Monthly Archives: April 2021

“Do Something”

COVID cases in BC have shown an alarming upswing. There are reports of people refusing to abide by the guidelines about gatherings. There are indications that the nasty Brazilian variant is on the rise. And, as always, hospitals are under tremendous pressure. Add to that a shortage of vaccines and the provincial government felt it had to act.

It announced a “non-essential” travel ban. The details are sketchy but in the first instance the police would be empowered to conduct random checks to ensure that no one left their Health Authority for non-essential purposes. (This was walked back a bit, now police will set up roadblocks to check on motorists.) And BC Ferries is cancelling the reservations of RVs. Constitutional niceties be damned, this time we’re serious.

There is simply no way that this “order” will work. Begin with the fact that Health Authority boundaries are principally administrative and that the average citizen is entirely unaware of where Coastal ends and Fraser begins. Worse, in the Lower Mainland, there are literally thousands of people who commute to work across the Fraser Coastal HA divide. Then there is the question of what is essential travel. (Probably best defined negatively as “travel whose purpose is not primarily recreational – take that you RVers.)

The entire scheme reeks of panic. Not panic at the relentless course of the virus, rather panic at the inability of the government to “do something” to stop that virus. A ban on ill defined non-essential travel between bureaucratic fiefs pretty much defines “half measure.”

There is a happy battalion of lefties who want nothing less than “COVID Zero” and who want that by way of a very strict, Australian style lockdown. Mandatory stay at home orders with only the most limited exemptions for food shopping. These people tend to refer to Dr. Bonnie Henry as a “libertarian” which they don’t mean in a nice way. It is certainly an option.

Counter poised to the “COVID Zero” types are people who don’t think lockdowns, masks and the various other non-pharmaceutical interventions are worthwhile – either because they don’t work or don’t work well enough to justify their significant economic, social and medical cost.

The great difficulty the current provincial government faces is that for any of the potential measures to work there has to be a level of public trust and agreement. It is becoming clear that the Canadian Courts take a dim view of fines and orders which are in direct violation of the Charter of Rights. All the provincial governments know this and it explains why so very few cases have been taken to Court. The last thing a government wants is for a Court to rule that its orders are unconstitutional.

Just as the COVID Zero people point at Australia and New Zealand, the anti-lock down people point at Florida and Texas. The COVID Zero folks point at case rates, the no lockdowners are more interested in deaths and hospitalizations. Both sides seem to agree that vaccination offers the best hope of beating the virus although there is some skepticism about whether “beating the virus” means eradicating it or reducing it to manageable levels.

Where people fall in this argument is largely a matter of their view as to the effectiveness of the state itself. Which is precisely where the travel ban fell apart. The one thing left and right will agree on is that a half hearted, unenforceable, unconstitutional set of restrictions will not work. That these restrictions were proposed at all undermines people’s confidence that the state can be effective. “Do something” is not the basis for policy which will have widespread support.

Right now, the government of British Columbia is faced with a set of unpleasant options. My own sense is that a really hard lockdown for a set period might still be possible; but that window is rapidly closing absent some truly horrible COVID outcomes. Which means that the default option of piecemeal activity, masking, closed restaurants and the hope that the vaccine and warmer weather work their magic is our most likely outcome.

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Trends, Narratives and Imagination

Conventional conspiracy theory – a term invented back in the 1960’s to discredit people who did not take the Warren Commission findings in the Kennedy assassination as gospel – usually posits a shadowy cabal of connected people driving towards a nefarious goal. The red yarn comes out and everything becomes connected. Implicit in any conspiracy theory worth its salt is a directing intelligence, either a mastermind or an occult group.

I’ve always been a conspiracy skeptic simply because I don’t believe that more than three or four people can keep a secret. Plus, there are usually non-conspiracy explanations for the phenomena a conspiracy theory seeks to explain.

People are more than happy to place the “Great Reset” as the pivot point around which everything from COVID-19 lockdowns, to the grand debasement of the West’s currency to the assorted questions surrounding election integrity. It is just vague enough to serve as the fulcrum for pretty much any occult explanation of daily events. And I think it is nonsense.

In place of a grand design, I see tens of thousands of minor decisions which all trend in the same direction without any need for central co-ordination. The central narrative of the COVID-19 phenomena, from the initial panic at the prospect of hospitals being overwhelmed, to the assorted public health measures – social distancing, masks, school closures, travel restrictions, general “stay at home orders”, lockdowns and curfews – to the drive towards universal vaccination, have all been largely good faith attempts to deal with a nasty virus. At each stage, all over the West, politicians deferred to public health officials who, in turn, looked to “science” for clues as to how to flatten the curve.

As we went along the public health narrative gradually became the only acceptable narrative. People who suggested that lockdowns might be doing more harm than good or that COVID was not spread from surfaces or that treatments should be looked at along with vaccines were marginalized. Now, no one person or entity was responsible for this; rather, a group consensus in favour of the public health narrative became overwhelmingly dominant.

Politicians and the media were heavily invested in this public health narrative. The narrative was enforced by everyone from Facebook and Twitter taking down messages suggesting alternatives, to Youtube flat out removing any content which suggested things like “treatment” with Vitamin D or ivermectin. The mechanism for narrative enforcement was very simple – if you said or wrote anything which was not in line with the CDC and or WHO you were promulgating “misinformation” and big tech had an obligation to avoid giving a platform for “misinformation”. (Never mind that the CDC and WHO have been wildly inconsistent in their recommendations.)

Once the “public health, no effective treatment, only vaccine will save us” narrative was in place there was a noble cause case for good information “hygiene”. People who raised questions could conveniently be dismissed as “anti-vaxers” or “covidiots” and their views and medical experience debunked by citing the lack of double blind, peer reviewed, studies. Again, no one had to direct the media or big tech or the political class to stick with the narrative. The arc of the COVID story was set as soon as the WHO declared COVID a pandemic which would only end when vaccination had created herd immunity.

The key piece to all of this is “science”. Assorted boffins modelling exponential growth (a bad thing) which could only be countered with a certain set of policy responses drove the conversation. If you think lockdowns are a bad idea or are unwilling to wear a mask outdoors or fail to use the hand sanitizer you are against “science” and thus indifferent to the horror of exponential growth.

The fact that the “science”, particularly the models, has been wrong as often as it has been right is relegated to the margins. The fact that there are scientists who dissent from “the science” is largely unreported. The fact that there are doctors who are having success with treatment regimes remains obscure.

The good thing about “science” is that it is never “settled”. Quite recently the CDC quietly admitted that it was extremely unlikely for COVID to be transmitted by surface contact. A small thing perhaps but the beginning of the end for the hygiene theatre we have been going through for a year. Other chinks in the “science” are emerging. It really does appear that COVID numbers follow the seasonal cycles other upper respiratory viruses do. The arrival of Spring along with increasingly widespread vaccination seems to be reducing cases and the severity of those cases.

Unfortunately, the public health narrative got in the way of a number of things which could have reduced mortality. The actual testing of ivermectin as a treatment and Vitamin D as a prophylactic have been, at best, haphazard. (Not to mention a suite of steroids and anti-biotics which have shown some promise.) Training staff to deal with ICU surges apparently was lost in the shuffle. Paying close attention, at a very granular level, to where and how infections occur may have happened but it has not been part of the public conversation.

As a matter of human nature, it is a lot easier to take on one, cohesive, narrative than it is to deal with two or even three concurrent stories. However, that is why we have political leaders. People who are supposed to look at the whole board rather than a small section of it. In the face of COVID, with few exceptions, our political leaders failed to look at anything other than implementing the public health/mask mandate/lockdown/vaccinate narrative. It was a costly failure of imagination.

Spring

It is a glorious spring day out here on Canada’s West Coast. I’ll be off to the dog park this afternoon. Good exercise, lots of sunshine, good mental health break. When I am doing the circuit of the park I will have the company of my 20 year old son, Sam, who is very smart but not quite as skeptical as I would like him to be. We’ll be discussing this video: https://rumble.com/vfa2gh-peter-mccullough-md-testifies-how-successful-early-treatment-for-covid-make.html?mref=6zof&mc=dgip3&utm_source=newsletter&utm_medium=email&utm_campaign=HealthImpactNews&ep=2

Dr. McCullough is a very smart, very eminent, doctor and he raises the question of why COVID patients are not offered treatment when they first test positive for the virus. He outlines some of the early treatment options but the real take away is that patients are routinely not offered any treatment or even information about treatment at all.

This has puzzled me from the outset of the pandemic. I realize that this time last year there were few clues as to what might make a difference. HCQ was touted but dismissed on the basis of some rather badly constructed single drug, later intervention, studies. Ivermectin was still over the horizon and some the steroids were being looked at but were not really options. But, a year later, you would think that early treatment would have advanced. But it hasn’t. Nor has there been much official conversation about the benefits of having strong Vitamin D levels and trying to bolster your immune system.

The entire arc of the COVID story has been social distance, masks, closures and lockdowns until vaccines can be delivered in bulk. The idea of a parallel track where doctors and researchers come up with a set of best practices to treat patients once they have tested positive seems to have simply never gained traction. At least not in the West.

Dr. McCullough points out that while all eyes were on the vaccine there was no comparable effort to develop treatment protocols. Why not? The good doctor points out that none of Trump’s COVID advisors had ever actually treated a COVID patient which might explain a bit. But Trump’s people were not the only people advising political leaders. Every country had its advisers.

My own ten cents worth is to look at it from a public policy perspective. From the go COVID has been seen as a public health emergency. Public health, by definition, looks at population scale solutions. Hospital capacity, rates of transmission, reduction of transmission by restriction on movement and activities. To public health officials, with the best will in the world, COVID is a mass phenomena which requires mass solutions. There are, however, other lenses to bring to COVID.

COVID could have been viewed as public emergency like an earthquake or an economic collapse. Through this lens, public health is one element of a government wide response. Through this lens, the public health interest in containing the spread of COVID would be matched by a medical response on a case by case basis. There is no reason we could not have done both. (Obviously, in the hospitals and the ICUs, case by case medicine is being practiced with somewhat encouraging clinical results.)

In a purely public health response, the idea of treating individual cases and developing protocols for early intervention can easily be lost in the drive to preserve the population until vaccines can be developed to save us all. And the logic of public health can justify all manner of non-pharmaceutical interventions to avoid overwhelming the hospitals and keep people from getting the virus. However, the public health response tends to see the virus as a binary: either you avoid it long enough to get vaccinated or you don’t and your risk of death rises. For a nastier virus than COVID has turned out to be, that might have been the correct reaction. But COVID is not ebola or even the Spanish flu, its nasty but most people will survive it.

The medical question, rather than the public health question, is what Dr. McCullough wants to talk about. It is a conversation which should have been had in the Spring and Summer of 2020 when the first wave had broken and the second wave had not yet arrived. Doctors now had clinical experience with severe COVID and were developing strategies to deal with it in hospital settings. But, apparently, there was very little work being done to figure out what to do in the critical week or two between a person testing positive and developing symptoms severe enough to require hospitalization.

Frankly, that amazes me. It shocks and amazes Dr. McCullough.

Right now I am going to organize the daily dog park tour and drink in the Spring sun. Like most upper respiratory infections, COVID should fade quickly as the weather warms. But, as it does, it would be a very good idea, even with the vaccines, to come up with standard of care treatment plans for people who come down with COVID as we wait for the vaccine.

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