Wednesday, April 22, 2020

For those who demand we trust the "experts" . . .

... how do you respond to these experts?

The New England Journal of Medicine, one of the most highly-regarded medical publications in the country, puts it plainly: the C19 medical regimes put in place weeks ago are killing non-Covid patients.
Although canceling procedures such as elective hernia repairs and knee replacements is relatively straightforward, for many interventions the line between urgent and nonurgent can be drawn only in retrospect. As Brian Kolski, director of the structural heart disease program at St. Joseph Hospital in Orange County, California, told me, “A lot of procedures deemed ‘elective’ are not necessarily elective.” Two patients in his practice whose transthoracic aortic valvular replacements were postponed, for example, died while waiting. “These patients can’t wait 2 months,” Kolski said. “Some of them can’t wait 2 weeks.” Rather than a broad moratorium on elective procedures, Kolski believes we need a more granular approach. “What has been the actual toll on some of these patients?” he asked.

Mr. R., a 75-year-old man with advanced heart failure, is another of Kolski’s patients for whom the toll has been great. Because he had progressive volume overload and delirium, Kolski referred him to a hospital for an LVAD workup in early March. Then, as his wife, Ms. R., told me, “the world went wonky, and everything went down the toilet.” Having begun admitting patients with coronavirus, the hospital told the couple it was kicking everyone else out. “They are telling me my husband has 6 to 12 months to live without this procedure,” Ms. R. said, “and now they are canceling it on us.” They were then quarantined at home — 2 hours away from the hospital — with no plan in place. Mr. R.’s health quickly deteriorated again, but his wife had been advised to keep him out of the hospital. When they finally had a video visit on April 9, he’d become so ill that the heart failure physician didn’t recognize him. Mr. R. was promptly admitted, and the LVAD was placed. Though Ms. R. is relieved, ongoing challenges include her husband’s persistent delirium, a visitor policy that allows her to be at the bedside only intermittently, and the need for nearby lodging that they can’t afford.
Thankfully, states are starting to wake up to the reality. Georgia, Tennessee, and even Colorado will transition out of strict regimes within the next week or so.

I have asked before (to receive no answer from anyone at all) so I will ask again: How many non-Covid-infected persons, especially children, are you personally willing to see die to keep the lockdowns in place? Give me an actual number and explain why preventing those persons' deaths is less desirable than preventing deaths from C19.

We need to heed what the NEJM says explicitly: these are "Trade-offs We Don’t Have to Make." The Economist knew in early April.
Covid-19 presents stark choices between life, death and the economy - The trade-offs required by the pandemic will get even harder

Imagine having two critically ill patients but just one ventilator. That is the choice which could confront hospital staff in New York, Paris and London in the coming weeks, just as it has in Lombardy and Madrid. Triage demands agonising decisions. Medics have to say who will be treated and who must go without: who might live and who will probably die
And that same kind of tradeoff has already cost the lives of non-Covid patients who were denied lifesaving procedures because of the possibility that the medical facility might have a sudden, large inflow of C19 patients.

I have to be frank: I simply dismiss anyone's view that pretends there is no such tradeoff.

Updates:

Stanford University's Hoover Institution Senior Fellow Scott Atlas, MD, former head of neuroradiology at Stanford University Medical Center, writing in The Hill, makes these points:
  • The overwhelming majority of people do not have any significant risk of dying from COVID-19.
  • Protecting older, at-risk people eliminates hospital overcrowding.
  • ital population immunity is prevented by total isolation policies, prolonging the problem.
  • [Non-Covid] People are dying because other medical care is not getting done due to hypothetical projections.
  • We have a clearly defined population at risk who can be protected with targeted measures.
"The recent Stanford University antibody study now estimates that the fatality rate if infected is likely 0.1 to 0.2 percent." [That is almost exactly the same as seasonal flu. Important you note that it is .01% of the people who actually get the virus, not of the whole US population!]
Critical health care for millions of Americans is being ignored and people are dying to accommodate “potential” COVID-19 patients and for fear of spreading the disease. Most states and many hospitals abruptly stopped “nonessential” procedures and surgery. That prevented diagnoses of life-threatening diseases, like cancer screening, biopsies of tumors now undiscovered and potentially deadly brain aneurysms. Treatments, including emergency care, for the most serious illnesses were also missed. Cancer patients deferred chemotherapy. An estimated 80 percent of brain surgery cases were skipped. Acute stroke and heart attack patients missed their only chances for treatment, some dying and many now facing permanent disability.
Also: "Pandemic 2020: Layoff-related deaths exceed covid-19 deaths by 41%"
According to data from the National Bureau of Economic Research and the Lancet, a medical journal, every one percent hike in unemployment will likely produce a 3.3 percent increase in drug-overdose deaths and a 0.99 percent increase in suicides.

For the year ending February 2019 (NCHS), 69,029 people died of drug overdoses, almost 7 out of 10 the result of opioids. Suicide, the tenth leading cause of death in the United States, accounted for 48,344 deaths (CDC), more than twice the number of homicides (19,510).

Lockdown-related deaths will likely exceed the base-case number of covid-19 deaths by 141%—and this offsets 60% of the highest estimate of 140,381 predicted by IMHE researchers.
NBC News: "Social distancing could have devastating effect on people with depression"
In our studies of suicide in my Master program at Vanderbilt University, we learned that while not everyone with clinical or deeper depression commits suicide, almost every person who commits suicide was suffering from depression.

Toronto Sun: "The secondary harms caused by the lockdown get worse every day"

Tens of thousands of people in the UK and Canada have already died because their own non-Covid medical conditions were not treated in order to save beds for C19 patients. Who did not materialize in near the numbers predicted. [Ontario Health Minister Christine] said last week that,
... a number of hospitals and medical associations are actually saying that they now want to proceed with these postponed and cancelled surgeries. It’s the government that’s holding them back.

“We want to make sure we’re not going to have increased pressures with COVID-19 cases before we can start opening up those surgeries,” Elliott said on Tuesday.

But that FAO report appears to have answered that question. They found that, as of April 23, there were 9,345 empty acute-care beds and 2,191 empty critical care beds across Ontario, which is Canada’s second hardest hit province.

We were originally told that the point of the lockdown was to guarantee we don’t overwhelm the health care system. We haven’t.

So what’s the hold up on safely re-opening the Canadian economy? The secondary harms are getting worse by the day.

Monday, April 20, 2020

Deliberately inflating the Covid count - why?

Consider this FB post, which I have personally verified (I deleted the person's name).

Now, why is that the rule? Having been a federal bureaucrat, I will say (in my view, authoritatively) that the reason is simple: money.

Understand that this listing decision was not originated by physicians or nurses, but by administrators. And the overwhelming desire of every bureaucratic administrator everywhere is this: Increase his/her department's budget.  Because bureaucrats get promoted by showing they can manage ever-larger budgets, not for managing programs or people.

Medical bureaucrats know very well that C19-related, enormous streams of money are already flowing from federal spigots and will continue to do so for months or even years to come. And the amount any operation or agency will get will relate very directly to the number of C19 cases they report, especially the fatalities.

If you think this sounds cynical, I assure you: It is far from cynical enough.

And the beat goes on:
The Big Apple’s new death toll is 10,367. That figures combines the 6,589 victims who tested positive for the virus plus another 3,778  who were never tested, but whose death certificates list the cause of death as “COVID-19 or an equivalent,” according to city Health Department data from March 11 through April 13.
Italics mine, to illuminate what is being done here. What exactly is an "equivalent" cause of death to C19? Why, something that killed them, duh. You know, like lung cancer.

I said on my FB page, "First, let’s kill the children."
 Serious question: How many people are we willing to kill to stop people from dying of Covid-19?  
More specifically: How many children are we willing to kill to do it? Read this and weep:
"Hundreds of thousands of children could die this year due to the global economic downturn sparked by the coronavirus pandemic and tens of millions more could fall into extreme poverty as a result of the crisis, the United Nations warned on Thursday. ...

But the U.N. report warned that “economic hardship experienced by families as a result of the global economic downturn could result in an hundreds of thousands of additional child deaths in 2020, reversing the last 2 to 3 years of progress in reducing infant mortality within a single year.”
The full report is here, including the shocking nugget that 368 million children across 143 countries rely on school lunches as a source of nutrition, and,
"Hastily implemented lockdown measures risk disrupting food supply chains and local food markets,” which “pose potentially grave consequences for food security.”
Do you remember when, "Let's do it for the children!" was a rallying cry? Yeah, me, neither.

However, the sanguinary calculus is real: If we do not do lockdown/distancing by shutting down the economy, people will die. And if we do lockdown/distancing by shutting down the economy, people will still die - and the UN says that "hundreds of thousands" of them will be children. But as Roger Kimball explains,
We have often been presented with a false dichotomy between saving the economy and saving lives. This is a false dichotomy because, as Geach points out, “the state of our economy is not just a monetary risk, it is a health risk.” For one thing, “when people lose their jobs, they typically lose their health insurance.” He notes that there were more than 10,000 “economic suicides” as a result of the 2008 recession. There is also a spike in cancer deaths, drug abuse, domestic violence, and other pathologies.
This is not a guess, it is fact:
Every 1% hike in the unemployment rate will likely produce a 3.3% increase in drug overdose deaths and a 0.99% increase in suicides according to data provided by the National Bureau of Economic Research and the medical journal Lancet. These are facts based on experience, not models. If unemployment hits 32%, some 77,000 Americans are likely to die from suicide and drug overdoses as a result of layoffs. Scientists call these fatalities deaths of despair.
There are protests around the country against long-continuing the restrictions from now. I frankly would be far more impressed with the protesters if they would leave their guns and flags at home and at least substantively acknowledge that the C19 threat is real.

But lockdown absolutists need to under stand this: More than 22 million Americans have become unemployed in the last month. The longer we are told to stay "safe at home" instead of going back to work, the less safe homes will become because of the despair and depressions that unavoidably will manifest. More people will kill themselves or a family member, more spouses and children will suffer abuse and injury, more alcoholics will be made, more people will suffer fatal non-Covid illnesses, more drug addicts will be made - that list goes on and on.

To be clear: 
I am not saying that the lockdown and distancing measures should not have been imposed. I am saying as clearly as I can that the time will come when continuing them will become more costly and lethal than lifting them. 

It is long past the time when we must stop having a false debate about the lockdown.
"At some point," [Princeton bioethicist] Peter Singer says, "we are willing to trade off loss of life against loss of quality of life. No government puts every dollar it spends into saving lives. And we can't really keep everything locked down until there won't be any more deaths.

We need to think about this in the context of the well-being of the community as a whole….We are currently impoverishing the economy, which means we are reducing our capacity in the long term to provide exactly those things that people are talking about that we need—better health care services, better social-security arrangements to make sure that people aren't in poverty. There are victims in the future, after the pandemic, who will bear these costs. The economic costs we incur now will spill over, in terms of loss of lives, loss of quality of life, and loss of well-being.

I think that we're losing sight of the extent to which that's already happening. And we need to really consider that tradeoff.
 The "false debate," in other words, is not the discussion that considers the enormous human cost of suppressing economic activity. It's the discussion that pretends there is no such tradeoff. 
If lockdowns are not substantially lifted much past the middle of May, I predict very large numbers of the American people will start concluding that the real point of these restrictions is not the health of Americans at all, but something politically sinister. And no podium appearances by Dr. Fauci or Dr. Birx is going to persuade them otherwise.

Friday, April 10, 2020

The cup of wrath and who finished it



Actually, this accords very well with the doctrine of substitutionary atonement.

In John 18, in the Garden,
Jesus said to Peter, “Put your sword back into its sheath. Am I not to drink the cup that the Father has given me?”
Jesus had already prayed that God would take the cup away from him, but by the time he was arrested, Jesus knew God would not.

But what is that cup he refers to? It is not the cup of wine in Communion - the Lord's Supper was already in the past. So that cup does not refer to Jesus' blood.

There are two schools of thought about what that cup is. One is that it represents the fifth cup of the Passover, the cup of Elijah, which is not drunk during the Passover meal but symbolically placed at the table's center. It represents God's promise, that "I will bring you into the land."

That is an eschatological promise and so cannot be fulfilled except by the Messiah. And so Jesus understood he was personally its fulfillment, but the means of fulfillment was filled with dread.

The other understanding is that this cup is the cup of God’s wrath upon sinful humanity. A "cup" is used as a symbol of God’s wrath several times in the Jewish Scriptures (Jeremiah 25:15-16; Isaiah 51:17, 22; Lamentations 4:21; Ezekiel 23:28-34; Habakkuk 2:16). It is likewise used as a symbol for enduring God’s wrath in Revelation 14:9-10 and 16:19.

Here, when Jesus said on the cross, "Tetelestai" ("It is finished") Jesus was saying he had himself consumed all the wrath of God. He had drunk all the cup of God's wrath that should be poured on humankind, but was no longer. "It is finished" - all the work of Christ on the earth was completed and the salvation of humanity was now accomplished. And so he could say, "Into your hands I commend my Spirit."

All the wrath of God would be buried with Jesus but it would not arise from the burial. It is gone forever. And that is the response of God to all the wrath humanity has poured out upon him and the Son, and one another. It is not poured back onto us but was destroyed on the cross and buried in the earth, for wrath has no place in the eternal presence of God.

Jesus is served

John 6.5-14 When he looked up and saw a large crowd coming toward him, Jesus said to Philip, “Where are we to buy bread for these people t...