Coldfusion blog

500 days of COVID

I realize that I haven’t written much about COVID-45. This blog is generally about the weird and interesting little features of infectious diseases. While this is a disaster, there hasn’t been much about COVID that’s been so strange or interesting to write about. Literature / science has changed so quickly that most entries would be out of date upon publication.

But it’s been 500 days of COVID, and it looks like we’re nearing the end of the initial bolus of illness. So what have I learned / concluded? My opinion. Your mileage may vary.

Not that COVID is ever going to go away. A remarkable number of Americans prefer to be vulnerable to COVID, able to get sick or pass it on to and kill others. Large swathes of the world will remain unvaccinated and provide a reservoir for the reintroduction of the virus into susceptible populations, with localized epidemics and deaths. Whether it’s a seasonal issue or a constant underlying issue, of course I don’t know, but I would bet on a combination. COVID is here to stay.

In January, I thought we would have 1.5 million deaths after a year and a half. Thanks to the vaccines and the masks, I am so happy to be wrong, even though we are approaching 600,000 dead, which is about the same number since the influenza pandemic of 1918. Or the number of combat deaths in all of our lives. combined wars (666,442). Compared to the flu, it took COVID six times longer in a population about three times the size of 1918 to kill so many people. As pandemics disappear, not so virulent. I am still worried about the next influenza pandemic.

Also note that I did not use the descriptor “only” in front of the death toll. I’m a John Donne du type guy classic version, not the 2020 edition. Anyone who considers death and human suffering, even one, to be alone is a curse of your choice.

The very idea of ​​”natural” collective immunity is ludicrous. There is no such beast. To my knowledge, we have never had natural herd immunity to infection. The only time you get herd immunity is when everyone who can be vaccinated is vaccinated. As there is currently no way for the United States to come close to collective immunity, COVID is here to stay.

Here is a rule for the treatment of acute viral infections: The antiviral must directly interfere with a major viral metabolic pathway and must be administered within 72 hours of its onset.

One could predict that azithromycin, lopinavir, hydroxychloroquine and ivermectin would do nothing. It was like a cold fusion. Although they are bogus based on basic science, people have come up with all kinds of reasons why they could, could, could be effective. They didn’t do it because they can’t. So much time and money wasted.

It is said that those who do not remember the past are doomed to repeat it. what goes around comes around, guy.

It was so nice to take hydroxychloroquine out of patients we know works and saves lives and wastes it on COVID, thanking them for their sacrifice. I have never prescribed any of the above products. It was stupid. And I don’t do anything stupid.

I still think that remdesivir is more of a placebo than not. The problem with most of my patients is that they present on day 7 or later of illness, long past when I thought any antiviral would work. And there is no way to clinically tell whether remdesivir is working, given the protracted nature of the disease. So I have to trust the literature, as it stands, that remdesivir is beneficial. And always remember: Most published research results are false.

I was surprised when the recovery serum turned out to be a failure. But on second thought, I shouldn’t have been surprised. By the time most people received the serum, they were probably on the road to their own immunity. Again, too little too late – the currency of COVID therapy. Except for dexamethasone and IL-6 inhibitors. The late pro-inflammatory stage and the long haul have been a curious and unexpected COVID manifestation.

Until last year, I took the CDC’s word for law and took what they said at face value. Not anymore. It is now trust, but verify.

It was shown at the start of the pandemic that all disinfection of everything was a medical theater, but it is still ongoing.

I remember talking to a radiologist in February 2020 that they didn’t need masks; the CDC said COVID is spread by contact and masks are not necessary. It was, of course, male cow manure and a lie for the wrong reasons.

If I had thought about it, instead of taking the CDC at its word, I would have realized that the only way for a virus to spread so quickly in Wuhan was through the respiratory system.

As the man put it, “There’s an old saying in Tennessee – I know it’s Texas, probably Tennessee – that goes, ‘Fool me once, shame on… shame on you. Cheat on me, you can’t go wrong anymore.

I also think the droplet / aerosol set 6 feet away is a worthless medical theater.

From a hospital infection control perspective, the difference between the spread of aerosols and droplets is significant. There you have a patient in a bed who does not move and who controls the air management. There, 6 feet for droplets makes sense to protect personnel. The vector is always, their Pigsty like the controlled COVID haze.

In the real world, the COVID haze moves with the vector, and the chaotic airflow will carry droplets and aerosols willy-nilly into the indoor environment.

I’m 6 feet away in line at the store, and the air conditioning breeze pushes COVID-laden air from the person behind me into my space, but then I step 6 feet into the COVID haze of the person in front of me . Six feet my ass.

In my opinion, it is more about the density of the vectors. The lower the density of people, the less likely a person is to have COVID, and the more likely the COVID haze will disperse before I walk around in search of beer. Optimal density would depend on the incidence of COVID, but I think only me in the store is about correct.

That is why it is the masks that are important indoors to prevent the spread. But outside? Wearing a mask outside when by yourself is stupid, and like I mentioned, I don’t play stupid. I walk 3 km every day in the neighborhood and I don’t wear a mask. Or while playing golf. Or on a hike. I rarely meet anyone. If I see someone coming, I cross the street. If for some reason I meet a group of people that I cannot avoid, I attend a small medical theater and wear a mask.

What surprised me the most about the COVID pandemic? The incompetence and lies of the executive branch of government, or was it the willingness of large numbers of Americans to participate in behaviors that sickened and killed hundreds of thousands of their fellow citizens?

Good question.

But the United States has always been happy that large numbers of people die from preventable causes.

This has always been the problem with infection control: the person who transmits MRSA or COVID never sees the consequences of their actions. All of the 560,000+ deaths of COVID have occurred because someone transmitted it. But who? Usually you never know. In a perfect world, those who do not practice infection control would be the ones who contract the infection, but as President Carter once noted, “There are many things in life that are not right. .

There was a time when masks in the hospital were optional, and I would ask those who didn’t wear a mask why they wanted to kill me. At the time, given my age and my comorbidities, I estimated a risk of death of 5%. I wouldn’t put a gun to my head if I had a 1 in 20 chance of pulling the trigger and blowing my brains out.

But I was lucky and the infection control is working. Despite all the COVID patients I have seen, I have never contracted COVID, and now with the vaccine my chance of dying from the disease is zero.

I am always amazed at how quickly we figured out COVID. The HIV pandemic started when I was a medical student, and it took years to find out the cause and find a cure. COVID took months. What about getting safe and effective vaccines so quickly? Unbelievable.

But my main reaction to the COVID pandemic is desperation. COVID was, in the scheme of things, simple to understand and control.

A lot of Americans don’t want to worry about science or reality. So when the next pandemic hits, one with a 5% or 10% death rate, the corpses will pile up. And we will let it happen.

What about what we need to do to combat global warming? COVID has been commonplace.

So we are doomed. As a people. As a company. As a democracy. As a planet. I’ll probably be dead before the worst happens, but the children born today?


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About Dr Mark Crislip

Mark A. Crislip, MD, has been practicing infectious diseases in Portland, Oregon, since 1990. He’s a nobody from nowhere but has a huge ego that makes him think someone might care what he has. to say about infectious diseases. He’s been blogging about the most fascinating specialty in all of medicine since 2008 and hasn’t run out of material yet. Or maybe he is just a slow learner. Its multimedia empire is at