A Rebuttal – Leadership Vacuum

The New England Journal of Medicine article: “Dying in a Leadership Vacuum”¹ was annoying on many levels. It's a biased, one-sided hit job on President Trump without actually naming him. It is mostly devoid of evidence or references and full of opinions, accusations and cheap shots presented as facts.

How is it one-sided? For starters, it praises China for their results in combating the virus with no mention that it is because of China that the world is dealing with COVID-19 in the first place. It is almost conclusive that the virus originated in China.² Worse, a Chinese doctor, now in exile, Dr. Li-Meng Yan came forward recently to allege that the coronavirus was a lab-manufactured disease that was intentionally released by the Chinese Communist Party.³ She said her former supervisors at the Hong Kong School of Public Health, a reference laboratory for the World Health Organization, silenced her when she sounded the alarm about human-to-human transmission in December last year.⁴ She left so she could tell her story. She is working on a report detailing her evidence. Sadly, Dr. Yan’s mother has since disappeared, but Dr. Yan is still resolute in exposing China’s lies. That few people would destroy their lives to spread a lie is strong evidence that she is telling the truth. What the NEJM has done is equivalent to heaping praise on a killer for resuscitating some of his victims.

Additionally, China hoarded PPE all the while withholding (lying about) vital information about the virus's release and means of transmission. Chinese authorities held off from telling the WHO that the unknown illness was contagious, ”to buy them time to import more PPE, including face masks and surgical gowns”, a DHS report stated. ⁵ And being the global supplier, in their hoarding of PPE they were denying the same to the rest of the world. That affected the ability of the U. S. to obtain sufficient PPE. Nevertheless, the NEJM criticized the U.S. for not procuring enough PPE.

The NEJM article was also one-sided and unfair by its excoriation of President Trump without giving him credit for his actions. He shut down travel into the U.S. from China in good time, and his detractors criticized him for it.⁶  The New York Times wrote that “some public health and policy experts” believed the restrictions would do nearly nothing to help contain the virus. Dr. Michael T. Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said ”At this point, sharply curtailing air travel to and from China is more of an emotional or political reaction. Joe Biden called Trump’s closure of travel from China “xenophobic”, although he later said he wasn’t referring to the shutdown, after it became obvious that the shutdown was effective. Medical professionals agreed the China travel ban saved lives.

President Trump directed the FDA to fast-track a vaccine. He also expects it will be released only after its safety and effectiveness have been proven. To improve the odds that one will work, the Trump administration has helped finance the development of four COVID-19 vaccines in parallel though its Operation Warp Speed Program.⁷ He encouraged rapid development and testing of treatments.

Aside from being obviously biased against President Trump, the NEJM took a very narrowly-focused view of an unimaginably-difficult problem. The COVID pandemic presents a multi-faceted one. Certainly there is the medical and scientific facet, but there are also the socio-economic and personal liberty facets. The problem was and still is necessarily complex.  From the start, we didn’t know how it is transmitted. We didn’t know the transmission rate. We didn’t know the hospitalization rates over time. We didn’t know what treatments would work. We didn’t know the death rate. We didn’t know the disease’s variability across age groups. We didn’t have a vaccine. We didn’t know the death rate due to elective medical treatment denied by shut-down actions. We didn’t know the economic impact because of shut-downs. We didn’t know the ripple effect on suicides by denial of social contact and jobs lost. We didn’t know the impact of isolation on the mental health of our youth. We didn’t know some states would have minimal infection and others would have many, or the disparity of infections and deaths across countries, suggesting more complexity in the disease than it would appear on the surface. We still don’t know many or most of these variables. These are just the obvious unknowns – in addition, we didn’t know what we didn’t know. Even if we could have had perfect forward-looking vision and lots of preexisting data on the problem, we had no experience with solving the n-unknown, n-variable equations. One can see this is not just a medical problem; it became a multi-faceted political problem, at least for our republican form of government. Who would want a president’s job during this unprecedented year? Who would criticize a sitting president for mishandling such a huge problem? Monday-morning quarterbacking is usually easy, but in the case of the COVID pandemic, even Monday-morning quarterbacking is hard. Who would have wanted the NEJM in charge? They didn’t even offer the possibility that President Trump and his administration have been struggling with such a difficult problem and acknowledging his good intentions. Instead, they took a pompous, accusatory position - criticizing without proposing a plan.

Further, the NEJM took issue with ”late and inconsistent quarantine and isolation measures, often without any effort to enforce them.” But that criticism ignores that we are a country with a strong belief in human rights, the most important of which are guaranteed by the U.S. Constitution. Thankfully, there are limits on what the government, federal, state, and local, can do relative to restricting travel and behavior. State constitutions also come into play. For example, Michigan Gov. Gretchen Whitmer’s emergency declaration over the pandemic was recently ruled unconstitutional by the Michigan Supreme Court.⁸ I suspect that at least half of the nation’s governors have similarly encroached on constitutional rights. The NEJM might like to have absolute power, but thankfully they don’t. It is to President Trump’s credit that he is sensitive to our constitutionally-guaranteed rights.

The NEJM unfairly compared the administration’s results to those of China.  But Kai Kupferrschmidt and Jon Cohen wrote “How feasible these kinds of stringent measures are in other countries is debatable.⁹ “China is unique in that it has a political system that can gain public compliance with extreme measures,” Gostin says [Lawrence Gostin, a global health law scholar at Georgetown University]. “But its use of social control and intrusive surveillance are not a good model for other countries.” The country also has an extraordinary ability to do labor-intensive, large-scale projects quickly, says Jeremy Konyndyk, a senior policy fellow at the Center for Global Development: ‘No one else in the world really can do what China just did.’”

“Nor should they, says lawyer Alexandra Phelan, a China specialist at Georgetown’s Center for Global Health Science and Security. ‘Whether it works is not the only measure of whether something is a good public health control measure,’ Phelan says. ‘There are plenty of things that would work to stop an outbreak that we would consider abhorrent in a just and free society.’” The images we saw of China arresting sick, old women and hauling them off to quarantine haunt us.

And since the NEJM feels free to offer speculation with no evidence, how about this theory. If China released the virus with malice and foresight, they had plenty of time to study the parameters of the virus in advance and develop plans to deal with it. Maybe their low infection rate is because they had already developed a vaccine and administered it to their population. This is not a ridiculous theory for a nation which has no problem imprisoning and executing its population for just political reasons. But it’s near impossible to get true information out of Communist China.

With all that said, we can't deny the data on what Rona has done to our country or deny that we have done less-well than some countries. Much of the blame for COVID’s impact on our country can be placed directly on our Obama-legacy CDC, which was pushing gun control and other liberal causes rather than preparing for the next pandemic.¹⁰ We’ll never know how many thousands of lives were lost due to the depleted and not replaced PPE stockpile. We'll never know how many thousands of lives were lost because of their initial recommendation that we not wear masks.¹¹ Dr. Anthony Fauci actually laughed about the mask lie while admitting the lie. We’ll never know how many thousands of lives were lost because of their withholding evidence that 6 foot spacing is not safe indoors or outdoors.¹² They now admit the logical and obvious conclusion which is that the virus can be carried in aerosols much farther than 6 feet.

Yes, as President Truman popularized, “The buck stops here.” But I don’t blame President Trump for not fixing the CDC in his first term. For starters, he didn’t know it was broken, and further he has been dealing with the left’s attacks on him for three years over “Russia collusion” and impeachment. Which problem would you focus on – the one you know about or the one you don’t?

The NEJM proudly proclaimed 34 editors signed the article. But that doesn’t impress, other than to point out what has been occurring for years. The medical profession, including the AMA¹³ and other medical associations and journals, has been infected by the liberal virus, to use a play on words, much in the way the media and primary and secondary education have. According to the NYT, this is the first political publication of the NEJM in its 208 years of existence.¹⁴ So aside from its decidedly liberal politics, why specifically did the NEJM decide to publish a lightly-referenced, evidence-devoid, biased hit piece on Donald Trump? And why did they withhold publication until three weeks before the election? There is little in the article that wasn’t known months ago. I think the answer is obvious. The Journal has a right to engage in politics, but doesn’t it detract from and call into question their scientific Bona Fides? Progressives lately have been quick to say “follow the science”. And how much political bias is finding its way into “science”? The NEJM should stick to their medical reports, which they heretofore have done well, and keep their liberal propaganda to themselves. 

Update: Since publication of this article earlier today, I have discovered reports that the published work of Dr. Li-Meng Yan has been called into question by numerous virologists. My apologies for not discovering this before publication.

Reader comment - 10/14 

The following comment was received from a NextDoor forum member. "Bill", a scientist and engineer, made some important observations about the NEJM article which I had missed. He waived credit for the comments and gave his written permission to append them here.

"So here are some real Facts that no one seems to put into writing. Excluding them is absolute abuse by the scientific community.

 1. The US was the third most traveled to country in the world, pre Covid. Over 200,000 people entered the US each and every day. Even now, we could not possibly contact trace this many people or those potentially infected by them. Even more important and because of this fact, the virus seed rate in the US was much higher than most other countries. Further Domestic travel within the US is larger than any other country, meaning that once the virus landed on our shores it spread rapidly across the country. Obviously any small country can contact trace if they are only letting in 100 foreigners/day.

2. 78% of all Americans are overweight. 40% of all Americans are obese. Other than some small countries like Samoa, we are the most obese medium or large size nation in the world. Many countries have nearly half the obesity of the US. Given the above it is clear that the US should be expected to have a much higher death rate than almost every other country. Obviously Covid co-morbidities of heart disease and diabetes are directly related to obesity. So if a medical journal mentions nothing about the relationship between Covid and the high US obesity rate then that publication is excluding very pertinent facts and should no longer even be considered a medical journal. It is similar to saying there is no relationship between any cancers and any chemicals in our environment.

3. If you exclude New York City, our death rates averages go down substantially. Many countries appear to have better death rates but they protected their elderly, something Andrew Cuomo failed to do."

 References:

1 https://www.nejm.org/doi/full/10.1056/NEJMe2029812

2 https://www.nationalreview.com/2020/04/coronavirus-china-trail-leading-back-to-wuhan-labs/

3 https://www.foxnews.com/media/chinese-virologist-government-intentionally-coronavirus

4 https://nypost.com/2020/09/11/chinese-virologist-says-she-has-proof-covid-19-was-made-in-wuhan-lab/

5 https://www.forbes.com/sites/isabeltogoh/2020/05/04/china-covered-up-coronavirus-to-hoard-medical-supplies-dhs-report-finds/#3c8f7b81dbab

6 https://dailycaller.com/2020/03/20/flashback-how-the-press-covered-trumps-china-travel-ban/

7 https://news.yahoo.com/u-official-says-operation-warp-214212323.htm

8 https://www.dailywire.com/news/michigan-supreme-court-shutdown-violation-of-state-constitution

9 https://www.sciencemag.org/news/2020/03/china-s-aggressive-measures-have-slowed-coronavirus-they-may-not-work-other-countries

10 https://www.frontpagemag.com/fpm/2020/03/cdc-was-fighting-racism-and-obesity-instead-daniel-greenfield/

11 http://opinionatedoldman.blogspot.com/search/label/Abolish%20the%20CDC%21

12 http://opinionatedoldman.blogspot.com/search/label/%E2%80%9CSocial%20Distancing%E2%80%9D%20Kills

13 https://www.kevinmd.com/blog/2011/06/ama-decline-doctors-care.html

14 https://www.nytimes.com/2020/10/07/health/new-england-journal-trump.html

 

 

“Social Distancing” Kills

Last month I wrote about the damage the Center for Disease Control’s (CDC’s) mask and respirator guidelines were doing to public health. They have since adopted more reasonable guidelines, recommending that everyone wear a mask in public instead of the former insane statement that “For the general American public, there is no added health benefit to wear a respiratory protective device.” How many American lives did this cost? They still stop short of making the best recommendation, which is for everyone to wear an N95 respirator in public. The N95 respirator is so labeled because it is tested to ensure that it blocks 95% of pathogens, thereby protecting the wearer against infection. (Yes, I know they’re scarce and medical professionals need them most, but there are homemade alternatives which are almost as good.) See this study report.

The CDC continues to make unfounded, unscientific and dangerous recommendations. The subject of this article concerns social distancing. The CDC states “To practice social or physical distancing, stay at least 6 feet (2 meters) from other people.” The media and government officials make the harmful recommendation worse by using the term “practicing safe social distancing.” The implication is that if we remain 6 feet apart, we are unlikely to become infected.

But important research done by Dr. Lydia Bourouiba, Assistant Professor at MIT and researcher of Applied Mathematics, along with companion researchers, starting in 2014 and continuing through this year have revealed that “pathogen-bearing droplets from a sneeze can travel 23 to 27 feet propelled only by the person’s ballistic release of air.” And with indoor ventilation systems and outdoor wind currents, no practical limit can be stated beyond which it is safe to be from an infected person. Just today, Fox News contributor, Dr. Janette Nesheiwat stated that virus born clouds could remain viable for up to 2 hours. How many have become infected and died while keeping six feet or more from an infected person or unknowingly walking into a viral aerosol cloud? By its misleading social distancing guidelines, the CDC has blood on its hands by withholding the truth which would enable us to stay safer.

Supporting research

To my knowledge, there are no scientific studies which support the CDC assertion that the Chinese corona virus "spreads mainly among people who are in close contact (within about 6 feet) for a prolonged period." In fact, years of scientific research and a recent study in a Chinese hospital provide strong evidence to the contrary.

In 2014, Dr. Bourouiba, with the assistance of Dr. John Bush, Professor of Applied Mathematics at MIT, used fluid mechanics to quantify the physics of sneezes and coughs into still air. They learned some very useful things about the travel of emitted pathogens.

Quoting the researchers: “We think of the cloud [from a sneeze] as being turbulent, that is to say very disordered, vigorous motion. If characteristic speed in that cloud is larger than its settling speed, then it will be dominated more by that internal cloud motion than by its settling speed. The smaller drops go much farther than the large drops, because the cloud keeps them afloat. The science shows that these clouds, particularly under usual conditions of temperature and buoyancy, have a tendency to go higher in the room and get sucked into the ventilation system. ‘I could be in this end of the building and somebody could be in contact with my pathogens through the filtration and ventilation system without me actually meeting that person.’”

“That COVID-19 pathogens can leave a patient’s room was confirmed by a recent study in a hospital in Singapore. It was reported in JAMA Network that: “Swabs taken from the air exhaust outlets tested positive, suggesting that small virus-laden droplets may be displaced by airflows and deposited on equipment such as vents.”

Hospital administrators know this, which is why we hear of COVID-19 patients being placed in “negative pressure” rooms. Under negative pressure, all the pathogens which escape into the room are quickly evacuated and pass through a filtration and sterilization system before being evacuated into the atmosphere. It is the same principle by which bathroom exhaust fans work.

That ventilation systems move pathogen clouds is not unique to hospital rooms. In recent computer simulations done by researchers in Finland, it was demonstrated that pathogens propelled from a person coughing will quickly spread over multiple aisles in a grocery store. All it takes is moving air.

I stated above that no practical limit can be stated beyond which it is safe to be from an infected person. In reporting on the work of Drs. Bourouiba and others, Peter Dizikes | MIT News Office reported: “Indeed, the study finds, the smaller droplets that emerge in a cough or sneeze may travel five to 200 times further than they would if those droplets simply moved as groups of unconnected particles.”

Later in 2016, Dr. Bourouiba and others published the results of high speed camera measurements of actual sneezes. Using two high-speed cameras, the researchers recorded more than 100 sneezes from healthy human subjects and captured the fraction of a second during which fluid is expelled from the mouth and flung through the air. These experiments helped confirm the engineering analysis results produced in 2014, that pathogen-bearing droplets from a sneeze can travel 23 to 27 feet.

Then last month on March 26, Dr. Bourouiba reported on recent findings specifically about the current COVID-19 crisis. This work was published in the prestigious Journal of the American Medical Association (JAMA). Quoting from JAMA Insights:

“Even when maximum containment policies were enforced, the rapid international spread of COVID-19 suggests that using arbitrary droplet size cutoffs may not accurately reflect what actually occurs with respiratory emissions, possibly contributing to the ineffectiveness of some procedures used to limit the spread of respiratory disease.”

“Recent work has demonstrated that exhalations, sneezes, and coughs not only consist of mucosalivary droplets following short-range semiballistic emission trajectories but, importantly, are primarily made of a multiphase turbulent gas cloud that entrains ambient air and traps and carries within it clusters of droplets with a continuum of droplet sizes. The locally moist and warm atmosphere within the turbulent gas cloud allows the contained droplets to evade evaporation for much longer than occurs with isolated droplets. Under these conditions, the lifetime of a droplet could be considerably extended by a factor of up to 1000, from a fraction of a second to minutes.”

“Given various combinations of an individual patient’s physiology and environmental conditions, such as humidity and temperature, the gas cloud and its payload of pathogen-bearing droplets of all sizes can travel 23 to 27 feet.”

“In the latest World Health Organization recommendations for COVID-19, health care personnel and other staff are advised to maintain a 3-foot (1-m) distance away from a person showing symptoms of disease, such as coughing and sneezing. The Centers for Disease Control and Prevention recommends a 6-foot (2-m) separation. However, these distances are based on estimates of range that have not considered the possible presence of a high-momentum cloud carrying the droplets long distances. Given the turbulent puff cloud dynamic model, recommendations for separations of 3 to 6 feet (1-2 m) may underestimate the distance, timescale, and persistence over which the cloud and its pathogenic payload travel, thus generating an underappreciated potential exposure range.”

Conclusion

It would be a lot more honest, helpful and less dangerous to the public they are commissioned to protect if the CDC would write:

Stay as far away from other people as possible. Virus clouds from sneezes and coughs can be immediately propelled up to 27 feet or farther. Even talking or singing can emit virus-laden aerosols. In addition to the initial propulsion of pathogens, there are many variables which make it impossible to recommend a safe distance. Air conditioning design, room size and how fast people are moving around and stirring the air inside an enclosed space will affect how far and fast virus-containing aerosols will travel. Wind speed and direction, humidity, how fast people are moving and other variables will affect how far and fast virus-containing aerosols will travel person-to-person outside. Self-quarantining and immediately sterilizing incoming items such as mail and groceries is the safest protocol.

This proposed guideline is actually supported by scientific research, clinical setting studies and common sense.

Abolish the CDC! 

The Centers for Disease Control and Prevention (CDC) is useless and even harmful to the country. With the advent of the Corona Virus (aka. COVID-19), people are asking if wearing respirators, aka. masks, will help keep them from becoming infected with the virus. The answer the CDC is giving is confusing , contradictory and actually harmful to the public.

Their website states: “For the general American public, there is no added health benefit to wear a respiratory protective device (such as an N95 respirator).” And the FDA goes even further, stating this headline: “N95 Respirators Not for Use by the Public.”

The CDC’s advice is contradicted by their own documentation.  They have this advice for medical professionals. “Use respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece [sic] respirator before entry into the patient room or care area.” This is consistent with the CDC’s National Institute of Occupational Safety and Health (NIOSH) rule 42 CFR 84 which certifies N95 respirators to catch 95% of particles 0.3 microns or larger. Viral pathogens are larger than 0.3 microns which means they are caught by N95 respirators. Respirators are protective, but the proletariat masses shouldn’t have them, according to our government.

It gets worse. Again according to CDC’s website, “Older people and people with certain underlying health conditions like heart disease, lung disease and diabetes, for example, seem to be at greater risk of serious illness.” Most of the deaths from Corona have been from this population. Why then is the CDC not at least recommending respirators for  this community?

So with a deadly virus in our midst, why is the CDC recommending that the general public not wear respirators, which by their own definitions are protective? I could speculate, but I won’t. I don’t know the answer. But the facts are that 1) N95 respirators are protective against exposure to viral agents and 2) we are being told by the CDC they are not.

The press and others are happy to repeat the lies. The press regularly changes “no added health benefit” to “should not wear them.”  Just this morning, Surgeon General Jerome Adams stated that respirators are not for the general public. He made the incorrect advice even more harmful by stating that wearing respirators can actually increase our risk of contacting Corona. The reason: because we don’t know how to wear them and they will make us overconfident! That is an insulting statement designed to support an obviously incorrect recommendation.

The CDC should issue factual recommendations which actually help prevent the spread of disease, or be abolished. The press should be more curious about recommendations which are false on their face. And it should be a crime for high-level government agents such as the Surgeon General to spout such nationally-harmful lies.

The Impeachment of Donald John Trump

OPINION

It has come to my attention through sporadic viewing of the subject proceedings that the procedure being followed in the Senate is a disaster. Yes, it is a political process, or so I’ve heard, but it should have some rules grounded in what has been shown to work. American jurisprudence over time has developed rules of procedure which serve to afford the litigants fair and efficient trials. The Constitution provides very little detail on how to conduct an impeachment trial. Article I, Section 3, paragraph 6 states: “The Senate shall have the sole Power to try all Impeachments. When sitting for that Purpose, they shall be on Oath or Affirmation. When the President of the United States is tried, the Chief Justice shall preside: And no Person shall be convicted without the Concurrence of two thirds of the Members present.” That’s it.  Left to its creative minds, and I use “creative” somewhat derisively, the Senate has chosen to set aside many of the Federal rules of trial. One of the more important, and bedrock of U. S. jurisprudence, is the Federal Rules of Evidence. Federal Rules of Evidence are comprised of over 60 Rules numbered101 through 1102, which stipulate how to determine what is admissible and what is not¹. The judge in a trial has the sole responsibility to apply these rules to allow admissible evidence and deny inadmissible evidence. The jury is not allowed to hear inadmissible evidence, and for good reason. To be fair to both parties in a trial, the minds of the jurors should not be corrupted by hearsay, speculation and opinion. Sharing of inadmissible evidence is grounds for a mistrial.

By conducting the impeachment trial of President Trump with no application of evidentiary rules, the first two weeks of the trial are at best a waste of time, and worse, a serious obstacle to justice.  Weeks are being given to what is classically called “opening statements” wherein each side states a summary of what will be proven. Opening statements are generally an hour or two, or at most a day, for each side. Opening statements are not evidence. But in this impeachment trial, opening statements are being given as though they are presentations of evidence. They are not. Chief Justice Roberts, who should be enforcing rules of evidence, isn’t. He is just acting as moderator, and doing nothing a judge normally does. The most I’ve seen him do is admonish litigants to watch their language. Really? As acting, he has little to no value in the process.

Impeachment is arguably the most important trial which can be conducted in this country. Why then shouldn’t it be conducted most formally? I submit that omniscient though they make think themselves to be, many if not most Senators left to their biases and constituent pressures have a difficult time discerning evidence of fact from opinion. This is a great disservice to the defendant and the country. I say the Senate Majority Leader and the Chief Justice are equally culpable in the problem. The country deserves better.

References:

        Federal Rules of Evidence https://www.law.cornell.edu/rules/fre