Coronavirus in one state (155)

In the words of John Lennon, war is over (if you want it) — the war in this case being the war on COVID-19. The public health emergency is over and yet governors such as Minnesota’s egregious Tim Walz continue to control the “dials” of our lives, as the authorities here refer to them. They have us fighting on like Japanese soldiers who haven’t heard that the Emperor surrendered.

Kevin Roche promulgated 11 theses regarding the epidemic here last week. These are Kevin’s 11 theses:

1, CV-19 is a serious public health problem, it causes a lot of serious disease and deaths. Is it as bad as portrayed in the media? No. Cases and deaths are counted in an unprecedented way. If we did the same thing with influenza, I think the two pathogens would look pretty similar. And CV-19 appears to be very substitutive of influenza; it kills a lot of people who otherwise would die of influenza.

2. CV-19 is one of a series of coronaviruses, more are likely to arise, this one is likely to become endemic. We better figure out how to adapt to it without destroying our lives. It is going to be around, no matter what we do.

3. Like most respiratory viruses, this one is pretty infectious, fairly easily transmitted–in certain conditions. Wish we could tell what those conditions are, but the formula is pretty complex. The conditions are clearly best at certain times of the year in certain geographies. There are likely meteorological factors at work, which interact with other factors, like age, population density, pre-existing immune status and so on. The formula, if there is one, is multi-factorial.

4. Like most respiratory viruses, this one mutates a fair amount and as you would expect, mutations that increase infectiousness are favored. All a virus cares about is replicating; that is its only goal. Whatever furthers that goal, gets selected. Mutations may help evade an existing immune response, but those responses are still likely to minimize disease and limit spread. There is some risk that with a virus that is already widely spread, trying too hard to suppress it could lead to a truly ugly variant. One that, say, had a much more stable lipid envelope and survived on surfaces or in the air indefinitely. A little bit of live and let live wouldn’t be the worst approach. So far, none of the CV-19 variants seems particularly worrisome.

5. There is immense heterogeneity among the population in susceptibility to infection, in infectiousness, and in the nature of disease, if any, resulting from infection. The dose needed to cause an infection in a person likely has enormous variation. This heterogeneity likely is largely due to existing immune status variation. How strong and how diverse is a persons innate and trained immune system, does the person have cross-reactive coronavirus adaptive immunity that in some way controls infection or infectiousness. There is an enormous difference in impact of CV-19 among the young and among the frail elderly.

6. We don’t know how many CV-19 infections there have been because there are so many asymptomatic or mild cases. Serious illness occurs in well under 1% of cases. I suspect the true fatality rate is around one to two-tenths of a percent. In the general, non-long-term care population, the fatality rate is miniscule. This pathogen, for almost the entire population, has a very low burden of illness.

7. The response to this epidemic has been unprecedented as well–unprecedentedly stupid. It was based on poor data from China, poor modeling from England and everywhere else, and me-tooism among political leaders. Rank panic, hysteria and mass delusion. I think China’s leaders said “we can do whatever we want to our population, let’s see if Western leaders are stupid enough to do the same things in their countries”. Never before have we attempted to lockdown societies, close schools, close businesses. Pure insanity.

8. The modeling of the epidemic used by governments has been pathetic. No accounting for seasonality, no accounting for that variability in susceptibility or infectiousness, overweighting the value of attempts to suppress. The virus laughs at our models.

9. No intervention has made a significant difference, beyond what voluntary human behavior would have done. We know this by looking at case curves. We might momentarily slow transmission, but it doesn’t last. But governments are too pig-headed to admit that they made a mistake and change course. Instead, they have implemented a campaign of terror to convince the population how dangerous CV-19 is and how necessary those futile suppression efforts are. Masks are the worst example of this, as data and science has been twisted and distorted to try to demonstrate an effect that doesn’t exist.

10. What the interventions have done is significantly weaken democratic societies, through the use of non-democratic decision-making by mini-dictators. This should horrify people, but has been meekly accepted by most of the population.

11. The interventions have ruined businesses, caused the loss of good jobs, worsened other health outcomes, irreparably damaged the lives of most children, led to further domestic and child abuse, worsened government finances and so on, with no noticeable effect on the progress of the epidemic. The costs of these interventions will far outweigh any damage done by the virus for years, possibly decades.

As I noted last week, one of our physician readers has been treating with Walgreens to get his prescriptions for hydroxycloroquine and ivermectin filled. He wrote to update us on his experience with Walgreens:

So now I have heard from Walgreens Corp. who informed me that it is actually not their own corporate policy, but rather the individual PBM (pharmacy benefit manager) that rejects payment for the ivermectin if it is being used for the coronavirus. So as you probably know, most third-party payers such as Blue Cross Blue Shield, Health Partners, etc., contract with PBM’s to manage their pharmacy benefits. Whether the third-party payer or PBM or combine decision-making, they basically tell Walgreens what to do.

I then have determined that Walgreens will indeed dispense it if the patient pays cash. The current cash price for a course of ivermectin to treat CV 19 is ~ $60. It should not have taken three weeks to learn this, but Walgreens initially was not forthcoming with this amount of candor. So, FYI, hydroxychloroquine and ivermectin can easily be dispensed for a cash price that is not for the vast majority of people very expensive.

The Minnesota Department of Health took 8 days to provide their legally required response to the questions I submitted last week. Here are my questions and their answers without further comment (I have omitted one question and answer I submitted on behalf of Kevin):

1. Question: In her February 14 Pioneer Press op-ed column, St. Thomas School of Law Professor Lisa Schiltz pleads for the inclusion of those with Down Syndrome in the Phase 1b priority population for vaccination. Will you please state your rationale for not including them?

Answer: Following CDC Advisory Committee on Immunization Practice recommendations, MN has prioritized those with Down Syndrome and developmental disabilities living in congregate care facilities by vaccinating them as part of Phase 1A tier 3. For those with developmental disabilities living independently or outside a facility, the CDC recommends that they be in group 1C. We will continue to monitor vaccine access for this group, with a focus on the issue of underlying conditions.

[Appearing in a shaded color, the following paragraph was pasted in to the answer.] From the beginning of the pandemic, Gov. Walz has taken a strong stance that those with disabilities should receive equal treatment and access to care. There are many Minnesotans who need and deserve the vaccine right now. While we are currently vaccinating those with developmental disabilities living in care facilities, health care workers, long term care residents, Minnesotans age 65 and older, and teachers, school staff and child care workers, it’s clear more vaccine is needed. That’s why Governor Walz and Commissioner Malcom have continued to press the federal government to send more vaccine as quickly as possible and will announce more soon about how more Minnesotans can expect to access vaccine in the coming months. ​

2. Question: Many private schools have been open for full in-person learning since September. You recently advised me that this was the result of largely local decision-making yet the Safe Learning Plan prescribes the learning model that school districts must use at arbitrary county-case rate measures [table omitted].

The only “local decision” possible is to be MORE restrictive than these guidelines prescribe; less requires permission from “Regional Support Teams” staffed by MDE and MDH representatives. The Regional Support Teams apply these arbitrary measures somewhat arbitrarily. Some districts have received permission to remain in hybrid, when distance learning would have been required. Other districts have their plans rejected by their Regional Support Team.

At the start of the school year, East Sibley school district, for example, voted to start the year in-person, against the Safe Learning Plan guidelines. They were threatened by the state with lost funding and potential jail time for Board members, but the reality also is that Executive Order 20-82 and the Safe Learning Plan clearly authorize the MDE Commissioner to overrule the local school board and administration and close schools if she determines to do so. As a result, many districts across the state don’t even bother advocating for students with their RST. Will you please summarize current information suggesting all schools could not be open as many private schools have been?

Answer: The Safe Learning Plan allows for local decision-making with the regional support teams in a consultative role and the Minnesota Department of Education in an oversite [sic] role for public schools. Regional support teams themselves were never in a position to approve or deny a plan, though plans that did not meet minimum standards for mitigation, etc. did have an internal process for escalation when needed. As for private schools, MDH and MDE offer consultative services to private schools, though these schools are not overseen by MDE.

In addition, to clarify, the Safe Learning Plan was flexible enough to allow for fewer restrictions depending on factors that would be considered in a broader conversation involving local data and abilities to meet all of the minimum health standards. These decisions involved the five-step process below [omitted].

To your question about a summary of implementation of the Safe Learning Plan, we’d refer you to the MDE Safe Learning Model Dashboard here. Questions about specific districts can be addressed to the MDE media relations contact.

MDH has held press briefings on February 18, 22, and 24 since I last reported. The reporters focus intensely on vaccines. In my written questions this week I asked the department when they will declare the war is over. Not one of the reporters inside the MDH circle of love has bothered to ask. As Kevin notes, we have had “a truly retch-inducing spell of listening to CV-19 briefings.” In the words of Johnny Burke’s lyrics, “What’s new?”

Kevin writes that “after listening to over an hour and a half of recordings, I hear that the state has gone full delusional, Commissioner of Health saying that the goal is to have zero cases, hospitalizations or deaths. That is literally not possible, and we have to get past this nonsense” (emphasis in original).

Kevin adds that “time is rapidly running out on Dr. Osterheimlich’s prediction of disaster. We are halfway through his 6 to 14 weeks of unmitigated hell, and cases continue to fall. Hmmm, could it be possible that he just doesn’t know what he is talking about.”

Of the recent briefings I’m including only the audio of the MDH briefing yesterday (below). If you listen closely, you will hear evidence supporting another of Kevin’s observations — that they “are doing their best to keep the terror campaign going.”

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