Random Pandemic Thoughts

Hello, Everyone- It’s my first post since we restarted the Blog and instead of being excited, I feel like crying. I just do not feel like I have anything profound to say these days. I think part of my sadness stems from the fact that just a few months ago last December, I was hundo P excited to slough off the carnage of what was the year of 2019.  Sadly enough, this was the second year in a row where I looked back on the year and thought to myself, “Good riddance-don’t let the door hit you on the way out.” But after paying for all my bad Karma over two straight years, I was hopeful. I HAD to have paid my debts to mankind, I thought. So ultimately I believed  2020 was going to be an epic year - I was going to be living my best life. All of a sudden it’s almost May and I find myself feeling like I am further from living my best life than ever before. I can’t blame it all on the pandemic, but it did not help that my new favorite past time involves fast food and take out or that my kids are so needy I can’t seem to get farther than one block of a run in before they call me demanding my return.

But, I think what has really got me in a funk, is that I am exhausted from hearing all of the arguments for and against the shelter in place orders.  Listen, I am not an infectious disease expert. I am not a medical doctor either. I’m an attorney-a profession even my own father has made known he despises. So I have no authority in this arena admittedly. I can’t say that I understand COVID-19 from a biological perspective. But I’ve done my research and what I do understand, however, is numbers. 

Let’s start with the last pandemic-The swine flu also known as H1N1. I remember this time as it happened in 2009. I remember people wearing masks for a time, mostly in airports. I do remember hearing it on the news. But nothing like we are experiencing right now.  There are a couple of distinctions between the two viruses. H1N1 resulted in 12,469 deaths in the United States from April 2009 to April 2010. That stat is taken directly from the CDC website here: https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html. The primary differences between COVID-19 and H1N1 were the death rate (COVID-19 had a higher estimated death rate) and it appeared that older people had some herd immunity built up since H1N1 was more deadly to young adults and children. Symptoms appeared in 1-4 days so the number of potential exposure before symptoms appeared was minimal. Similarly, the regular seasonal  flu is estimated to have killed 24,000 to 62,000 people in the United States during the 2019 -2020 flu season. Note the flu season spans 6 months from October 2019 to April 2020. This information also comes from the CDC. https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm.  Again, the death rate for COVID-19 was estimated to be higher and medical researchers understand the flu and have a vaccine for the most common strains. Contrast this with COVID-19. The reason it is sometimes referred as being “novel,” is because no one had herd immunity to the virus as it was a virus that had not been seen before in the world. Stated differently, humans had no pre-existing defenses to the virus. In addition, people could not have symptoms for up to two weeks, thereby exposing three times the people to the virus as H1N1 before a carrier realized the need to self-quarantine. From the first identified case in the US through April 25, 2020, the CDC has reported 52,459 deaths caused by COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html. The numbers from the CDC indicate it took H1N1 one year to kill 12,500 people in the US. It takes the regular flu six months to kill between 24,000 to 62,000 people in the US. COVID-19 has killed 52,459 people in two months. Those are the numbers that are reported.

As the COVID-19 deaths mount, people have begun to question these numbers. I don’t mind questioning things but I think it is important to understand what is implied when these stats are called into question. The primary theory I have heard postulated is the numbers are inflated. For this to be true, it would mean that (1) the CDC is manufacturing data; (2) doctors are misclassifying deaths or (3) the CDC provides guidance that errs on the side of over classifying the cause of death as being due to COVID-19. I have no way of disproving (1). I can say I have never heard people in the past accusing the CDC in this fashion. However, people will point out that it is an election year so perhaps the CDC is politically motivated. The problem with that is that the head of the CDC is appointed by the President. Yes, in March of 2018, President Trump appointed Dr. Robert Redfield as director of the CDC. I’m not sure why Dr. Redfield would bite the hand that feeds him but it is possible. However, if he was doing something President Trump disagreed with, I have no doubt the President would ask for his resignation. Without offering my opinion, I simply have no evidence to support that (1) is actually occurring.

With respect to (2)-that doctors are missclassifying deaths- for this theory to be true, it means that we should have been routinely questioning doctors’ opinions because they are either untrustworthy by choosing to promote a political agenda over the Hippocratic oath, or they are simply unintelligent. On two different occasions in my life, I can say I have strongly questioned a doctor’s determination about cause of death. Therefore, I think I have some credibility in questioning their abilities now because it is not the first time I have done so. But I truly do not think most people have ever thought twice about a doctor’s opinion regarding the cause of death and may not have ever seen a death certificate. Even so, I think people should know that they are implying an ethics violation or ignorance of medical professionals when this argument is raised. I don’t have a problem with this, I just want people to be clear about the implications and be comfortable with them if they are going to make this suggestion. I personally realize that the guy or gal who graduated last in their medical school program is still called Doctor. Point being, in general, I do not think Doctors are infallible by any means.  However, it does seem slightly illogical for physicians to inflate death counts. Hospitals are actually losing money because they cannot see patients or conduct elective surgeries. Physicians have been laid off. Why? Because a podiatrist cannot treat a COVID patient. His malpractice insurance likely would not cover activities out of his specialized area. Yes, as my dad pointed out, a podiatrist still went to medical school. However, that podiatrist may not have ever taken more than one class on infectious diseases and would not and should not treat a patient with severe respiratory failure. Without elective surgeries, that podiatrist may not currently be needed. And given the money hospitals are hemorrhaging, it makes sense that a hospital would not want to pay $600K/year to a doctor that has no patients to see at the moment. So while I think doctors can and do make many mistakes, I’m not sure I see an upside to their profession and employers by extending the pandemic unnecessarily.

Finally, that brings us to (3)-that the CDC guidance errs in over counting COVID-19 deaths. The CDC guidance is available for everyone to read here: https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf. In short, it is true that the guidance may tend to err on classifying a cause of death as being due to COVID-19 because it provides that if the certifier suspects COVID-19 or determines it was likely, they can report COVID-19 as “probable” or “presumed” in the death certificate.  However, it is important to understand that “probable” and “presumed” have a specific meaning wherein the circumstances must be compelling within a reasonable degree of certainty. There also needs to be a basic understanding of certain terms on a death certificate. Part I is where the doctor lists the Underlying Cause of Death (UCOD). Part II is where the doctor lists other underlying conditions that contributed to the death. According to the CDC guidance, medical examiners should list COVID-19 as the UCOD in instances wherein victims have had other conditions (hypertension or COPD, for example) which make them more susceptible to COVID-19 complications. This guidance appears to be fueling the concern that COVID-19 deaths are being inflated. The question, however, is NOT what guidance has the CDC provided because that is available for everyone to read. The real question is whether the CDC guidance departs from typical guidance on determining the UCOD-that would be what some might call evidence of a political motivation. Here is where having questioned a death certificate comes in handy.  As an asshole who has done that before (yes, I still plan to call myself an asshole in every blog I write as I used to do) I am familiar with the Physicians’ Handbook on Medical Certification of Death. You can access it here: https://www.cdc.gov/nchs/data/misc/hb_cod.pdf. I refer to pages 9-10 which discusses UCOD. It is defined as “the disease or injury that initiated the train of morbid events leading directly to death or the circumstances of the accident or violence that produced the fatal injury. On page 12 it also provides, “The cause-of-death information should be the physician’s best medical opinion. Report each disease, abnormality, injury, or poisoning that the physician believes adversely affected the decedent. A condition can be listed as ‘probable’ it is has not been definitively diagnosed.” The CDC’s guidance on COVID-19 does not appear to differ from standard published guidance. So going back to (3), if we have heartburn with this, the heartburn should extend beyond COVID-19. I am not saying the guidance should not be refined or injecting my opinion on this topic in general. However, my research does show the guidance from the CDC to be relatively consistent. Is it overclassifying the death count? I’ll leave that up to you to decide but if so, then the CDC is overestimating many other UCODs for different illnesses as well. Part of the reason for the inclination to over classify as opposed to under classify is because the numbers drive research money and from a public safety standpoint it is better to over estimate a threat than under estimate it. Again, I’m not saying this is right or wrong. You can decide that in your own. 

I have stated all of this research in a very pragmatic tone, with only calling myself a name during the process. However, in Facebook or even the news, I have seen people get ugly over their opinions. This is what has contributed to my sense of despair. People are repeating half-information in both sides based on the media’s spin of the situation. We are being ugly without realizing what we are truly implying and without even asking the right questions. I’m sad by how polarizing a deadly situation has become. We can disagree about how deadly-but people have died and will continue to die for some time-and I don’t think that is really debatable. The scope and magnitude, absolutely, but not the mere existence of the virus. Why have we not allowed this to bring us closer together? Or to have productive discussions regarding what might need to change in order to better capture numbers and causes of death? People can have opinions-however, I have seen some downright nasty exchanges simply because we don’t do our own research and instead, let the media manipulate us and play on our emotions. Don’t be a pawn of whatever media organization you support. To quote from the X-Files, the truth is out there. Go find it-we should all have the time since there is nothing else to do! Hope you enjoyed my return to the blog. I’ll try to not be so serious next time! Until then, Cheers!