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Archive for May, 2020

Dr. Nadal: Welcome back to the hot seat. Tempting fate?

DR. NADAL: Sure. Why not?

Dr. Nadal: Well, let’s get right to it. There’s lots of talk about Sweden being the model for herd immunity with this virus. You look like you’ve swallowed a lemon at my merely mentioning it. What’s up?

DR. NADAL: Few people understand what herd immunity is, and the misperceptions that are out there are scary. Add to that Sweden’s disastrous policy of voluntary social distancing…

Dr. Nadal: You drifted off there. What’s so disastrous about the Swedish model? Don’t you think they’re doing a better job at protecting their economy?

DR. NADAL: Those are two separate issues. Let’s tackle the Swedish model first, and before that, we need to define what Herd Immunity is.

Dr. Nadal: You seem to be fond of saying that herd immunity is a result, not a process. That’s kind of confusing to people.

DR. NADAL: You nailed it. Herd Immunity is a result. Specifically, it is an end result, not a process. The concept of herd immunity is simple. If all the members of a herd, except a few, are immune to a disease then the few remaining members will have a vastly diminished chance of being infected by the pathogen and be protected by the collective immunity of the herd.

Dr. Nadal: Because…

DR. NADAL: Because diseases run through populations when members pick up a pathogen such as a virus. The virus amplifies greatly in number within the infected animal, who then spreads it to other members of the population, and so forth. If almost all the members of a population are immune, then the likelihood of any one susceptible member picking up the pathogen through random encounter is pretty slim. If per chance it does, the animal is surrounded by immune members and cannot pass it on through the herd. The same holds true for humans.

Dr. Nadal: And why is this a result?

DR. NADAL: I was getting to that. There are two ways to get to herd immunity. The first is you simply let all the members get diseased. The weak die and the survivors produce antibodies, those little y-shaped proteins that bind to the virus and mark it for destruction while also preventing it from being able to infect cells. The survivors also develop the ability to have white blood cells destroy any infected cells in the future. So that’s the first way to arrive at herd immunity.

The second way is to do mass vaccination of the population. In a vaccination we are injecting either the whole virus in weakened form, or parts of the virus we would like to see antibodies made against. That’s the simplified explanation.

Dr. Nadal: So which is better at prevention?

DR. NADAL: Well, let’s think about that for a moment. The Swedish model is the first case. Their program of voluntary social distancing has been an unmitigated disaster. They have a 12% case fatality rate while NYC has one at 5.7%…

Dr. Nadal: Sorry to interrupt, but Anders Tegnell, chief epidemiologist at Sweden’s Public Health Agency has said that they are mere weeks away from achieving herd immunity. That’s a good thing, right?

DR. NADAL: Wrong. Dead Wrong. As of April 28, that was Tegnell’s position. At that time about 25% of Sweden had been infected, again, with a 12% case fatality rate (CFR). In a country of 10.23 million people, another 50% would need to be infected at a minimum to reach herd immunity. That’s another 5 million people. At 12% CFR, that means 600,000 additional dead on the way to herd immunity. Tell me how you think that represents “prevention”.

Dr. Nadal: Well, I…

DR. NADAL: It’s slaughter. It isn’t medicine. It isn’t prevention. It’s putting Charles Darwin in the driver’s seat on national policy. That’s the absence of medicine. Vaccination is the only program of prevention that results in herd immunity. So it comes down to Darwinian Natural Selection or vaccination to achieve herd immunity, but that brings up a larger point, and the reason why I get dyspeptic at these discussions of herd immunity.

The goal right now, in the absence of a vaccine, is to save as many lives as we can until a vaccine is created. Social distancing and other mitigation measures slow the rate of transmission over time, and purchase valuable time to develop a vaccine as well as effective therapeutics.

But with that said, let’s just reiterate. Herd Immunity is the end result of Darwinian Natural Selection, OR the end result of a vaccination program. ONLY vaccination is a program of prevention.

Dr. Nadal: And what do you say to people who are suspicious of Dr. Fauci pushing for a vaccine?

DR. NADAL: My butcher’s name is Anthony. I’m really suspicious of Anthony because he’s always selling meat. Never any vegetables. Why do you think that is?

Dr. Nadal: Well, that 43lb. Turkey last Thanksgiving WAS impressive…

DR. NADAL: Dr. Fauci’s job, his life’s work, is to protect the nation from infectious disease. You don’t protect people from disease by sitting back and watching all the susceptible members of society die off from it and then pat yourself on the back for having achieved herd immunity by that means. That’s not prevention.

Vaccines save lives.

Dr. Nadal: You’re starting to piss off a lot of readers right now. There are those who say vaccines injure people and they point to the HHS Vaccine Adverse Event Reporting System (VAERS)

DR. NADAL: VAERS is an open system where anybody can make a claim. There is no substantiation of any of those claims on VAERS…

Dr. Nadal: Wait, are you saying people don’t get injured by vaccines?

DR. NADAL: A very small percentage do. Very small. But did you know that 10% of the population is allergic to antibiotics? Where would we be in the war against infectious diseases if we mounted as vehement a campaign against antibiotics? It is the combination of vaccines and antibiotics in the years immediately following World War II that took the world population from just over 2 billion people to 7.5 billion people today. If that isn’t proof that vaccines save lives, then I give up.

Of course Fauci is pushing hard on a vaccine. So is every microbiologist and physician worth anything.

Dr. Nadal: So what do you say about people’s objections to using vaccines made with cells from aborted babies? Why put parts of babies in a vaccine?

DR. NADAL: The Pontifical Academy for Life under Pope John Paul II and Cardinal Ratzinger gave guidance on when it is permissible to use vaccines that have made use of fetal cells for the purpose of growing viruses. Read it here.

There are cell lines, some from 1965, that use the descendants of cells obtained from aborted babies. Viruses are used to infect these cells, and the cells produce a bumper crop of viruses to be used in the vaccine. It’s the same principle as infecting chicken eggs with influenza virus in order to produce tons of flu virus for use in a vaccine.

Dr. Nadal: Then why do people say they are injecting our bodies with fetal cells?

DR. NADAL: People are mistaken about all sorts of things. The kernel of truth, however, is that when the cells are broken open, some DNA and protein from the fetal cells escapes the purification methods and ends up in the vaccine. We can do much better, and Dr. Theresa Deischer has developed ethically derived cells for use in vaccine production.

Dr. Nadal: So, what do you say to people who refuse to get the COVID-19 vaccination when it comes out?

DR. NADAL: Good Luck, and I respect your integrity.That’s a deeply personal decision and the individual who chooses that option is putting their life on the line for their principles.

Dr. Nadal: So, to achieve herd immunity, should the vaccine be mandatory?

DR. NADAL: No. This isn’t Smallpox. The goal here is NOT herd immunity. The goal is to save lives first, to offer our people the options. People with moral objections to the vaccine will benefit from the collective immunity of those who choose the vaccine, provided enough people avail themselves of the vaccine when one comes out.

Dr. Nadal: IF one comes out… We never got one for SARS or MERS.

DR. NADAL: True, but those outbreaks were more limited in time and scope. There’s way more effort being put in on this one.

Dr. Nadal: Well, we’ve certainly covered a lot of ground. I’ll give you the last word if you want to sum it all up.

DR. NADAL: Thanks. First, herd immunity is NOT the goal here, and I’ll repeat that. Herd Immunity is NOT the goal here.

The goal is preventing disease and saving lives. If the goal is herd immunity, then the Swedish model of voluntary social distancing, a 12% CFR becomes just one option.

We’re out to prevent infections. Right now that involves as much social distancing as we can tolerate economically. It involves aggressive use of Hydroxychloroquine, convalescent antibodies, more research and use of Remdesivir, etc. Ultimately, prevention is best achieved through the development of a vaccine.

The Catholic Church has issued guidance on morally acceptable use of morally problematic vaccines. Individuals should consult the document and their consciences should be respected.

Vaccines are far safer than antibiotics, and they save lives.

We have no absolute guarantees of safety in life, but we need a sense of proportion. I find that increasingly lacking in the public discourse. Without it, we simply cannot make intelligent, informed, or nuanced choices that will determine the length and quality of our lives.

Update: Clearly Sweden has not reached 25% infection rate. By their own numbers as of this writing they have had 25,265 diagnosed cases and 3,175 deaths, which yields a 12.57% CFR. I liked to play along for a moment with the delusion that they’ve achieved 25% infection rate, which they decidedly have not achieved. So, we go with the actual number of cases they’ve counted. 25K diagnosed cases yield a percentage 100x lower than they would like to believe. Applying the very real 12% CFR to 5 million infections will get us 600,000 fatalities. 25% population affected is a fantasy not grounded in solid data. It isn’t 25% infected. It’s 0.25% if the data shown below are to be believed. Hopefully that clears any misunderstandings.

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I’ve been getting a lot of headwind about where I stand on reopening. I’ll say it with crystal clarity, and thought that interviewing myself might be a better way of saying it in shorter bites.

Dr. Nadal: Tell me, do you think we should reopen the economy soon?

DR. NADAL: Yes. We need to. But… we can’t just rush back to work without some major changes, and I think the Trump Administration’s phased re-opening criteria make the most sense and guarantee the least amount of loss of life. With that said, I think we have a great deal of evidence that a great many people are going to simply ignore physical distancing and other mitigation criteria.

Dr. Nadal: Your point there leads to the observations by many around the nation that this just isn’t an issue in many other parts of the country as it is in New York City, so wasn’t this all an overreaction?

DR. NADAL: Right. The same way that widespread use of Vaccines and antibiotics were an overreaction to infectious diseases. Look, we have really good baseline data that show how infectious this virus is. The good news is that Dr. Birx has estimated the Case Fatality Rate at 0.7%. I think it’s a bit lower at 0.5%. So, that’s good news and bad news. The good news is that 99.5% of those who get infected will live. The bad news is that this is a highly infectious virus. If everyone in the nation were to get infected we could expect 1.64 million deaths without any therapeutic interventions. That’s not exactly your standard flu season. NYC got out of control before the rest of the country did when the shutdown came.

Dr. Nadal: So, you see, you sound like you’re saying we need to stay closed. In California, Stanford and USC did an antibody study that showed the infection rate was 50-85x higher than previously thought. What do you say to that?

DR. NADAL: First, on the 50-85x higher business. The Santa Clara study found a positive test result in 50 out of 3,330 people. That means that they are saying a whole whopping 1.5% of the population has been infected. That’s their 50-85% higher estimate than previous estimates. Get that? Look at the reverse of 1.5%. They are saying that 98.5% of the population could still get infected. Let me repeat that.

According to the wildest optimism, 98.5% of Californians are susceptible, which means the shutdown happened BEFORE things could get out of hand as they did in NYC. That said, the antibody test that these guys used has a 1.7% false positive rate, which means EVERY. SINGLE. TEST. RESULT. IS. IN. THE. MARGIN. OF. ERROR.

The study is worthless.

Those studies were rushed to an online outlet that does not do peer review. Guess why? We could talk about how unscientific the sampling was, but really, why bother.

Californians are hanging their hats on these “studies,” regarding reopening.

Dr. Nadal: But don’t you think…

DR. NADAL: Wait, let me finish this point. Most of the rest of the nation, even with wildly optimistic studies, remains uninfected. Here in NYC we are testing like mad and have come up with about 21% of NYC residents showing positive antibody tests. That’s way higher than the 1.5% from the fatally flawed studies in California. That means that 79% of NYC residents have not yet been infected. At least 98.5% of Californians have not been infected, if you recall that the flawed study showing a 1.5% infection rate was 50-85% higher in its estimate than previous estimates.

Dr. Nadal: But what are you saying? You seem to be talking out of both sides of your mouth, and what about the people who are committing suicide?

DR. NADAL: Actually it’s all consistent. This is a pandemic. We have options that suck. Options that suck badly. And options that are nightmarish. What we DON’T HAVE is the choice between some people dying and no people dying. You pick a course of action that is going to save the most lives, realizing that some demographic is going to get the short end of the stick, if I can put it in the most blunt language possible. We don’t have every hospital in NYC with multiple refrigerated morgue trucks parked outside and filled with the bodies of suicide victims. We DO have them filled with COVID cases that didn’t make it.

I’ve repeatedly called for the government to put on the full court press for mental health outreach. I’ve posted resources repeatedly for the same. It’s a pandemic, and there are no good options. Yes, suicides are elevated. And if we didn’t shut down? If we had 1.6-2.2 million deaths, and crashed hospital system, etc… do we not think that there would also be an elevated rate of suicide?

Again, and again, and again… it’s a pandemic. All the options suck. No matter which way leadership turns, people are going to die. That happens in pandemics.

By all means reopen, but follow the administration’s guidelines to do it safely.

Remember this as well. We cannot protect the vulnerable. Fully 60% of the American people have one risk factor. 40% have two risk factors, so factor that in when thinking about how to do this safely.

Dr. Nadal: Don’t you think you come off a bit calloused there?

DR. NADAL: It’s a raw reflection of reality. Not pretty, is it? If that sounds calloused, pray for the leaders who have to choose between options that are one worse than the other.

Dr. Nadal: So, we crashed the greatest economy in the world, and for what? Many think it wasn’t worth it.

DR. NADAL: It all depends on whose ox is being gored.

Dr. Nadal: Meaning?

DR. NADAL: I lost my private tutoring business here, so I get the economic pain. I’m one of the millions of unemployed. My pro-life work is unpaid. But let’s look at the initial goal of Flattening the Curve.

It’s been a wild success. We’ve had about 60K deaths in the past two months, with 95% of them happening in the past five weeks. That’s a frightful number…

Dr. Nadal: I don’t mean to interrupt, but aren’t we no worse off than a typical flu season?

DR. NADAL: Actually, we’re far worse off. In a typical 10-month flu season we incur about 37,000 deaths. We’ve had 60,000 so far in just about a month. You tell me.

Dr. Nadal: But people are saying that most of the victims have underlying medical conditions…

DR. NADAL: Yes. Same with deaths attributable to flu. I have heart and lung issues, but they are stable and well managed. I lead a normal, fully active life. If I contract this virus and it exploits those issues, destabilizes them, and kills me, what was it that was most directly responsible for my death? It was the virus. Even if you want to shave off 20% of coded cases, you’re left with 48K deaths in over a month, every major hospital in NYC ringed with stuffed morgue trucks, and 79% of the population yet to get infected. Tell me what kind of flu season that reminds you of.

Dr. Nadal: So back to the benefits of the shutdown…

DR. NADAL: Yes. We vastly reduced the numbers of people getting infected, so we reduced greatly the number of people who otherwise would have died. We also accomplished something else, We bought precious time to do clinical trials on Hydroxychloroquine, Famotidine, Remdisivir, convalescent serum, monoclonal antibodies etc. We also bought time to ramp up industry in vastly producing PPE, hand sanitizer, ventilators, tests for the virus, tests for antibodies, and on and on.

Dr. Nadal: But lots of people lost their jobs.

DR. NADAL: I know. I’m one of them.

Dr. Nadal: But…

DR. NADAL: No buts… I get it. Reopen according to the president’s plan. Just realize the risks you are all incurring in so doing. New York City is not an outlier. We are a cautionary tale. Once you hit critical mass the genie gets loose and there’s no stuffing it back in the bottle. I’ve been hearing a lot of smug arrogance and seeing people congregating en masse without face masks, etc.

Pathogens are apolitical. They exploit pride, arrogance, and ignorance.

And this one is unforgiving.

That’s really my last word on the subject of reopening. It wasn’t worthless to shut down. We bought time, advanced the research ball, advanced the production of the tools needed by our clinicians, developed more potential therapeutics, and most of all in the balance we saved lives.

Lots of lives.

Photocredit: https://www.inquirer.com/business/drugs/coronavirus-johnson-and-johnson-stoffels-wuhan-20200128.html

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