Friday, July 24, 2020

Why The Unorthodox Perspective Matters In The COVID-19 Conversation

What a fascinating, albeit divisive period in history.  COVID-19 threw everyone off-course in some way, giving the entire world a rare shared experience.  Who would have thought that, especially in the 21st century, a virus could hold a country as powerful as the United States hostage, demanding as ransom both the health of entire industries and a way of life collectively taken for granted?  The people continue to pay dearly, and everyone is invested in the best path forward.  Accordingly, it feels like the appropriate time for learning and to put egos aside to facilitate important discussions about big picture healthcare topics.  There has been only one prominent voice in the coronavirus conversation, though, and that voice has spoken nothing of the battle-tested human immune system and how to optimize it, while championing largely untested concepts (i.e. social distancing, lockdown, and universal masking) as the only viable methods for successfully navigating this unprecedented situation.  As will be demonstrated in the forthcoming analysis of the two concepts that have shaped America’s COVID response, other voices need to be heard who advocate shifting healthcare's focus to personal empowerment, from being reactive to proactive.   

The current cultural climate presents a roadblock to learning and discussing healthcare and other social issues because American society has seemingly forgotten how, the collective having become so deeply embroiled in constant arguing that the discussion has become a lost art; that may prove to be an important acknowledgement given the realities of COVID about to be shared will likely be eye-opening to readers.  Nobody wins an argument and little change comes from arguing.  So, please know that the following is not intended to incite an argument, but rather to stimulate an on-going discussion.  The contents include cited statistics and corresponding interpretations. 

Rewind the clock to March, when the novel coronavirus came to the forefront in the United States.  The initial question that had to be answered was what made COVID-19 different enough from previous threats, such as Zika, Swine Flu, and even the yearly seasonal Flu, to warrant a drastic shift in response to it.  After all, it had years ago become a popular trend in the media to talk about unique viruses and their potential impact, but the public reaction remained measured.  On March 3rd, multiple news outlets reported the World Health Organization's claim that the COVID-19 death (mortality) rate was 3.4%, alarming considering that the death rate for seasonal flu hovers annually around 0.1% by comparison.  Granted, so little was known about the virus at that point, but the numbers warranted attention.  The gravity of mortality set in rather harshly and the ensuing projection models escalated the fear of what might happen when the number of cases predictably rose. 

Uncertainty can be as scary as risk evaluation on limited data is challenging.  Decision-making is at its best when the decision-maker is at his/her best.  Fear, meanwhile, clouds judgment, and though decisive action must at times be taken in the face of it, fear tends to spur on the increasingly common “ready-FIRE-aim” mentality that permeates American culture by disrupting the pathways in the brain that lead to sound judgment[i].     

Epidemiological predictions certainly begged the question as to whether there was enough knowledge to allow the reaction to the actual data to match the fear about the hypothetical numbers.   The initial fear was justifiable, but it was not as if COVID-19 was happening in a bubble, isolated from the recent history of disease and health.  The developed world has not dealt with an infectious disease death rate as high as 3% in modern times[ii], since before sanitation curbed in humanity’s favor the ratio of immune system integrity to infections capable of overwhelming the immune system.  It was perhaps a bold assumption that the baseline strength of present-day immune systems among the vast majority of the population was not up to the task against an opponent like COVID-19.  Confidence in the immune system’s adaptability was justifiable too, as demonstrated throughout the industrialized world repeatedly, to the point that infectious disease has ranked well behind its peers atop the leading causes of death list for decades.  Would patience have been more prudent?  Only time and contextualization via further data would tell. 

It was an unenviable position to be the ones responsible for weighing the options for how to initially respond, the ultimate test between fear of the virus and faith in the immune system.

Amplifying the fear during the early weeks of spring was a concept as novel as the 2019 coronavirus: that people without symptoms – who do not feel ill – were spreading COVID-19 to others.  White House Coronavirus Task Force leader Dr. Anthony Fauci stated that there was "no doubt" about asymptomatic transmission occurring.  That assertion, much like the reported mortality rate, was eye-opening.  Precedents had been set for noteworthy statistical spikes in infectious disease, but the suggestion of the silent spreader hypothesis completely changed the game, introducing the idea that anyone at any time could infect someone else with a potentially deadly disease, regardless of whether a person was traditionally ill.   

Before the silent spreader premise rose to prominence in March, it was generally accepted that the reason why people who do not exhibit symptoms of disease are not threats to spread it is because their immune systems could be trusted to essentially self-quarantine infections when exposed.  For context, Dr. Fauci had confirmed in late January 2020 interviews the long-held standard that “asymptomatic transmission has never been the driver of outbreaks.”  What changed?

The immune system is innately built with a catalogue of all types of cells that should be there and the capability to recognize and swiftly deal with foreign invaders when they arrive and attempt to replicate.  Such is why, with respect to the focus of infectious disease commentary being the small percentage of people who get diagnosed and/or perish, it is of paramount importance to remember that, by an overwhelming margin, people recover and/or do not get sick; as of this writing, for instance, there were 11.8 million confirmed COVID cases worldwide, which means there would need to be an additional 66 million confirmed cases just to equal 1% of Earth’s population. 

Conceptually, asymptomatic transmission crafted a horrifying new narrative that, in conjunction with the originally reported mortality rate of 3.4%, created the controversial public health protocols, including the lockdowns, and all the accompanying turmoil.  In the United States and beyond, the response to COVID was as extreme as the projections.  Few countries played the role of the pragmatist, as an unprecedented spread of fear demanded its terror be mirrored worldwide.  In the United States, the unemployment rate consequently saw its greatest month-to-month increase in the history of the statistic, 3.5% to 14.7%[iii]; millions of small businesses were forced to shut down; many lives were changed forever.  The validity of both the hypothesis of silent spreading and the accuracy of the projections based on the death rate, therefore, must be determined to figure out the best way to proceed, now and in the future.   

Perception is reality, which is another important acknowledgement in this discussion.  Opinions are shaped by worldviews.  In this age of social media and 24-hour news, confirmation bias – interpreting information in a way that matches an existing viewpoint – runs rampant.  Nobody is unaffected by it.  So, this is the point when things can get tricky. Industries have been ravaged.  Airlines are down 81%, a quarter to half of all restaurants are facing permanent shutdown, construction had its worst financial quarter since the housing crisis of 2008; the list goes on and on[iv].  This is dire, ladies and gentlemen.  It must be clear and obvious that COVID-19 is the threat it was feared to be, and so the following data must be shared and understood for everyone to be fully cognizant of the situation at hand.  

Interestingly, the “no doubt” suggestion by Dr. Fauci regarding asymptomatic transmission was based on the testimony of just one person, who initially said she was asymptomatic, but later admitted to being ill[v].  To date, only a few studies have been published about silent spreading, yet none of them confirm the hypothesis and the current hallmark study outright refuted it[vi].  How revealing, considering that silent spreading is one of the core tenets of social distancing, mandatory masks, and the continued restrictions.  

Asymptomatic transmission nevertheless remains the backbone of the explanation for the number of cases continuing to rise, which is the driving force behind the recent re-escalating fear.  Should it, though?  The key question remains whether the intense reaction to the virus was/is necessary.  Anywhere from 40%[vii] to 80%[viii] of all confirmed cases are symptom free.  Regarding infectious disease, these people are perfectly healthy, yet due to the lingering panic they are being tested, often multiple times, skewing the data in spite of the lack of evidence to support that they can spread the virus.  Dr. Zach Bush, a worldwide leader in understanding immunity, has said that if a random person was tested for a panel of known-viruses, of which thousands among the presumed millions have been named, he/she would test positive for dozens of them, even without symptoms[ix].  Typically, these people would have been living their lives, unaware of the virus present because their immune systems handled it already; presently, they are being treated like sick people.     

The number of cases is really not the concern, which is a statement that may seem confusing since so much attention has been given to the so-termed spike.  Obviously, when you increase the number of tests given five-fold[x], the number of positive tests will naturally increase too.  Again, though, most of the cases are asymptomatic and the silent spreader hypothesis remains at best a gray area.  Furthermore, 85% to 95%[xi] of all symptomatic (traditionally ill) cases experience only mild symptoms; 60% of the elderly, the highest risk group, experience only mild symptoms; children are hardly being affected at all by the virus itself[xii]. 

Studies conducted by Penn State[xiii], Stanford[xiv], and Southern Cal[xv] (among others) have deduced that there may be upwards of 80 times more cases than currently reported, research endorsed in part by the possibility that the origins of the 2019 coronavirus date back to last August[xvi].  On the surface, that too is alarming, but it is actually good news.  These studies are based on the presence of antibodies to COVID-19 and other forms of coronavirus (which cause about 20% of common colds) that help develop immunity to COVID-19.  The immune system is like a super navy, with stations set up throughout the body to alert of foreign invaders.  An anti-body is the memory of an old battle fought against infection stored by the immune system so that defenses will kick in immediately upon re-detection, swarming the virus and quarantining it; the second line of defense then comes in once the admiral in the brain is made aware of the significance of the threat and destroys it.  That system is a well-oiled machine; it has quietly been working against COVID-19 all year, and it can be trusted.

When accounting for those who have immunity to COVID already, the death rate, as it turns out, is right on par with the seasonal flu after all, at around 0.2%[xvii].  Plus, the overwhelming majority of the people dying from the novel coronavirus have comorbidities (i.e. other major health problems)[xviii], which is consistent with the data collected on other respiratory infections, and over 40% of the deaths from coronavirus are coming from nursing homes[xix].  Also, it bears mentioning that the over-inflation of COVID deaths has been a hot topic from the outset[xx], spurred on by the vague CDC language[xxi] of what constitutes a COVID death and the first-person accounts[xxii] of the unfortunate practice of misrepresenting causes of death.  Incorporating the regrettable 25% over-estimate, of course, lowers the mortality rate even further.  

If life were a football game, a replay would be in order to re-assess the public health policies enforced.  All Americans have had their worlds turned upside down.  A once thriving economy was plunged directly into a recession and government-imposed restrictions continue to slow the establishment of a new normal, with the possibility of longer-term restrictions strangling the hope that life can get back into balance sooner than later.  Yet, this is not football, when the ruling on the field stands if replay evidence cannot indisputably overturn the original call.  In life, decisions and their makers are held accountable by assessment of proof beyond a reasonable doubt, of which there is plenty in this case it would be fair to conclude.

The statistical realities thus far mentioned greatly call into question the necessity of the contentious lockdown.  Though much vitriol has been sparked by the topic, it is important to explore it to learn a better response down the road.  The lockdown has had massively negative socio-economic ramifications, as once warned by Dr. D.A. Henderson, credited as “the leader of the international effort to eradicate smallpox” and a staunch detractor of the lockdown concept when it was introduced in the mid-2000s.  Dr. Henderson promoted allowing viruses to spread so that immunity could naturally be built.  Michael Levitt, a 2013 Nobel Prize winner and professor at the Stanford School of Medicine, has observed that, regardless of restrictions imposed, there has been a short-term peak of significant cases followed by a sharp decline everywhere in the world.  He called the lockdowns a “huge mistake,” advocating instead for approaches like the ones mentioned below[xxiii]. 

Japan and Sweden were the most prominent countries of the pragmatic few, and they did not lock down so much as they suggested practical restrictions.  Both nations were heavily ridiculed for not following the global trend, but it has become clearer over time that the rest of the world can learn from them[xxiv].  Japan has just 20,000 cases compared to 3 million in the USA, adding just 4,000 cases since removing its restrictions in late May. 

Sweden took the most rational approach to COVID of any developed nation, keeping businesses and grade schools open and asking the elderly to shelter in place.   It has a similar population as the state of Illinois, yet half the number of COVID cases and 30% fewer deaths; Illinois locked down tight, while Sweden was relatively wide open.  Dr. Anders Tegnell, Sweden’s chief epidemiologist, referred to the lockdowns as “madness” that ignored everything known about pandemic containment.

The data also demands an explanation as to why officials have continued implementing panic-driven restrictions based on March projections that fortunately proved inaccurate.  The elderly are being kept away from their families even though the approach has not made them less susceptible to COVID[xxv].  Massive hoops through which families must jump for kids to go back to school are being created when so little evidence exists that children are spreading the virus[xxvi] and while experts around the world maintain a position that schools should go back to normal[xxvii].  Suicide rates, alcohol and drug related deaths, child abuse, and domestic violence have all increased.  Quality of life has practically been deemed inconsequential, as savings and retirement accounts have been drained.  These are just a few examples of how living life around fear is a dangerous path.  What began as a conscious exercise to reduce risk has become an unsettling journey to create an impossible-to-achieve no risk scenario.         

There is a lot to sort out once the above breakdown is digested.  Each of the other components of the COVID response hinge on the validity of the previously discussed, highly flawed concepts.  Social distancing is another poorly researched hypothesis without peer-reviewed support[xxviii]; at face value, the hashtags for stopping the spread, flattening the curve, and staying home to save lives made sense, but when their foundation was shaken, they no longer carried weight and are no longer logical, especially considering the socio-economic downsides.  And if quarantining healthy people is unfounded, then what does that say for mandatory masking of healthy people, another notion with little to no support[xxix], as confirmed by the US Surgeon General[xxx] and the New England Journal of Medicine[xxxi].  On the contrary, masks can slow down the immune system and have other detrimental side effects[xxxii].  And if there is already a massive natural immunity to COVID-19, then why is the dominant theme of the expert commentary still that a vaccine is needed to propel America beyond the crisis?  It takes a decade to properly develop a vaccine[xxxiii] and it is very dangerous to rush that process[xxxiv].

COVID-19 is one of the most emotional topics in modern history.  It is hard to have a conversation about it without an argument occurring.  Let that be the last of the important acknowledgements made as the end of this article draws near.  Unfortunately, the asymptomatic transmission hypothesis has made it that much more challenging to avoid conversations about the coronavirus becoming circular arguments, which tend to spiral out of control and accomplish nothing more than upsetting all parties.  If it is generally accepted without the critical element of it becoming a supportable scientific theory, Americans could be forced to live their lives around infectious disease indefinitely; it opens Pandora’s Box.  While maintaining an unjustified undercurrent of fear, church, football games, vacations, movies, etc. could forever be lessened in their inherent ability to help you grow, escape, or destress.  Life might never be the same. 

The bright side of this is that it offers the chance to make change and rebuild.  The caveat is that change only happens when there is a realization that it needs to be made.  COVID has opened the door for conversations about the systemic problem that America has been dealing with for decades.  Healthcare has been designed around fear and around removing personal responsibility, and the last four months have shown how deep that rabbit-hole can go.  System wide, it has been assumed that human immunity was too weak to be trusted.  People, as a direct result of modern American healthcare’s educational shortcomings, do not understand health or the immune system.  Such is why it “shocks” the general public and its leaders when they learn that you cannot run and hide from viruses[xxxv].  American healthcare, as a system, has done the equivalent of tune into one radio frequency, then ignored the existence by and large of all other frequencies and taught the people that there is only one frequency that matters.  It is hard to hear hope on the frequency that only plays fear’s greatest hits.  So, change the frequency. 

It is not 1918, when the water supply used for elimination was also used for rehydration and bathing.  The baseline strength of the immune system today is immense, a fact being proven repeatedly in the age of COVID.  That cannot be downplayed, ignored, or dismissed as conspiracy theorist jargon.  Japan swiftly dealt with COVID.  They suggested (not forced) the biggest restrictions on Tokyo, which is home to 5 million more people than New York City, one of the most locked down cities in the world, but Tokyo has 250 times less COVID deaths.  Why?  The Japanese are generally much healthier than Americans, their system ranking among the top 10 in the industrialized world, whereas the USA ranks at the bottom.  Their immune systems are stronger. 

The immune system is the key to all of this.  Understanding it and the responsibility that everyone has to their own health offers the path to hope.  Unlocking the immune system’s full strength is as simple as keeping the body structurally balanced and functioning properly[xxxvi], making sure that nutrition is constructive and not destructive[xxxvii], staying physically active instead of being sedentary[xxxviii], and keeping a positive attitude to better manage stress[xxxix].  Viruses are everywhere and humans encounter millions of them every day; they negatively impact people who are either generally unhealthy or in a state of weakened health.  It is time to shift the focus of American healthcare from disease to health.  When that happens, life will not only be different, but it will be better.  

So, to recap, the reaction to COVID-19 was based on the death rate and hypothetical asymptomatic transmission, but the mortality rate is 94% lower now than it was reported originally and there is presently no quantifiable indication to support silent spreading, the burden of proof for which is on laboratory science to supply evidence that would unseat biological scientific observations of the human immune system as the enduring standard.  Quarantining healthy people remains a bold, disputed, and limitedly tested approach with its own paltry origins[xl] that other countries and even seven American states have shown to be needless.  As America continues to feel the aftershocks from the equivalent of a terrible earthquake, it is important to look at all of the relevant data and recognize that the coronavirus itself may actually be a tremor while the response to it – and the mindset driving the response to it – is the earthquake. 

[iii] The Bureau of Labor Statistics
[v] The New England Journal of Medicine
[vii] Various sources from April to June 2020
[xvi] Harvard Medical School
[xxviii] Oxford University Center for Evidence-Based Medicine