The following is an email sent on May 19, 2020 to the Dr. Diana L. Fite, President of the Texas Medical Association regarding COVID-19. I am extremely grateful to Dr. Fite for responding to my previous email addressing some controversies surrounding COVID-19.
Good afternoon Dr. Fite,
Thank you for taking the time to respond to my email. We are in agreement in regards to the generally accepted CDC guidelines regarding social distancing in a pandemic. I am aware of the rationale used by the CDC to recommend social distancing. I am also aware of studies that have shown a general correlation with social distancing to slow the spread and flatten the curve. Please note that the observational evidence used to defend current lock-down measures were taken from studies on the 1918 influenza pandemic, over 100 years ago.
I appreciate your comments regarding Texas Medical Association’s consensus statements of medical experts on the evidence of social distancing. At the same time, as I’m sure you are well aware, consensus statements are rated “level C” in evidence based literature. We need to be careful that “consensus” is not subconsciously replaced with “groupthink”. Countless stories exist of this phenomenon happening in medicine over the years, most recently with the story of daily aspirin for prevention of heart disease.
What I find fascinating is how full-scale lock-downs, (an extreme form of social distancing), from an observational standpoint, are not slowing the COVID-19 mortality over and above general social distancing measures, and may actually be fueling the severe impacts of COVID-19, in addition to creating an underlying pandemic of untreated MI’s, strokes, and renal failure, also resulting in deaths, due to shelter-in-place orders by governments.
Take, for instance, Italy and Spain. Italy instituted full lock-down on March 21. Spain instituted a full lock-down on March 15. The average time from infection to death according to most studies (here, here, and here) range from 15-24 days. Most symptoms appear between 2-14 days after infection. If lock-down measures were truly effective, then one should expect a drastic decline in new deaths after 3-4 weeks. What actually happened, was a continual increase in mortality (see here and here) over that time frame.
Governor Cuomo of New York recently stated that 66% of new COVID-19 hospitalizations came from patients who were sheltering in home. Could it be that sheltering in home actually worsens our collective ability to stay healthy? It appears to. Studies regarding UV light, such as the sun, suggest that getting outside, while staying socially distanced, rather than sheltering inside all day and night, (and may actually be worse than loose social distancing measures). Another well done study I sent previously to you backs up this evidence. A quick look at https://www.worldometers.info/coronavirus/ confirms again that there is simply no significant correlation between lock-down measures and overall mortality rate. This contradiction must be addressed by the medical community.
There is very little evidence to support the practice of mass incidence testing (nasal swab PCR) and contact tracing for the current COVID-19 pandemic. Again, a quick review of https://www.worldometers.info/coronavirus/ shows that there is no correlation between number of tests performed per million population, and deaths per million population. Antibody tests to ascertain prevalence are much more helpful. Contact tracing makes vanishing little sense in viruses with an R0 value over 2.5, with a noted viral transmission of 2-14 days before symptom onset. There is no current evidence that paying millions (or billions) of dollars on testing and contact tracing for COVID-19 will reduce mortality. It may be true for Ebola, but COVID-19 is a whole different story.
ER’s around the nation are all saying the same thing–ER’s are basically empty (see here, here, here, and here). That is not to say that there are some hot spots around the nation with crowded funeral homes, mainly in New York and Detroit. Outside of these hot areas, there is no evidence that funeral homes are being overwhelmed. At the same time, ER visits for MI’s and strokes have plummeted nationally. Many of these people may very well be dying at home. One study in Austria revealed that likely 110 people died of untreated heart attack, while 86 died of COVID-19, creating severe, unintended repercussions of draconian lock-downs. And all this despite no significant change in weekly reported deaths OTHER THAN COVID-19 deaths by the National Center for Health Statistics.
As physicians, we all know this instinctively. We talk to our colleagues across the country. However, we collectively allow ourselves to follow a false narrative set by news media outlets (with an apparent motive to keep the fear alive and increase market share) and then never allow discussion of how and why it is not only wrong, but by remaining silent, create an illusion that this false narrative is supported by the medical community.
I recommend that Texas Medical Association form a group of physicians from across the state who come to the table and debate on specific points of evidence. Bring in voices from the entire spectrum–not only those most closely aligned with educational and government institutions–with the only rule that any point made must have a reference to some available scientific evidence. This will allow the Texas Medical Association to have a rich and robust well of knowledge and experience to draw from, while avoiding the groupthink mentality that can jeopardize the process of advising the Governor and other state and national authorities. I also recommend that Texas Medical Association stop emailing daily updates linking to news articles that are full of conjecture and devoid of scientific evidence.
Scott Hastings DO
Diplomate, American Board of Family Medicine