutions by reputable doctors and after their work appeared in peer reviewed journals.
I accept that most people have life experiences different from mine. They are comfortable using treatments that have not had this type of validation. I understand that, but based on my life experience, I would never make that choice.
Treat a patient with love
Caring for a helpless patient is a responsibility comparable to what you have as a parent. You must act out of love, and the best choices are made based on facts. As a doctor, my facts came from peer reviewed studies from reputable medical institutions.
I understand that is easy to look for medical advice from people who are very good at getting on the news. For example, the President, Navarro, or many doctors who look and sound professional but are unable to get their work published in peer reviewed journals.
However, I have met a lot of frauds, pseudoscientists, and snake oil salesmen in my career. The best frauds are always the most convincing. But without seeing their work reviewed by a panel of experts and repeated at several other institutions, I would not rely on it to treat a patient.
Treating a patient is sacred, and I saw every patient as a family member. I would only do what I thought was scientifically verified, especially since most of what is not is fraudulent.
Dr. Brooks’s earlier special reports on the Covid-19 pandemic:
- Covid-19: Heart disease, Russian vaccine, and the end of the hydroxychloroquine hoax
- Many Covid vaccines and treatments, and less flu
- Covid-19 pandemic vaccine and its euphoric market impact