By Paul Kempen, MD, PhD
We saw SARS and MERS as severe Corona infections in the past, and COVID19 is also known as SARS-2:
The 2002–2004 SARS outbreak was an epidemic involving severe acute respiratory syndrome (SARS) caused by SARS-CoV. The outbreak was first identified in Foshan, Guangdong, China in November 2002. Over 8,000 people from 29 different countries and territories were infected, and at least 774 died worldwide. We watched it in Torono, Canada, just across the border.
Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Most MERS patients developed severe respiratory illness with symptoms of fever, cough and shortness of breath. About 3 or 4 out of every 10 patients reported with MERS have died. Health officials first reported the disease in Saudi Arabia in September 2012. https://www.cdc.gov/coronavirus/mers/about/index.html
The past epidemics didn’t kill enough Americans to create enough interest in solving the problem. The current SARS or COVID19 pandemic was first documented on January 10, 2020, while the name itself identifies the pandemic as starting in 2019. We are now 3 months INTO the epidemic, with an anticipated death rate of 5% and are still only reacting! Instead of closing down the country, we should have been ramping up industry to provide for THIS EXPECTED pandemic and providing the PPE, drugs material and manpower. The current plan to “self-quarantine” serves only to spread out the ultimate number of infections over time, to allow the available facilities to be able to “cope” with the expected severe infections. But please remember, that the USA has been reducing total numbers of hospital beds and closing hospitals for decades. It will also remain to be seen if this COVID19 pandemic will equal or exceed the deaths from those yearly Flu season’s infections (epidemics) which KILL 30-60 THOUSAND each year in the USA.
Oddly enough, we never have seen this sort of PPE response to the flu in spite of the significant mortality-so why are we treating COVID19 as if it were EBOLA, when it is a respiratory infection just like the FLU? Or will we now be responding to flu seasons like the Covid-shutting down the country, especially if the flu actually kills more people than the covid virus? Why are nurses suddenly utilizing PPE with such high level of protection, exceeding that required for flu season? Why are we seeing nurses crying on TV that “they never signed up for this”. “This” comes EVERY YEAR! The vast majority of flu and COVID patients do NOT die, as many have minimal or no symptoms, especially the young and healthy. Yes, be safe, but in which “War” did this country shut down the industries? Most workers in industry are easily 6 feet from each other.
The LAST place anyone should be going now-if they are healthy, is to a HOSPITAL -why join the infected if YOU are not-stay home!!! All this wasted “news” on testing has been counter-productive. A Test does not save anyone, it does not insure citizens are not infective for a number of reasons-more importantly, you could BECOME infected getting the test in a hospital. Getting yourself tested in your car from a person who is reaching into test hundreds of patients an hour is not someone I want to encounter as they may be infected. Why risk to “see” if I am infected driving up and opening my mouth and possibly GETTING the virus (my test will be negative and I will be positive a day later). The emphasis on daily declarations of the total number of “cases” rather than DEATHS serves to maintain the hysteria in the population, facilitating and exploiting the fear, to force all citizens to comply with whatever the “Current recommendation” is issued, being true or false. Testing only provides access for numerators and denominators in the tracking of epidemiology-but this is also an effective way to scare the populace into “following orders”. No person without symptoms needs testing as a matter of acute care. The overwhelming of facilities with hysterical people wanting testing and treatment for “possible” (not probable or symptomatic disease) is counterproductive, helping to spread the disease and tying up those health care workers and facilities need to care for the sick.
The CDC has failed us by stating “civilians should not wear masks”, and should be reversing this statement soon, because it is WRONG. If it is useful to doctors and nurses, why would it not be true for citizens out in public? Sure, the statement was a political based decision and NOT a doctor-patient decision. The CDC wanted to conserve PPE. Sure, the epidemiologists also have “recommended” for decades to change your face mask after EVERY use before the Covid hit (i.e. every time you leave the operating room)-but no one does this in real life because THAT too is wasteful and excessive. Now we are reusing and prolonged using of PPE because of a shortage, which after 3 months since the first warning, should NOT have occurred.
We as health care professionals-Doctors KNOW what masks do and this is important and is NOT being disseminated via the news. Surgical masks contain YOUR secretions during normal operations from falling into the wound. N95 masks are not the same and prevent other’s aerosol infections from being transmitted to you! A Mask is NOT “a mask”. There are different types, uses and functions. Hand made cloth masks are NOT N95 and protect those around you from your secretions but do not reliably protect you from theirs. Everyone should be wearing surgical masks in public, and “high risk” civilians should have N95 if they NEED to leave their homes to go to the doctor or grocery store. People should not need to reuse masks, but they could be disinfected with rubbing alcohol 70% in a plastic bag overnight and air dried (or even baked at 200 degrees) prior to reuse.
I have YET to see any information on the “NEWS” to explain the use of masks to the public to date. Yet, every hospital health care worker must comply with OSHA guidelines and submit to an “N95 Fitting session” to LEARN how to use this type of “duckbill” N95 mask for PPE! Because of the misinformation presented on the “daily news” it is high time for these issues to be presented. It is high time for EVERY person appearing on TV to WEAR a surgical mask, whenever there are more than 2 people present! We need the RIGHT messaging sent out to the population and the right example projected!
I have personally Worked on the USNS Comfort twice during missions to South America, once after the Haiti earthquake. ALL patients were screened for Tuberculosis-a severe respiratory infection- to insure no one with TB was brought onto the ship, because of the danger of widespread infection once on board. The current presence and use of these warship hospitals appear to me to be primarily one of “reassurance” or some political statement in this pre-election period. In this PANdemic however, the likelihood that COVID patients will NOT become apparent onboard-even if they bring only “non-covid tested patients onboard to “relieve landside facilities” is highly unlikely., After the 800 workers and first 800 patients are brought onboard, the infection may become apparent after days. Testing is not able to exclude latent infection and the COVID is extremely infectious-especially if the patients are coming from a high risk zone=i.e. a HOSPITAL. The size of patient bays on those ships is small, the ventilation is “common” and cross infection will be a given, after the first Covid infection manifests onboard. Our experience with quarantine on cruise ships and COVID is, well…….. nobody is going on a cruise until Covid is over! The resources (personnel and materials) of these two hospital ships would be better placed landside, in a converted mall or convention center with adequate space and ventilation. The shortage is one of material and personnel-NOT floating sardine cans, which are known to be at risk for dissemination of respiratory infections. These military health care workers should be used landside in this “War on Covid”. We need an army and not a navy today.
The government has made many decisions to allow “compassionate care” approval of drugs. It has been STANDARD PRACTICE to allow doctors to prescribe medicine for “off label” use-prescription for conditions other than those formally studied and allowed to be advertised under FDA “labeled” guidelines. Almost ALL use of drugs in children was initiated as “off label” for decades. IN the face of an epidemic, the use of hydroxychloroquine had been curtailed and in spite of information from as early as 2004, suggesting effectiveness in slowing viral reproduction in SARS as a treatment and therapy. Of course the scientists at the CDC “want further study”………….but people are DYING NOW. But the political agenda is to now build thousands of ventilators, instead of releasing drugs. The drugs are quickly and easily marketed, are very low risk in the young and healthy, but alias, as generics these drugs were unlikely to find the financial incentives noted with complex machine products. They may well be able to specifically prevent and treat the disease, as opposed to fight the symptoms of disease (with ventilators). SARS is not new-it has been there for study for over a DECADE. The lessons of the flu season (epidemics) EVERY YEAR are the same as COVID. Are we learning or even asking these questions? Why not?
Many questions remain in this War and cannot be answered until addressed, unlike most of the preceding matters discussed. Because the young, healthy population is resistant to severe symptoms, should they be restricted from service in this war? Should the elderly and infirm? Should ALL TV persons be WEARING MASKS to promote the “war effort”? When will educational, instead of hysterical “news” be screened to teach the population what is TRUE and effective? Why are the drugs not in high priority production and dissemination for prescription by physicians to PATIENTS who desire them?
COVID19 is a form of virus (Corona), one which usually causes about 20% of the yearly common colds. We have not developed testing or immunization for corona virus in the past BECAUSE it is benign. Are children and non-geriatric people less affected, because of their yearly exposures to the similar, yet innocuous corona virus? We know that immunizations for Smallpox, polio and other viral disease prevented these serious diseases by inoculations of similar and less deadly live virus. Infections are typically one pathogen and competition with others may reduce pathogen’s disease-we know eugenic bacteria exist in the bowel and if destroyed by antibiotics, allow pathogens to become deadly there. Should we be passing out “Common cold virus” now to compete and possibly prevent severe COVID? Can it “compete” in cell cultures or animals/humans? Should we stop publishing daily “Corvid cases” on the news channels-sticking to deaths and promulgation of useful information like safe and correct mask use for all?
It is time for medical and not political decision making. We should be anticipating needs for now AND the next decade, and not be awaiting each crisis.
Pau Kempen, MD, PhD
213 Vista Dr
Weirton, WV 26062
412 860 6827
“Gee, Jim, I wish I would have run for congress after graduating high school like you! I could have saved myself 12 years of grinding medical education to become an expert in health care like you and your many colleagues in congress!” From a late night joke on TV
Head of China CDC:
“The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact.”
https://www.sciencemag.org/news/2020/03/not-wearing-masks-protect-against-coronavirus-big-mistake-top-chinese-scientist-says
A physician in Michigan sent this to me last night.
And separately these Korean modelers concluded that these strategies were working:
“To early end of the COVID-19 epidemic, efforts to reduce the spread of the virus such as social distancing and mask wearing are absolutely crucial with the participation of the public, along with the policy of reducing the transmission period by finding and isolating patients as quickly as possible through efforts by the quarantine authorities.”
https://www.e-epih.org/journal/view.php?doi=10.4178/epih.e2020011
“Estimating the reproductive number and the outbreak size of Novel Coronavirus disease (COVID-19) using mathematical model in Republic of Korea
Sunhwa Choi Choi , Moran Ki , Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea, Goyang, Korea
